Spouses often assume that some of their support efforts will be helpful, but that is not always accurate. “When a partner criticizes a partner’s coping efforts or provides unsolicited or unwanted advice or avoids discussing topics because he thinks those topics will be distressing, this actually makes the situation worse for the patient and reduces her ability to cope effectively,” Dr. Revenson said.
A study by Holtzman and DeLongis published in Pain reported that when patients were satisfied with how their spouses responded, the patients were less likely to increase negative affects due to catastrophizing. These patients were less likely to feel overwhelmed or helpless to deal with their daily pain.1
Holtzman and DeLongis found that how spouses respond “serves as a coping resource, and suggests the importance of involving close others in treatments to reduce pain and catastrophizing.”
Other studies have shown that low spouse support correlates with poor coping from patients. “Lower satisfaction with spousal support is associated with decreased coping efforts and decreased effectiveness of coping in reducing rheumatoid arthritis pain and with poorer same-day and next-day mood,” Dr. Revenson said. “It is difficult to cope effectively when you don’t have support and empathy from your partner and it is also very dangerous when you get critical responses from your partner about how you are coping.”
Much of the research into coping behavior related to RA has focused on strategies used by the patients with the disease. Little has been directed to their spouses, who are also greatly affected …
Dyadic Coping
Dr. Revenson performed a cross-sectional study of 113 heterosexual couples where one of the partners had RA.2 Seventy-five percent of those with the disease were women, most couples were middle-aged, and the average number of years married was 30. The patient and the spouse filled out separate questionnaires that examined how the patient rated his or her own coping skills and how the partner rated his or her own strategies for coping with his spouse’s illness.
Responses to their questionnaires were stratified into four clusters of coping styles among couples. The first cluster was called the effortful partnerships, where couples were trying everything to cope, including problem solving, rational thinking, seeking support, escaping into fantasy, distancing, passive acceptance, and finding blame.
Although these couples were working hard to cope, they also had more depression. The spouses felt they were under greater stress, that there were more illness intrusions into their daily life, and that there was a greater burden on the caregiver. However, these couples also reported greater personal growth despite their distress and were able to reappraise the illness in a positive light.
