Month: July 2023

Description of Sample

Wives featured the following primary anxiety disorders: panic disorder with agoraphobia (PDA; n = 2; 6%), GAD (n = 9; 27.2%), SAD (n = 15; 45.5%), OCD (n = 5; 15.1%), and PTSD (n = 2; 6%). The majority were receiving treatment for their anxiety (84.8% in psychotherapy, 24.2% receiving psychotropic medication), although most were enrolled in this study during the first 3 weeks of their current treatment (n = 24; 85.7%). Ten (30.3%) met criteria for comorbid dysthymic disorder, and 19 (57.6%) met criteria for at least one additional anxiety disorder, including GAD (n = 4), SAD (n = 11), PDA (n = 1), PTSD (n = 2), and anxiety disorder not otherwise specified (n = 1). Husbands’ mean scores on the STAI–A (M — 12.90, SD = 3.02) and the STAI–D (M = 24.67, SD = 6.57) subscales were comparable to those reported by Bieling and colleagues (1998) for their control sample (STAI–A M = 10.20, SD = 2.45; STAI–D M = 23.18, SD = 4.58). Husbands’ mean raw score on the SCL-90 GSI subscale (M = 0.55, SD = 0.12) was below the clinical threshold suggested by Schauenburg and Strack (1999), with the majority of husbands (73.5%) scoring below the cut-off. Although husbands’ diagnostic status was not formally assessed, they did not demonstrate generally elevated levels of psychological distress.

Wives and husbands reported nearly identical levels of global relationship satisfaction on the DAS (see Table 1). Total DAS scores were comparable to those reported for a sample of agoraphobic married and cohabiting women (M = 103.2, SD = 17.2; Chambless et al., 2001). Based on empirically established cutoffs (i.e., 98; Eddy, Heyman, & Weiss, 1991), 29.5% of couples in the current sample had at least one partner who scored within the distressed range of marital functioning. Mean levels of daily negative mood aggregated across the study period were significantly higher for wives than for husbands, as would be expected given wives’ clinical status. ICCs, representing the proportion of variance between-persons indicated that significant variability existed between and within persons on affect measures for wives (anxiety ICC = .44; anger ICC = .34; depression ICC = .40) and husbands (anxiety ICC = .42; anger ICC = .33; depression ICC = .31).

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Married or cohabiting adults seeking psychotherapy at the clinics listed above were contacted by a research assistant about a study on “relationships and stress.” Students were contacted if they endorsed being married or living with a significant other. All prospective participants were administered a telephone screening interview by a master’s-level clinician to inquire about the presence of anxiety disorder symptoms and to evaluate exclusion criteria. Those who endorsed clinically significant anxiety disorder symptoms in this phone interview were invited to complete a face-to-face diagnostic interview with a master’s-level clinician.

Couples who met study criteria and provided informed consent were given baseline questionnaires and 14 diary reports. Partners were instructed to complete diary reports separately at the end of each day, to refrain from discussing their responses, and to return each report in a prestamped envelope after completion. Compliance was monitored in two ways: (a) Couples were phoned once at the end of each study week to remind them to complete questionnaires separately, give them an opportunity to ask questions, and encourage consistent mailing of reports; (b) on each diary, participants were asked to indicate whether they completed the report on a day other than the one designated on the form. At study completion, couples were debriefed and given $100.00 remuneration.

Of 34 couples (i.e., 68 participants) enrolled, 91.2% (n = 31) of wives and 91.2% (n = 31) of husbands provided 14 daily reports. The mean number of data points provided was 13.8 (range = 12–14; SD = 0.41) for wives and 13.76 (range = 10–14; SD = 0.81) for husbands. Baseline questionnaires were completed by all participants. One couple was eliminated because more than half of their reports were noncompliant (completed on an incorrect day). Eight additional couples had noncompliant reports (M = 2, range = 1–3). Rather than eliminate their data, we omitted from our analyses their noncompliant days (19 total). Our final sample was therefore 33 couples.

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Our sample consisted of 33 married and/or cohabiting (≥6 months) heterosexual couples in which the female partner met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994) criteria for a principal anxiety disorder. Exclusion criteria included evidence of psychosis, risk of self-harm, partner abuse, alcohol or substance abuse in the last 6 months, an organic mental disorder, or a history of bipolar disorder. Couples were excluded if the diagnosed partner met criteria for a current major depressive episode to minimize the potentially confounding effects of comorbid depression.

Participants were recruited from four sites in the Philadelphia area: (a) the Adult Anxiety Clinic of Temple University (n = 16 couples; 47.1%), (b) the Psychological Services Center of Temple University (n = 7; 20.6%), (c) the Anxiety and Agoraphobia Treatment Center (n = 4; 11.8%), and (d) the Temple University student body (n = 7; 20.6%) during 2004–2005.

The majority of couples (n = 21; 62%) were married (M = 7.6 years, SD = 8.7) or cohabiting for a mean duration of 3.04 years (SD = 2.0). The average age was 33.8 years (SD = 10.3). Participants were predominantly Caucasian (61.8%), with 17.6% identified as African American, 2.9% Hispanic, 8.8% Asian/Asian American, and 8.8% Other. Analysis of variance for age and chi-square analyses for categorical variables revealed site differences in the age of the diagnosed partner, Welch F(3, 10) = 7.30, p < .05, and the frequency of married versus cohabitating and unmarried couples, χ²(3, N = 66) = 19.89, p < .05. None of these variables were significantly related to mean aggregated scores on daily measures of mood or relationship quality or baseline measures of relationship adjustment.

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We observed associations between anxiety and relationship quality (RQ) among couples in which one partner (the wife) was diagnosed with an anxiety disorder. We used a daily process design to improve on prior studies that relied on cross-sectional, between-person analyses. Specifically, we hypothesized that:

1. Wives’ daily anxiety would be associated with daily perceptions of RQ for both partners.
2. The associations between wives’ anxiety and perceptions of RQ would be moderated by wives’ anxiety-specific, but not global, relationship adjustment. We hypothesized that associations would be stronger for couples with lower anxiety-specific relationship adjustment.
3. On days in which wives reported elevations in anxious mood, husbands would be perceived as having at least some involvement in their wives’ anxiety. Exploratory analyses examined how often husbands were perceived as contributing to the (a) reason for anxiety, (b) worsening of anxiety, or (c) alleviation of anxiety.
4. Wives’ daily anxiety would be associated with husbands’ level of distress (i.e., anxiety, anger, depression) on the same day.
5. The association between wives’ anxiety and husbands’ levels of distress would be moderated by (a) husband-reported hostility toward the wife and (b) husband’s accommodation of wives’ anxiety symptoms. We hypothesized that wives’ anxiety would be more strongly associated with husbands’ distress for husbands who report greater hostility and greater accommodation of wives’ symptoms.

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Research on the interpersonal consequences of depression highlights the adverse effects of one partner’s mood disturbance on another (Joiner & Katz, 1999). The tendency to “catch” another person’s distress is referred to as emotional contagion and has been supported extensively in social psychology (e.g., Hatfield, Cacioppo, & Rapson, 1994) as well as in the literature on depression (Katz et al., 1999). Spouses of depressed partners show higher levels of depressed mood than do controls, with a substantial portion carrying levels of distress that warrant clinical intervention (Benazon & Coyne, 2000; Coyne et al., 1987). Yet data on the concordance of anxiety in dyads is sparse. One study found that displays of anxiety elicited high levels of distress, rejection, and devaluation from others, with some evidence for affect-specific mood induction (Gurtman, Martin, & Hintzman, 1990). However, most studies in this area used nonclinical samples and did not examine these phenomena in the context of intimate relationships. Adults who meet diagnostic criteria for an anxiety disorder may be more likely to show dyadic concordance in distress than nonclinical groups, perhaps as a function of the severity, chronicity, and perceived unmanageability of their anxiety (e.g., Joiner & Katz, 1999). A second focus of the current study was therefore to examine the degree to which one partner’s anxiety is associated with elevated distress in the partner.

We were further interested in specifying conditions that strengthen this concordance in distress. Studies examining familial responses to a relative with an anxiety disorder have identified response styles that may contribute to shared distress (Calvocoressi et al., 1995). For example, Amir, Freshman, and Foa (2000) found that the degree of distress felt by relatives of patients with obsessive-compulsive disorder (OCD) was significantly related to how frequently they accommodated the patient’s symptoms and how critical or rejecting they felt toward the patient. Geffken et al. (2006) similarly reported that high levels of family accommodation to OCD patients’ symptoms was strongly related to relatives’ disengagement and denial in the face of stressful situations. In the present study, we examined whether adults with anxiety disorders were more likely to transmit distress to their partners when their partners featured certain habitual response styles, such as hostility and rejection, or symptom accommodation.

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Population studies point to strong associations between an anxiety disorder in one partner and perceptions of poor marital quality by both partners (e.g., McLeod, 1994). A longitudinal analysis of 4,796 married couples indicated that baseline marital quality was a strong predictor of the onset of an anxiety disorder over a subsequent 2-year period (Overbeek et al., 2006). Recent data from the National Comorbidity Survey Replication have also demonstrated that marital distress is significantly associated with increased risk of having any concurrent anxiety disorder, particularly social anxiety disorder (SAD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD; Whisman, 2007). The association between anxiety disorders and poor marital functioning does not appear to be an artifact of general social impairment (Whisman, Sheldon, & Goering, 2000) and is not better accounted for by age, gender, or comorbidity with depression or with alcohol or drug dependence (McLeod, 1994; Whisman, 1999, 2007). Moreover, adults with anxiety disorders may engage in interpersonal behaviors that elicit poor reactions from others or jeopardize opportunities for support and intimacy (e.g., Darcy, Davila, & Beck, 2005).

Prior research in this area has taken a predominantly nomothetic approach, in which associations between anxiety disorders and marital quality were examined across a group of individuals. These data tell us that, on average, adults with anxiety disorders are likely to experience poor relationship quality. However, it remains unknown whether a person affected by an anxiety disorder is more or less likely to experience relational difficulties on those occasions when he or she experiences elevated anxiety. Tennen, Affleck, Armeli, and Carney (2000) cautioned against using cross-sectional, between-person associations to draw inferences about how two variables are related within the same person. It is possible, for instance, that adults with anxiety disorders experience improved relationship quality during episodes of heightened anxiety because of increased support received from an intimate partner at this time.

In developing theoretical models and designing interventions, clinicians and researchers rely on idiographic formulations of how these processes unfold for a given person. Over the last decade, there have been significant advances in the procedural and analytic tools available to study idiographic processes over time. In particular, the daily diary method has proven to be a useful way to examine how two processes (e.g., marital quality and anxiety) covary within the same person over time. In the present study, daily diary reports were used to determine the within-person association between anxiety and relationship quality among adults with anxiety disorders and their partners.

One limitation of prior literature on anxiety disorders and relationship quality is the inconsistency across studies in how relationship quality is defined. Daiuto, Baucom, Epstein, and Dutton (1998) argued that it is important to distinguish relationship satisfaction (i.e., subjective appraisal of how happy one is in a relationship) from relationship adjustment (i.e., the quality of specific relational processes such as communication or problem-solving). The utility of this distinction is supported by previous studies showing that aspects of relationship adjustment (e.g., avoidance of communication) significantly predicted the outcome of treatment for an anxiety disorder, even when global relationship satisfaction was high (Craske, Burton, & Barlow, 1989; Marcaurelle, Belanger, & Marchand, 2003). Exclusive reliance on global evaluations of relationship satisfaction may therefore miss clinically useful information about areas of relationships more or less disrupted by anxiety. Even when couples describe their relationships as high functioning across multiple domains, couples who struggle to accommodate one partner’s anxiety symptoms (e.g., with effective support and communication) may experience more pronounced relational impact in the context of these symptoms (Craske et al., 1989). In observed interactions between agoraphobic women and their husbands, problem-solving difficulties were greater when the topic of discussion was the wife’s anxiety (Chambless, Bryan, Aiken, Steketee, & Hooley, 2001). In the present study, we used a measure of anxiety-specific relationship adjustment to provide a contextually sensitive assessment of relationship functioning. We hypothesized that anxiety-specific relationship adjustment would be more informative in predicting the strength of the association between anxiety and daily relationship quality than would a measure of global relationship functioning.

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