Cardiovascular Reactivity During Marital Conflict in Laboratory and Naturalistic Settings: Differential Associations with Relationship and Individual Functioning Across Contexts

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

Benchmarking Mental Health Status Using Passive Sensor Data: Protocol for a Prospective Observational Study

BACKGROUND

Computational psychiatry has the potential to advance the diagnosis, mechanistic understanding, and treatment of mental health conditions. Promising results from clinical samples have led to calls to extend these methods to mental health risk assessment in the general public; however, data typically used with clinical samples are neither available nor scalable for research in the general population. Digital phenotyping addresses this by capitalizing on the multimodal and widely available data created by sensors embedded in personal digital devices (eg, smartphones) and is a promising approach to extending computational psychiatry methods to improve mental health risk assessment in the general population.

OBJECTIVE

Building on recommendations from existing computational psychiatry and digital phenotyping work, we aim to create the first computational psychiatry data set that is tailored to studying mental health risk in the general population; includes multimodal, sensor-based behavioral features; and is designed to be widely shared across academia, industry, and government using gold standard methods for privacy, confidentiality, and data integrity.

METHODS

We are using a stratified, random sampling design with 2 crossed factors (difficulties with emotion regulation and perceived life stress) to recruit a sample of 400 community-dwelling adults balanced across high- and low-risk for episodic mental health conditions. Participants first complete self-report questionnaires assessing current and lifetime psychiatric and medical diagnoses and treatment, and current psychosocial functioning. Participants then complete a 7-day in situ data collection phase that includes providing daily audio recordings, passive sensor data collected from smartphones, self-reports of daily mood and significant events, and a verbal description of the significant daily events during a nightly phone call. Participants complete the same baseline questionnaires 6 and 12 months after this phase. Self-report questionnaires will be scored using standard methods. Raw audio and passive sensor data will be processed to create a suite of daily summary features (eg, time spent at home).

RESULTS

Data collection began in June 2022 and is expected to conclude by July 2024. To date, 310 participants have consented to the study; 149 have completed the baseline questionnaire and 7-day intensive data collection phase; and 61 and 31 have completed the 6- and 12-month follow-up questionnaires, respectively. Once completed, the proposed data set will be made available to academic researchers, industry, and the government using a stepped approach to maximize data privacy.

CONCLUSIONS

This data set is designed as a complementary approach to current computational psychiatry and digital phenotyping research, with the goal of advancing mental health risk assessment within the general population. This data set aims to support the field's move away from siloed research laboratories collecting proprietary data and toward interdisciplinary collaborations that incorporate clinical, technical, and quantitative expertise at all stages of the research process.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53857.

Sense of power and markers of challenge and threat during extra-dyadic problem discussions with romantic partners

Power, the capacity to influence others while resisting their attempts at influence, has implications for a wide variety of individual- and relationship-level outcomes. One potential mechanism through which power may be associated with various outcomes is motivation orientation. High power has been linked to greater approach-oriented motivation, whereas low power has been linked to greater avoidance-oriented motivation. However, current research has mostly relied on artificially created relationships (and the power dynamics therein) in the lab to assess the associations between power and motivation orientations. Utilizing the Biopsychosocial Model of Challenge and Threat framework, the current study examined how power is related to physiological responses indicative of psychological challenge (i.e., approach) and threat (i.e., avoidance) during discussions of problems outside of the relationship between romantic partners. The primary hypothesis that higher power would be associated with more approach-oriented challenge and less avoidance-oriented threat was supported via self-reports, but not via physiological assessments. Instead, physiological assessments revealed that for those disclosing problems to high-power partners, greater power was associated with reactivity consistent with more avoidance-oriented threat and less approach-oriented challenge. This is the first research to examine associations between power and in vivo indices of challenge and threat during interactions between romantic partners. It advances our understanding of how power elicits motivation orientations and influences the stress response system by highlighting the importance of situational attributes (e.g., role during a conversation) that may undermine power during disclosures with a high-power partner.

A pilot exploration of the relationships between optimism, affect, and cardiovascular reactivity

Introduction

Cardiovascular reactivity refers to changes in blood pressure and heart rate in response to internal or external stimuli. Previous research has shown that excessively high and low cardiovascular reactivity are associated with an increased risk of cardiac problems. Dispositional optimism has been associated with numerous health benefits, including better cardiovascular responses to stressors, and reduced mortality risk. Conversely, pessimism has been associated with negative health outcomes and worse cardiovascular reactivity to stress. Mood, comprising positive and negative affect, can significantly impact psychological adjustment and physical health. Therefore, it is important to consider mood as a potential confounding variable in the link between optimism and cardiovascular reactivity. The study hypothesized that optimism and pessimism would still influence cardiovascular reactivity even when mood variables were controlled for.

Methods

A within-subjects correlational design with 107 young adult participants was used. Sociodemographic and clinical questionnaires were administered to collect information on participants' characteristics. The Dispositional Optimism Scale (LOT-R) and the Positive and Negative Affect Scale (PANAS) were used to assess participants' levels of optimism, pessimism, and mood. Measures of cardiovascular reactivity, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), were taken during a stressor task (PASAT).

Results

There is a moderate positive correlation between dispositional optimism and positive affect, while pessimism demonstrated a moderate positive association with negative affect. Linear regression analyses were conducted, controlling baseline reactivity variables, gender, and body mass index. The results showed that pessimism had a significant negative effect on SBP reactivity, suggesting that higher levels of pessimism decreased SBP response. Optimism had a significant positive effect on DBP reactivity, while pessimism had a significant negative effect.

Discussion

Overall, these results suggest that dispositional optimism and pessimism are related to cardiovascular reactivity, even after controlling for positive and negative affect. Pessimism was associated with lower SBP reactivity, while both optimism and pessimism influenced DBP reactivity. These findings are consistent with previous research indicating that optimism enables more effective stress management during challenging events, whereas pessimism can serve as a risk factor, heightening the likelihood of experiencing future cardiac issued caused by blunted cardiovascular reactivity.

The Story of Us: Older and Younger Couples' Language Use and Emotional Responses to Jointly Told Relationship Narratives

OBJECTIVES

Social-emotional well-being is said to improve over adulthood, and studies of couples' age differences have focused primarily on marital conflict. The way couples discuss their relationship story predicts marital quality among newlyweds and long-married couples alike, yet older and younger couples' accounts have never been compared. The current study examined age differences in couples' use of I/we-talk, emotion words, and immediacy (i.e., an urgent and unresolved style) during a relationship history discussion and their subsequent mood reactivity and appraisals.

METHOD

Married couples (N = 186 individuals within 93 couples, aged 22-77) recounted the story of their relationship then rated the discussion and their negative mood. Mediation models assessed the 3 linguistic features as parallel dyadic mediators linking couple age to negative mood responses and appraisals, controlling for global marital satisfaction, and baseline negative mood. Secondary analyses examined partners' concordance in language use.

RESULTS

Compared with younger couples, older couples used more positive than negative words and less immediacy which, in turn, was associated with husbands' and wives' less negative mood and more positive appraisals, only among husbands. Partners in older couples used more similar I/we-talk and emotional language, but these were unrelated to mood or appraisals.

DISCUSSION

This study extends our understanding of how marital interactions differ by age in the understudied context of relationship history discussions, which may grow increasingly important for couples' well-being with older age. Findings broadly align with social-emotional aging theories and uncover novel linguistic features relevant to the age-related emotional benefits of joint reminiscing.

Is daily-life stress reactivity a measure of stress recovery? An investigation of laboratory and daily-life stress

Typical measures of laboratory reactivity (i.e. difference between control and stress) and recovery (i.e. difference between stress and post-stress) were compared with a conventional measure of daily-life reactivity, best known as event-related stress. Fifty-three healthy individuals between 19 and 35 years of age took part in a laboratory session where stress was induced using the repeated Montreal Imaging Stress Task and 8 days of experience sampling method. Measures of negative affect, heart rate (HR), HR variability, and skin conductance level were collected. Findings show no strong associations between laboratory and daily life measures with the exception of laboratory affective recovery and daily life reactivity. Findings and their implications are discussed.

Negative Partner Attributions Moderate the Association between Heart Rate Reactivity During Relationship Conflict and Relationship Satisfaction

Numerous theoretical models of relationship distress suggest that strong, negative reactions to conflict are directly associated with lower levels of relationship satisfaction. Consistent with this supposition, substantial evidence links higher levels of subjective negative emotion, more pronounced and frequent expressions of negative affect, and higher levels of negative communication behaviors to lower levels of relationship satisfaction (e.g., Bradbury, Fincham, & Beach, 2000, Journal of Marriage and Family, 62(4), 964). However, the evidence linking stress-related physiological responding during relationship conflict and relationship satisfaction is less compelling than would be anticipated based on theory. We propose that these theoretically unexpected but empirically well-replicated findings may be the result of different patterns in association between physiological reactivity and relationship satisfaction for couples with varying styles in how they typically perceive unwanted behavior in one another. The present study tests negative attributions for undesirable partner behaviors as a moderator of the association between heart rate reactivity (HRR) during relationship conflict and relationship satisfaction in a sample of 60 married couples. A significant interaction emerged between HRR and negative attributions of partner behavior in predicting relationship satisfaction such that higher levels of HRR were associated with lower levels of relationship satisfaction for individuals who typically made more negative attributions for undesirable partner behaviors, but with higher levels of relationship satisfaction for individuals who typically made fewer negative attributions for undesirable partner behaviors. Implications for conceptualizing reactivity during relationship conflict and couple interventions are discussed.

The Healing Hearts Together Randomized Controlled Trial and the COVID-19 Pandemic: A Tutorial for Transitioning From an In-Person to a Web-Based Intervention

Supportive couple relationships are associated with reduced risk of chronic illness development, such as cardiovascular disease, as well as improved secondary prevention. Healing Hearts Together (HHT) is an 8-week couples-based intervention designed to improve relationship quality, mental health, quality of life, and cardiovascular health among couples in which one partner has experienced a cardiac event. A randomized controlled trial began in October 2019 to test the efficacy of the in-person, group-based HHT program as compared to usual care. In March of 2020, all recruitment, assessments, and interventions halted due to the COVID-19 pandemic. Guided by optimal virtual care principles, as well as by Hom and colleagues’ four-stage framework—consultation, adaptation, pilot-testing, and test launch—this paper is a tutorial for the step-by-step transition planning and implementation of a clinical research intervention from an in-person to a web-based format, using the HHT program as an example. Clinical and research considerations are reviewed, including (1) privacy, (2) therapeutic aspects of the intervention, (3) group cohesion, (4) research ethics, (5) participant recruitment, (6) assessment measures, (7) data collection, and (8) data analyses. This tutorial can assist clinical researchers in transitioning their research programs to a web-based format during the pandemic and beyond.

Romantic partner presence and physiological responses in daily life: Attachment style as a moderator

The present study investigated whether the presence of a romantic partner in daily life is associated with attenuated sympathetic nervous system responses. Additionally, romantic attachment style was tested as a moderator. For one day, 106 heterosexual young adult dating couples wore ambulatory sensors that monitored electrodermal activity (EDA) - an index of sympathetic arousal. Couples reported whether they were together or apart for every hour of the data collection day. Men and women exhibited lower EDA during hours in which their partner was present compared to hours in which they were absent. Additionally, romantic attachment style moderated this association; those who had low anxious attachment showed a stronger attenuating effect of partner presence compared to those with higher anxious attachment. Similarly, those who had low avoidant attachment showed heightened effects of partner presence compared to those with higher avoidant attachment. Romantic partner presence may facilitate everyday health-promoting physiological processes.

Cortisol Synchrony in Older Couples: Daily Socioemotional Correlates and Interpersonal Differences

OBJECTIVE

Social relationships can have positive and negative influences, and these associations are particularly pronounced in old age. This study focuses on everyday interpersonal physiological dynamics (cortisol synchrony) in older couples and investigates its associations with partner presence, positive daily partner interactions, and empathy.

METHODS

We conducted coordinated multilevel analyses using data from two samples of older couples from Vancouver, Canada, and Berlin, Germany (study 1: n = 85 couples aged 60-87 years; study 2: n = 77 couples aged 66-85 years), who completed questionnaires and provided salivary cortisol samples five to seven times daily for 7 days.

RESULTS

Significant dyadic covariation in cortisol (synchrony) was present across studies (study 1/2: b = 0.04/0.03, p < .001/.001). Partner presence was only associated with greater cortisol synchrony in study 1 (b = 0.06, p = .003) but not in study 2 (b = 0.02, p = .187). Cortisol synchrony was higher when partners reported prior positive socioemotional partner interactions (study 1: b = 0.09, p = .005; study 2: b = 0.04, p = .005). There was no statistically significant association between cortisol synchrony and empathic concern (b = 0.01, p = .590) or perspective taking (b = 0.02, p = .065).

CONCLUSIONS

Moments of social bonding are intertwined with physiological synchrony in everyday life. The implications of potential repeated transmission of stress in the context of high synchrony for individual health and relationship functioning warrant further investigation.

The effects of dispositional restrictiveness on physiological markers of challenge and threat during a hypothetical transitional period in romantic relationships

Restrictiveness, a component of relationship dominance associated with monitoring and regulating partners' behavior, is a risk factor and accelerant of Intimate Partner Violence (IPV). Few studies, however, have examined in vivo physiological responses associated with restrictiveness. Toward this end, 105 romantic couples (N = 210) completed measures of restrictiveness and had their physiological responses recorded in anticipation of and during a dyadic interaction in which they discussed a hypothetical transitional period in which one person (the discloser) revealed to their partner (the responder) that they had just gotten into their dream school or was offered their dream job. Individuals high (vs. low) in restrictiveness exhibited physiological responses indicative of greater psychological challenge (e.g., elevated cardiac output and lower peripheral resistance) in anticipation of and during the conversation. In contrast, their partners exhibited greater physiological indicators of psychological threat in anticipation of (but not during) the conversation, particularly when assigned to the discloser role. Exploratory analyses of communication behaviors corroborated the physiological data. This research integrates the biopsychosocial model of challenge and threat with theories of relationship power and dominance to demonstrate the physiological manifestations of a well-known risk factor for IPV in romantic relationships and interpersonal restrictiveness.

Patient Extratherapeutic Interpersonal Problems and Response to Psychotherapy for Depression

OBJECTIVES

This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression.

METHODS

A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings.

RESULTS

Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality.

CONCLUSIONS

Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.

Relationships Matter: Progress and Challenges in Research on the Health Effects of Intimate Relationships

Social connections play an important role in health and disease and provide opportunities for clinical and public health interventions. Marriage and similar intimate relationships play a central role in the potential health benefits of positive social connections. This editorial provides an integrative perspective on three papers in this issue of Psychosomatic Medicine that examine intimate relationships and health and illustrates the application of current areas in relationship science. The importance of integrated conceptual models and statistical techniques to disentangle common third factors and overlapping constructs are highlighted, as well as the need for a multi-method approach that goes beyond self-report questionnaires. This editorial concludes with a summary of biobehavioral and psychological mechanisms and directions for future research.

The Unease Modulation Model: An Experiential Model of Stress With Implications for Health, Stress Management, and Public Policy

Stress has a pervasive, global, and negative influence on individual health. Stress also has negative effects on families, organizations, and communities. Current models of stress are either too general or too detailed to guide effective interventions across the spectrum of medical and social conditions that are stress-related. A new model is needed that explains how stress can have such varied effects and describes how to reduce its harm. The model must also capture both the dynamic nature of stress and its ability to persist and cause chronic effects. The model must guide those who use it in selecting effective interventions and in developing more effective interventions. Ideally, the model will be helpful to people who are experiencing stress and do not have access to professional help. The authors propose a model in an attempt to address the above concerns. The proposed model is called the Unease Modulation Model (UM Model). Briefly, the UM Model separates stress into several elements common to people's experience. The model describes how these elements interact and how those interactions lead to recurring states that are associated with health or illness. Finally, the model enables the person under stress to identify the elements where they will have the most leverage to evoke change and apply specific, effective techniques for that purpose. While the model is experiential, it is also based on mathematical theories of perception, nonlinear dynamics, neurophysiology, and cognitive psychology. In spite of this underlying sophistication, it can be used by those without a medical education. The proposed model has been taught successfully to patients in a clinical setting. The model is now being used in an international training program with police officers to address the long-term stress associated with the career and reduce decision-making errors regarding use of force. This article introduces the model by defining components based on patient descriptions of stress and integrating those into a formal structure. We then demonstrate how the model can be applied to a number of medical and psychiatric conditions. The article concludes by briefly discussing the model's application to family and societal stress-related difficulties.