Category: Mental Health

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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While every marriage has to work through inevitable tensions and stresses, the toxicity that comes with trauma can saturate a marriage with a disastrous cocktail of chronic misunderstandings, alienated individuals, and hopeless hearts. But you can help to turn the tide and be an active participant in God’s redemptive work in your marriage. You can help to bring health and restoration to your family. Here are a few key ways to pursue health in a marriage plagued by complex childhood trauma.

• Learn your spouse’s story. Be a listening ear whenever your spouse is willing to share his or her story. Listen actively and empathetically. Avoid criticizing. Instead, offer words of compassion and affirmation (affirmation regarding the pain and struggles of their experiences, not affirmation of their poor choices or toxic behavior.)
• Ask your spouse what he or she wants. Because of impaired attachment, many trauma survivors will not ask for what they want. You can begin to help your spouse develop healthy emotional muscles and build bridges of attachment by inviting him or her to share what he or she needs from you in a given situation or dynamic.
• Grieve. Being in a marriage affected by trauma means you have sustained many losses. There are things you hoped for relationally and otherwise that your spouse may just not be able to give you. You need to acknowledge and grieve the pain of those losses. One day your spouse may be able to give you those things that your heart rightly longs for.
• Get help. Simply put, this is a tough road to walk! Getting marriage counseling from an experienced counselor who knows how to recognize and treat trauma is key. That counselor may also be able to encourage your spouse to get the individual therapy he needs so he can begin to truly heal and experience a much richer life.  And reach out for individual counseling yourself, whether it is every week, once a month, or from time to time. Family counseling may also be warranted.
• Express your needs. Whether or not your spouse is capable of meeting those needs, hearing the needs expressed puts them on his or her radar and can help create an awareness and motivation to pursue healing and growth.
• Build the family you desire. When you are married to a trauma survivor there is a great deal to navigate. And what you envision for your family might seem like an impossibility. But not every hope and dream has to be a casualty of trauma’s realities. Create the memories and traditions you believe should be a part of your children’s experiences. Instill the values you want them to have. Be consistent with discipline, instruction, and nurture. It will not always be easy. It will not always go according to plan. But build anyhow! It will be worth it!
• Listen to the Lord. This is listed last, but is certainly not least! Though you may not know all of the ins and outs of your spouse’s trauma journey, God does! He is able to guide you each step of the way, and He is ultimately the only One who can redeem the ravages of trauma. Let Him be your Healer, your Comforter, and your Guide.

There is no doubt about it, being married to a survivor of complex childhood trauma is not easy. But it is possible to anchor yourself in the midst of the tumultuous waters. Your life may feel like it constantly shifts, but you as a person can have a strong, resilient internal fortitude that can foster a measure of stability for your family.

You do not have to journey alone. For additional help, visit us here.

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The reality of being married to a survivor of complex childhood trauma is that it will often feel like storms are constantly rolling in to shore. These storms can be costly, exhausting, and overwhelming. They can accost every area of your life in ways that are difficult to quantify.

Because survivors of complex childhood trauma can function with the appearance of normalcy in everyday life, especially if they are very talented, there can be such ambiguity in your experience. On one hand, your life can have  the appearance of, or potential for, what others would call success. On the other hand, you are often simultaneously recovering from a storm, experiencing a storm, and watching new storm clouds gather. It can be a steady, unrelenting cascade. This makes it seemingly impossible to gain stability and traction in your life.

Feelings of discouragement are common here. It is disheartening to feel like your life takes two to ten steps back maritally, relationally, financially, and/or professionally every time you try to take one step forward. Much of what you gain, you perhaps feel like you lose. There is a high cost to living with the effects of unhealed complex trauma. If you have children, it is even more complicated. You are likely doing your best to create as normal a life as possible for them, while being regularly confronted with the reality that you cannot shield them from all of the implications of living a life that is affected by trauma.

If you decide to work toward your marriage surviving, there will be storms to weather. (Please note, if there is abuse, weathering the storms does not mean staying and enduring it. You need to seek professional help and intervention immediately for the safety of yourself and your children.) Weathering the storms will require tenacity, but please understand that it is not your responsibility to “fix” the trauma. Weathering the storms will also likely require the help of a knowledgeable trauma counselor who can help you identify what storms to weather and how to weather them. The journey is not in vain if you walk it constructively and with intentionality.

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Complex childhood trauma often, though not always, has its roots and origins buried amid the parents, caregivers and/or authority figures of the trauma survivor’s childhood life. As unbelievable as it may seem, some trauma survivors find it very difficult to view those adult figures as having harmed them. Instead, survivors may blame themselves. They may also blame the non-abusive parent. And incredibly, many of them blame their spouses. Some trauma survivors are not even aware of their trauma, even though they live with the effects. Furthermore, it is common for them to not see how the poor and dysfunctional relational examples they may have been exposed to in childhood have distorted the way they perceive and engage in relationships.

While it may be virtually impossible for you to connect the historical dots of trauma in a way that your spouse can see and acknowledge them, being able to connect those dots for the sake of your own awareness is valuable. It will help you to understand and counter your spouse’s negative self talk and misdirected blame. It is important to note that countering his or her self talk and misdirected blame does not mean being combative or argumentative. But it does mean speaking truth to yourself. And it also means being willing to speak the truth to your spouse in a fitting manner when appropriate.

Survivors of complex childhood trauma are very beholden to their dysfunctional childhood blueprints. Your willingness to gently counter the lies and assumptions can shed needed light for them. It can help them to challenge their internal narratives and begin the process of discovering how to free their brains from the trauma imprint. But remember, this is not about strong arming your spouse. You cannot force him or her to connect the dots.

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If you are married to a survivor of complex childhood trauma, understanding his or her inner world is one of the keys to cultivating a meaningful marriage. I have heard trauma survivors describe their inner worlds as “a constant noise” they live with. The noise has a lot to do with the hyper vigilance we touched on. Sadly, these survivors are used to the noise, and they own it as normal. Because the trauma impacted them at such an early age they do not know anything other than the noise. It is their normal. But this noise profoundly affects how they perceive, interpret, and experience life. The “noise” can also go up in volume depending on if a situation is particularly overwhelming.

Think of it like this. You are walking down the side walk in a neighborhood where snakes have recently been spotted. Everywhere you step you are cautious, and you frequently glance behind you to ensure that nothing is slithering along at your heels. Suddenly, out of the corner of your eye, you think you see something curled up in the grass. At that moment, without any conscious effort on your part, an alarm is fired in your brain and a physiological sequence of events is activated. Hormones are released. Your heart rate speeds up. Your blood flow engages with a new priority, which is to help your arms and legs fight or flee. And your brain quickly determines which one to do, fight or flee. This all happens in a split second. Then you realize it’s a false alarm. What you are seeing is just a garden hose. You breathe a sigh of relief, but now you’ve been spooked. You hasten your steps to get out of that neighborhood. Finally, once you are out of harms way, your heart rate begins to return to normal, your blood flow returns to supporting your vital organs, and you are no longer in fight or flight mode. All is well.

Now, imagine living in that hypervigilant or “spooked” mode constantly. Imagine not being able to find an exit from the neighborhood. That would be an exhausting way to live. But that is how many survivors of childhood trauma live everyday. In childhood they lived with threat and danger. Not only did the trauma convince them that they are perpetually unsafe (there is always a snake at their heels), but it ravaged their neurobiological development.  Now the alarms are constantly going off and there is little reprieve. The ability to regulate thinking, feeling, and physical sensations is profoundly fractured, and the ability to have appropriate and fitting internal responses to adult stresses is severely compromised. Their brains have difficulty properly regulating the flight, fight, or freeze response. As a result, it is difficult for them to fully experience enthusiasm and absorb good experiences, though on the outside they may look like they are living a well adjusted life.

It is not hard to empathize when you understand these inner realities with which childhood trauma survivors live. Meeting your spouse with kindness and compassion is a loving way to respond to their hypervigilance. You may be the first safe family member with whom your spouse has ever lived. This is a tremendous opportunity for you to build toward intimacy.

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