PHILADELPHIA—A spouse’s coping skills affect his or her partner’s ability to manage the chronic pain and disability of rheumatoid arthritis (RA), according to Tracey A. Revenson, PhD.
Dr. Revenson, professor of psychology at the Graduate Center of City University of New York, said that how well a patient copes with the pain and disability of RA also affects his or her spouse’s well-being and the integrity of their marriage.
“It is time for us to start doing research on couples and families where one person has rheumatoid arthritis,” she said in her ARHP Daltroy Memorial Lecture titled “Something’s Gotta Give: Couples Coping with Chronic Pain,” presented here at the 2009 ACR/ARHP Annual Scientific Meeting. “We need to move toward including the larger social context into the study of coping with rheumatoid disease.”
Dr. Revenson noted that 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 by their partner’s pain and disability. “Relatively few studies have investigated coping as a relational phenomenon; for example, how family members cope with an illness stressor, how they mutually influence each other, how they help and hurt,” she said.
“Most coping efforts take place within an interpersonal context,” she continued. “When one family member experiences stressors of illness, other family members are affected,” she said. The family members must learn to adjust to living an unpredictable life, one that includes pain and unexpected flares.
The resulting stress affects marital communication and satisfaction, with chronic stress leading to a higher probability of divorce. Chronic stress affects physical functioning, immune function, and mental health. “When you see your partner in pain and feel unable to help, that correlates with emotional distress,” Dr. Revenson said.
Spouses play a dual role in the coping process. They give help to the ill person, but they also need help themselves. “They are expected to provide help to their partner while also coping with their own stress and rearranging their daily life,” she said.
Stressors for Partners
Rheumatoid arthritis can have several effects on the spouse of the patient. Compared to spouses married to healthy partners, these partners are at greater risk of depression, experience greater loneliness, and have a high prevalence of psychological disturbance, Dr. Revenson said.
She outlined several stressors that affect the spouses of people with RA. The top stressor is seeing their partner in pain and feeling helpless to do anything about it. Another is the frustration with a partner’s physical limitations that can change from one day to the next. The negative changes in the patient’s mood can lead to depression in the spouse. Partners also have feelings of fear and uncertainty about their spouse’s future health, along with worries about what that may mean for their marriage. And, finally, a major stressor is the inevitable reduction in pleasurable activities, such as sex, socializing with friends, and “just having fun,” she said.
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.
“Their intense problem solving-focused efforts were not helpful. They were falling apart, but [they were] doing it together and could see some positives,” Dr. Revenson said.
A second type of coping among couples was a type in which both partners used several strategies. The patients were using problem-solving skills, and their partners used more strategies involved escaping into fantasy and finding blame.
The third type of couple used few coping skills, and the fourth type included patients who coped alone with the spouse doing very little.
Spouses Affect Response to Pain
Another recent study conducted by Dr. Revenson and her colleagues has considered coping strategies within married couples and their responses to pain, as well as how spouses are integrated into the patient’s responses to chronic pain. Using the MPI, a personality inventory, the researchers looked at three spousal responses to pain: punishing responses through anger or frustration, solicitous responses through social support, and distancing responses.
In couples where patients felt their partners were using more punishing behavior than their partners said they were using, there was worse adjustment to pain.
There was also worse adjustment among couples where the partner rated himself high on helpfulness but where both he and his spouse agreed that he was doing a fair amount of punishing and distancing. These partners reported the most caregiver strain and the least marital satisfaction. “These couples agree with how the partner is acting, and it’s not good,” Dr. Revenson said. “It is apparent that we must study coping in its social context, and that for a patient with rheumatoid disease, the spouse and the family are the first step. How to do this still needs attention.”
“The next challenge for us is how to conceptualize and study coping beyond the individual and how to use a variety of methods to really get at the stories that people tell us and come up with general patterns,” she continued. “From this research, I hope that 10 years from now we will be able to talk about how to develop couple-based interventions and will be able to teach couples how to communicate.”
Kathy Holliman is a medical journalist based in New Jersey.
Reference
- Holtzman S, DeLongis A. One day at a time: The impact of daily satisfaction with spouse responses on pain, negative affect and catastrophizing among individuals with rheumatoid arthritis. Pain. 2007;131:202-213.
- Abraído-Lanza AF, Revenson TA. Illness intrusion and psychological adjustment to rheumatic diseases: a social identity framework. Arthritis Rheum. 2006;55:224-232.
