Tamara Goldman Sher

The psychology of couples and illness : theory, research, and practice

Basic research on the psychobiology of intimate relationships, T. Groth, G. Fehm-Wolfsdorf, K. Hahlweg coronary heart disease and couples, L. Rankin-Esquer, A. Deeter, C.B. Taylor couples coping with respiratory disorders, K.B. Schmaling, N. Afari rheumatic illnesses and relationships - coping as a joint venture, S. Danoff-Burg, T.A. Revenson helping each other through the night - couples and coping with cancer, W.K. Halford, J.L. Scott, J. Smythe couples with HIV-AIDS, S. Kalichman couples and chronic pain, L. Schwartz, D. Ehde couples and premenstrual syndrome - partners as moderators of symptoms?, A. Jones, V. Theodos, T.G. Sher, M. Young couples facing fertility problems, L. Pasch, A. Christensen alcohol and couples - drinking in an intimate relational context, L.J. Roberts, K.D. Linney couples approaches to smoking cessation, C.A. Palmer, D.H. Baucom, C.M. McBride when the bough breaks - the relationship between chronic illness in children and couple functioning, R. Gaither, K. Bingen, J. Hopkins.

Supplementing Behavioral Marital Therapy with Cognitive Restructuring and Emotional Expressiveness Training: An Outcome Investigation.

The current study investigated whether the effectiveness of behavioral marital therapy (BMT) would be increased by the addition of cognitive restructuring (CR) and/or emotional expressiveness training (EET) for maritally distressed couples. Sixty such couples were randomly assigned to 1 of 3 therapists and 1 of 5 treatment conditions (BMT Alone, CR + BMT, BMT + EET, CR + BMT + EET, or waiting list) for 12 weeks of conjoint marital therapy. Within each treatment condition, couples typically improved on the variables focused on in treatment. However, comparisons among active treatment conditions showed few significant differences among treatments; the treatments were equally effective in increasing marital adjustment. Thus, the addition of CR and EET did not appear to increase the overall effectiveness of treatment. Possible reasons for the current findings are provided, and suggestions for future marital outcome investigations are outlined.

The Impact of Receiving an HIV Diagnosis and Cognitive Processing on Psychological Distress and Posttraumatic Growth

This study examined human immunodeficiency virus (HIV) as a traumatic stressor, intrusive and deliberate cognitive processing, psychological distress, and posttraumatic growth. One-hundred twelve participants completed interviews on posttraumatic stress disorder (PTSD) Criterion A, Rumination Scale-Revised, Impact of Event Scale, and the Posttraumatic Growth Inventory; relationships were modeled using path analysis. Model 1 attempted to replicate prior empirical research, Model 2 attempted to empirically replicate part of the posttraumatic growth theoretical model, and Model 3 attempted to empirically replicate an integrated model of posttraumatic growth and traumatic stress theories. Model 3 had good fit with study data. Results suggest shared and separate pathways from traumatic stressor to psychological distress and posttraumatic growth, with pathways mediated by cognitive processing. Implications of findings are discussed.

The Effect of Intracouple Coping Concordance on Psychological and Marital Distress in Infertility Patients

The effect of intracouple coping concordance on psychological and marital distress was examined in a sample of 46 couples undergoing different stages of infertility treatment. Results indicate that the effect of coping similarity within couples is dependent on both the type of coping examined and the stage of the stressor. Specifically, for women the use of high levels of task-oriented coping by their partners and themselves is associated with the highest level of marital satisfaction. The findings also indicate that the use of high emotion-oriented coping by both partners is associated with the most psychological distress for men. Finally, the results show that marital satisfaction among women undergoing late stage treatment is highest in couples where the males are using low levels of emotion-oriented coping. Interestingly, the least satisfaction for women is evident when the woman is using less emotion-oriented coping while her partner is using more, rather than when both partners are using more emotion-oriented coping strategies. Clinical implications of the findings are discussed.

The partners for life program: a couples approach to cardiac risk reduction.

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety-three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.

Mending a broken heart: A couples approach to cardiac risk reduction

Abstract Long-term maintenance of behavior change to reduce health risk factors is essential to producing a positive effect on medical outcomes. Recently, increased attention has turned toward a patients spouse, or intimate partner, in understanding response to illness, medically necessary behavioral change, and adherence with medical recommendations. The following article reviews the literature on couples and behavior change. Additionally, a description of an ongoing intervention with cardiac patients and their partners is included as an example of a multidisciplinary approach that addresses the needs of patients, their partners, and their relationships for sustained and meaningful behavioral change.

Communication Differences between Physicians and Their Patients in an Oncology Setting

The physician-patient relationship has critical importance in the quality of medical care, especially in the oncology setting. Of particular interest over the past two decades has been the communication between physicians and their patients. It is understood that communication is related to patient and physician satisfaction as well as other medical outcomes. However, despite this interest and attention, investigators have only recently begun to assess the communication between physicians and patients from the patients point of view. Additionally, previous investigations have primarily relied upon retrospective reports of the interaction from patients or physicians. The current investigation assessed physician–patient communication in an oncology setting, both as it was occurring and following the interaction. The units of analysis included participant ratings as well as those of trained observers. Findings revealed that physicians and patients disagree as to the valence of the messages which transpired. Additionally, results suggest that it is the patients who distort the messages in the positive direction. Research and clinical implications of this disagreement and positivity bias are discussed.

Non-conventional practices and immune functioning among individuals receiving conventional care for HIV

Objective: to examine the relationships among non-conventional practices, adherence and immune functioning in individuals with HIV. Methods: 92 participants completed an interview on non-conventional practices (complementary and alternative medicines (CAM), psychosocial therapies, and religious practice). They also completed the Psychiatric Symptom Index and the AIDS Clinical Trials Group Adherence Follow-up Questionnaire. Medical chart reviews determined CD4 count and viral load. Results: Hierarchical logistic regressions revealed religious practice was associated with adherence and CAM was associated with viral load. Conclusion: Participation in non-conventional practices in HIV populations may lead to positive health and health behaviors. Clinical implications are discussed.

Psychological treatment of couples undergoing fertility treatment

This article addresses a number of questions directly relevant to clinicians working with infertility patients. Issues addressed include a review of the impact of moderating variables on psychological adjustment; how to identify whether an individual or couple is experiencing psychological or marital distress that warrants treatment; whether to treat the individual or the couple; and what treatment interventions are appropriate for a given individual or couple.

Going the Distance: Health in Long-Distance Versus Proximal Relationships

Healthy romantic relationships are beneficial to an individuals physical and mental health. The prevalence of long-distance relationships (LDRs) is increasing; yet, no research has assessed whether the marriage–health association applies to individuals in LDRs. The present study investigated the marriage–health association in LDRs by comparing PR and LDR individuals on various health and relationship indices. Using both Qualtrics and Amazons Mechanical Turk, we designed an online survey (N = 296 married, 21 years or older, English speakers). Health measures included the patient-reported outcomes measurement information system (PROMIS-29); Perceived Stress Scale; and substance use, diet, and exercise surveys. Relationship variables assessed included satisfaction, maintenance, relationship stress, and sex. Overall, results were mixed, with no clear relationship arrangement relating to better health or relationship variable ratings. Relationship satisfaction did not differ across groups; however, individuals in PRs reported better maintenance, higher sexual frequency, and lower relationship stress. In terms of health, LDR individuals reported better health on several indices: overall scores; lower anxiety, depression, and fatigue subscale scores; and better diet/exercise behaviors. PR individuals reported lower individual stress levels, better medication adherence, and higher physical functioning scores than their LDR counterparts. Regression analyses indicated being in a LDR predicted more individual and relationship stress but simultaneously better diet and exercise behaviors. This study challenges the popular notion that health and happiness in a relationship stem from partner proximity and provides potential points of intervention to improve relationship satisfaction and health for individuals in both PRs and LDRs.