PSYCHOLOGY OF RELATIONSHIPS
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PSYCHOLOGY OF RELATIONSHIPS
EMMA CUYLER AND
MICHAEL ACKHART EDITORS
Nova Science Publishers, Inc. New York
Copyright © 2009 by Nova Science Publishers, Inc.
All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS.
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Cuyler, Emma. Psychology of relationships / Emma Cuyler and Michael Ackhart. p. cm. ISBN 978-1-60741-931-0 (E-Book) 1. Interpersonal relations. I. Ackhart, Michael. II. Title. HM1106.C89 2009 302.3'4--dc22 2008039628
Published by Nova Science Publishers, Inc.Ô New York
CONTENTS Preface
ix
Chapter 1
Communicating Empathies in Interpersonal Relationships Grace Anderson and Howard Giles
Chapter 2
Interpersonal Representations: Their Structure, Content, and Nature Shanhong Luo
Chapter 3
Generalized Anxiety Disorder and Interpersonal Relationships: The Case For a Systemic Intervention Danielle Black, Amanda Uliaszek, Alison Lewis and Richard Zinbarg
Chapter 4
Another Kind of “Interpersonal” Relationship: Humans, Companion Animals, and Attachment Theory Jeffrey D. Green, Maureen A. Mathews and Craig A. Foster
Chapter 5
The Role of Oxytocin in the Pathophysiology of Attachment Marazziti Donatella, Catena Dell’Osso Mari, Consoli Giorgio and Baroni Stefano
Chapter 6
Identity Exploration and Commitment Associations with Gender Differences in Emerging Adults’ Romantic Relationship Intimacy H. Durell Johnson, Kristen A. Loff, George Bell, Evelyn Brady, Erin A. Grogan, Elizabeth Yale, Robert J. Foley and Trishia A. Pilosi
Chapter 7
Development of an Interview for Assessing Relationship Quality: Preliminary Support for Reliability, Convergent and Divergent Validity, and Incremental Utility Erika Lawrence, Robin A. Barry, Rebecca L. Brock, Amie Langer, Eunyoe Ro, Mali Bunde, Emily Fazio, Lorin Mulryan,Sara Hunt, Lisa Madsen and Sandra Dzankovic
1 35
65
87 111
131
149
vi Chapter 8
Chapter 9
Chapter 10
Contents Assessing Relationship Quality: Development of an Interview and Implications for Couple Assessment and Intervention Erika Lawrence, Rebecca L. Brock, Robin A. Barry, Amie Langer and Mali Bunde The Tendency to Forgive in Premarital Couples: Reciprocating the Partner or Reproducing Parental Dispositions? F. Giorgia Paleari, Silvia Donato, Raffaella Iafrate and Camillo Regalia Is the Serotonergic System Altered in Romantic Love? A Literature Review and Research Suggestions Sandra J. E. Langeslag
173
191
213
Chapter 11
Update on Pheromone Research Donatella Marazziti, Irene Masala, Stefano Baroni, Michela Picchetti, Antonello Veltri and Mario Catena Dell’Osso
219
Chapter 12
Normal and Obsessional Jealousy: An Italian Study Donatella Marazziti, Marina Carlini, Francesca Golia, Stefano Baroni, Giorgio Consoli and Mario Catena Dell’Osso
229
Chapter 13
Jealousy, Serotonin and Subthreshold Psychopathology Donatella Marazziti, Francesca Golia, Marina Carlini, Stefano Baroni, Irene Masala, Mario Catena Dell’Osso, and Giorgio Consoli
237
Chapter 14
Advances in Dyadic and Social Network Analyses for Longitudinal Data: Developmental Implications and Applications William J.Burk,Danielle Popp, and Brett Laursen
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Mother-Infant Interaction in Cultural Context: A Study of Nicaraguan and Italian Families Ughetta Moscardino, Sabrina Bonichini and Cristina Valduga “It’s Saturday…I’m Going out with My Friends”: Spending Time Together in Adolescent Stories Emanuela Rabaglietti and Silvia Ciairano Prevention of the Negative Effects of Marital Conflict: A Child-Oriented Program Patricia M. Mitchell, Kathleen P. McCoy, E. Mark Cummings, W. Brad Faircloth and Jennifer S. Cummings Mother-Infant Bonds: The Effects of Maternal Depression on the Maternal-Child Relationship Deana B. Davalos, Alana M. Campbell and Amanda L. Pala
245
259
281
303
319
Contents Chapter 19
Social Networks and Psychosocial Functioning among Children and Adolescents Coping with Sickle Cell Disease: An Overview of Barriers, Considerations, and Best Practices Rebecca H. Foster, HaNa Kim, Robbie Casper, Alma Morgan, Wanda Brice and Marilyn Stern
vii
339
Chapter 20
Parenting and Children’s Involvement in Bullying at School Ken Rigby
365
Chapter 21
Neurobiology of Social Bonding Donatella Marazziti, Alessandro Del Debbio, Isabella Roncaglia, Carolina Bianchi and Liliana Dell’Osso
369
Chapter 22
Cooperative and Non-cooperative Behavior in Pairs of Children: The Reciprocal Effects of Social Interaction in the Ongoing Construction of a Play Sequence Emanuela Rabaglietti, Fabrizia Giannotta, and Silvia Ciairano
Chapter 23
Chapter 24
Chapter 25
381
Social Relationships and Physical Health: Are We Better or Worse off because of Our Relationships? Julianne Holt-Lunstad and Briahna Bushman
399
Living in Discrepant Worlds: Exploring the Cultural Context of Sexuality among Turkish and Moroccan male Adolescents Barbara C. Schouten and Chana van der Velden
417
HIV/AIDS Prevention on Mexican Adolescents: The Synthesis of two Theories Considering the Interpersonal, Individual, and Psychological Influences Raquel A. Benavides-Torres, Georgina M. Núñez Rocha, Esther C. Gallegos Cabriales, Claude Bonazzo, Yolanda Flores-Peña, Francisco R. Guzmán Facudo, and Karla Selene López García
437
Chapter 26
Adolescents with Cancer: Adjustment and Supportive Care Needs Luisa M. Massimo
451
Chapter 27
The Quality of Caring Relationships Tineke A. Abma, Barth Oeseburg, Guy A. M. Widdershoven and Marian Verkerk
461
Chapter 28
An Attachment-Based Pathways Model Depicting the Psychology of Therapeutic Relationships Geoff Goodman
Chapter 29
A Study of the Relationship between Self-conscious Affects, Coping Styles, and Depressive Reaction after a Negative Life Event Masayo Uji, Toshinori Kitamura and Toshiaki Nagata
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493
viii Chapter 30 Index
Contents The Neuropsychology of Passionate Love Elaine Hatfield and Richard L. Rapson
519 545
PREFACE This book describes the various aspects of interpersonal relationships, which can be defined as the interactions between one group and another. How people represent their interpersonal relationships based on past experiences is explored, as well as the three main aspects of interpersonal representations- structure, content, and nature. Conflictive social interpersonal relationships and how they influence mental health are explored in this chapter, as well as the different coping styles people have. In addition, the various dimensions of empathy and how they relate to interpersonal relationships are reviewed and incorporated into a unified source of reference for future research. The role of the nonapeptide called oxytocin in the pathophysiology of attachment is described as well as the possible involvement of oxytocin in the onset of mental disorders. Differences in romantic relationship intimacy, resulting from identity exploration are discussed, as well as the differences in commitment based on gender. In addition, the correlation(s) between relationship adjustment, satisfaction, and quality are reviewed based on the Relationship Quality Interview (RQI), which assesses relationship quality across five dimensions, including trust, inter-partner support, quality of intimacy, respect, and communication. Furthermore, the association between social relationships and physical health is examined. The tendency to forgive in premarital couples is examined as well as the reasons behind forgiveness-possibly deriving from parental model behavior or reciprocation of the partner's behavior. In addition, a review of studies is done on the relationship between serotonin levels and romantic love, as well as how the thoughts of infatuated individuals mirror those who suffer from obsessive-compulsive disorder. Furthermore, generalized anxiety disorder (GAD), one of the more common anxiety disorders, is discussed and how it affects occupational, interpersonal and family functioning, as well as the different treatments for GAD. This book presents the most up-to-date information on pheromone research, including how pheromones may influence reproductive endocrinology and have a positive effect on one's mood. In addition, the differences between normal and obsessional jealousy is explored, as well as the role that neurotransmitters may play in the expression of jealousy. The neurobiological correlates of attachment in both animals and humans is examined, including infant-mother attachment, mother-infant attachment, adult-adult pair bonding formation, and human bonding. Human-pet relationships and their importance in the field of human psychology animal are also explained in this book. Furthermore, the relationships
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between cooperative and non-cooperative or competitive behavior in pairs of children in the ongoing process of interaction is reviewed. The social networking and psychosocial functioning among children and adolescents coping, in particular, with sickle cell disease is examined in this book, as well as the best practices for treatment. Furthermore, studies done on the adjustment and supportive care for adolescents that are dealing with high-risk diseases such as cancer are discussed. This book explores the major public health issue of HIV/AIDS in Mexican adolescents and Turkish and Moroccan male adolescents in the Netherlands. Three types of influences are discussed, including interpersonal influences, individual influences, and psychosocial influences. Finally, this book explores the psychology of therapist-patient relationships as well as the relationships between patients or disabled persons and professionals. The ways in which conflictive social interpersonal relationships may influence mental health is also discussed. Chapter 1 - Empathy is a concept that has been widely researched across the social sciences and, more importantly, is commonly used outside of academe as a method “to openup the channel of communication with the other” (Wikipedia, 2006). Although commonly employed colloquially, empathy is challenging to define explicitly and, hence, this chapter begins with some conceptual wood-clearing. Prior definitions reflect the specific contexts in which empathy was measured and studied. For instance, a study measuring empathy as a response to media defines empathy differently than a study that examines empathy as an interpersonal communication construct – and these definitions are not mutually exclusive or disparate. Instead, different definitions are a result of the various dimensions of empathy that researchers choose to highlight as a function of the particular empirical study’s focus. For this reason, many individuals may find empathy easier to enact than to describe its meaning in words. This chapter will examine the major definitional variations of empathy that have developed in research on interpersonal relationships, comparing and contrasting their implications. For instance, one major difference is whether empathy is a stable trait or a changing state; this definitional difference can lead to very different methods of research. An attempt is made to accomplish a more global definition of empathy by discussing the distinct ways in which it has been examined in the past, such as in terms of communicative competence, personal distress, and nonverbal expressions, and incorporating the many dimensions of empathy into a unified source of reference for future research. In so doing, this chapter will discuss how one individual may feel and express empathy and how that empathy may or may not be perceived as such by its recipients. The psychological origins of empathy will be identified and questions regarding motives underlying empathy will be raised, including whether it can be used as a form of impression management during social interactions. Empathy has been recognized as an important component of health communication. Research has shown that an empathic person holds more positive attitudes towards healthy behaviors regarding smoking and alcohol consumption (Kalliopuska, 1992). Moreover, an effective health campaign will evoke empathy among its target audience because it evokes greater cognitive and affective processing of the campaign message (Campbell & Babrow, 2004). Empathic communication with people with disabilities (particularly those inflicted by cancer) will be a continuous example used to help us understand the multidimensional implications of empathic communication. Empathy can ease tensions that may occur during
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this form of interaction and suggestions of appropriate empathic communication will be offered. Finally, a new communication model of the process of empathy will be introduced. Chapter 2 - How people represent their interpersonal relationships based on past experiences has great impact on their subsequent interactions with others. This chapter reviews previous theories and presents new propositions regarding three important aspects of interpersonal representations (IRs)—their structure, content, and nature. Specifically, the structure of IRs can be viewed as a three-level hierarchical organization, with general representations at the highest level, domain-specific representations at the midlevel, and relationship-specific representations at the lowest level. The content of IRs can be divided into three distinct yet interrelated components: self representations, other representations, and relationship representations. With regard to the nature, IRs can be conceptualized as consisting of accurate perceptions, systematic biases, and random errors. Chapter 3 - Generalized anxiety disorder (GAD), one of the more common anxiety disorders, is associated with significant impairment in occupational, interpersonal and family functioning. There is growing consensus that there is a need to improve the effectiveness of treatments for GAD given that even the most positive findings suggest that only 50% of patients treated with cognitive-behavior therapy (CBT) and/or medications experience what might be considered to be a cure. Whereas established treatments for GAD are individual modalities, there is evidence from several lines of research suggesting current treatments for that systemic therapy has promise to augment the effectiveness of therapy for GAD. These lines of research include (a) evidence that elevated marital dissatisfaction is associated with GAD; (b) evidence that marital and family problems are associated with other anxiety disorders including panic disorder with agoraphobia and obsessive compulsive disorder and are associated with poor outcome in the treatment of these other anxiety disorders; (c) evidence that marital and family problems are associated with major depression - another psychiatric condition closely related to GAD – and poor outcome in the treatment of major depression; (d) preliminary evidence that marital functioning and interpersonal problems predict outcome in the treatment of GAD; and (e) evidence that at least some forms of couples therapy are effective treatments for major depression and panic disorder with agoraphobia. Chapter 4 - Human-companion animal relationships provide an important but largely unexplored component of the human experience. Research examining these interspecies relationships may elucidate the depth and meaning of these relationships as well as provide unique insights into the fundamental nature of human psychology. Human-animal relationships offer a distinctive testing ground because pet choice is unilateral, whereas human friendships and romantic partner choices are mutual, and individuals may have reduced fear of rejection or evaluation from a pet than from a human relationship partner. This chapter reviews and applies to human-pet relationships key elements of attachment theory, including caregiving, exploration, the malleability of attachment styles, and the role of attachment anxiety and avoidance in choosing relationship partners. Potential future research directions using relationships theories in companion animal contexts is also covered. Chapter 5 - Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Although OT-like substances are present in all vertebrates, oxytocin has been identified only in mammals where it seems to be fundamental in the onset of typical mammalian behaviors, including labour and lactation. In the present chapter, the physiological role of oxytocin in the regulation of different functions and behaviors will be
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addressed: several data, mainly coming from animal models, have highlighted the role of this neuropeptide in the formation of caregiver-infant attachment, pair-bonding and, more generally, in linking social signals with cognition, behaviours and reward. In addition, recent evidences have demonstrated alterations of oxytocin system in several human neuropsychiatric disorders, leading to the hypothesis of a possible involvement of oxytocin in the onset of mental disorders. In this frame, the psychopathological implication of the disregulation of the oxytocin system and the possible use of oxytocin or its analogues and/or antagonists in the treatment of psychiatric disorders will be discussed. Chapter 6 - Emerging adulthood is considered a time when intimacy becomes an integral aspect of romantic relationships, and Arnett (2000) argues intimacy in emerging adults’ romantic relationships results from identity explorations. Previous research, however, suggests emerging adults’ romantic intimacy is associated not only with identity exploration, but also with identity commitments and gender. In an attempt to examine the theorized relationships among identity exploration, identity commitment, gender, and perceived romantic intimacy, the current study examined identity and romantic intimacy responses from a sample of 271 emerging adults (183 females, mean age = 19.22 years; and 88 males (mean age = 19.29 years). Findings indicated 1) both identity exploration and commitment predict emerging adults’ romantic relationship intimacy, 2) gender differences in romantic relationships differ according to emerging adults’ identity status, and 3) identity status differences in romantic relationship intimacy differs for emerging adult males and females. The current study’s test of Arnett’s (2000) hypothesis regarding identity exploration and romantic relationship intimacy development did not fully support his theorized association. Rather, findings suggest differences in emerging adults’ romantic intimacy are associated with their gender and identity commitments as well as identity exploration. As a result, Arnett’s (2000) proposal that identity exploration during emerging adulthood is a necessary precursor for intimate romantic relationships may not completely describe the association between identity and intimacy that emerges during this period, and this association may be more complex than originally theorized. Results are discussed in terms of understanding the moderating association of gender on identity exploration and commitment differences in emerging adults’ reports of romantic relationship intimacy. Chapter 7 - Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. The first section of the chapter reviews the long-standing debate regarding – and clarify the distinctions among – relationship adjustment, satisfaction, and quality. Also discussed is the need for an empirically-supported, psychometrically strong measure of relationship quality. The second section presents the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings from the interviews. It was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. The third section provides preliminary evidence of the reliability and validity of the interview. Across two samples, the RQI demonstrated strong reliability (internal consistency, inter-rater agreement, agreement across interviewers based on two members of the same couple, correlations among the scales) convergent validity (correlations between RQI scales and self-report questionnaires assessing similar relationship dimensions), and divergent validity (correlations between RQI scales and
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behavioral observations of related constructs, global measures of marital satisfaction, and individual difference measures of related constructs). A brief discussion of broader clinical issues relevant to couple assessment and prevention efforts concludes the chapter. Chapter 8 - Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. In the first section of the chapter is a review of the long-standing debate regarding -- and clarify the distinctions among -relationship adjustment, satisfaction, and quality. Also discussed is the need for an empirically-supported, psychometrically strong measure of relationship quality. In the second section, the multidimensional nature of relationship quality, and review prior research relevant to each dimension. An introduction on the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings is covered. The RQI was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. In the third section, preliminary evidence of the reliability and validity of the interview is provided. Across samples of dating and married couples, were examined reliability, convergent and divergent validity, and incremental validity of the RQI. A broader clinical issues relevant to couple assessment and intervention efforts is discussed in the fourth section. Chapter 9 - Although the tendency to forgive the partner has been shown to enhance personal and relational well-being, little is known about how this tendency originates. One possibility is that the tendency to forgive the partner develops as a function of the forgiveness exchanges people experience within their romantic relationships, thereby leading them to become more and more similar to the partner in their proneness to forgive. Another possible explanation is that social experiences people were exposed to within their own family of origin has led them to gradually internalize parental models and to become more and more similar to their parents in their willingness to forgive. These associations may be particularly evident during emerging adulthood, when engaged couples have to balance their family heritage and the forming of their new couple. The present work aimed at providing initial evidence in support of these hypotheses by investigating in a sample of premarital couples (N=165) and their parents the extent to which young adults’ tendency to forgive the partner was similar to the partner’s tendency to forgive them as well as to their mothers’ and fathers’ tendency to forgive one another. Dyads were the units of analysis and stereotype accuracy was controlled. Results indicate that young adults’ disposition to forgive the partner is similar to that of their partner and of their parents. Gender moderated these associations, as females were more similar to their parents than were males in their disposition to forgive. The findings are consistent with the idea that premarital couples, even though strongly involved in defining their own couple identity, are nonetheless affected by the forgiveness models to which they are exposed within their family of origin. Chapter 10 - Infatuated individuals think about their beloved a lot. The notions that these frequent thoughts resemble the obsessions of obsessive-compulsive disorder (OCD) patients and that those patients benefit from serotonin reuptake inhibitors (SSRIs), have led to the hypothesis that romantic love is associated with reduced central serotonin levels. In this chapter, the literature on this topic is reviewed and suggestions for future research are made.
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Previous studies have shown that romantic love is associated with lower blood serotonin levels and with lower serotonin transporter densities, the latter of which has also been observed in OCD patients. Further, SSRIs have been found to decrease feelings of romantic love and the serotonin 2 receptor gene has been associated with the love trait ‘mania’, which is a possessive and dependent form of love. Given that serotonin 2 receptors in the prefrontal cortex have also been implicated in impulsive aggression, this suggests that stalking behavior may be associated with these receptors. In short, the serotonergic system appears to be altered in romantic love indeed. Future research is needed to identify what parts of the serotonergic system, such as which serotonergic projections, brain areas, transmission stages and receptor types, are affected in romantic love and in what way they are altered. Furthermore, challenging the serotonergic system would be useful in determining the causal relationship between central serotonin levels and feelings of romantic love. In addition, future research should specifically investigate the different aspects of romantic love, such as state, trait, requited and unrequited love and its development in time. Chapter 11 - Pheromones are volatile compounds secreted into the environment (in sweat, urine) by one individual of a species and perceived by another individual of the same species, in which they trigger a behavioral response or physiological change. Besides insects, pheromones have been described in several invertebrate and vertebrate animals; moreover, they have been shown to modulate mating preferences, timing of weaning, learning ability to distinguish poisoning from not-poisoning food, social recognition and level of stress. Several studies suggest that pheromones might play an important role also in mammals, as it has been demonstrated that they can use chemical signals for mate attraction, territorial marking, dominance and probably other functions yet to be identified, amongst which, perhaps, some social behaviors. In humans, several studies have indicated that pheromones may influence reproductive endocrinology and have a positive effect on mood. Menstrual synchrony amongst women sharing the same environment is a long-recognized phenomenon related to pheromones produced in the armpits; these substances are not perceived as having any particolar odour, but nonetheless can influence the lenght of the mestrual cycle through the interference with different hormones. The aim of the present paper is to review the latest data on pheromones with a specific focus on humans and future developments. Chapter 12 - Background: Jealousy is a complex emotion spanning from normality to pathology. The present study aimed to define the boundaries between normal and obsessional jealousy by utilizing a specific self-report questionnaire. Methods: The so-called “Questionnaire of Affective Relationships (QAR)” was administered to 400 university students of both sexes, as well as to 14 outpatients affected by obsessive-compulsive disorder (OCD). The total scores and the responses to each of the 30 items were analyzed and compared. Results: Two hundred and forty-five (approximately 61 %) of the questionnaires given to the students were returned. Statistical analyses revealed that the OCD patients had higher total scores than the healthy students. Moreover, it is possible to identify an intermediate group of subjects, consisting of 10 % of the total, who exhibited thoughts of jealousy regarding their partner, but to a lesser degree than the OCD patients. These were labeled as “healthy jealous subjects” because no other psychopathological trait could be observed. in addition, significant intergroup differences in single items were observed.
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Conclusion: The present study showed that in the population of university students, 10 % of the subjects, although normal, had excessive jealous thoughts regarding their partner. In fact, this clearly distinguishes these subjects from the OCD patients and from the healthy subjects with no jealousy concerns by means of the specific questionnaire developed by us. Probably, they represent a subgroup of jealous , albeit normal, subjects. Chapter 13 - Background: Different studies have suggested that some neurotransmitters may play a role in the expression of jealousy. This study utilized the specific binding of 3Hparoxetine (3H-Par) as a peripheral tool to explore the serotonergic system in platelets of healthy subjects with and without jealousy concerns. Methods: Twenty-one subjects with thoughts of jealousy and 21 subjects without jealousy concerns, as revealed by their score at a specific questionnaire (“Questionnaire of Affective Relationships”, QAR), were included in the study. Subjects in the first group were administered a battery of self-report instruments designed to detect the presence of subthreshold psychopathology. The binding of 3H-Par was carried according to a standardized protocol. Results: The results showed a reduced density of 3H-Par binding in the “jealous” subjects, as compared with the “non-jealous” subjects. In addition, most of the subjects of the first group had one or moresubthreshold psychopathological conditions. Conclusion: In conclusion, jealousy may be considered an expression of subtle forms of psychopathology, and may provoke an alteration of the serotonergic system, as reflected by the lower density of the platelet serotonin transporter. Chapter 14 - Interdependence, a central feature of close relationships, presents contemporary scholars with theoretical and statistical challenges. Dyadic and social network analytic techniques have recently been formulated that offer several advantages over previous statistical methods by accounting for various forms of interdependence for longitudinal data collected from both relationship partners. Two of these methods are described: the ActorPartner Interdependence Model (APIM: Kenny, Kashy, & Cook, 2006) and actor-based models of network-behavioral dynamics (Snijders, Steglich, & Schweinberger, 2007). The APIM partitions variance into estimates of behavioral stability of both dyad members (actor effects), and interpersonal influence (partner effects), while adjusting for initial behavioral similarity between partners. The actor-based models describe dyadic relationships as embedded within a multitude of interconnected dyadic relationships (i.e., social networks). These dynamic models utilize computer simulations to partition variance into parameters that ascribe similarity based on network, dyadic and individual behavioral attributes. To illustrate the applicability of both methods, empirical examples from recent work using these models techniques are described. Chapter 15 - Although a common goal for parents is to promote their children’s successful development in a respective society, there is considerable cross-cultural variation in the beliefs parents hold about children, families, and themselves as parents. Previous research suggests that in traditional rural areas across the world, parents highly appreciate interrelatedness in their conceptions of relationships and competence, whereas in urban settings of Western industrialized societies, parents seem to promote independent parent– child relationships from early on. The main purpose of this study is to compare conceptions of parenting and mother-infant interactions in two cultural contexts that may be expected to hold different beliefs about parent-child relationships: Nicaraguan farmer families and middleclass Italian families. Fifty-six mothers from central Nicaragua (n = 26) and northern Italy (n
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= 30) and their infants aged 0-14 months participated in the study. Mothers were interviewed regarding their childrearing beliefs and behaviors, and were videotaped interacting with their infants during a free play session. Maternal responses were qualitatively analyzed using a thematic approach; maternal behaviors were coded into one of the following categories: social play, object play, motor stimulation, verbal stimulation, and face-to-face interaction. Findings indicated that: 1) Nicaraguan mothers emphasized interdependence and connectedness to other people in their socialization goals, whereas Italian mothers placed greater focus on childrearing strategies consistent with a more individualistic orientation; 2) Nicaraguan mothers exhibited a higher overall frequency of behaviors related to motor stimulation and face-to-face interaction, whereas Italian mothers were more likely to engage in social play, object play, and to emit a greater overall number of verbal behaviors towards their infants during the free-play session. The results suggest that parents’ conceptions of childcare reflect culturally regulated norms and customs that are instantiated in parental behavior and contribute to the structuring of parent-child interactions from the earliest months of life, thus shaping developmental pathways of infants and children. Implications for theory on the psychology of relationships as well as for clinical practice are discussed. Chapter 16 - During adolescence, peer relationships and friendships are relevant contexts for cognitive and social development [Bukowski, Newcomb and Hartup, 1996] and for future adult adjustment [Hartup and Stevens, 1999]. It is also known that people, and particularly adolescents, by way of narration and autobiographic construction, can define and attribute meaning to their self and their relationships with others. Bruner and colleagues [Amsterdam and Bruner, 2000; Bruner, 2002] pointed out that individuals construct stories to attribute meaning and order to daily life events. By narrating one’s own story it is possible to organise episodic memory, to shape the recollection of events, and to build reality [Smorti and Pagnucci, 2003]. Specifically in friendship relationships, narrative autobiographic experiences represent specific interpretative modalities used by adolescents to give meaning to the self and the others within these relationships. In this study, which is based on adolescent narrations, adolescent leisure-time behaviour in the company of friends, specifically on Saturday afternoons was explored. This study is also interested in identifying the self markers [Bruner, 1986; 1997], by which adolescents perceive themselves and others, and attribute meaning to their own experiences. Finally, investigating the relationship between the Self markers and some indicators of well-being (e.g. positive self-perception and expectations of success), social self-efficacy, adulthood (e.g. value of autonomy), and discomfort (e.g. feelings and sense of alienation). Participants included thirty adolescents (11 girls and 19 boys) aged 14 to 20 years (M= 15.8; D.S.= 1.4) attending two different types of high school (43% lyceum, 57% technical and vocational) in the northwest of Italy. The adolescents were asked to write a essay on the subject: “It’s Saturday…I’m going out with my friends”. The essays were analysed using thematic analysis of content as well as Bruner’s [1986; 1997] system of self markers. The following profiles summarise the findings. Most of the adolescents go out on Saturday and they have fun, talk, share convivial activities and sometimes also illegal activities (particularly boys) with their friends. Adolescents use frequently especially the Self markers of Agency (97%), Commitment (87%), Coherence (80%) and Social references (83%). Girls use the subjective aspects of Self markers, such as Qualia and Evaluation on the bases of expectations, more frequently than boys. Older adolescents use Agency and Resources more frequently than younger adolescents. Finally,
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Resources and Evaluation are related to positive self-perception and Social references is linked to Social self efficacy. This study has some limitations, such as the limited number of participants and the specificity of the essay, which make it impossible to generalise these findings to adolescent social life. Nevertheless, the findings can contribute to a better understanding of the meaning that peers and friends assume in adolescence. Chapter 17 - A psycho-educational program for advancing children’s coping skills and reactions to marital conflict was evaluated. Families with a child between the ages of 4 and 8 were randomly assigned to one of three groups: 1) parent program only; 2) parent and child program; or 3) self-study (control group). Parents in the parent-only and parent-child groups received the same psycho-educational program. Only children in the parent-child group received the child program which consisted of four visits in which children learned about marital conflict and family relationships; were taught about emotions and different levels of emotions; and were given tools for coping with conflict that would help them react in optimal ways for their development. Analyses suggested the promise of a child program for older children (ages 6-8) with regard to improved emotional security about marital conflict. However, consistent with other research, simply educating children about coping with marital conflict had minimal effects on outcomes associated with conflict between the parents. Chapter 18 - The mother infant bond has long been recognized as being crucial in multiple areas of infant development. The value that is placed on this relationship is recognized across the world and across groups of varying socioeconomic status. The multitudes of variables that are thought to be influenced by the mother infant relationship are impressive, even staggering. Research suggests that, depending on the level of bonding or lack thereof, infants may suffer outcomes as severe as irreversible neuropsychological deficits or development of long-standing psychopathology. However, others have argued that the effects are likely much more subtle, but certainly still important. During the last two decades there has been an increase in research focusing on the effects of maternal depression on the mother infant bond. Research in this field has apparently developed out of; a recognition of a relatively higher prevalence of postpartum maternal depression than once believed and recurring observations of differences in mother/infant relationships or infant behavior associated with maternal postpartum depression. The infant behaviors that have been implicated as resulting from this theoretically compromised mother infant relationship have included slight, transient effects on sociability and affective sharing to results suggesting significant increases in irritability, cognitive delays, behavioral problems, and difficulties with attachment, among others. Longitudinal data suggest that while some problems appear to resolve relatively quickly, there are some characteristics that endure long after infancy. Specifically, some researchers have argued that children and even adolescents who experienced problems bonding with their depressed mothers are at significantly greater risk of experiencing a variety of psychological symptoms, including depression, anxiety, and problems with addiction. Again, this view is controversial and others in the field link these increased risks to other factors such as low socioeconomic status or marital discord. While there appears to be consensus among most researchers in recognizing that there are likely effects of postpartum depression on mother infant bonding that affect early development, there is little consensus regarding the specific details of these effects. This review will systematically analyze research focusing on the effects of postpartum depression on the mother infant bond and those variables that are believed to be affected from potential difficulties in this bond.
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Chapter 19 - Over 70,000 individuals in the United States are diagnosed with sickle cell disease, yet relatively little attention has been paid to this group when compared to those diagnosed with other chronic illnesses such as asthma, cystic fibrosis, diabetes, or cancer. Like most major chronic illnesses, sickle cell disease influences familial and social relationships in numerous and ever-changing ways. Advances in sickle cell disease treatments and improved survival rates have resulted in dramatic shifts in relationship networks and psychosocial adaption for each child diagnosed. Several primary areas of concern have been identified for children and families facing sickle cell disease such as disruptions to educational and socialization processes, sudden changes in medical conditions including the persistent threat of pain crises, existential anxieties about death, the wide range of emotions that are often present in managing with the various stages of the disease and treatment, the overarching developmental trajectory of the child, and coping with having a serious illness or caring for a child with a serious illness. Literature has cited and research continues to find evidence of challenges faced by these children and adolescents including ways in which family functioning, social acceptance by peers, interactions with siblings, parenting style used in the home, and daily anxieties and pressures can play integrated roles in shaping life-long relationships and overall quality of life. Because sickle cell disease predominantly affects minority groups within the United States, families and medical professionals also must consider the cultural needs of each patient in order to promote best practices for treatment and the development of sustained, healthy relationships. While these noted challenges tend to be constant foci for all concerned with caring for and working to develop optimal relationships among individuals diagnosed with sickle cell disease, many individuals and families coping with a sickle cell disease diagnosis seem to function quite well when adaptive coping and supportive networks are present and persistent. This chapter will investigate how the many relationships that exist within the social context of a child’s world are impacted by sickle cell disease. An overview will be provided examining dynamics between parents, the children diagnosed with sickle cell disease, and their peers and siblings in terms of the challenges faced and the relationship strengths displayed. Cultural influences and means of improving life-long relationships will be explored. Lastly, currently implemented interventions promoting positive relationships will be discussed as well as future directions for research and intervention studies. Chapter 20 - Research into bullying amomg children has suggested that parents can play an important role in reducing the risk of their children becoming involved in bully/victim problems at achool .and can take steps to enable their children to cope more effectively (Smith and Myron-Wilson, 1998; Stelios, 2008; Rigby 2008). At the same time, it should be acknowledged that parental influence is limited by such factors as their child’s genetic endowment (Ball et al., 2008) peer pressure at school and unpredictable life events. (Harris, 1998). What parents can do to reduce the risk or impact of bullying on children can be considered under these headings: 1) Early childhood parenting 2) Parenting style with older children 3) Parents promoting skills that are helpful in reducing the risk of 4) Parents assisting children who are being bullied at school 5) Parents providing emotional and social support when children are bullied
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Chapter 21 - Social bonding development is fundamental for several animals, particularly for humans who are the most immature at birth, for its relevant impact upon survival and reproduction. Several neural and endocrine factors, most of which are still largely unknown, may modulate reproductive behaviors, mother-infant attachment and adult-adult bonding. Consequently, the aimed to review the neurobiological correlates of attachment in both animals and humans. MEDLINE and Pub-Med (1970-2008) databases were searched for English language articles using the keywords attachment, neuropeptides, neurotrophins, pair bonding, social behavior. Papers were reviewed that addressed the following aspects of attachment neurobiology: 1) Infant-mother attachment; 2) Mother-infant attachment; 3) Adult-adult pair bonding formation; 4) Human bonding. Oxytocin and vasopressin, two neurohypophyseal peptides, are known to be involved in the attachment process. Oxytocin is supposed to facilitate a rapid conditioned association to maternal odor cues, while linking environmental cues to the infant's memory of the mother. While oxytocin plays a role in the onset of maternal behavior in rats, vasopressin seems to influence paternal behavior in praire voles. Parental behavior development requires also gonadal steroids action. In adults, oxytocin and vasopressin may contribute to pair bonding process by modulating the neuroendocrine response, behaviors and emotions associated to preference formation and pair bonding. Recently, even neurotrophins have been suggested to play a role in social bonding. In conclusion, although the neurobiological basis of social attachment is mainly based on animal data, preliminary findings suggest that the same mechanisms may occur also in humans and would involve multi-sensory processing, complex motor responses and cognitive functions, such as attention, memory, recognition and motivation. The few data available in humans are intriguing and seem to open even more exciting perspectives to the treatment of a broad range of neuropsychiatric disorders. Chapter 22 – It is known that some social interactions begin and end cooperatively, while others start aggressively and end up even more so. It is also known that in some social interactions one of the partners might initially behave either cooperatively or competitively and aggressively towards the other partner, who may respond with the opposite type of behavior. However, over time, as the relationship evolves, behavioral patterns may change as each partner adapts to the behavior of the other. As social interactions evolve over time, it is possible to identify two phases: first, a reciprocal exploration phase, and second, an adjustment phase. Investigating very short term social interaction sequences of about ten minutes, concluded that these two phases last about five minutes each. The present study investigates the relationships between cooperative and non-cooperative or competitive behavior in pairs of children in the ongoing process of interaction during a tenminute play sequence. To reach the goal, it was necessary to first divide the time of the play sequence (10’) in two phases and looked at the differences between the first and second phase (5’ each). Second, divide the pairs of children in three groups: i) initially high in cooperation; ii) initially high in competition; iii) initially high in both. Third, look at the outcomes using both linear and logistic regression analyses. Hypothesised that: a) initially prevalent cooperative behavior is more likely to end in cooperation; b) initially prevalent competitive behavior is more likely to end in competition; c) initially mixed social interactions (both cooperative and competitive) are more likely to end in abandonment of the interaction and doing nothing.
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The sample is composed of 125 pairs of children. 69% (N=86) of the pairs were composed of same-sex children, while the remaining 31% (N=39) were mixed. The individuals within each pair were the same age. 35% of the pairs (N =44) were eight years old, 38% (N =48) were ten years old, and 27% (N=33) were twelve years old. The cooperative and competitive behavior of both the partners were observed.. The task was to finish a puzzle in ten minutes. The findings confirmed only the first two hypotheses. It was found that initially mixed situations were also more likely to end in cooperation. These findings underline the importance of intervention programs aimed at promoting social and cooperative skills in children to avoid starting negative social cycles or patterns. Chapter 23 - When asked, “What is necessary for your happiness?” or “What is it that makes your life meaningful?” most people mention before anything else-- satisfying close relationships with family, friends, or romantic partners. Relationships with others form a pervasive role in our everyday lives and are generally regarded as emotionally satisfying. Although it may not be surprising that social relationships are associated psychological benefits, there is also evidence to suggest that these relationships have beneficial effects on physical health and/or the lack of meaningful relationships may be detrimental. In fact, reviews of the literature indicate that a lack of meaningful relationships is associated with increased risk for morbidity and mortality from a variety of causes. Importantly, both the quantity and quality of social relationship can affect health and mortality. Overall, research suggests that having more and better quality relationships is associated with beneficial effects on health, while fewer and negative relationships are associated with detrimental effects on health. Therefore, a complete understanding of health-related consequences of social relationships requires simultaneous consideration of both the negative and the positive aspects of social experience. In this chapter, the health consequences of social relationships will be examined. This chapter will proceed by first, reviewing definitions of social support; second, a brief review of the substantial body of evidence that has linked social relationships with health benefits will be provided; third, the chapter will also include a brief review of the evidence showing the negative side of relationships (e.g., negativity and conflict within relationships is associated with negative health outcomes); and finally, the bulk of the chapter will focus on a relatively newer line of research that examines relationships that are characterized by both positive and negative aspects (ambivalent relationships). Because research has examined the positive and negative aspects of relationships separately, less is known about relationships that are not entirely positive or negative-but a mix of both negative and positive feelings. The remainder of this chapter will (1) define ambivalent relationships and provide theoretical and empirical justification for examination of ambivalent relationships; (2) summarize evidence linking ambivalent relationships to both mental and physical health outcomes; (3) provide evidence regarding maintenance of ambivalent relationships; and (4) propose future research. Thus, this chapter will summarize empirical research on the health impact of social relationships characterized by mixedfeelings (ambivalence). This data on ambivalent relationships will be presented in the context of the larger literature on social relationships and physical health and highlight the need for new directions in social relationships research. Chapter 24 - A high percentage of Turkish and Moroccan male adolescents in the Netherlands is sexually active. At the same time, they frequently engage in risky sexual
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behavior, which makes them vulnerable to HIV/STDs infection. To be able to design culturally appropriate health promoting interventions, more knowledge about the factors that influence their sexual behavior is needed. Therefore, this paper reports on a qualitative study that aims to increase our understanding of the influences on Turkish and Moroccan adolescent male sexuality within a broader interest in HIV/STD prevention. Seven focus groups with 29 Moroccan and 20 Turkish boys, aged between 14 and 18 years, were conducted. Analysis of the data highlighted several factors that may hinder condom use, such as lack of knowledge, lack of perceived risk, peer norms, lack of parent-adolescent communication about sexuality, and lack of self-efficacy toward buying condoms. Results also show some significant differences between the Turkish and Moroccan adolescents. Turkish adolescents are more conservative toward sexuality, they stick more strongly to cultural traditions and they have less knowledge about HIV/STDs than Moroccan adolescents. Moroccan adolescents experiment more frequently with sex. Therefore, they may be at higher risk of getting infected with HIV/STDs. The findings of this study provide a fertile starting point for designing culturally appropriate and effective health education programs in the field of safe sex promotion for ethnic minority adolescents. Chapter 25 - In Mexico, HIV/AIDS is a complex public health issue that carries significant psychosocial, socio-political, and economic repercussions. Adolescence is a period of development that not only encompasses physical and social changes, but also psychological. Adolescents engaging in unprotected sexual activities during this stage of development are at risk of contracting HIV infections. This paper posits that the Theory of Planned behavior has shown to be helpful in guiding research in HIV/AIDS prevention, but remains limited in the inclusion of ecological influences. Hence, this limitation is addressed using the Ecodevelopmental Theory. Therefore, this paper aims to develop a model based on the Theory of Planned Behavior and the Ecodevelopmental Theory that will explain HIV/AIDS prevention within the context of Mexican adolescents using concepts from both theories and the empirical evidence available. Three types of influences were identified during the process of theory synthesis: a) Interpersonal influences from the microsystem were parent communication about sex and peer influences; b) Individual influences included HIV/AIDS knowledge, gender (female), and age; and c) psychosocial influences consisted of perceived behavioral control for sexual health behaviors, subjective norms (gender roles), positive HIV attitudes, and sexual intentions. Results provide insight into the complex dynamics of the synthesis of the two aforementioned theories with respect to HIV/AIDS prevention. Communication about sex is positively related to sexual health behaviors for HIV/AIDS prevention, being female, and knowledge about HIV/AIDS. Peer influence is negatively correlated with sexual behaviors for HIV/AIDS prevention. It is unclear the relationship of HIV/AIDS knowledge and sexual behaviors and being female. Gender (female) is positively correlated with sexual behaviors and perceived behavioral control, but its relationship is unclear with subjective norms. Age is positively correlated with subjective norms, but negatively correlated with sexual health behaviors. Perceived behavioral control and positive attitudes are positively correlated to intentions and sexual health behaviors. In the case of subjective norms, it was positively correlated with intentions, but not with sexual behaviors. Finally, high intentions to use condoms influence sexual health behaviors. The final model allows for a better understanding of the connections among concepts related to sexual health behaviors in HIV/AIDS prevention. Future research is recommended regarding the unknown associations between gender, knowledge, subjective norms, and attitudes for
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future implementation of preventions programs against this fatal disease in the Mexican Adolescents. Chapter 26 - Adolescence is a difficult in-between age, even in good health, and any kind of illness can alter this situation. Living with a high risk disease for several years during adolescence requires the activation of psychological defense mechanisms, cognitive functions, perception, acceptance, memory, communication, judgment, and emotions, which taken together mean good coping. The successful evolution of the coping process ultimately leads to good quality of life and adaptation. Over the last few years, physicians and clinical psychologists have endeavored to provide a good psychosocial status to their patients, especially those with cancer and those undergoing painful and distressing treatments. This study chose to use the "narrative" approach with sick adolescents, since it would appear to be the most suitable in individual encounters. There is often the need to overcome an important barrier through a friendly approach. Narrative medicine, more than others, lends itself to the intimate knowledge of the person being examined. Listening and talking through a patient/doctor alliance are the first steps towards true psychological healing. Over the last few years this sort of dialogue with adolescent patients was chosen, since they turn to us both seeking the physicians who know them well and a space where they can talk openly. The narrative approach requires time, willingness and an appropriate setting. In addition, the supportive care needs of these youngsters with cancer are often brought up in these encounters and this suggests the extent to which these needs may remain unmet. The dialogue that takes place following the “narrative” approach allows us to obtain detailed personal information and insight into the values and abilities of each subject. Undoubtedly, some psychosocial disorders can be prevented. Nowadays, pediatricians, supported by psychologists and other specialists, can create an alliance with the parents and the sick adolescents in order to adequately face pitfalls that may become the source of disorders in their physical, cognitive, emotional and behavioral development, and especially with regards to post-traumatic stress. Four different situations of adolescents who were either suffering from or who were cured of cancer are reported in detail in this chapter, including information concerning their need for understanding, discrepancy in appearance and insight, crisis in quality of life and the identity process. Chapter 27 - In healthcare, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations. Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue, they will better be able to attune their care to the needs of patients. This is illustrated with the stories of three women with Multiple Sclerosis. Their narratives of identity differ from the narratives that caregivers and others use to understand and identify them. Since identities give rise to normative expectations in all three cases there is a conflict between what the women expect of their caregivers and vice-versa. These stories show that the quality of care, defined as doing the right thing, at the right time, in the right way, for the right person, is dependent on the quality of caring relationships. Chapter 28 - Throughout the history of psychotherapy, clinical theoreticians have evoked various metaphors to depict the therapist-patient relationship. With the advent of attachment
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theory and other advances in developmental psychology in the 1950s and 1960s, a new therapeutic metaphor was born: the caregiver-infant attachment relationship. This metaphor has yielded a number of insights into the process of psychotherapy and the nature of the interactions in which the therapist and patient engage. The first objective of this article is to illuminate both the advantages and disadvantages of using this metaphor to depict the psychology of therapeutic relationships. One distinction between this metaphor and the therapeutic relationship is the state of development of mental structures in the infant versus the patient. Whereas the caregiver is behaving in response to the infant’s emotional cues not contextualized by an interactional history of expectations to guide these cues, the patient enters into a therapeutic relationship with a complex and intricate interactional history of expectations. This asynchrony between the caregiver-infant attachment relationship and the therapist-patient relationship requires the therapist to behave in sometimes noncomplementary ways to challenge and interpret these transferential patterns rather than simply responding to emotional cues, as a caregiver would do. These interactional expectations, typically organized around definable patterns of behavior in the therapeutic relationship, are “often neither conscious and verbalizable nor repressed in the dynamic sense”, and thus pose challenges to traditional psychotherapy models that rely exclusively on symbolization to produce therapeutic change. This new understanding of therapeutic change forces therapists to focus more intensively on their own attitudes and behaviors vis-à-vis the patient as the quintessential instruments of change. Various aspects of the therapeutic relationship, in addition to verbalized interpretations of repressed conflict, have thus come under increased scrutiny. I present an attachment-based pathways model for understanding the interrelations among three relationship-based concepts used in contemporary psychotherapies: working alliance, patient attachment and therapist caregiving, and transference and countertransference. Thus, the second objective of this article is to sensitize therapists and psychotherapy process researchers to the structure and functioning of these interrelated concepts to increase therapeutic effectiveness. Chapter 29 - This study aimed to explore how the affects that result from conflictive social interpersonal relationships influence mental health, as well as to investigate how specific coping styles mediate between these affects and mental health. The Test of Self-Conscious Affect-3 assesses six self-conscious affects, namely guiltproneness, shame-proneness, externalization, detachment, alpha pride, and beta pride. In this study, selected for analysis were the four affects that originated from negative evaluations of the presented scenarios (guilt-proneness, shame-proneness, externalization, and detachment). This study used the Coping Inventory for Stressful Situations for estimating coping style, specifically task-oriented coping, emotion-oriented coping, and avoidance-oriented coping. A structural equation model that makes it possible to explore the causal relationship between self-conscious affects, coping styles, and mental health, was chosen as a statistical technique. Among the 394 Japanese university students who agreed to participate in this study, 298 experienced moderate to severe stressful negative life events during the fourmonth study. Of those 298 respondents, 268 completed every item of the TOSCA-3, the CISS, and the Self-rating Depressive Scale. These 268 were subjected to a structural equation model. Among the four affect categories which occur under stressful situations, only shameproneness directly contributed to a depressive reaction, whereas the other three (guiltproneness, externalization, and detachment) did not. Individuals with shame-proneness tended
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towards an emotional-oriented coping style, but this inhibited task-oriented coping. Guiltproneness induced task-oriented coping and avoidance-oriented coping. Externalization induced task-oriented coping and emotion-oriented coping. Detachment gave rise only to avoidance-oriented coping. Interestingly, among the three coping styles, only task-oriented coping induced a depressive reaction, whereas emotion-oriented coping and avoidanceoriented coping did not. These results were discussed primarily from the psychological perspective but also look briefly at how they might be applied to a clinical setting within psychiatry. Chapter 30 - Throughout history, artists, poets, and writers have been interested in the nature of passionate love, sexual desire, and sexual behavior. In the 1960s, social psychologists and sexologists began the systematic investigation of these complex phenomena. Yet, only recently have neuroscientists and biochemists begun to explore these complex phenomena. In this entry will review what these distinguished theorists and researchers have learned about these processes.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 1
COMMUNICATING EMPATHIES IN INTERPERSONAL RELATIONSHIPS Grace Anderson* and Howard Giles Department of Communication University of California, Santa Barbara, California 93106, USA
ABSTRACT Empathy is a concept that has been widely researched across the social sciences and, more importantly, is commonly used outside of academe as a method “to open-up the channel of communication with the other” (Wikipedia, 2006). Although commonly employed colloquially, empathy is challenging to define explicitly and, hence, we shall need to begin this chapter with some conceptual wood-clearing. Prior definitions reflect the specific contexts in which empathy was measured and studied. For instance, a study measuring empathy as a response to media defines empathy differently than a study that examines empathy as an interpersonal communication construct – and these definitions are not mutually exclusive or disparate. Instead, different definitions are a result of the various dimensions of empathy that researchers choose to highlight as a function of the particular empirical study’s focus. For this reason, many individuals may find empathy easier to enact than to describe its meaning in words. This chapter will examine the major definitional variations of empathy that have developed in research on interpersonal relationships, comparing and contrasting their implications. For instance, one major difference is whether empathy is a stable trait or a changing state; this definitional difference can lead to very different methods of research. We seek to accomplish a more global definition of empathy by discussing the distinct ways in which it has been examined in the past, such as in terms of communicative competence, personal distress, and nonverbal expressions, and incorporating the many dimensions of empathy into a unified source of reference for future research. In so doing, we will discuss how one individual may feel and express empathy and how that empathy may or may not be perceived as such by its recipients. The psychological origins of empathy will be identified and questions regarding motives underlying empathy will be *
Contact: Grace L. Anderson. Department of Communication, University of California, Santa Barbara, Santa Barbara, CA 93106-4020, USA.
[email protected]; Fax: 805-893-7102
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Grace Anderson and Howard Giles raised, including whether it can be used as a form of impression management during social interactions. Empathy has been recognized as an important component of health communication. Research has shown that an empathic person holds more positive attitudes towards healthy behaviors regarding smoking and alcohol consumption (Kalliopuska, 1992). Moreover, an effective health campaign will evoke empathy among its target audience because it evokes greater cognitive and affective processing of the campaign message (Campbell & Babrow, 2004). Empathic communication with people with disabilities (particularly those inflicted by cancer) will be a continuous example used to help us understand the multidimensional implications of empathic communication. Empathy can ease tensions that may occur during this form of interaction and suggestions of appropriate empathic communication will be offered. Finally, a new communication model of the process of empathy will be introduced.
HOW IS EMPATHY CONCEPTUALIZED? Empathy has been recognized as a multidimensional concept, consisting of both cognitive and emotional components (Duan & Hill, 1996). Researchers consider the cognitive component to be characterized as the ability to take another’s perspective in a social encounter (Coke, Batson, & McDavis, 1978; Smith, 2006; Smither, 1977; Wilson & Cantor, 1985). Yet, this distinct form of perspective-taking requires the individual to imagine what the other person is experiencing rather than what the individual him/herself would experience under similar circumstances (Batson, Early, & Salvarani, 1997; Jackson, Brunet, Meltzoff, & Decety, 2006). Bennett (1979) distinguished between the perspective-taking of the self and other by contrasting sympathy and empathy. More specifically, sympathy involves a form of perspective-taking based upon the notion that all individuals perceive a common reality and, therefore, react to stimuli in a similar manner. As a result, an individual will take another’s perspective by envisioning how him/herself will react to circumstances in a uniform reality. Conversely, empathy is based upon the assumption that all individuals experience different realities. As a result, perspective-taking must incorporate the possibility that another individual may react differently to similar circumstances. Ritter (1979) found this differentiation between sympathy and empathy apparent during the maturation of adolescents. More specifically, younger adolescents engage in more generalized perspective-taking strategies, failing to differentiate between the needs of others and the needs of themselves. In comparison, older adolescents engage in more complex perspective-taking because they “simply have a greater range of interpersonal constructs available, particularly those relevant to understanding others’ psychological characteristics, upon which to base communication strategies” (Ritter, 1979, p. 50). Listener-adapted communication was exhibited by older adolescents as a result of their increased communicative strategy repertoire. As a consequence of their interpersonal experience, older adolescents have a greater ability to understand the specific perspective of another. In sum, perspective-taking gives the empathizer knowledge regarding another individual’s affective state, but the communicator must develop an understanding of others’ psyche through accumulated life experiences. The empathizer can understand how others may feel and possibly identify the causes for their emotions. Consequently, this has been labeled
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cognitive empathy. Yet, empathy entails an intimate form of communication that goes beyond cognitive understanding and an empathizer can adopt the emotions of others in order to vicariously feel their sentiments (Smith, 2006; Smither, 1977; Warner, 1997). This second dimension of empathy has been labeled emotional empathy. As an illustration, imagine an empathic person communicating with a young investment banker who smokes cigarettes and has just been diagnosed with lung cancer. Cognitive empathy allows the empathizer to take the specific perspective of the investment banker. Although smoking may be the direct cause of the investment banker’s cancer diagnosis, an empathizer would also realize that such a stressful job with long hours may have driven the banker to use nicotine as a stimulant in order to increase job productivity. As a result, the banker is not directly to blame for his cancer diagnosis and an empathizer realizes that a number of complex factors - in addition to smoking - may have contributed to the presence of cancer in the body. In addition, empathy is emotional because the empathizer also shares in the emotions of the investment banker. The empathizer would be able to vicariously feel the stress of the investment banker’s career and his subsequent anguish because the banker’s future is threatened by a potentially fatal illness. It is the sharing of emotions that makes empathy a unique concept. In order to share an affective state with another individual, some scholars assert that the empathizer must suspend his/her own emotions in order to better feel the emotions of another individual. On the other hand, the empathizer should refrain from complete integration of identity with the other individual (Greenberg & Elliott, 1997; Vanaerschot, 1997; Warner, 1997). In this respect, the empathizer is aware of the other’s emotions yet, retains his/her distinct identity from the other individual. For example, when empathizing with a jealous individual “one does not become jealous himself but merely experiences what it must be like [for the other individual] to feel jealously” (Smither, 1977, p. 257). This identity distinction can help the empathizer validate the other individual’s emotions in relation to his/her own experiences (Bohart & Greenberg, 1997). This disagreement may not have to be resolved immediately. Instead, individuals can possess different forms of empathy depending upon the degree to which they retain a distinct identity. In other words, there is a spectrum of identity suspension. The empathizer can experience complete emotional contagion with another communicator or understand the other communicator’s emotion without intensely experiencing the specific emotions him/herself. This may vary as a function of communication context, the communicator’s ability to take the other’s perspective, and/or distracting communicative noise. But as yet, this phenomenon needs empirical examination. Some researchers have clarified the debate over identity suspension by further subdividing emotional empathy into emotional contagion and empathic concern (Stiff, Dillard, Somera, Kim, & Sleight, 1988). The former occurs when the empathizer adopts the affective state of the other individual, as discussed previously. The latter can be characterized as a general concern and regard for the welfare of others. Empathizers who experience empathic concern will exhibit prosocial behaviors, such as helping and communicative responsiveness, because they are motivated by a concern for the other’s welfare. However, empathizers who also experience emotional contagion will vicariously feel the other’s distress and become less communicatively responsive. They are egotistically motivated to reduce their own unpleasant feelings instead of comforting the distressed other. Taken together, empathic concern is positively associated with emotional contagion such that empathizers must first feel concerned for the other’s welfare in order to vicariously feel the other’s emotions. These
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findings suggest that empathizers should suspend their identities from complete integration with the other individual in order to behave altruistically. But, complete identity suspension during empathy may deny the empathizer the more visceral experiences of empathy which may be more intrinsically and extrinsically rewarding (for an intercultural perspective on empathy, see Arnett & Nakagawa, 1983; Broome, 1991; & DeTurk, 2001). Empathy, therefore, has been conceptualized as a multidimensional concept that consists of two forms of empathy with corresponding functions. Cognitive empathy describes the perspective-taking function that enables the empathizer to understand and anticipate the thoughts, reactions, urges of the recipient of empathic communication. This allows the empathizer to best tailor a message specifically towards the recipient and consequently communicate a message that empathically incorporates the recipient’s specific needs. The second form of empathy is emotional empathy. This form of empathy serves the function of emotional sharing where the empathizer can feel the emotions of the other individual. This function validates another’s emotions because they are justified by an empathizer who legitimately feels similar emotions as result of their communicative interaction. When combined, the two functions of empathy leads the recipient of empathic communication to feel increased perceived support and personal control as a consequence of such an interactive experience (Williams, Giles, Coupland, Dalby, & Manasse, 1990). Future research could illuminate exactly how such a communicative context is created and maintained by the empathizer. Ritter (1979) found that the general ability to take another’s perspective develops as an individual matures and gains life experiences to become knowledgeable about the possible perspectives of another (see section below for further elaboration). It would be interesting to discover which immediate contextual circumstances alter this perspective-taking ability. What is the degree to which perspective-taking ability can be weakened by contextual noise? Additionally, empirical analysis could study the degree to which individuals suspend their identity when sharing emotions during empathic communication with another individual. Which kind of empathizer retains a distinct identity when sharing in the emotions of another individual? Is there a difference between these empathizers and other empathizers that completely integrate their identities with other individuals when sharing in their emotions? This could be related to the attributions the empathizer assigns to the other individual and his/her distress. For instance, an empathizer may empathize with a speaker who has acquired lung cancer. However, the empathizer does not fully integrate his/her identity with the other when sharing the in the other’s emotions, because the empathizer feels that the other is partially to blame for contracting lung cancer as a result of heavy smoking. The degree to which a communicator suspends his/her own identity when sharing in another’s emotions may be a way in which communicators can vary the degree of empathy they communicate. In the next section, we will discuss variation in empathic communication in more depth and related methodological considerations.
EMPATHY: TRAIT VERSUS STATE Variation in empathy is most pronounced when it is defined as an emotional state. In this case, an individual’s empathy fluctuates as a function of differing social interactions and their level of respect for and affiliation with another (Duan & Hill, 1996). For instance, a single
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individual can experience varying degrees of empathy, depending upon how the context evokes empathy. Conversely, empathy can be considered similar to a personality trait whereby empathy is tantamount to a stable ability that an individual develops through maturation (Smither, 1977; Wilson & Cantor, 1985). In this case, trait empathy varies from individual to individual as some have greater capacity to empathize compared to others. The investigation of trait empathy would lend itself well to a between-subjects design where personality differences between individuals could be observed. On the other hand, investigation of state empathy lends itself to a within-subjects design where changes in empathy could be observed within the individual as context changes. Methodological difference between state empathy and trait empathy can be demonstrated by considering the degree of identity suspension during emotional empathy. For instance, one individual may experience complete emotional contagion while other empathizers may maintain a distinct identity. In this way, there are inter-individual differences of identity suspension during emotional empathy (Duan & Hill, 1996). Imagine a young child in day care who observes another child start to cry and, as a result, the initial child offers his/her security blanket as solace. However, observing another peer in distress proves to be too overwhelming and this child starts to cry as well. In comparison, an older adolescent may have a better sense of personal identity and, consequently, suspends his/her identity during empathic communication. This exemplifies that emotional contagion differs between individuals as a function of developmental ability. In addition, one individual may experience varying degrees of identity suspension during emotional empathy. In this case, empathy is a fluctuating state where a single individual may experience different forms of empathy over a relatively short period of time (Duan & Hill, 1996). For instance, picture a female teenager waiting by the telephone for a call from her love interest. Her little brother approaches her seeking attention because he has cut his finger while playing and wants comfort. The sister acknowledges her brother’s hurt finger, covers it with a Band-Aid and tells him to play with more caution. The telephone rings and the teenager excitedly greets her love interest on the other end, but swoons when the love interest informs her that he has injured himself during a touch football game. Her response over the telephone is emotional and she feels weak at the knees. The same individual has exhibited fluctuating state empathy as a consequence of a change in context. In this case, a change of interactants during empathic communication causes the individual’s state empathy to vary. It is important to remember that each empathizer exhibits both trait empathy and state empathy, as in Figure 1. Each individual has a general empathic ability (trait empathy) that is a function of their life experiences and cognitive complexity. Yet each individual experiences variations of empathy (state empathy) that fluctuates around their general empathic ability level (trait empathy) as a consequence of context and other temporary situational variables (Duan & Hill, 1996). Individuals’ state empathy fluctuates around their general ability level of trait empathy.
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Figure 1. Model exhibiting the inter-individual differences of trait empathy in addition to the intraindividual and inter-individual differences of state empathy.
As above, it may be useful to measure trait empathy with a between-subjects design and state empathy with a within-subjects design, but this may not always be the case. Sometimes it may be useful to measure state empathy with a between-subjects design when the frequency of and size of fluctuations around each individual’s trait empathy differs between individuals. For example, some individuals may experience more rapid fluctuations of state empathy in comparison to others and/or they may experience greater extremes of empathy as their state empathy fluctuates dramatically from their general trait empathy level. This may be the case when an individual is more behaviorally sensitive to contextual cues and, consequently, experiences greater fluctuations of state empathy more frequently than other individuals who may be better able to ignore contextual distractions or communicative noise. In this manner, state empathy varies on an inter- as well as intra-individual basis. Additionally, trait empathy may be measured with a within-subjects design if one were interested in investigating how life-altering events may influence an individual’s general empathy level overall. For instance, experiencing the death of a loved one may boost an individual’s trait empathy to a higher level by gaining the experiential knowledge of that event so that perspective-taking is easier to enact when empathizing with others also experiencing devastating life events. In sum, the difference between state empathy and trait empathy lies in the manner in which empathy is conceptualized. Research that treats empathy as a state is concerned with the manner in which individuals empathically respond to specific stimuli that evoke empathy. In this way, state empathy is usually considered an outcome variable where individuals react to contextual cues. On the other hand, research examining trait empathy focuses on the maturational or experiential differences between individuals and how this affects their stable empathic patterns. In this case, trait empathy is generally treated as a pre-existing variable where individuals respond to particular stimuli as a function of their previous experiences and maturity.
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A DEVELOPMENTAL PERSPECTIVE ON EMPATHY A developmental perspective on empathy considers it an artifact of an individual’s maturity. Empathy is developed as one gains life experiences with which to use as cognitive reference tools when taking the other’s perspective during communicative interactions. In other words, an empathic individual must first understand his/her own identity to use as a reference with which to compare to another’s identity (Smither, 1977). In fact, the components of empathy may be evolutionary in nature. Perspective-taking may have evolved as a result of a complex social environment in which individuals must predict the behaviors of others in order to manipulate social circumstances to their advantage. In addition, emotional sharing may have evolved in order for individuals to facilitate group cohesion, such as kin and sexual selections (Smith, 2006). Not only is empathy a construct that has evolved with the growth of general society, but empathy and perspective-taking, in particular, are skills that develop as one matures (Ritter, 1979). Wilson and Cantor (1985) measured the self-reports and physiological responses of children of differing ages to television programming and found that younger children became less emotionally aroused by a television character’s fear than older children who experienced the same treatment. Wilson and Cantor believe that the lack of empathy exhibited by the younger children did not result from a failure to recognize the nature of the character’s emotion, but a failure to take the character’s perspective when compared to older children. Conflicting research, however, suggests that children as young as preschoolers exhibit affective perspective-taking towards each other in the sense that they infer each others’ feelings in a non-egocentric manner and engage in cognitive perspective-taking (Denham, 1986). In addition, there is evidence that perspective-taking abilities can be fostered among relatively young children by allowing them to work cooperatively together. Bridgeman (1981) found that fifth grade students when learning in a cooperative peer-initiated classroom environment engaged in increased role-taking when compared to fifth grade students in a more formal teacher-centered classroom and other innovative classroom environments. She concludes that role-taking is critical to the development of a child’s conscious self as described by George Herbert Mead. An individual’s identity can only be conceived in relation to others. The important conclusion to be drawn from this contrary evidence of younger children regards the peer interactivity of these methodological designs. Young children are able to relate to other children of similar age in a manner that best fosters an environment for the acquisition of empathic skills. It seems as though interactions among young peers stimulates empathic behaviors at an earlier age than would unfettered maturation. In addition, this peer interactivity has been found to increase empathy among older children (fourth and fifth graders) with below age norm performance on empathy, in the absence of explicit training (Silvern et. al., 1979). It would seem that peers can teach each other empathic behaviors in the place of trained professionals when another peer needs to be caught-up to an age-appropriate empathic skill level. Empirical research that takes a developmental perspective on empathy tends to treat empathy as a stable trait of research participants. Less research has been conducted that measures empathy as a fluctuating dispositional state. Yet, dispositional state empathy suggests that “empathic disposition can be trained” and, therefore, raises important empirical questions for future research (Greif & Hogan, 1973, p. 284). This implies that state empathy
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and trait empathy are not mutually exclusive. Over time, state empathy can become less variable and more stable with the recurrence of a certain context and emotional state and, accordingly, more closely resemble trait empathy. As a certain form of state empathy becomes engrained into an individual’s normal behavioral patterns, this particular form of empathy becomes trait empathy. Previous research has examined this process by measuring children’s state empathy as a function of the common environment of television viewing. Zillmann and Cantor (1977) measured children’s dispositional reactions to a television character’s emotions. This study, however, did not fully support empathy as the impetus for the children’s reaction to the television character. Instead, these researchers found state empathy to be a partial mediator in the relationship between a television show and children’s reactions to the programming. When the television character behaved benevolently and neutrally, the children’s affective responses conformed to the character’s emotional reaction. When the benevolent character expressed triumph, the children also responded with triumph. Alternatively, when the character behaved malevolently the children’s affective responses were discordant with the character’s emotional reaction. When the malevolent character expressed triumph, the children may express disappointment. In this case, the children could not have behaved empathically because they would have conformed to the malevolent character’s emotions as well. Instead, Zillmann and Cantor concluded that children’s affective reactions conformed when they held positive sentiments towards the television character and exhibited discordant affective reactions when they had negative sentiments towards the television character. This is also known as the affective-dispositional rationale. This study demonstrates that state empathy has precursors during interpersonal interactions. In this case, children only exhibit state empathy when positive sentiment is felt for the target individual. This behavior will be cultivated as these children mature and continue to view television as a common pastime. State empathy towards well-liked characters becomes less variable and more established as a trait form of empathy. In addition, this empathic reaction to television characters may also become a reaction to target individuals in reality according to the cultivation hypothesis. More specifically, there may be precursors to empathy towards people with disabilities and the disease of cancer. Will the affective-dispositional rationale be supported among research subjects empathizing with a target individual diagnosed with cancer? This implies that individuals would only express empathy towards another with cancer if the individual harbors positive sentiment towards the latter. This requires that the two individuals have a personal relationship where positive sentiment has been developed and harbored between them. Consequently, the affective-dispositional rationale may only be a fragment of the entire picture because empathy can be expressed between individuals who do not have a close personal relationship with each other. What if a personal relationship has not developed? An important factor to consider would be the attributions an individual assigns without much personal knowledge about the interactant. For example, different attributions are typically assigned to individuals with lung cancer when compared to individuals with leukemia. Individuals may assign blame and believe that an adult with lung cancer caused this infliction to occur to him/herself when compared to an individual with a type of cancer that is less preventable, such as leukemia. This train of thought is supported by previous research where it was found that “cancer patients held less firm convictions about causative factors in the etiology of cancer than did
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non-cancer patients” (Linn et al., 1982, p. 838). The researchers suggest that cancer patients are not necessarily avoiding reality, instead they are more aware of the complexities of the disease and its multitude of possible causes. Individuals without cancer, however, are not so acutely aware of the disease and its causes and, consequently, use heuristics in order to assign attributions to the cancer patient. The assignment of attributions is not contingent upon a personal relationship between the individuals. In addition, the assignment of attributions is more commonplace during everyday communication and may serve as a more universal and explanatory precursor to the expression of empathy towards individuals with cancer. The predictive influence of attributions can be investigated by measuring empathic reactions to individuals with diverse forms of cancer diagnoses. Different cancer diagnoses may affect the empathic reactions individuals with cancer receive from others because attributions influence this relationship.
FROM WHERE DOES EMPATHY COME? Aside from the precursors and the communicative context, empathy is an innately human response to observing another human in distress. This section takes a step back in order to best examine the fundamental derivation of empathy. The field of psychoanalysis considers the origins of empathy to arise from human identity itself. More specifically, individuals each possess a dual identity that consists of an articulate self and an organic self. The articulate self is an individual’s responsible agent with values, goals, and intentions. This is an individual’s conscious identity that is manifested when the individual refers to him/herself as ‘I’. In contrast, the human identity also consists of an organic self, where the interdependence of bodily functions allows for the existence of the articulate self to exist and function (BarrettLennard, 1997). The most fundamental form of empathy is ‘self empathy’ and this occurs when an individual’s organic self and articulate self are in equilibrium. This can be conceived as a form of inner listening where the needs of the organic self are realized by the articulate self (Barrett-Lennard, 1997). Self-empathy can be conceptualized as the articulate self’s recognition of the organic self’s limitations. For instance, an individual may consciously desire to attend a university but may experience health limitations resulting from cancer and the corresponding treatment. The equilibrium of the articulate self with the organic can be represented by the individual’s recognition of the specific implications that cancer will have on his/her academic performance. This equilibrium may be maintained over time if the individual enrolled in a university with a large medical facility where he/she would have more immediately convenient access to treatment. The internal empathic process has been documented in the form of a magnetic resonance imaging experiment (Jackson, Brunet, Meltzoff, & Decety, 2006). Researchers found that respondents activated different portions of their brains when imagining themselves in pain compared to imagining another individual in pain. More specifically, brain activation was restricted to the affective components such as the anterior cingulate cortex, the insula, and the right temporo-parietal region associated with perspective-taking tasks when the research subject was asked to imagine another individual in pain. In comparison, further activation was detected when the research participant was asked to imagine him/herself in pain. The sites of
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the brain already activated by imagining another in pain were accompanied by further activation of the medial prefrontal cortex and the neural circuit, which has been associated with self-identification. The researchers associated the overlapped difference in brain activation to Batson’s (1983) distinction between empathy and personal distress. Empathy may be represented by the perspective-taking and affective activation of the brain when the research subject imagines another in pain. However, the greater activation when research subjects imagining themselves in pain may be an indication of the egocentric characteristic of personal distress. “Focusing on our own thoughts and feelings reduces empathy, whereas focusing on those of distressed Others increases empathy” (Jackson et al., 2006, p. 759). These researchers further speculate that experiencing another’s pain to the same degree as one experiences his/her own pain would result in over-arousal of empathy where every individual’s distress would become distressing to the observer as well. The fact that there is not a complete overlap in brain activity between the self and other conditions suggests support for the above distinction between the articulate and the organic self. The brain activity stimulated by imagining another individual in pain may be an indication of the activation of the articulate self. The research subject is consciously processing the pain of another individual as an outside observer. In comparison, the increased brain activity stimulated by imagining oneself in pain may represent the simultaneous activation of the articulate and the organic self. The research subject can imagine exactly how the pain would feel him/herself through the organic self. In addition, research subjects use their articulate selves to imagine how they would appear to others observing their pain. Problems arise for the individual when the organic and articulate self internally conflict. For example, people with invisible inflictions, such as many forms of cancer in early stages, may appear to be healthy externally, yet are ailing internally. In other words, the organic self is unhealthy, however, the articulate self may seem healthy to other individuals because a person with cancer may function and communicatively appear as a healthy individual. In fact, some people in the early stages of cancer may strive to keep their cancer diagnosis concealed during casual interactions and may experience anxiety as a result. In this manner, a person with cancer is motivated to avoid being labeled as disabled and unhealthy (Harwood & Sparks, 2003; Matthews & Harrington, 2000). Matthews and Harrington (2000) believe, however, that people with cancer may be susceptible to feelings of shame during communicative encounters because these people are aware that they are externally representing a healthy person when they are not internally healthy. In other words, the person with cancer is consciously withholding information regarding their diagnoses during interpersonal interactions in order to maintain group membership in a dominant social group of healthy people. In this respect, shame may increase because there is potential for a negative discovery of the cancer diagnosis. More specifically, shame may increase with time when a person harbors a clandestine cancer diagnosis during relationships with others. Additionally, shame may dramatically amplify when this furtive diagnosis is abruptly discovered by another. In this case, shame can be considered an outcome of a discord between the articulate and organic self when one is not self-empathic. Although empathy is typically considered a behavior that requires the interaction of two or more individuals, the origins of empathy arise from the identity and the self. At the most basic level, an individual empathizes with him/herself when the individual strikes a compromise between his/her organic self and articulate self. This form of intrapersonal
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empathy gives the individual a balanced identity and the foundation with which to feel and express empathy with others in the interpersonal setting.
FELT AND PERCEIVED EMPATHIES Just as there may be inconsistencies between a single individual’s organic and articulate selves, there can be inconsistencies where some may try to communicate empathy, yet the recipient does not interpret their communication as such. Braithwaite and Eckstein (2003) have documented such empathic discrepancies by interviewing people with disabilities regarding their management of instrumental help from other individuals. For instance, a person with a disability may want and/or need assistance, yet the manner in which the assistance is offered and enacted may not respect the needs of the disabled person. The individual’s initial motivation may have been empathic, yet the recipient of the assistance will not likely interpret the help as empathic because it was unwanted or conducted in an inappropriate manner. This suggests that an individual with a disability may seek or need a form of empathy that a healthy individual is unable to enact as a result of a lack of awareness or an inappropriate perspective. Previous research supports this claim by finding that observers’ judgments of individuals’ illnesses are more highly correlated with the actual severity of illness when compared to individuals’ self-rating of their illnesses. Brissette, Leventhal, and Leventhal (2003) conducted a 9-year longitudinal study and attributed the observers’ greater accuracy of illness severity to their reliance on objective manifestations of illness, such as appearance and visible symptoms. In comparison, the individual with the illness harbors more hopeful judgments about themselves stemming from their positive affect and optimism which can cause them to underestimate their own illness severity. This divergence in judgments may be the root of the discrepancy between the observer’s perceived empathy and how that empathy is interpreted by the person with the illness. An observer may empathically offer unwanted assistance because the noticeable symptoms of the illness are compelling to the observer. However, the person with the illness may be too optimistic to believe that such help is necessary and, therefore, the offer of assistance is not perceived as empathic. Not unrelatedly, Williams et al. (1990) argue that the motivation to seek support and or provide support is a consequence of an individual’s personal goals. Accordingly, an inconsistency between an individual’s communicated empathy and how that empathy is perceived by the recipient can be a consequence of conflicting goals. For instance, individuals may express empathic support in order to communicate their altruism. Yet, the recipient of the empathic communication may wish to remain autonomous and not desire support or the manner in which the empathic support was offered violated the recipient’s autonomy. Consistent with the development perspective, empathy may take practice in order to accurately and affectively share in another’s emotions. To facilitate this form of empathy, the empathizer must learn to distinguish the appropriate cues. More specifically, the communicator must perceive and recognize behaviors of the other individual that reveals their internal emotional state. This recognition includes gestures that are intentionally enacted to communicate an internal emotional state and natural expressions which are non-intentional symptoms of the individual’s internal emotional turmoil (Smither, 1977). In this case, a
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discrepancy between felt empathy and perceived empathy would occur if the empathizer does not effectively recognize these emotional manifestations or if the individual seeking empathy does not effectively communicate their emotional gestures to the empathizer. At the very least, both individuals need to recognize the importance of communicating internal emotional states. In order to avoid a discrepancy between felt and perceived empathy, observers should first be confident that they are taking the perspective of the specific target of their empathic efforts. Many times someone with a disability prefers to seek assistance from acquaintances and friends in order to ensure that his/her perspective is in mind (Braithwaite & Eckstein, 2003). However, even family members of cancer patients experience difficulties in this regard (Lobchuk & Vorauer, 2003). This suggests that family members need to be consciously reminded to refrain from taking their own self-oriented viewpoint and take the cancer patient’s instead. Once accomplished, however, the assistance will appeal to the needs of the ill individual, not to the philanthropic needs of the observer. Family members’ difficulty with empathizing and visualizing the needs of another family member diagnosed with cancer may stem from unawareness. The health consequences of cancer and chemotherapy are experiences that many people have not encountered and this may make empathy difficult to effectively enact. Family members of a person with cancer can overcome this difficulty by first acknowledging that the cancer experience is different that their own healthy experiences. This will combat the family members’ tendency to consider their own self-oriented viewpoint as similar to the viewpoint of the individual diagnosed with cancer. In addition, it will help the healthy family member to harbor a more appropriate estimation of the specific perspective of the person with cancer. The second component of empathy, affective contagion, may be difficult as well for family members. They have not likely experienced the emotions and sensations associated with cancer and chemotherapy and, therefore, cannot fully comprehend the discomfort and pain associated with the condition of the actual diagnosis. In this case, it is important to listen attentively to the individual’s requests for help and accomplish exactly what was requested (Braithwaite & Eckstein, 2003). A common mistake family members make when assisting a cancer patient is to foresee and predict assisting duties that the cancer patient may need in the future. For example, family members may commonly help loved ones with cancer by assisting them to the restroom when they are too weak. These family members may believe that they can further assist their loved ones by purchasing and placing a chamber pot next to the bed in order to eliminate the trek to the restroom and the need for assistance. Yet, this chamber pot may represent a loss of autonomy and control for people with cancer. The loved ones with cancer may feel ashamed by the negative associations of the chamber pot and regret asking for assistance from family members. Healthy family members do not always have the specific knowledge regarding the emotions associated with a cancer diagnosis to make such assumptions. Many times people with a disability prefer to ask for assistance before being offered assistance in order to maintain control of their daily routine. In addition, general offers of assistance may be better received than specific suggestions of assistance (Braithwaite & Eckstein, 2003). For example, “May I help you?” is a better offer of assistance than “Do you need help opening the cabinet door?”. The increased specificity of the second offer of assistance may make the person’s disability overly salient. In this way, the observer’s empathy is drawing too much attention towards the individual’s inability to open the cabinet
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door instead of the individual’s personal identity (Merrigan, 2000). Empathy should be exclusively directed towards target individuals’ emotional state instead of characteristics of the target individuals, such as their disabilities or general health conditions. General messages of assistance are better than specific messages because the individual without the disability does not likely have sufficient knowledge to make specific assumptions about the emotional state of the individual with a disability. Hence, the individual without a disability must become comfortable with the emotional uncertainty involved in an interaction with an individual with a disability. The latter will reduce this uncertainty for the individual without the disability by asking for assistance when it is desired and needed. In this case, the individual without the disability can exhibit empathy by recognizing that the perspective of the individual with the disability may be too different for the individual without the disability to accurately imagine on his/her own. “If incompetence, paradoxically, is necessary along the road to competent, enmeshed intercultural relationships [between disabled culture and nondisabled culture], perhaps short-term, local risks in each individual interaction are exchanged for long-term attitudinal change and development” (Merrigan, 2000, p. 233). The Communication Predicament of Disability Model displays communication between cultures and may lend insight to this discussion (Ryan, Bajorek, Beaman, & Anas, 2005). This model is cyclical and describes how non-disabled individuals allow stereotypes to dictate the manner in which they address disabled individuals. The cyclical characteristic of this model demonstrates how stereotypes can be continuously confirmed and stray further and further from reality. In this case, an individual may express empathy in an inappropriate manner because it is stemming from a faulty stereotype that has been internalized. The solution to this predicament empowers the people with disabilities by suggesting that they exhibit selective assertiveness. In this manner, the stereotype may be weakened and the individual with the disability is not labeled as a constant dissenter. Interestingly, experienced empathy discrepancy does not always occur on an interpersonal level. This discrepancy is observable during intrapersonal communication as well. Loewenstein (2005) labels these discrepancies as hot-cold empathy gaps. He believes that individuals can misjudge their own behaviors and tendencies across different affective states. Individuals who are in affectively ‘cold’ states - or are not affectively aroused - will fail to recognize how they will behave when they become affectively aroused or when they are in a ‘hot’ state. For example, an individual who has a benign cancer tumor may wish to undergo surgery in order to remove the tumor. Yet, this individual may regret this decision when he/she is experiencing anxiety directly before the surgery. Conversely, individuals who are experiencing affectively ‘hot’ states may underestimate the influence of their emotional state and overestimate the resolution of their decision. For instance, individuals who have just been diagnosed with life-threatening cancer may feel especially vulnerable and choose to undergo aggressive chemotherapy treatment. Yet, these individuals may come to regret this decision when the side-effects of chemotherapy dramatically reduce their quality of life. In order to combat the effects of hot-cold empathy gaps, individuals must exhibit a presence of mind where individuals may feel affectively hot or cold, yet are able to foresee their emotions when the affective state has changed. To summarize, individuals exhibit helping behaviors stemming from empathic altruism even when the needs of the other are different from the needs of the empathizer (Denham, 1986; Litvack-Miller, McDougall, & Romney, 1997). Empathy springing from good intentions may fall short and not be interpreted reciprocally as empathic by the receiver. This
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problem can be combated by accurate perspective-taking and emotional awareness of the other’s affective state. However, accuracy becomes increasingly difficult when the other individual is experiencing something that empathizers have not experienced themselves, such as cancer and corresponding treatments. In this case, the empathizer must tolerate a level of uncertainty during the preliminary stages of the interaction or relationship in order to allow the other individual to seek the specific empathy or assistance that is truly needed. A “conservative” form of empathic communication is more appropriate when unsure of the correct application of empathy during unfamiliar social encounters.
EMPATHY AS AN IMPRESSION MANAGEMENT TOOL Can a person strategically communicate empathy without actually feeling it? In others words, can an individual express a manufactured or even deceitful version of empathy in order to favorably manipulate an interpersonal relationship? There is evidence that people may avoid feeling empathy when they anticipate that they will be asked to help - and when such helping could be considered costly for the empathizer (Shaw, Batson, & Todd, 1994). But what if the communicator still wants to be perceived as empathic in order to maintain a positive social identity? This is a circumstance where an individual intends to maintain a division between experienced empathy and expressed empathy in order to communicate a form of so-called Machiavellian empathy. This section will discuss how empathy can be used for impression management when the communicators vary in the degree to which they enact perspective-taking and emotional contagion, respectively. Smith (2006) believes that the answer lies in the very conceptualization of empathy. More specifically, all individuals may not have the capacity to enact both components of empathy, perspective-taking and affective sharing. An individual may possess greater perspective-taking abilities and lack the affective ability to share in another’s emotions. This kind of individual may be a skilled manipulator of social circumstances because these individuals will not become overwhelmed with the emotions of others around them. A lack of sensitivity to others’ affective states combined with a skilled sense of others’ perspectives will give these individuals the capacity to manipulate social relationships to their advantage. Yet, this individual’s Machiavellian empathy may incur personal costs, such as social isolation, because others may become aware that they are being manipulated or, intuitively, sense that this manipulator is not sincere. There is evidence that this egocentrism is common because taking another’s perspective does not automatically lead to empathic behaviors. After considering the other’s perspective, individuals will have less egotistic judgments concerning resource allocation and fairness (Epley, Caruso, & Bazerman, 2006). However, these judgments of fairness are not reflected in the behaviors of these individuals. Egotistic or self serving behaviors did not reduce as a consequence as taking the other’s perspective. In this manner, an individual may engage in perspective-taking of the other and realize the fair and just manner in which to treat the other, yet still behave egotistically in order to gain an advantage over another or accomplish a personal goal (as above, see Stiff et al., 1988). On the other hand, Smith (2006) contends that an individual may easily share in another’s emotions, yet neglect to take that person’s perspective. These individuals are likely to be
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easily influenced by empathic emotion and this affective contagion will cause them to have a fluctuating sense of self. In addition, such individuals will neglect to imagine how others perceive their behavior and, therefore, lack the ability to purposely tailor communicative messages. This type of empathic ability, consisting of low perspective-taking and high affective sensitivity, may lend the individual to being susceptible to Machiavellian empathy because they would be captive to the emotional surges of an interpersonal encounter. However, to lack the ability of affective sensitivity or perspective-taking is an extreme condition that would not frequently manifest itself in many individuals. It is more likely that individuals possess both components of empathy and, instead, exhibit moderate fluctuations in both perspective-taking and affective sensitivity in order to adhere to social expectations, as shown in Figures 2 and 3. “One could be empathic (i.e., enter the other’s frame of reference) but then use one’s sense of the other’s experience to manipulate the person” (Mahrer, 1997, p. 168). For example, an individual may momentarily engage in increased perspective-taking in order to gain the approval of another communicator. Or an individual may feign emotional contagion in order to emphasize similarity and affective connection with another. This discussion re-conceptualizes empathy to have a looser definition whereby individuals differentially engage in perspective-taking or emotional contagion for an egocentric advantage during interpersonal relationships. In this manner, empathic communication can differ in degree and intensity such that only the “purest” form of empathy can be communicated when both perspective-taking and emotional contagion are authentically enacted.
Figure 2. Diagram of empathy and impression management.
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Figure 3a. The components of empathy and an individual’s ability to manage another’s impressions of him/herself.
Figure 3b. The components of empathy and an individual’s susceptibility to impression management from another.
Again, the distinction between state and trait empathy is an important one. The individual who lacks the ability to take another’s perspective or share in another’s emotions will exhibit a different form of trait empathy than another who possesses both components of empathy. Conversely, individuals’ who have the capacity to change their perspective-taking and affective sharing abilities in order to match social appropriateness exhibit a fluctuating state empathy that changes within the individual according to specific contexts. Either way, empathy, without compassion, can be dangerously manipulative - and empathy without perspective-taking can be foolhardy (Bohart & Greenberg, 1997). It would be interesting to study variations in perspective-taking and affective sharing abilities using the theoretical framework of communication accommodation theory.
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Following this, individuals would vary the empathy that they express to another in order to explicitly communicate their intergroup attitudes (Gallois, Ogay, & Giles, 2005; Giles, Coupland, & Coupland, 1991; Hecht, Jackson, & Pitts, 2005). For example, communicators that wish to distinguish themselves from a member of an outgroup might underaccommodate their speech style when interacting with them. In terms of empathy, these communicators would take the other’s perspective only to determine their outgroup status, yet neglect to communicate any emotional response that they may or may not feel as a consequence of interacting with the other individual. In other words, the communicators are intentionally withholding their emotional empathy in order to make group boundaries explicit and seemingly impermeable during the interaction. On the other hand, communicators can use empathy to linguistically converge towards another in order to reduce intergroup dissimilarity and soften the emphasis of group boundaries with communication accommodation. In this case, communicators would take the other’s perspective more intensely in order to determine the individual’s group membership and better tailor a message towards the listener. In addition, these communicators would emphasize that they are sharing in the emotions of the other and consequently verbally accentuate emotional similarity. Future research that supports this approach would imply that empathy can be used as an impression management tool during interpersonal interactions when individuals behave vis-à-vis their intergroup beliefs (see Harwood & Giles, 2005).
OPERATIONALIZATIONS OF EMPATHY Empathy may seem difficult to measure, yet previous researchers have already belabored the arduous task of creating operational measures that capture the multidimensional nature of it. Valid and reliable measurement tools, such as the Hogan Empathy Scale (EM) and the Mehrabian and Epstein Questionnaire Measure of Emotional Empathy (QMEE), have been developed and they measure two distinct aspects of empathy (Chlopan, McCain, Carbonell, & Hagen, 1985; Duan & Hill, 1996). Although some research has found both measures to be reliable and valid, the QMEE seems to be measuring vicarious emotional arousal and, possibly, an individual’s general tendency to become emotionally aroused in various contexts. Alternatively, EM more closely measures the perspective-taking component of empathy (Hogan, 1969). But some have questioned its validity because EM has been found to be multidimensional at both the first- and second-order factor levels, suggesting that EM’s subscales are more informative than its composite score (Dillard & Hunter, 1989). “Taken together, these two scales, the QMEE and Hogan’s EM scale measure empathy as the ability (a) to become emotionally aroused to the distress of another and (b) to take the other person’s point of view, in order to have true empathy” (Chlopan et. al., 1985, p. 650). In fact, Davis (1983) has integrated these components of empathy into one scale entitled the Interpersonal Reactivity Scale (IRI). “Rather than treating empathy as a single unipolar construct (i.e., as either cognitive or emotional), the rationale underlying the IRI is that empathy can best be considered as a set of constructs, related in that they all concern responsivity to others but are also clearly discriminable from each other” (Davis, 1983, p. 113). More specifically, the IRI consists of four subscales that each measure perspectivetaking, empathic concern, fantasy, and personal distress. The perspective-taking and empathic
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concern subscales attempt to measure the components of empathy previously discussed. However, Davis also considered fantasy tendencies and personal distress as additional components. Davis’ fantasy subscale measures an individual’s ability to imagine the feelings of fictitious characters in books and movies, for example. Fantasy tendencies are expected to have a positive relationship to an individual’s emotionality. The personal distress subscale measures the egocentric feelings of personal anxiety during interpersonal interactions. The association between empathy and personal distress will be discussed in greater detail in an ensuring section. Davis found a positive correlation between the perspective-taking and the empathic concern subscales which support the previous discussion indicating that perspective-taking and affective contagion are important components of empathy (Coke et al., 1978). In addition, Davis found that the perspective-taking subscale was highly correlated with the EM and the fantasy tendencies and empathic concern subscales were highly correlated with the QMEE. This confirms the claims made by Chlopan et al. regarding the distinct measurements of the EM and the QMEE. In sum, the EM measures the perspective-taking component of empathy and the QMEE measures vicarious emotional arousal in various contexts. In general, the fantasy subscale resembles the empathic concern subscale in that both subscales have a relationship with emotional reactivity and selfless concern. However when compared to the empathic concern scale, the fantasy subscale has a weaker relationship with other-oriented sensitivity and a stronger relationship with verbal intelligence measures (Davis, 1983). Other-oriented sensitivity is integral to the concept of empathy and its weak relationship with the fantasy subscale may indicate that an empathic individual with fantasy tendencies has trouble tailoring a message that incorporates another individual’s specific needs. Overall, research has shown that an individual with fantasy tendencies will react emotionally to another in distress and have selfless concern for the other individual; however this concern may not be communicated with other-oriented sensitivity. In other words, the receiver of the empathic communication may not interpret the message as empathic because it was communicated in an inappropriate manner. The fantasy aspect of empathy has been the target of intriguing investigations in media communication where fantasy involvement (i.e., perspective-taking of fictional characters) has led to some interesting reactions to film (Tamborini, Salomonson, & Bahk, 1993; Tamborini, Stiff, & Heidel, 1990). Davis’ personal distress subscale was important because it exhibited a negative correlation with the EM. This indicates that individuals with high personal distress will be less able to take another’s perspective and, therefore, less likely to feel empathy. In other words, personal distress is an opposite reaction to another in distress and a reaction that is separate and distinct from empathy. This is consistent with the research conducted by Batson, O’Quin, Fultz, and Vanderplas, (1983) where a distinction was invoked between empathy and personal distress as separate reactions to the same stimulus of viewing another individual’s suffering. Personal distress is an egocentric reaction to another’s distress because individuals are focused on their own negative feelings as a consequence of the other’s distress. Empathy, on the other hand, is an altruistic reaction in the sense that the individual’s focus is on the other’s distress. Taken as a whole, these correlations further confirm that researchers are sharpening empathy measures towards increased validity. Smither (1977) offers the researcher a word of caution regarding the measurement of empathy. ‘Pseudo-empathy’ must be controlled for during measurement. More specifically, ‘pseudo-empathy’ is an individual’s normative reactions to another in order to adhere to
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implicit social expectations. “The concern here is an important one: empathy is a response to the particular feeling-states of another individual, and cannot be a response to a generalizedother or to the situation itself” (emphasis in text; p. 258). In order to prevent the measurement of ‘pseudo-empathy,’ the individual or research participant must have information regarding the specific emotions and relational context in which the individual is embedded. Many times individuals respond to a situation in a generic manner because they prefer to be careful and cautious during interpersonal interactions or because they have experienced similar situations in the past. It is important for future research to have poignant stimuli that actually evoke empathy instead of a cautious normative response. Another way to combat the measurement of ‘pseudo-empathy’ would be to confront research participants with unfamiliar situations and individuals during experimental treatments. Consequently, research participants would be forced to specifically scrutinize the current research condition because they do not have a similar past experience to rely upon. However, Duan and Hill (1996) call for a dramatic change in the manner by which empathy is measured. They believe the previous measures of empathy do not adequately evaluate intra-individual fluctuations of empathy (state empathy) and, instead, suggest that an indirect measurement of empathy is superior. These researchers believe a better calculation of the perspective-taking function of empathy would be to measure the attributions that empathizers assign to the behaviors of recipients in addition to the attributions recipients assign to their own behaviors. Empathy has occurred when both the empathizer and the recipient identify the same attributions for the recipient’s behavior. “The validity of the method can be theoretically inferred, because the accuracy of the match [of assigned attributions] should reflect the degree to which one person is taking another’s perspective” (Duan & Hill, 1996, p. 267). Similarly, the emotional contagion function of empathy can be measured by the degree of match between the empathizer’s and the recipient’s emotions or affective state. In sum, the unit of analysis when measuring the perspective-taking component of empathy is attribution congruence and the unit of analysis when measuring the emotional contagion component of empathy is affective congruence. Duan and Hill’s second-order manner of assessing empathy has the benefit of using the empathic recipient’s perspective and emotions as the comparison baseline to which an empathizer must conform in order to exhibit a true form of empathy. In other words, this is a subjective measure of empathy that is more adaptable to personal and contextual differences. This is to be compared to objective measures where an individual’s empathy is compared to a pure and superior form of empathy that independently exists outside of the particular interaction. However, Duan and Hill’s measurement of empathy was intended for counseling psychology and psychotherapy and, consequently, has methodological drawbacks when their conclusions are applied to the empirical context of social science. In order for a match of perspectives and emotions to occur, both an empathizer and a recipient of empathy must be present in a controlled environment in order for researchers to measure their congruence. This limits the measurement of empathy to the experimental setting with at least two interacting research participants. This rules out the measurement of empathy in response to media forms, for example, and limits the possibility of surveys and content analyses of empathic content. In fact, different methods of empathy measurement result in varying associations between empathy and prosocial behavior. For instance, positive associations between empathy and prosocial behavior are strongest when empathy is measured with physiological indices (i.e. heart rate), when similarity is experimentally manipulated, and by self-report measures during
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experimental situations (Eisenberg & Miller, 1987). Interestingly, picture/story procedures measuring empathy among children were not associated with prosocial behavior. This suggests that some methods can better detect altruistic behavior associated with empathic communication than others. A global construct such as empathy needs an amalgamated analysis in order to accurately measure the multidimensional nature of the variable during empirical research. Although pitfalls such as pseudo-empathy have been identified, there are subtle ways to combat these pitfalls during the empirical process that reduce the chances of measuring normative responses instead of empathy. In addition to the methods of measurement identified above, the strength of empirical research investigating empathy lies in the treatment stimuli that in fact evoke empathy from research participants.
RELATED CONSTRUCTS Empathy is an important construct to measure empirically because it primarily leads to positive behaviors, such as assistance and helping behaviors towards others in distress. However, it is important to make a distinction between empathy and other reactions individuals have when observing another in distress. The relationship between empathy and personal distress confirmed by Batson et al. (1983) is one of many findings that purport empathy and personal distress to result in distinct motivations to help another individual. More specifically, empathy motivates an individual to help another out of altruistic desire. On the other hand, personal distress leads to an egocentric form of helping behavior where individuals will help another in order to calm down their own state of mind (Batson, Fultz, & Schoenrade, 1987; Batson et al., 1983; Coke et al., 1978). In sum, both empathy and personal distress can be reactions to the same stimulus of witnessing another individual experiencing distress. However, empathy and personal distress are distinct reactions because they trigger divergent motivations to help. Unfortunately, empathic altruistic desires to help diminish as the cost of helping the other individual increases (Batson et al., 1983). For instance, the treatment of cancer can be financially costly especially when considered at an aggregate level where hospital administrators have to consider the costs and rewards of treating a number of cancer patients without health coverage. On a case-by-case basis, administrators empathize with each cancer patient and their families and are altruistically motivated to help. However, the costs dramatically accrue when all cancer patients without health coverage are considered on a budgetary basis. In this case, the financial costs increase hospital administrators’ personal distress and egotistic concern for their job security because it is their responsibility to adhere to a manageable budget. This egotistic desire will eventually override an empathic administrator’s altruistic motivation to help. The altruistic alternative would sacrifice resources at the cost of the collective good. Hospital funds would be allocated to a few individuals and less total resources would be available for general upkeep of the hospital facilities that would benefit all patients indiscriminately. There is evidence documenting how egotistic and altruistic allocations of resources change as a consequence of empathy. Individuals’ are primarily motivated to benefit oneself and secondarily motivated to allocate resources that benefit their social group as a whole
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(Batson et al., 1995). But if individuals feel empathy for a particular other, then they are motivated to benefit the other individual even when it costs the group, as a whole. Interestingly, there are times when the altruistic motivations of empathy may conflict with the collective good. An egotistic motivation to help oneself and one’s social group can lead to greater long-term self-benefit because resource allocation to the collective good would solidify a positive social standing for oneself within the social group and would benefit the group in relation to other groups also competing for resources in a society. In this case, an altruistic motivation to help a particular other at the expense of the group would not lead to long-term self benefit. Perhaps this illustrates why empathy is so intriguing to examine. Empathic communication is a common human behavior of altruism that paradoxically occurs at the expense of the collective good and long-term self-benefit. Perhaps the two distinct forms of motivation produced by empathy and personal distress are the cause of ambiguous empirical results concerning attitudes and stereotypes about individuals diagnosed with cancer. For instance, Gray and Rodrigue (2001) found that young adolescents with high trait empathy had stronger desire to participate in academic, social and general activities with a hypothetical new peer with cancer. In fact, this stronger desire remained when empathic young adolescents considered participating in activities with a healthy hypothetical new peer. This indicates an absence of a cancer stigma. And all adolescents (empathic and non-empathic) intended to exhibit positive behaviors towards the peer with cancer when compared to a hypothetical peer without cancer. These encouraging results may have been a result of the researchers’ ability to successfully evoke an altruistic desire to help and, subsequently, measure empathy towards a peer with cancer. Conversely, Sherman, Smith, and Cooper (1982-83) found that individuals had less positive affect towards contact with a cancer patient when compared to contact with a patient with a broken leg. More specifically, positive affect increased with the patients’ attractiveness and decreased when the individuals perceived the patient to be in greater pain. In this case, the researchers may have evoked personal distress among their research respondents. Interacting with an unattractive patient in great pain may be personally distressing. These findings have unfortunate implications. Cancer patients who may, arguably, be considered less attractive under certain conditions tend to be individuals who have undergone intense chemotherapy and have consequently experienced hair and weight loss. These individuals also tend to be in great pain from the treatment itself in addition to an aggressive form of cancer. This is a ripe opportunity for empathy to be expressed in order to quell cancer patients’ physical and emotional distress. However, Sherman et al. has shown that empathy is not healthy individuals’ common reaction under these circumstances. In fact, this finding remains consistent with Gray and Rodrigue because their research participants were asked to imagine a hypothetical peer with cancer. These research participants were children who probably would not imagine a new peer who is unattractive and in constant pain. It can be suggested that Gray and Rodrigue would have encountered different results if their research participants were actually confronted with a new peer who was observably experiencing pain and other physical indications of an aggressive cancer diagnosis. As above, the empathizer experiences increased emotional contagion and vicariously feels the distress of the peer, the empathizer is more likely to become communicatively unresponsive in order to reduce one’s own distress (Stiff et al., 1988). Future research is needed in order to specifically identify aspects of the cancer experience that evoke empathy among healthy observers instead of personal distress. Or which
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individuals tend to express empathy more often towards others with cancer? Can increased contact cultivate empathy towards individuals-with-cancer and reduce personal distress? Increased contact could help a healthy individual realize and appreciate another individual’s distinct personality and how a cancer diagnosis inhibits the other’s persona (Pettigrew & Tropp, 2000; Wright, Broday, & Aron, 2005). This would imply that individuals who have had a relative with cancer or experienced cancer themselves would be more likely to express empathy in this context. Medical personnel of oncology may also express increased empathy according to this contact hypothesis, however their increased knowledge about treatment and medical practice may be a covariate. A common aim for future research could be focused on discovering the aspects of the cancer experience that bring out the best responses in healthy observers in addition to individuals-with-cancer. Another construct related to empathy is communication competence (Greif & Hogan, 1973; Ritter, 1979). Wiemann (1977) considered competent communicators as empathic, affiliative, supportive, relaxed while interacting, and able to adapt their behavior according to the specifics of the interaction and between interactions. Individuals have greater competence as they possess more of these qualities and the degree to which they exhibit these qualities. Redmond (1985) found the concepts of communication competence and empathy very closely related (r = .98). Communication competence and empathy may be composed of the same set of skills and behaviors. In fact, Redmond believes that such a strong correlation may methodologically hinder effective research and indicate that the concept of empathy is being treated too globally. It is possible that one factor, empathy/the competent communication of empathy, is being measured twice when researchers treat empathy and communicator competence as separate and distinct concepts. Empathy may be an internal skill and communication competence may be the behavioral manifestation of empathy. It may be possible for an individual to feel empathy yet not be able to effectively communicative his/her empathic state. This internal empathy, unfortunately, would not be recognized as empathy because it was not effectively communicated. This is consistent with Redmond’s findings because research subjects were required to take the third person perspective and assess empathy and communicative competence as an outsider to an auditory interaction. Research participants listened to an auditory interaction and, accordingly, did not have visual cues and personal knowledge regarding the communicator’s internal affective state. These research participants will not be able to detect the communicator’s empathy unless it is competently verbalized. Any empathy that was detected by research participants was detected only because the communicator was competently able to express empathy. Therefore, the strong correlation between empathy and communication competence existed because auditory manifestations of communicator competence were required in order for research participants to perceive the presence of empathy in the target individual during the auditory interaction. In sum, empathy has to be competently communicated in order for another individual to recognize it as empathy. Thompson (1981) found that children with handicaps had lower communication competence in that they were less able to adapt their communication towards the listener. In addition, children without handicaps were less able to adapt their communication toward children with handicaps as well. This effect persisted even when children with and without handicaps shared classes together. The authors find these results an indication that children with handicaps are not receiving empathic communication from their peers and, therefore, not able to model empathic communication themselves because they are not being exposed to it.
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However, another possibility could be a circumstance where the children are experiencing a form of intergroup conflict and children with and without handicaps are each avoiding any consideration of the other’s perspective. Either way, empathic communication can often be problematic between children with and without handicaps. According to communication accommodation theory, this behavioral pattern can be considered reciprocal underaccommodation where handicapped and non-handicapped children are maintaining a division between social groups within the classroom. Although there are other factors influencing the communicative competence of handicapped children, this discussion implies that the environment in which children communicate with disabled children is already unstable and not naturally fostering reciprocal empathic communication. Interestingly, however, siblings of children with cancer experience fewer difficulties in psychological adjustment when they also experience high empathy (Labay & Walco, 2004). Empathy may help them emotionally reconcile discrepancies in family resources that are focused away from the siblings. Conversely, siblings who are less empathic and less able to understand others’ emotional states may have difficulty communicating their needs and act impulsively. It would seem that the empathizer has increased communicative competence during the distress following cancer diagnoses in the family. Empathy was also found to be correlated with age, further suggesting that empathy is a developmental ability that may develop in tandem with communicative competence during maturation. Can nonverbal cues effectively communicate empathy? Recently, researchers have focused on the combination of person-centered messages and nonverbal immediacy cues in comforting messages (Jones, 2004, 2005; Jones & Burleson, 1997, 2003; Jones & Guerrero, 2001; Jones & Wirtz, 2006). Comforting messages could be considered a way for individuals to express their empathy and altruistic desire to help another individual. Person-centered comforting messages validate and acknowledge another individual’s specific emotional distress and Jones (2004) found that individuals who receive person-centered messages feel reduced emotional distress and perceive the communicator of person-centered messages as supportive and caring. On the other hand, nonverbal immediacy conveys liking, interpersonal warmth and connection, and stimulates psychological arousal which helps the individual to recognize the prior emotions of warmth, liking and connectedness. In addition, Jones found that individuals who communicate nonverbal immediacy are perceived as more competent communicators. It would seem that communicators who express nonverbal immediacy and person-centered supportive messages are more competent communicators of empathic warmth and connection. However, Jones and Guerrero (2001) maintain that nonverbal immediacy and personcenteredness facilitate different functions during the emotional support process and may be distinct concepts. Nonverbal immediacy communicates a warm and open context for comforting, but person-centeredness incorporates explicit statements which encourages disclosure of distressing emotions. Consequently, person-centered comforting messages overtly provide an opportunity for emotional distress to be verbalized and allows for the reappraisal of these emotions in an interpersonal context. Jones and Wirtz (2006) further suggest that the comforting process consists of a reappraisal of distressing emotions which can lead to emotional improvement. In other words, emotional reappraisal was a mediating variable between person-centeredness and affective improvement. Individuals who use person-centered messages in order to comfort distressed individuals will explicitly encourage other individuals to verbalize their feelings. This
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verbalization will help determine the cause of distress and spur other sense-making cognitive reappraisals that will eventually reduce the initial distress. However, reappraisal was found to be only a partial moderator because there was a direct decrease in emotional distress resulting from person-centered comforting messages. More specifically, an individual’s emotional distress will reduce simply as a result of another individual validating and acknowledging his/her distress with person-centered comforting messages, as in Figure 4. In sum, person-centered comforting messages communicate empathy in two ways. First, an individual is acknowledging another’s distress by tailoring a message towards the particular distress of the other individual. Second, person-centered messages explicitly allow the distressed individual to verbalize emotional distress and commence a reappraisal process towards distress reduction (Bohart & Greenberg, 1997; Jones & Wirtz, 2007; Warner, 1997). Both functions of person-centered messages manifest a unique form of perspective-taking required of the empathizer. An individual can take another’s perspective by simply acknowledging the other individual’s emotional distress. On the other hand, the reappraisal process can be considered a more dynamic form of perspective-taking where each individual shares his/her perspective regarding the emotional distress of one individual and, thus, negotiate a more balanced interpretation of the distressing emotions. In this manner, a mutual perspective of all members of the interaction is achieved and this leads to emotional distress reduction. There are a number of constructs related to empathy as the latter is not an isolated orthogonal entity. Instead, empathic communication is part of a process where another’s distress is recognized by an individual and that individual’s empathic response may or may not be competently communicated. However, the presence of empathy in the individual’s psyche can trigger an altruistic motivation to help another individual in distress which can be manifested by the comforting behaviors of nonverbal immediacy and person-centered messages.
Figure 4. Model of outcomes resulting from comforting behaviors.
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In further examining the process of empathic communication, the following came to mind. What circumstances or events in everyday life commonly trigger individuals’ egotistic motivation of personal distress to override their empathic altruistic motivation to help another? What strategies can individuals use to combat personal distress and restrain egotistic motivation in order to uphold an altruistic desire to help in the face of adversity or personal hardship? Are there other helping behaviors that better manifest an empathic individual’s altruistic desire to help? Is there a way to measure empathy that an individual legitimately harbors, yet is not able to competently communicate? These questions only seek to further illuminate an empathic process that has been diligently documented by previous research.
OUTCOMES OF EMPATHY As just discussed, messages of empathy and their underlying altruistic motivations to help can be manifest by comforting behaviors such as nonverbal immediacy and personcentered messages. In many respects, the emotional distress reduction resulting from the reappraisal process spurred by person-centered messages can be considered an outcome of empathic communication. This is supported by cancer research where supportive conversations consisting of the mutual sharing of personal cancer experiences lead to greater perceptions of effective helping among interactants (Pistrang, Solomons, & Barker, 1999). In this case, the self-disclosure regarding cancer was more positively evaluated when empathy was first communicated during the relationship. Consequently, one positive outcome of empathy is the perceived emotional assistance resulting from the mutual sharing of experiences. Other, more global, outcomes of empathy have been explored as well. For instance, international conflicts may be resolved through the proper enactment of collective empathy (Nadler, 2003; Nadler & Liviatan, 2004, 2006; Nadler & Saguy, 2005). Researchers have analyzed the international conflict between the Palestinians and the Israelis to discover the role of empathy in the achievement of conflict resolution. They have found that empathy leads towards conflict resolution only when the conflicting parties maintain a preliminary level of trust. If trust is not present between the conflicting parties, expressions of empathy may sometimes lead to increased conflict. In this case, an expression of empathy is perceived as an empty offer of reconciliation and possibly perceived as intentionally deceptive. In this manner, trust has been found to moderate the relationship between empathy and conflict resolution. Trust can be engendered when the opposing groups participate in successive interactions towards a common goal that fulfills the needs of all groups involved. The researchers use social identity theory for support by asserting that groups engaging in collective action will embrace a larger group identity that overrides their separate identities and lead to cooperative interaction. Likewise, trust may be an important moderator during interpersonal conflict and two individuals in disagreement can engender trust by working towards a common goal. Over time, trust will develop once cooperative interaction becomes more frequent. Similar intergroup conflict can be observed between healthy individuals and individualswith-cancer. Individuals may avoid others who have been diagnosed with cancer or individuals may exhibit overly intrusive behaviors that can strain the interpersonal
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relationship (Flanagan & Holmes, 2000). Moreover, this conflict may lack trust. Cancer is a disease that can remain invisible to an observer some days and, yet, produce noticeable symptoms other days. Healthy individuals may harbor doubts about the severity of the disease when the observable signs of the illness are ambiguous (Matthews & Harrington, 2000). These doubts may spring from a wishful desire for the cancer diagnosis of their friend or family member to be bogus. In order for empathy to reconcile the strained relationship, trust must be re-established. Trust may be restored by educating healthy individuals about the fluctuating symptoms of cancer, especially if this education is collectively achieved through a partnership between the healthy individual and the individual-with-cancer. If these individuals collectively work towards the goal of cancer education together, they both will have increased knowledge in addition to a larger shared identity between them. Increased trust will further increase the likelihood of a positive relationship between empathy and conflict resolution. These possible outcomes demonstrate that the effects of empathic communication resonate from the interpersonal to the international level. However, it is important to remember that positive outcomes from empathy will only occur when empathy is communicated in the context of a trusting relationship.
A MODEL OF INTERPERSONAL AND INTERGROUP EMPATHY AS A COMMUNICATIVE PROCESS The empirical findings discussed in the previous sections have been mapped-out into a model in order to display the process of empathic communication. For simplicity, this model of empathy displays the communication between an empathizer and a receiver. The communicator has just witnessed or become aware that another individual is experiencing some form of distress and, consequently, this communicator feels personal distress and/or the beginnings of empathy: perspective-taking and emotional contagion, as in Figure 5. Picture this model as a set of three concentric circles that start at the upper left-hand section of the model and each circle represents a different process related to empathy. As depicted, two processes commence when communicators observe another in distress. These communicators can experience personal distress themselves as a result of witnessing another endure a painful experience or emotional turmoil. The outmost circle represents the process of personal distress where egotistic motivation compels communicators to reduce their own distress by comforting the other individual. This particular process is represented by personal distress appearing twice on the processional model in order to reflect both the empathizer’s and the recipient’s distress. The empathic process is represented by the next concentric circle where individuals can respond to others’ distress by taking their perspective and sharing in their emotions because empathizers have an altruistic desire to help the other individuals. Lastly, the innermost circle represents the process of conflict resolution where empathy is fundamental to the resolution of conflict between two parties. Empathy is integral to the two inner circles and consequently there is overlap of the empathic process and the process of conflict resolution.
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Figure 5. Empathic communication process model.
Parsimony notwithstanding at this stage of model development, there are a number of possible additions and potential changes to this model that future research can implement. One improvement entails the identification of specific helping behaviors individuals enact when exhibiting empathy. The current dialog box signifying ‘helping behaviors’ is perhaps generic and needs elaboration in future theorizing. It would be interesting to assess whether individuals experiencing personal distress resort to different helping behaviors as a consequence of their egotistic motivation to help in comparison to the altruistically motivated helping behavior commonly chosen by individuals who exhibit empathy. Any differences would have direct implications for the empathy as a communicative process model. Instead of one ‘helping behaviors’ dialog box, personal distress and empathy would have relationships with two separate ‘helping behaviors’ dialog boxes, each representing the differing helping behaviors that personally distressed individuals and empathic individuals typically enact. Additionally, it would be interesting to discover if helping behavior springing from personal distress results in as much emotional improvement in the target individual as helping behavior exhibited by an empathic individual.
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EPILOGUE Empathy’s multidimensional nature has been reflected by the diverse manner in which it has been examined in previous research in addition to this present analysis. Although a mainly interpersonal construct, historically, empathy research has been expanded to embrace the dynamics of media communication, intergroup, and intrapersonal communication. However, empathy has not been explicitly examined in organizational settings. Boggs and Giles (1999) scrutinize the communication accommodation that occurs in the workplace as a consequence of gender social groups. Could the observed accommodative patterns be a corollary of empathy (or lack thereof) in the workplace? Can an empathic workplace be intentionally fostered? In addition, empathy research has yet to investigate the effect of intercultural differences. Duan and Hill (1996) report that collectivistic values are positively related to dispositional empathy. However, they question whether this tendency would remain when an individual with collectivistic values is confronted with another’s distress about a decidedly individualistic issue. Other questions regarding empathy in collectivistic cultures remain. For instance, will empathy communicated in a collectivistic culture be more broadly directed to the family of the distressed individual? How does empathy change when comparing cultures that typically communicate with high vs. low contexts? More specifically, is empathy more likely to be implicitly communicated in a high context culture when compared to a low context culture? Overall, research has focused on the role of the empathizer as opposed to the receiver of empathic communication. However, the research which incorporates empathy into the context of disability and cancer better focuses the attention on the receiver of empathic communication. The experience of a cancer diagnosis and treatment is embedded within the social relationships of people with cancer which contributes to their social identity (Harwood & Sparks, 2003; Sparks & Harwood, 2008). This highlights the importance of social relationships when facing the health threat of cancer. Yet, empirical findings indicate that friends and family have difficulty taking the perspective of the person-with-cancer. In consideration, friends and family members should recognize that the cancer experience may be beyond their perspective-taking abilities. Although this can be psychologically uncomfortable as a result of uncertainty, empathy can be best expressed by its availability. It might be helpful to allow people with cancer to ask for assistance and emotional support when needed and in the manner that they desire. The cancer experience changes as a consequence of different stages from diagnosis to chemotherapy to remission and social relationships of support need to adapt accordingly (Sparks & Harwood, 2008). Fortunately, empathy is a common reaction when observing another in distress and contributes to comforting behaviors in addition to a variety of other prosocial behaviors (Litvack-Miller, McDougall, & Romney, 1997). It can be the manner in which empathy is expressed during sensitive communicative interactions that heightens or dampens its positive effect on the social relationship. Needless to say, there is an array of other viable theories we could have fruitfully invoked (e.g. uncertainty reduction theory) however, space and parsimony precludes such a luxury. For instance, the dual identity proposed as the origin of empathy in this chapter may be similar to the dual identity proposed by the theory of Symbolic Interactionism. Do the
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articulate self and the organic self correspond with the ‘I’ and the ‘me’? In addition, social identity theory has been used to examine the intergroup relationships between individualswith-cancer and other social groups (Harwood, & Sparks, 2003). It would be interesting to further study how empathy may change intergroup communication. Does empathy change the manner in which group identity is achieved and maintained via social comparison? Can empathy soften the perceived boundaries between social groups? Moreover, communication accommodation theory (as above) may explain the linguistic manifestations of empathic intergroup interaction. Do the linguistic strategies of communication accommodation theory provide a better framework with which to examine empathic communication? Can a communicator linguistically diverge from another while still expressing empathy; or is empathy solely a form of communication convergence? Almost finally and returning to our starting point, empathy still deserves more conceptual scrutiny. More specifically, empathy has been regarded as an individual’s response to observing another experiencing distress. This implies that empathy only occurs when an individual observes another’s negative emotion(s). However, empathy can be a response to another’s positive emotion(s) such as a wedding engagement, a pregnancy announcement, graduation, etc. It would be interesting to discover if there is a difference between positive emotions and negative emotions in the manner in which empathy is elicited. Duan and Hill (1996) believe that “empathizing with someone with positive emotions can be emotionally rewarding and empathizing with someone with negative emotions can be morally rewarding” (p. 268). Future research could empirically explore this assumption in order to determine if empathizers responding to another’s positive emotions experience a different empathic process than communicators responding to another’s negative emotions. Empathic communication in response to another’s positive emotions is outside of the framework of this chapter, yet it is an important manner in which empathy can vary and, therefore, an area in need of further development A global concept such as empathy requires a global method of examination. However, analysis of such a ubiquitous concept is needed in order to better understand interpersonal relationships. Previous research has met this demand and has proven to be both enlightening and enigmatic. Most importantly, empathy is not simply a reification of academia, but a concept pragmatically used by the general population in a fairly reliable manner (Hogan, 1969).
REFERENCES Arnett, R. C., & Nakagawa, G. (1983). The assumptive roots of empathic listening: A critique. Communication Education, 32, 368-378. Barrett-Lennard, G. T. (1997). The recovery of empathy – Towards others and self. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered: New directions in psychotherapy (pp. 103-123). Washington, DC: American Psychological Association. Batson, C. D., Batson, J. G., Todd, M., Brummett, B. H., Shaw, L. L., Aldeguer, C. M. R. (1995). Empathy and the collective good: Caring for one of the others in a social dilemma. Journal of Personality and Social Psychology, 68, 619-631.
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Batson, D. C., Early, S., & Salvarani, G. (1997). Perspective taking: Imagining how another feels versus imagining how you would feel. Personality and Social Psychology Bulletin, 23, 751-758. Batson, D. C., Fultz, J., & Schoenrade, P. A. (1987). Distress and empathy: Two qualitatively distinct vicarious emotions with different motivational consequences. Journal of Personality, 55, 19-39. Batson, D. C., O’Quin, K., Fultz, J., & Vanderplas, M. (1983). Influence of self-reported distress and empathy on egoistic versus altruistic motivation to help. Journal of Personality and Social Psychology, 45, 706-718. Bennett, M. J. (1979). Overcoming the golden rule: Sympathy and empathy. Communication Yearbook, 3, 407-422. Boggs, C., & Giles, H. (1999). “The canary in the coalmine”: The nonaccommodation cycle in the gendered workplace. International Journal of Applied Linguistics, 9, 223-245. Bohart, A. C., & Greenberg, L. S. (1997). Empathy: Where are we and where do we go from here?. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 419-450). Washington, DC: American Psychological Association. Bohart, A. C., & Tallman, K. (1997). Empathy and the active client: An integrative, cognitive-experimental approach. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 393-417). Washington, DC: American Psychological Association. Braithwaite, D. O., & Eckstein, N. J. (2003). How people with disabilities communicatively manage assistance: Helping as instrumental social support. Journal of Applied Communication Research, 31, 1-26. Brissette, I., Leventhal, H., & Levethal, E. A. (2003). Observer ratings of health and sickness: Can other people tell us anything about our health that we don’t already know?. Health Psychology, 22, 471-478. Bridgeman, D. L. (1981). Enhanced role taking through cooperative interdependence: A field study. Child Development, 52, 1231-1238. Broome, B. J. (1991). Building shared meaning: Implications of a relational approach to empathy for teaching intercultural communication. Communication Education, 40, 235249. Campbell, R. G., & Babrow, A. S. (2004). The role of empathy in responses to persuasive risk communication: overcoming resistance to HIV prevention messages. Health Communication, 16, 159-182. Chlopan, B. E., McCain, M. L., Carbonell, J. L., & Hagen, R. L. (1985). Empathy: Review of available measures. Journal of Personality and Social Psychology, 48, 635-653. Coke, J. S., Batson, C. D., & McDavis, K. (1978). Empathic mediation of helping: A twostage model. Journal of Personality and Social Psychology, 36, 752-766. Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113-126. DeTurk, S. (2001). Intercultural empathy: Myth, competency, or possibility for alliance building? Communication Education, 50, 374-384. Denham, S. A. (1986). Social cognition, prosocial behavior, and emotion in preschoolers: Contextual validation. Child Development, 57, 194-201.
Communicating Empathies in Interpersonal Relationships
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Dillard, J. P., Hunter, J. E. (1989). On the use and interpretation of the emotional empathy scale, the self-consciousness scales, and the self-monitoring scale. Communication Research, 16, 104-129. Duan, C., & Hill, C. E. (1996). The current state of empathy research. Journal of Counseling Psychology, 43, 261-274. Eisenberg, N., & Miller, P. A. (1987). The relation of empathy to prosocial and related behaviors. Psychological Bulletin, 101, 91-119. Epley, N., Caruso, E. M., & Bazerman, M. H. (2006). When perspective taking increases taking: Reactive egoism in social interaction. Journal of Personality and Social Psychology, 91, 872-889. Gallois, C., Ogay, T., & Giles, H. (2005). Communication accommodation theory: A look back and a look ahead. In W. Gudykunst (Ed.), Theorizing about intercultural communication (pp. 121-148). Thousand Oaks, CA: Sage. Giles, H., Coupland, J., & Coupland, N. (1991). Accommodating theory: Communication, context, and consequence. In H. Giles, J. Coupland, & N. Coupland (Eds.), Contexts of accommodation: Developments in applied sociolinguistics (pp. 1-68). Cambridge: Cambridge University Press. Gray, C. C., & Rodrigue, J. R. (2001). Brief report: Perceptions of young adolescents about a hypothetical new peer with caner: An analog study. Journal of Pediatric Psychology, 26, 247-252. Greenberg, L. S., & Elliott, R. (1997). Varieties of empathic responding. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 167186). Washington, DC: American Psychological Association. Greif, E. B., & Hogan, R. (1973). The theory and measurement of empathy. Journal of Counseling Psychology, 20, 280-284. Flanagan, J., & Holmes, S. (2000). Social perceptions of cancer and their impacts: Implications for nursing practice arising from the literature. Journal of Advanced Nursing, 32, 740-749. Harwood, J., & Giles, H. (Eds.) (2005). Intergroup communication: Multiple perspectives. New York: Peter Lang. Harwood, J., & Sparks, L. S. (2003). An intergroup communication approach to cancer. Health Communication, 15, 145-160. Hecht, M. J., Jackson, R. L. II, & Pitts, M. J. (2005). Culture: Intersections of intergroup and identity theories. In J. Harwood, & H. Giles (Eds.), Intergroup communication: Multiple perspectives (pp. 117-137). New York: Peter Lang Publishing, Inc. Hogan, R. (1969). Development of an empathy scale. Journal of Consulting and Clinical Psychology, 33, 307-316. Jackson, P. L., Brunet, E., Meltzoff, A. N., & Decety J. (2006). Empathy examined through the neural mechanisms involved in imagining how I feel versus how you feel pain. Neuropsychologia, 44, 752-761. Jones, S. M. (2004). Putting the person into person-centered and immediate emotional support. Communication Research, 31, 338-360. Jones, S. M. (2005). Attachment style differences and similarities in evaluations of affective communication skills and person-centered comforting messages. Western Journal of Communication, 69, 233-249.
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Jones, S. M., & Burleson, B. R. (2003). Effects of helper and recipient sex on the experience and outcomes of comforting messages: An experimental investigation. Sex Roles, 48, 119. Jones, S. M., & Burleson, B. R. (1997). The impact of situational variables on helpers’ perceptions of comforting messages. Communication Research, 24, 530-555. Jones, S. M., & Guerrero, L. K. (2001). The effects of nonverbal immediacy and verbal person-centeredness in the emotional support process. Human Communication Research, 27, 567-596. Jones, S. M., & Wirtz, J. G. (2006). How does the comforting process work?: An empirical test of an appraisal-based model of comforting. Human Communication Research, 32, 217-243. Jones, S. M., & Wirtz, J. G. (2007). “Sad monkey see, monkey do:” Nonverbal matching in emotional support encounters. Communication Studies, 57, 71-86. Kalliopuska, M. (1992). Attitudes towards health, health behavior, and personality factors among school students very high on empathy. Psychological Reports, 70, 1119-1122. Labay, L. E., & Walco, G. A. (2004). Brief report: Empathy and psychological adjustment in siblings of children with cancer. Journal of Pediatric Psychology, 29, 309-314. Linn, M. W., Linn, B. S., & Stein, S. R. (1982). Beliefs about causes of cancer in cancer patients. Social Science and Medicine, 16, 835-839. Litvack-Miller, W., McDougall, D., & Romney, D. M. (1997). The structure of empathy during middle childhood and its relationship to prosocial behavior. Genetic, Social, and General Psychological Monographs, 123, 303-322. Lobchuk, M. M., & Vorauer, J. D. (2003). Family caregiver perspective-taking and accuracy in estimating cancer patient symptom experiences. Social Science and Medicine, 57, 2379-2384. Loewenstein, G. (2005). Hot-cold empathy gaps and medical decision making. Health Psychology, 24, S49-S56. Mahrer, A. R. (1997). Empathy as therapist-client alignment. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 187215). Washington, DC: American Psychological Association. Matthews, C. K., & Harrington, N. G. (2000). Invisible disability. In D. O. Braithwaite & T. L. Thompson (Eds.), Handbook of communication and people with disability (pp. 405422). Mahwah, New Jersey: Lawrence Erlbaum. Mehrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40(4), 525-543. Merrigan, G. (2000). Negotiating personal identities among people with and without identified disabilities: The role of identity management. In D. O. Braithwaite & T. L. Thompson (Eds.), Handbook of communication and people with disability (pp. 223-238). Mahwah, New Jersey: Lawrence Erlbaum. Nadler, A. (2003). Post resolution process: An instrumental and socio-emotional routes to reconciliation. In G. Salomon & B. Nevo, (Eds.) Peace education worldwide: The concept, underlying principles, the research. Mahwah, N.J.: Erlbaum. Nadler, A., & Liviatan, I. (2004). Intergroup reconciliation process in Israel: Theoretical analysis and empirical findings. In N. R. Branscombe & Doosje (Eds.), Collective guilt: International perspectives (pp. 216-235). New York: Cambridge University Press.
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Nadler, A., & Liviatan, I. (2006). Intergroup reconciliation: Effects of adversary’s expressions of empathy, responsibility, and recipient’s trust. Personality and Social Psychology Bulletin, 32, 459-470. Nadler, A., & Saguy, T. (2005). Reconciliation between nations: Overcoming emotional deterrents to ending conflicts between groups. In. H. Langholtz & C. E. Stout (Eds.), The psychology of diplomacy (pp. 29-46). New York: Praeger. Pettigrew, T. F., & Tropp, L. (2000). Does intergroup contact reduce prejudice? Recent metaanalytical findings. In S. Oskamp (Ed.), Reducing prejudice and discrimination: Social psychological perspectives (pp. 93-113). Mahwah, NJ: Erlbaum. Pistrang, N., Solomons, W., & Barker, C. (1999). Peer support for women with breast cancer: The role of empathy and self-disclosure. The Journal of Community and Applied Social Psychology, 9, 217-229. Redmond, M. V. (1985). The relationship between perceived communication competence and perceived empathy. Communication Monographs, 52, 377-382. Ritter, E. M. (1979). Social perspective-taking ability, cognitive complexity and listeneradapted communication in early and late adolescence. Communication Monographs, 46, 40-51. Ryan, E. B., Bajorek, S., Beaman, A., & Anas, A. P. (2005). “I just want you to know that ‘them’ is me”: Intergroup perspectives on communication and disability. In J. Harwood & H. Giles (Eds.), Intergroup communication: Multiple perspectives (pp. 117-137). New York: Peter Lang. Shaw, L. L., Batson, D., & Todd, R. M. (1994). Empathy avoidance: Forestalling feeling for another in order to escape the motivational consequences. Journal of Personality and Social Psychology, 67, 879-887. Sherman, M. F., Smith, R. J., & Cooper, R. (1982-83). Reactions towards the dying: The effects of a patient’s illness and respondents’ beliefs in a just world. OMEGA, 13, 173189. Silvern, L. E., Waterman, J. L., Sobesky, W., & Ryan, V. L. (1979). Effects of a developmental model of perspective taking training. Child Development, 50, 243-246. Smith, A. (2006). Cognitive empathy and emotional empathy in human behavior and evolution. The Psychological Record, 56, 3-21. Smither, S. (1977). A reconsideration of the developmental study of empathy. Human Development, 20, 235-276. Sparks, L., & Harwood, J. (2008). Cancer, aging, and social identity: Development of an integrated model of social identity theory and health communication. In L. Sparks, H. D. O'Hair, & G. L. Kreps, (Eds.), Cancer communication and aging. (pp. 77-95). Cresskill, NJ: Hampton Press. Stiff, J. B, Dillard, J. P., Somera, L., Kim, H., & Sleight, A. C., (1988). Empathy, communication, and prosocial behavior. Communicaiton Monographs, 55, 198-213. Tamborini, R., Salomonson, K., & Bahk, C. (1993). The relationship of empathy of comforting behavior following film exposure. Communication Research, 20, 723-738. Tamborini, R., Stiff, J., & Heidel, C. (1990). Reacting to graphic horror: A model of empathy and emotional behavior. Communication Research, 17, 616-640. Thompson, T. L. (1997). Interpersonal communication and health care. In M. L. Knapp & G. R. Miller (Eds.), Handbook of interpersonal communication (2nd ed., pp. 696-725). Thousand Oaks, CA: Sage.
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Thompson, T. L. (1981). The development of communication skills in physically handicapped children. Human Communication Research, 7, 312-324. Vanaerschot, G. (1997). Empathic resonance as a source of experience-enhancing interventions. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 141-166). Washington, DC: American Psychological Association. Warner, M. S. (1997). Does empathy cure? A theoretical consideration of empathy, processing, and personal narrative. In A. C Bohart & L. S. Greenberg (Eds.), Empathy reconsidered, New directions in psychotherapy (pp. 125-140). Washington, DC: American Psychological Association. Wiemann, J. M., (1977). Explication and test of a model of communicative competence. Health Communication Research, 3, 195-213. Wikipedia [online]. 2006 [8/25/06]. Empathy (keyword). Available from: URL: http://en.wikipedia.org/wiki/Empathy. Williams, A., Giles, H., Coupland, N., Dalby, M., & Manasse, H., (1990). The communicative contexts of elderly social support and health: A theoretical model. Health Communication, 2, 123-143. Wilson, B. J., & Cantor, J. (1985). Developmental differences in empathy with a television protagonist’s fear. Journal of Experimental Child Psychology, 39, 284- 299. Wright, S. C., Broday, S. M., & Aron, A. (2005). Intergroup contact: Still our best hope for improving intergroup relations. In C. S. Crandall & M. Schaller (Eds.), Social psychology of prejudice: Historical and contemporary issues (pp. 143- 164). Seattle, WA: Lewinian Press. Zillmann, D. & Cantor, J. R. (1977). Affective responses to the emotions of a protagonist. Journal of experimental social psychology, 13, 155-165.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 2
INTERPERSONAL REPRESENTATIONS: THEIR STRUCTURE, CONTENT, AND NATURE Shanhong Luo* Department of Psychology, University of North Carolina at Wilmington, North Carolina, USA
ABSTRACT How people represent their interpersonal relationships based on past experiences has great impact on their subsequent interactions with others. This chapter reviews previous theories and presents new propositions regarding three important aspects of interpersonal representations (IRs)—their structure, content, and nature. Specifically, the structure of IRs can be viewed as a three-level hierarchical organization, with general representations at the highest level, domain-specific representations at the midlevel, and relationshipspecific representations at the lowest level. The content of IRs can be divided into three distinct yet interrelated components: self representations, other representations, and relationship representations. With regard to the nature, IRs can be conceptualized as consisting of accurate perceptions, systematic biases, and random errors.
Keywords: Interpersonal representations, working models, relational schema, general representations, domain-specific representations, relationship-specific representations, self representations, other representations, relationship representations, accuracy, bias
One of the most important ideas in the area of close relationships is that individuals’ past relationship experiences exert powerful influences on their subsequent interactions with others. It has been theorized that the mechanism by which past experiences influence current behaviors is through internal representations. That is, people internalize repeated experiences and develop mental representations that capture regularities in patterns of the self in relation *
Correspondence should be sent to Shanhong Luo, Department of Psychology, Social Behavioral Science Building, University of North Carolina at Wilmington, Wilmington, NC, 28403. Email:
[email protected].
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to others; these interpersonal representations guide how people process, interpret, and respond to incoming information (see Bowlby, 1973, 1980; Baldwin, 1992; Safran, 1990a, 1990b). Given the central role these representations play in interpersonal behaviors, it is of particular importance to understand three key aspects of interpersonal representations (IRs)—their structure, content, and nature. Over the past two decades, researchers have made great strides in understanding the structure and content of IRs. However, little attention has been given to the nature of IRs until recently. This chapter has two primary goals. The first goal is to provide an integration of theoretical propositions and a review of empirical evidence regarding the structure and the content of IRs. The second goal is to introduce a conceptualization to help understand the nature of IRs. More specifically, I discuss the following three propositions: First, with regard to structure, IRs are hypothesized to be organized in a hierarchical fashion, including general representations at the highest level, domain-specific representations at the midlevel, and relationship-specific representations at the lowest level. Second, with regard to content, IRs can be thought of as having three distinct yet interrelated components: representations of the self, others, and the relationship between the two. Finally, with regard to the nature of IRs, it is suggested that IRs can be conceptualized as consisting of accurate perceptions, systematic biases, and random errors. In discussions of these propositions, I draw heavily on attachment literature, particularly theory and research regarding internal working models, because working models of attachment are central elements of IRs. However, I also review theories and empirical work in other fields that are not necessarily within the attachment framework, such as relational schema theory and person perception research. The term “interpersonal representations” is selected because of its broad applicability and inclusiveness.
THE STRUCTURE OF INTERPERSONAL REPRESENTATIONS General and Specific Representations Typically individuals are involved in more than one relationship. For example, most people have relationships with parents, romantic partners, friends, colleagues, and etc. Consequently, it is likely that individuals do not hold a single set of representations but have a family of representations. Early attachment theorists have suggested that internal working models should include both overarching, general representations and more contextualized representations that correspond to specific relationships (Bowlby, 1973, 1980; Bretherton, 1985; Main, Kaplan, & Cassidy, 1985). This idea of multiple representations has been widely accepted by relationship researchers (e.g., Baldwin, 1992; Collins & Read, 1994; Pietromonaco & Feldman Barrett, 2000; Shaver, Collins, & Clark, 1996). The hypothesis of multiple representations has received little empirical examination until recently. Several studies have been designed to explicitly test this hypothesis (e.g., Baldwin, Keelan, Fehr, Enns, & Koh-Rangarajoo, 1996; Cozzarelli, Hoekstra, & Bylsma, 2000; Klohnen, Weller, Luo, & 2005; Pierce & Lydon, 2001; Ross & Spinner, 2001). These studies show that individuals indeed hold both general representations as well as specific representations that correspond to different types of relationships. Moreover, specific
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representations tend to be positively associated with each other, suggesting that individuals tend to hold similar models across different relationships. However, the size of these correlations ranged only from small to moderate (Furman et al., 2002; Pierce & Lydon, 2001; Ross & Spinner, 2001; Klohnen et al., 2005), indicating that representations that correspond to various relationships are not identical. General representations are also positively associated with specific representations; once again these associations tend to have modest magnitude, suggesting that general representations are not simply a composite of specific representations (Pierce & Lydon, 2001; Cozzarelli et al., 2000; Klohnen et al., 2005). Overall, these findings show that individuals have distinct, yet interrelated representations for different relationships, and that these specific representations are also linked to general representations.
A Hierarchical Model of Interpersonal Representations To date, research designed to test the structure of representations has typically assessed IRs on two levels—general and specific representations. However, it is important to differentiate between two types of specific representations that differ in their level of abstractness. Specifically, adults are not only involved in many different types of relationships (e.g., parental, friendships, romantic relationships), but within each type of relationship they also typically interact with many different individuals. Therefore it is very likely that in addition to holding the more general representations corresponding to each type of relationship, individuals also hold distinct, concrete representations for each person whom they are interacting with. Consistent with these ideas, Collins and colleagues suggested that the structure of IRs can be conceptualized as a three-level hierarchical organization (Collins & Read, 1994; Collins, Guichard, Ford, & Feeney, 2004). Figure 1 provides a hypothetical example of this hierarchy. General representations, the most abstract representations, are at the top of the hierarchy. At the midlevel are domain-specific representations—representations corresponding to different types of relationships, such as relationships with parents, romantic partners, and friends. Relationship-specific representations are at the lowest level of the hierarchy. These are the most concrete representations corresponding to specific individuals, such as mother and father, previous and current romantic partners, and different friends. Due to space limitation, Figure 1 only provides two examples of specific individuals under each type of relationship. However, it is very likely that several different persons are nested within each type of relationship in real life. Overall, Fletcher, & Friesen (2003) has tested the validity of this hierarchical conceptualization of interpersonal representations. The researchers took a confirmatory factor analysis (CFA) approach to examine the hierarchical structure of attachment working models. They assessed working models at both domain-specific level (i.e., how people view themselves and others in different types of relationships including familial, friendship, and romantic relationships) and relationship-specific level (i.e., how people view themselves and specific others in each relationship, for example, relationship with one’s mother and father, specific friends, and current romantic partner). CFA results from both sets of data showed that the manifest indicators at the relationship-specific level could be modeled as forming domainbased latent variables, which in turn formed one overarching, second-order latent factor. This higher-order factor can be thought of as representing individuals’ most general attachment
Figure 1. A hypothetical example of the hierarchical model of interpersonal representations. Note. Ptn1 = partner 1. Ptn 2 = partner 2. Frd 1 = friend 1. Frd 2 = friend 2.
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representations. These findings suggest that manifest indicators of relationship-specific representations measured for different relationships can be successfully modeled as forming a hierarchical structure similar to the model in Figure 1. A limitation of this research was that it treated domain-specific and general representations as latent factors which in theory cannot be directly assessed. However, the studies reviewed earlier have shown that individuals do have access to these more generalized representations (e.g., Baldwin et al., 1996; Klohnen et al., 2005). It thus will be important for future research to examine the proposed three-level hierarchical model more directly by assessing all three levels of the hierarchy (rather than treating the more general levels as latent factors) and modeling all of the levels simultaneously.
Implications of a Hierarchical Organization of Interpersonal Representations Differential Predictive Power of General and Specific Representations General and specific representations are likely to have differential power when it comes to prediction of intra- and interpersonal functioning. For example, representations at the higher levels of the hierarchy should be stronger predictors of broader constructs such as general well-being and psychological adjustment, whereas representations at the lower levels should be better predictors of narrower outcomes such as quality of specific relationships. Several studies provide evidence that general and specific representations are differentially associated with different outcomes (Cozarelli et al., 2000; Crowell, Fraley, & Shaver, 1999; Klohnen et al., 2005; Pierce & Lydon, 2001). For example, Klohnen et al. (2005) found that general attachment models were the strongest and most reliable predictors of personal wellbeing variables such as emotional stability, self-esteem, and ego-resiliency, whereas domainspecific models best predicted relationship outcomes (e.g., satisfaction, conflict, closeness) within different types of relationships. Although these studies did not investigate the predictive validity of relationship-specific representations, it is expected that relationshipspecific representations should be the best predictor of quality of relationships with specific individuals. Which Lower-level Representations are Most Important to Higher-level Ones? Given that individuals hold multiple sets of specific representations, it is important to test which specific representations make the most contributions to the more abstract representations. It is likely that representations of the most important relationships (such as relationships with significant others) at a lower level will have the strongest influence on representations at the next higher-level of abstraction. In Figure 1, this proposition is illustrated by showing the links between the most influential representations and next higherlevel representations in bold. Klohnen et al. (2005) provide some support for this proposition. In a sample of college students, they found that romantic partner and friend models made the strongest and independent contributions to the prediction of general models than models of mother and father. This pattern of results is consistent with the proposal that most young adults have shifted their focus from parents to peers as their primary source of fulfillment of their attachment needs (see Fraley & Davis, 1997; Trinke & Bartholomew, 1997).
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A related proposition is that the relative importance of lower-level representations to higher-level representations may change over time. Children may base their general representations primarily on their relationship experiences with their major caregivers, usually their parents. As individuals reach adulthood, peers, particularly romantic partners, play an increasingly important role in individuals’ lives. Klohnen et al. (2005) found that the longer individuals had been involved in their romantic relationships, the more strongly their romantic attachment models were predictive of their general attachment models. As individuals take on new roles and responsibilities (e.g., moving away from parents, getting married, starting a career, having children, taking care of aging parents), the relative importance of representations of each relationship type as well as of each person may change drastically. Thus, it is extremely important that researchers who pursue these types of questions to take a developmental perspective and examine how lower-level representations contribute to higher-level representations at different life stages.
What Is Adaptive, More Consistent or More Variable Representations? Given that individuals hold fairly distinct representations under different relationship contexts (e.g., La Guardia et al., 2000), it is important to examine whether some people show greater variation in their representations across relationships than others. If individual differences in variability do exist, what implications does this have for psychological wellbeing and relationship functioning? Klohnen and Weller (2006) assessed working models that participants held for the self in relation to romantic partners, friends, their father, and their mother. They indexed working model variability by computing the standard deviation of the ratings across the four relationships for each participant; that is, each participant obtained a variability index that indicated how much his or her self-representations varied across the four relationships. They indeed found substantial individual differences in the variability of working models. Moreover, differences in variability were systematically associated with attachment security. Specifically, more insecure individuals tended to hold more variable working models than more securely attached individuals. Individuals who held more variable working models were also lower in self-esteem, less emotionally stable and ego-resilient, and had lower self-concept clarity. With regard to relationship outcomes, variability was associated with less adaptive relationship functioning, including lower satisfaction, less involvement, and more conflict. Most importantly, this pattern of results held when attachment insecurity was controlled, suggesting that variability had negative consequences for intra- and interpersonal functioning above and beyond effects due to attachment insecurity. These findings are quite consistent with self-concept differentiation theory, which suggests that variability of internal self representations across roles may indicate a maladaptive fragmentation of the self (Donahue, Robins, Roberts, & John, 1993). The findings go against attachment researchers’ idea that having a singular, rigid representation of self in different relationships is likely to be maladaptive given that different relationship partners will, in fact, behave differently and therefore should be interacted with differently (e.g., Linville, 1987; Pierce & Lydon, 2001). However, given the lack of research on variability of representations across relationships, it is important to test the robustness of these findings and to examine the causal direction of these effects as well as the underlying processes.
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Accuracy of Representations Varying in Specificity Specificity of representations is likely to play a role in the extent to which these representations are accurate and biased. Neff and Karney (2002, 2005) reasoned that for more specific representations, it should be relatively easy to find objective standards to evaluate the accuracy of these representations and thus more difficult to hold biased perceptions that have little basis in reality. As representations become more general and abstract, fewer objective standards exist, making it more necessary and more likely to develop biases. It is predicted that more general representations are likely to be more biased and less accurate, whereas the opposite should be true for more specific representations. It is important to note that this proposed pattern should also hold for representations that are within the same level of the hierarchy but differ in their extent of abstractness. For example, perceiving a partner as “loving” is more global than perceiving him or her as “taking care of me when I’m sick.” Global partner perceptions are likely to be less accurate than perceptions of the partner’s specific attributes (Neff & Karney, 2005).
THE CONTENT OF INTERPERSONAL REPRESENTATIONS Because IRs develop on the basis of repeated interactions primarily within dyadic relationships, the content of these representations should involve representations of the self, of others, and of the relationship between the self and others.1 As Figure 1 shows, representations at every level of the hierarchy are hypothesized to have all of these three components. Specifically, at the lowest, relationship-specific level, people hold representations of themselves and each specific interaction partner, and representations of the relationship between themselves and the partner. At the domain-specific level, they hold a more generalized representations of the self and others involved in each type of relationship, and representations of every type of relationship. At the highest level, individuals hold the most general representations of the self, others, and relationships. Thus, IRs are not only vertically connected within the hierarchy (i.e., across different levels), but also horizontally connected (i.e., across representations of the self, others, and relationships).
Representations of the Self and Others Relationship researchers have long-standing interests in mental representations of the self and others. Attachment theory, one of the classical theories in relationship literature, suggests 1
Different authors have conceptualized content of interpersonal representations from slightly different perspectives. Some researchers think of content components in terms of the target of representation (Pietromonaco & Feldman Barrett, 2000); that is, the content of IRs includes how people represent about the self (e.g., am I lovable?) and about others (e.g., are others trustworthy?). Other researchers conceptualize the content of representations from a more cognitive perspective (Collins & Read, 1994; Collins et al., 2004); that is, the content of IRs is likely to include several different types of cognitions such as memories, beliefs and expectations, goals and needs, plans and action tendencies. Each of these two conceptualizations has their own merits and is not mutually exclusive. I chose to take the “target” approach because the focus of the entire article is on schema-like representations that are abstracted from past experiences and are consciously accessible. It seems most appropriate to think of the content of these representations as including self representations, other representations, and relationship representations.
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that individuals develop internal working models of self and other on the basis of repeated interactions with primary attachment figures. Whereas models of self capture the generalized beliefs about how acceptable and worthwhile the self is, models of others capture the generalized beliefs about how available and responsive others are (e.g., Bowlby, 1973; Bartholomew & Horowitz, 1991; Hazan & Shaver, 1987; Pietromonaco & Feldman Barrett, 2000). Models of self and others can be viewed as representations of self and others at the general level. According to relational schema theory (Baldwin, 1992), self schemas and other schemas are two of the three key elements of relational schemas. Baldwin (1992) defined self schemas and other schemas as “generalizations about the self and others in specific relational contexts that are used to guide the processing of social information.” (pp. 468) Self and other schemas thus are highly contextualized constructs and quite similar to relationship-specific representations of the self and others in the three-level hierarchical model. The current conceptualization of IRs is able to integrate the essence of both working models of attachment and relational schemas and expand it into a broader framework. In particular, I propose that the content of self representations should not limit to the worthiness of the self; similarly, the content of other representations should not restrict to the availability and responsiveness of others. Both self and other representations should contain multiple dimensions including the more intrapersonal (e.g., competent, worrying) and the more interpersonal dimensions (e.g., sociable, distant). I will illustrate this point further below.
Are Self Representations and Other Representations Independent or Interdependent? Because IRs develop on the basis of repeated interactions between the self and others, self representations and other representations are likely to be related to each other. According to Bowlby’s (1973) original attachment theory, children’s models of self and models of others are hypothesized to be mutually confirming. For example, a child with a consistently rejecting mother may come to think of the self as worthless and of others as undependable. This interdependence between self and other representations should also hold for adults. For example, a person with loving and responsive romantic partner may perceive the self as lovable and of the partner as trustworthy. More recently several authors have argued that individuals who are involved in close relationships are motivated to represent the self and close others in a collective rather than in an individualistic manner (e.g., Agnew, Van Lange, Rusbult, & Langston, 1998; Aron, Aron, Tudor, & Nelson, 1991; Cross, Morris, & Gore, 2002). Empirical research provides strong evidence for this hypothesis. For example, individuals tend to perceive their romantic partners and their close friends as being similar to themselves even though there is little actual similarity between them (Kenny & Acitelli, 2001; Klohnen & Luo, 2006; Watson, Hubbard, & Wiese, 2000b; Murray, Holmes, Bellavia, Griffin, & Dolderman, 2002; Cross et al., 2002); they also tend to show greater spontaneous usage of plural pronouns (e.g., we, us, ours, Agnew et al., 1998) and have more difficulty differentiating between characteristics of the self and of close others (Aron et al., 1991); finally, individuals view partners’ successes as shared glories rather than threats to self-esteem as the classical social comparison theory would expect (Gardner, Gabriel, & Hochschild, 2002; Beach et al., 1998). These findings suggest that representations of the self and of others are highly interdependent rather than independent.
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However, attachment studies tend to show that self models and other models are largely independent of each other (e.g., Cozzarelli et al., 2000; Griffin & Bartholomew, 1994; Pierce & Lydon, 2001). How do we reconcile this seeming inconsistency? I argue that the independence between self models and other models based on attachment research should not be interpreted as evidence for the relation between representations of self and others, because (1) these studies actually only measured self representations and did not explicitly measure individuals’ representations of others (i.e., they did not ask participants to rate how they view others); (2) essentially these studies assessed two dimensions of self representations—a more intrapersonal dimension (which was named “self model”) captures a sense of competence and confidence, whereas the other dimension is more interpersonal in nature (which was named “other model”) and captures how individuals perceive themselves in relation to others (e.g., do individuals perceive themselves as trusting and loving, or cold and distant?) (e.g., Griffin & Bartholomew, 1994). The interpersonal dimension (i.e., other model) is expected to be relatively independent from the intrapersonal dimension (i.e., self model) because they capture quite different domains of self representations. In other words, the finding that self and other models tend to be independent only reflects the association between the two dimensions—the intrapersonal dimension and the interpersonal dimension, rather than the true association between self- and other representations. In order to test whether self- and other representations are truly interdependent, particularly whether this interdependence holds at more general levels as most evidence for the interdependence has been obtained from studies of relationship-specific representations, future research will need to independently assess these two representations and systematically test their associations.
Individual Differences in Self and Other Representations Important individual differences seem to underlie representations of the self and others. Attachment researchers have theorized that individuals with different attachment styles are likely to hold systematically different models of self and other: Whereas primarily secure individuals have positive beliefs about the self and others, fearful individuals are typically characterized by low self-worth and negative expectations about others. Dismissing individuals tend to hold negative models of others and highly positive models of the self, whereas preoccupied individuals show the opposite pattern—they have negative beliefs about the self and positive models of others (see Bartholomew & Horowitz, 1991; Griffin & Bartholomew, 1994). Pietromonaco and Feldman Barrett (2000) provided a comprehensive review regarding the evidence for these hypothesized patterns associated with different attachment styles. They concluded that whereas there is robust evidence for the theoretically predicted patterns of models of self, evidence is less consistent for models of others. Part of the inconsistency observed for other models is likely to be due to the fact that some studies examined self and other representations in general terms (e.g., Collins & Read, 1990; Hazan & Shaver, 1987), whereas others tested them in specific relationships (e.g., Pietromonaco & Feldman Barrett, 1997). Since every specific interaction partner is different from each other, accordingly, one’s representations of others should show reasonable variability. In general, most previous studies have only examined individual differences on either general representations or a specific type of representations and thus failed to take into consideration the fact that individuals hold multiple representations at different levels. Thus, it will be important for future research to clarify (1) for each level in the hierarchy of IRs, how different individuals represent the self
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and others and (2) to what extent these individual differences in self representations and other representations hold across different levels of abstractness.
Importance of Self and Other Representations to Relationship Functioning Self- and other representations have strong associations with relationship satisfaction. Previous research has shown that individuals who perceive themselves as low in self-esteem, highly neurotic, or insecurely attached tend to be less satisfied with their relationship; their relationships also tend to be less stable (e.g., Karney & Bradbury, 1995; Murray, Holmes, & Griffin, 2000; Campbell, Simpson, Boldry, & Kashy, 2005; Watson, Hubbard, & Wiese, 2000a). Individuals tend to be happier in their relationships if they perceive their partner as more extraverted, agreeable, conscientious, and less neurotic, and if they view their partner as less avoidant and anxious (e.g., Kosek, 1996; Watson et al., 2000a; Watson et al., 2004). Watson et al. (2000a, 2004) used both individuals’ self-ratings and partner-ratings on a range of individual difference domains (e.g., Big Five, affectivity) to predict relationship satisfaction in dating and married samples. Their findings showed that in spite of their interdependence, self and other ratings made independent, substantial contributions to the prediction of relationship satisfaction. However, partner ratings tended to contribute more than self ratings did, suggesting that self and partner representations may play different roles in relationship maintenance and that partner representations may be the more proximal predictors of relationship satisfaction than self representations.
Relationship Representations In their interactions with others, individuals form representations of many aspects of their interpersonal experiences. Self- and other representations are two subsets of these representations. In addition to holding representations of the self and others, individuals may also develop representations of the relationship between themselves and others. Relationship representations can be conceptualized as organized knowledge, perceptions, and evaluations of the relationship between the self and others. The content of relationship representations may include perceptions of various aspects of the relationship such as relationship closeness, mutual trust, control in relationship, optimism about future of relationship, severity of relationship conflict, and quality of communication. To date, there has been sporadic discussion about relationship representations in the relationship literature. For example, attachment theorists propose that internal working models have two primary components—models of the self and models of others. Although some authors have suggested that working models may also include models of the relationship between the self and others (e.g., Pietromonaco & Feldman Barrett, 2000), there is no systematic conceptualization of relationship representations as a unique component of working models. Other theorists tend to focus on representations of specific interactions or events between the self and others rather than on representations of the relationship between the two (Baldwin, 1992; Stern, 1985; Mitchell, 1988; Safran, 1990a, 1990b). For instance, in addition to proposing that self schemas and other schemas are important components of relational schema, Baldwin (1992) defined a third component, interpersonal scripts, as schemas for the typical “if-then” interaction sequences between self and other in a particular situation. Example interpersonal scripts are “if I come home late, my girlfriend will suspect
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that I am with some other girl and will complain for hours.” Because interpersonal scripts are schemas of “if-then” interaction sequences between the self and specific others, whereas relationship representations are expected to consist of generalized expectations regarding the relationship between the self and others, interpersonal scripts can be thought of as forming the basis of relationship representations. It is very important for researchers to start to consider relationship representations as a unique component of IRs and as an equally important component as self- and other representations. Although relationship representations are likely to be closely associated with representations of self and others, they may contain unique perceptions of the relationship and reflect the interactive nature of the relationship that is not likely to be fully captured by self and other representations. Thus including relationship representations in the study of IRs should greatly improve our understanding of IRs. Empirical research regarding relationship representations is scarce. However, some initial findings shed important light on the link between relationship representations and self representations. Helgeson (1994) found that positive self-beliefs and positive relationship beliefs showed differential predictive power to general psychological wellbeing (i.e., anxiety, depression, hostility) and relationship outcomes (i.e., breakup or not, adjustment to physical separation, adjustment to breakup). More specifically, positive self-beliefs were associated with better wellbeing but not with relationship outcomes, whereas relationship beliefs predicted all three relationship outcomes. Fowers, Lydons, and Montel (1996) tested whether positive illusions about marriage are primarily outgrowths of the self-enhancing illusions or an integral part of a satisfaction maintenance mechanism. Their results supported that positive illusions about marriage are more closely associated with marriage quality than with selfenhancement tendencies. Finally, Endo, Heine and Lehman (2000) found that relationshipserving biases were largely unrelated to self-esteem and self-serving biases. Overall, it seems that relationship representations are quite distinct from self representations and may serve very different functions. As Van Lange and Rusbult (1995) pointed out, “compared to selfenhancement processes, relationship enhancement may be more complex… and may be multifaceted.” However, these pioneering studies have focused on one particular aspect of relationship representations—enhancement perceptions and have only examined the links between relationship representations and self representations. It thus will be important to test (1) how relationship representations and other representations are associated and (2) whether these two components independently predict relationship outcomes.
THE NATURE OF INTERPERSONAL REPRESENTATIONS To date, theorizing about the nature of IRs has been limited to the notion that IRs are internalized, general beliefs about the self in relation to others that develop from past interpersonal experiences. For example, attachment theorists have suggested that working models include general beliefs about self and others (e.g., Bowlby, 1973; Collins & Read, 1994). According to Baldwin’s (1992) conceptualization, relational schemas primarily consist of generalizations about self and other as well as expectations of behavior sequences involved in their interactions. However, what is exactly the nature of these “general beliefs” about self, others, and the relationship? These theories did not provide further hypotheses. One important
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purpose of this chapter is to provide a useful conceptualization of the nature of IRs. Although IRs are likely to include other components such as past memories and future goals (see Collins & Read, 1994; Collins et al., 2004), the focus here is on the nature of “working” representations that are expected to have the most direct and powerful influence on individuals’ current thoughts, feelings, and behaviors. In particular, I focus on consciously accessible representations that can be assessed by self-report methods. One way to conceptualize the nature of IRs is to think from the perspective of accuracy and inaccuracy of these representations. Individuals are able to obtain reasonable accuracy when they are motivated to be accurate and have sufficient cognitive resources to do so (see Gagne & Lydon, 2004). At the same time, representations may be systematically biased in one way or another due to cognitive (e.g., Watson et al., 2000b) and motivational factors (e.g., Klohnen & Luo, 2006; Murray, Holmes, & Griffin, 1996a; Murray et al., 2002). Finally, random perceptual errors occur due to temporary, situational factors (see Funder, 1995; Murray et al., 1996a). Therefore, the nature of IRs should necessarily reflect reality to some degree and should also contain misperceptions. Some misperceptions are systematic biases and some are purely erroneous perceptions (see Figure 2). Accordingly, it is useful to conceptualize IRs as a composite of accurate perceptions, systematic biases, and random errors (see Klohnen & Luo, 2006; Murray et al., 1996a). This three-component conceptualization can be readily incorporated in the proposed hierarchical model of IRs. We can think of the three components as being nested within self, other, and relationship representations at each level of the hierarchy. That is, general, domain-specific, and relationship-specific representations of self, others, and relationships, should all contain accurate perceptions, systematic biases, and random errors.
Interpersonal Representations
=
Accurate Perceptions
+
Inaccurate Perceptions
Systematic Biases
Random Errors
Figure 2. A conceptualization of the nature of interpersonal representations.
In the following sections of the article, my focus is on the systematic components of representations—accurate and biased perceptions since these two components are expected to have systematic and most meaningful influences on personal and relational outcomes. I first discuss the methodological approaches to studying accuracy and bias, followed by a review of research regarding accuracy and bias in representations of the self, the partner and the relationship in the romantic context. I choose to focus on accuracy and bias in romantic representations because romantic relationship is usually the most influential relationship in adulthood and thus romantic representations should have the greatest impact on individuals’ intra- and interpersonal functioning.
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Approaches to Conceptualizing and Measuring Accuracy and Bias There are two major approaches to conceptualizing and assessing accuracy and bias: the logical impossibility approach and the accuracy benchmark approach (see Funder, 1995; Taylor & Brown, 1988).
The Logical Impossibility Approach This approach has been widely used to examine social comparison processes. In a typical paradigm of this approach, participants are asked to rate themselves relative to average others. Results show the majority rate desirable attributes as more descriptive of themselves than of average others (the “above-average effect”) and undesirable attributes as less descriptive of themselves than of the average others (the “below-average effect”) (e.g., Brown, 1986; Kruger, 1999). Because most attributes have a statistically normal distribution, it is logically impossible for the majority to be truly better than the average; that is, some people must be exaggerating. This self-serving tendency is considered to be a bias. The “better than average effect” is seen not only in self perceptions, but also in perceptions of one’s close others, including romantic partners (e.g., Murray & Holmes, 1997), friends (e.g., Brown, 1986; Suls, Lemos, & Stuart, 2002), and family members (e.g., Endo et al., 2000). Although this approach clearly shows that some people in the population must be biased, it does not allow us to pinpoint who are biased and to what extent these individuals are biased. The Accuracy Benchmark Approach Researchers who take this approach first need to define an accuracy benchmark, which then allows them to show to what extent individuals’ perceptions deviate from that benchmark. Any systematic differences between individuals’ perceptions and the accuracy benchmark are then considered a bias. This approach is popular among psychologists who are interested in self perceptions and other perceptions. The basic assumption behind this approach is that individuals’ perceptions contain both accurate perceptions and biases, and it is possible to separate accurate perceptions and biases as long as there is an accuracy benchmark. However, unlike object perception, for which we are able to find some objective criteria to judge whether the perceptions are accurate or not, there is no perfect “objective truth” or accuracy benchmark in person perception. In fact, various accuracy benchmarks have been used and justified depending on the particular research purposes (e.g., Funder, 1995). In the study of intimates’ perceptions, one possible accuracy benchmark is ratings provided by an outside observer of the couple, for example, a common friend to both partners. Self-friend agreement on ratings of the same attributes is then considered as an index of accuracy. If intimates’ ratings significantly and systematically deviate from the ratings made by outsiders, the deviations are considered as indicators of perceptual bias (e.g., John & Robins, 1994; Murray, Holmes, Dolderman, & Griffin, 2000). Self-ratings provided by the partners can be another accuracy benchmark for individuals’ perceptions of their partners. Deviations in participants’ partner perceptions from the partners’ self-perceptions are then be considered as evidence of bias (e.g., Murray et al., 1996a, 1996b; Kenny & Acitelli, 2001; Klohnen & Luo, 2006; Watson et al., 2000b; see Gagne & Lydon, 2004 for a more detailed review).
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Accuracy and Bias in Self Representations Overall, people seem to hold fairly accurate self representations because (1) there is substantial agreement between participants’ self ratings and their partner’s ratings of them (e.g., Klohnen & Luo, 2006; Watson et al., 2000b; Murray et al., 1996a), (2) the agreement between participants’ self-ratings and friends’ ratings of them is reasonable (e.g., John & Robins, 1994; Murray et al., 2000), and (3) self-evaluations of performance show considerable convergence with evaluations from unacquainted peers and observers (John & Robins, 1994). Despite this accuracy, there is also robust evidence that individuals’ self representations are biased. Taylor and Brown (1988) published an influential review of the enhancement bias in self-concepts. They suggest that self-enhancement biases are a rule rather than an exception and that these biases can be observed in three domains: (a) overly positive views of the self, (b) exaggerated perceptions of personal control, (c) unrealistic optimism about one’s future. How do romantic relationships influence individuals’ self representations? Important changes in self views seem to take place when people start to have romantic feelings for somebody. Aron, Paris and Aron (1995) followed their participants five times over 10 weeks and found that those who had just fallen in love during this period showed significant selfconcept changes: participants discovered new aspects of self, and their self-efficacy and selfesteem increased. These findings indicate that falling in love has a powerful, positive influence modifying self representations. However, because the researchers only obtained self-report measures of the representations, it is not clear to what extent the changes in selfconcepts reported by those who fell in love would be evident to outside observers; that is, we are not sure how accurate these changes are. We also do not know whether these changes in self representations are permanent. For example, would individuals lose the changes in selfconcepts when they do not have feelings for the person any more? Would they show negative changes in self representations when they experience relationship break-ups? Longitudinal studies following individuals throughout their relationships are needed to answer these questions. Research on dating and married couples suggests that people in relationships may rely on their partners’ feedback to construct their self views. Murray et al. (1996b) followed dating individuals over a year and found that partners’ initial perceptions of participants were a significant predictor of participants’ self-perceptions one year later when participants’ initial self perceptions were controlled. This finding suggests that intimates tend to incorporate partners’ perceptions into their self views. Drigotas and his colleagues (Drigotas, 2002; Drigotas, Rusbult, Wieselquist, & Whitton, 1999) found that the more individuals believed that their partner perceive them in line with what they ideally would like to become, the more individuals indeed became so over time. It seems that partners’ perceptual confirmation of individuals’ ideal self motivates them to move further toward their ideal self, thus bringing their actual self representations closer to their ideal self over time. In summary, romantic partners’ feedback plays an important role in shaping individuals’ self representations.
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Accuracy and Bias in Romantic Partner Representations Partner representations have been extensively studied in the past decade. Overall, research suggests that there is substantial accuracy in individuals’ partner representations. For instance, individuals’ ratings of their partners show moderate agreement with partners’ selfratings (Kenny & Acitelli, 2001; Klohnen & Luo, 2006; Klohnen & Mendelsohn, 1998; Watson, et al., 2000b; Murray et al., 1996a, 1996b). Individuals also share considerable agreement with their friends regarding perceptions of their partners (Murray et al., 2000). Finally, married and dating couples are relatively accurate in inferring each other’s ongoing thoughts and feelings (Thomas, Fletcher, & Lange, 1997; Thomas & Fletcher, 2003). On the other hand, as the old saying “beauty is in the eyes of the beholder” illustrates, partners’ perceptions of each other are nevertheless biased even though they are able to perceive their partners fairly accurately. In order to test how people form perceptions of their partners, researchers have examined possible ways by which individuals’ perceptions of their partners systematically deviate from the partners’ self-perceptions. Perceiving Actual Partner as Being Similar to One’s Ideal Partner Everybody has his or her own ideas about what their ideal partner is like. However, in real life very few people end up with a partner who fits their ideal images perfectly. Rather than being constrained by the less-than-perfect reality of what partners are actually like, individuals may be motivated to view their partners in an idealized fashion. For example, research has consistently shown that individuals perceive their partner as being similar to their ideal partner standards to a degree that goes beyond the actual resemblance between their partner’s self-ratings and their ideal partner images (Murray et al., 1996a, 1996b). More importantly, individuals tend to be happier and stay longer in their relationships when they perceive partners close to their own ideal partner images (Fletcher, Simpson, & Thomas, 2000; Fletcher, Simpson, Thomas, & Giles, 1999). Therefore, distorting partner perceptions in the direction of one’s ideal partner images may have beneficial rather than detrimental effects. Perceiving the Partner as Being Similar to One’s Ideal Self The motivation that underlies this process is similar to the previous one. Individuals seek in partners what they value in themselves and what they ideally want to be but are not able to achieve; in short, individuals are motivated to fulfill their own “ideal self” in their partners (Klohnen & Mendelsohn, 1998; Klohnen & Luo, 2003). However, because people do not always secure a partner who resembles their ideal self, they might bias their partner perceptions toward their ideal self. There is empirical evidence for this hypothesized perceptual pattern. At the initial attraction stage, the more similar the potential partner is perceived to be to one’s ideal self, the more attractive the partner appears to be (Klohnen & Luo, 2003; LaPrelle, Hoyle, Insko, & Bernthal, 1990). Dating and married individuals tend to perceive their partners as being more similar to their ideal selves than they actually are (Murstein, 1971; Klohnen & Mendelsohn, 1998). It seems that people wish to be with somebody who has the potential to fulfill their ideal self and are motivated to perceive their current partners in line with their ideal selves.
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Perceiving the Partner in An Overly Positive Way Individuals may also be motivated to simply perceive their partner in a generally positive light or in a socially desirable way—not necessarily in line with their ideal self or ideal partner images. There are good reasons for people to do so because positive biases allow them to maintain their conviction that their partner is the “right” one and that their relationship is worth keeping, particularly when the relationship is threatened by feelings of doubt and uncertainty (Murray, 1999). Indeed, recent research provides robust evidence for positive biases in partner perceptions. Research taking the logical impossibility paradigm has well documented the “(partner) better than average effect” among dating and married individuals; that is, the majority of individuals believe their own partners are more virtuous than average or typical partners (e.g., Murray & Holmes, 1997; Endo et al., 2000) and better than their friends’ partners (e.g., Murray et al., 2000). Research based on the accuracy benchmark approach also shows that intimates tend to perceive their partners more positively than the partners view themselves or their friends perceive the partner (e.g., Murray et al., 1996a, 1996b, 2000). Moreover, individuals who hold these positive biases tend to be happier and their relationships are more likely to persist over time (e.g., Murray et al., 1996a, 1996b; Rusbult, Van Lange, Wildschut, Yovetich, & Verette, 2000). Perceiving the Partner as Being Similar to One’s Actual Self From a motivational perspective, it is psychologically rewarding to perceive partners similar to the self because the perceived similarity may validate one’s self views, increase familiarity between intimates, and result in fewer disagreements and conflicts (Aron et al., 1991; Klohnen & Luo, 2003; Murray et al., 2002). In fact, the more individuals perceive a potential partner as similar to themselves, the more attracted they are to him or her (Klohnen & Luo, 2003). People in dating and married relationships also exaggerate the similarity between themselves and their partner on a variety of dimensions such as interpersonal qualities, values, and feelings (Murray et al., 2002; Kenny & Acitelli, 2001), general personality and affectivity (Klohnen & Luo, 2006; Watson et al., 2000b), adaptive and nonadaptive personality characteristics (Ready, Clark, Watson, & Westerhouse, 2000), and attachment dimensions (Klohnen & Luo, 2006; Ruvolo & Fabin, 1999). It is important to note that different labels have been applied to this general phenomenon, including “egocentrism” (Murray et al., 2002), “similarity bias” (Klohnen & Luo, 2006), “assumed similarity” (Watson et al., 2000b), “self-based heuristic” (Ready et al., 2000), and “social projection” (Ruvolo & Fabin, 1999). Irrespective of the label, the underlying idea is the same—intimates tend to perceive more similarity between themselves and their partners than their actual similarity. Furthermore, this similarity bias is positively associated with feelings of being understood and relationship satisfaction (Klohnen & Luo, 2006; Murray et al., 2002). In summary, individuals’ partner representations include both accurate and biased perceptions. There appears to be several processes leading to biases in partner representations: perceiving partners as similar to one’s actual self, ideal self, ideal partner, as well as perceiving partners in an overly positive way. There is at least one other process in partner perceptions—perceiving partners as highly secure in terms of attachment (Klohnen & Luo, 2003). It is likely that these processes may be partly overlapping, or that one or several of these processes may be more influential than others. So far no study has investigated all of these processes in the same context. Klohnen and Luo (2003) examined three processes in participants’ perceptions of hypothetical dating partners: perceiving the partner as similar to
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(a) participants’ actual self, (b) their ideal self, and (c) the secure attachment prototype. Results showed that the effect of perceptual security on attraction to the partner was subsumed by the effect of perceptual ideal self similarity. However, both actual and ideal self similarity made significant and independent contributions to the prediction of attraction. Future research should examine all of these processes simultaneously to determine which of these processes has the strongest influence on partner representations, and to what extent these processes make independent contributions to attraction and subsequent relationship development.
Accuracy and Bias in Romantic Relationship Representations Although relationship representations have received less attention compared to self- and partner representations, several studies have shown that accuracy and bias coexist in romantic relationship representations. Evidence for accuracy in relationship representations mainly comes from two types of research: First, representations are considered accurate if dyadic partners’ ratings of the relationship are correlated. For example, couples’ perceptions of improvement in their relationship, optimism about the relationship, perceptions of joint control over events in the relationship were moderately correlated (Murray & Holmes, 1997; Spretcher, 1999). Second, individuals’ thoughts and feelings about their relationship (e.g., their self-reported love, satisfaction, commitment, and closeness) are valid predictors of the future status of their relationships (see Gagne & Lydon, 2004 for a review). Individuals’ predictions of their own relationship length are also moderately correlated with how long their relationships last six months later (MacDonald & Ross, 1999). On the other hand, recent research also shows robust evidence for relationship enhancement bias. Parallel to Taylor and Brown’s (1988) typology of self enhancement bias, relationship enhancement bias can be categorized into three domains: perceived superiority of one’s own relationships, exaggerated control over relationships, and unrealistic optimism about the relationship development. Perceived Superiority of One’s Own Relationships Individuals take it for granted that their own relationships are much better than those of others. For example, intimates perceive the quality of their own relationships or marriages as better than that of average others’ in terms of closeness, mutual understanding, supportiveness, happiness, and the importance of the relationship (Endo et al, 2000; Fowers, Lyons, Montel, & Shaked, 2001). Individuals also tend to rate their relationships as better than those of their friends (Helgeson, 1994; Van Lange & Rusbult, 1995; Rusbult et al., 2000; Agnew, Loving, & Drigotas, 2001; Martz et al., 1998). Compared to outside observers, such as friends, intimates egocentrically view their own relationships more positively (MacDonald & Ross, 1999; Murray et al., 2000). Exaggerated Control Over One’s Own Relationships Murray and Holmes (1997) asked dating and married individuals to rate the amount of joint control they possessed over positive and negative events within their relationships; that is, their ability to increase the probability of good outcomes and decrease the probability of bad outcomes. Results showed that participants believed that they had much more control
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than other couples had. Using a similar procedure, Martz et al. (1998) found that intimates also believed that they had better control over their relationships than their friends had. Unrealistic Optimism about Romantic Relationship Development People tend to egocentrically believe their relationships are getting better over time. Sprecher (1999) conducted a longitudinal study that followed couples over four years. When asked to make a global comparison between their current relationship quality and the relationship quality measured last time, participants believed that their relationships were becoming more enjoyable and satisfactory. However, their actual ratings of relationship satisfaction obtained each time showed that their satisfaction, in fact, decreased over time. Another longitudinal study conducted by Karney and Frye (2002) corroborated this finding. They followed newlyweds over 10 years and found that intimates’ actual ratings of marital satisfaction were getting lower as time went by; however, when thinking in retrospective, they believed that their relationships were becoming better. Individuals also tend to overestimate how long their own relationships will last, whereas their roommates, friends and parents make more accurate predictions (Drigotas et al., 1999; MacDonald & Ross, 1999). When it comes to prediction of the likelihood of divorce, the majority of married respondents believed that they were unlikely to divorce, while the national divorce rate is nearly 50% (e.g., Fowers et al., 2001; Heaton & Albright, 1991). In summary, partners tend to show reasonable agreement with each other in their views and predictions of the relationship. On the other hand, they egocentrically believe that their own relationships are better than others, that they have more control over their own relationships, and that their relationships are becoming better. These relationshipenhancement biases are associated with better concurrent relationship outcomes, such as greater satisfaction and less conflict; these biases are also associated with greater relationship stability (Murray & Holmes, 1997). Given that representations of the self, partners, and relationships all contain enhancement biases, one important next step is to examine the how self-, partner-, and relationship-enhancement biases are related to each other and whether these biases play independent roles in relational functioning.
Revisiting Several Key Questions about Accuracy and Bias Over the last decade, an increasing number of researchers have become interested in accuracy and bias in perceptions of romantic partners (Gagne & Lydon, 2004; Kenny & Acitelli, 2001; Klohnen & Luo, 2006, 2005b; Klohnen & Mendelsohn, 1998; Murray et al., 1996a, 1996b, 2002; Neff & Karney, 2002, 2005). However, theorizing and research on this topic to date are quite limited because (1) most research and theory have primarily been concerned with understanding “when and how people are accurate as well as when and how they are mistaken” (pp. 652, Funder, 1995) rather than systematically considering accuracy and bias in the same context, and (2) previous research has not vigorously related accuracy and bias to other variables such as individual differences and relationship outcomes. I hope that conceptualizing the nature of IRs as containing accurate and biased perceptions (as well as random errors) will provide helpful insights for addressing the following questions about accuracy and bias.
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How Should We Conceptualize the Relation between Accuracy and Bias? The above review of romantic representations provides robust evidence that accuracy and bias coexist in representations people hold about themselves, their partners, and their relationships. In fact, this has become a consensus among relationship researchers (Gagne & Lydon, 2004; Kenny & Acitelli, 2001; Klohnen & Luo, 2006; Neff & Karney, 2002, 2005). However, little research has examined how being accurate is associated with being biased. A common, naïve assumption is that accuracy and bias are mutually exclusive; that is, the more accurate one’s perceptions are, the less biased these perceptions must be. Klohnen and Luo (2006) explicitly proposed that accuracy and bias do not have to be inversely associated. Because IRs are conceptualized to consist of accurate perceptions, systematic biases, and random errors, it is possible that when one of the three components changes, it does not necessarily translate into direct, one-to-one change in the other components. The association between perceptual accuracy and bias is likely to depend on the specific context in which these perceptions develop, such as the nature of the relationship and the degree of acquaintanceship. In the context of committed romantic relationships, Klohnen and Luo (2006) reasoned that accuracy and bias in partner perceptions are independent because the motivational factors that are likely to foster accuracy and those likely to foster biases are quite distinct in nature. Indeed, their results showed that accuracy was unrelated to the similarity or positivity bias. It is interesting to reflect on what these findings really mean. They suggest that knowing how accurate a person’s perceptions of his partner are, does not necessarily inform us about how biased he is—he may be very biased, moderately biased, or not at all biased. These findings thus fundamentally challenge the common assumption that greater accuracy in our perceptions of others must necessarily entail becoming less biased. I hope that this new perspective will stimulate more research on the nature of the association between accuracy and bias. For example, it will be important to examine how type of relationship and acquaintanceship may moderate the relation between accuracy and bias (see Klohnen & Luo, 2006). Is Everybody Equally Accurate and Biased? Although on average, individuals tend to be both accurate and biased when perceiving their partners, there appears to be considerable variability in the degree to which they are accurate and biased. Luo and Klohnen (2006) found that more ego-resilient and more securely attached individuals tend to show greater accuracy, similarity bias, and positivity bias in partner perceptions. Murray et al. (1996a, 1996b) showed that individuals with more positive self-views tend to see their partners more consistent with their ideals, whereas those who have more negative self-views engage in less idealization of their partners. John and Robins (1994) found that there was substantial variation in the extent to which individuals enhance their self evaluations; in particular, people whose self-evaluations were the most unrealistically positive tended to be narcissistic. It appears that individuals’ tendency to be accurate and biased are at least in part a function of who they are (see also Gagne & Lydon, 2004). However, the processes underlying the link between individual differences and perceptual accuracy or bias have not been fully explored.
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Which is More Adaptive: Accuracy or Bias? Another interesting question is to what extent accuracy and bias in IRs are beneficial. There has been a long debate regarding whether accuracy or positive bias is more adaptive. Some researchers argue that positivity or enhancement bias is adaptive (e.g., Endo et al., 2000; Martz et al., 1998; Murray et al., 1996a, 1996b; Murray & Holmes, 1997; Taylor & Brown, 1986), whereas others argue that accurate perceptions are beneficial (Colvin, Block, & Funder, 1995; Kobak & Hazan, 1991; Swann, Hixon, & De La Ronde, 1992; Swann, De La Ronde, & Hixon, 1994). It is suggested that these seemingly contradictory perspectives may both be true to some extent and can be reconciled if we conceptualize the relationship between accuracy and bias not as mutually exclusive but as relatively independent. Based on this conceptualization, it is possible for accuracy and bias to both have adaptive effects. Klohnen and Luo (2006) provided the most direct evidence for this proposition. They created an accuracy index and a positivity index for each individual in their newlywed sample; results suggested that accuracy and positivity bias contributed independently to the prediction of marital satisfaction. Neff and Karney (2005) also found that accuracy and positivity bias can operate simultaneously at different levels: Although most newlyweds enhanced their partners at the level of global perceptions, those who held more accurate perceptions of partners’ specific qualities were more supportive and less likely to divorce. Finally, Katz and her colleagues (Katz & Joiner, 2002; Katz, Anderson, & Beach, 1997) found that the association between positivity bias and relationship satisfaction was curvilinear, indicating that even though people tend to idealize their partners, their perceptions are also constrained by reality; perceptions that are too positive and have no basis in reality tend to have negative effects on relationships. These results consistently show that both accurate perceptions and positive bias are important to relationships. With regard to the adaptive value of similarity bias, researchers have found that similarity bias is associated with better marital satisfaction (Murray et al., 2002). More importantly, Klohnen and Luo (2006) showed that accuracy and similarity bias made independent contributions to the prediction of satisfaction. In summary, these findings suggest that both accuracy and bias are beneficial and important to a happy, satisfactory relationship or marriage. It is likely that a combination of moderate accuracy and bias may be most adaptive for relationship functioning; that is, accuracy without bias or bias without accuracy can both have negative implications for relationships (see also Gagne & Lydon, 2004; Neff & Karney, 2005).
FURTHER CONSIDERATIONS The primary aim of this chapter was to review, discuss, and propose theories and research relevant to how people represent their interpersonal relationships based on past experiences, with a particular emphasis on romantic contexts. Specifically, I have discussed three important aspects of IRs: their structure, content, and nature. Although the discussion has mainly focused on these aspects of IRs, I would like to draw attention to several additional questions that are broader in scope.
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Do Interpersonal Representations Contain Both Implicit and Explicit Components? I have been mainly discussing consciously accessible (i.e., explicit) representations that can be obtained from self-report measures. However, IRs are likely to include more than just explicit components. Research on attitudes, self-esteem, and stereotypes suggests that these psychological processes contain both implicit and explicit components that independently influence perceptions, judgments and behaviors (for a review see Greenwald & Banaji, 1995). Recent empirical evidence suggests that personality also includes implicit and explicit components (Asendorpf, Banse, & Mucke, 2002). Although little direct evidence indicates that IRs contain both explicit and implicit components, relationship researchers have reflected on this possibility. For example, attachment theorists have suggested that conscious and unconscious working models may be inconsistent and that the more conscious side may serve self-defensive functions (Bowlby, 1980; Collins & Read, 1994; Collins et al., 2004; Mikulincer, 1995; Pietromonaco & Feldman Barrett, 2000; Simpson & Rholes, 2002). In particular, Bartholomew (1997) elaborated on this issue in light of the observation that dismissing individuals tend to hold positive self models and that preoccupied individuals tend to hold positive other models when assessed with explicit measures. She noted that at some unconscious level dismissing individuals may feel negatively about themselves, yet they manage to maintain a positive self-image as a way to defend a “fragile” sense of self. Similarly, preoccupied individuals may unconsciously hold negative models of others, and their conscious positive other models are a defense against the fact that their significant others are at times unavailable and unsupportive. In order to get a comprehensive understanding of IRs, it is extremely important for researchers to use more implicit measures (e.g., the Implicit Association Test) in addition to explicit measures to examine representations that are less masked by conscious self-defense or self-presentation motives. Specific questions to be addressed include: (1) Are there systematic discrepancies between responses obtained from explicit and implicit measures of IRs? (2) If there are systematic discrepancies, does the nature of these discrepancies differ across individuals? (3) How do explicit and implicit representations jointly influence the processing of information? (4) Are explicit and implicit representations differentially associated with personal and relationship well-being?
How Do Interpersonal Representations Influence Perceptions, Feelings, and Behaviors? The main purpose of this chapter is to review theories and research regarding the more static aspects of IRs—their structure, content, and nature. However, one of the most important tasks that relationship researchers face is to understand the dynamic aspects of IRs—how representations affect individuals’ perceptions, feelings, and behaviors. Social cognition research has provided important insights in this regard. Representations can be largely categorized into two types in terms of their accessibility. Most frequently used representations become chronically accessible and they influence information processing in an automatic manner, whereas representations that are less accessible can be temporarily activated (e.g.,
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Bargh, Bond, Lombardi, & Tota, 1986); which specific representations that are activated and used to guide perceptions and behaviors will likely depend on the extent to which it applies to the specific situation (see Higgins, & Brendl, 1995). IRs, just like other mental representations, include both chronically and temporarily accessible representations. Different individuals are likely to hold different chronically accessible representations that have automatic and systematic influence on their perceptions, feelings, and behaviors. For example, individuals with low self-esteem may hold chronic negative self representations that may lead them to perceive others’ positive feedback as sarcastic. With chronic positive other representations, securely attached individuals may interpret their partner’s absence as temporary and unintentional. For individuals who hold chronic negative relationship representations, they may be hesitant to get involved in committed relationships because they believe that relationships are difficult and frustrating. Research designed to examine temporarily accessible IRs is still at its earliest stage; however, initial findings shed important light on how these representations are activated and applied to subsequent information processing. For example, Mikulincer, Gillath, and Shaver (2002) found that subliminal priming of threat led to increased accessibility of representations of attachment figures, suggesting that situation plays an important role in the activation of representations. Baldwin, Carrell, and Lopez (1990) found that participants gave less positive self-evaluations after the subliminal presentation of a disapproving significant other, whereas subliminally priming a disapproving non-significant other did not have any effect. Mikulincer, Hirschberger, Nachmias, and Gillath (2001) subliminally primed attachmentsecure representations or non-attachment representations and found that the primed secure representations led to more positive reactions to neutral stimuli than non-attachment priming did. Pierce and Lydon (2001b) showed that subliminal activation of positive interpersonal expectations increased reports of seeking emotional support and decreased the use of selfdenigrating coping, whereas activation of negative interpersonal expectations decreased experiences of positive affect and tended to impede constructive coping. In summary, it seems that both chronic accessible and temporarily activated representations strongly influence the processing of incoming information. Given that social cognition research has shown that chronically and temporarily accessible representations have additive influences on social perception (Bargh et al., 1986), it will be useful for relationship researchers to explore the nature of the joint influence of these two types of representations in relationship contexts—whether their effects are independent, overlapping, or interactive.
Stability and Change in Interpersonal Representations Most theorists acknowledge that IRs are quite stable over time but also changeable when life circumstances change (e.g., Bowlby, 1969; Pietromonaco, Laurenceau, & Feldman Barrett, 2003). Indeed, previous research has provided robust evidence that individuals’ representations of themselves and others are remarkably stable over time (e.g., Kirkpatrick & Hazan, 1994; Klohnen & Bera, 1998; Murray et al., 1996b; Scharfe & Bartholomew, 1994). In spite of this high stability, IRs also show interesting changes over time in response to new experiences. For example, when individuals fall in love with somebody, their self concepts are expanded and their self-esteem increases (Aron et al., 1995). Dating and married individuals come to adopt partners’ perceptions of them into their self representations
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(Murray et al., 1996b; Drigotas et al., 1999). They also tend to represent the self and close others as a unit over time (e.g., Aron et al., 1991; Agnew et al., 1998). The marital intervention literature suggests that it is possible and useful to induce changes in people’s representations of the self, the spouse, and the relationship; these changes provide alternatives to maladaptive representations (see Pietromonaco et al., 2003 for a review). To date, research investigating the question of representational stability has primarily focused on individuals who are involved in well-established relationships. Only a few studies have examined IRs at earliest stages of relationship development (Aron et al., 1995; Fletcher et al., 2000). Even less research has been conducted to examine how individuals represent themselves, their ex-partners, and previous relationships after the relationship has dissolved (but see Felmlee, 2001 for an exception). Given that individuals tend to hold “positive illusions” for themselves, their partner, and their romantic relationship while they are involved in an ongoing relationship, would they become more objective or more negatively biased after they break up with their partner? It is very important to examine IRs throughout the entire course of relationship development, including initial crush or attraction, consolidation, and dissolution. This type of longitudinal research is extremely valuable because they not only inform us regarding the stability of IRs, but also help to address questions regarding the direction of causality between representations and relationship outcomes, for example, do positive partner representations lead to attraction or does attraction to someone make people biased?
CONCLUSIONS A good understanding of how people represent themselves in relation to others is of enormous importance to relationship research because what we think about ourselves, others, and our relationship is likely to greatly influence how we attend to new information and how we interpret new facts; moreover, our representations guide what we feel and how we act in relationships. The structure, content, and nature are the three most fundamental aspects of these representations. Understanding these aspects of IRs as well as of the links between IRs and individuals’ feelings and behaviors in relationships also has important practical implications because such knowledge helps us design interventions that will hopefully promote healthy relationship patterns and prevent maladaptive ones from developing in the first place. The study of IRs is therefore both theoretically rich and practically valuable. It nicely bridges social cognition and relationship research, and cuts across different areas of psychology, including social, personality, developmental, and clinical psychology. This challenging work will likely require creative methodologies that combine techniques typically employed by social psychologists (e.g., priming, response latencies) and research designs typically used by relationship researchers (e.g., dyadic design, longitudinal studies). As an effort to accomplish this goal, this chapter provides an extensive review and discussion of theories and research regarding the structure, content, and nature of IRs. I hope that this chapter will provide a useful beginning of a more comprehensive theoretical framework that can help shape future research on IRs.
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ACKNOWLEDGEMENT The author wishes to thank Eva Klohnen for her helpful comments on earlier drafts of this chapter.
REFERENCES Agnew, C. R., Loving, T. J., & Drigotas, S. M. (2001). Substituting the forest for the trees: Social networks and the prediction of romantic relationship state and fate. Journal of Personality & Social Psychology, 81, 1042-1057. Agnew, C. R., Van Lange, P. A. M., Rusbult, C. E., & Langston, C. A. (1998). Cognitive interdependence: Commitment and the mental representation of close relationships. Journal of Personality & Social Psychology, 74, 939-954. Aron, A., Aron, E. N., Tudor, M., & Nelson, G. (1991). Close relationships as including other in the self. Journal of Personality and Social Psychology, 60, 241-253. Aron, A., Paris, M., & Aron, E. N. (1995). Falling in love: Prospective studies of self-concept change. Journal of Personality and Social Psychology, 69, 1102-1112. Asendorpf, J. B., Banse, R., & Mucke, D. (2002). Double dissociation between implicit and explicit personality self-concept: The case of shy behavior. Journal of Personality & Social Psychology, 83, 380-393. Baldwin, M. W. (1992). Relational schemas and the processing of social information. Psychological Bulletin, 112, 461-484. Baldwin, M. W., Keelan, J. P. R., Fehr, B., Enns, V. E., & Koh-Rangarajoo, E. (1996). Social-cognitive conceptualization of attachment working models: Availability and accessibility effects. Journal of Personality and Social Psychology, 71, 94-109. Baldwin, M. W., Carrell, S. E., Lopez, D. F. (1990). Priming relationship schemas: My advisor and the Pope are watching me from the back of my mind. Journal of Experimental Social Psychology, 26, 435-454. Bargh, J. A., Bond, R. N., Lombardi, W. J., & Tota, M. E. (1986). The additive nature of chronic and temporary sources of construct accessibility. Journal of Personality & Social Psychology, 50, 869-878. Bartholomew, K. (1997). Adult attachment processes: Individual and couple perspective. British Journal of Medical Psychology, 70, 249-263. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226-244. Beach, S. R. H., Tesser, A., Fincham, F. D., Jones, D. J., Johnson, D., & Whitaker, D. J. (1998). Pleasure and pain in doing well, together: An investigation of performancerelated affect in close relationships. Journal of Personality and Social Psychology, 74, 923-938. Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. NY: Basic. Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss: Sadness and depression. New York: Basic.
Interpersonal Representations: Their Structure, Content, and Nature
59
Bretherton, I. (1985). Attachment theory: Retrospect and prospect. In I. Bretherton & E. Waters (Eds.) Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50, (1-2, Serial No. 209), 3-35. Brown, J. D. (1986). Evaluations of self and others: Self-enhancement biases in social judgments. Social Cognition, 4, 353-376. Campbell, L., Simpson, J. A., Boldry, J., & Kashy, D. A. (2005). Perceptions of Conflict and Support in Romantic Relationships: The Role of Attachment Anxiety. Journal of Personality & Social Psychology, 88, 510-531. Collins, N. L., Guichard, A., Ford, M. B., & Feeney, B. C. (2004). Working models of attachment: New developments and emerging themes. In W. S. Rholes & J. A. Simpson (Eds) Adult Attachment: Theory, Research, and Clinical Implications. New York: Guilford Press. Collins, N., & Read, S. J. (1994). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58, 644-663. Collins, N., & Read, S. J. (1994). Cognitive representations of attachment: The structure and function of working models. In D. Perlman & K. Bartholomew (Eds.) Advances in Personal Relationships (Vol. 5, 53-90). London: Jessica Kingsley. Colvin, C. R., Block, J., & Funder, D. C. (1995). Overly positive self-evaluations and personality: Negative implications for mental health. Journal of Personality and Social Psychology, 68, 1152-1162. Cozzarelli, C., Hoekstra, & Bylsma, W. (2000). General versus specific mental models of attachment: Are they associated with different outcomes? Personality and Social Psychology Bulletin, 26, 605-618. Cross, S. E., Morris, M. L., & Gore, J. S. (2002). Thinking about oneself and others: The relational-interdependent self-construal and social cognition. Journal of Personality & Social Psychology, 82, 399-418. Crowell, J. A., Fraley, R. C., & Shaver, P. R. (1999). Measurement of individual differences in adolescent and adult attachment. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 434-465). New York: Guilford Press. Donahue, E. M., Robins, R. W., Roberts, B. W., & John, O. P. (1993). The divided self: Concurrent and longitudinal effects of psychological adjustment and social roles on selfconcept differentiation. Journal of Personality & Social Psychology, 64, 834-846. Drigotas, S. M. (1999). The Michelangelo phenomenon and personal well-being. Journal of Personality, 70, 59-77. Drigotas, S. M., Rusbult, C. E., Wieselquist, J., & Whitton, S. (1999). Close partner as sculptor of the ideal self: Behavioral affirmation and the Michelangelo phenomenon. Journal of Personality and Social Psychology, 77, 293-323. Endo, Y., Heine, S. J., Lehman, D. R. (2000). Culture and positive illusions in close relationships: How my relationships are better than yours. Personality and Social Psychology Bulletin, 26, 1571-1586. Felmlee, D. H. (2001). From appealing to appalling: Disenchantment with a romantic partner. Sociological Perspectives, 44, 263-280. Fletcher, G. J. O., & Fincham, F. D. (1991). Attribution processes in close relationships. In G. J. O. Fletcher & G. D. Fincham (Eds.), Cognition in close relationships (pp. 7-35). Hillsdale, NJ: Erlbaum.
60
Shanhong Luo
Fletcher, G. J. O., Simpson, J. A., & Thomas, G. (2000). Ideals, perceptions, and evaluations in early relationship development. Journal of Personality and Social Psychology,79, 933940. Fletcher, G. J. O., Simpson, J. A., Thomas, G., & Giles, L. (1999). Ideals in intimate relationships. Journal of Personality and Social Psychology, 76, 72-89. Fowers, B. J., Lyons, E. M., & Montel, K. H. (1996). Positive marital illusions: Selfenhancement or relationship enhancement? Journal of Family Psychology, 10, 192-208. Fowers, B. J., Lyons, E., Montel, K. H., & Shaked, N. (2001). Positive illusions about marriage among married and single individuals. Journal of Family Psychology, 15, 95109. Fraley, R. C., & Davis, K. E. (1997). Attachment formation and transfer in young adults' close friendships and romantic relationships. Personal Relationships, 4, 131-144. Funder, D. C. (1995). On the accuracy of personality judgment: A realistic approach. Psychological Review, 102, 652-670. Furman, W., Simon, V.A., Shaffer, L., & Bouchey, H.A. (2002). Adolescents' working models and styles with parents, friends, and romantic partners. Child Development, 73, 241-255. Gagne, F. M., & Lydon, J. E. (2004). Bias and Accuracy in Close Relationships: An Integrative Review. Personality & Social Psychology Review, 8, 322-338. Gardner, W. L., Gabriel, S., & Hochschild, L. (2002). When you and I are “We”, you are not threatening: The role of self-expansion in social comparison. Journal of Personality and Social Psychology, 82, 239-251. Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: Attitudes, self-esteem, and stereotypes. Psychological Review, 102, 1-27. Griffin, D., & Bartholomew, K. (1994). Models of self and other: Fundamental dimensions underlying models of adult attachment. Journal of Personality and Social Psychology, 67, 430-445. Hazan, C., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. Heaton, T. B., & Albright, S. L. (1991). Stable unhappy marriages. Journal of Marriage and the Family, 53, 747-758. Helgeson, V. S. (1994). The effects of self-beliefs and relationship beliefs on adjustment to a relationship stressor. Personal Relationships, 1, 241-258. Higgins, E. T., & Brendl, C. (1995). Accessibility and applicability: Some "activation rules" influencing judgment. Journal of Experimental Social Psychology, 31, 218-243. John, O. P., & Robins, R. W. (1994). Accuracy and bias in self-perception: Individual differences in self-enhancement and the role of narcissism. Journal of Personality & Social Psychology, 66, 206-219. Karney, B. R., & Bradbury, T. N. (1995). The longitudinal course of marital quality and stability: A review of theory, method, and research. Psychology Bulletin, 118, 3-34. Karney, B. R., & Frye, N. E. (2002). “But we’ve been getting better lately”: Comparing prospective and retrospective views of relationship development. Journal of Personality and Social Psychology, 82, 222-238. Katz, J., & Joiner, T. E. J. (2002). Being known, intimate, and valued: Global self-verification and dyadic adjustment in couples and roommates. Journal of Personality, 70, 33-58.
Interpersonal Representations: Their Structure, Content, and Nature
61
Katz, J., Anderson, P., & Beach, S. R. H. (1997). Dating relationship quality: Effects of global self-verification and self-enhancement. Journal of Social and Personal Relationships, 14, 829-842. Kenny, D. A., & Acitelli, L. K. (2001) Accuracy and bias in the perception of the partner in a close relationship. Journal of Personality & Social Psychology, 80, 439-448. Kirkpatrick, L. A., & Hazan, C. (1994). Attachment styles and close relationships: A fouryear prospective study. Personal Relationships, 1, 123-142. Klohnen, E. C. (2005). A circumplex measure of working models of adult attachment. Manuscript under review. Klohnen, E. C., & Bera, S. (1998). Behavioral and experiential patterns of avoidantly and securely attached women across adulthood: A 31-year longitudinal perspective. Journal of Personality & Social Psychology, 74, 211-223. Klohnen, E. C., & Luo, S. (2003). Interpersonal attraction and personality: What is attractive—Self similarity, ideal similarity, complementarity, or attachment security? Journal of Personality and Social Psychology. Klohnen, E. C., & Luo, S. (2005). Accuracy and bias in newlyweds' partner perceptions: Not mutually exclusive but mutually beneficial. Manuscript under revision. Klohnen, E. C., & Mendelsohn, G. A. (1998). Partner selection for personality characteristics: A couple-centered approach. Personality and Social Psychology Bulletin, 24, 268-278. Klohnen, E. C., & Weller, J. A. (2005). Variation in attachment organization across relationships. Manuscript in preparation. Klohnen, E. C., Weller, J. A., Luo, S., & Choe, M. (in press). Organization and predictive power of general and relationship-specific attachment models: One for all, and all for one? Personality and Social Psychology Bulletin. Kobak, R., & Hazan, C. (1991). Attachment in marriage: Effects of security and accuracy of working models. Journal of Personality and Social Psychology, 60, 861-869. Kosek, R. B. (1996). The quest for a perfect spouse: Spousal ratings and marital satisfaction. Psychological Reports, 79, 731-735. Kruger, J. (1999). Lake Wobegon be gone! The “Below-Average Effect” and the egocentric nature of comparative ability judgments. Journal of Personality and Social Psychology, 77, 221-232. La Guardia, J. G., Ryan, R. M., Couchman, C. E., & Deci, E. L. (2000). Within-person variation in security of attachment: A self-determination theory perspective on attachment, need fulfillment, and well-being. Journal of Personality and Social Psychology, 79, 367-384. LaPrelle, J., Hoyle, R. H., Insko, C. A., & Bernthal, P. (1990). Interpersonal attraction and descriptions of the traits of others: Ideal similarity, self similarity and liking. Journal of Research in Personality, 24, 216-240. Linville, P. W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality & Social Psychology, 52, 663-676. Luo, S., & Klohnen, E. C. (2005). Partner perceptions in newlyweds: Who are accurate and who are biased? Manuscript in preparation. MacDonald, T. K., & Ross, M. (1999). Assessing the accuracy of predictions about dating relationships: How and why do lovers' predictions differ from those made by observers? Personality and Social Psychology Bulletin, 25, 1417-1429.
62
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Main, M., Kaplan, K., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. Monographs of the Society for Research in Child Development, 50 (1-2, Serial No. 209), 66-104. Martz, J. M., Verette, J., Arriaga, X. B., Slovik, L. F., Cox, C. L., & Rusbult, C. E. (1998). Positive illusion in close relationships. Personal Relationships, 5, 159-181. Mikulincer, M. (1995). Attachment style and the mental representation of the self. Journal of Personality and Social Psychology, 69, 1203-1215. Mikulincer, M., Gillath, O., & Shaver, P. R. (2002). Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality & Social Psychology, 83, 881-895. Mikulincer, M., Hirschberger, G., Nachmias, O., & Gillath, O. (2001). The affective component of the secure base schema: Affective priming with representations of attachment security. Journal of Personality and Social Psychology, 81, 305-321. Mitchell, S. A. (1988). Relational concepts in psychoanalysis. Cambridge, MA: Harvard University Press. Murray, S. L. (1999). The quest for conviction: Motivated cognition in romantic relationships. Psychological Inquiry, 10, 23-34. Murray, S. L., & Holmes, J. G. (1997). A leap of faith? Positive illusions in romantic relationships. Personality and Social Psychology Bulletin, 23, 586-604. Murray, S. L., Holmes, J. G., & Griffin, D. W. (1996a). The benefits of positive illusions: Idealization and the construction of satisfaction in close relationships. Journal of Personality and Social Psychology, 70, 79-98. Murray, S. L., Holmes, J. G., & Griffin, D. W. (1996b). The self-fulfilling nature of positive illusions in romantic relationships: Love is not blind, but prescient. Journal of Personality and Social Psychology, 71, 1155-1180. Murray, S. L., Holmes, J. G., & Griffin, D. W. (2000). Self-esteem and the quest for felt security: How perceived regard regulates attachment processes. Journal of Personality & Social Psychology, 78, 478-498. Murray, S. L., Holmes, J. G., Bellavia, G., Griffin, D. W., & Dolderman, D. (2002). Kindred spirits? The benefits of egocentrism in close relationships. Journal of Personality and Social Psychology, 82, 563-581. Murray, S. L., Holmes, J. G., Dolderman, D., & Griffin, D. W. (2000). What the motivated mind sees: Comparing friends' perspectives to married partners' views of each other. Journal of Experimental Social Psychology, 36, 600-620. Murstein, B. I. (1971). Self-ideal-self discrepancy and the choice of marital partner. Journal of Consulting and Counseling Psychology, 37, 47-52. Neff, L. A., & Karney, B. R. (2002). Judgments of a relationship partner: Specific accuracy but global enhancement. Journal of Personality, 70, 1079-1112. Neff, L. A., & Karney, B. R. (2005). To know you is to love you: The implications of global adoration and specific accuracy for marital relationships. Journal of Personality & Social Psychology, 88, 480-497. Overall, N.C, Fletcher, G. J., & Friesen, M.D. (2003). Mapping the intimate relationship mind: Comparisons between three models of attachment representations. Personality & Social Psychology Bulletin, 29, 1479-1493. Pierce, T., & Lydon, J. E. (2001a). Global and specific relational models in the experience of social interactions. Journal of Personality and Social Psychology, 80, 613-631.
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Pierce, T., & Lydon, J. E. (2001b). Priming relational schemas: Effects of contextually activated and chronically accessible interpersonal expectations on responses to a stressful event. Journal of Personality and Social Psychology, 75, 1441-1448. Pietromonaco, P. R., & Feldman Barrett, L. (1997). Working models of attachment and daily social interactions. Journal of Personality and Social Psychology, 73, 1409-1423. Pietromonaco, P. R., & Feldman Barrett, L. (2000). The internal working models concept: What do we really know about the self in relation to others? Review of General Psychology, 4, 155-175. Pietromonaco, P. R., Laurenceau, J., & Feldman Barrett, L. (2003). Change in relationship knowledge representations. In H. Reis, M. S. Fitzpatrick, & A. Vangelisti (Eds.) Advances in Personal Relationships: Stability and Change in Relationships. NY: Cambridge University Press. Ready, R. E., Clark, L. A., Watson, D., & Westerhouse, K. (2000). Self- and peer-related personality: agreement, trait ratability, and the “self-based heuristic.” Journal of Research in Personality, 34, 208-224. Ross, L. R., & Spinner, B. (2001). General and specific attachment representations in adulthood: Is there a relationship? Journal of Social and Personal Relationships, 18, 747766. Rusbult, C. E., Van Lange, P. A. M., Wildschut, T., Yovetich, N. A., & Verette, J. (2000). Perceived superiority in close relationships: Why it exists and persists. Journal of Personality and Social Psychology, 79, 521-545. Ruvolo, A. P., & Fabin, L. A. (1999). Two of a kind: Perceptions of own and partner's attachment characteristics. Personal Relationships, 6, 57-79. Safran, J. D. (1990a). Towards a refinement of cognitive therapy in light of interpersonal theory: I. Theory. Clinical Psychology Review, 10, 87-105. Safran, J. D. (1990a). Towards a refinement of cognitive therapy in light of interpersonal theory: II. Practice. Clinical Psychology Review, 10, 107-121. Scharfe, E, & Bartholomew, K. (1998). Do you remember?: Recollections of adult attachment patterns. Personal Relationships, 5, 219-234. Shaver, P.R., Collins, N., & Clark, C.L.(1996). Attachment styles and internal working models of self and relationship partners. In G. Fletcher & J. Fitness (Eds.), Knowledge structures in close relationships: A social psychological approach (pp. 25-61). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. Simpson, J. A & Rholes, W. S. (2002). Fearful-avoidance, disorganization, and multiple working models: Some directions for future theory and research. Attachment and Human Development, 4, 223-229. Sprecher, S. (1999). “I love you today more than yesterday”: Romantic partners’ perceptions of change in love and related affect over time. Journal of Personality and Social Psychology, 76, 46-53. Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books. Suls, J., Lemos, K., & Stewart, H. L. (2002). Self-esteem, construal, and comparisons with the self, friends, and peers. Journal of Personality and Social Psychology, 82, 252-261. Swann, W. B., De La Ronde, C., & Hixon, J. G. (1994). Authenticity and positivity strivings in marriage and courtship. Journal of Personality and Social Psychology, 66, 857-869. Swann, W. B., Hixon, J. G., & De La Ronde, C. (1992). Embracing the bitter “truth”: Negative self-concepts and marital commitment. Psychological Science, 3, 118-121.
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Taylor, S. E., & Brown, J. D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103, 193-210. Thomas, G., & Fletcher, G. J. O. (2003). Mind-reading accuracy in intimate relationships: Assessing the roles of the relationship, the target, and the judge. Journal of Personality & Social Psychology, 85, 1079-1094. Thomas, G., Fletcher, G. J. O., & Lange, C. (1997). On-line empathic accuracy in marital interaction. Journal of Personality & Social Psychology, 72, 839-850. Trinke, S. J., & Bartholomew, K. (1997). Hierarchies of attachment relationships in young adulthood. Journal of Social and Personal Relationships, 14, 603-625. Van Lange, P. A. M., & Rusbult, C. E. (1995). My relationship is better than—and not as bad as—yours: The perception of superiority in close relationships. Personality and Social Psychology Bulletin, 21, 32-44. Watson, D., Hubbard, B., & Wiese, D. (2000a). General traits of personality and affectivity as predictors of satisfaction in intimate relationships: Evidence from self- and partnerratings. Journal of Personality, 68, 413-449. Watson, D., Hubbard, B., & Wiese, D. (2000b). Self-other agreement in personality and affectivity: The role of acquaintanceship, trait visibility, and assumed similarity. Journal of Personality and Social Psychology, 78, 546-558. Watson, D., Klohnen, E. C., Casillas, A., Simms, E. N., Haig, J., & Berry, D. S. (2004). Match makers and deal breakers: Analyses of assortative mating in newlywed couples. Journal of Personality, 72, 1029-1068.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 3
GENERALIZED ANXIETY DISORDER AND INTERPERSONAL RELATIONSHIPS: THE CASE FOR A SYSTEMIC INTERVENTION Danielle Black The Family Institute at Northwestern University, Evanston, Illinois 60201, USA
Amanda Uliaszek, Alison Lewis Northwestern University, Evanston, Illinois 60208, USA
Richard Zinbarg Northwestern University, Evanston, Illinois 60208, USA The Family Institute at Northwestern University, Evanston, Illinois 60201, USA
ABSTRACT Generalized anxiety disorder (GAD), one of the more common anxiety disorders, is associated with significant impairment in occupational, interpersonal and family functioning. There is growing consensus that we need to improve the effectiveness of our treatments for GAD given that even the most positive findings suggest that only 50% of patients treated with cognitive-behavior therapy (CBT) and/or medications experience what might be considered to be a cure. Whereas established treatments for GAD are individual modalities, there is evidence from several lines of research suggesting current treatments for that systemic therapy has promise to augment the effectiveness of therapy for GAD. These lines of research include (a) evidence that elevated marital dissatisfaction is associated with GAD; (b) evidence that marital and family problems are associated with other anxiety disorders including panic disorder with agoraphobia and obsessive compulsive disorder and are associated with poor outcome in the treatment of these other anxiety disorders; (c) evidence that marital and family problems are associated with major depression - another psychiatric condition closely related to GAD – and poor outcome in the treatment of major depression; (d) preliminary evidence that marital functioning and interpersonal problems predict outcome in the treatment of GAD; and (e) evidence that at least some forms of couples therapy are effective treatments for major depression and panic disorder with agoraphobia.
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INTRODUCTION Generalized Anxiety Disorder (GAD) is an impairing psychological problem in which an individual experiences worry and anxiety over a number of different things most of the day, nearly every day, for a period of at least six months (DSM-IV-TR, 2000). In order to meet diagnostic criteria for GAD, worries must be accompanied by a number of physical and psychological symptoms including restlessness, muscle tension, sleeplessness, difficulty concentrating, frequent fatigue, and irritability. Subjective distress over symptoms is often quite severe, with feelings of loss of control over worry serving as another diagnostic criterion (DSM-IV-TR, 2000). GAD is very common; epidemiological results from the National Cormorbidity Survey (NCS) found lifetime prevalence rates of GAD to be nearly seven percent for females and four percent for males (Kessler et al., 1994). Further, according to this study, more than three percent of the population suffers from GAD within any given year. The more recent National Comorbidity Survey Replication found very similar prevalence rates (Kessler, Berglund, Demler, Jin, et al., 2005; Kessler, Chiu, Demler & Walters, 2005). Within the NCS, regardless of whether lifetime or one year prevalence rates were examined, among suffers of GAD, women outnumbered men by a rate of two to one (Wittchen, Zhao, Kessler, & Eaton, 1994). GAD typically begins early in life and has a relatively chronic course. Fifty percent of cases report onset by age 18 and 75 percent report onset by age 26 (Campbell, Brown & Grisham, 2003). Further, in DSM-IV, the former diagnosis of Overanxious Disorder (OAD) in children was subsumed under GAD. According to Albano, Chorpita, and Barlow (2003), data collected using DSM-III and DSM-III-R diagnoses, suggest that GAD may typically begin in childhood between 10.8 and 13.4 years of age. Among patients with GAD, rates of full remission are low (Kessler, Keller, & Wittchen, 2001). Although epidemiological studies have not yet looked at the longitudinal course of this disorder in a non-treatment seeking population, based on comparisons of point prevalence rates and lifetime prevalence rates in these studies, researchers have estimated that 40 to 60 percent of individuals with a lifetime history of GAD are experiencing an episode at any given point (Kessler, Keller, & Wittchen, 2001). This suggests that individuals with a history of GAD are symptomatic for much of their lifetimes and that the course of GAD is relatively chronic. Symptoms of this disorder appear to wax and wane, getting worse during times of stress (DSM-IV-TR, 2000). Research indicates that GAD has considerable costs, both for individuals who suffer from this disorder and for society as a whole. GAD can severely impair physical, psychological, and social functioning as well as quality of life (e.g. Ninan, 2001; Roy-Byrne & Katon, 1997; Wittchen, Carter, Pfister, Montgomery, & Kessler, 2000). Within the National Commorbidity Survey, individuals with GAD were 2.5 times more likely than others to report high levels of social impairment and 3.5 times more likely to report high levels of work impairment (Wittchen, 2002). Studies suggest that GAD has a significant financial impact, with the primary costs relating to nonpsychiatric healthcare expenses. GAD is the most common anxiety disorder in primary care medical settings and primary care physicians often order expensive tests to try to find end-organ dysfunction rather than diagnosing GAD (Ninan, 2001; Wittchen, 2002). Patients with GAD report a two-fold higher average number of visits to primary care
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physicians than individuals with depression and significantly more visits to non-mental health doctors even after entering the presence of physical illness as a covariate (Wittchen, 2002). Workplace costs are also significant (Ninan, 2001; Wittchen, 2002). In one study, 34 percent of individuals who experienced pure GAD within a 12-month period year and 48 percent of individuals who experience GAD and comorbid depression exhibited reductions of ten percent or more in work productivity over the course of a month (Wittchen, 2002).
LIMITATIONS IN THE EFFECTIVENESS OF CURRENT TREATMENTS FOR GAD To date, two types of treatments for GAD, pharmacotherapy and Cognitive Behavioral Therapy (CBT), have received extensive empirical support. However, there is reason to believe that both of these forms of treatment are limited in their effectiveness. Many individuals with GAD do not show any improvement following treatment, and among those who do improve, a number remain symptomatic (Borkovic & Whisman, 1996; Gould, Otto, Pollack, & Yap, 1997). Medications that are commonly used to treat GAD include benzodiazepines, azapirones, tricyclic anti-depressents, selective-serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors (Wittchen, 2002). A recent meta-analysis suggested that pharmacotherapy is superior to placebo in producing short-term reductions in symptoms of generalized anxiety disorder (Mitte, Noack, Steil, & Hautzinger, 2005). Empirically supported CBT packages for GAD target the physiological, cognitive, and behavioral components of this disorder using a number of different techniques. Techniques utilized in CBT for GAD include psychoeducation, relaxation training, cognitive restructuring, worry imagery exposure, in-vivo situational exposure, and time management (e.g., Brown, O’Leary, & Barlow, 1994; Craske & Barlow, 2005Craske, Barlow & O’Leary, 1992; Zinbarg, Craske & Barlow, 19932006). Chambless and Gillis (1993) meta-analyzed 9 trials of CBT for GAD and reported that the mean effect size for CBT compared with either wait-list, pill placebo or nondirective therapy was 1.54. This mean effect size was significantly greater than zero, indicating that CBT is an effective treatment for GAD. Gould, Otto, Pollack and Yap (1997) reported a more modest mean effect size of .70 on symptoms of anxiety based on 22 trials of CBT for GAD. However, this more modest effect size was still significantly greater than zero, again indicating that CBT is an effective treatment for GAD. In addition, Gould et al. found that CBT was just as effective as pharmacotherapy for symptoms of anxiety and was significantly more effective than pharmacotherapy for symptoms of depression that commonly co-occur with GAD. Looking at the clinical significance of these treatments, however, paints a more sobering picture. Borkovec & Whisman’s (1996) meta-analysis of CBT trials examined the percentage of patients in these studies who were classified as high on end state (HES) functioning at post-treatment, defining HES as falling within the normal range of scores on the majority of outcome measures given at the end of each study. They reported an average HES figure of 50 percent. Though pharmacotherapy trials have tended not to report HES statistics, given that CBT produces at least as large an effect size as medications on symptoms of anxiety in GAD
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trials (Gould, Otto, Pollack, & Yap, 1997), it seems reasonable to assume that medications produce no more impressive outcomes than CBT for GAD in terms of HES. Borkovec, Newman, Pincus and Lytle (2002) attempted to improve on the effectiveness of CBT for GAD in several ways, increasing therapy time by 50 percent and refining previously included treatment components. Despite these modifications, HES rates of treatment effectiveness were comparable to rates found in previous studies, leading Borkovec and colleagues to conclude that other methods are needed to improve upon the results produced by CBT techniques. Within this study, higher levels of interpersonal difficulties as measured by the Inventory of Interpersonal Problems–Circumplex Scales (Alden, Wiggins & Pincus, 1990; Horowitz, Alden, Wiggins & Pincus, 2000) at both pre- and post-treatment, were associated with poorer outcome at 6 month follow-up. Hence, one potential method for improving treatment efficacy would be to incorporate treatment components targeting patient interpersonal functioning. Preliminary results from the current trial just being completed by the Borkovec laboratory, in which individual interpersonal therapy techniques were added to their CBT package, have yielded a post-treatment effect size that is 17.5% to 78.8% larger than the posttreatment effect sizes from their previous trials of pure CBT packages (Borkovec & Sharpless, 2003). Clearly, these preliminary results are promising. At the same time, it is important to consider that for most people marriage is the relationship that is the greatest source of both social support (e.g., Argyle, 1999; Argyle & Furnham, 1983; Denoff, 1982;) and conflict (e.g., Argyle, 1999; Argyle & Furnham, 1983; Whisman, Sheldon & Goering, 2000). Thus, couples therapy may also have promise in the treatment of GAD. Indded, As we discuss below, there are several indirect lines of evidence that suggest that couples therapy may be at least as promising an interpersonal therapy as individual interpersonal therapy to add to the CBT package for GAD patients with partners. We begin by reviewing the evidence on GAD and problematic interpersonal functioning in general. We then proceed to focus more specifically on difficulties in marital and family functioning in GAD and disorders closely related to GAD.
GAD AND PROBLEMATIC INTERPERSONAL STYLES Several studies have shown that people with GAD experience significant interpersonal problems with peers, family, and romantic partners (Borkovec, Newman, Pincus, & Lytle, 2002; Whisman et al., 2000). Perhaps not surprisingly, therefore, the content of worry experienced by people with GAD is often interpersonal in nature (Breitholtz, Johansson, & Ost, 1995; Roemer, Molina, & Borkevec, 1997). More specifically, people with GAD appear to exhibit interpersonal styles that may impact their experience of interpersonal problems and worry. Using the Inventory of Interpersonal Problems (IIP; Horowitz, Alden, Wiggins, & Pincus, 2000), several studies have found that GAD is related to specific problematic interpersonal styles, specifically behaviors associated with being overly nurturant, nonassertive, overly accommodating, self-sacrificing, and intrusive/needy (Crits-Christoph, Gibbons, Narducci, Schamberger, & Gallop, 2005; Eng & Heimberg, 2006). There is also evidence that people with GAD have perceptual biases during interpersonal interactions which impact their interpersonal problems and experiences. Studies on
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information processing have shown that people with high anxiety (as opposed to normal controls or people with depression) show an attentional bias toward social threat cues, which depressed and normal controls tended to direct their attention away from the same threatening stimuli (MacLeod, Matthews, & Tata, 1986; Mathews & MacLeod, 1985; Mogg, Matthews, & Eysenck, 1992). GAD is also associated with a greater vigilance and orientation toward threatening faces (Bradley, Mogg, White, Groom, & de Bono, 1999;; Mogg, Millar, & Bradley, 2000). One study also found adolescent’s perception of parental rejection, overcontrol, and attachment was correlated with adolescent GAD, with perceived parental rejection and alienation uniquely predicting GAD (Hale, Engels, & Meeus, 2006). Some research has speculated that people with GAD lack awareness of their negative interpersonal impact on others (Erikson & Newman, 2007; Newman, Castonguay, Borkevec, & Molnar, 2004). Research has examined both overestimation of negative impact or catastrophizing bias (a belief that the GAD participant had a much more negative impact on the confederate than the confederate believed) and underestimation of negative impact or naivety bias (a lack of awareness on the part of the GAD participant concerning their negative impact as perceived by the confederate). In a study where those with GAD and control participants interacted with a confederate in a self-disclosure task, results showed that GAD was associated with a greater discrepancy between how the participant believed they impacted confederates and how the confederates actually reported feeling (Erikson & Newman, 2007). This finding was most pronounced in the Hostile-Submissive domain of interpersonal impact. This domain refers to a sense that one’s partner feels inadequate and nervous in the interaction, which exerts an interpersonal “pull” for one to put the other at ease or otherwise contain their discomfort. This behavioral style is therefore submissive in its unassertive aspects and hostile in the passive sense of expecting ridicule and coldly withdrawing from full social engagement. This study also found a U-shaped relationship between the amount of worry and degree of discrepancy in estimation in the HostileSubmissive area. In other words, high worry was associated with both over- and underestimating the degree of hostility-submissiveness, illustrating both a catastrophizing and naivety bias. Those demonstrating the naivety bias (those who underestimated their impact on others) were the least liked by the confederates, possibly because they were unable to read social cues concerning their interpersonal behaviors (Erikson & Newman, 2007). For patients with GAD, problematic interpersonal styles tend to change in the more desirable direction over the course of therapy (Borkevec et al., 2002; Crits-Christoph et al., 2005). Crits-Christoph and colleagues (2005) found a significant change in social avoidance, nonassertive, exploitable, overly nurturant, and intrusive interpersonal styles, as well as a change in a total score of all problematic styles combined. Borkevec and colleagues (2002) also found a change in all IIP categories from pre- to post-treatment.
MARITAL FUNCTIONING AND GAD There are several lines of evidence to suggest that GAD is associated with poor marital functioning. McLeod (1994) investigated marital distress and GAD among couples in which one member had a diagnosis of GAD (wives with GAD only and husband with GAD only) as well as couples in which both members had GAD. Wives with GAD reported significantly
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higher levels of marital distress than wives without GAD. However, husbands with GAD did not significantly differ on their report of marital distress compared to husbands without GAD. Couples who both had GAD did not report significantly higher levels of marital distress than couples with only one spouse diagnosed with GAD. Whisman (1999) replicated these results in a randomized national sample. That is, GAD was significantly associated with marital distress for woman but not for men with GAD. Whisman et al. (2000) extended this finding by examining nine diagnoses and found that the strongest diagnostic correlate of marital dissatisfaction was GAD. However, this study did not replicate the findings with regard to gender; gender did not moderate the relationship between GAD and marital distress. This study also compared the relationship between GAD and dissatisfaction among different social relationship including spouse, relatives, and friends. Individuals suffering with GAD reported significantly more dissatisfaction with their marital relationship compared with their dissatisfaction with other social relationships such as relatives and friends. In the most recent national sample investigating the relationship between GAD and marital distress, marital distress was significantly associated with elevated risk of GAD (Whisman, 2007). Among all of the anxiety disorders, marital distress had the strongest association with GAD. Further, GAD had one of the strongest associations with marital distress than any other psychiatric disorder excluding bi-polar disorder and alcohol dependence. Finally, gender did not moderate the relationship between GAD and marital distress. Overall, the association between marital distress and GAD is robust across several large national samples. Further, GAD appears to have a higher association with marital distress compared to other psychiatric disorders across these studies. Marital distress is one of the most robust predictors of divorce (see Bradbury & Karney, 1995 for a review). The previous research suggests GAD should also be associated with a higher risk for divorce. Only one study has investigated this association. In a national random survey, GAD was associated with a significantly elevated risk of divorce for both men and woman (Kessler, Walters, & Forthofer, 1998). Men with GAD had a higher risk of divorcing than men with any other disorder excluding mania. For women, GAD was significantly associated with an elevated risk for divorce; however, the odds ratio for elevated risk of divorce was equal to or lower than most of the other psychiatric disorders. Interestingly, whereas GAD is associated with an elevated risk of divorce, one study has shown that GAD is also associated with a higher likelihood of entering into marriage or a marriage-like relationship (Yoon & Zinbarg, 2007). Negative marital interaction appears to be one of the main factors that contribute to increased marital distress and divorce (see Karney and Bradbury, 1995; Weis & Heyman, 1990 for reviews). Thus, the previous evidence from the GAD marital functioning research would indicate GAD most likely would be associated with negative marital interaction. Only one study, conducted by our laboratory, has investigated the observed marital interaction of GAD couples (Zinbarg, Lee & Yoon, 2007). However, this study did not compare observed marital interaction between GAD, normal controls, and other psychiatric disorders but rather studied associations between marital interaction and treatment outcome within a GAD sample. We have since recruited a normal control sample and are currently working on analyses comparing the GAD couples and the normal control couples. By extension of the previous marital interaction research with normal and distressed couples, we expect GAD couples to have higher levels of negative marital interaction compared to other psychiatric diagnoses and normal controls. Given that GAD shares core features in common with the other anxiety disorders and depression (e.g., Zinbarg & Barlow, 1996; Kendler, Gardner,
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Gatz, & Pederson, 2007; Krueger, Caspi, Moffitt, Silva, & McGee, 1996), we next turn to the evidence regarding associations of marital and family functioning with anxiety disorders other than GAD and with depression.
MARITAL AND FAMILY FUNCTIONING AND ANXIETY DISORDERS OTHER THAN GAD Dysfunctional family functioning (e.g., marital and extended family members) relates to anxiety disorders other than GAD. The majority of research between family functioning focuses on Panic Disorder with Agoraphobia (PDA). A growing number of studies focus on the relationship between dysfunctional family functioning and Post Traumatic Stress Disorder (PTSD). Finally, there exist a small number of studies investigating the relationship between family functioning and Obsessive Compulsive Disorder (OCD) and Social Anxiety Disorder (SAD). PDA is sometimes associated with dysfunctional marital functioning. Bryne, Carr, and Clark (2004) reviewed 24 studies investigating the relationship between marital distress and PDA. Ten of these studies investigated the relationship between marital distress and PDA retrospectively. The majority of these studies (n = 9) found an association between marital distress and PDA (Fry, 1962; Goldstein and Chambless, 1978; Goodstein and Swift, 1977; Holmes, 1982; Kleiner & Marshall, 1987; Quadrio, 1984; Roberts, 1964; Symonds, 1971; Webster, 1953). Only one study did not find a significant relationship between marital distress and PDA. However, retrospective studies have many methodological flaws such as response biases. Fourteen studies investigated the relationship between marital distress and PDA prospectively (Arrindell & Emmelkamp, 1986; Buglass et al., 1977; Emmelkamp et al., 1992; Fisher and Wilson, 1985; Friedman, 1990; Hafner, 1977a, 1983; Hand and Lamontagne, 1976; Kleiner et al., 1987; Lange and van Dyck, 1992; McLeod, 1994; Markowitz et al., 1989; Massion et al., 1993; Torpy and Measey, 1974). In six studies, PDA was significantly associated with marital distress. In seven of the prospective studies, marital distress was not significantly associated with PDA (Arrindell & Emmelkamp, 1986; Buglass et al., 1977; Emmelkamp et al., 1992; Fisher and Wilson, 1985; Friedman, 1990; Hafner, 1977a; Lange and van Dyck, 1992). Finally, one study (Massion et al., 1993) found that couples in which one member had PDA reported similar levels of marital distress compared to couples in which member had GAD. Thus, whereas the association between PDA and marital distress may not be as strong when measured prospectively as when assessed retrospectively, the prospective studies do converge with the retrospective ones in demonstrating that PDA is associated with marital distress. There is a growing body of research investigating the relationship between family functioning and PTSD. In a series of studies, PTSD has been significantly associated with marital distress (Forbes, et al, 2003; Whisman, 1999; Whisman, 2007). In one national study, PTSD was even found to be more highly associated with martial distress than any other psychiatric disorder (Whisman, 1999). Further, across different PTSD populations (e.g., veterans, POWs, etc.), individuals with PTSD, compared to their non affected counterparts (those experiencing the same trauma without PTSD), reported higher levels of marital distress (Carroll, Rueger, Foy, & Donahoe, 1985; Cook et al., 2004; Dekel & Solomon, 2006).
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PTSD has been linked to other forms of marital dysfunction such as marital violence and divorce. PTSD symptoms are significantly associated with the use of physical aggression with intimate partners (O’Donnell et al., 2006; Hughes, 2007) and an elevated risk for divorce (Kessler, Walters, & Forthofer, 1998). Individuals with PTSD have higher rates of divorce and marital violence compared to their counterparts without PTSD. Men diagnosed with PTSD, compared with men without PTSD, are more likely to be physically aggressive toward their relationship partners (Carroll, Rueger, Foy, & Donahoe, 1985; Sherman, Fred, Jackson, Lyons, & Han, 2006) and are twice as likely to divorce and three times as likely to experience multiple divorces (Jordan et al., 1992). Less is known about the relationship between marital functioning and OCD. For example, whereas Whisman (1999, 2000, 2007) investigated the relationship between several psychiatric diagnoses and marital distress, OCD was not included in any of these three studies. Similarly, Kessler, Walters, and Forthofer (1998) investigated the likelihood of divorce associated with several different psychiatric diagnoses; however, OCD was not included in the study. To date, only one small sample study has investigated the relationship between marital distress and OCD symptoms (Riggs, Hiss, & Foa, 1992). This study did not find a significant relationship between OCD symptoms and marital distress. Little is also known with regards to social phobia and marital functioning. Whisman (1999) found a significant relationship between social phobia and marital distress and this relationship was replicated in a separate national sample by Whisman (2007). It should be noted, however, that once the presence of other psychiatric diagnoses were entered as covariates in Whisman (1999), social phobia was no longer significantly correlated with marital distress. Further, social phobia is not related to an increased risk of divorce (Kessler, Walters, & Forthofer, 1998).
MARITAL AND FAMILY FUNCTIONING AND MAJOR DEPRESSION Several lines of empirical research support a close link between GAD and major depressive disorder (MDD). First, GAD and MDD co-occur at a rate greater than what would be expected by chance (Kessler, Nelson, McGonagle, Liu, Schwartz, & Blazer, 1996; Mineka, Watson, & Clark, 1998). Second, similar phenotypic patterns have emerged suggesting that GAD is more closely related to MDD than to other anxiety disorders (e.g., Zinbarg and Barlow, 1996). Third, GAD and MDD have a genetic correlation of 1.0, indicating that they are not genetically distinguishable from one another (Kendler, Gardner, Gatz, & Pederson, 2007; Kendler, 1996, Kendler, Neale, Kessler, Heath, & Eaves, 1992). Fourth, according to personality studies, GAD and MDD share the common vulnerability trait of neuroticism or negative emotionality (Krueger, Caspi, Moffitt, Silva, & McGee, 1996; Barlow & Campbell, 2000; Watson, Gamez, & Simms, 2005). Therefore, the literature on marital and family functioning in MDD might be relevant to similar topics in GAD. Epidemiological research indicates the MDD is significantly related to not getting along with one’s spouse and not having any close friends (Whisman, Sheldon, & Goering, 2000). Other studies have documented elevated rates of insecure adult romantic attachment in depressed patients and their partners, with the likelihood of insecure attachment in partners covarying with the chronicity of the patient’s depressive symptoms (e.g., Roberts, Gotlib &
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Kassel, 1996; Whiffen, Kallos-Lilly & MacDonald, 2001; Whisman & McGarvey, 1995). Several lines of research offer an explanation for the interpersonal difficulties found in those with MDD. One literature review summarized four major areas of interactional problems among depressed dyads (Beach, Sandeen & O'Leary, 1990). First, depressed patients engage in more “depressive” behaviors with their spouses than do non-depressed spouses and these behaviors suppress spousal aggression (Beach & Nelson, 1989; Biglan, et al., 1985, 1989; Hops et al., 1987; Nelson & Beach, 1990). Second, depressed and discordant couples experience low levels of relationship cohesion, even when compared to discordant, nondepressed dyads (Beach et al., 1988; Monroe, Bromet, Connell, & Steiner, 1986). Third, the interactions of depressed persons and their spouses lack symmetry, such that depressed individuals are more likely to be passive and let decision making be done for them. Fourth, even though they suppress the expression of hostility, depressed discordant dyads are likely to reciprocate negative partner behavior when it occurs (Biglan, et al., 1985). Another possible explanation for the interpersonal problems found in those with MDD concerns reassurance seeking behavior (e.g., Joiner & Metalsky, 1995, 2001; Joiner & Schmidt, 1998; Potthoff, Holahan & Joiner, 1995). This research has been done in the context of peer/roommate relationships, as well as with married and dating couples. Findings suggest that reassurance seeking predicts negative attitudes and contagious depression in partners, as well as depression in response to partner devaluation (e.g., Benazon, 2000; Katz, Beach & Joiner, 1998, 1999). While some studies have reported that reassurance seeking is specific to depression, at least two analyses have supported a link between anxiety and reassurance seeking (e.g., Joiner, 1994; Joiner, Katz and Lew, 1999). In addition to the problematic interpersonal styles evidenced by people with MDD, there is also growing evidence that depressed individuals play a role in generating interpersonal stressors in their lives (e.g., Hammen, 1991; Hammen, Davila, Brown, Ellicott, & Gitlin, 1992; Uliaszek, Zinbarg, Mineka, Craske, & Griffith, 2008). Research has shown that depressed women subsequently experience more dependent (i.e., at least party due to the woman’s behavior), interpersonal stressful life events compared with others, but not on stressful life events that were judged to be independent or outside the woman’s control. The types of interpersonal stress experienced included marital problems (including divorce or separation) and social dysfunction.
MARITAL AND FAMILY FUNCTIONING AND PREDICTION OF TREATMENT RESPONSE IN DEPRESSION AND ANXIETY DISORDERS OTHER THAN GAD Marital, familial, and peer interpersonal difficulties have relevance for response to treatment of depression. There is a large body of research on expressed emotion (EE) and treatment response in depression. EE is conceptualized as consisting of three factors: criticism and hostility, emotional overinvolvement (EOI), and positivity (Chambless, Steketee, Bryan, Aiken, & Hooley, 1999). The evidence suggests that the expression of hostility toward the depressed patient by family members (most of whom are spouses) and patient perceived criticism predict poor treatment response (e.g., Addis & Jacobson, 1996; Hooley & Teasdale, 1989; Rounsaville, Weissman, Prusoff & Herceg-Baron, 1979). It is also noteworthy that the
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severity of expressions of hostility toward the patient correlates with the chronicity of the symptoms among depressed patients (Hayhurst, Cooper, Paykel, Vearnals & Ramana, 1997). Dysfunctional family interactions also influence response to treatment for a variety of anxiety disorders. EE has been linked to treatment outcome across a variety of anxiety disorders. Peter and Hand (1998) found that higher criticism expressed by a spouse toward the patient with PDA predicted better long – term outcome in CBT for PDA. However, Tarrier, Sommerfield and Pilgrim (1999) found that greater levels of relative hostility expressed toward the patient predicted poorer treatment outcome in PTSD patients treated with either cognitive therapy or imaginal exposure therapy for PTSD. Although these results seem contradictory, other researchers have found differential relationships between the different facets of the EE construct and treatment outcome for anxiety disorders. In a sample of OCD and PDA patient completing CBT, Chambless and Steketee (1999) found that greater levels of hostility expressed toward the patient by relatives predicted higher rates of dropout and poorer treatment outcome. On the other hand, they also found that higher rates of nonhostile criticism predicted better treatment outcome. Fogler, Tompson, Stektee, and Hofmann (2007) investigated the impact of EE on treatment outcome for social phobia. These researchers found lower levels of perceived criticism were associated with a greater likelihood of treatment dropout; whereas, hostile EE and emotional overinvolvement were not associated with treatment dropout.
INTERPERSONAL PREDICTORS OF GAD TREATMENT RESPONSE Results from studies utilizing the IIP have found that interpersonal problems can predict of the patient’s response to treatment. One GAD treatment study found that greater interpersonal problems (as assessed by the IIP) predicted worse outcome at 6-month followup (Borkevec et al., 2002). Another study demonstrated that being overly nurturant was associated with less change in anxiety and worry symptomatology at post-treatment (CritsChristoph et al., 2005). Overall, improvement in interpersonal problems, especially of the overly nurturant variety, was associated with improvement in symptomatology (CritsChristoph et al., 2005). The results of a study examined interpersonal interactions between GAD patients and their partners also suggests that interpersonal problems are predictors of treatment response just as the IIP studies do (Zinbarg, Lee, & Yoon, 2007). This study found that partner hostility when discussing the GAD patients’ worries predicted worse functioning at the end of treatment. Non-hostile criticism by the partner during the worry discussion predicted better end-state functioning.
EFFICACY OF COUPLES THERAPY FOR DEPRESSION ND ANXIETY DISORDERS OTHER THAN GAD The efficacy of couples therapy for GAD has yet to be investigated. Several studies have investigated the efficacy of couples therapy or spouse assisted therapy for depression and
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other anxiety disorders. For the reasons discussed above, these studies may have relevance for GAD and so we review them below. Given the dyadic problems of many depressed individuals and the effects of marital functioning on treatment response in depression, it should perhaps not be surprising that several studies have tested the efficacy of couples therapy for depression. Across these studies, couples therapy improved both depressive symptoms and marital functioning. Jacobson et al. (1991) randomly assigned married women diagnosed with depression to Behavioral Marital Therapy (BMT), individual cognitive therapy (CT), or a treatment combining BMT and CT. BMT was as effective as the other conditions at reducing depressive symptoms, but only BMT significantly improved marital distress. Beach and O’Leary (1992) replicated and extended these findings in a sample of distressed couples in which the wife was depressed. The couples were randomized to three different conditions: BMT, CT, or a 15 week waiting list condition. BMT and CT both significantly reduced depressive symptoms. Similarly to the Jacbson et al. (1991) study, only BMT provided significant improvements in marital distress. These previous studies focused on depressed wives. Emanuels-Zuurveen and Emmelkamp (1996) extended and replicated these previous findings by including depressed husband and depressed wives in their sample. Couples were randomly assigned to either individual cognitive/behavioral therapy or communication-focused marital therapy. In both conditions depressive symptomotology improved post treatment; however, only the marital therapy condition exhibited significant reductions in marital distress. Finally, Foley et al. (1989) extended these findings using a different theoretical intervention than CBT. Depressed patients (including men and woman) were randomized to either individual interpersonal psychotherapy (IPT) or a couple format version of IPT. Similar to past findings, both conditions improved depression, but only the couple IPT intervention improved marital functioning. Overall, these studies provide evidence that couples therapy is an efficacious treatment for depression. Further, couples treatment has the extra benefit of improving marital functioning; whereas, individual treatment only reduces depressive symptoms. Several treatment outcome studies have investigated the efficacy of involving relationship partners in the treatment of Agoraphobia. Interventions involving partners in the treatment of Agoraphobia differ in the focus of treatment. These interventions can be divided into two main foci. One group of interventions target the patient’s avoidance through partner assisted exposure therapy. The second group target relationship functioning through interpersonal skills training for both the patient and partner. Daiuto, Baucom, Epstein and Dutton (1998) conducted a meta analysis that distinguished outcomes based on these two types of interventions. The first set of analyses compared individual exposure therapy to partner assisted exposure therapy. Across six treatment outcome studies, individual exposure therapy, if anything, outperformed partner assisted exposure therapy; however, the two types of treatment were not significantly different from one another. The second group of analyses compared interventions targeting couple functioning to interventions targeting general interpersonal problems. Interventions targeting couple functioning led to significantly better outcomes at follow-up than exposure alone. In contrast, interventions targeting general interpersonal problems led to significantly worse outcomes at both post-treatment and followup than exposure alone. Thus, it appears that including the partner in treatment is most effective when interventions are included that are aimed at the partners’ interaction patterns. Indeed, some forms of involving the partner in treatment (i.e., partner-assisted exposure) may even be counter-productive.
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Despite the large body of literature establishing a relationship between PTSD and marital functioning and the fact that several treatment developers have developed clinical interventions for PTSD incorporating couple therapy (e.g., Johnson, 2002), there exists only one randomized clinical trial of family therapy for PTSD.. Monson et al. (2004) investigated a Cognitive –Behavioral Couples’ treatment for PTSD. The PTSD patients improved significantly on PTSD symptoms from pre-test to post-test; however, this study did not include a control sample. Thus, it is difficult to attribute the results to the intervention. Glynn et al. (1999) conducted the first randomized clinical control trial of couples therapy with a PTSD population. Veterans and a family member were randomly assigned to three different conditions: waiting list, 18 sessions of twice-weekly exposure therapy, or 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Both active treatments performed better than the wait-list control group. However, BFT was not significantly different than individual exposure therapy at reducing PTSD symptoms. Despite evidence showing that family functioning may influence OCD response to treatment and the fact that some therapists have developed systemic treatments for OCD (e.g., MacFarlene, 2001), there has yet to be a randomized clinical trial investigating the efficacy of family or couple therapy for OCD. Some research has investigated family therapy for children suffering from social phobia (e.g., Barrett, Dadds, & Rapee, 1996); however, an empirical evaluation of a systemic intervention for adults has not yet been investigated.
CONCLUSION GAD is not only common but is also associated with significant impairment in occupational, interpersonal and family functioning. Unfortunately, there is also growing consensus that our current treatments for GAD are not effective enough and we need to improve them. Whereas established treatments for GAD are individual modalities, we have reviewed evidence from several lines of research suggesting current treatments for that systemic therapy has promise to augment the effectiveness of therapy for GAD. One of the important lessons from the literature on the inclusion of the patient’s partner in the treatment of PDA, is that one needs to choose one’s intervention targets carefully when including a family member in treatment as some forms of couples interventions so appear to augment the effectiveness of CBT for PDA whereas others show a trend toward worse outcomes compared with individual CBT (Daiuto, Baucom, Epstein & Dutton, 1998). We are currently beginning a study designed to assist in the process of selecting systemic targets. One aim of this study is to replicate the findings from Zinbarg, Lee & Yoon (2007) showing that pre-treatment levels of partner hostility predict worse response to individual CBT whereas pre-treatment levels of partner non-hostile criticism predicts better treatment response. A second aim of this study is to extend our earlier findings by testing whether similar patterns hold for interactions with other relatives for those patients with GAD who are not married or in a marriage-like relationship as well as testing whether these systemic variables predict treatment response above and beyond the effects of potential third-variables such as chronicity of GAD, axis II pathology in the patient, and axis I or axis II pathology in the partner/relative. If our earlier results are replicated and found to be not entirely attributable to plausible third-variables, it
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would suggest that systemic interventions designed to reduce hostility and increase nonhostile criticism would hold great promise for increasing the efficacy of treatment for GAD.
REFERENCES Addis, M. E., & Jacobson, N. S. (1996). Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies. Journal of Consulting and Clinical Psychology,64, 1417–1 424. Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In E. J. Mash, & R. A. Barkley (Eds.), Child psychopathology (pp. 279–329). New York: Guilford Press. Alden, L. E., Wiggins, J. S., & Pincus, A. L. (1990). Construction of circumplex scales for the Inventory of Interpersonal Problems. Journal of Personality Assessment, 55, 521– 536. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. Argyle, M. (1999). Causes and correlates of happiness. In D. Kahneman, E. Diener, & N. Schwarz (Eds.), Well-being: The foundations of hedonic psychology (pp. 353–373). New York: Russell Sage Foundation. Argyle, M., & Furnham, A. (1983). Sources of satisfaction and conflict in long-term relationships. Journal of Marriage & the Family, 45, 481–493. Arnow, B. A., Taylor, C. B., Agras, W. S., & Telch, M. J. (1985). Enhancing agoraphobia treatment outcome by changing couple communication patterns. Behavior Therapy, 16, 452–467. Arrindell, W. A., & Emmelkamp, P. M. (1986). Marital adjustment, intimacy and needs in female agoraphobics and their partners: a controlled study. British Journal of Psychiatry, 149, 592–602. Arrindell, W. A., Emmelkamp, P. M., & Sanderman, R. (1986). Marital quality and general life adjustment in relation to treatment outcome in agoraphobia. Advances in Behavior Research and Therapy, 8, 139–185. Barlow, D. H., & Campbell, L. A. (2000). Mixed anxiety-depression and its implications for models and anxiety disorders. Comprehensive Psychiatry, 41 (1), 55–60. Barlow, D. H., O’Brian, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia. Behavior Therapy, 15, 41–58. Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333–342. Beach, S. R., Nelson, G. M., & O'Leary, K. D. (1988). Cognitive and marital factors in depression. Journal of Psychopathology & Behavioral Assessment, 10, 93–105. Beach, S. R., & O'Leary, K. D. (1986). The treatment of depression occurring in the context of marital discord. Behavior Therapy, 17, 43–49. Beach, S. R., & O'Leary, K. D. (1992). Treating depression in the context of marital discord: Outcome and predictors of response of marital therapy versus cognitive therapy. Behavior Therapy, 23, 507–528.
78
Danielle Black, Amanda Uliaszek, Alison Lewis et al.
Beach, S. R., Sandeen, E., & O’Leary, K. D. (1990). Depression in Marriage: A Model for Etiology and Treatment. New York: Guilford Press. Benazon, N. R. (2000). Predicting negative spousal attitudes toward depressed persons: A test of Coyne's Interpersonal Model. Journal of Abnormal Psychology, 109, 550–554. Biglan, A., Hops, H., Sherman, L., Friedman, L. S., Arthur, J., & Osteen, V. (1985). Problemsolving interactions of depressed women and their husbands. Behavior Therapy, 16, 431– 451. Biglan, A., Rothlind, J., Hops, H., & Sherman, L. (1989). Impact of distressed and aggressive behavior. Journal of Abnormal Psychology, 98, 218–228. Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting & Clinical Psychology, 70, 288–298. Borkovec, T. D. & Sharpless, B. (2004). Generalized anxiety disorder: Bringing cognitive behavioral therapy into the valued present. In: S.C. Hayes, V.M. Follette and M.M. Linehan, Editors, Mindfulness and relationship: Expanding the cognitive-behavioral tradition, The Guilford Press, New York (pp. 209–242). Borkovec, T. D., & Whisman, M. A. (1996). Psychosocial treatment for generalized anxiety disorder. In M. R. Mavissakalian & R. F. Prien (Eds.), Long-term tratments of anxiety disorders (pp. 171–199). Washington, DC: American Psychiatric Press. Bradley, B. P., Mogg, K., White, J., Groom, C., & De Bono, J. (1999). Attentional bias for emotional faces in generalized anxiety disorder. British Journal of Clinical Psychology, 38, 267–278. Breitholtz, E., Johansson, B., & Ost, L. G. (1995). Cognitions in generalized anxiety disorder and panic disorder patients: A prospective approach. Behaviour Research and Therapy, 37, 533–544. Brown, T., O'Leary, T., & Barlow, D. H. (1994). Generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders (pp. 154-208). New York: Guilford. Bryne, M., Carr, A., & Clark, M. (2004). The efficacy of couple-based interventions for panic disorder with agoraphobia. Journal of Family Therapy, 26, 105–125. Buglass, D., Clarke, J., Henderson, A., Kreitman, N. and Presley, A. (1977). A study of agoraphobic housewives. Psychological Medicine, 7, 73–86. Carroll, E. M., Rueger, D. B.,Foy, D. W. & Donahoe, C. P. (1985). Vietnam combat veterans with Posttraumatic Stress Disorder: Analysis of marital and cohabitating adjustment. Journal of Abnormal Psychology, 94, 329–337. Cerny, J. A., Barlow, D. H., Craske, M. G., & Himadi, W. G. (1987). Couples treatment of agoraphobia: A two-year follow-up. Behavior Therapy, 18, 401–415. Chambless, D. L., & Gillis, M. M. (1993). Cognitive therapy of anxiety disorders. Journal of Consulting & Clinical Psychology, 61, 248–260. Chambless, D. L., & Steketee, G. (1999). Expressed emotion and behavior therapy outcome: A prospective study with obsessive-compulsive and agoraphobic outpatients, Journal of Consulting and Clinical Psychology, 67, 658–665. Chambless, D. L., Steketee, G., Bryan, A. D., Aiken, L. S., & Hooley, J. M. (1999). The structure of expressed emotion: A three-construct representation, Psychological Assessment, 11, 67–76.
Generalized Anxiety Disorder and Interpersonal Relationships
79
Cook, J. M., Riggs, D. S., Thompson, R., Coyne, J. C., & Sheikh, J. I. (2004). Posttraumatic stress disorder and current relationship functioning among World War II ex-prisoners of war. Journal of Family Psychology, 18, 36–45. Craske, M. G., Barlow, D. H., & O’Leary, T. A. (1992). Mastery of your anxiety and worry. San Antonio, TX: The Psychological Corporation. Crits-Christoph, P., Gibbons, M. B. C., Narducci, J., Schamberger, M., & Gallop, R. (2005). Interpersonal problems and the outcome of interpersonally oriented psychodynamic treatment of GAD. Psychotherapy: Theory, Research, Practice, Training, 42(2), 211224. Denoff, M. S. (1982). The differentiation of supportive functions among network members: An empirical inquiry. Journal of Social Service Research, 5, 45–59. Emanuels-Zuurveen, L., & Emmelkamp, P. M. G. (1996). Individual behavioral-cognitive therapy v. marital therapy for depression in maritally distressed couples, British Journal of Psychiatry, 169,181–188. Emanuels-Zuurveen, L., & Emmelkamp, P. M. G. (1997). Spouse-aided therapy with depressed patients, Behavior Modification, 21, 62–77. Emmelkamp, P. (1980). Agoraphobics’ interpersonal problems: their role in the effects of exposure in vivo therapy. Archives of General Psychiatry, 37, 1303–1306. Emmelkamp, P., & Gerlsma, C. (1994). Marital functioning and the anxiety disorders. Behavior Therapy, 25, 407–429. Emmelkamp, P., van Dyck, R., Bitter, M., Heins, R., Onstein, E. J. and Eisen, B. (1992). Spouse-aided therapy with agoraphobics. British Journal of Psychiatry,160, 51–56. Eng, W., & Heimberg, R. G. (2006). Interpersonal correlates of generalized anxiety disorder: Self versus other perception. Anxiety Disorders, 20, 380–387. Erikson, T. M., & Newman, M. G. (2007). Interpersonal and emotional processes in generalize anxiety disorder analogues during social interaction tasks. Behavior Therapy, 38, 364 – 377. Fisher, L. M. and Wilson, G. T. (1985). A study of the psychology of agoraphobia. Behavior Research and Therapy, 23, 97–107. Fogler, J., Tompson, M. C., Steketee, G., & Hofmann, S. G. (2007). Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia. Behaviour Research and Therapy, 45, 235–249. Foley, S. H., Rounsaville, B. J., Weissman, D. S., & Cheveron, E. (1989). Individual versus conjoint interpersonal therapy for depressed patients with marital disputes, International Journal of Family Psychiatry, 10, 29–42. Forbes, D., Creamer, M., Allen, N., McHugh, T., Debenham, P., Hopwood, M. (2003). MMPI-2 as a predictor of change in PTSD symptom clusters: A further analysis of the Forbes et al. (2002) data set. Journal of Personality Assessment, 81, 183–186. Friedman, S. (1990). Assessing the marital environment of agoraphobics. Journal of Anxiety Disorders, 4, 335–340. Fry, W. F. (1962) The marital context of anxiety syndrome. Family Process, 1, 245 – 252. Glynn, S. M., Eth, S., Randolph, E. T., Foy, D. W., Urbaitis, M., Boxer, L., Paz, G., Leong, G. B., Firman, G., Salk, J. D., Katzman, J. W., & Crothers, J. (1999). A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 67, 243–251.
80
Danielle Black, Amanda Uliaszek, Alison Lewis et al.
Goldstein, A. and Chambless, D. (1978) A reanalysis of agoraphobia. Behavior Therapy, 9, 47–59. Goodstein, R. K. and Swift, K. (1977) Psychotherapy with phobic patients: the marriage relationship as the source of symptoms and focus of treatment. American Journal of Psychotherapy, 31, 284–293. Gould, R. A., Otto, M. W., Pollack, M. H., & Yap, L. (1997). Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis. Behavior Therapy, 28, 285–305. Hafner, R. J. (1976). Fresh symptom emergence after intensive behaviour therapy. British Journal of Psychiatry, 129, 378–383. Hafner, R. J. (1977a). The husbands of agoraphobic women: assortative mating or pathogenic interaction? British Journal of Psychiatry, 130, 233–239. Hafner, R. J. (1977b). The husbands of agoraphobic women and their influence on treatment outcome. British Journal of Psychiatry, 131, 289–294. Hafner, R. J. (1979). Agoraphobic women married to abnormally jealous men. British Journal of Medical Psychology, 52, 99–104. Hafner, R. J. (1983). Marital systems of agoraphobic women: contributions of husband’s denial and projection. Journal of Family Therapy, 5, 379–396. Hale, W. W., Engels, R., & Meeus, W. (2006). Adolescent’s perception of parenting behaviours and its relationship to adolescent generalize anxiety disorder symptoms. Journal of Adolescence, 29, 407–417. Hammen, C. (1991). Generation of stress in the course of unipolar depression. Journal of Abnormal Psychology, 100, 555–561. Hammen, C., Davila, J., Brown, G., Ellicott, A., & Gitlin, M. (1992). Psychiatric history and stress: Predictors of severity of unipolar depression. Journal of Abnormal Psychology, 101, 45–52. Hand, I., & Lamontagne, Y. (1976). The exacerbation of interpersonal problems after rapid phobia removal. Psychotherapy: Theory, Research & Practice, 13, 405–411. Hayhurst, H., Cooper, Z., Paykel, E. S., Vearnals, S., & Ramana, R. (1997). Depressed emotion and depression. British Journal of Psychiatry, 171, 439–443. Holmes, J. (1982) Phobia and counterphobia: family aspects of agoraphobia. Journal of Family Therapy, 4, 133–152. Hooley, J. M., & Teasdale, J. D. (1989). Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism. Journal of Abnormal Psychology, 98, 229–235. Hops, H., Biglan, A., Sherman, L., Arthur, J., et al. (1987). Home observations of family interactions of depressed women. Journal of Consulting & Clinical Psychology, 55, 341– 346. Horowitz, L. M., Alden, L. E., Wiggins, J. S., & Pincus, A. L. (2000). IIP–64/IIP–32 professional manual. San Antonio, TX: The Psychological Corporation. Hughes, F. (2007). Predicting the use of aggressive conflict tactics in a sample of women arrested for domestic violence. Journal of Social and Personal Relationships, 24, 155– 176. Jacobson, N. S., Dobson, K., Fruzzetti, A. E., Schmaling, K. B. & Salusky, S.. (1991). Marital therapy as a treatment for depression. Journal of Consulting and Clinical Psychology, 59, 547–557.
Generalized Anxiety Disorder and Interpersonal Relationships
81
Joiner, T. E. (1994). Contagious depression: Existence, specificity to depressed symptoms, and the role of reassurance seeking. Journal of Personality and Social Psychology, 67, 287–296. Joiner, T. E., Jr., Katz, J., & Lew, A. (1999). Harbingers of depressotypic reassurance seeking: Negative life events, increased anxiety, and decreased self-esteem. Personality and Social Psychology Bulletin, 25, 630–637. Joiner, T. E., Jr., & Metalsky, G. I. (1995). A prospective test of an integrative interpersonal theory of depression: A naturalistic study of college roommates. Journal of Personality & Social Psychology, 69, 778–788. Joiner, T. E., Jr., & Metalsky, G. I. (2001). Excessive reassurance seeking: Delineating a risk factor involved in the development of depressive symptoms. Psychological Science, 12, 371–378. Joiner, T. E., Jr., & Schmidt, N. B. (1998). Excessive reassurance-seeking predicts depressive but not anxious reactions to acute stress. Journal of Abnormal Psychology, 107, 533–537. Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. New York, NY: Guilford Press. Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., & Weiss, D. S. (1992). Problems in families of male Vietnam veterans with posttraumatic stress disorders. Journal of Consulting and Clinical Psychology, 60, 916–926. Karney, B. R., & Bradbury, T. N. (1995). The longitudinal course of marital quality and stability: A review of theory, method, and research. Psychological Bulletin, 118, 3–34. Katz, J., Beach, S. R. H., & Joiner, T. E., Jr. (1998). When does partner devaluation predict emotional distress? Prospective moderating effects of reassurance-seeking and selfesteem. Personal Relationships, 5, 1–13, 409–421. Katz, J., Beach, S. R. H., & Joiner, T. E., Jr. (1999). Contagious depression in dating couples. Journal of Social & Clinical Psychology, 18, 1–13. Kendler, K. S. (1996). Major depression and generalised anxiety disorder. Same genes, (partly) different environments revisited. British Journal of Psychiatry, 30, 68–75. Kendler, K. S., Gardner, C. O., Gatz, M., & Pederson, N. L. (2007). The sources of comorbidity between major depression and generalized anxiety disorder in a Swedish national twin sample. Psychological Medicine, 37(3), 453–462. Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C. & Eaves, L. J. (1992). Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Archives of General Psychiatry 49, 716–722. Kessler, R. C., Keller, M.B., & Wittchen, H.-U. (2001). The epidemiology of generalized anxiety disorder. Psychiatric Clinics of North America, 24, 19–39. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19. Kessler, R. C., Nelson, C. B., McGonagle, K. A., Liu, J., Swartz, M. S. & Blazer, D. G. (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry, 168, 17–30.
82
Danielle Black, Amanda Uliaszek, Alison Lewis et al.
Kessler, R. C., Walters, E. E., & Forthofer, M. S. (1998). The social consequences of psychiatric disorders, III: Probability of marital stability. American Journal of Psychiatry, 155, 1092–1096. Kleiner, L., & Marshall, W. L. (1985). Relationship difficulties and agoraphobia. Clinical Psychology Review, 5, 581–595. Kleiner, L., & Marshall, W. L. (1987). The role of interpersonal problems in the development of agoraphobia with panic attacks. Journal of Anxiety Disorders, 1, 313–323. Kleiner, L., Marshall, W. L. & Spevack, M. (1987). Training in problem-solving and exposure treatment for agoraphobics with panic attacks. Journal of Anxiety Disorders, 1, 219–238. Krueger, R. F., Caspi, A., Moffitt, T. E., Silva, P. A., & McGee, R. (1996). Personality traits are differentially linked to mental disorders: A multi-trait/multi-diagnosis study of an adolescent birth cohort. Journal of Abnormal Psychology, 105, 299–312. Lange, A., & van Dyck, R. (1992). The function of agoraphobia in the marital relationship. Acta Psychiatrica Scandinavica, 85, 89–93. Leff, J., Vearnals, S., Brewin, C. R., Wolff, G., Alexander, B., Asen, E., et al. (2000). The London Depression Intervention Trial: Randomised controlled trial of antidepressants v. couple therapy in the treatment and maintenance of people with depression living with a partner: Clinical outcome and costs. British Journal of Psychiatry, 177, 95–100. MacFarlene, M. M. (2001). Systemic treatment of obsessive-compulsive disorder in a rural community mental health center: An integrative approach. In MacFarlane, M. M. (Ed.), Family therapy and mental health: Innovations in theory and practice, (pp. 155–183). Binghamton, NY, US: Haworth Clinical Practice Press. MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95, 15–20. Markowitz, J. S., Weissman, M. M., Quellette, R., Lish, J. D., & Klerman, G. L. (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46, 984–992. Massion, A. O., Warshaw, M. G. and Keller, M. B. (1993). Quality of life and psychiatric morbidity in panic disorder and generalised anxiety disorder. American Journal of Psychiatry, 150, 600–607. Mathews, A. M., & MacLeod, C. (1985). Selective processing of threat cues in anxiety states. Behaviour Research and Therapy, 23, 563–569. McLeod, J. D. (1994). Anxiety disorders and marital quality. Journal of Abnormal Psychology, 103, 767–776. Mineka, S., Watson, D., & Clark, L. A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377– 412. Mitte K., Noack P., Steil R., & Hautzinger M. A. (2005). A meta-analytic review of the efficacy of drug treatment in generalized anxiety disorder. Journal of Clinical Psychopharmacology, 25, 141–50. Mogg, K., Mathews, A., & Eysenck, M. (1992). Attentional bias to threat in clinical anxiety states. Cognition and Emotion, 6, 149–159. Mogg, K., Millar, N., & Bradley, B. P. (2000). Biases in eye movements to threatening facial expressions in generalized anxiety disorder and depressive disorder. Journal of Abnormal Psychology, 109, 695–704.
Generalized Anxiety Disorder and Interpersonal Relationships
83
Monroe, S. M., Bromet, E. J., Connell, M. M., & Steiner, S. C. (1986). Social support, life events, and depressive symptoms: A 1-year prospective study. Journal of Consulting & Clinical Psychology, 54, 424–431. Monson, C.M, Schnurr, P. P, Stevens, S.P., & Guthrie, K. A. (2004). Cognitive-behavioral couple's treatment for posttraumatic stress disorder: Initial findings. Journal of Traumatic Stress, 17, 341–344. Nelson, G. M., & Beach, S. R. (1990). Sequential interaction in depression: Effects of depressive behavior on spousal aggression. Behavior Therapy, 21, 167–182. Newman, M. G., Castonguay, L. G., Borkevec, T. D., & Molnar, C. (2004). Integrative therapy. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 320–350). New York: Guilford Press. Ninan, P. T. (2001). Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry, 62, 5–10. O'Donnell, C., Cook, J. M., Thompson, R., Riley, K., & Neria, Y. (2006). Verbal and physical aggression in World War II former prisoners of war: Role of posttraumatic stress disorder and depression. Journal of Traumatic Stress, 19, 859–866. O'Leary, K. D., & Beach, S. R. (1990). Marital therapy: A viable treatment for depression and marital discord. American Journal of Psychiatry, 147, 183–186. Peter, H., & Hand, I. (1988). Patterns of patient-spouse interaction in agoraphobics: Assessment by Camberwell Family Interview (CFI) and impact on outcome of selfexposure treatment. In: I. Hand, & H.-U. Wittchen (Eds.), Panic and phobias: 2. Treatments and variables affecting course and outcome. Berlin: Springer. Potthoff, J. G., Holahan, C. J., & Joiner, T. E. (1995). Reassurance seeking, stress generation, and depressive symptoms: An integrative model. Journal of Personality and Social Psychology, 68, 664–670. Quadrio, C. (1984) Families of agoraphobic women. Australian and New Zealand Journal of Psychiatry, 18, 164–170 Riggs, D. S., Hiss, H., & Foa, E. B. (1992). Marital distress and the treatment of obsessive compulsive disorder. Behavior Therapy, 23, 585–597. Roberts, A. (1964) Housebound housewives: a follow-up study of phobic-anxiety state. British Journal of Psychiatry, 110, 191–197. Roberts, J. E., Gotlib, I. H., & Kassel, J. D. (1996). Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70(2), 310–320. Roemer, L., Molina, S., & Borkevec, T. D. (1997). An investigation of worry content among generally anxious individuals. Journal of Nervous and Mental Disease,185, 314–319. Rounsaville, B. J., Weissman, M. M., Prusoff, B. A., & Herceg-Baron, R. L. (1979). Marital disputes and treatment outcome in depressed women. Comprehensive Psychiatry, 20, 483–490. Roy-Byrne, P. P., & Katon, W. (1997). Generalized anxiety disorder in primary care: The precursor/modifier pathway to increased health care utilization. Journal of Clinical Psychiatry, 58, 34–40. Sherman, M. D., Sautter, F., Jackson, M. H., Lyons, J. A, & Han, X. (2006). Domestic violence in veterans with posttraumatic stress disorder who seek couples therapy. Journal of Marital & Family Therapy, 32, 479–490.
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Symonds, A. (1971) Phobias after marriage: women’s declaration of dependence. American Journal of Psychoanalysis, 31, 144–152. Tarrier, N., Sommerfield, C., & Pilgrim, H. (1999). Relatives’ expressed emotion (EE) and PTSD treatment outcome. Psychological Medicine, 29, 801–811. Torpy, D. M. and Measey, L. G. (1974). Marital interaction in agoraphobia. Journal of Clinical Psychology, 30, 351–354. Uliaszek, A. A., Zinbarg, R. E., Mineka, S., Craske, M. G., & Griffith, J. (2008). A longitudinal examination of the stress generation model of emotional disorders and personality. Manuscript in Preparation. Watson, D., Gamez, W., & Simms, L. J. (2005). Basic dimensions of temperament and their relation to anxiety and depression: A symptom-based perspective. Journal of Research in Personality, 39, 46–66. Webster, J. (1953) The development of phobias in married women. Psychological Monographs: General and Applied, 67, 1–18. Weiss, R. L., & Heyman, R. E. (1990). Observation of marital interaction. In F. D. Fincham & T. N. Bradbury (Eds.), The psychology of marriage: Basic issues and applications (pp. 87–117). New York: Guilford Press. Whiffen, V. E., Kallos-Lilly, A. V., & MacDonald, B. J. (2001). Depression and attachment in couples. Cognitive Therapy and Research, 25(5), 577–590. Whisman, M. A. (1999). Marital dissatisfaction and psychiatric disorders: Results from the national comorbidity survey. Journal of Abnormal Psychology, 108, 701–706. Whisman, M. A. (2007). Marital Distress and DSM–IV Psychiatric Disorders in a PopulationBased National Survey. Journal of Abnormal Psychology, 116, 638–643. Whisman, M. A., & McGarvey, A. L. (1995). Attachment, depressotypic cognitions, and dysphoria. Cognitive Therapy and Research, 19(6), 633–650. Whisman, M. A., Sheldon, C. T., & Goering, P. (2000). Psychiatric disorders and dissatisfaction with social relationships: Does type of relationship matter? Journal of Abnormal Psychology, 109, 803–808. Wittchen, H.U. (2001). Generalized anxiety disorder: Prevalence, burden, and cost to society. Depression and Anxiety, 16, 162–171. Wittchen, H. U., Carter, R. M., Pfister, H., Montgomery, S. A., & Kessler, R. C. (2000). Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. International Clinical Psychopharmacology, 15, 319–328. Wittchen, H. U., Zhao, S., Kessler R. C. , & Eaton W. W. (1994). DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Archives of General Psychiatry, 51, 355–364. Yoon, L. & Zinbarg, R. (2007). Generalized anxiety disorder and entry into marriage or a marriage-like relationship. Journal of Anxiety Disorders, 21, 955 – 965 Zinbarg, R.E., Craske, M. & Barlow, D. H. (1994). Therapist's Guide for the Mastery of Your Anxiety and Worry Program. Albany, NY: Graywind Publishing Co. Zinbarg, R. E., & Barlow, D. H. (1996). Structure of anxiety and the anxiety disorders: A hierarchical model. Journal of Abnormal Psychology, 105, 181–193.
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Zinbarg, R. E., Lee, J. E., & Yoon, L. (2007). Dyadic predictors of outcome in a cognitivebehavioral program for patients with generalized anxiety disorder in committed relationships: A “spoonful of sugar” and a dose of non-hostile criticism may help. Behaviour Research and Therapy, 45, 699–713.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 4
ANOTHER KIND OF “INTERPERSONAL” RELATIONSHIP: HUMANS, COMPANION ANIMALS, AND ATTACHMENT THEORY
Jeffrey D. Green, Maureen A. Mathews Virginia Commonwealth University, USA
Craig A. Foster United States Air Force Academy, USA
ABSTRACT Human-companion animal relationships provide a important but largely unexplored component of the human experience. Research examining these interspecies relationships may elucidate the depth and meaning of these relationships as well as provide unique insights into the fundamental nature of human psychology. Human-animal relationships offer a distinctive testing ground because pet choice is unilateral, whereas human friendships and romantic partner choices are mutual, and individuals may have reduced fear of rejection or evaluation from a pet than from a human relationship partner. We review and apply to human-pet relationships key elements of attachment theory, including caregiving, exploration, the malleability of attachment styles, and the role of attachment anxiety and avoidance in choosing relationship partners. We also discuss potential future research directions using relationships theories in companion animal contexts.
Human beings are social creatures, and as such have a fundamental need to belong (Baumeister & Tice, 1990; Leary, Tambor, Terdal, & Downs, 1995). We seek the security, support, and comfort of friends and family. It is therefore not surprising that the field of close relationships has been a central and burgeoning area within psychology. However, most close relationships theory and research overlooks the important fact that “interpersonal” needs can be met without other people per se. Individuals commonly attach themselves to objects, concepts, and abstractions to serve attachment and belonging functions. One particularly
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prevalent and compelling type of attachment involves the one that humans have with nonhuman animals. Individuals go to great lengths to form or maintain social connection. Gardner, Pickett, and Knowles (2005) proposed that individuals use one-sided (“parasocial”) attachments to maintain belongingness when necessary. In two recent studies, Knowles and Gardner (2008) found that writing about or viewing a picture of one’s favorite TV character (i.e., characters from the NBC show “Friends”) buffered individuals from the negative emotional consequences of social rejection. Similarly, researchers have studied God as a “substitute attachment figure” (e.g., Kirkpatrick, 1998), including possible psychological and physical health benefits of feeling interdependent with a deity. Connection to nature in general also may foster a sense of belongingness. Frantz, Winter, and Mayer (2008) found that individuals who felt a strong connection to nature reported a higher sense of belongingness as a result of interaction with the natural world and were psychologically shielded from the effects of social rejection. If individuals feel a connection to and appear to benefit from a relationship with intangible or invisible characters, it stands to reason that significant benefits may accrue from relationships with animal companions. Though relationships with some animals (e.g., fish) may be relatively parasocial or onesided, relationships with other common pets, such as cats and dogs, clearly provide companionship, physical contact, and comfort. Human-animal relationships are profoundly important ones, and pets frequently are treated as family members. Though the influence of pets on human well-being has been investigated, little theoretically based work has been conducted to fully explicate the psychology of these relationships. Human-animal relationships are different from interpersonal relationships in many ways. Unique characteristics of the human-animal relationship (e.g., ability of humans to unilaterally choose their animal companions, reduced fear of evaluation by animal companions) provide an opportunity to examine human psychology in contexts unavailable to traditional humanhuman relationships. That is, a closer investigation of human relationships with animals may extend our understanding of human cognition, emotion, and behavior. In this chapter, we provide a selective review of some research on human-animal relationships to demonstrate that these relationships have a significant impact on the human experience. At the same time, we argue that researchers have just scratched the surface of this potentially rich field and should investigate human-animal relationships using available interpersonal relationship theories and methods. Our review will draw primarily upon the important theory of attachment (Bowlby, 1969) as one example of an appropriate theory to extend to human-animal relationships. Finally, we propose ways in which human-animal relationships can be used to both examine and extend traditional psychological theory, and suggest new avenues of research in order to advance our understanding of human-animal relationships. We begin by providing some background on the evolution of the most common pets (i.e., cats and dogs) as an intial basis for explaining the prevalence and depth of humananimal relationships.
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CO-EVOLUTION OF HUMANS AND ANIMALS The dog-human relationship is arguably the closest we humans can ever get to establishing a dialogue with another sentient life-form, so it is not surprising that people tend to emerge from such encounters with a special sense of affinity with ‘man’s best friend.’ James Serpell (1995), p. 2
Companion animals vary widely from fish to birds to several species of mammals, but canine-human relationships have a particularly long evolutionary history. Descended from the grey wolf (Vila et al., 1997), modern domestic dogs (Canis familiaris) were the first animals that humans domesticated at the end of the last Ice Age, approximately 15,000 years ago (Serpell, 1995). One account suggests that this domestication accompanied the hunting shift to early archery; domesticated dogs facilitated successful hunting by helping track herds and subdue wounded prey (Serpell, 1995). However, a more radical view by Schleidt and Shalter (2003) argues that humans and wolves, both omnivores and both relatively cooperative, group-oriented species, started following herds in Eurasia around the same time, and thus coevolved as joint partners in obtaining food. In either case, it is notable that humans domesticated dogs before domesticating the animals that have provided them with their most common sources of animal protein (e.g., cattle, goats, pigs), animals whose domestication requires less nomadic living. Whether through domestication or co-evolution, the long history of dogs living with humans has led dogs to understand verbal and non-verbal communication from humans. Scientific views about the abilities of non-human animals to use language and, more broadly, engage in symbolic thought, have ebbed and flowed in recent decades, but the latest research suggests that humans have underestimated the abilities of canines and other animals such as orangutans, parrots, and dolphins (Morell, 2008). Some dogs have learned to understand hundreds of words, and recent research suggests that they may engage in other types of symbolic cognition such as connecting an object to its two-dimensional picture (Morell, 2008). A series of studies (Hare, Brown, Williamson, & Tomasello, 2002), found that dogs were superior to chimpanzees (our closest existing relative biologically) and wolves in reading nonverbal human cues. In these studies, humans pointed to, tapped, or gazed at the location of hidden food; even puppies (but not wolf pups) were relatively successful at decoding these human behaviors, suggesting that this ability is not the result of learning but the result of the evolution of dogs living with humans. Thus, it appears that dogs are able to communicate with humans on a level that even humans’ closest relatives (i.e., chimpanzees) cannot. The domesticated cat (Felis catus) also has a storied history with human beings. The modern-day house cat descends from Felis silvestris lybica in the Far East. The development of agriculture is thought to have spurred the relationship between cats and humans; cats eradicated vermin from grain storage, and humans, in return, provided basic shelter and food (Driscoll et al., 2007). A recent archeological excursion uncovered 9,500 year-old cat remains buried with human remains on the island of Cyprus (Vigne, Guilaine, Debue, Haye, & Gérard, 2004). In addition, the ancient Egyptian culture had a high reverence toward cats, and even had gods (e.g., Bastet) that took feline form. Cats were considered to be intelligent but mysterious, and thus were treated with wonder and respect.
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SIGNIFICANCE OF ANIMAL COMPANIONS TO HUMANS The rich history between humans and dogs or cats helps to explain the lavish interdependence that can occur between humans and animals today. The American Pet Products Manufacturers Association (APPMA) reports in the 2007-2008 National Pet Owners Survey that 63% of U.S. households include a pet. It is estimated that in 2008, the total U.S. expenditures within the pet industry will exceed $43.3 billion, nearly double the 1998 figure. It may be the case that more people own pets, but it is also appears that individuals are spending increasing amounts of time and money on their pets. Many types of brand-name or luxury pet products and services have been developed and marketed in recent years, including products analogous to those for humans. Companies such as Paul Mitchell and Omaha Steaks are marketing new designer pet products, such as dog shampoo and gourmet steak dog treats (APPMA, 2007), and massage, acupuncture, and yoga for pets are now readily available. Many hotel chains have adopted increasingly pet-friendly policies, and insurance companies offer accident and life insurance for pets. As of 2007, 39 states allow for the establishment of trusts to take care of pets in case of the owner’s or guardian’s death (Bennett, 2007). Some owners also spend vast sums of money on ceremonies to celebrate milestones such as pet birthdays and pet weddings, complete with wedding outfits, cakes, and (human) officiants. State courts have recognized that animals represent far more than mere possessions. In two notable cases, owners have been awarded upwards of $30,000 when their pets were deemed to have been killed wrongfully (Tanick, 1998). In short, pets are ubiquitous. Individuals go to great lengths to care for them, and illustrate their deep attachment by traveling with them, celebrating milestones with them, and (as we will revisit later) mourning their loss. Psychologists appear to have underestimated the similarities to interpersonal relationships, but they also largely have ignored characteristics of human-animal relationships that are unique. Such characteristics may provide new insights into human psychology.
HUMAN-ANIMAL RELATIONSHIPS AND PSYCHOLOGICAL INQUIRY Unique facets of the human-animal relationship might provide elegant and compelling tests of traditional psychological theory. We will summarize a few ways in which the development and maintenance of interpersonal relationships differs from human-animal relationships.
Risk of Rejection One critical issue is that the decision to acquire an animal companion can be a unilateral choice, whereas the choice of a romantic partner or friend is almost inevitably a mutual one. This issue is most clearly revealed in unrequited love, where a suitor experiences love for someone who does not love in return (Baumeister, Wotman, & Stillwell, 1993). Although interpersonal rejection commonly is associated with romantic relationships, social exclusion also occurs between friends and acquaintances and has powerful psychological consequences,
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including aggressive and self-defeating behaviors (Twenge, Baumeister, Tice, & Stucke, 2001; Twenge, Catanese, & Baumeister, 2002). Some individuals may hesitate to initiate friendship or romantic relationships due to fear of rejection, but when it comes to relationships with animals, individuals experience virtually no risk of partner rejection.
Fear of Evaluation A related aspect of human-animal relationships is the reduced fear of evaluation. According to George Eliot, “we long for an affection altogether ignorant of our faults. Heaven has accorded this to us in the uncritical canine attachment.” There are many implications for this reduced fear of evaluation by an animal companion. For example, owning a pet could be particularly beneficial for the socially anxious. Social anxiety is the distress felt when one perceives that she will be negatively evaluated by another person (Fenigstein, Scheier, & Buss, 1975; Leary, 1983), and is associated with hypersensitivity to social situations and presenting oneself as non-confrontational (Schlenker & Leary, 1985). Social anxiety, loneliness, and feeling that one has poor social skills often co-occur (Bruch, Kaflowitz, & Pearl, 1988; Solano & Koester, 1989). Companion animals may provide the socially anxious with relatively non-evaluative and therefore non-threatening social interaction experiences both at relationship initiation and during relationship maintenance. The socially anxious person’s fears of possessing poor social skills are unlikely to be activated in interactions with animals. The presence of an animal companion may reduce feelings of loneliness in some circumstances (e.g., Banks & Banks, 2005, but see Gilbey, McNicholas, & Collis, 2007). Having a pet may even increase one’s confidence in social interactions with other people, including but not limited to opportunities to meet likeminded individuals via one’s pet (such as behavioral training classes or pet playdates), situations that also may be relatively less threatening since the focus often is on the animals.
Choice and the Selection of Partner Characteristics Humans have an unprecedented amount of choice in choosing whether to obtain a pet and the corresponding nature of that animal companion. The process of selecting pets may be limited by individuals’ living arrangements or finances. Nevertheless, the choice of a pet is a relatively unconstrained, particularly when compared to mutually negotiated human relationships. Mail-order brides notwithstanding, one cannot simply unilaterally choose to enter into a romantic relationship, but one can wake up intending to initiate a relationship with a pet, go to a shelter or pet store, and begin a close relationship that very day. Moreover, individuals can choose the species that they prefer based on the amount of care required, and can even choose the specific characteristics they desire in an animal companion. In fact, some animals, particularly different breeds of dog, have been bred selectively to possess certain temperaments and characteristics. Thus, animals generally are more predictable than humans (Leary et al., 1994). Animals (even cats) do not plot how to put their best paw forward, selectively disclose information, or engage in outright deception in order to be viewed more favorably. A relationship with a pet is “what you see is what you get” relative to the unpredictability of a human relationship.
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In summary, companion animals offer qualitatively different types of supportive relationships, especially compared to romantic relationships, by providing a great deal of choice in a relatively non-evaluative context. We revisit these and other aspects of humananimal relationships in the context of attachment theory.
ATTACHMENT THEORY AND THE HUMAN-ANIMAL RELATIONSHIP Introduction to Attachment Theory Attachment theory describes interlocking behavioral systems centered on the formation of close interpersonal bonds. Bowlby (1969; 1980) asserted that the attachment system evolved due to prolonged helplessness on the part of human offspring. Behaviors such as the crying of infants serve to maintain or increase proximity between infant and caregiver. Infants and children use their caregivers as a safe haven, where they can seek refuge and support when afraid. Caregivers also serve as a secure base from which children can explore their environments. Ainsworth and colleagues (e.g., Ainsworth, Blehar, Waters, & Wall, 1978) employed the “Strange Situation,” a laboratory procedure in which children and caregivers experience separation and reunion, to systematically test some of the tenets of Bowlby’s theory. They identified specific ways in which children reacted to the reappearance of their mother, which led to theory and research on different attachment styles. Ainsworth and colleagues (1978) found three primary attachment styles based on her Strange Situation research: secure, anxious-ambivalent, and avoidant. A secure style presumably develops when the caregiver is consistently responsive and affectionate. Secure individuals are comfortable with closeness, and approach relationships with confidence and trust. An anxious-ambivalent style presumably develops when the caregiver is inconsistently responsive. The unpredictability leads anxious-ambivalent individuals to be more uncertain of and preoccupied with the status of their relationships. An avoidant attachment style presumably develops when the caregiver is cool and emotionally unresponsive. Avoidant individuals tend to be more emotionally distant, reluctant to express physical expression or emotional need, and more independent. In recent decades, social psychologists have appropriated the attachment framework to explore issues of intimacy, support seeking, caregiving, and emotion regulation in adult relationships, particularly romantic relationships. Hazan and Shaver (1987) led this expansion of attachment theory, and adapted and validated the secure, anxious-ambivalent, and avoidant styles for adult romantic relationships. Bartholomew and Horowitz (1991) provided a revised but complementary framework by conceptualizing attachment as two dimensions on a positive-negative continuum: view of self and view of others, yielding four different styles. A positive view of both self and others corresponds to Hazan and Shaver’s secure attachment. A negative view of self and positive view of others corresponds to Hazan and Shaver’s anxious ambivalent attachment, which Bartholomew and Horowitz refer to as preoccupied. The Hazan and Shaver avoidant category describes a negative view of others, but Bartholomew and Horowitz characterize a positive view of self and negative view of others as dismissingavoidant and a negative view of self and negative view of others as fearful-avoidant.
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Subsequent research has proposed moving beyond a typology or style approach, instead characterizing attachment along two dimensions: attachment avoidance and attachment anxiety (Fraley & Waller, 1998). However, the four Bartholomew and Horowitz styles have heuristic value when considered as mapping avoidance and anxiety in two-dimensional space (e.g., low avoidance and high anxiety corresponds to preoccupied attachment; high avoidance and low anxiety corresponds to dismissing-avoidant attachment).
Attachment to Pets The emotional depth of the human-companion animal bond suggests that attachment theory can be applied to human-animal relationships. Many researchers agree with this informal view (Beck & Madresh, 2008). Moreover, humans frequently treat companion animals similarly to children or domestic partners; attachment theory has demonstrated that it is versatile enough to apply both to parent-child and romantic relationships. However, we mention a few important caveats. First, the word attachment is commonly used by researchers when they are referring to general bonding with animals but does not necessarily refer to Bowlby’s attachment theory in particular (Crawford, Worsham, & Swineheart, 2006). Several scales purportedly measure human attachment to pets, but are not based on attachment theory (e.g., the Lexington Attachment to Pets Scale; Johnson, Garrity, & Stallones, 1992). Second, human-pet relationships are inherently unequal: the animal is dependent on its human companion for virtually all of its major needs. (However, it is worth noting that this power differential is characteristic of many interpersonal relationships, from parent-child to supervisor-worker to romantic relationships, where one member of the dyad possesses more control in the relationship.) Third, some debate exists over the quality of attachment to animals. For example, Endenburg (1995) conducted a large survey study in the Netherlands and described the attachment relationships assessed between humans and their animals as “weak,” though the strongest attachments were felt to dogs and cats relative to other animals. Indeed, many animals are owned for work-related reasons (e.g., herding) or are otherwise seen as instrumental (e.g., for protection of the home); owners do not necessarily feel psychologically attached to such animals. Put another way, some pet owners consider their pet merely to be their property, whereas others consider their pet to be a valued member of the family deserving of the rights and privileges as such (Carlisle-Frank & Frank, 2006). Fourth and most important, much of the recent research involving attachment theory and human-animal relationships is theoretically or methodologically problematic. Researchers need to develop or adapt (Beck & Madresh, 2008) more valid measures of attachment to pets and study a wider variety of pet-related behaviors and cognitions. Much of the extant humanpet work is correlational, bringing into question some of the conclusions that may be drawn. Experimental methods often are challenging (e.g., it is difficult to randomly assign people to be cat owners or dog owners), but are essential for advancing our understanding of these relationships. In addition, the research has been limited because its focus primarily has been the influence of pets on humans, rather than the psychology of the human-animal relationship more broadly. An enhanced application of traditional interpersonal relationships theory and methods to the companion animal arena can demonstrate the significance of these relationships and use these unique relationships to further understand people. In short, this research area would benefit from a superior integration of established theory and
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methodology. Nevertheless, researchers have begun to explore this profoundly important component of human relationships.
Can Humans be Attached to Animals? What Defines an “Attachment”? Bowlby (1969) hypothesized that the attachment system is activated automatically by threatening situations. Recent research has found that peers (i.e., close friends and romantic partners) replace parents as serving the functions of safe haven (to whom do you turn when you feel vulnerable?), proximity maintenance (with whom do you want to spend time?), and secure base (whom do you count on to support you when you really need it?), and that separation from close others, particularly romantic partners, is both subjectively distressing (e.g., Fraley & Shaver, 1998) and physiologically arousing (Fraley & Shaver, 1997). These functions may be identified in cognition, emotion, physiology, and behavior (Hazan, GurYaish, & Campa, 2006). The attachment process appears to take time to develop, and these behavioral systems may be transferred from parent to romantic partner or best friend in progressive stages (i.e., proximity seeking followed by safe haven and then secure base; Fraley & Davis, 1997). It takes about six or seven months for infants to direct the various attachment behaviors to a particular caregiver (Ainsworth, Bell, & Stayton, 1973; Bowlby, 1969). Adults appear to take months or years to transfer these systems to their romantic partner (Hazan & Zeifman, 1994). Most types of strong attachment bonds are marked by high degrees of physical contact, though the type of contact varies according to relationship type (e.g., sexuality for romantic partners). In short, attachment relationships are qualitatively different from the relationships between acquaintances and are marked by a particular pattern of cognition, emotion, and behavior. How might one assess the degree to which humans are attached to animals? The tools of cognitive-social psychologists might be harnessed to test attachment to animals. In a series of lab studies, Mikulincer, Gillath, and Shaver (2002) subliminally primed threat and found that the names of attachment figures were more accessible. Participants first provided several lists of names, including individuals who served attachment functions for them, individuals they were close to but who were not attachment figures, and acquaintances. Participants were presented with a string of letters that was either a word or not, and tasked with deciding as quickly as possible whether the string of letters was a word. Prior to the presentation of the letter string, participants were subliminally exposed to either a threat word (failure, separation) or neutral word (hat). Individuals were quicker to recognize the names of attachment figures after the threat word but not after the neutral word; this difference was not significant for the names of other close persons, acquaintances, unknown persons, or nonwords. This research also revealed differences in individual attachment style. Those high in anxiety showed heightened accessibility of the names of attachment figures even without the subliminal threat word prime, and individuals high in avoidance appeared to inhibit the activation of attachment figure names when the threat prime word was separation. This is consistent with other research (e.g., Simpson, Rholes, & Nelligan, 1992); these investigators brought couples into the lab and told the female member of the couple that she was going to experience an anxiety-provoking experimental procedure, showing her a room filled with psychophysiological equipment. Unbeknownst to them, the couples were filmed while
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waiting for this ostensible procedure, and their caregiving and support-seeking behaviors were observed and coded. Securely attached women, relative to anxious or avoidant women, were more likely to seek support and reassurance from their romantic partner when facing a stressful situation. The paradigm developed by Mikulincer and colleagues (2002) could be modified to test whether individuals form attachment bonds to their pets. Although the variety and distinctiveness of pet names may need to be accounted for, adding pet names to the lists of names provided by participants and engaging in the same lexical decision task would assess whether this heightened accessibility exists for close pets. We suggest that a significant percentage of individuals, those who report a longer and closer relationship with their pets, will identify their pets’ names more quickly when exposed to a subliminal threat. The method employed by Simpson and colleagues (1992) also could be applied to pets, by observing how individuals seek support from their pets during stressful and non-stressful situations (also see following discussion of Allen, Blascovich, Tomaka, & Kelsey, 1991). More broadly, research in the lab or in the field could assess the extent to which individuals perceive their pets as serving proximity maintenance, safe haven, and secure base functions. For example, individual preferences for animal companions when under stress, either in a diary-type study or manipulated directly in the lab, could be investigated. Presumably, these functions, though different in their manifestations from human relationships, should be present in many human-animal relationships. Like human relationships, human-animal companion relationships likely take months or years to develop, and the proximity seeking, safe haven, and secure base functions likely transfer at different stages as they do from parents to peers. Examining individuals who lack a primary human attachment (e.g., single adults living alone but with a pet) would be a particularly interesting test of these processes. The strong attachment that many humans form with their companion animals is revealed in the bereavement that humans endure after losing their non-human friends (Hunt & Padilla, 2006). The significance of losing an animal companion has been characterized as “disenfranchised,” meaning that the depth of this loss is underestimated and social support often is lacking (Stewart, Thrush, & Paulus, 1989), but scholars have observed a significant animal-related bereavement process. Over half of participants in one study reported believing in an afterlife for their deceased pet (Davis, Irwin, Richardson, & O’Brien-Malone, 2003). One researcher has developed a social work bereavement model based on traditional human grief therapy, but specifically designed for animal loss (Turner, 2003). Attachment theory should be harnessed to further research pertaining to pet bereavement; reactions to the death of a spouse as well as the death of a pet proceed through similar stages as the distress of separation from an attachment figure: protest, despair, and detachment (Parks, 1972). In short, some evidence for the viability of the notion that humans may be as attached to their pets as they are to humans is manifest in similar and profound emotional reaction to their loss.
Safe Haven, Caregiving, and Support Seeking Many safe haven and secure base functions of the attachment system may be subsumed under the notion of caregiving (Feeney & Collins, 2006); a caregiver provides felt security. Caregivers typically regulate their behavior in response to the needs and expressions of infants. Cries of hunger and cries of pain elicit different responses by parents to restore
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closeness and meet the infant’s needs. However, attachment style differences exist regarding how effectively the caregiver notices and interprets the needs of the infant, and the extent to which the caregiver appropriately regulates behavior. More distressing events elicit a stronger desire to restore proximity to an attachment figure (e.g., people often seek physical contact with a romantic partner or parent when distressed or ill). Unfortunately, individuals often give the type of support that they themselves have received (e.g., abused individuals often are insensitive to the needs of others). Avoidant individuals are more likely to use indirect support-seeking strategies, which often lead to unhelpful forms of support (Collins & Feeney, 2004). Avoidant men overall provide less support and are more insensitive to their partners’ needs, failing to regulate the amount of support given as a function of distress that the partner feels. There is some evidence that the more stressful the situation, the less support provided by avoidant men to their partners, the opposite of the pattern typically desired by their partners (Simpson et al., 1992). Avoidant individuals are less likely to provide the physical proximity and contact that their distressed partners desire. Research on the relationship between avoidant individuals and their animal companions could further reveal the dimensions and causes of this pattern of support giving. Do avoidant individuals turn to their pets when stressed? Are they more likely to engage in physical contact with animals but not human romantic partners in such circumstances? Do they provide comfort to their distressed animal companions better than they do to their distressed human companions? Anxious individuals provide less effective support and exhibit more compulsive or overinvolved caregiving (Kunce & Shaver, 1994). That is, the care they offer may be more focused on their own needs (and their perceptions of non-fulfillment) and not well coordinated with their partners’ preferences. We suspect that compulsive caregiving by anxious individuals extends to treatment of pets. This may lead to animals that are unruly and poorly trained. We also suspect that patterns of support-seeking directed at pets might differ from the pattern directed at humans by anxious individuals. Feeney and Collins (2006) took attachment-related support-seeking and caregiving research a step further by investigating motivations for caregiving. Avoidant caregivers are more likely to help their partners for selfish reasons, such as feeling a sense of obligation or assuming that the help will be reciprocated later. Anxious caregivers show a mixture of these motivations and more selfless motivations, including concern for their partners and intrinsic enjoyment of helping their loved ones. Secure individuals appear to be motivated more by love and concern for their partners. Thus, these different motivations suggest reasons why insecurely attached (i.e., avoidant or anxious) individuals provide less effective support or more compulsive support. The motivations for caregiving potentially could be assessed even more powerfully by comparing motivations for the selection of different animals as pets, such as by modifying Kunce and Shaver’s (1994) adult caregiving questionnaire. Such research also would have implications for animal welfare (e.g., if there is a link between owner attachment style and pets that are overfed or more likely to develop separation anxiety).
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Secure Base and Exploration Exploration is a fundamental need that is active when the attachment system is quiescent. Bowlby (1969, 1988) discussed the notion of the secure base as a central one in attachment theory. Infants and children use their primary caregivers as launching pads from which to explore. As they get older, children typically operate in ever-increasing orbits around their caregivers. The attachment and exploration systems are connected because exploration potentially exposes explorers to dangers as they increase distance from caregivers. When the threat of danger is perceived, the attachment system is activated and individuals seek to reestablish greater proximity to attachment figures. Research on exploration and especially the concept of the secure base have been virtually ignored by researchers. One of the few direct investigations of the secure base found that when individuals felt that they had a reliable secure base in their partners (i.e., their partners were sensitive to their needs when they were stressed), they felt that their goals were more attainable and had higher goal-related self-efficacy (Feeney, 2003). Mikulincer (1997) found that curiosity or information search, a cognitive precursor to exploration, was greater for secure individuals relative to avoidant individuals, and that secure individuals also had reduced need for cognitive closure relative to anxious and avoidant individuals. Hazan and Shaver (1990) operationalized exploration as orientation to work, and found that secure individuals were more confident about work, enjoyed work for its own sake, and were not preoccupied by fears of failure. Anxious individuals, in contrast, feared negative evaluation and appeared to be motivated to gain the approval of others. Avoidant individuals often used work to replace social interactions. Elliot and Reis (2003) identified a link between attachment and exploration-related motivation, specifically effectance motivation—the desire to have successful interactions with one’s environment. Effectance motivation, and the desire for exploration in general, should be a default motivation unless other motives temporarily establish primacy (e.g., individuals who believe that their safety is threatened will cease exploring their environment). Anxiously attached individuals, for example, may therefore have chronic interference with explorationbased motivation because they feel threatened (Elliot & Reis, 2003; White, 1959). Elliot and Reis found that secure attachment was associated with a high need for achievement (and a low fear of failure) in academic settings. Security also was associated with more approach goals (how can I get better at this?) than avoidance goals (how do I prevent failing?). Green and Campbell (2000) developed an index to measure exploration in the social (e.g., meet new people), intellectual (e.g., visit a modern art museum), and environmental (e.g., travel overseas) domains, and found that attachment avoidance and anxiety both were negatively correlated with exploration. That is, less anxiety and greater comfort with closeness correlated with the desire to engage in activities such as joining a new social group, visiting a strange place, or thinking about unusual ideas. A second study activated one of the three attachment relational schemas (cf. Baldwin, 1992; Baldwin, Carrel, & Lopez, 1990) to assess experimentally the link between attachment and adult exploration. Individuals were primed with a secure, anxious, or avoidant relational schema via an ostensible sentence memorization task in which key words in the sentences related to attachment constructs (e.g., dependence, unpredictability, trust, disclosure, uncertainty). Individuals primed with one of the two insecure styles were less interested in exploration and expressed reduced preference
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for novel stimuli (e.g., unusual Escher prints such as a dragon biting its own tail) relative to those primed with the secure style. Future research could investigate how couples affect each other’s exploration. Perhaps securely attached couples foster more exploration as each partner serves as a secure base for the other from which to try new activities. In a similar vein, animal companions might provide the emotional resources (i.e., the secure base) for an individual to engage in greater social or environmental exploration, or even change an owner’s dispositional levels of anxiety or avoidance, preparing him or her for more secure human relationships. Perhaps simply having a pet might open the door to pet-related activities that facilitate the development of human relationships (e.g., volunteering at the ASPCA, online chats with fellow cat lovers). On the other hand, some types of exploration might be inhibited by the attachment to an animal companion. For example, Mikulincer (1997) found that avoidant individuals read more about consumer products (i.e., acted more curious) when that choice competed with social interaction. That is, avoidant individuals may choose a less threatening relationship with a pet over a human relationship. In addition to possible moderation by attachment anxiety or avoidance, the type of animal companion or the quality of the human-animal relationship might moderate this relationship. In short, examining exploration from the perspective of pet-human relationships may provide valuable insights about human attachments and exploration in various domains.
Pet Choice and Attachment Style A great deal of social psychological theory has addressed how individuals choose their friends and romantic partners, and these concepts may be applied to research on choosing pets. Attachment theory provides a particularly fascinating approach to this issue. Research suggests that the pairing of individuals according to attachment style is not random. Some research has found that individuals are most attracted to those who share their attachment style (Frazier, Byer, Fischer, Wright, & DeBord, 1996). However, these preferences may not become reality. Kirkpatrick and Davis (1994) found no avoidant-avoidant or anxious-anxious pairs in a sample of 354 heterosexual dating couples. They also found that couples composed of an avoidant man and an anxious woman were fairly stable over three years, in spite of the fact that these relationships were relatively unhappy. It may be that individuals find themselves with partners who confirm their (often negative) attachment-related expectations (e.g., an avoidant man expects his partner to be clingy and demanding, which characterizes anxious-ambivalence). What is the relevance of this research for human-animal pairings? First, do humans view different pets along attachment-related dimensions? We have obtained suggestive evidence that they do. We asked individuals to provide open-ended descriptions of dogs and cats, and used content analysis to examine the attachment-related words. Dogs were described with more security-related words, whereas cats were described with more avoidance-related words. (These results were not qualified by individual levels of avoidance and anxiety—similar perceptions of cats and dogs existed for everyone.) These findings were replicated when we adapted the Experiences in Close Relationships (ECR-R) scales (Fraley, Waller, & Brennan, 2000; Sibley, Fischer, & Liu, 2005), the most commonly used and validated measure of attachment avoidance and anxiety, to dogs and cats separately. That is, we asked individuals
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to imagine owning a particular animal and to report how they would feel in the context of a relationship with that animal (“it is easy for me to be affectionate with my dog”). If dogs and cats are perceived to vary along attachment-related dimensions, does their desirability as pets depend in part on the level of avoidance or anxiety of potential owners? We collected some preliminary data on this question as well. Not surprisingly, the more avoidant individuals reported themselves to be, the less interested they were in owning a pet. The more anxious individuals reported themselves to be, the more interested they were in wanting to own a pet. However, findings for specific animals varied somewhat: anxiety was positively correlated with wanting to own a cat, but not correlated with wanting to own a dog. Our tentative conclusion is therefore consistent with the Kirkpatrick and Davis (1994) findings and their interpretation of attachment pairing: individuals may end up choosing a pet that confirms their expectations (e.g., an anxious person is more likely to choose a cat, who is perceived to be relatively avoidant). More direct research is needed to assess if attachment avoidance and anxiety predict the type of pet that individuals actually choose.
Do Attachment Styles Change? Another fascinating theoretical question involves the malleability of attachment styles or dimensions. Attachment usually is conceptualized as a stable individual difference developed during childhood as a result of the pattern of behavior by one’s primary caregiver. Reports of the stability of attachment styles have varied widely in the literature, but the best conclusion at this time is that these styles are only moderately stable over the long-term (Fraley, 2002). Individuals likely have different attachment styles with different individuals (Kamenov & Jelic, 2005). Put another way, individuals have schemas or working models of different attachment styles in memory. Even though there likely is a primary (or chronically activated) style, the other styles can be activated under different circumstances or in different relationships (Green & Campbell, 2000). For example, one may feel securely attached to many friends, but feel anxious when considering a particular friend who rarely returns calls. Attachment stability is affected by the beginning or ending of a romantic relationship (Kirkpatrick & Hazan, 1994) and non-romantic relationships (i.e., those with family members and friends) tend to be more secure than romantic relationships (Kamenov & Jelic, 2005). When we directly compared individuals’ attachment anxiety and avoidance (as assessed by the ECR-R) with their reports on the same measure adapted for different animals, we found that individuals reported significantly more attachment security to dogs than to people (with cats falling in between). Similar results of strongly felt security associated with pets were recently reported by Beck and Madresh (2008), supporting our previous contention that human-pet relationships are characterized by reduced evaluation concerns. Research shows that experiences with family members, friends, and romantic partners may buffer and possibly even alter attachment anxiety and avoidance; however, whether pets may help individuals change on attachment dimensions (i.e., become less avoidant or less anxious) is a currently unaddressed but fascinating question. That is, will the felt security from a long-term relationship with a pet change one’s predominant attachment style from an insecure to a secure one? If so, how might that affect the individual’s human relationships? In summary, attachment anxiety and avoidance can be measured at the general level or at the partnerspecific level. Relationships with many animals may be associated with less anxiety than
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relationships with humans. Future research should investigate whether pet-human relationships affect more general attachment orientations, and thus possibly affect future human relationships. More broadly, research on both humans and animals as third parties to dyadic relationships is needed (Green, Burnette, & Davis, 2008), because third parties can profoundly influence those relationships. This area is woefully underresearched, in part due to methodological and statistical challenges. Balance theory (Heider, 1958) provides a particularly useful framework for investigating the role of third parties in dyadic relationships. Being overly attached to one’s pet (one’s first love?) may have deleterious consequences for a romantic relationship if the partner feels he or she is competing against the pet. Stammbach and Turner (1999) found that attachment to cats correlated negatively with the number of close others who provided social support. On the other hand, as mentioned previously, pets may provide a secure base or buffer for some individuals, or provide a training ground for learning caregiving and support-seeking, leading to better human relationships longer-term.
COMPANION ANIMALS AND HEALTH Physical Contact, Ownership, and Health Attachment theory can also be seen in the considerable literature (of which we discuss only representative examples) investigating the influence of animals on human well-being. Such research generally has found that companion animals improve physical and mental wellbeing for human owners (Crawford, Worsham, & Swinehart, 2006). Proximity to a variety of pets (e.g., watching aquarium fish; Katcher, Segal, & Beck, 1984) or petting an animal (even snakes, Eddy, 1996) can reduce blood pressure or heart rate, although the evidence is somewhat mixed. Other work has confirmed that touching pets can attenuate cardiovascular responses (Vormbrock & Grossberg, 1988), but some research has found no significant benefits or even come to the opposite conclusion (i.e., raised physiological markers in the presence of an animal). However, some of these studies have used unfamiliar animals, highlighting the differences between the potential calming presence of any animal and the unique bond with one’s own animal. The attachment system is activated under stressful conditions, so attachment-related concerns will be more pronounced in stressful situations than in non-stressful situations. Though they did not assess attachment style, which may have qualified their results, Allen and colleagues (1991) had female dog owners perform a stressful mental arithmetic task in the lab as well as at home. Autonomic responses (e.g., skin conductance, pulse rate) were assessed on both occasions. Participants completed the task at home either alone (only the experimenter present), with their dog present (but no touching of the pet occurred), or with a close friend. Compared to the alone condition, participants had significantly less physiological reactivity when their pets were present, but more reactivity when their friends were present. Participants apparently were concerned about being evaluated by their friends even though the friends intended to be supportive; participants tried to perform the arithmetic tasks more quickly but made more errors when their friends were present. The dogs in this
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case appear to have provided non-evaluative social support, consistent with our previous assumptions. These more controlled experiments are complemented by research focusing on the influence of animals on longer-term physical and psychological health. Research confirms that companion animals usually provide health benefits, though this evidence is also sometimes conflicting (for reviews see Podberscek, Paul, & Serpell, 2000; Wilson & Turner, 1998). For example, a longitudinal study demonstrated that individuals who had recently acquired pets, as opposed to non-pet owners, showed significant decreases in the number of subsequent physician visits (Headey & Grabka, 2007). Researchers found lower rates of depression among humans highly attached to their pets (Garrity et al., 1989). The limitations of correlational research are particularly noteworthy in these situations. It is possible that the presence of a pet reduces depressive symptoms, but it is also possible that non-depressed individuals are more likely to seek out a pet for companionship, and that additional variables may moderate this association.
Special Populations Much of the companion animal and health research has focused on special populations such as the elderly, likely due to potential increases in loneliness and health-related issues associated with this demographic group (Siegel, 1990; Tucker, Friedman, Tsai, & Martin, 1995). Elderly animal owners, relative to non-owners, showed less deterioration in general health (Raina, Waltner-Toews, Bonnett, Woodward, & Abernathy, 1999), engaged in healthier behaviors such as exercise and diet (Dembrecki & Anderson, 1996), and had significantly fewer visits to the doctor (Siegel, 1990). However, the influence of companion animals on elderly health has not been entirely consistent (Parslow, Jorm, Christensen, Rodgers, & Jacomb, 2005; Siegel, 1990) likely due to the considerable methodological challenges associated with studying pet ownership in this population (Pachana, Ford, Andrew, & Dobson, 2005). Another special population that has received attention is individuals recovering from serious illness. For example, dog ownership (but not cat ownership) was associated with a higher survival rate from heart episodes over one year (Friedman & Thomas, 1995). A parallel study examined the role of pet ownership in lung transplant recipients (Irani, Mahler, Goetzmann, Russi, & Boehler, 2005). Lung transplant recipients who owned pets showed subsequently greater quality of life but no significant physical health differences when compared to lung-transplant recipients who did not own pets. The absence of any significant health differences is compelling when considering that health centers sometimes warn against pets because of the possibility for zoonotic disease transmission. At least in this intriguing study, any physical health-related risks associated with having pets appear to be negligible or offset by the psychological boosts associated with owning a pet. The influence of pets on human health dovetails nicely with growing utilization of animals in pet-facilitated therapy. Pet-facilitated therapy (PFT) refers to the use of animals as catalysts in several forms of therapeutic intervention (Brodie & Biley, 1999; Hines & Fredrickson, 1998). “Therapy” in this context may carry some degree of ambiguity; it often is unclear whether PFTs are tied to a specific therapeutic goal or the more general goals of personal development and well-being. To illustrate the former, Levinson (1969), in a seminal
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paper, had his dog (described as a co-therapist) attend therapy sessions with child psychiatric patients and found that withdrawn children often opened up after interacting with the dog. To illustrate more general well-being or skill goals, pets have been used to facilitate reading development in children: the presence of a pet helped children increase their reading skill and their confidence in reading (Philips, 2006). The most common applications of PFT involve elderly populations who frequently lack social support (Hooker, Freeman & Stewart, 2002) or children and adults with clinical or related disorders. For example, PFT has been utilized for hospitalized children (Kaminski, Pellino, & Wish, 2002), autistic children (Prothmann et al., 2005; Redefer & Goodman, 1989), children with eating and anxiety disorders (Prothmann et al., 2005), and adult incarcerated felons (Moneymaker & Strimple, 1991). The fact that animals can assist in the recovery or increased well-being of individuals with a variety of physical or psychological problems provides further evidence that the human-animal bond can be a close and vital one.
Explanations for Health Benefits: Direct and Indirect Effects Several explanations have been proffered for why animals confer health benefits to their human companions. One obvious direct effect involves the affection that individuals receive from pets and the fact that individuals can affiliate with pets during stressful times (Collis & McNicholas, 1998). In addition, some researchers have investigated the idea that animals provide humans with greater meaning or purpose because they are responsible for the care of their pets (e.g., Collis & McNicholas, 1998). One indirect explanation for the association between pet ownership and health is that companion animals can increase social support by facilitating interactions between humans (e.g., Chinner & Dalziel, 1991). Another indirect explanation is that pet owners may exhibit increased physical activity, such as dog owners going for walks more often than non-dog owners.
Connections to Attachment Theory Much less work has approached these questions from an attachment theory (or other theoretical) perspective. Indirectly related to attachment theory and its emphasis on close emotional bonds, unmarried dog owners who reported feeling close to their pet had fewer doctor visits than unmarried dog owners who reported not feeling close to their pet, as well as fewer doctor visits than unmarried non-owners (Headey, 1999). Colby and Sherman (2002) incorporated attachment style directly into an examination of pet visitation and subjective well-being in an institutionalized elderly population. They demonstrated that attachment styles play an important role in the effectiveness of pet visitation; whereas individuals with secure or anxious/ambivalent attachment styles responded positively to dog visitation, those with avoidant attachment styles responded negatively. This pattern is consistent with research on humans. Carpenter and Kirkpatrick (1996) found the following attachment style differences regarding stress and physiological reactivity: Securely attached women did not show different reactivity to a psychological stressor when alone than when with their romantic partner, but avoidant women showed higher blood pressure when their partner was with them compared to when they were by themselves. As queried previously, do avoidant
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individuals inhibit contact with pets when highly stressed, or is the lack of evaluation going to make them just as likely to turn to a pet, rather than a human, for comfort? In summary, the majority of research suggests that companion animals provide physical and psychological health benefits. Nevertheless, researchers should continue to incorporate attachment theory and other relationship theories and methods to investigate the connection between animals and health.
SUMMARY One of the most popular textbooks on the psychology of interpersonal relations (Berscheid & Regan, 2005) includes a section on “relationships with companion animals.” This brief synopsis includes wonderful anecdotes about the bonds between individuals and animals as well as examples in which an animal beloved by one person increases the stress felt by that person’s spouse. However, no scientific research is cited, which emphasizes (a) the poor integration of the human-animal relationship into the broader notion of “interpersonal relationships” and (b) the opportunity for additional research. We hope that our selective review of the relevant literature helps spur researchers to venture into these largely uncharted waters, so that future textbooks on relationships have a surfeit of sources from which to draw. We have touched on only a few of the myriad applications to both human and animal welfare. Bowlby’s attachment theory and his insights about human emotional bonds were in part inspired by research on animals, including the Harlow studies (e.g., Harlow, 1958) of rhesus monkey babies who attached to artificial cloth mothers that did not provide milk over wire mothers that provided milk (highlighting the importance of physical touch in an emotional bond), as well as animal imprinting studies that demonstrated the tendency of many baby animals such as goslings to follow the first animal they see after they are born or hatched. Therefore, it is gratifying to see that attachment theory may come full circle and be fruitfully applied to relationships between humans and their animal companions. We deliberately focused on this one theoretical perspective, but other theories of human relationships also may be applied to relationships between humans and animal companions. For example, interdependence theory (Kelley & Thibaut, 1978; Rusbult & Arriaga, 2000) may help to illuminate issues of power and dependence and the variety of interdependent situations in which humans and animals find themselves enmeshed. As psychologists and pet owners, we are excited about what the future holds for research on human-animal relationships. These close relationships are worthy of study in their right, but we also are confident that a theoretically and methodologically rigorous approach to studying them will expand our understanding of interpersonal human bonds.
ACKNOWLEDGEMENTS We thank Jeni Burnette, Jennifer Clarke, and Jody Davis and for their constructive feedback on earlier drafts. We also thank our beloved pets Indy, Maggie, Mini, Durango, Jupiter, and Emily for their inspiration and support during this project. Correspondence
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concerning this article should be addressed to Jeffrey D. Green, Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, P. O. Box 842018, Richmond, Virginia 23284-2018; E-mail:
[email protected]
REFERENCES Ainsworth, M.D.S., Bell, S.M.V., & Stayton, D. J. (1973). Individual differences in the strange-situation behavior of one-year-olds. In L. S. Stone, H. T. Smith, & L. B. Murphy (Eds.), The competent infant. New York: Basic Books. Ainsworth, M.D.S., Blehar, M. C.,Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum. Allen, K. M., Blascovich, J., Tomaka, J., & Kelsey, R. M. (1991). Presence of human friends and pet dogs as moderators of autonomic responses to stress in women. Journal of Personality and Social Psychology, 61, 582-589. American Pet Products Manufacturers Association (2007). 2007/2008 National Pet Owners Survey, 11th ed. Byrum, CT: APPMA. Baldwin, M.W. (1992). Relational schemas and the processing of social information. Psychological Bulletin, 112, 461-484. Baldwin, M. W., Carrel, S. E., & Lopez, D. F. (1990). Priming relationship schemas: My advisor and the pope are watching me from the back of my mind. Journal of Experimental Social Psychology, 26, 435-454. Banks, M. R., & Banks, W. A. (2005). The effects of group and individual animal-assisted therapy on loneliness in residents of long-term care facilities. Anthrozoös, 18, 396-408. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226-244. Baumeister, R. F., & Tice, D. M. (1990). Anxiety and social exclusion. Journal of Social and Clinical Psychology, 9, 165-195. Baumeister, R. F., Wotman, S. R., & Stillwell, A. M. (1993). Unrequited love: On heartbreak, anger, guilt, scriptlessness, and humiliation. Journal of Personality and Social Psychology, 64, 377-394. Beck, L., & Madresh, E. A. (2008). Romantic partners and four-legged friends: An extension of attachment theory to relationships with pets. Anthrozoös, 21, 43-56. Bennett, L. (2007, December 10). Pet industry trends for 2008. Retrieved March 4, 2008, from http://www.smallbiztrends.com/2007/12/pet-industry-trends-for-2008.html/ Berscheid, E., & Regan, P. (2005). The psychology of interpersonal relationships. Upper Saddle River, NJ: Pearson Education. Bodsworth, W., & Coleman, G. J. (2001). Child-companion animal attachment bonds in single and two-parent families. Anthrozoös, 14, 216-223. Bowlby, J. (1969). Attachment and loss: Volume 1. Attachment. New York: Basic Books. Bowlby, J. (1980). Attachment and loss: Volume 3. Loss: Sadness and depression. New York: Basic Books. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.
Another Kind of “Interpersonal” Relationship
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Brodie, S. J., & Biley, F. C. (1999). An exploration of the potential benefits of pet-facilitated therapy. Journal of Clinical Nursing, 8, 329-337. Bruch, M. A., Kaflowitz, N. G., & Pearl, L. (1988). Mediated and nonmediated relationships of personality components to loneliness. Journal of Social & Clinical Psychology, 6, 346355. Carlisle-Frank, P., & Frank, J. M. (2006). Owners, guardians, and owner-guardians: Differing relationships with pets. Anthrozoös, 19, 225-242. Carpenter, E. M., & Kirkpatrick, L. A. (1996). Attachment style and presence of a romantic partner as moderators of psychophysiological responses to a stressful laboratory situation. Personal Relationships, 3, 351-367. Colby, P. M., & Sherman, A. (2002). Attachment styles impact on pet visitation effectiveness. Anthrozoös, 15, 150-164. Collins, N. L., & Feeney, B. C. (2004). Working models of attachment shape perceptions of social support: Evidence from experimental and observational studies. Journal of Personality and Social Psychology, 87, 363-383. Collis, G. M., McNicholas (1998). A theoretical basis for health benefits of pet ownership. In C. C. Wilson & D. C. Turner (Eds.), Companion animals in human health (pp. 105-122). Thousand Oaks, CA, USA: Sage Publications. Chinner, T. L., & Dalziel, F. R. (1991). An exploratory study on the viability and efficacy of a pet-facilitated therapy project within a hospice. Journal of Palliative Care, 7, 13-20. Crawford, E. K., Worsham, N. L., & Swinehart, R. (2006). Benefits derived from companion animals, and the use of the term “attachment.” Anthrozoös, 19, 98-112. Davis, H., Irwin, P., Richardson, M., & O’Brien-Malone, A. (2003). When a pet dies: Religious issues, euthanasia and strategies for coping with bereavement. Anthrozoös, 16, 57-74. Dembrecki, D., & Anderson, J. (1996). Pet ownership may be a factor in improved health of the elderly. Journal of Nutrition for the Elderly, 15, 1531. Driscoll et al. (2007). The Near Eastern origin of cat domestication. Science, 317, 519-523. Eddy, T. J. (1996). RM and beaux: Reductions in cardiac activity in response to a pet snake. Journal of Nervous and Mental Disease, 184, 573-575. Elliot, A. J., & Reis, H. T. (2003). Attachment and exploration in adulthood. Journal of Personality and Social Psychology, 85, 317-331. Endenburg, N. (1995). The attachment of people to companion animals. Anthrozoös, 8, 83-89. Feeney, B. C. (2003). Adult romantic attachment and couple relationships. In M. Mikulincer & P. R. Shaver (Eds.), Attachment in adulthood: Structure, dynamics, and change (pp. 355-377). New York, NY: Guilford Press. Feeney, B. C., & Collins, N. L. (2006). Interpersonal safe haven and secure base caregiving processes in adulthood. In J. Simpson (Ed.), Adult Attachment: Theory, Research, and Clinical Implications (pp. 300-338). New York, NY: Guilford Press. Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43, 522-527. Fraley, C. R. (2002). Attachment stability from infancy to adulthood: Meta-analysis and dynamic modeling of developmental mechanisms. Personality and Social Psychology Review, 6, 123-151. Fraley & Davis, 1997). Attachment formation and transfer in young adults’ close relationships and romantic relationships. Personal Relationships, 4, 131-144.
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Fraley, R. C., & Shaver, P. R. (1997). Adult attachment and the suppression of unwanted thoughts. Journal of Personality and Social Psychology, 73, 1080-1091. Fraley, R. C., & Shaver, P. R. (1998). Airport separations: A naturalistic study of adult attachment dynamics in separating couples. Journal of Personality and Social Psychology, 75, 1198-1212. Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A test of the typological model. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 77-114). New York, NY: Guilford Press. Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365. Frazier, F. A., Byer, A. L., Fischer, A. R., Wright, D. M., & DeBord, K. A. (1996). Adult attachment style and partner choice: Correlational and experimental findings. Personal Relationships, 3, 117-136. Friedman, E., & Thomas, S. A. (1995). Pet ownership, social support, and one-year survival after acute myocardial infarction in the cardiac arrhythmia suppression trial (CAST). American Journal of Cardiology, 76, 1213-1217. Gardner, W. L., Pickett, C. L., & Knowles, M. L. (2005). Social snacking and shielding: Using social symbols, selves, and surrogates in the service of belonging needs. In K. D. Williams, J. P. Forgas, & W. Von Hippel (Eds.), The social outcast: Ostracism, social exclusion, rejection, and bullying (pp. 227-241). New York, NY: Psychology Press. Garrity, T. F., Stallones, L., & Marx, M. B. (1989). Per ownership and attachment as supportive factors in health of the elderly. Anthrozoös, 3, 35-44. Gilbey, A., McNicholas, J., & Collis, G. M. (2007). A longitudinal test of the belief that companion animal ownership can reduce loneliness. Anthrozoös, 20, 345-353. Green, J. D., Burnette, J., & Davis, J. L. (2008). Third-party forgiveness: (Not) forgiving your close other's betrayer. Personality and Social Psychology Bulletin, 34, 407-418. Green, J. D., & Campbell, W. K. (2000). Attachment and exploration: Chronic and contextual accessibility. Personality and Social Psychology Bulletin, 26, 452-461. Hare, B., Brown, M., Williamson, C., & Tomasello, M. (2002). The domestication of social cognition in dogs. Science, 298, 1634-1636. Harlow, H. F. (1958). The nature of love. American Psychologist, 13, 673-685. Hazan, C., Gur-Yaish, N., & Campa, M. (2006). What does it mean to be attached? In J. Simpson (Ed.), Adult Attachment: Theory, Research, and Clinical Implications (pp. 5585). New York, NY: Guilford Press. Hazan, C., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. Hazan, C., & Shaver, P. R. (1990). Love and work: An attachment-theoretical perspective. Journal of Personality and Social Psychology, 59, 270-280. Hazan, C., & Zeifman, D. (1994). Sex and the psychological tether. In K. Bartholomew & D. Pearlman (Eds.), Advances in personal relationships: Vol. 5. Attachment processes in adulthood (pp. 151-178). London: Jessica Kingsley. Headey, B. (1999). Health benefits and health costs savings due to pets: Preliminary estimates from an Australian national survey. Social Indicators Research, 47, 233-243. Headey, B., & Grabka, M. M. (2007). Pets and human health in Germany and Australia: National longitudinal results. Social Indicators Research, 80, 297-311.
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Heider, F. (1958). The psychology of interpersonal relations. New York, NY: Wiley. Hines, L., & Fredrickson, M. (1998). Perspective on animal-assisted activities and therapy. In C. C. Wilson & D. C. Turner (Eds.), Companion animals in human health (pp. 232-239). Thousand Oaks, CA: Sage Publications. Hooker, S. D., Freeman, L. H., & Stewart, P. (2002). Pet therapy research: A historical review. Holistic Nursing Practice, 17, 17-23. Hunt, M., & Padilla, Y. (2006). Development of the pet bereavement questionnaire. Anthrozoös, 19, 308-324. Irani, S., Mahler, C., Goetzmann, L., Russi, E. W., & Boehler, A. (2006). Lung transplant recipients holding companion animals: Impact on physical health and quality of life. American Journal of Transplantation, 6, 404-411. Johnson, T. P., Garrity, T. F., & Stallones, L. (1992). Psychometric evaluation of the Lexington Attachment to Pets Scale. Anthrozoös, 5, 160-175. Kamenov, Z., & Jelic, M. (2005). Stability of attachment styles across students’ romantic relationships, friendships and family relations. Review of Psychology, 12, 115-123. Kaminski, M., Pellino, T., & Wish, J. (2002). Play and pets: the physical and emotional impact of child-life and pet therapy on hospitalized children. Children’s Health Care, 31, 321-335 Katcher, A., Segal, H., & Beck, A. (1984). Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. American Journal of Clinical Hypnosis, 27, 14-21. Kelley, H. H., & Thibaut, J. W. (1978). Interpersonal relations: A theory of interdependence. New York, NY: Wiley. Kirkpatrick, L. A. (1998). God as a substitute attachment figure: A longitudinal study of adult attachment style and religious change in college students. Personality and Social Psychology Bulletin, 24, 961-973. Kirkpatrick, L. A., & Davis, K. E. (1994). Journal of Personality and Social Psychology, 66, 502-512. Kirkpatrick, L. A., & Hazan, C. (1994). Attachment styles and close relationships: A fouryear prospective study. Personal Relationships, 1, 123-142. Knowles, M. L., & Gardner, W. L. (2008, February). “Ill be there for you…”: Favorite television characters as social surrogates. Paper presented at the Society for Personality and Social Psychology conference, Albuquerque, New Mexico. Kunce, L. J., & Shaver, P. R. (1994). An attachment-theoretical approach to caregiving in romantic relationships. In K. Bartholomew & D. Pearlman (Eds.), Advances in personal relationships: Vol. 5. Attachment processes in adulthood (pp. 205-237). London: Jessica Kingsley. Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375. Leary, M. R., Nezlek, J. B., Downs, D., Radford-Davenport, J., Martin, J., & McMullen, A. (1994). Self-presentation in everyday interactions: Effects of target familiarity and gender composition. Journal of Personality and Social Psychology, 67, 664-673. Leary, M. R., Tambor, E. S., Terdal, S. K., & Downs, D. L. (1995). Self-esteem as an interpersonal monitor: The sociometer hypothesis. Journal of Personality and Social Psychology, 68, 518-530.
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Levinson, B. M. (1969). Pet-Oriented Child Psychotherapy. Springfield, IL, USA: Charles C. Thomas. Frantz, C. M., Winter, O., & Mayer, S. (2008, February). Meeting the need to belong through connection to nature. Paper presented at the meeting of the Society for Personality and Social Psychology, Albuquerque, New Mexico. Mikulincer, M. (1997). Adult attachment style and information processing: Individual differences in curiosity and cognitive closure. Journal of Personality and Social Psychology, 72, 1217-1230. Mikulincer, M., Gillath, O., & Shaver, P. R. (2002) Activation of the attachment system in adulthood: Threat-related primes increase the accessibility of mental representations of attachment figures. Journal of Personality and Social Psychology, 83, 881-895. Moneymaker, J. M., & Strimple, E. O. (1991). Animals and inmates: A sharing companionship behind bars. Journal of Offender Rehabilitation, 16(3-4), 133-152. Morell, J. (2008, March). Minds of their own: Animals are smarter than you think. National Geographic, 36-61. Pachana, N. A., Ford, J. H., Andrew, B., & Dobson, A. J. (2005). Relations between companion animals and self-reported health in older women: Cause, effect, or artifact? International Journal of Behavioral Medicine, 12, 103-110. Parkes, C. M. (1972). Bereavement: Studies of grief in adult life. New York, NY: International University Press. Parslow, R. A., Jorm, A. F., Christensen, H., Rodgers, B., & Jacomb, P. (2005). Pet ownership and health in older adults: Findings from a survey of 2,551 community-based Australians aged 60-64. Gerontology, 51, 40-47. Philips, M. (2006, December 11). A reader’s best friend. Newsweek, 14. Podberscek, A. L., Paul, E. S., & Serpell, J. A. (2000). Companion animals and us: Exploring the relationships between people and pets. New York: Cambridge University Press. Prothmann, A., Albrecht, K., Dietrich, S., Hornfeck, U., Stieber, S., & Ettrich, C. (2005). Analysis of child-dog play behavior in child psychiatry. Anthrozoös, 18, 43-58. Raina, P., Waltner-Toews, D., Bonnett, B., Woodward, C., & Abernathy, T. (1999). Influence of companion animals on the physical and psychology health of older people: An analysis of a one-year longitudinal study. Journal of the American Geriatrics Society, 47, 323329. Redefer, L. A., & Goodman, J. F. (1989). Brief report: Pet-facilitated therapy with autistic children. Journal of Autism and Developmental Disorders, 19, 461-467. Rusbult, C. E., & Arriaga, X. B. (2000). Interdependence in personal relationships. In W. Ickes & S. Duck (Eds.), The social psychology of personal relationships (pp. 79-108). Chichester, UK: Wiley. Schleidt, W. M., & Shalter, M. D. (2003). Co-evolution of human and canids. Evolution and Cognition, 9, 57-72. Schlenker, B. R. & Leary, M. R. (1985). Social anxiety and communication about the self. Journal of Language and Social Psychology, 16, 171-192. Sibley, C. G., Fischer, R., & Liu, J. H. (2005). Reliability and validity of the revised experiences in close relationships (ECR-R) self-report measure of adult romantic attachment. Personality and Social Psychology Bulletin, 31, 1524-1536. Siegel, J. M. (1990). Stressful life events and the use of physician services among the elderly. Journal of Personality and Social Psychology, 58, 1081-1086.
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Serpell, J. (1995). The domestic dog: Its evolution, behaviour, and interactions with people. Cambridge, UK: Cambridge University Press. Siegel, J. M. (1990). Stressful life events and use of physician services among the elderly: The moderating role of pet ownership. Journal of Personality and Social Psychology, 58, 1081-1086. Simpson, J., Rholes, W., & Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434-446. Solano, C. H., & Koester, N. H. (1989). Loneliness and communication problems: Subjective anxiety or objective skills? Personality and Social Psychology Bulletin, 15, 126-133. Sprecher, S., & Felmlee, D. (1992). The influence of parents and friends on the quality and stability of romantic relationships: A three-wave longitudinal investigation. Journal of Marriage and the Family, 54, 888-900. Stammbach, K., B., & Turner, D. C. (1999). Understanding the human-cat relationship: Human social support or attachment. Anthrozoös, 12, 162-168. Stewart, C. S., Thrush, J. C., & Paulus, G. (1989). Disenfranchised bereavement and loss of a companion animal: Implications for caring communities. In K. J. Doka (Ed.), Disenfranchised grief: Recognizing hidden sorrow (pp. 147-159). Lexington, MA, USA: Lexington Books. Tanick, M. H. (1998, December). Pets must have more legal worth than replacement costs. Dog World, 83(12), 78-80. Tucker, J. S., Friedman, H. S., Tsai, C. M., & Martin, L. R. (1995). Playing with pets and longevity among older people. Psychology and Aging, 10, 3-7. Turner, W. G. (2003). Bereavement counseling: Using a social work model for pet loss. Journal of Family Social Work, 7(1), 69-81. Twenge, J. M., Baumeister, R. F., Tice, D. M., & Stucke, T. S. (2001). If you can’t join them, beat them: Effects of social exclusion on aggressive behavior. Journal of Personality and Social Psychology, 81, 1058-1069. Twenge, J. M., Catanese, K. R., & Baumeister, R. F. (2002). Social exclusion causes selfdefeating behavior. Journal of Personality and Social Psychology, 83, 606-615. Vigne, J., Guilaine, J., Debue, K., Haye, L., & Gérard, P. (2004). Early taming of the cat in Cyprus. Science, 304, 259. Vilà, C., Savolainen, P., Maldonado, J. W., Amorim, I. R., Rice, J. E., Honeycutt, R. L., Crandall, K. A., Lundeberg, J., & Wayne, R. K. (1997). Multiple and ancient origins of the domestic dog. Science, 276, 1687–1689. Vormbrock, J. K., & Grossberg, J. M. (1988). Cardiovascular effects of human-pet dog interactions. Journal of Behavioral Medicine, 11, 509-517. White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333. Wilson, C. C., & Turner, D. C. (1998). Companion animals in human health. Thousand Oaks, CA: Sage Publications.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 5
THE ROLE OF OXYTOCIN IN THE PATHOPHYSIOLOGY OF ATTACHMENT Marazziti Donatella1,*, Catena Dell’Osso Mari2, Consoli Giorgio1, and Baroni Stefano1 1
Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Italy 2 Dipartimento di Psicologia, University of Florence, Italy
ABSTRACT Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Although OT-like substances are present in all vertebrates, oxytocin has been identified only in mammals where it seems to be fundamental in the onset of typical mammalian behaviors, including labour and lactation. In the present chapter, the physiological role of oxytocin in the regulation of different functions and behaviors will be addressed: several data, mainly coming from animal models, have highlighted the role of this neuropeptide in the formation of caregiver-infant attachment, pair-bonding and, more generally, in linking social signals with cognition, behaviours and reward. In addition, recent evidences have demonstrated alterations of oxytocin system in several human neuropsychiatric disorders, leading to the hypothesis of a possible involvement of oxytocin in the onset of mental disorders. In this frame, the psychopathological implication of the disregulation of the oxytocin system and the possible use of oxytocin or its analogues and/or antagonists in the treatment of psychiatric disorders will be discussed.
*
Author to whom correspondence and reprint requests should be sent: Dr. Donatella Marazziti. Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, I-56100 Pisa, Italy; Telephone: +39 050 835412; Fax: +39 050 21581; E-mail address:
[email protected]
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INTRODUCTION The first evidence of the existence of a neural pathway from the supraoptic (SON) nucleus of the hypothalamus to the posterior pituitary dates back to the end of the 19th century [1]. Subsequently, Scharrer (1928) discovered, in the fish hypothalamus, the existence of neurons which could secrete substances via exocytosis of cytoplasmic vesicles, the so-called “glandular cells” [2]. Two decades later, oxytocin (OT) was isolated in pituitary extracts and became the first peptide hormone to have its amino acid sequence identified and to be synthesized in its active form [3]. This chapter aimed to provide a comprehensive review of the OT system and of its role in the formation of social bonds, as well as its possible involvement in the onset of psychopathology.
SYNTHESIS AND LOCALIZATION OT is a small peptide characterized by a six amino acid ring and a three amino acid tail. It differ from vasopressin (AVP) in terms of two amino acids: Ile vs Phe at position 3 and Leu vs Arg at position 8, respectively. The presence at the position 8 of the chain of a neutral amino acid enables OT to bind to its receptors [4]. All vertebrates possess at least a OT-like and a AVP-like peptide, while suggesting the existence of two evolutionary molecular lineages: the isotocin-mesotocin-OT line, implicated in reproductive functions, and the vasotocin-vasopressin line, involved in the water homeostasis. On the contrary, OT and AVP have been found only in mammals and probably have developed in parallel with typical mammalian behaviors, such as uterine contraction during labour and milk ejection essential for lactation. Magnocellular neurons of the SON and paraventricular (PVN) nuclei of the hypothalamus OT and AVP are the major source of OT [5]. OT and AVP are assembled as precursors which are subsequently processed in the neurosecretory vesicles. The largest precursor of OT is preprooxytocin, that comprises three components: a signal sequence of about 16–30 amino acid residues at the neuropeptide terminal, the neuropeptide sequence and the space parts [6]. During the intravescicular post-translational processing, OT precursor undergoes sequential proteolytic cleavage and other enzimatic modifications, such as glycosylation, phosphorylation, acetylation and amidation, that lead to the three final products: OT, neurophysin and a carboxy-terminal glycoprotein. Once synthetized, OT is targeted along the axon to the posterior pituitary [7] where each axon produces several nerve terminals that constitute about 50% of the total volume of the neural lobe. At this level OT and its transporting proteins may be released into the blood, so that they can stimulate their receptors located in distant target organs, such as mammary gland and kidney. Several other biologically active substances, including AVP, neuropeptide Y, tyrosine hydroxylase, dynorphin, thyrotropin-releasing hormone, atrial natriuretic factor, galanin and nitric oxide (NO) synthase, are co-released with OT, even if the reciprocal effects between them and OT are still unknown [8, 9]. Oxytonergic magnocellular projections do not reach only the posterior pituitary, but also terminate in the arcuate nucleus, the lateral septum, the medial amygdaloid nucleus and the
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median eminence [10]. In the magnocellular SON and PVN nuclei, OT is also locally released from dendrites and can act as self-neuromodulators: the somatodendritic release occurs in response to several stimuli, including suckling, parturition, dehydration, hemorrhage, fever, physical restraint, pain, mating and territorial marking behaviors, administration of hypertonic solutions or pharmacological challenges [11]. OT, through the hypothalamic-pituitary portal vascular system, can also reach the adenohypophysis where it seems to be involved in the regulation of the release of different adenohypophysial hormones, including prolactin, adrenocorticotropic hormone (ACTH) and gonadotropins. OT is supposed to act as a prolactin-releasing factor but only when the dopamine levels are low, like during periods of dopamine withdrawal that characterize the onset of prolactin secretion. Moreover, since pituitary OT receptor gene expression is restricted to lactotrophs and increases at the end of gestation [12], it seems that OT function as a prolactin-releasing factor only around the end of gestation. OT may play a role in the endocrine response to stress: in rats, OT seems to potentiate the release of ACTH induced by CRH. In fact, if CRH is responsible for the immediate secretion of ACTH following an acute stress, when CRH levels begin to decrease during prolonged stress, the persistent level of OT in the median eminence seems to be related to the delayed ACTH response and the generation of ACTH pulsatile secretory bursts [13]. However data are controversial: in humans, OT infusion inhibited the plasma ACTH responses to CRH, and suckling and breast stimulation increased and decreased, respectively, plasma OT and ACTH levels; these evidences would indicate an inhibitory influence of OT on ACTH secretion. OT has also been demonstrated to stimulate LH release: an advancement of the LH surge with earlier ovulation has been described after OT administration to proestrous rats. However, the physiological relationships between OT and LH has yet to be clarified [14]. OT is also released from neurons localized in the dorsal-caudal part of PVN and called parvicellular given their smaller size, as compared with that of the magnocellular neurons. Their axons are part of the descending tract directed to the sympathetic centers of the spinal cord and to the parasympathetic caudal autonomic centers, such as the dorsal motor nucleus of the nervus vagus and the nucleus of tractus solitarii [15, 16]. A peripheral synthesis of OT has also been demonstrated in placenta, uterus, corpus luteum, amnion, testis and heart.
OXYTOCIN RECEPTORS There is a single population of OT receptors which can be found in the brain and peripheral organs. They belong to the class I of G protein-coupled receptor family and are coupled to phospholipase C-beta which, once activated, leads to the generation of 1,2-diacylglycerol and inositol trisphosphate. The final increase of intracellular Ca2+ may trigger several cellular events, such as smooth cell contraction, changes of cellular excitability, modifications of gene trascription and protein synthesis [17]. The brain distribution of OT receptors show a large interspecies variability. In rats, OT binding sites have been found in the olfactory system, basal ganglia, thalamus, lymbic system (bed nucleus of the stria terminalis, central amygdaloid nucleus, ventral subiculum), hypothalamus (ventromedial nucleus), brain stem and spinal cord. In the rabbit, no receptors have been detected in the ventral subiculum of the hippocampus or in the hypothalamic
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ventromedial nucleus. In human brain, they are mainly distributed in the pars compacta of substantia nigra and globus pallidus, areas which have been linked to attachment, as well as in the anterior cingulate and medial insula [18]. Conversely, OT binding sites were absent in hippocampus, amygdala, entorinal cortex and olfactory bulb. Theoretically, the different distribution of OT receptors in the brain of individuals belonging to different species might be related to the variety of functions potentially regulating by them. The density and distribution of OT receptors in the brain also varies across development and can be influenced by steroids, such as estrogen, progesterone, androgens and glucocorticoids. At peripheral level they have been demonstrated to be localized in kidney, heart, thymus, pancreas and adipocytes. These receptors are stimulated by the OT released into the blood by the neurohypophisis and carry on several important physiological function.
SOCIAL ATTACHMENT AND OXYTOCIN Most of the data on the neurobiological mechanisms that subtend the formation of social bonds came from animal models. In fact, the methods of science (invasive, rigorously controlled) are difficult to apply to personal experiences associated with social attachment in humans. Neuropeptides, particularly OT, seem to play a critical role in the initiation and maintenance of complex social behaviors [19-21]. They would act trough the inhibition of defensive behaviours associated with fear and anxiety and trough the promotion of positive social behaviours which may lead to social bonds formation. The most relevant data on this issue will be reviewed, according to Harlow’s classification of social bonds (parental attachment, infant attachment, pair attachment) [22]. The hormonal effects of specific physiological states, which are known to encourage positive social behaviours, will also be reported.
Parental Attachment The most stable and long-lasting form of social bond is maternal attachment, which is critical for the survival of mammals. Most of the data on the biochemical and neurobiological mechanisms that subtend maternal bonding came from precocial ungulates, especially sheep, who develop selective filial attachment. In fact, as in humans, in these animals maternal attachment is usually developed only towards the ewe’s own lamb. The hormones regulating birth and lactation have been implicated in the genesis of caregiver – infant attachment [23, 24]. OT, the mammalian hormone with the predominant role in both birth and lactation, has been obviously considered the main candidate for the onset of caregiver – infant attachment and about 30 years ago was proposed as the hormone of the mother love [25, 26]. Vaginal stimulation and sukling may lead to maternal bonding trough a release of OT and endogenous opioids [24]. In sheep, it has been demonstrated that OT injection can lead ewes to get attached to unfamiliar lamb, while OT antagonists may block the maternal bond formation [27]. Rats represent another ideal subject for studying the maternal care: nulliparous female rats do not show any interest in infants until the parturition, when a drastic change in
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motivation occurs and typical maternal behaviours became established [28]. OT injection in the lateral ventricles of nulliparous ovariectomized rats may induce maternal behaviors [29], while the central injection of OT antagonists or lesions of OT-producing magnocellular neurons in the hypothalamus inhibit the onset of maternal behaviors. These data, coupled with the fact that, once a female has become maternal, OT antagonists have no effect, might indicate that OT is foundamental for the onset, but not for the maintenance of maternal attachment [30]. In humans, little is known on the influence of OT in maternal behaviors: in a old study it was reported that breast-feeding within 1 h of birth, when OT levels are high, could contribute to a long-lasting mother-infant bond with beneficial effects on the development of the child [31]. Although the neurobiological mechanisms underlying OT-related onset of maternal behaviors are still unclear, the increase of OT receptors in the bed nucleus of the stria terminalis and the ventromedial nucleus of the hypothalamus, that occurs just before parturition, may represent crucial steps of this process [32].
Infant Attachment Infant attachment has been often studied on the basis of behavioural and hormonal changes associated to the separation from the attachment figure. In primates, the attachment object represent the safe and secure base which can protect the infant from threats and provide him with food. During the early development, the mother-infant interaction and the early social experiences may produce long-lasting changes in the brain of the infant with profound behavioural and emotional effects throughout the whole life. OT seems to be critical in the genesis of infant attachment: infants are exposed to the high levels of maternal OT during both labor and lactation. In animals, infants do not develop preferences for the mother if they are pretreated with OT antagonists, while OT administration was demonstrated to facilitate a rapid conditioned association to maternal odor cues [33]. Therefore, the increased blood levels of this hormone may induce positive social interactions, including the formation of social bonds and of their memories, as well as of selective infant–parent attachments. OT administration reduces the separation response of the rat pups, consistently with the role of this peptide in either attachment or separation response [34, 35]. Interestingly, OT receptors have been found in the developing brain with a transient but marked “overproduction” (as compared to the adult) in the limbic areas in the first two postnatal weeks [36, 37]. In addition, OT receptors are present in the reward circuit that includes the nucleus accumbens, the cortex, the talamus and the pallidus, and which, during infant development, has been implicated in the regulation of that sense of ssafety and protection which makes social and parental interactions highly rewarding. OT is considered to be one of the potential candidates involved in the transduction of early experiences (birth process, breast-feeding and other aspects of parent-infant interactions) into physio- (patho-) logical changes, including brain growth, later stress reactivity and ovarian disorders [38]. In humans, the deprivation of the normal parental cares has been recently shown to produce long-lasting changes in the sensitivity to OT during adulthood [39] and to alter the development of children’s OT and AVP systems, which interfere with the comforting effects that typically emerge between children and familial adults who take care of them; in fact, OT
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and AVP levels are increased by socially pleasant experiences, including comforting touches and smells [40].
Adult Pair Bonds A natural animal model for studying the neurobiological substrates of pair bond formation is provided by the prairie voles, small arvicoline rodents that live in pairs and develop adult heterosexual pair bonds that resemble those of humans [41]. In fact, the prairie vole, that are usually found in multigenerational family, shows the classic features of monogamy: a breeding pair lives in the same nest and territory, males, too, take care of infants and intruders of either sex are refused [42]. On the contrary, montane voles are not monogamous and live in isolated conditions showing little interest in social contact. The two species show a different neural distribution of OT receptors: the prairie voles show OT receptors in the nucleus accumbens and prelimbic cortex, brain regions associated with the reward system, while suggesting that OT might have reinforcing properties. In the montane voles the OT receptors are mainly distributed in the lateral septum and seem to be responsible for the effects of OT on self-grooming behavior observed only in this species. Similar differences in receptor distribution have also been observed in pine and meadow voles which are characterized by different social organization (i.e., monogamous versus nonmonogamous) [43]. In prairie voles, period of non-sexual cohabitation can lead to pair bond formation, however, if mating is allowed, they are developed more quikly [44]; mating is known to lead to a release of OT which, therefore, has been hypothesized to be involved in pair bonding [21]. The hypothesis of the involvement of OT in pair bonding seemed to be confirmed by the evidence that, in female prairie voles, central OT treatments increase social contact and facilitate partner preference formation which, on the contrary, seem to be inhibited by the use of OT antagonists [45, 46]. In any case, OT seems to produce different effects in male and female prairie voles: central OT administration in females, but not in males, facilitates the development of a partner preference in the absence of mating [34]. However, the role of OT in males remain unclear, possibly because males are more dependent on AVP. In humans, OT administration seem to increase the trust towards the others, possibly through the involvement of the amygdala, the main component of the circuit of fear and social cognition which highly expresses OT receptors [47]. OT seem to be able to modulate some functions of human amygdala: a neuroimaging study (functional magnetic resonance) showed that OT reduced significantly the activation of amygdala and its coupling to brain regions implicated in autonomic and behavioral responses to fear [48]. The property of OT to facilitate the formation of social bonds has been related to the improvement of the inference of the affective mental state of the other subjects, which, in turn, would lead to a reduction of the ambiguity experienced during a social interaction with subsequent decreases of anxiety levels [49]. This theory is in line with the previous result of a reduction of the autonomic response to aversive pictures after OT treatment [50]. OT administration, however, did not affect self-report scales of psychological state regarding anxiety and mood [51]; it seems that the presence of a social interaction is necessary to elicit the OT effect, since it would become evident only in the social context, but not when subjects rate themselves in isolation. Moreover, it has been demonstrated that the decrease of amigdala activation after OT
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administration was more significant for social stimuli, such as faces, than for non social ones, suggesting that different neural systems may mediate social and non-social fear [51]. A critical requirement for the formation of pair bonds is the ability to identify conspecifics [52]. OT seem to be involved in social learning and recognition, the so-called social memory. In fact, OT knock-out mices are not able to recognize previously encountered conspecifics and do not show any attachment behaviour; however, central OT administration before the first contact can restore normal attachment behaviors [53]. Therfore, OT seems to be involved in acquisition rather than in consolidation of social bonds and, in rats, OT can lead to the onset of partner preference [54]. The likelihood of a social encounter is also important for pair bond formation: for example, anxiety and novelty avoidance may reduce the likelihood of approaching a conspecific. While OT has been demonstrated to decrease anxiety-like behaviors, AVP seems to increase them [55]. The opposite effects on behaviors produced by OT and AVP may be explained by the need of a gender-specific modulation of different behaviors. Although OT influences sexual behaviors and social interactions in both males and females, the onset of maternal behaviors is fundamental in females [16] and require the inhibition of novelty avoidance, the suppression of prior social avoidance learning and a decrease of aggression. On the contrary, AVP promotes behavioral modifications leading to the establishment of territories and dominance hierarchies characteristic of male social behavior.
Sexual Behavior and Attachment There is a strong relationship between neuropeptides and sexual behaviour. In those species that form heterosexual pair bonds, such as prairie voles, sexual contacts are followed by the formation of stable bonds [42]. In humans, plasma OT levels increase during sexual arousal and are significantly higher during orgasm than at baseline in both males and females [20, 21]. Moreover, the level of muscular contractions during orgasm has been positively related to OT plasma levels [56], suggesting that some OT effects may depend on its ability to stimulate smooth muscles contraction in the genital area. In addition, intranasal OT administration seems to enhance the sexual arousal and orgasm intensity: interestingly, a woman who had used a synthetic OT spray, experienced an increased sexual desire associated with intense vaginal transudate [57, 58]. Overall, during sexual arousal OT seems to act peripherally on reproductive organs and activates the sexual functions in both women and men. Beyond its peripheral effects on reproductive organs, OT might also sensitize the neurons responsible for the cognitive feelings of orgasm, while representing a physiological substrate for both sexual behavior and performances. In men, AVP concentrations increased significantly during arousal and returned to basal levels at the time of ejaculation, while plasma OT rose about five-fold during ejaculation and returned to basal concentrations within about 30 minutes [59].
Stress and Attachment It is well known that threatening situations might strengthen and facilitate the onset of social bonds [60]. In prairie voles, stress and corticosterone injection have been demonstrated
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to facilitate pair bond formation. The underlying hypothesized mechanism is that glucocorticoids modulate social bonds by influencing synthesis and release of OT and/or OT receptors [61]. OT may be released from the pituitary gland in response to different stressful stimuli, such as pain, conditioned fear and exposure to novel environments [62]. In rats, the acute exposure to immobilization stress resulted in increased OT-mRNA levels, while both forced swimming and shaker stress provoked a raise of central and plasma OT concentrations. OT would facilitate the activation of the hypothalamic-pituitary-adrenal axis by increasing the glucocorticoid release. Along this line, it is supposed that the stressinduced central release of OT can ameliorate some stress-related disorders, such as depression and anxiety: in mice and in rats, OT showed anxiolytic properties in estrogen-treated females possibly mediated by its influence on dopaminergic neurotransmission in the limbic areas. Since stress and anxiety impair maternal caretaking, a reduced stress responsiveness during lactation appear to be adaptive for both mother and infant. In line with these observations, lactating women showed reduced hormonal responses to exercise stress, as compared with postpartum women who bottle-feed their infants [63]. Furthermore, women with panic disorder have been demonstrated to experience, during lactation, a reduction of their anxiety symptoms [64].
OXYTOCIN AND NEUROPSYCHIATRIC DISORDERS Only a few data exist on a possible involvement of OT in the pathophysiology of neuropsychiatric disorders. Although most of them should be considered as suggestions, nevertheless they are intriguing and would indicate the need of further research in this promising area.
Depression Since OT has been shown to decrease stress response and anxiety levels, to modulate cognitive functions and promote positive social relationships, some symptoms of depression, including social withdrawal, cognitive impairment, appetite modifications and stress reactivity [65], have been related to alteration of the OT system [66]. In a postmortem study, increased density of AVP- and OT-expressing neurons was detected in the PVN nucleus of depressed patients [67]; on the contrary, no difference in OT levels was found in cerebrospinal fluid (CSF) of depressed patients and control subjects [68]. As far as OT plasma levels, although in a first study decreased levels of the neuropetide have been reported in depressed patients [69], no difference in a larger group of patients, as compared with healthy subjects was also found [70]. More recently, a negative correlation correlation was found between plasma OT and symptoms of depression and anxiety in 25 patients affected by major depression [71]. The OT abnormalities reported in depression, although requiring further support, may be linked to the dysregulation of the HPA axis reported in this condition, together with the multiple neurotransmitters and modulators acting at this level.
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Anxiety Disorders Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions. OT may influence physiological activities, including memory acquisition, maintenance and retrieval, as well as grooming, maternal and sexual behaviors, which may be related to some OCD features. OT receptors have been identified in some brain areas, which have also been implicated in the pathophysiology of OCD [72-75]. In animals, the central OT injection produce a significant increase of grooming behavior [76, 77] which is considered a model of compulsions, as cleaning behaviors are prototypical symptoms in OCD patients [78, 79] and parallel the OT-induced grooming behaviors observed in animals [80]. The hypothesis of an involvement of the OT system in the pathophysiology of OCD is supported by the evidence that pregnancy and the postpartum period are characterized by an increased risk for the onset of contamination obsessions [81-84]. It is possible that a subgroup of women are vulnerable to the induction or exacerbation of OCD after the exposure to the elevated OT levels, such as those occurring during the pregnancy [85, 86]. Moreover, increased OT levels in the CSF of adults with OCD and Tourette’syndrome, as compared with healthy control subjects, have been reported and they seem to correlate with the current severity of OCD [87]. The attempts to administer OT to OCD patients led to controversial results [88-92], so that further data are necessary to understand the potentiality of OT or its analogues as antiobsessional treatment. OT seems to have anxiolytic properties. In mothers, OT levels have been demonstrated to positively relate with a reduction of the incidence of stress and anxiety disorders [63]; pregnancy, a period characterized by increased OT levels, seems to be protective for some anxiety disorders, including panic disorder. OT, which is released during stress, seems to be an important modulator of anxiety and fear response, with a final reduction of anxiety [9395]. Dysfunctions of the amygdala, which is implicated in the biological response to danger signals in social interaction, have been reported in anxiety disorders; however, it is known that amygdala activity is modulated by OT, since its intranasal administration reduce amygdala activation and its coupling to the brain regions involved in the autonomic and behavioral response to fear [48]. Recently, a downregulation of OT receptors has been related to the pathophysiology of social anxiety disorder that might explain the cognitive misappraisals typical of the patients affected by this condition [48]. In patients with post-traumatic stress disorder (PTSD), the intranasal OT administration was able to decrease the memory retrieval and conditioned response [50]. In fact, OT attenuates memory consolidation and retrieval, facilitates the extinctions of an activated avoidance response and attenuates passive avoidance behavior [96, 97]. Alterations of the OT system following severe early stress and trauma may interfere with the normal brain devolpment while increasing the subsequent risk of developing PTSD and, more in general, any kind of psychopathology [98].
Eating Disorders OT and AVP, which have been demonstrated to influence feeding behavior [99], have been eating disorders where inconclusive results have been reported [100-103]. The serum activity of the prolyl endopeptidase (PEP), an enzyme that cleavages many active
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neuropeptides, such as OT, AVP, thyrotropin releasing hormone, substance P, bradykinin, neurotensin and angiotensin [104], was decreased in both bulimic and anorectic patients [105]. The CSF OT levels were found to be low in restricting anorectic partients [103], but, since they tend to normalize after weight restoration, they were interpreted as secondary to malnutrition and abnormalities in fluid balance [105, 106]. Autoantibodies against OT were reported in both anorexia and bulimia nervosa and seem to indicate that immune dysfunctions may also be involved in the pathophysiology of these disorders [107].
Addiction A crucial drug-sensitive component of the reward circuit, which is enhanced by abuse drugs, is represented by the mesolimbic dopaminergic system which is under the modulatory control of several neurotransmitters and hormones [108]. OT could be involved in the development of tolerance and dependence towards abuse substances including opiates and cocaine [109]. Given that adaptation and learning are likely to be implicated in the neural events leading to drug tolerance and dependence [110], OT is supposed to modulate dopamine in the reward circuit. In mice, OT seems to inhibit the onset of tolerance to morphine [111] and to attenuate the symptoms of morphine withdrawal [109]. OT attenuated also the cocaine-induced hyperactivity and inhibited the behavioral tolerance to the effect of this drug, while facilitating the development of behavioral sensitization [112-114]. As far as ethanol is concerned, OT was shown to inhibit the development of tolerance to ethanol in mice [115]; acute alcohol administration inhibits OT secretions [116], while its chronic use stimulates it [117]. It has also been hypothesized that OT might be involved in the cognitive dysfunctions observed in alcoholics [117, 118].
Schizophrenia Only a few data are available on the relationship between OT system and psychoses. OT levels were increased in schizophrenic patients, as compared with healthy controls, particularly in those taking neuroleptics [119]. In addition, in the brain of untreated schizophrenic patients, a morphometric evaluation of neurophysin-immunoreactivity suggested the presence of alterated OT function [120].
Autism and Related Disorders OT and AVP seem to be implicated in social skills [19-21, 121, 122] and abnormalities of their neural pathways may underlie several aspects of autism, such as repetitive behaviors, cognitive and social deficits, early onset, and genetic loading [123, 124]. The central regulation and expression of OT and AVP may help to explain the higher prevalence of the disorder in male subjects: in fact, centrally active AVP has been related to increased vigilance, anxiety, arousal and activation, while OT seems to have opposite effects including reduced anxiety, relaxation, growth and restoration. Therfore, higher activity of AVP, due to
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an increased exposure to androgens, might contribute to the male vulnerability to autism, while OT, which is estrogen-dependent and is higher in female subjects, especially during early development, may be a protective factor [125]. There are only a few data on the relationships between OT and autism: plasma OT levels have been reported to be decreased in 29 autistic children, as compared with healthy control subjects, and to negatively relate to the reported scores on social and developmental measures [126]. Moreover, in the blood of autistic children, an altered, extended form of OT, which is normally detected only during the fetal life, has been found at higher levels than in normal subjects [127]; this fetal form less active than the adult OT and may interfere with the functioning of the OT system. In addition, it has been suggested that the OT receptor gene may be an excellent candidate for the susceptibility to autism [123, 128-130]: two specific nucleotide polymorphisms of OT receptors, rs2254298 and rs53576, seem to characterized autistic subjects in a Chinese Han population [131]; this association has been replicated in a Caucasian sample of United States but only for the rs2254298 polymorphism [132]. Another association study has recently confirmed that specific haplotypes in the OT receptor gene may confer the risk to develop autism [133].
Prader-Willy Syndrome The Prader Willy syndrome (PWS) is a genetic disorder characterized by mental retardation, hypogonadism, short stature and distinctive dysmorphic features. A 42% reduction of OT-expressing neurons was described, post-mortem, in the PVN nucleus of PWS subjects, as compared with healthy controls [134]. Similarly to what described in OCD patients, increased OT CSF levels have been found in PWS subjects [81].
CONCLUSION OT and the OT system are currently attracting an increasing interest and have become one of the main topics of several research lines. Several data, mainly coming from animals, suggest that OT plays a major role in the modulation of a broad range of functions and of complex behaviours including its role in the formation of caregiver-infant attachment, pairbonding and, more generally, in linking social signals with cognition, behaviours and reward. Recently OT has been implicated in the pathophysiology of different neuropsychiatric disorders, even if data are scattered and the abnormalities described in patients are quite meagre and, therefore, should be considered preliminary.
REFERENCES [1] [2]
Ramon, Cajal (1894). La fine structure des centres nerveux. Procedings of the royal society, London.. Scharrer, E., Scharrer, B. (1940). Secretory cells within the hypothalamus. Res. Publ. A. Nerv. Ment. Dis. 20, 170-174.
122 [3] [4] [5]
[6] [7] [8] [9]
[10]
[11]
[12]
[13]
[14] [15]
[16]
[17] [18]
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al. Du Vigneaud, V., Ressler, C., Trippet, S. (1953). The sequence of amino acids in oxytocin, with a proposal for the structure of oxytocin. J. Biol. Chem. 205(2), 949-57. Barberis, C., Movillac, B., Durroux, T. (1998). Structural bases of vasopressin/oxytocin receptor function. J. Endocrinol. 156(2), 223-9. Swaab, D. F., Pool, C. W., Nijveldt, F. (1975). Immunofluorescence of vasopressin and oxytocin in the rat hypothalamo-neurohypophyseal system. J. Neural Transmission 36, 195-215. Holmgren, S. & Jensen, J. (2001). Evolution of the nervous system, evolution of vertebrate neuropeptides. Brain Res. Bull. 55, 723– 735. Arvan, P. & Castle, D. (1998). Sorting and storage during secretory granules biogenesis: looking backward and looking forward. Biochem. J. 332, 593–610. Pretel, S. & Piekut, D. (1990). Coexistence of corticotropin-releasing factor and enkephalin in the paraventricular nucleus of the rat. J. Comp. Neurol. 294, 192-201. Xiao, M., Ding, J., Wu, L., Han, Q., Wang, H., Zuo, G., Hu, G. (2005). The distribution of neural nitric oxide symthose-positive cerebrospinal fluid-contacting neurons in the third ventricular wall of male rats and coexistence whith vasopressin or oxytocin. Brain Res. 1038, 150-62. Pittman, Q. T., Blume, H. W., Renaud, L. P. (1981). Connections of the hypotholamic paraventricular nucleus with the neurohypophisis, median eminence, amigdale, lateral septum and midbrain perioqueductal gray : an electrophysiological study in the brain. Brain Res. 215, 15-28. Neumann, I., Douglas, A. J., Pittman, Q. J., Russell, J. A., Landgraf, R. (1996). Oxytocin released within the supraoptic nucleus of the rat brain by positive feedback action in involved in parturition-related events. J. Neuroendocrinol. 8, 227-233. Breton, C., Pechoux, C., Morel, G., Zingg, H. H. (1995). Oxytocin receptor messenger ribonucleic acid: characterization, regulation, and cellular localization in the rat pituitary gland. Endocrinology 136, 2928–2936. Boyle, L. L., Brownfield, M. S., Lent, S. J., Goodman, B., Vo Hill, H., Litwin, J., Carnes, M. (1997). Intensive venous sampling of adrenocorticotropic hormone in rats with sham or paraventricular nucleus lesions. The Journal of endocrinology 153, 159– 167. Evans, J. J. (1996). Oxytocin and the control of LH. Journal of Endocrinology 151, 169–174. Amico, J. A., Challinor, S. M., Comeron, J. L. (1990). Pattern of oxytocin concentrations in the plasma and cerebrospinal fluid of lactating rhesus monkeys (Macaca Mulatta): evidence for funtionally independent oxytocinergic pathways in primates. J. Clin. Endocrinol. Metab. 71(6), 1531-5. Palkovits, M., Toth, Z. E., Gallatz, K., Fodor, M. (1999). Decussations of the descending paraventricular pathways to the brainstein and spinal cord autonomic centers. J. Comp. neurol. 414, 255-66. Gimpl, G., Fahrenholz, F. (2001). The oxytocin receptor system: structure, function, and regulation. Physiol. Rev. 81, 629-683. Brown, C. H., Stern, J. E., Jackson, K. L., Bull, P. M., Leng, G., Russell, J. A. (2005). Morphine withdrawal increases intrinsic excitability of oxytocin neurons in morphinedependent rats. Eur. J. Neurosci. 21(2), 501-12.
Development of an Interview for Assessing Relationship Quality
123
[19] Wakerley, J. B., Lincoln, D. W. (1973). The milk-ejection reflex of the rat: a 20- to 40fold acceleration in the firing of paraventricular neurones during oxytocin release. J. Endocrinol. 57, 477-93. [20] Carmichael, M. S., Humbert, R., Dixen, J., Palmisano, G., Greenleaf, W., Davidson, J. M. (1987). Plasma oxytocin increases in the human sexual response. The Journal of clinical endocrinology and metabolism 64, 27–31. [21] Carter, C. S. (1992). Oxytocin and sexual behavior. Neuroscience and Biobehavioral Reviews 16, 131–144. [22] Harlow, H. F. & Mears, C. (1979). The Human Model: Primate Perspectives. John Wiley & Sons, New York. [23] Keverne, E. B. (1995). Neurochemical changes accompanying the reproductive process: their significance for maternal care in primates and other mammals. In: C. R. Pryce, R. D. Martin & D. Skuse (Eds). Motherhood in human and non-human primates. Karger, Basel, pp. 69-77. [24] Keverne, E. B., Nevison, C. M., Martel, F. L.(1997). Early learning and the social bond. Annals of the New York Academy of science. 807, 329-339. [25] Klopfer, P. H. (1971). Mother love: what turns it on? American Scientist 59, 404-407. [26] Newton, N. (1973). Interrelationships between sexual responsiveness, birth and breast feeding. In: J. Zubin & J. Money (Eds). Contemporary sexual behaviour: critical issues in the 1970s. Johns Hopkins University Press, Baltimore, pp. 77-98. [27] Carter, C. S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology 23, 779-818. [28] Numan, M. (1994). A neural circuitry analysis of maternal behavior in the rat. Acta Paediatr. Suppl. 397, 19-28. [29] Pedersen, C. A., Prange, A. J. (1979). Induction of maternal behavior in virgin rats after intracerebroventricular administration of oxytocin. Proceedings of the National Academy of Sciences of the United States of America 76, 6661–6665. [30] Skutella, T., Weber, T., Jirkowski, G. F. (1993). Coexistence of oxytocin and tyrosine hydroxylase in the rat hypothalamus, an immunocytochemical study. J. Neural. Transm. Gen. Sect. 94, 55-61. [31] Kennell, J. H., Jerauld, R., Wolfe, H., Chesler, D., Kreger, N. C., Mcalpine, W. (1974). Maternal behavior one year after early and extended post-partum contact. Developmental medicine and child neurology 16, 172–179. [32] Caldwell JD, Walker CH, Pedersen CA, Barakat AS, Mason GA (1994). Estrogen increases affinity of oxytocin receptors in the medial preoptic area-anterior hypothalamus. Peptides 15, 1079–1084. [33] Nelson, E. & Panksepp, J. (1996). Oxytocin mediates acquisition of maternally associated odor preferences in preweanling rat pups. Behav. Neurosci. 110, 583-92. [34] Winslow, J. T., Hastings, N., Carter, C. S., Harbaugh, C. R., Insel, T. R. (1993). A role for central vasopressin in pair bonding in monogamous prairie voles. Nature 7, 365, 545-8. [35] Tribollet, E., Goumaz, M., Raggenbass, M., Dreifuss, J. J. (1991). Appearance and transient expression of vasopressin and oxytocin receptors in the rat brain. J. Recept. Res. 11, 333-46. [36] Shapiro, L. E., Insel, T. R. (1989). Ontogeny of oxytocin receptors in rat forebrain: a quantitative study. Synapse 4, 259-66.
124
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
[37] Insel, T. R. & Winslow, J. T. (1991). Central administration of oxytocin modulates the infant rat's response to social isolation. Eur. J. Pharmacol. 2;203(1),149-52. [38] Carter, C. S. (2003). Developmental consequences of oxytocin. Physiology & Behavior 79, 383-397. [39] Meinlschmidt, G., Heim, C. (2007). Sensitivity to intranasal oxytocin in adult men with early parental separation. Biol. Psychiatry 1;61(9), 1109-11. [40] Fries, A. B., Ziegler, T. E., Kurian, J. R., Jacoris, S., Pollak, S. D. (2005). Early experience in humans is associated with changes in neuropeptides critical for regulating social behavior. Proc. Natl. Acad. Sci. USA 102 (47), 17237-40. [41] Insel, T. R. (1997). A neurobiological basis of social attachment. Am. J. Psychiatry 154, 727-35. [42] Carter, C. S., DeVries, A. C., Getz, L. L. (1995). Physiological substrates of mammalian monogamy: the prairie vole model. Neurosci. Biobehav. Rev. 19(2), 30314. [43] Insel, T. R., Wang, Z. X., Ferris, C. F. (1994). Patterns of brain vasopressin receptor distribution associated with social organization in microtine rodents. J. Neurosci. 14(9), 5381-92. [44] Williams, J. R., Catania, K. C., Carter, C. S. (1992). Development of partner preferences in female prairie voles (Microtus Ochrogaster): the role of social and sexual experience. Hormones and Behavior 26, 339-349. [45] Williams, J. R., Insel, T. R., Harbaugh, C. R., Carter, C.S. (1994). Oxytocin administered centrally facilitates formation of a partner preference in female prairie voles (Microtus ochrogaster). J. Neuroendocrinol. 6(3):247-50. [46] Insel, T. R., Winslow, J. T., Wang, Z. X., Young, L., Hulihan, T. J. (1995). Oxytocin and the molecular basis of monogamy. Advances in experimental medicine and biology 395, 227–234. [47] Kosfeld, M., Heinrichs, M., Zack, P. J., Fischbacher, U., Fehr, E. (2005). Oxytocin increases trust in humans. Nature 435, 673-676. [48] Kirsch, P., Esslinger, C., Chen, Q., Mier, D., Lis, S., Siddhanti, S., Gruppe, H., Mattay, V. S., Gallhofer, B., Meyer-Linderberg, A. (2005). Oxytocin modulates neural circuitry for Social Cognition and Fear in Humans. J. Neurosci. 25, 11489-11493. [49] Domes, G., Heinrichs, M., Gläscher, J., Büchel, C., Braus, D. F., Herpertz, S. C. (2007). Oxytocin attenuates amygdala responses to emotional faces regardless of valence. Biol. Psychiatry 15;62(10), 1187-90. [50] Pittman, R. K., Orr, S. P., Lasko, N. B. (1993). Effects of intranasal vasopressin and oxytocin on physiologic responding during personal combat imagry in Vietnam veterans with posttraumatic stress disorder. Psychiatry Res. 48, 107-17. [51] Meyer-Lindenberg, A., Hariri, A. R., Munoz, K. E., Mervis, C. B., Mattay, V. S., Morris, C. A., Berman, K. F. (2005). Neural correlates of genetically abnormal social cognition in Williams syndrome. Nat. Neurosci. 8, 991-3. [52] Insel, T. R., Frenald, R. D. (2004). How the brain processes social information: searching for the social brain. Annu. Rev. Neurosci. 27, 697-722. [53] Dantzer, R., Bluthe, R. M., Koob, G. F., Le Moal, M. (1987). Modulation of social memory in male rats by neurohypophysial peptides. Psychopharmacology 91, 363– 368.
Development of an Interview for Assessing Relationship Quality
125
[54] Popik, P. & Van Ree, J. M. (1993). Social transmission of flavored tea preferences: facilitation by a vasopressin analog and oxytocin. Behav. Neural Biol. 59, 63-8. [55] Bielsky, I. F., Young, L. J. (2004). Oxytocin, vasopressin, and social recognition in mammals. Peptides 25(9), 1565-74. [56] Carmichael, M. S., Warburton, V. L., Dixen, J., Davidson, J. M. (1994). Relationships among cardiovascular, muscular, and oxytocin responses during human sexual activity. Archives of Sexual Behavior 23, 59–79. [57] Anderson, H. M. & Dennerstein, L. (1994). Increased female sexual response after oxytocin. B.M.J. 309, 929. [58] Anderson, H. M., Dennerstein, L. (1995). Oxytocin and female sexuality. Gynecologic and obstetric investigation 40(4), 217-211. [59] Murphy, C. R., Dwarte, D. M. (1987). Increase in cholesterol in the apical plasma membrane of uterine epithelial cells during early pregnancy in the rat. Acta Anatomica 128, 76–79. [60] Bowlby, J. (1980). Attachment and Loss. New York: Basic Books. [61] DeVries, A. C., DeVries, M. B., Taymans, S. E., Carter, C. S. (1996). The effects of stress on social preferences are sexually dimorphic in prairie voles. Proceedings of the National Academy of Science 93, 11980-11984. [62] Onaka, T. (2004). Neural pathways controlling central and peripheral oxytocin release during stress. J Neuroendocrinol. 16(4), 308-12. [63] Altemus, M. (1995). Neuropeptides in anxiety disorders. Effects of lactation. Ann. N.Y. Acad. Sci. 771, 697-707. [64] Klein, D. F., Skrobola, A. M., Garfinkel, R. (1995). Preliminary look at the effects of pregnancy on the course of panic disorder. Anxiety 1, 227–232. [65] Pariante, C. M., Miller, A. H. (2001). Glucocorticoid receptors in major depression: relevance to pathophysiology and treatment. Biol. Psychiatry 49, 391–404. [66] Bell, C. J., Nicholson, H., Mulder, R. T., Luty, S. E., Joyce, P. R. (2006). Plasma oxytocin levels in depression and their correlation with the temperament dimension of reward dependence. J. Psychopharmacol. 20(5), 656-60. [67] Purba, J. S., Hoogendijk, W. J., Hofman, M. A., Swaab, D. F. (1996). Increased number of vasopressin- and oxytocin-expressing neurons in the paraventricular nucleus of the hypothalamus in depression. Arch. Gen. Psychiatry 53, 137-43. [68] Newport, D. J., Heim, C., Owens, M. J., Ritchie, J. C., Ramsey, C. H., Bonsall, R., Miller, A. H., Nemeroff, C. B. (2003). Cerebrospinal fluid corticotropin-releasing factor (CRF) and vasopressin concentrations predict pituitary response in the CRF stimulation test: a multiple regression analysis. Neuropsychopharmacology 28, 569– 576. [69] Frasch, A., Zetzsche, T., Steiger, A., Jirikowski, G. F. (1995). Reduction of plasma oxytocin levels in patients suffering from major depression. Adv. Exp. Med. Biol. 395, 257-8. [70] van Londen, L., Goekoop, J. G., van Kempen, G. M., Frankhuijzen-Sierevogel, A. C., Wiegant, V. M., van der Velde, E. A., De Wied, D. (1997). Plasma levels of arginine vasopressin elevated in patients with major depression. Neuropsychopharmacology 17(4), 284-92.
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[71] Scantamburlo, G., Hansenne, M., Fuchs, S., Pitchot, W., Maréchal, P., Pequeux, C., Ansseau, M., Legros, J. J. (2007). Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology 32(4), 407-10. [72] Rapoport, J. L.& Wise, S. P. (1988). Obsessive–compulsive disorder: evidence for basal ganglia dysfunction. Psychopharmacology Bulletin 24, 380–384. [73] Stahl, S. M. (1988). Basal ganglia neuropharmacology and obsessive–compulsive disorder: the obsessive–compulsive disorder hypothesis of basal ganglia dysfunction. Psychopharmacology Bulletin 24, 370–374. [74] Modell, J. G., Mountz, J. M., Curtis, G. C., Greden, J. F. (1989). Neurophysiologic dysfunction in basal ganglia:limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive compulsive disorder. Journal of Neuropsychiatry 1, 27–36. [75] Insel, T. R. (1992). Toward a neuroanatomy of obsessive–compulsive disorder. Archives of General Psychiatry 49, 739–744. [76] Van Wimersma Greidanus, T. B., Kroodsma, J. M., Pot, M. L. H., Stevens, M., Maigret, C. (1990). Neurohypophyseal hormones and excessive grooming behavior. European Journal of Pharmacology 187, 1–8. [77] Marroni, S. S., Nakano, F. N., Gati, C. D., Oliveira, J. A., Antunes-Rodrigues, J., Garcia-Cairasco, N. (2007). Neuroanatomical and cellular substrates of hypergrooming induced by microinjection of oxytocin in central nucleus of amygdala, an experimental model of compulsive behavior. Mol. Psychiatry 12(12):1103-17. [78] Holzer, J. C., Goodman, W. K., McDougle, C. J., Baer, L., Boyarsky, B. K., Leckman, J. F., Price, L. H. (1994). Obsessive compulsive disorder with and without a chronic tic disorder: a comparison of symptoms in 70 patients. British Journal of Psychiatry 164, 469–473. [79] Leckman, J. F., Grice, D.E., Barr, L.C., de Vries, A. L. C., Martin, C., Cohen, D. J., McDougle, C. J., Goodman, W. K., Rasmussen, S. A. (1995). Tic-related vs. non-ticrelated obsessive compulsive disorder. Anxiety 1, 208–215. [80] McDougle, C. J. (1999). Possible role of neuropeptides in obsessive compulsive disorder. Psychoneuroendocrinology 24, 1-24. [81] Jenike, M. A. (1990). Obsessive–compulsive disorders in pregnancy and childbirth. Year Book Medical Littleton. [82] Neziroglu, F., Anemone, R., Yaryura-Tobias, J. A. (1992). Onset of obsessive compulsive disorder in pregnancy. American Journal of Psychiatry 149, 947–950. [83] Sichel, D. A., Cohen, L. S., Dimmock, J. A., Rosenbaum, J. F. (1993). Postpartum obsessive compulsive disorder: a case series. Journal of Clinical Psychiatry 54, 156– 159. [84] Epperson, C. N., McDougle, C. J., Brown, R. M., Leckman, J. F., Goodman, W. K., Price, L. H. (1995). OCD during pregnancy and the puerperium. American Psychiatric Association New Research Abstract #NR 112: 84. [85] Leckman, J. F. & Mayes, L. C. (1999). Preoccupations and behaviors associated with romantic and parental love—the origin of obsessive-compulsive disorder? Child. Adolesc. Psychiatry Clin. North Am. 8, 635 665. [86] Albert, U., Maina, G., Bogetto, F., Ravizza, L. (2000). The role of recent life events in the onset of obsessive-compulsive disorder. CNS Spectr. 5(12), 44-50.
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[87] Leckman, J. F., Goodman, W. K., North, W. G. (1994). Elevated cerebrospinal fluid levels of oxytocin in obsessive-compulsive disorder. Comparison with Tourette’s syndrome and healty controls. Arch. Gen. Psychiatry 51, 782-792. [88] Ansseau, M., Legros, J. J., Mormont, C., Cerfontaine, J. L., Papart, P., Geenen, V., Adam, F., Franck, G. (1987). Intranasal oxytocin in obsessive–compulsive disorder. Psychoneuroendocrinology 12, 231–236. [89] Charles, G., Guillaume, R., Schittecatte, M., Pholien, P., Van Wettere, J. P., Wilmotte, J. (1989). Oxytocin in the treatment of obsessive–compulsive disorder: a report on two cases. Psychiatry and Psychobiology 4, 111–115. [90] Den Boer, J. A., Westenberg, G. M. (1992). Oxytocin in obsessive compulsive disorder. Peptides 13, 1083–1085. [91] Salzberg, A. D. & Swedo, S. E. (1992). Oxytocin and vasopressin in obsessive– compulsive disorder. American Journal of Psychiatry 149, 713–714. [92] Epperson, C. N., McDougle, C. J., Price, L. H. (1996). Intranasal oxytocin in obsessive compulsive disorder. Biological Psychiatry 40, 547–549. [93] Jezova, D., Skultetyova, I., Tokarev, D. I., Bakos, P., Vigas, M. (1995). Vasopressin and oxytocin in stress. Ann. N. Y. Acad. Sci. 29;771, 192-203. [94] McCarthy, M. M., McDonald, C.H., Brooks, P. J., Goldman, D. (1996). An anxiolytic action of oxytocin is enhanced by estrogen in the mouse. Physiol. Behav. 60(5):120915. [95] Marazziti, D., Dell'Osso, B., Baroni, S., Mungai, F., Catena, M., Rucci, P., Albanese, F., Giannaccini, G., Betti, L., Fabbrini, L., Italiani, P., Del Debbio, A., Lucacchini, A., Dell'Osso, L. (2006). A relationship between oxytocin and anxiety of romantic attachment. Clin. Pract. Epidemol. Ment. Health 11;2, 28. [96] Bohus, B., Kovacs, G. L., de Wied, D. (1978). Oxytocin, vasopression and memory: opposite effects on consolidation and retrieval processes. Brain Research 157, 414-417. [97] Amico, J. A., Robinson, G. (1985). Oxytocin: Clinical and Laboratory Studies. Elsevier, New York. [98] Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., Navata, C. P. (2002). Developmental neurobiology of childwood stress and trauma. Psychiatr. Clin. North Am. 25, 397-426. [99] Olson, B. R., Drutarosky, M. D., Stricker, E. M., Verbalis, J. G. (1991). Brain oxytocin receptor antagonism blunts the effects of anorexigenic treatments in rats: evidence for central oxytocin inhibition of food intake. Endocrinology 129, 785–791. [100] Baranowska, B. (1990). Are disturbance in opioid and adrenergic sytems involved in the hormonal dysfunctions of anorexia nervosa? Psychoneuroendocrinology 15, 371379. [101] Gold, P. W., Gwirtsman, H., Avgerinos, P. C., Nieman, L. K., Gallucci, W. T., Kaye, W., Jimerson, D., Ebert, M., Rittmaster, R., Loriaux, D. L., Chrousos, A. (1986). Abnormal hypotalamic-pituitary-adrenal function in anorexia nervosa: pathophysiology mechanisms in underweight and wieght-corrected patients. N. Engl. J. Med. 314, 13351342. [102] Kaye, W. H. (1996). Neuropeptide abnormalities in anorexia nervosa. Psychiatry research 62, 65-74.
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Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
[103] Demitrack, M. A., Lesem, M. D., Listwak, S. J., Brandt, H. A., Jimerson, D. C., Gold, P. W. (1990). CSFf oxytocin in anorexia nervosa:clinical and pathophysiologic considerations. Am. J. Psychiatry 147, 882-886. [104] Welches, W. R., Brosnihan, K. B., Ferrario, C. M. (1993). A comparison of the properties and enzymatic activities of three angiotensin processing enzymes: angiotensin converting enzyme, prlyl endopeptidase and neutral endopeptidase. Life Sci. 52, 1461-1480. [105] Maes, M., Lin, A., Bonaccorso, S., Goossens, F., Van Gastel, A., Pioli, R., Delmeire, L., Scharpe, S. (1999). Higher serum prolyl endopeptidase activity in patients with post-traumatic stress disorder. J. Affect. Disorders 53, 27-34. [106] Chiodera, P., Volpi, R., Capretti, L., Marchesi, C., D’Amato, L., De Ferri, A., Bianconi, L., Coiro, V. (1991). Effect of estrogen or insulin-induced hypoglicemia on plasma oxitocin levels in bulimia and anorexia nervosa. Methabolism 40, 1226-1230. [107] Fetissov, S. O., Harro, J., Jaanisk, M., Jarv, A., Podar, I., Allik, J., Nilsson, I., Sakthivel, P., Lefvert, A. K., Hokfelt, T. (2005). Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. PNAS 102 (41), 1486514870. [108] Koob, G. F. (1992). Neuronal mechanisms of drug reinforcement. Annals of the New York Academy Science 654, 171-191. [109] Kovacs, G. L., Sarnyai, Z., Szabo, G. (1998). Oxytocin and addiction: a review. Psychoneuroendocrinology 23, 945-62. [110] De Wied, D., Gispen, W. H., Van Wimersma Greidanus, T. J. B. (1986). Neuropeptides and Behavior. Pergamon Press, Oxford. [111] Kovacs, G. L. & Telegdy, G. (1987). Endorphin tolerance is inhibited by oxytocin. Pharmacology and Biochemical Behavior 26, 57-60. [112] Kovacs, G. L., Sarnyai, Z., Babarczy, E., Szabò, G., Teledgy, G. (1990). The role of oxytocin –dopamine interactions in cocaine-induced locomotor hyperactivity. Neuropharmacology 29, 365-368. [113] Sarnay, Z., Birò, E., Babarczy, E., Vecsernyes, M., Laczi, F., Szabò, G., Krivan, M., Kovacs, G. L., Telegdy, G. (1992a). Oxytocin modulates behaviouraladaptation to repeated treatment with cocaine in rats. Neuropharmacology 31, 593-598. [114] Sarnay, Z., Szabò, G., Kovacs, G. L., Telegdy, G. (1992b). Opposite actions of oxytocin and vasopressin in the development of cocaine-induced behavioral sensitization in mice. Pharmacology and Biochemical Behavior 43, 491-494. [115] Szabò, G., Kovacs, G. L., Telegdy, G. (1989). Intraventricular administration of neurohypophyseal hormones interferes with the development of tolerance to ethanol. Acta Physiologia Hungaricae 73, 97-103. [116] Nemeroff , C. B. & Loosen, P. T. (1987). Handbook of Clinical Endocrinology. Guilford Press, New York. [117] Marchesi, C., Chiodera, P., Brusamonti, E., Volpi, R., Coiro, V. (1997). Abnormal plasma oxytocin and beta-endorphin levels in alcoholics after short and long term abstinence. Prog. Neuropsychopharmacol. Biol. Psychiatry 21, 797-807. [118] Holden, J. J., McLaughlin, E. J., Reilly, E. L., Overall, J. E. (1988). Accelerated mental aging in alcoholics patients. J. Clin. Psychiatry 44, 286-292.
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[119] Beckmann, H., Lang, R. E., Gattaz, W. F. (1985). Vasopressin-Oxytocin in cerebrospinal fluid of schizofrenic patients and normal controls. Psychoneuroendocrinology 10 (2), 187-91. [120] Mai, J. K., Berger, K., Sofroniew, M. V. (1993). Morphometric evaluation of neurophysin-immunoreactivity in the human brain: pronounced inter-individual variability and evidence for altered staining patterns in schizophrenia. J. Hirnforsh 34, 133-54. [121] Insel, T. R. (1992). Oxytocin, a neuropeptide for affiliation: evidence from behavioral, receptor autoradiographic, and comparative studies. Psychoneuroendocrinology 17, 335. [122] Panskepp, J. (1992). Oxytocin effects on emotional processes: separation distress, social bonding and relationships to psychiatric disorders. Ann. N. Y. Acad. Sci. 652, 243-252. [123] Insel, T. R., O’Brien, D. J., Leckman, J. F. (1999). Oxytocin, vasopressin, and autism: is there a connection? Biol. Psychiatry 45 (2), 145-57. [124] Insel, T. R., Young, L. J. (2001). The neurobiology of attachment. Nat. Rev. Neorosci. 2,129-136. [125] Carter, C. S. (2007). Sex differences in oxytocin and vasopressin: implications for autism spectrum disorders? Behav. Brain Res. 10;176(1), 170-86. [126] Modahl, C., Green, L., Fein, D., Morris, M., Waterhouse, L., Feinstein, C., Levin, H. (1998). Plasma oxytocin levels in autistic children. Biol. Psychiatry 15;43(4), 270-7. [127] Green, L., Fein, D., Modhal, C., Feinstein, C., Waterhouse, L., Morris, M. (2001). Oxytocin and autistic disorder: alterations in peptide forms. Biol. Psychiatry 50 (8), 609-13. [128] Young, L. J. (2001). Oxytocin and vasopressin as candidate genes for psychiatric disorders: Lessons from animal models. Am. J. Med. Genet. 105, 53-54. [129] Young, L. J., Pitkow, L. J., Ferguson, J. N. (2002). Neuropeptides and social behavior: animal models relevant to autism. Mol. Psychiatry 7, 538-39. [130] Ylisaukko-oja, T., Alarcon, M., Cantor, R. M., Auranen, M., Vanhala, R., Kempas, E., von Wendt, L., Jarvela, I., Geschwind, D. H., Peltonen, L. (2006). Search for autism loci by combined analysis of Autism Genetic Resource Exchange and Finnish families. Ann. Neurol. 59, 145-55. [131] Wu, S., Jia, M., Ruan, Y., Liu, J., Guo, Y., Shuang, M., Gong, X., Zhang, Y., Yang, X., Zhang, D. (2005). Positive associations of the Oxytocin Receptor Gene (OXTR) with Autism in the Chinese Han Population. Biol. Psychiatry 58, 74-77. [132] Jacob, S., Brune, C. W., Carter, C. S., Leventhal, B. L., Lord, C., Cook, E. H. (2007). Association of the oxytocin receptor gene (OXTR) in Caucasian children and adolescents with autism. Neurosci. Lett. 24;417(1), 6-9. [133] Lerer, E., Levi, S., Salomon, S., Darvasi, A., Yirmiya, N., Ebstein, R. P. (2007). Association between the oxytocin receptor (OXTR) gene and autism: relationship to Vineland Adaptive Behavior Scales and cognition. Mol. Psychiatry Sep 25. [Epub ahead of print] [134] Swaab, D. F., Purba, J. S., Hofman, M. A. (1995). Alterations in the hypothalamic paraventricular nucleus and its oxytocin neurons (putative satiety cells) in Prader-Willy syndrome: A study of five cases. J. Clin. Endocrinol. Metab. 80, 573-579.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 6
IDENTITY EXPLORATION AND COMMITMENT ASSOCIATIONS WITH GENDER DIFFERENCES IN EMERGING ADULTS’ ROMANTIC RELATIONSHIP INTIMACY H. Durell Johnson*, Kristen A. Loff, George Bell, Evelyn Brady, Erin A. Grogan, Elizabeth Yale, Robert J. Foley, and Trishia A. Pilosi Pennsylvania State University, Pennsylvania, USA
ABSTRACT Emerging adulthood is considered a time when intimacy becomes an integral aspect of romantic relationships, and Arnett (2000) argues intimacy in emerging adults’ romantic relationships results from identity explorations. Previous research, however, suggests emerging adults’ romantic intimacy is associated not only with identity exploration, but also with identity commitments and gender. In an attempt to examine the theorized relationships among identity exploration, identity commitment, gender, and perceived romantic intimacy, the current study examined identity and romantic intimacy responses from a sample of 271 emerging adults (183 females, mean age = 19.22 years; and 88 males (mean age = 19.29 years). Findings indicated 1) both identity exploration and commitment predict emerging adults’ romantic relationship intimacy, 2) gender differences in romantic relationships differ according to emerging adults’ identity status, and 3) identity status differences in romantic relationship intimacy differs for emerging adult males and females. The current study’s test of Arnett’s (2000) hypothesis regarding identity exploration and romantic relationship intimacy development did not fully support his theorized association. Rather, findings suggest differences in emerging adults’ romantic intimacy are associated with their gender and identity commitments as well as *
Correspondence concerning this article should be addressed to H. Durell Johnson, Human Development and Family Studies, Pennsylvania State University, 120 Ridge View Drive, Dunmore, PA 18512-1699, Phone: 570-963-2672, Fax: 570-963-2535, E-mail:
[email protected]
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Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al. identity exploration. As a result, Arnett’s (2000) proposal that identity exploration during emerging adulthood is a necessary precursor for intimate romantic relationships may not completely describe the association between identity and intimacy that emerges during this period, and this association may be more complex than originally theorized. Results are discussed in terms of understanding the moderating association of gender on identity exploration and commitment differences in emerging adults’ reports of romantic relationship intimacy.
INTRODUCTION Early romantic relationships act as a “training ground” for social development by allowing adolescents to experiment with intimacy and sexual activity within a secure context (Davies & Windle, 2000; Furman & Shaffer, 2003), and this secure context is beneficial to the members of the relationship. For example, involvement in a romantic relationship increases one’s status within the peer group (Furman & Simon, 1999; Miller & Benson, 1999; Davies & Windle, 2000) and serves as an additional friendship context (Furman & Shaffer, 2003). Further, the secure context of romantic relationships provides both members with a feeling of connectedness to the other member as well as a sense of companionship. The connectedness and companionship associated with romantic relationships are associated with increased positive affect (Furman & Shaffer, 2003; Joyner & Udry, 2000), increased positive self-concept (Davies & Windle, 2000; Brendgen, Vitaro, Doyle, Markiewicz, & Bukowski, 2002), and lower levels of loneliness and anxiety (Collins & Sroufe, 1999; Davies & Windle, 2000). Higher levels of self-esteem are associated with adolescent feeling of being understood and cared for within their romantic relationship (Collins & Sroufe, 1999). By providing companionship that is beneficial for its members (Furman & Simon, 1999; Miller & Benson, 1999), involvement in romantic relationships can lead to positive social adjustment (Brengden et al., 2002; Davies & Windle, 2000). The transition to intimate romantic relationships is considered a normative developmental process. However, individuals vary in their capacity for developing and maintaining these relationships. One factor associated with the capacity for developing intimate romantic relationships is each member’s personal identity development. Previous research suggests that identity and intimacy progress concurrently during adolescence and emerging adulthood (Craig-Bray, Adams, Dobson, 1988; Dyk & Adams, 1987; Franz & White, 1985; Mellor, 1989; Paul & White, 1990). According to Erikson (1968), it is possible to share oneself with another through the formation of intimate relationships after the development of identity. Before the formation of identity, however, the person is not able to share and commit a self that is not fully differentiated and not fully understood. Sullivan (1953), however, states that the development of intimacy and emotional closeness is an important milestone for the development of identity during adolescence. Research supports the association between identity and intimacy formation as well as similar patterns of identity development during later periods of adolescence for males and females (Schiedel & Marcia, 1985). Although males and females display similar patterns of identity development, research by Schiedel and Marcia (1985) indicates that 1) females generally score higher than males in relationship intimacy when identity development is low and 2) females typically report higher levels of intimacy when compared to males with
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similar identity characteristics. These findings suggest that males and females take different pathways towards intimacy development, and intimacy is contingent upon identity for males but not for females. By adolescence, boys focus on developing an independent identity. In contrast, females organize and develop the self in the context of important relationships which serves as the basis of their identity process (Gilligan, 1982; Josselson, 1987; Patterson, Sochting, & Marcia, 1992; Surrey, 1991). Therefore, “identity and intimacy issues may be merged for females” (Dyk & Adams, 1990, p. 93), and “identity [development] precedes the emergence of … intimacy for males” (Dyk & Adams, 1987, p. 232). As a result, female reports of relationship intimacy may not be as strongly related to their identity development as are male reports of relationship intimacy, and this pattern of intimacy and identity development is likely to continue until adulthood (Josselson, 1987). Although Erikson (1968) and Sullivan (1953) appear to argue contradictory roles of intimacy and identity in development, both agree that the later period of adolescence is characterized by the development and integration of intimacy and identity. Establishing emotional closeness is important for relationship development and assists in establishing a safe context (i.e., a close relationship) for identity exploration (Mclean & Thorne, 2003). Further, commitment to an interpersonal identity is associated with higher intimacy for females than males in same- as well as opposite-sexed relationships (Craig-Bray et al., 1988). Possessing a more advanced identity status promotes the development of emotional closeness and intimacy in adolescent friendships which further promotes identity development. As a result, individuals with “more advanced identity statuses are typically in more advanced intimacy statuses” (Dyk & Adams, 1987, p.232).
INTIMACY AND IDENTITY ASSOCIATIONS DURING EMERGING ADULTHOOD Despite the established association between intimacy and identity in the literature, the relationship between these constructs during emerging adulthood is not as well known (Montgomery, 2005). New theories of adolescent and adult development (i.e., Arnett, 2000) have proposed that identity exploration is a process characteristic of late adolescent and adult development, and exploration seen during early and middle adolescence is not associated with identity development. Only in late adolescence and young adulthood does one see the examination and exploration processes necessary for identity achievement. According to Arnett’s (2000) conceptualization of emerging adulthood (i.e., 18 to roughly 25 years of age), identity exploration during this period involves “trying out various life possibilities and gradually moving toward making enduring decisions”, and emerging adulthood is “the period that offers the most opportunity for identity explorations of romantic relationships” (p. 473). Further, emerging adults who engage in identity exploration increasingly focus on long-term factors in their romantic relationships than emerging adults who have not engaged in identity exploration or have limited explorations. As a result, emerging adults’ decisions regarding their romantic relationships increasingly focus on relationship intimacy as they engage in identity explorations (Arnett, 2000; Nelson & Barry, 2005). Arnett’s (2000) argument regarding identity exploration as a component of romantic relationship intimacy development is supported by previous research (e.g., Dyk & Adams,
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1987, 1990). However, he proposes identity exploration as leading to romantic intimacy commitments. In his description of emerging adults’ romantic intimacy development, Arnett (2000) implies that emerging adults who engage in identity explorations develop more intimate romantic relations than individuals not exploring their identity. Although identity exploration may lead to identity commitments, identity commitment is not considered an end result of identity exploration (Waterman, 1993, 1999). Rather, Marcia (1980) and Bilsker and Marcia (1991) state that identity commitment and exploration are separate but interrelated processes of identity development. As a result, 1) emerging adults can commit to intimacy beliefs without exploring these beliefs, 2) emerging adults can explore intimacy beliefs without making a commitment, or 3) emerging adults can neither explore nor commit to intimacy beliefs. Rather than viewing identity exploration as the primary process to intimacy commitments and viewing identity commitment as an end result of identity exploration, the joint role of identity commitment and exploration may serve as a better predictor of emerging adults’ romantic relationship intimacy. Research examining the joint role of identity commitment and exploration associations with relationship intimacy suggests identity commitment (separate from identity exploration) predicts relationships intimacy. For example, findings by Loff, Bell, Grogan, Foley, Pilosi, and Johnson (2005) and Loff and Johnson (2006) indicate that individuals characterized as having made identity commitments have more intimate romantic relationships than those characterized as having not made identity commitments regardless of their reported identity explorations. Further, Meeus, Iedema, Helsen, and Vollebergh (1999) state that individuals may find decisions made without exploration an “acceptable end-point of identity development” because identity exploration is not a necessarily needed component of “progressive development” (p. 429). Waterman (1993) also argues that individuals who have made commitments without exploring these commitments may be as satisfied with their life choices as those who have explored their commitments, and these decisions should not be disrupted unless they interfere with one’s ability to function effectively. An additional limitation concerning Arnett’s (2000) argued association between identity exploration and romantic intimacy concerns gender differences in identity and intimacy development. Several researchers (i.e., Markstrom & Kalmanir, 2001) propose that males and females take different identity pathways towards developing relationship closeness and intimacy. According to Dyk and Adams (1987, 1990) and Surrey (1991), female identity and intimacy development may unfold simultaneously while male identity development may precede intimacy development. As a result, females who have made identity commitments may report higher levels of intimacy than females who have not made commitments, regardless of their explorations. Males, however, who have not made commitments or who have made commitments without exploration may not report intimacy levels as high as those males who have both explored and committed to their identity decisions. Although identity exploration may serve as a precursor for more advanced intimacy development in romantic relationships, previous research 1) does not suggest identity exploration as the definitive pathway to more intimate relationships and 2) suggests the identity – intimacy association possibly differs for males and females. To test Arnett’s (2000) proposed association between identity exploration and romantic intimacy in relation to these previous findings, the associations among gender, identity status, and perceived romantic relationship intimacy were examined in the current study. First, results were hypothesized to indicate significant identity status differences in romantic relationship intimacy for female
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and male participants. As previously stated, female relationship intimacy often coincides with their identity development. As a result, females low in identity exploration and commitment were expected to report the lowest levels of romantic relationship intimacy. Females high in identity commitment, however, were expected to report higher levels of intimacy than females who had not reported identity commitments. Further, males typically do not report high levels of relationship intimacy until they have resolved identity-related issues. Therefore, males high in both identity exploration and commitment were expected to report higher intimacy levels than males low in identity commitment and/or exploration. Second, results were hypothesized to indicate significant gender differences in intimacy across identity statuses. Because females generally report more intimate relationships than males regardless of identity status, female participants were hypothesized to report higher levels of romantic relationship intimacy than males regardless of identity status.
METHOD Participants A total of 437 emerging adults from a commuter campus of a large Northeastern university were recruited to participate in the current study. Given the focus on emerging adults who were “exploring” romantic relationships, only unengaged and unmarried participants were included in the current study. Based on this criteria, the preliminary sample consisted of 292 participants (93 males, mean age = 19.27 years; Range = 18 to 21 years, and 199 females, mean age = 19.17 years; Range = 18 to 21 years). Examination of missing data resulted in two additional participants being removed from the study. Analysis of the remaining participants indicated a final sample of 88 males (mean age = 19.29 years; Range = 18 to 21 years), and 183 females (mean age = 19.22 years; Range = 18 to 21 years). The final sample did not significantly different in age from participants not reporting a romantic relationship, t (271) = < -1, p = .49. In order to reduce potential selection and response bias associated with recruiting from introductory social science classes, requests for participation were directed to the general student body through the posting of fliers on campus and speaking to undergraduate courses across disciplines. Participants were given a small gift and course extra-credit for their participation.
Demographic and Relationship Description Measures Personal data (i.e., age and gender) were obtained from each participant. Participants were then asked to think of their romantic partner, report on the length of time they have known their friend (years and months), and indicate the average amount of time per day that they typically spent with that person (hours and minutes).
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Females Males
Diffuse 32 26
Foreclosed 51 28
Moratorium 56 23
Achieved 44 11
Identity Status Measure The Ego Identity Process Questionnaire (EIPQ: Balistreri, Busch-Rossnagel, & Geisinger, 1995) was used to assess participant perceptions of their current identity process characteristics. The EIPQ is a 32-item scale that measures dimensions of commitment (e.g., “I have definitely decided on the occupation I want to pursue.”) and exploration (e.g., “I have considered adopting different kinds of religious beliefs.”) on a six point scale that ranges from 1 - Strongly disagree to 6 - Strongly agree. Commitment and exploration responses are measured on eight different areas of identity development (e.g., Occupation, Religion, Politics, Values, Family, Friendship, Dating, and Sex-Roles). Reliability of the overall commitment and exploration scales was α = .81 and .79, respectively. Using median split procedures (Mdn = 61.00 for commitment and Mdn = 64.00 for exploration), individuals were categorized as either high or low in identity commitment and exploration. Identity commitment and exploration categories were then combined to categorize individuals according to a specific identity status: diffuse (low commitment and exploration), foreclosed (high commitment and low exploration), moratorium (low commitment and high exploration), or achieved (high commitment and exploration). Frequencies for each identity category are presented in Table 1.
Romantic Relationship Intimacy Measures General Friendship Intimacy General same- and cross-sex friendship intimacy was assessed using the intimacy component subscale of Triangular Love Scale Sternberg (1997). The intimacy component sub-scale is a 15-item scale that measures perceived closeness in relationships (e.g., “I am able to count on ____________ in times of need.”). Responses are measured according to a nine point Likert scale ranging from 1 – Not at all to 9 – Extremely. Scale reliability in the current study was α = .91. Intimacy Intensity and Frequency The Miller Social Intimacy Scale (MSIS) is a 17-item scale that measures dimensions of intimacy frequency and intensity (Miller & Lefcourt, 1982). Six questions are used to assess intimacy frequency (e.g., “How often do you show your friend affection.”), and responses are recorded on a ten point scale that ranges from 1- Very rarely to 10 – Almost always. Eleven questions are used to assess intimacy intensity (e.g., “How close do you feel to your friend most of the time.”), and responses are recorded on a ten point scale ranging from 1 – Not
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much to 10 – A great deal. Reliability of the overall frequency and intensity scales was α = .83 and .84.
Positive and Negative Intimacy The positive intimacy subscale of the Personal Assessment of Intimacy in RelationshipModified inventory (PAIR-M; Theriault, 1998) was used to assess participant perceptions of their capacity for closeness. The positive intimacy subscale consists of 5-items that measure participant perceptions of positive intimacy behaviors. (e.g., “I can tell my feelings to my friend.”) and 7-items that measure negative intimacy (“I have the tendency to neglect my romantic partner’s needs.”). Responses to the PAIR-M are recorded on a five point Likert scale that ranges from 1 – Very rarely to 5 – Very often. Scale reliabilities in the current study were α = .83 for positive intimacy and α = .79 for negative intimacy. Relationship Closeness The Inclusion of Other in the Self (IOS) Scale developed by Aron, Aron, and Smollar (1992) was used to measure participant perceptions of relationship closeness. The IOS Scale consists of two circles that signify the participant and a designated other (e.g., same-sex friend). Participants were asked to choose one of the seven sets of circles, ranging from no overlap between the two circles (scored as 1 - Not a close relationship) to nearly complete overlap between the two circles (scored as 7 - Very close relationship) that best describes the closeness of the relationship. The IOS shows good convergent validity with other measures in the current study measuring relationship closeness (See Table 1), and reliability measures of the IOS Scale as reported by Aron et al. (1992) show satisfactory measurement test-retest reliability for friendships, α = .92. Relationship Commitment Commitment level in participant friendships was measured using the commitment subscale from the Rusbult Investment Model Scale (Rusbult, Drigotas, & Verette, 1994). This seven-item Likert-scale assesses four domains of personal relationships. Each item in the commitment scale asked the participant to indicate such features as the strength of commitment, stability, and the likely duration of a specified relationship on a scale from 1 Not very; quite short to 5- Completely committed/Very long duration. Rusbult et al. (1994) report commitment subscale reliabilities of α =.91 to .95. Scale reliability in the current study was α = .81.
Data Collection Procedures Data used in the current study were part of larger study examining interpersonal and intrapersonal factors associated with college students’ friendship and romantic relationship intimacy. Data collection occurred during a one and a half-hour session. Participants were informed by the researchers that the study was examining relationship intimacy and closeness. Participants were then administered one of a series of booklets asking them to report their demographic information and to think of either a same-sex friend, cross-sex friend or romantic partner. Participants were then asked to read the instructions very carefully before
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beginning, and instructed to describe the length of time they have know their friend and the amount of time spent with the friend daily, as well as the intimacy and emotional closeness experienced with their same-sex or cross-sex friend. Questionnaires were collected after participants completed the first friendship description, and participants were administered the identity questionnaire (as well as several others not used in the current study). After completing the identity measurements, participants were then administered a second booklet asking them to describe another of their relationships (depending upon which relationship was described previously) and report on the same relationship characteristics. On completion of the second relationship booklet, participants were administered a series of questionnaires that assessed social adjustment. Finally, participants were administered the final relationship questionnaire and requested to follow the same instructions. Once participants completed the third relationship rating, they were debriefed and compensated for participating. Table 2. Participant Demographics, Relationship Demographics, Identity Component, and Romantic Relationship Intimacy Correlations
1. Gender Identity Components 2. Exploration 3. Commitment Relationship Demographics 4. Months Known 5. Minutes Spent w/ Daily Intimacy Measures 6. Closeness 7. General Intimacy 8. Commitment 9. Positive Intimacy 10. Negative Intimacy 11. Intimacy Frequency 12. Intimacy Intensity
1 2 3 --- -.25** -.17**
---
-.15 ---
4 -.12*
5 -.11
6 .02
7 -.19**
8 -.10
9 -.15*
10 .20**
11 -.40**
12 -.25**
-.01 .11
-.07 .17**
-.20** .12*
-.11 .39**
-.12* .36**
-.07 .37**
-.14* -.47**
-.03 .27**
-.06 .31**
---
.18**
.18**
.14*
.17**
.11
-.02
.18**
.02
---
.08
.13*
.12
.18**
-.07
.27**
.19**
---
.61**
.40**
.39**
-.19**
.42**
.33**
---
.59** ---
.65** .46**
-.45** -.43**
.60** .27**
.63** .31**
---
-.49**
.49**
.53**
---
-.37** -.40-** ---
.66** ---
Note: Spearman’s Rho presented for Gender correlations (-1 = Female and 1 = Male). *p < .05. **p < .01.
RESULTS Data Transformations and Preliminary Correlation Analysis Prior to testing the hypothesized associations between gender, identity status, and romantic relationship intimacy, identity and intimacy scores were transformed to standardized
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Z-scores. In addition, correlations were conducted to examine relationships 1) among predictor variables, 2) between relationship descriptive variables (i.e., minutes spent with daily and months known) and friendship intimacy variables, and 3) among intimacy measures. As shown in Table 2, correlations among predictor variables (i.e., gender and identity status) indicated females reported higher levels of identity exploration and commitment than did males. The pattern of correlations indicates differential reporting of the predictor variables according to participants’ gender. Examination of relationship descriptive variables and romantic relationship intimacy variable correlations indicated the number of months participants have known their romantic partner was significantly associated with each intimacy measure except positive intimacy, negative intimacy, and intimacy intensity. Further, the number of minutes participants spent daily with their romantic partner was positively associated general intimacy, positive intimacy, intimacy intensity, and intimacy frequency (see Table 2). Given the consistent correlation patterns, both the number of months participants have known their friend and the amount of time spent with their friend daily were used as covairates when examining the gender, identity, and intimacy associations. Finally, as shown in Table 2, examination of intimacy correlations indicated significant correlations among all measures and supports the use of multivariate analysis of variance in the examination of the hypothesized intimacy differences.
Examination of Proposed Intimacy Differences Multivariate analysis of covariance (MANCOVA) was conducted to examine differences in romantic relationship intimacy. Because the number of months participants have known their romantic partner and the amount of time participants spend weekly with their romantic partner was correlated with the intimacy measures (see Table 2), both relationship descriptive variables were used as covariates. A 2 (Gender) X 4 (Identity Status) MANCOVA failed to indicate either months know, Wilk’s λ= .93, F(7, 255) = 2.10, p = .06, or minutes spent with daily Wilk’s λ= .95, F(7, 255) = 1.97, p = .07, as significant covariates of intimacy reports. As a result, the relationship demographic variables were dropped from further analysis, and a 2 (Gender) X 4 (Identity Status) multivariate analysis of variance (MANOVA) was used to test the proposed hypotheses. The 2 (Gender) X 4 (Identity Status) MANOVA indicated a significant Gender X Identity Status interaction associated with reports of romantic relationship intimacy, Wilk’s λ= .73, F(21, 744) = 4.00, p < .001. Examination of the interaction’s identity status simple-effects indicated significant gender differences for participants classified as diffuse, Wilk’s λ= .46, F(7, 50) = 8.25, p < .001, foreclosed, Wilk’s λ= .49, F(7, 71) = 10.37, p < .001, moratorium, Wilk’s λ= .65, F(7, 73) = 5.61, p < .001, or achieved, Wilk’s λ= .65, F(7, 47) = 3.59, p < .01. Further, gender simple-effects indicated significant identity status differences for females, Wilk’s λ= .42, F(21, 503) = 8.34, p < .001, and males, Wilk’s λ= .54, F(21, 225) = 2.51, p < .001.
Identity Status Simple-effects Multiple Comparisons As shown in Table 3, Tukey’s-b examination of gender differences across identity statuses revealed diffuse females reported higher levels of romantic relationship intimacy than males except on reports of closeness and negative intimacy. Foreclosed females reported
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higher levels of intimacy than males except on reports of negative intimacy. Moratorium females differed from moratorium males on reports of negative intimacy and intimacy frequency. Achieved females differed from achieved males on reports of closeness and commitment. No other significant differences were indicated between moratorium and achieved females and males. Table 3. Gender and Identity Status Differences in Romantic Relationship Intimacy Identity Status Intimacy Variable
Diffuse
Foreclosed
Moratorium
Achieved
Female
.08a
.48b
-.51c
.12a
Male
-.04
-.03
-.04
.42
Female
-.33a
.76b
-.69c
.33a
Male
-.64a
-.40a
-.16a
.55b
Female
.03a
.69b
-.67c
.21a
Male
-.41a
-.08a
-.40a
.79b
Female
.29a
.56b
-.51c
.32a
Male
-.69a
.02a
-.58a
.32b
Female
.40a
-.57b
.11a
-.36b
Male
.67a
-.12b
.69a
-.38b
Female
.23a
.86b
-.26c
.38a
Male
-.62a
-.82a
-.65a
.24b
.13a
.69b
-.41c
.45a
a
.79b
Closeness
General Intimacy
Commitment
Positive Intimacy
Negative Intimacy
Intimacy Frequency
Intimacy Intensity Female Male
-.55a
-.39a
-.66
Note: Intimacy variable row means with different superscripts significantly different, p < .05. Intimacy variable column means in bold significantly different, p < .05.
Female Identity Status Differences As shown in Table 3, Tukey’s-b examination of female intimacy scores indicated several identity status differences. First, foreclosed females reported higher levels of closeness, general intimacy, commitment, positive intimacy, intimacy frequency, and intimacy intensity than did achieved, moratorium, and diffuse females. Further, achieved and diffuse females reported higher scores on each of these intimacy measures than did moratorium females. Achieved and diffuse females did not differ on their reports of these measures. Second, foreclosed and achieved females did not differ in their reports of negative intimacy and
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reported lower levels of negative intimacy than did diffuse and moratorium females. Diffuse and moratorium females did not differ in their reports of negative intimacy.
Male Identity Status Differences Tukey’s-b examination of male identity status differences revealed achieved males reported more intimate romantic relationships than did diffuse, foreclosed, and moratorium males across each intimacy measure except negative intimacy and closeness. Achieved and foreclosed males reported lower levels of negative intimacy than did diffuse and moratorium males, and no significant differences were indicated for romantic relationship closeness (see Table 3).
CONCLUSION As previously stated, Arnett (2000) argues emerging adults’ identity explorations allow them to make long-term commitments regarding intimacy decisions in their romantic relationships. Although identity exploration is often considered an integral part of identity development, theorist and researchers do not necessarily view exploration as a necessary process when making identity commitments (Meeus et al., 1999; Waterman, 1993). Further, Arnett’s (2000) argument stating identity exploration is a distinct and necessary process for intimacy development during emerging adulthood minimizes the role of identity commitment and gender in the formation of romantic relationship intimacy. As evidenced in the current study, identity exploration explained certain specific differences in emerging adult intimacy reports. However, several instances are evident where identity exploration was not an effective predictor of intimacy. As a result, the proposal that identity explorations occurring during emerging adulthood are necessary for intimacy development may not apply equally to all emerging adults. The conceptualization of the identity exploration and intimacy relationship during emerging adulthood fails to recognize the differential approach to relationship intimacy taken by females and males. Because the identity development process varies for each individual and does not follow one developmental sequence (Grotevant, 1986), Arnett’s (2000) theoretical position concerning qualitative differences in the identity process during adolescence and adulthood overlooks the importance of gender and identity commitments associated with exploration when attempting to explain emerging adults’ capacity for romantic relationship intimacy. The current study’s test of Arnett’s (2000) hypothesis regarding identity exploration and romantic relationship intimacy development did not fully support his theorized association. Rather, findings indicate 1) both identity exploration and commitment predict emerging adults’ romantic relationship intimacy, 2) gender differences in romantic relationships differ according to emerging adults’ identity status, and 3) identity status differences in romantic relationship intimacy differs for emerging adult males and females. As a result, Arnett’s (2000) proposal that identity exploration during emerging adulthood is a necessary precursor for intimate romantic relationships may not completely describe the association between identity and intimacy that emerges during this period, and this association may be more complex than originally theorized.
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Gender Differences in Romantic Relationship Intimacy across Identity Statuses As mentioned previously, research indicates females report more intimate relationships than males. Results, however, qualify this finding in that gender differences in intimacy are moderated by emerging adults’ identity status. Gender comparison of emerging adults who reported low exploration scores and either low or high commitment scores (i.e., diffuse and foreclosed identity statuses) indicated females reported more romantic intimacy than did males. Although gender differences were evident for moratorium and achieved emerging adults, the number of variables in which females and males differed was relatively small when compared to genders differences for diffuse and foreclosed emerging adults. This finding was not expected, and it possibly provides further insight into previously reported gender differences in relationship intimacy, as well as provides support for Arnett’s (2000) argument concerning the association between identity exploration and romantic intimacy. Adolescents have generally not engaged in identity explorations concerning romantic intimacy (Arnett, 2000). Although male and female adolescents are similar in their identity explorations and romantic intimacy, females report closer and more intimate relationships than males (Clark-Lempers, Lempers, & Ho, 1991; Fischer, Munsch, & Greene, 1996; Johnson, 2005). Findings from the current study suggest similar gender differences in romantic intimacy reports for emerging adults who report low levels of identity exploration. Emerging adults who reported low levels of identity explorations reported romantic intimacy patterns similar to that of adolescents. Romantic intimacy differences present during adolescence likely continue into emerging adulthood for those individuals who have not engaged in identity exploration. However, this difference in emerging adults’ intimacy reports appears to decrease as males and females begin their identity explorations.
Female and Male Identity Status Differences in Romantic Relationship Intimacy The current study’s general pattern of findings does not fully support Arnett’s (2000) position regarding the association between emerging adults’ identity exploration and romantic relationship intimacy. Findings do, however, suggest that Arnett’s proposal may describe male experiences of romantic intimacy. In the current study, males who were classified as achieved (i.e., reported high levels of exploration and commitment) reported higher levels intimacy than did males classified as diffuse, foreclosed, or moratorium (and lower levels of identity exploration and/or commitment). These findings support the notion that increased romantic intimacy and relationship commitment emerges out of explored identity commitments. Further, this finding supports previous research examining the association between identity and intimacy that suggests 1) males place a greater importance on identity relative to intimacy (Surrey, 1991), and 2) males are likely to develop intimate relationships as identity issues are resolved through exploration and commitment (Dyk & Adams, 1990). As a result, associations suggest emerging adult males may be more committed to their romantic relationships and view these relationships as more intimate after identity commitments are made through exploration. Further the identity status difference evident in
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male reports of intimacy does provide support for Arnett’s (2000) argument that emerging adult identity explorations are necessary for the formation of intimate romantic relationships. Associations between male emerging adults’ identity and intimacy reports support Arnett’s (2000) theory regarding identity exploration and romantic intimacy. However, responses from female emerging adults suggest a very different set of associations between identity and intimacy. Females who reported high levels of identity commitment and low levels of exploration reported more intimate romantic relationships than did females with other identity commitment and exploration patterns (Females who reported low levels of commitment and high levels of exploration reported the lowest levels of relationship intimacy.). As stated previously, Arnett (2000) argues that explored identities are a necessary component of romantic relationship intimacy. However, Erikson (1968) states that individuals with formed identities are more likely to form and maintain intimate romantic relationships relative to those without an established identity. Based on the current findings, it is possible the commitment to an identity (regardless of exploring these identity decisions) constitutes an established identity for emerging adult females. For example, one can be satisfied with their identity beliefs without having explored these beliefs (Waterman, 1993). Further, Patterson et al. (1992) state that previous studies examining female identity patterns suggest foreclosed females “looked more similar to those in identity achievement” (p. 18). As a result, females who have made identity commitments but are not currently questioning or exploring these decisions may have clear romantic relationship expectations that are associated with an increased focus on the formation, maintenance, and development of romantic relationships. Further, these relationship expectations and increased relationship focus likely lead to more committed, intimate, and emotionally close romantic relationships relative to females with different identity patterns. A second pattern of findings somewhat contradictory to Arnett’s argument regarding the necessity of identity exploration concerns the similar intimacy reports of identity diffuse (i.e., low commitment and exploration) and achieved (i.e. high commitment and exploration) females. Although these two groups did not report the same intimacy levels as foreclosed females, previous research, suggests achieved females would have more intimate relationships than diffuse females. The higher than expected intimacy levels can possibly be explained by the interpersonal approach taken by females who have not explored or committed to a set of identity beliefs. Muuss (1996) argues that females who are low in identity exploration and commitment may become “overly receptive” to their relationship experiences (p. 63). These females may become “distracted by the pleasures” of the relationship (Waterman, 1993; p. 153) which leads to the perceptions of a committed and intimate romantic relationship. However, as evidenced by the higher negative intimacy score for diffuse females, diffuse females appear to view their romantic relationships more negatively than achieved and foreclosed females. As a result, the similar romantic relationship intimacy scores between diffuse and achieved females indicated in the current study is likely qualitatively different despite the quantitative similarities and warrants further investigation. Arnett (2000) argues identity exploration during emerging adulthood is a necessary precursor for the development of romantic intimacy. The position that identity exploration is isolated to late adolescence and young adulthood is misrepresentative of the identity process must be interpreted with caution. Identity development is a fluid process that does not necessarily begin or end in any specific developmental stage, and previous research shows identity exploration is not limited to one developmental trajectory or developmental period.
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As a result, identity research that follows the theory that identity exploration is a specific late adolescent and young adult process will overlook the importance of the superficial and transient decisions made during early adolescence that provide the foundation for later identity explorations. Although previous findings provide moderate support for this position, the current study indicates identity commitment associations with romantic relationship intimacy as well as gender differences in the relationship among identity commitment, exploration, and romantic relationships intimacy. Use of a college sample possibly limits generalization of the current study. However, findings may provide a better understanding of the identity process associated with romantic intimacy development for male and female emerging adults by indicating that identity exploration is only a part of the larger process that leads to the development of intimate romantic relationships.
AUTHOR NOTES H. Durell Johnson, Kristen A. Loff, George Bell, Evelyn Brady, Erin A. Grogan, Elizabeth Yale, Robert J. Foley, and Trishia A. Pilosi, Department of Human Development and Family Studies, Penn State Worthington Scranton. Elizabeth Yale and George Bell are currently pursuing graduate degrees at Marywood University, Scranton, PA. Portions of this research were funded by the Pennsylvania State University Matthew’s Research Award and Research Development Grant awarded to the first author and the Pennsylvania State University’s Undergraduate Research Grant awarded to Kristen A. Loff, George Bell, Erin A. Grogan, Robert J. Foley, and Trishia A. Pilosi. Portions of this study were presented at the 2005 Annual Meting of the Society for Research on Identity Formation, Miami, FL and the 2007 Biennial Meeting of the Society for Research on Adolescence, Boston, MA.
REFERENCES Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the early twenties. American Psychologist, 55, 469 – 480. Aron, A., Aron, E. M., & Smollar, D. (1992). Inclusion of other in the self-scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63, 596-612. Balistereri, E., Busch-Rossnagel, N. A., & Geisinger, K. F. (1995). Development and preliminary validation of the Ego Identity Process Questionnaire, Journal of Adolescence, 18, 179-192. Bilsker, D., & Marcia, J. E. (1991). Adaptive regression and ego identity. Journal of Adolescence, 14, 75 – 84. Brendgen, M., Vitaro, F., Doyle, A. B., Markiewicz, D., Bukowski, W. M. (2002). Same-sex peer relations and romantic relationships during early adolescence: Interactive links to emotional, behavioral, and academic adjustment. Merrill-Palmer Quarterly, 48, 77-103.
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Clark-Lempers, D. S., Lempers, J. D., & Ho, C. (1991). Early, middle, and late adolescents’ perceptions of their relationships with significant others. Journal of Adolescent Research, 6, 296 – 315. Collins, W. A., & Sroufe, L. A. (1999). Capacity for intimate relationships: A developmental construction. In W. Furman, B. B. Brown, & C. Feiring (Eds.), The development of romantic relationships in adolescence. Cambridge studies in social and emotional development (pp.125-147). New York: Cambridge University Press. Craig-Bray, L., Adams, G. R., & Dobson, W. R. (1988). Identity formation and social relationships during late adolescence. Journal of Youth and Adolescence, 17, 173-187. Davies, P. T., & Windle, M. (2000). Middle adolescents’ dating pathways and psychosocial adjustment. Merrill-Palmer Quarterly, 46, 90-118. Dyk, P. A., & Adams, G. R. (1987). The association between identity development and intimacy during adolescence: A theoretical treatise. Journal of Adolescent Research, 2, 223-235. Dyk, P. A., & Adams, G. R. (1990). Identity and intimacy: An initial investigation of three theoretical models using cross-lag panel correlations. Journal of Youth and Adolescence, 19, 91-110. Erikson, E. H. (1968). Identity: Youth and crisis. New York: Norton Fischer, J. L., Munsch, J., & Greene, S. M. (1996). Adolescence and intimacy. In G. R. Adams, R. Montemayor, & T. P. Gullotta (Eds.), Psychosocial development during adolescence (pp. 95-129). Newbury Park, California: Sage Publications. Furman, W., & Shaffer, L. (2003). The role of romantic relationships in adolescent development. In P. Florsheim (Ed.), Adolescent romantic relationships and sexual behavior: Theory, research, and practical implications (pp. 3-22). Mahwah, New Jersey: Lawrence Erlbaum. Furman, W., & Simon, V. A. (1999). Cognitive representations of adolescent romantic relationships. In W. Furman, B. B. Brown, & C. Feiring (Eds.), The development of romantic relationships in adolescence. Cambridge studies in social and emotional development (pp.75-98). New York: Cambridge University Press. Franz, C. E., & White, K. M. (1985). Individuation and attachment in personality development: Extending Erikson’s theory [Special Issue: Conceptualizing gender in personality theory and research]. Journal of Personality, 53, 224-256. Gilligan, C. In a different voice: Psychological theory and women’s development. Cambridge: Harvard University. Grotevant, H. D. (1986). Assessment of identity development: Current issues and future directions. Journal of Adolescent Research, 1, 175-181. Johnson, H. D. (2004). Grade, gender, and relationship differences in emotional closeness within adolescent friendships. Adolescence, 39, 243-256. Josselson, R. (1987). Finding herself: Pathways to identity development in women. San Francisco: Jossey-Bass. Joyner, K., & Udry, J. R. (2000). You don’t bring me anything but down: Adolescent romance and depression. Journal of Health and Social Behavior, 41, 369-391. Loff, K. A., Bell, G., Grogan, E. A., Foley, R. J., Pilosi, T. A., & Johnson, H. D. (2005,
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February). Identity status associations with sex differences in the emotional closeness of college students’ friendships and romantic relationships. Poster presented at the Annual Conference of the Society for Research on Identity Formation. Miami. Loff, K. A., & Johnson, H. D. (2006, March). Identity and sex-role associations with gender differences in emerging adults’ same- and cross-sex friendship intimacy. Poster presented at the Annual Conference of the Society for Research on Identity Formation. San Francisco. Marcia, J. E. (1980). Identity in adolescence. In J. Adelson (Ed.), Handbook of adolescent psychology. New York: Wiley Press. Markstrom, C. A., & Kalmanir, H. M. (2001). Linkages between the psychosocial states of identity and intimacy and the ego strengths of fidelity and love. Identity, 1, 179-296. McLean, K. C., & Thorne, A. (2003). Late adolescents’ self-defining memories about relationships. Developmental Psychology, 39, 635-645. Meeus, W., Iedema, J., Helsen, M., & Vollebergh, W. (1999). Patterns of adolescent identity development: Review of literature and longitudinal analysis. Developmental Review, 19, 419-461. Mellor, S. (1989). Gender differences in identity formation as a function of self-other relationships. Journal of Youth and Adolescence, 18, 361-375. Miller, B. C., & Benson, B. (1999). Romantic and sexual relationships during adolescence. In W. Furman, B. B. Brown, & C. Feiring (Eds.), The development of romantic relationships in adolescence. Cambridge studies in social and emotional development (pp.99-121). New York: Cambridge University Press. Miller, R. S., & Lefcourt, H. M. (1982). The assessment of social intimacy. Journal of Personality Assessment, 46, 514-518. Montgomery, M. J. (2005). Psychosocial intimacy and identity: From early adolescence to emerging adulthood. Journal of Adolescent Research, 20, 346-374. Muuss, R. E. (1996). Theories of adolescence (6th ed.). New York: McGraw-Hill. Nelson, L. J., & Barry, C. N. (2005). Distinguishing features of emerging adulthood: The role of self-classification as an adult. Journal of Adolescent Research, 20, 242-262. Patterson, S. J., Sochting, I., & Marcia, J. E. (1992). The inner space and beyond: Women and identity. In G. R. Adams, T. P. Gullotta, & R. Montemayor (Eds.), Adolescent identity formation. Advances in adolescent development (Vol 4., pp. 9-24). Thousand Oaks, California: Sage. Paul, E. L., & White, K. M. (1990). The development of intimate relationships in late adolescence. Adolescence, 25, 375-400. Rusbult, C. E., Drigotas, S. M., & Verette, J. (1994). The investment model: An interdependence analysis of commitment processes and relationship maintenance phenomena. In D. Canary & L. Stafford (Eds.), Communication and relational maintenance (pp. 115-139). New York: Academic Press. Schiedel, D. G., & Marcia, J. E. (1985). Ego identity, intimacy, sex-role orientation, and gender. Developmental Psychology, 21, 149-160. Sternberg, R. J. (1997). Construct validation of a triangular love scale. European Journal of Social Psychology, 27, 313-335. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton.
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Surrey, J. L. (1991). The “self-in-relation”: A theory of women’s development. In J. Jordan, A. Kaplan, J. Miller, I. Stiver, and J. Surrey (Eds.), Women’s growth in connection: Writings from the Stone Center. New York: Guilford Press. Theriault, J. (1998). Assessing intimacy with the best friend and sexual partner during adolescence: The PAIR-M inventory. The Journal of Psychology, 5, 493-506. Waterman, A. S. (1993). Finding something to do or someone to be: A Eudaimonsit perspective on identity formation. In J. Kroger (Ed.), Discussions on ego identity. Hillsdale, NJ: Erlbaum. Waterman, A. S. (1999). Identity, the identity statuses, and identity status development: A contemporary statement. Developmental Review, 19, 591-621.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 7
DEVELOPMENT OF AN INTERVIEW FOR ASSESSING RELATIONSHIP QUALITY: PRELIMINARY SUPPORT FOR RELIABILITY, CONVERGENT AND DIVERGENT VALIDITY, AND INCREMENTAL UTILITY Erika Lawrence, Robin A. Barry, Rebecca L. Brock, Amie Langer, Eunyoe Ro University of Iowa, Iowa City, Iowa, USA
Mali Bunde CIGNA Behavioral Health Care, Minnesota, USA
Emily Fazio University of Denver, Denver, Colorado, USA
Lorin Mulryan University of Loyola,Chicago, Illinois, USA
Sara Hunt Utah State University, Logan, Utah, USA
Lisa Madsen Emory University, Atlanta, Georgia, USA
Sandra Dzankovic Des Moines University, Des Moines, Iowa, USA
ABSTRACT Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention have been paid to the assessment of relationship quality. In the first section of our paper, we
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Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al. review the long-standing debate regarding – and clarify the distinctions among – relationship adjustment, satisfaction, and quality. We also discuss the need for an empirically-supported, psychometrically strong measure of relationship quality. In the second section, we present the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings from the interviews. It was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. In the third section, we provide preliminary evidence of the reliability and validity of the interview. Across two samples, the RQI demonstrated strong reliability (internal consistency, inter-rater agreement, agreement across interviewers based on two members of the same couple, correlations among the scales) convergent validity (correlations between RQI scales and self-report questionnaires assessing similar relationship dimensions), and divergent validity (correlations between RQI scales and behavioral observations of related constructs, global measures of marital satisfaction, and individual difference measures of related constructs). We conclude with a brief discussion of broader clinical issues relevant to couple assessment and prevention efforts.
INTRODUCTION Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention have been paid to the assessment of relationship quality. In the first section of our paper, we review the long-standing debate regarding – and clarify the distinctions among – relationship adjustment, satisfaction, and quality. We also discuss the need for an empirically-supported, psychometrically strong measure of relationship quality. In the second section, we present the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings from the interviews. It was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. We describe the development of the interview, our justification for the dimensions of relationship quality included, and the microanalytic and macro-analytic coding systems we developed. In the third section, we provide preliminary evidence of the reliability and validity of the interview. Our goal is for the RQI to be used as an assessment tool prior to the implementation of prevention programs with young couples. Therefore, we administered the RQI to 101 newlywed couples 91 dating individuals. To assess reliability, we analyzed internal consistency, inter-rater agreement, agreement across interviewers based on two members of the same couple, and correlations among the scales. To examine convergent validity, we analyzed correlations between RQI scales and self-report questionnaires assessing similar relationship dimensions. To examine divergent validity, we computed correlations between RQI scales and: (a) behavioral observations of related constructs, (b) global measures of relationship satisfaction, and (c) individual difference measures of related constructs. In the fourth section, we discuss broader clinical issues relevant to couple assessment and prevention efforts. First, we discuss the importance of standardizing empirically-supported couple assessments, and review ongoing efforts to achieve this goal. Second, we make
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specific recommendations for enhancing couple prevention programs. Third, we discuss the possible utility of interviews as motivational tools to increase participation in prevention programs among couples at high risk for longitudinal distress and dissolution, and review ongoing efforts to achieve this goal.
SECTION 1: RELATIONSHIP SATISFACTION, ADJUSTMENT, AND QUALITY For as long as relationship satisfaction has been assessed, there has also been considerable confusion and controversy over the differences among the terms relationship satisfaction, relationship adjustment, and relationship quality (See Snyder, Heyman, & Haynes, 2005, and Heyman, Sayers, and Bellack, 1994 for detailed discussions of these issues.) Relationship satisfaction refers to global sentiment or happiness as a unitary construct. Relationship adjustment is broader in scope, and includes a consideration of dyadic processes such as conflict management skills and relationship outcomes such as satisfaction. Relationship quality refers to dyadic processes alone, such as the quality of a couple’s conflict management skills, supportive transactions, sexual relations, or emotional intimacy. Additionally, several terms have been used to describe low satisfaction or adjustment, including relationship discord, dissatisfaction, distress, and dysfunction. Low relationship satisfaction is also distinguished from dissolution, which refers to separation or divorce. Over the last 60 years, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. They have been assessed via epidemiological research, treatment outcome research, and basic close relationships research. They are the field’s measures of whether couples are happy and whether our couple therapies are working. Relationship satisfaction and adjustment are strongly associated with the 50% divorce rate in the U.S., individual distress (e.g., depression, anxiety, and alcohol abuse), physical health, and children’s well-being. Far less attention has been paid to the assessment of relationship quality. Some dimensions of relationship quality have received a lot of attention, such as communication and conflict management processes. Others have received almost no attention, such as emotional intimacy and balance of decision-making and interpersonal control within a couple. Still others have received attention in other disciplines but have not been integrated into couple research or couple therapy, such as investigations of the quality of a couple’s sexual relationship. Among the measures that do exist for assessing relationship quality, several conceptual and methodological limitations hinder their utility. First, these measures are typically specific to one dimension such as conflict management skills, rather than capturing the multidimensional construct of relationship quality. Second, existing measures of relationship quality are often confounded with measures of satisfaction or adjustment. Specifically, these measures include items that tap into both relational processes and satisfaction. The purpose of this study is to introduce and provide preliminary evidence for a new instrument designed to assess relationship quality as a multidimensional phenomenon. Historically, relationship satisfaction and adjustment have been assessed by administering questionnaires to partners and then calculating sum scores based on their responses. Scores
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are typically placed on a continuum from low to high satisfaction. Starting in the 1950s, relationship adjustment was assessed with omnibus measures in which partners evaluated multiple aspects of their relationships, such as the amount of disagreement across different areas of conflict, global evaluations of the relationship, and frequency of sexual relations. The Marital Adjustment Test (MAT; Locke & Wallace, 1959) and Dyadic Adjustment Scale (DAS; Spanier, 1976) are two widely used measures of dyadic adjustment. In the 1980s, researchers and clinicians also began assessing relationship satisfaction with shorter, unidimensional measures of global sentiment toward one’s relationship. The Quality of Marriage Index (QMI; Norton, 1983) and Kansas Marital Satisfaction Scale (KMS; Schumm et al., 1986) are widely used measures of global relationship satisfaction. Researchers and clinicians also began to assess relationship satisfaction using a semantic differential approach, a way of quantifying partners’ evaluations of their relationships by having them rate their perceptions on scales between two opposite adjectives (e.g., satisfied to dissatisfied, good to bad; Osgood, Suci, & Tannenbaum, 1957; Huston & Vangelisti, 1991). Since the mid-1990s, there has been a move toward assessing relationship satisfaction and adjustment with multidimensional approaches. For example, the Positive and Negative Quality in Marriage Scale (PANQIMS; Fincham & Linfield, 1997), on which partners evaluate the positive and negative qualities of their partner and relationship, yields scores for two distinct aspects of relationship satisfaction. Other measures collapse these two domains, making it impossible to determine whether it is lack of positive or high levels of negative evaluation that reduces relationship happiness. In contrast, the PANQIMS allows partners to be categorized as happy (high positive and low negative), distressed (low positive and high negative), ambivalent (high on both positive and negative), or indifferent (low on both positive and negative). The Marital Satisfaction Inventory (MSI-R; Snyder & Aikman, 1999) is a multidimensional measure of relationship adjustment that differentiates among levels and sources of distress. Dimensions include assessments of family of origin conflict, sexual satisfaction, and problem-solving communication strategies. Three other multidimensional inventories have been used in the last decade or two (PREPARE, Olsen, Fournier, & Druckman, 1996; FOCCUS, Markey & Micheletto, 1997; RELATE, Busby, Holman, & Taniguchi, 2001). Each of these inventories provide scores on dimensions such as realistic relationship expectations, effective communication, emotional health, exposure to negative family-of-origin experiences, and personal stress management (Larson, Newell, Topham, & Nichols, 2002). Thus, like the MSI-R, these measures are multidimensional in nature, yet they capture a variety of factors that may influence dyadic functioning and were not intended to measure relationship quality specifically. Couple researchers and clinicians have long used self-report questionnaires to quantify dyadic processes in basic research and to guide interventions. Unfortunately, self-report questionnaires are vulnerable to biases including social desirability (Godoy et al., 2008; Kluemper, 2008), depressed mood and depressive cognitions (e.g., Cohen, Towbest, & Flocco, 1988; Raselli & Broderick, 2007), memory biases in retrospective reports (Karney & Frye, 2002), and cognitive dissonance (e.g., newlyweds may be more likely to present couple processes in a positive light because they have just gotten married and do not want to consider the possibility that their marriage already has difficulties; McNulty, O’Mara, & Karney, 2008; Miller, Niehuis, & Huston, 2006). Behavioral observation tasks were developed to deal with these problems, and our ability to understand couple processes across domains became much stronger. However, observational methods are costly and time-consuming, and as such are
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less likely to be widely adopted by clinicians in the near future. Moreover, although standardized, psychometrically sound interaction protocols exist to assess couples’ transactions with established coding systems, there is no network at present that can readily and conveniently code these interactions and provide results in a timely manner. In sum, although an important methodological development in couple research methodology, behavioral observation tasks are not going to become a standardized assessment tool for couple therapists. In addition to self-report questionnaires and behavioral observation tasks, clinical interviews are often used to gather reliable and valid information during an assessment. Outside of the close relationships literature, The Structured Clinical Interview for the Diagnostic Statistical Manual (DSM-IV; First et al., 1995) is a standardized interview for assessing Axis I disorders. The Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) is routinely used by researchers studying attachment processes. There is also emerging interest in developing semi-structured interviews to assess relationship satisfaction and quality. There are several advantages to using clinical interviews rather than behavioral observation data in couple research. First, clinical interviews allow the objective coder to consider partners’ perceptions when evaluating the relationship; however, the biases of self report are still omitted (e.g., Morrison & Hunt, 1996). Second, interviews allow for a more global perception of dyadic processes as opposed to behavioral observation data that provide a snapshot of a particular type of interaction. Third, once an interviewer is trained to reliability, administering and coding clinical interviews is typically faster and less expensive than coding behavioral observation data. Fourth, clinical interviews are more likely to be embraced by clinicians compared to behavioral observation methods, affording us the opportunities to move toward standardization of couple assessments and bridge the gap between couple researchers and clinicians. There have been isolated efforts to develop and validate structured interviews for couple research and therapy. For example, the Structured Diagnostic Interview for Marital Distress and Partner Aggression (Heyman et al., 2001) allows researchers and clinicians to reliably and validly diagnose couples in terms of relationship distress and physical aggression. The content of the interview is similar to that of the Dyadic Adjustment Scale (Spanier, 1976) and the Conflict Tactics Scales (Straus et al., 1996), and the format is similar to that of the SCID. However, no interview exists to assess the construct of relationship quality. The purpose of the present study was to develop a semi-structured interview to assess relationship quality and to provide preliminary support of its reliability and validity.
SECTION 2: THE RELATIONSHIP QUALITY INTERVIEW AND DIMENSIONS OF RELATIONSHIP QUALITY The Relationship Quality Interview (RQI) was designed to provide an interview-based approach to quantifying important dimensions of relationship quality. It is a multidimensional interview to assess relationship quality across five key relationship domains, including emotional intimacy, inter-partner support, sexual relations, inter-partner respect and control, and communication and conflict management. We use objective interviewer ratings of couple functioning on each domain based on semi-structured, behaviorally anchored, individual
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interviews with both partners to control for the possibility that self-reports of relationship functioning might be influenced by factors such as global relationship satisfaction, depression or social desirability. The use of objective ratings also allowed us to control for the possibility that couples married only 3-6 months might experience cognitive dissonance when discussing potential weaknesses or problems in their relationships, which might influence their selfreports of the quality of their relationship.
Domains of Relationship Quality Our aim in the present study was to be comprehensive in our examination of dimensions of relationship quality that would influence the longitudinal course of relationship satisfaction and stability. As such, after an exhaustive review of the close relationships literature across multiple disciplines (e.g., social and clinical psychology, communication studies, family studies, sociology), we identified five dimensions of relationship quality as potential risk or protective factors. Communication and conflict management was operationalized as comprising frequency and length of arguments, verbal, psychological and physical aggression during arguments, withdrawal during arguments, emotions and behaviors before, during and after arguments, and conflict resolution strategies. In accord with Cutrona and colleagues’ work (e.g., Cutrona, Russell, & Gardner, 2005), inter-partner support was operationalized as comprising four types of support when one partner has had a bad day, is feeling down, or has a problem: emotional support (talking and listening to each other, holding hands, hugging, letting partner know s/he understands), direct or indirect tangible support (direct support: when one’s partner helps to solve the problem or make the situation better; indirect support: providing time or resources so that one’s partner is better able to solve the problem him- or herself, e.g., providing childcare), informational support (giving advice, providing partner with information, helping partner think about a problem in a new way), and esteem support (expressing confidence in one’s ability to handle things, telling partner s/he is not at fault for a problem). Match between types of support desired and types of support provided, and whether support is offered in a positive or negative manner, were also assessed. Level of dyadic emotional closeness and intimacy was operationalized as comprising emotional closeness (an overall mutual sense of closeness, warmth, affection, and interdependence), quality of the couple’s friendship, and demonstrations of love and affection (quantity and quality of love and affection expressed in the relationship, including verbal and physical expressions of love). Sensuality and sexuality was operationalized as comprising the quality of the sexual relationship (frequency of sexual activity, symmetry in initiation of sexual activity, satisfaction, negative emotions, sexual difficulties, concerns) and sensuality (touching, hugging, cuddling, massage, the extent to which sensuality exists separate from sexual activity in the relationship). Respect and control was operationalized as comprising mutual acknowledgement of competence and independence; acceptance and positive regard for the other even when one disagrees with him or her, a/symmetry in decision-making across a variety of areas, partners’ satisfaction with that division of responsibilities, and a couple’s ability to negotiate control across a variety of areas (e.g., scheduling one’s own day, controlling money). The overwhelming majority of research in the close relationships field has been focused on the quality of a couple’s ability to solve problems and conflicts. Theories of intimate
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relationships and of the determinants of relationship outcomes (e.g., Christensen & Walczynski, 1997; Gottman, Swanson, & Murray, 1999), a great deal of the empirical research on intimate relationships, most observational research on intimate relationships, reviews on dyadic interactions (e.g., Karney & Bradbury, 1995; Weiss & Heyman, 1997), and most existing psychological interventions for couple distress (e.g., Behavioral Marital Therapy; Jacobson & Holtzworth-Munroe, 1986; Prevention and Relationship Enhancement Program; Floyd, Markman, Kelly, Blumberg, & Stanley, 1995) have targeted relationship conflict. Within the last decade or so, there has been a tremendous increase in attention to the role of spousal support as an adaptive dyadic skill (e.g., Gable, Gonzaga, & Strachman, 2006; Neff & Karney, 2005; Pasch & Bradbury, 1998). Other researchers have focused specifically on emotional intimacy (e.g., Barnes & Sternberg, 1997; Barry, Lawrence, & Langer, in press; Cordova, Gee, & Warren, 2005; Laurenceau et al., 2005), the quality of a couple’s sexual relationship (e.g., Henderson-King & Veroff, 1994; LoPiccolo, Heiman, Hogan, & Roberts, 1985), and respect and control (e.g., Gray-Little & Burks, 1983; Ehrensaft, LanghinrichsenRohling, Heyman, & Lawrence, 1999; Huston, 1983; Whisman & Jacobson, 1990). We know of only one study in which multiple dimensions of relationship quality were examined (Schramm, Marshall, Harris, & Lee, 2005). (See Lawrence et al., in press for a detailed review of the literature relevant to our decisions to include each of these five dimensions of relationship quality.) In sum, the existing literature suggests that there are multiple aspects of relationship quality. However, when relationship quality is examined, researchers typically examine only one or two domains of dyadic processes per sample, which presumably grossly underestimates the complexity of relationship quality. Moreover, many of these studies did not statistically examine sex differences in relationship quality, which may lead to an incomplete, skewed, or inaccurate conceptualization of intimate relationships and, consequently, to interventions that are limited in their effectiveness. This literature has also suffered from methodological limitations, including measurement issues such as the use of self-report measures of relational behaviors which may be influenced by social desirability and cognitive dissonance (particularly among newlyweds), shared method variance, retrospective data, heterogeneous samples and cross-sectional designs. By developing the RQI, we sought to begin to overcome these limitations and provide a novel way to assess the dimensions of relationship quality. Our goal was to develop a semistructured interview that can be administered individually to partners to assess their relationship quality or functioning across multiple relationship domains and yield objective ratings. The goal of the RQI is to serve as an assessment tool prior to disseminating intervention programs for couples.
The Relationship Quality Inventory (RQI) The RQI is a 60-minute semi-structured interview yielding objective ratings of the quality of couples’ relationships across five dimensions. Partners are administered the interview individually. After obtaining information on relationship history, participants are asked to describe the quality of their relationship across five dimensions over the past six months; Open ended questions – followed by a series of closed ended questions – are asked to allow novel contextual information to be obtained. During the spouse’s description of each
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dimension of relationship quality, the interviewers probe using detailed behavioral indicators and exemplars of each area to establish veridicality of report (see Prescott et al., 2000). Answers are coded into nominal or ordinal categories; responses also guide decisions about which subsequent questions are asked. Thus, the interview is branch-structured to facilitate conditional questions. Broad dimensions and specific items originally were selected following a multidisciplinary review of the close relationships literature. Following the compilation of a pool of potential domain-specific items, a team of six psychology pre-doctoral and doctoral students specializing in couple relationships sorted the pool into the domain categories. Items were deleted if there was less than 80% agreement among raters on their dimension classification. To get at the domain of Emotional Closeness and Intimacy, items were included that aimed to measure a couple’s ability to create mutual emotional closeness and intimacy in their relationship. Sample items include “How close do you feel to your partner?” and “Are there any specific personal (i.e., non-relationship) topics that either of you avoid talking about with the other?” Items in the Support section of the interview measured the level of support provided in the relationship, the type of support (emotional, tangible, etc), whether the support is given in a variety of situations and the mutuality of the support in the couple. Sample items include “Does your partner try to support you by spending a lot of time talking with you when you have a problem?” and “Can your partner tell when you are feeling down or need support, even if you don’t say anything?” In the section on the domain of Sensuality and Quality of the Sexual Relationship, items were included that asked about the frequency of sexual and sensual behaviors, the partner’s satisfaction, negative emotions, and difficulties in this area. Examples of items include “How satisfied are you with your sexual relationship?” and “Do you engage in sensual behaviors together, such as touching, cuddling, hugging or massage?” Items in the Respect and Control domain ask about dyadic decisionmaking across a variety of topics, and the balance of control in the relationship. Sample items include “Does one of you tend to make most of the decisions in your relationship?” and “How is money managed in your relationship?” Items included to assess the domain of Communication and Conflict Management looked at negative affect in the relationship, verbal, psychological, and physical aggression, and conflict resolution strategies. Sample items include “Do you feel comfortable expressing your own opinions during a discussion with your partner?” and “Do either of you ever threaten to leave the relationship during an argument?” Interviewers independently rated the relationship on each domain using five-point scales. Ratings may range from 1-5 and scores of .5 (e.g., 3.5) are permissible. For example, in the domain of Spousal Support, a rating of 1 indicates that the couple “blames, challenges, gives advice when not requested; neither partner gives much/any support, or amount of support is extremely skewed in favor of one partner over the other.” A rating of 3 is assigned if “some support is provided, but skewed in favor of one partner over the other or provided in only certain situations. Variety of support is limited.” A rating of 5 indicates “a high level and quality of support from both partners; large variety of types of support spanning a variety of situations.” Interviewers made objective ratings to eliminate the possibility that associations between poor functioning in a key domain and other factors (e.g., marital distress) were due to reporting biases. All interviews were audio-taped, and inter-rater reliability was assessed using a random sample of 20% of the interviews. Coders were considered to be in agreement if two independent raters were within .5 on the 5-point scale.
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SECTION 3: PRELIMINARY EVIDENCE FOR THE RELIABILITY AND VALIDITY OF THE RELATIONSHIP QUALITY INVENTORY (RQI) In this section we provide preliminary evidence for the reliability and validity of the RQI in our target populations of young relationships – dating and newlywed couples. First, we assessed reliability, convergent validity, and divergent validity. Second, we examined the generalizability of the RQI across dating and marital relationships and across men and women. Third, we examined the utility of the RQI to assess risk of relationship distress over and above existing self-report measures and behavioral observation methods.
Samples Recruited to Assess Reliability and Validity of the RQI Sample 1 comprised 101 married couples recruited through marriage license records from suburban communities and small towns in Iowa. Couples dated an average of 48 months (SD = 27.79) prior to marriage and 77% of them cohabited. Average estimated annual joint income of couples was between $30,001- $40,000. Husbands’ average age was 25.91 (SD = 3.09) and their modal years of education were 14 years. Wives’ average age was 24.5 (SD = 3.46) and their modal years of education were also 14 years. For 15% of the couples, at least one member of the couple identified him or herself as a member of an ethnic minority group. (The proportion of non-Caucasian individuals in Iowa is 9%; US Census, 2007.) Sample 2 comprised 91 individuals in heterosexual romantic relationships lasting at least two months. Participants were enrolled in an introductory psychology course at The University of Iowa. They ranged in age from 18 to 27 (M = 18.27 years, SD = 1.03 years) and were predominantly Caucasian/Non-Hispanic (96.7%). Most participants defined their relationships as “seriously dating” (96%). Only 1.1% were cohabiting, and relationship duration ranged from 2 months to 5 years (M = 17.16 months, SD = 13.26). Objective codes for all five RQI scales are presented in Table 1. On a 1-5 scale, interviewers’ mean ratings ranged from 3.35 to 4.20 across all five RQI scales. On average, couples’ relationship quality in these five domains was good to very good, which would be expected in samples of dating or newlywed couples. Moreover, scores on all domains yielded normal distributions, suggesting that there was adequate range in relationship quality across participants in each of the five domains.
Reliability Analyses To assess reliability of the RQI, we analyzed inter-rater reliability, agreement of interviewers’ scores across husbands’ and wives’ interviews, and correlations among RQI scales; see Table 1 for all of the results.
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RQI Scales
Trust, Closeness & Emotional Intimacy Inter-partner Support
Descriptives and Agreement across Husband and Wife Interviews Marital Sample Dating Sample t(102) Mean Husbands Wives (SD) Mean Mean (SD) (SD) 4.13 4.20 1.06 3.40 (.53) (.39) (.65)
Intraclass Correlations Marital Sample
Dating Sample ICC
Husbands ICC
Wives ICC
.82
.71
.82
3.97 (.49)
3.94 (.50)
-.41
3.63 (.50)
.78
.88
.87
Sexual Relations
3.92 (.65)
3.87 (.64)
-.79
3.36 (.66)
.94
.76
.77
Respect, Acceptance, Decision-Making & Control Communication & Conflict Management
3.97 (.55)
4.01 (.47)
.51
3.36 (.69)
.82
.84
.91
3.69 (.75)
3.78 (.67)
1.17
3.35 (.83)
.93
.84
.92
Inter-Rater Reliability To assess inter-rater reliability, 20% of the audio-taped interviews were randomly assigned to a second coder. Intra-class correlations were computed by averaging across correlations for each pair of objective codes. Correlations were above .70 across all five RQI scales for husbands’ and wives’ interviews in the marital sample and for participants in the dating sample. See Table 1 for all intra-class correlations. Agreement Based on Husband versus Wife Interviews Cross-spouse correlations on RQI ratings were low to moderate in magnitude (rs ranged from .25 to .54), suggesting that husbands and wives were providing somewhat different (but related) information and perspectives on their relationship functioning. Even though ratings were objective and generated based on behavioral indicators of relationship functioning, spouses may be giving at least somewhat different behavioral indicators, which then guide those objective ratings. However, the magnitude of the majority of the inter-spousal associations suggested the potential utility of aggregating across RQI ratings based on husbands’ and wives’ interviews to create a more reliable rating for each domain. Moreover, the t-tests revealed that ratings based on husbands’ and wives’ individual interviews were not significantly different (ts(100) ranged from .51 to 1.17, all ns).
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Correlations among RQI Scales It was important to first determine that the RQI scales were sufficiently interrelated to justify conceptualizing them as components of a higher-order measure of relationship quality. Within-subject correlations across RQI scales are presented in Table 2. Pairs of RQI scales within wives and within husbands in the marital sample correlated .38 to .65. In the dating sample, pairs of RQI scales correlated .24 to .63. This level of inter-correlation is appropriate for sub-factors of a more general construct (Clark & Watson, 1995) and indicates that the different scales are moderately inter-correlated but not redundant. There was one exception to this pattern, however. Inter-partner Support and Respect and Control were strongly correlated within subjects in the marital sample, with correlations of .65 and .70 for husbands and wives, respectively.
Convergent/Divergent Validity Analyses To assess convergent/divergent validity, we examined the extent to which RQI interview scales correlated with data on these same dyadic processes collected via self-report questionnaires and behavioral observations. Self-report measures included: (a) the Problem Solving Communication (PSC) and Affective Communication (AFC) subscales from The Marital Satisfaction Inventory-Revised (MSI-R; Snyder & Aikman, 1999) to measure negative communication and conflict management patterns, and (b) a modified version of The Support in Intimate Relationships Rating Scale (SIRRS; Dehle et al., 2001; see Barry et al., 2008 for details and psychometric properties of the revised SIRRS) to assess perceptions of support amount from one’s partner and support adequacy. Behavioral observation indices of relationship quality included: (a) an inter-partner support interaction task and the Social Support Interaction Coding System (SSICS; Pasch, Harris, Sullivan, & Bradbury, 2002), a coding system that assesses the behaviors exchanged by partners during a supportive discussion, and (b) a problem-solving interaction task and the Specific Affect Coding System – Revised (SPAFF-R; Gottman McCoy, & Coan, 1996), designed to measure positive and negative affect expressed during a problem-solving discussion.
Correlations between RQI Subscales and Self-report Measures of Related Constructs First we examined the correlations between the RQI subscales and self-report measures of relationship function in the relevant domains. Thus the constructs were somewhat related and the methods of assessment differed (objective interview versus self-report questionnaires). For the Emotional Closeness and Intimacy subscale we used the Affective Communication subscale of the Marital Status Inventory-Revised. For the Inter-partner Support subscale we used the adequacy scale from the Support in Intimate Relationships Rating Scale. For the Communication and Conflict Management subscale we used the Problem-Solving Communication scale of the MSI-R. (Self-report measures of the quality of the sexual relationship and of respect and control were not available in the present sample to compare to the RQI Sexual Relations and Respect and Control subscales, respectively.) As shown in Table 3, the RQI scales were weakly to moderately correlated with the self-report questionnaires. Correlations ranged from .24 to .56 in the marital sample, and from .03 to .23 in the dating sample.
Table 2. Correlations among RQI Scales Marital Sample
Dating Sample
Husbands Respect & Control
Comm. & Conflict
.65****
.46****
.25*
.38****
.24*
-----
-----
.35**
.26****
-----
-----
-----
-----
.63**
-----
-----
-----
-----
-----
Wives
Trust & Closeness
Support
Sex
Respect & Control
Comm. & Conflict
Trust & Closeness
Support
Trust & Closeness
.32**
.56**
.38**
.54**
.49**
-----
.59****
.59**
.27**
.51**
.65**
.44**
-----
-----
.49**
.52**
.54**
.38**
.44**
-----
.52**
.70**
.47**
.25**
.54**
.46**
.57**
.40**
.63**
.51**
Inter-partner Support Sexual Relations Respect & Control Communication & Conflict Mgmt.
Sex .56****
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Table 3. Convergent and Divergent Validity Analyses Range of Correlations with other RQI Scales
Correlations with Questionnaires of Correlations with Similar Relationship Constructs a Behavioral Data of Similar Constructs
Correlations with Global Relationship Satisfaction c
Correlations with Individual Differences in Similar Constructs d
b
Trust & Closeness Support Sexual Relations Respect & Control Comm. & Conflict a
Marital Husb. Wife .38-.56 .48-.59
Dating .56-.65
Husb. .37**
.44-.65 .38-.51
.52-.70 .40-.52
.24-.56 .25-.56
.28** -----
.38-.65
.47-.70
.35-.65
.44-.54
.40-.63
.24-.63
Marital Wife .42**
Dating
Marital Wife -----
Husb. .41**
Marital Wife .41**
Dating
-.23*
Husb. -----
.24* -----
.03 -----
.18+ -----
-.05 -----
.46** .35**
.39** .37**
.002 -.05
-----
-----
-----
-.17+
-.05
.43**
.39**
-.01
.56****
.44****
-.08
.25**
.14+
.36**
.38**
.22*
.09
Marital Husb. Wife -(.07-(.20.29**) .22) -----------------(.19.34**) -(.34.51)***
-(.004.12) -(.26.31)*
Dating -(.05-.07) ---------.08-.12 -(.08-.12)
Self-report questionnaires of similar constructs for each RQI scale were: for Trust and Closeness, the AFC Scale of the MSI-R; for Support, the Adequacy scale of the SIRRS; for Communication and Conflict, the PSC Scale of the MSI-R. Of note, the Trust and Closeness RQI scale was also compared to the Intimacy and Passion Scales from the Sternberg Love, Passion, and Intimacy Scale, and the pattern of correlations remained the same (rs = -.01 and .02, respectively). b Behavioral observation data of similar constructs for each RQI scale were: for Support, the Social Support Interaction Task and the SSICS; for Respect and Control, the Problem-Solving Interaction Task and the Contempt, Disgust, Domineering, and Belligerence codes from the SPAFF-R; for Communication and Conflict, the Problem-Solving Interaction Task and the remaining 12 positive and negative affect codes from the SPAFF-R. Of note, SPAFF data were analyzed multiple ways using to examine correlations with Communication and Conflict Management, and the pattern of results remained the same. c The Quality of Marriage Index (QMI) was analyzed for all correlations with global relationship satisfaction. Of note, in the sample of dating couples, this pattern of findings was replicated using the Perceived Relationship Quality Components (PRQC); rs ranged from .00 to .13. d Self-report questionnaires of individual differences were identical in both samples unless otherwise noted here. Measures of individual differences in similar constructs for each RQI scale were: for Trust and Closeness, the SNAP Detachment and Mistrust Scales, the Relationship Scales Questionnaires (in the marital sample), and the ECR-R Avoidance Scale (in the dating sample); for Respect and Control, the SNAP Manipulativeness Scale and the Hostility Scale from the Buss-Perry Aggression Questionnaire; for Communication and Conflict Management, the SNAP Negative Temperament Scale and the Anger Scale from the Buss-Perry Aggression Questionnaire.
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Correlations between RQI Subscales and Behavioral Observations of Related Constructs Next we examined the correlations between the RQI subscales and behavioral observations of measures of relationship functioning in the relevant domains. (Behavioral observation data were only available in the marital sample.) Thus the constructs were related but the methods of assessment differed (objective interview versus behavioral observations of couple functioning). For the Inter-partner Support subscale we used behavioral observations from two support interaction tasks that were later coded via the Social Support Interaction Coding system. For the Communication and Conflict Management subscale we used behavioral observations from two problem-solving interaction tasks that were later coded via the Specific Affect Coding System – Revised. As shown in Table 2, conclusions about marital processes yielded based on the RQI did not correlate with data collected via behavioral observations of these marital processes. Correlations ranged from .05 to .25.
Divergent Validity Analyses To assess divergent validity, we examined the associations between RQI subscales and measures of individual differences in related constructs. For example, we examined associations between the Emotional Closeness and Intimacy domain to measures of detachment and mistrust as personality traits, and to avoidant attachment as an attachment style. We measured individual differences by administering: (a) the Negative Temperament, Detachment, Mistrust, and Manipulativeness scales from The Schedule for Nonadaptive and Adaptive Personality - 2nd Edition (SNAP-2; Clark, Simms, Wu, & Casillas, in press); (b) the Anger and Hostility Scales from The Buss-Perry Aggression Questionnaire (Buss & Perry, 1992); and the Relationship Scales Questionnaire (RSQ; Griffin & Bartholomew, 1994) and the Experiences in Close Relationships – Revised scale (ECR-R; Fraley, Waller, & Brennan, 2000). We also assessed divergent validity by examining the associations between RQI subscales and a global measure of relationship satisfaction, The Quality of Marriage Index (QMI; Norton, 1983), to determine whether our purported assessment of domain-specific relationship quality was distinct from global relationship satisfaction. Three aspects of discriminant validity were considered. First, Campbell and Fiske (1959) state that a good convergent/discriminant validity pattern exists when matched variables correlate more highly with each other than with any other variable. Thus we examined whether the inter-correlations among RQI scales were higher than the correlations between RQI scales and measures of similar constructs via different methods. Second, the associations between the RQI scales and related traits were examined to determine whether RQI subscale scores discriminated between functioning within one’s marriage on a given domain and individual differences in interpersonal functioning on that domain across relationships. Third, we examined associations between RQI scales and a measure of global marital satisfaction to determine whether the RQI is simply assessing global marital satisfaction rather than relationship quality across multiple domains. Results are presented in Table 3.
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Campbell and Fiske’s Test of Convergent/divergent Validity We examined whether the inter-correlations among RQI scales were higher than the correlations between RQI scales and measures of similar constructs via different methods. Results are presented in Table 3. In general, this target pattern was clearly obtained for all five RQI scales in both samples. For each RQI scale, the correlations with other RQI scales (convergent validity) were generally larger than correlations with questionnaire or behavioral observation data. This support was evident for husbands and wives, and across marital and dating participants. Three of the four RQI Scales – Emotional Closeness and Intimacy, Interpartner Support, and Respect and Control – clearly meet the Campbell and Fiske test for excellent convergent and discriminant validity at the scale level. In contrast, there is mixed but generally strong evidence regarding the RQI Communication and Conflict Management Scales. The scale does meet Campbell and Fiske’s criteria when compared to self-report questionnaires in the dating sample and when compared to behavioral observation data in the marital sample. Moreover, the RQI Communication and Conflict Management Scale is only moderately correlated with the corresponding self-report questionnaire. However, this moderate correlation is similar to the moderate correlations between the RQI Communication and Conflict Management scale and the other RQI scales (which range from .40 to .63); thus, it does meet the Campbell and Fiske criteria in that regard. Correlations between RQI Subscales and Relevant Traits Zero-order correlations between the RQI subscales and trait-level constructs related to each domain assessed were examined. (Trait questionnaires to measure sexual relations across relationships and global social support were not available in the present samples to compare to the RQI Sexual Relations and Inter-Partner Support subscales, respectively.) For the Emotional Closeness and Intimacy subscale we used the (a) SNAP Detachment scale, (b) SNAP Mistrust scale, and (c) ECR-R Attachment Avoidance scale. All of the associations relevant to the Emotional Closeness and Intimacy subscale were small across husbands and wives and across dating and marital participants (rs ranged from .05 to .29). These findings support our contention that the RQI Emotional Closeness and Intimacy subscale is not simply measuring individual differences such as global detachment or mistrust as personality traits or an avoidant attachment style but rather measures a construct that is specific to the intimate relationship. For the Respect and Control subscale we used the SNAP Manipulation scale and the AQ Hostility Scale. All of the associations were small across husbands and wives and across dating and married participants (rs ranged from .004 to .34). Therefore, the Respect and Control subscale is not simply measuring individual differences such as manipulative or hostile personality traits but rather measures a construct that is specific to the intimate relationship. For the Communication and Conflict Management subscale we used (a) the Anger Scale from the Buss-Perry Anger Questionnaire and (b) the SNAP Negative Temperament scale. With one exception, the correlations were small, with rs ranging from .08 to .34. (The correlation between this scale and Negative Temperament for husbands was moderate (.51), although this association was small among wives and dating participants. Thus, the quality of a couple’s communication and conflict management strategies is clearly distinct from both trait anger and global negative temperament; however, for husbands, quality of conflict management is also clearly related to husband negative temperament.
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Correlations between RQI Subscales and Global Relationship Satisfaction Correlations between ratings of domain-specific relationship quality and global relationship satisfaction were low to moderate for husbands and wives (rs ranged from .35 to .46) and low for dating participants (rs ranged from .002 to .22), indicating that the domainspecific assessments of relationship quality did not simply represent indicators of an underlying latent variable of marital satisfaction. Moreover, the associations between relationship quality and satisfaction are clearly stronger for married couples compared to dating couples, which we expected given the longer duration and stronger commitment of married couples.
Incremental Validity Analyses We examined the utility of the RQI to assess risk of relationship distress over and above existing self-report measures and behavioral observation methods. In addition to our assertions that a clinical interview will be more user-friendly for clinicians and that the interview provides a better measure of the constructs of interest (compared to existing selfreport questionnaires and behavioral observational data), we also expected the RQI scales to predict global relationship satisfaction over and above these existing measures. We examined the incremental utility of each RQI scale when predicting cross-sectional and longitudinal (three-year) satisfaction for men and women. In the marital sample, we examined the extent to which each RQI scale provided incremental predictive validity in accounting for global marital satisfaction. For four of the five RQI scales – Emotional Closeness and Intimacy, Inter-partner Support, Respect and Control, and Communication and Conflict – we analyzed the incremental predictive power of the RQI scale over and above self-report questionnaires of these marital processes and, when available, behavioral observation data of these marital processes. We did not have any selfreport questionnaire data for the quality of the couple’s sexual relations. Incremental validity was examined when predicting both concurrent and longitudinal marital satisfaction. Results for all regression analyses are presented in Table 4.
Cross-sectional Analyses In the marital sample, three of the four RQI scales – Emotional Closeness and Intimacy, Inter-partner Support, and Respect and Control – demonstrated incremental predictive power. Interestingly, in the dating sample, only the RQI Communication and Conflict Management scale demonstrated incremental predictive power. The RQI Emotional Closeness and Intimacy Scale predicted concurrent marital satisfaction for husbands and wives over and above our self-report measure of this construct (Affective Communication Scale of the MSIR; Snyder & Aikman). The RQI Inter-Partner Support Scale predicted concurrent marital satisfaction for husbands and wives over and above both our self-report measure (SIRRS; Dehle et al.) and our behavioral observation data (SS interaction task coded via the SSICS coding system; Pasch et al.). The RQI Respect and Control Scale predicted concurrent marital satisfaction for husbands – but not for wives – over and above both our self-report measure (Problem-Solving Communication Scale of the MSI-R; Snyder & Aikman) and our behavioral observation data (problem-solving interaction task coded for belligerence,
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dominance, contempt, and disgust via the SPAFF coding system; Gottman et al.). The RQI Communication and Conflict Management Scale predicted concurrent relationship satisfaction for dating participants (but not for husbands or wives) over and over and above our self-report measure (Problem-Solving Communication Scale of the MSI-R; Snyder & Aikman). Thus, the RQI appears to provide incremental utility to explaining global marital satisfaction compared to existing self-report questionnaires and behavioral observation data for Emotional Closeness and Intimacy, Inter-partner Support, and Respect and Control, but not for Communication and Conflict Management. Table 4. Incremental Predictive Validity
MSI-R: AFC Scale RQI Trust & Closeness SIRRS Adequacy Scale RQI Support Scale SIRRS Adequacy Scale SSICS Support Codes RQI Support Scale MSI-R: PSC Scale SPAFF Behaviors a RQI Respect & Control MSI-R: PSC Scale SPAFF Behaviors b RQI Commun./Conflict a
Predicting Time 1 Relationship Satisfaction Marital Sample Dating Sample Husbands Wives
Husbands
Wives
b (SE) / Adjusted R2
b (SE) / Adjusted R2 Δ
b (SE) / Adjusted R2 Δ
b (SE) / Adjusted R2
b (SE) / Adjusted R2
Predicting Time 4 Satisfaction Marital Sample
Δ
Δ
1.29**** (.19) 1.46* (.72) / .02*
1.07**** (.13) 1.91* (.98) / .02*
-1.59**** (.24) -.26**** (.43) / .33
1.02** (.33)
.45+ (.28)
3.02* (1.21) / .06*
.15 (1.95) /.00
.12+ (.05)
.14 *** (.04)
.28 (.09) **
.08 (.07)
.09 + (.05)
3.20**** (.87) / .22 .14** (.05)
2.72** (.92) / .26 .07 (.05)
-.01 (.48) / .09
.42 (1.28) / .001 .10 (.09)
1.21 (1.19) / .04 .07 (.06)
.01 (.02) 1 .82+ (1.07) / .192 -.63**** (.09) -.00 (.02) 1.51* (.69) / .03* 1.05**** (.15) .001 (.003) -.09 (.60) / .41
-.02 (.03) 3.30** (1.12) / .15 -.72**** (.09) .01 (.02) 1.45* (.74) / .02* 1.04**** (.14) .001 (.003) .70 (.60) / .46
.03 (.04) .91 (2.05) / .02 -.30 (.17)+
-.02 (.03) 1.28 (1.39) / .002 -.39* (.19)
-.02 (.03) 2.47* (1.23) / .04* .19 (.27)
.03 (.03) 1.13 (1.43) / .02 .34 (.21)
.003 (.005) 1.40 (1.10) / .03
-.001 (.004) 1.14 (.92) / .04
-------------.65**** -----.04/.41 -.91 (.12) **** ----.64* (.30) / .41*
Δ
SPAFF behaviors: Disgust, Contempt, Domineering, Belligerence. All other positive and negative SPAFF codes. Of note, SPAFF data were analyzed multiple ways to examine corr.s with Commun. & Conflict. Pattern of results remained the same. + p < .10; * p < .05; ** p < .01; *** p < .001; **** p < .0001. b
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Longitudinal Analyses Next we examined the incremental predictive utility of these same RQI scales when predicting longitudinal marital satisfaction – at three years of marriage. Two of the four RQI scales – Emotional Closeness and Intimacy and Respect and Control – demonstrated incremental utility in predicting husbands – but not wives – longitudinal marital satisfaction. The RQI Emotional Closeness and Intimacy Scale predicted husbands’ longitudinal marital satisfaction over and above our self-report measure of this construct (Affective Communication Scale of the MSI-R; Snyder & Aikman). The RQI Respect and Control Scale also predicted husbands’ longitudinal marital satisfaction over and over and above both our self-report measure (Problem-Solving Communication Scale of the MSI-R; Snyder & Aikman) and our behavioral observation data (problem-solving interaction task coded for belligerence, dominance, contempt, and disgust via the SPAFF coding system; Gottman et al.). The RQI Inter-partner Support Scale and Communication and Conflict Scales did not incrementally predict longitudinal marital satisfaction for either husbands or wives over and above our self-report measure or our behavioral observation data Thus, the RQI appears to provide incremental utility to explaining husbands’ – but not wives’ – longitudinal global marital satisfaction compared to existing self-report questionnaires and behavioral observation data for Emotional Closeness and Intimacy and Respect and Control, but not for Inter-partner Support or Communication and Conflict Management.
Conclusion The RQI demonstrated strong reliability, with inter-rater agreement consistently above .7, no significant differences among interviewer ratings based on whether the male or female partner was interviewed in a given couple. Correlations among RQI subscales ranged from .2 to .6 (with one exception), supporting our contention that the subscales are best conceptualized as related dimensions of the underlying construct of relationship quality, yet these subscales capture conceptually distinct (albeit related) dimensions of relationship quality. The RQI also demonstrated good convergent validity, with correlations ranging from .2 to .6 between the subscales and self-report measures of related relationship constructs (emotional intimacy, communication and conflict management, inter-partner support). Divergent validity was assessed four ways. First, correlations between RQI scales and behavioral observations of related constructs were weak, ranging from .05 to .25, supporting our contention that the RQI captures markedly distinct constructs from what is captured via behavioral observation interaction tasks. Second, correlations between RQI scales and measure of global relationship satisfaction were weak, ranging from .002 to .46, supporting our contention that the RQI is not simply a measure of global relationship satisfaction. Third, correlations between RQI subscales and individual difference measures of related constructs (e.g., avoidant attachment, mistrust, detachment, negative temperament, hostility) were weak, ranging from .004 to .3 (with one exception at .5), supporting our contention that the RQI scales capture constructs that are unique to one’s current intimate relationship rather than being indicative of individual differences that might be present across multiple types of relationships (e.g., friends, acquaintances, co-workers). Fourth, convergent validity analyses generally yielded stronger correlations then divergent validity analyses, lending partial support to the Campbell-Fiske (1959) test of construct validity.
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SECTION 4: CLINICAL IMPLICATIONS OF THE RQI FOR COUPLE ASSESSMENT AND PREVENTION EFFORTS In this section we discuss clinical implications at two levels. First, we discuss the generalizability of the RQI itself based on the data presented in Section 3. Second, we discuss the broader clinical implications of the RQI for improving couple assessment and prevention efforts.
Generalizability of the RQI We examined the generalizability of the RQI in two ways. First we examined its generalizability across men and women. The RQI yielded strong psychometric data for men and women. Second, we found that the RQI demonstrated reliability, validity, and incremental utility across dating and marital relationships. As the proportion of couples who cohabit and/or date for many years prior to marriage increases, greater attention is being given to the study of pre-marital relationships (e.g., Brown & Booth, 1996; Stanley, Rhoades, & Markman, 2006). Additionally, it has been suggested that patterns that develop early in relationships (i.e., even before marriage) are important for individual and dyadic outcomes (Cutrona et al., 2005). Thus, patterns of relationship quality that emerge during courtship likely impact individual and relationship functioning. Despite this potential importance, little work has addressed whether relationship quality functions similarly in dating and marital relationships. As expected, the pattern of findings was stronger in the analyses of the marital sample compared to the dating sample. The longer duration and stronger commitment of the married participants would presumably lead to greater utility of the RQI in such a sample. The next step is to examine the psychometric properties of the RQI in distressed samples of couples, such as in a sample of couples seeking couple therapy. We would expect the pattern of results to be similar, if not stronger, to that found with the marital sample. More generally, as the intimate relationship becomes more solidified and more central to one’s life, we would expect the RQI to have greater utility and for the interview to demonstrate stronger convergent and divergent validity when administered. There are several ways in which the generalizability of the RQI can be expanded in future research. First, although the RQI was developed as an assessment tool for young couples and to be administered in accord with prevention programs, it seems just as likely that it could be used as part of a standardized assessment protocol for treatment-seeking and/or distressed couples and to guide treatment for those couples. Before we can recommend that the RQI be used in this way, we must first assess the reliability and validity of the RQI in distressed, established, and/or treatment-seeking couples. Second, the reliability and validity of the RQI should be examined with same-sex couples and couples at other stages of their relationships (e.g., cohabiting couples, engaged couples, couples experiencing the transition to parenthood). Finally, other dimensions of relationship quality might be worth incorporated into the RQI, such as fun and leisure time and quality of the couple’s friendship.
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Implications for Couple Assessment and Prevention Efforts There are several implications of the present study for couple assessment and intervention efforts. First, the RQI is intended to be used as part of a standardized assessment battery for couple interventions. For example, it can be administered to couples and then incorporated into a feedback session in which relationship strengths/protective factors and relationship risk factors/ vulnerabilities are emphasized. By quantifying relative strengths and weaknesses across multiple dimensions of a relationship, feedback may be more palatable to couples. Second, the RQI might function as a motivational tool to get couples to participate in couple prevention programs or treatments. Cordova and colleagues (Cordova et al., 2005; Gee, Scott, Castellani, & Cordova, 2002) developed an indicated intervention program called the Marriage Checkup based on the principles of motivational interviewing. As they describe, prior to dissolution, it is likely that couples that become severely distressed first pass through an at-risk stage in which they experience early symptoms of marital deterioration but have not yet suffered irreversible damage to their marriage. It is during this at risk stage when couples might benefit most from early intervention. To date, they have found evidence for the attractiveness, tolerability, efficacy, and mechanisms of change produced by this interview, as well as its ability to predict marital satisfaction two years later. In line with this important work, it is possible that the RQI could be modified and tested as a motivational interview for at risk couples as well. Third, because the RQI can be used to identify domains of strength and weakness in couples’ relationships, it might be useful as a tool to identify at risk couples. To date, studies of leading preventive interventions have not fared well at recruiting couples at risk for adverse marital outcomes. Published samples have been disproportionately Caucasian, well educated, and middle class (see Carroll & Doherty, 2003, for a review). However, divorce rates are markedly higher among African American couples (70% vs. 47% in Caucasian couples), among couples who did not finish high school (60% vs. 36% for college graduates), and among couples who start marriage with children (rates are twice as high as couples who marry without children; Raley & Bumpass, 2003). Despite their omission from prevention programs, couples in these high-risk populations report high levels of interest in participating in these interventions (Johnson et al., 2002). In sum, relationship enhancing interventions appear to have failed to test their programs in the populations at greatest risk for distress and divorce. Administering the RQI prior to implementing a prevention program might allow at risk couples to be identified, while simultaneously being used as a motivational tool to encourage these at risk couples to participate in these prevention interventions. Fourth, intervention programs can be better tailored to the needs of specific couples, rather than implementing a one-size fits all approach. For example, a couple’s RQI may indicate strong quality of communication and conflict management skills but poor quality of inter-partner support. In this case, intervention techniques specific to improving the quality of support in that relationship is more appropriate and intervention techniques targeting conflict management skills are unnecessary. This approach seems more beneficial for treating couples and more cost-effective from a health care perspective.
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REFERENCES Barry, R.A., Bunde, M., Brock, R.L., & Lawrence, E. (2008). Examining the validity and utility of distinguishing among types of support in intimate relationships. Manuscript submitted for publication. Barry, R.A., Lawrence, E., & Langer, A. (in press). Conceptualization and assessment of disengagement in romantic relationships. Personal Relationships. Brown, S. L., & Booth, A. (1996). Cohabitation versus marriage: A comparison of relationship quality. Journal of Marriage and Family, 58, 668-678. Busby, D.M., Holman, T.B., Taniguchi, N. (2001). RELATE: Relationship evaluation of the individual, family, cultural, and couple contexts. Family Relations, 50, 308-316. Buss, A. H., & Perry, M. P. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452-459. Campbell, D.T., & Fiske, D.W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56, 81-105. Carroll, J.S., & Doherty, W.J. (2003). Evaluating the effectiveness of premarital prevention programs: A meta-analytic review of outcome research. Family Relations, 52, 105-118. Christensen, A., & Walczynski, P. T. (1997). Conflict and satisfaction in couples. In R. J. Sternberg & M. Hojjat (Eds.), Satisfaction in close relationships (pp. 249–274). NY: Guilford. Clark, L. (1993). Manual for the Schedule for Nonadaptive and Adaptive Personality. MN: University of Minnesota Press. Clark, L.A., Simms, L.J., Wu, K.D., & Casillas, A. (in press). Schedule for Nonadaptive and Adaptive Personality (2nd ed.). MN: University of Minnesota. Cohen, L.H., Towbes, L.C., & Flocco, R. (1988). Effects of induced mood on self-reported life events and perceived and received social support. Journal of Personality and Social Psychology, 55, 669-674. Cordova, J. V., Gee, C. B., Warren, L. Z. (2005). Emotional skillfulness in marriage: Intimacy as a mediator of the relationship between emotional skillfulness and marital satisfaction. Journal of Social and Clinical Psychology, 24, 218-235. Cutrona, C.E., Russell, D.W., & Gardner, K.A. (2005). The relationship enhancement model of social support. In T.A. Revenson, K. Kayser & G. Bodenmann (Eds.), Couples coping with stress (pp. 3-23). DC: APA. Cutrona, C.E., & Suhr, J.A. (1992). Controllability of stressful events and satisfaction with spouse support behaviors. Communication Research, 19, 154-174. Cutrona, C.E., & Suhr, J.A. (1994). Social support communication in the context of marriage: An analysis of couples’ supportive interactions. In B.R. Burleson, T.L. Albrecht & I.G. Sarason (Eds.), Communication of social support: Messages, interactions, relationships, and community (pp. 113-135). CA: Sage. Dehle, C., Larsen, D., & Landers, J.E. (2001). Social support in marriage. American Journal of Family Therapy, 29, 307–324. Ehrensaft, M.K., Langhinrichsen-Rohling, J., Heyman, R.E., O’Leary, K.D., & Lawrence, E. (1999). Feeling controlled in marriage: A phenomenon specific to physically aggressive couples? Journal of Family Psychology, 13, 20-32.
170
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
Fincham, F.D., & Linfield, K.J. (1997). A new look at marital quality: Can spouses feel positive and negative about their marriage? Journal of Family Psychology, 11, 489-502. First, M.B., Gibbon, M., Spitzer, R.L., & Williams, J.B.W. (1997). Structured Clinical Interview for DSM–IV Axis I Disorders—Clinician version. Washington, DC: American Psychiatric Association. Floyd, F.J., Markman, H.J., Kelly, S., Blumberg, S.L., & Stanley, S.M. (1995). Preventive intervention and relationship enhancement. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of couple therapy (pp. 212-226). NY: Guilford. Fraley, R.C., Waller, N.G., & Brennan, K.A. (2000). An item response theory analysis of selfreport measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365. Gable, S.L., Gonzaga, G.C., & Strachman, A. (2006). Will you be there for me when things go right? Supportive responses to positive event disclosures. Journal of Personality and Social Psychology, 91, 904-917. Gee, C.B., Scott, R.L., Castellani, A.M., & Cordova, J.V. (2002). Predicting 2-year marital satisfaction from partners’ discussion of their marriage checkup. Journal of Marital and Family Therapy, 28, 399-407. Geiss, S., & O’Leary, K. (1981). Therapist ratings of frequency and severity of marital problems: Implications for research. Journal of Marital & Family Therapy, 7, 515-520. George, C., Kaplan, N., & Main, M. (1985). The Berkeley adult attachment interview. Unpublished protocol. University of California, Berkeley. Godoy, R., Reyes-Garcia, V., Tanner, S., Leonard, W.R., McDade, T.W., & Huanca, T. (2008). Can we trust an adult's estimate of parental school attainment? Disentangling social desirability bias and random measurement error. Field Methods, 20, 26-45. Gottman, J., McCoy, K., & Coan J. (1996). The Specific Affect Coding System. In J. Gottman (Ed.) What predicts divorce? The measures (pp. 561). NJ: Erlbaum. Gottman, J.M., Swanson, C., & Murray, J. (1999). The mathematics of marital conflict: Dynamic mathematical nonlinear modeling of newlywed marital interaction. Journal of Family Psychology, 13, 3-19. Gray-Little, B., & Burks, N. (1983). Power and satisfaction in marriage: A review and critique. Psychological Bulletin, 93, 513– 538. Griffin, D.W., & Bartholomew, K. (1994). The metaphysics of measurement: The case of adult attachment. In K. Bartholomew & D. Perlman (Eds.), Attachment processes in adulthood: Henderson-King, D.H., & Veroff, J. (1994). Sexual satisfaction and marital well-being in the first years of marriages. Journal of Social and Personal Relationships, 11, 509–534. Heyman, R.E., Feldbau-Kohn, S.R., Ehrensaft, M.K., Langhinrichsen-Rohling, J., & O’Leary, K.D. (2001). Can questionnaire reports correctly classify relationship distress and partner physical abuse? Journal of Family Psychology, 15, 334–346. Heyman, R.E., Sayers, S.L., & Bellack. A.S. (1994). Global marital satisfaction versus marital adjustment: An empirical comparison of three measures. Journal of Family Psychology, 8, 432-446. Huston, T.L. (1983). Power. In H.H. Kelley, E. Berscheid, A. Christensen, J.H. Harvey, T.L. Huston, G. Levinger, E. McClintock, L.A. Peplau, & D.R. Peterson (Eds.), Close relationships (pp. 169-219). NY: Freeman.
Development of an Interview for Assessing Relationship Quality
171
Huston, T.L., & Vangelisti, A.L. (1991). Socioemotional behavior and satisfaction in marital relationships: A longitudinal study. Journal of Personality and Social Psychology, 61, 721-733. Jacobson, N.S., & Holtzworth-Munroe, A. (1986). Marital therapy: A social learning/cognitive perspective. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of marital therapy (pp. 29-70). NY: Guilford. Karney, B. R., & Bradbury, T. N. (1995). The longitudinal course of marital quality and stability: A review of theory, method, and research. Psychological Bulletin, 118, 3-34. Karney, B.R., & Frye, N.E. (2002). "But we've been getting better lately": Comparing prospective and retrospective views of relationship development. Journal of Personality and Social Psychology, 82, 222-238. Kluemper, D.H. (2008). Trait emotional intelligence: The impact of core-self evaluations and social desirability. Personality and Individual Differences, 44, 1402-1412. Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships, 19, 811-834. Larson, J.H., Newell, K., Topham, G., & Nichols, S. (2002). A review of three comprehensive premarital assessment questionnaires. Journal of Marital and Family Therapy, 28, 233-239. Laurenceau, J., Barrett, L.F., & Rovine, M.J. (2005). The interpersonal process model of intimacy in marriage: A daily-diary and multilevel modeling approach. Journal of Family Psychology, 19, 314-323. Locke, H.J., & Wallace, K.M. (1959). Short marital adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21, 251–255. LoPiccolo, J., Heiman, J.R., Hogan, D.R., & Roberts, C.W. (1985). Effectiveness of single therapists versus cotherapy teams in sex therapy. Journal of Consulting and Clinical Psychology, 53, 287-294. Markey, B., & Micheletto, M. (1997). Instructor manual for FOCCUS. Omaha, NE: Archdiocese of Omaha. McNulty, J.K., O'Mara, E.M., & Karney, B.R. (2008). Benevolent cognitions as a strategy of relationship maintenance: "Don't sweat the small stuff"....But it is not all small stuff. Journal of Personality and Social Psychology, 94, 631-646. Miller, P.J. E., Niehuis, S., & Huston, T.L. (2006). Positive illusions in marital relationships: A 13-year longitudinal study. Personality and Social Psychology Bulletin, 32, 1579-1594. Morrison, A.T., & Hunt, H.T. (1996). "Reals", "roles", and demand features: A critical look at interview versus questionnaire measures of subjective states. Canadian Psychology, 37, 112-119. Neff, L.A., & Karney, B.R. (2005). Gender differences in social support: A question of skills or responsiveness? Journal of Personality and Social Psychology, 88, 79-90. Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of Marriage and the Family, 45, 141-151. Olsen, D. H., Fournier, D. H., & Druckman, J. M. ( 1996). PREPARE. Minneapolis, MN: Life Innovations. Osgood, C.E., Suci, G.J., & Tannenbaum, P.H. (1957). The measurement of meaning. Urbana, IL: University of Illinois Press. Pasch, L.A., & Bradbury, T.N. (1998). Social support, conflict, and the development of marital dysfunction. Journal of Consulting and Clinical Psychology, 66, 219-230.
172
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
Pasch, L.A., Harris, K.M., Sullivan, K.T., & Bradbury, T.N. (2002). The social support interaction coding system. In P. Kerig & D. Baucom (Eds.), Couple observational coding systems. Mahwah, NJ: Lawrence Erlbaum & Associates. Prescott, A., Bank, L., Reid, J. B., Knutson, J. F., Burraston, B. O., & Eddy, J. M. (2000). The veridicality of retrospective reports of punitive childhood experiences. Child Abuse and Neglect, 24, 411-423. Raley, R.K. (2003). The topography of the divorce plateau: Levels and trends in union stability in the United States after 1980. Demographic Research, 8, 245-260. Raselli, C., & Broderick, J.E. (2007). The association of depression and neuroticism with pain reports: A comparison of momentary and recalled pain assessment. Journal of Psychosomatic Research, 62, 313-320. Reynolds, S. K., & Clark, L. A. (2001). Predicting personality disorder dimensions from domains and facets of the five factor model. Journal of Personality, 69, 199–222. Schramm, D.G., Marshall, J.P. Harris, V.W., & Lee, T.R. (2005). After "I do": The newlywed transition. Marriage and Family Review, 38, 45-67. Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., & Bugaighis, M.A. (1986). Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage and the Family, 48, 381–387. Simpson, J.A., Rholes, W.S., & Nelligan, J.S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434-446. Snyder, D.K., & Aikman, G.G. (1999). Marital Satisfaction Inventory-Revised. In M.E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment. (2nd ed., pp. 1173-1210). Mahwah, NJ: Erlbaum. Snyder, D.K., Heyman, R.E., & Haynes, S.N. (2005). Evidence-based approaches to assessing couple distress. Psychological Assessment, 17, 288-307. Spanier, G.B. (1979). The measurement of marital quality. Journal of Sex and Marital Therapy, 5, 288-300. Stanley, S.M., Rhoades, G.H., & Markman, H.J. (2006). Sliding vs. deciding: Inertia and the premarital cohabitation effect. Family Relations, 55, 499-509. Straus, M., Hamby, S., Boney-McCoy, & Sugarman, D. (1996). Revised Conflict Tactics Scales: Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316. US Census Bureau Population Division (2007) Race and Hispanic or Latino origin in Iowa’s counties: 2006. Weiss, R.L., & Heyman, R.E. (1990). Marital distress. In A.S. Bellack, M. Hersen, & A.E. Kazdin (Eds.), International handbook of behavior modification and therapy (2nd ed.; pp. 475-501). NY: Plenum. Whisman, M.A., & Jacobson, N.S. (1990). Power, marital satisfaction, and response to marital therapy. Journal of Family Psychology, 4, 202-212. Xu, Y., & Burleson, B.R. (2001). Effects of sex, culture, and support type on perceptions of spousal social support: An assessment of the “support gap” hypothesis in early marriage. Human Communication Research, 27, 535-566.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 8
ASSESSING RELATIONSHIP QUALITY: DEVELOPMENT OF AN INTERVIEW AND IMPLICATIONS FOR COUPLE ASSESSMENT AND INTERVENTION Erika Lawrence, Rebecca L. Brock, Robin A. Barry, Amie Langer University of Iowa, Iowa City, Iowa, USA
Mali Bunde CIGNA Health Solutions, Eden Prairie, Minnesota, USA
ABSTRACT Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. In the first section of our paper, we review the long-standing debate regarding -- and clarify the distinctions among -relationship adjustment, satisfaction, and quality. We also discuss the need for an empirically-supported, psychometrically strong measure of relationship quality. In the second section, we discuss the multidimensional nature of relationship quality, and review prior research relevant to each dimension. We also introduce the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings. The RQI was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. In the third section, we provide preliminary evidence of the reliability and validity of the interview. Across samples of dating and married couples, we examined reliability, convergent and divergent validity, and incremental validity of the RQI. In the fourth section, we discuss broader clinical issues relevant to couple assessment and intervention efforts.
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INTRODUCTION Historically, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. In contrast, far less attention has been paid to the assessment of relationship quality. In the first section of our paper, we review the long-standing debate regarding -- and clarify the distinctions among -- relationship adjustment, satisfaction, and quality. We also discuss the need for an empirically-supported, psychometrically strong measure of relationship quality. In the second section, we introduce the Relationship Quality Interview (RQI), a semi-structured, behaviorally anchored, individual interview that yields objectively coded ratings. It was designed to assess relationship quality across five dimensions: (a) trust, closeness, and emotional intimacy; (b) inter-partner support; (c) quality of the sexual relationship; (c) respect, power, and control; and (e) communication and conflict management. We describe the development of the interview, our justification for the dimensions of relationship quality included, and the coding system employed. In the third section, we provide preliminary evidence of the reliability and validity of the interview. Our goal is for the RQI to be used as an assessment tool prior to the implementation of prevention programs with young couples. Therefore, we administered the RQI to 101 newlywed couples and 91 dating individuals. To assess reliability, we analyzed internal consistency, inter-rater agreement, agreement across interviewers based on two members of the same couple, and correlations among the scales. To examine convergent validity, we analyzed correlations between RQI scales and self-report questionnaires assessing similar relationship dimensions. To examine divergent validity, we computed correlations between RQI scales and (a) behavioral observations of related constructs, (b) global measures of relationship satisfaction, and (c) individual difference measures of related constructs. We also examined the incremental utility of the RQI to explain cross-sectional and longitudinal relationship satisfaction over and above existing measures of these same dimensions of relationship quality. In the fourth section, we discuss broader clinical issues relevant to couple assessment and prevention efforts. First, we discuss the importance of identifying a standardized couple assessment strategy, and review ongoing efforts to achieve this goal. Second, we make specific recommendations for enhancing couple prevention programs. Third, we discuss the possible utility of interviews as motivational tools to increase participation in prevention programs among couples at high risk for longitudinal distress and dissolution, and review ongoing efforts to achieve this goal.
SECTION 1: RELATIONSHIP SATISFACTION, ADJUSTMENT, AND QUALITY Over the last 60 years, relationship satisfaction and adjustment have been the target outcome variables for almost all couple research and therapies. Nevertheless, there has also been considerable debate over the differences among the terms relationship satisfaction, relationship adjustment, and relationship quality. Relationship satisfaction refers to global sentiment or happiness as a unitary construct. Relationship adjustment is broader in scope,
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and includes a consideration of dyadic processes such as conflict management skills and relationship outcomes such as satisfaction. Relationship quality refers to dyadic processes alone, such as the quality of a couple’s conflict management skills, supportive transactions, sexual relations, or emotional intimacy (Lawrence, Barry, Brock, & Langer, in press; see Snyder, Heyman, & Haynes, 2005, and Heyman, Sayers, and Bellack, 1994 for detailed discussions of these issues). In this section, we provide a brief overview of the ways in which relationship adjustment, satisfaction, and quality have been assessed to date, followed by a discussion of the strengths and weaknesses of different methods of relationship assessment (e.g., self-report questionnaires vs. clinical interviews).
Assessments of Relationship Adjustment, Satisfaction and Quality Relationship adjustment is typically assessed with omnibus measures in which partners evaluate multiple aspects of their relationships, such as the amount of disagreement across different areas of conflict, global evaluations of the relationship, and frequency of sexual relations (cf. Dyadic Adjustment Scale, Spanier, 1976; Marital Adjustment Test, Locke & Wallace, 1959). Others have employed multidimensional approaches that distinguish among sources of distress. For example, dimensions of the Marital Satisfaction Inventory (MSI-R; Snyder & Aikman, 1999) include family of origin conflict, sexual satisfaction, and problemsolving communication. Other questionnaires include dimensions such as relationship expectations, emotional health, and personal stress management, as well as communication strategies and family of origin conflict (FOCCUS, Markey & Micheletto, 1997; Larson, Newell, Topham, & Nichols, 2002: PREPARE, Olsen, Fournier, & Druckman, 1996; RELATE, Busby, Holman, & Taniguchi, 2001). We contend that the multidimensional nature of these questionnaires represents an improvement over the omnibus measures that yield a single aggregated score for marital adjustment. However, the dimensions included in these newer questionnaires seem to confound predictors of dyadic functioning (e.g., family of origin conflict) with assessment of dyadic functioning (e.g., problem-solving communication) and, in some cases, with individual functioning (e.g., emotional health). Relationship satisfaction is often assessed with shorter, unidimensional measures of global sentiment toward one’s relationship (e.g., Kansas Marital Satisfaction Scale, Schumm et al., 1986; Quality of Marriage Index, Norton, 1983). Others have employed a semantic differential approach, a way of quantifying partners’ evaluations of their relationships by having them rate their perceptions on scales between two opposite adjectives (e.g., satisfied to dissatisfied, good to bad; Huston & Vangelisti, 1991; Osgood, Suci, & Tannenbaum, 1957). Still others have developed multidimensional approaches. For example, on the Positive and Negative Quality in Marriage Scale (PANQIMS; Fincham & Linfield, 1997), partners evaluate the positive and negative qualities of their partner and relationship, and are subsequently categorized as happy (high positive and low negative), distressed (low positive and high negative), ambivalent (high on both positive and negative), or indifferent (low on both positive and negative). In contrast to the wealth of attention paid to assessing relationship satisfaction and adjustment, far less attention has been paid to the assessment of relationship quality. Some dimensions of relationship quality have received a lot of attention, such as communication and conflict management processes. Others have received almost no attention, such as
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emotional intimacy or decision-making/interpersonal control processes. Still others have received attention in other disciplines but have not been integrated into couple research or therapy, such as investigations of the quality of a couple’s sexual relationship. Among the measures designed to assess relationship quality, several conceptual and methodological limitations hinder their utility. First, these measures are typically specific to one dimension such as conflict management, rather than capturing the multidimensional nature of relationship quality. Second, existing measures of relationship quality are often confounded with the constructs of satisfaction or adjustment. Specifically, these measures include items that tap into both relational processes and satisfaction.
Method of Assessment: Questionnaires, Behavioral Observations, and Clinical Interviews Couple researchers and clinicians have long used self-report questionnaires to quantify dyadic processes in basic research and to guide couple interventions. Unfortunately, selfreport questionnaires are vulnerable to biases including social desirability (Godoy et al., 2008; Kluemper, 2008), depressed mood and depressive cognitions (e.g., Cohen, Towbest, & Flocco, 1988; Raselli & Broderick, 2007), memory biases in retrospective reports (Karney & Frye, 2002), and cognitive dissonance (e.g., newlyweds may be more likely to present couple processes in a positive light because they have just gotten married and do not want to consider the possibility that their marriage already has difficulties; McNulty, O’Mara, & Karney, 2008; Miller, Niehuis, & Huston, 2006). Behavioral observation tasks were developed to deal with these problems, and our ability to understand couple processes across domains improved. However, observational methods are costly and time-consuming, and as such are less likely to be widely adopted by clinicians in the near future. Moreover, although standardized, psychometrically sound interaction protocols exist to assess couples’ transactions with established coding systems, there is no network at present that can readily and conveniently code these interactions and provide results in a timely manner. In sum, although an important methodological development in couple research methodology, behavioral observation tasks are unlikely to become standardized assessment tools for couple therapists. In addition to self-report questionnaires and behavioral observation tasks, clinical interviews are often used to gather information during an assessment. Outside of the close relationships field, The Structured Clinical Interview for the Diagnostic Statistical Manual (SCID; First et al., 1995), a standardized interview for assessing Axis I DSM disorders, is often used. The Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) is also routinely used by researchers studying attachment processes. There are several advantages to employing clinical interviews rather than behavioral observation data in couple research. First, clinical interviews allow the objective coder to consider partners’ perceptions when evaluating the relationship; however, the biases of selfreport are still omitted (e.g., Morrison & Hunt, 1996). Second, interviews allow for a more global perception of dyadic processes as opposed to behavioral observation data that provide a snapshot of a particular type of interaction. Third, once an interviewer is trained to reliability, administering and coding clinical interviews is typically faster and less expensive than coding behavioral observation data. Fourth, clinical interviews are more likely to be embraced by clinicians compared to behavioral observation methods. This latter advantage
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could have important implications for the future of couple assessment and intervention, including helping to facilitate a move toward the standardization of couple assessments, and bridging the gap between couple researchers and clinicians. (See Section 4 of this chapter for a detailed discussion of clinical implications.) There have been isolated efforts to develop and validate structured interviews for couple research and therapy. For example, the Structured Diagnostic Interview for Marital Distress and Partner Aggression (Heyman et al., 2001) allows researchers and clinicians to reliably and validly diagnose couples in terms of relationship distress and physical aggression. The content of the interview is similar to that of the Dyadic Adjustment Scale (Spanier, 1976) and the Conflict Tactics Scales (Straus et al., 1996), and the format is similar to that of the SCID. However, no interview exists to assess the construct of relationship quality. Therefore, as we describe in the next section, we sought to develop an interview-based approach to quantifying important dimensions of relationship quality.
SECTION 2: DIMENSIONS OF RELATIONSHIP QUALITY AND THE RELATIONSHIP QUALITY INTERVIEW As we began to develop our interview, we sought to be comprehensive in our examination of the dimensions of relationship quality that would influence the longitudinal course of relationship satisfaction and stability. Therefore, we first conducted an exhaustive review of the close relationships literature across multiple disciplines (e.g., social and clinical psychology, communication studies, family studies, sociology). In this section, we summarize our review and describe how it guided the development of the interview.
Dimensions of Relationship Quality The overwhelming majority of research in the close relationships field has been focused on the quality of a couple’s ability to solve problems and conflicts. Theories of intimate relationships and of the determinants of relationship outcomes (e.g., Christensen & Walczynski, 1997; Gottman, Swanson, & Murray, 1999), a great deal of the empirical research on intimate relationships, most observational research on intimate relationships, reviews on dyadic interactions (e.g., Karney & Bradbury, 1995; Weiss & Heyman, 1997), and most existing psychological interventions for couple distress (e.g., Behavioral Marital Therapy; Jacobson & Holtzworth-Munroe, 1986; Prevention and Relationship Enhancement Program; Floyd, Markman, Kelly, Blumberg, & Stanley, 1995) have targeted relationship conflict. Within the last decade or so, there has been a tremendous increase in attention to the role of partner support as an adaptive dyadic skill (e.g., Gable, Gonzaga, & Strachman, 2006; Neff & Karney, 2005; Pasch & Bradbury, 1998). Other researchers have focused specifically on emotional intimacy (e.g., Barnes & Sternberg, 1997; Barry, Lawrence, & Langer, 2008; Cordova, Gee, & Warren, 2005; Laurenceau et al., 2005), the quality of a couple’s sexual relationship (e.g., Henderson-King & Veroff, 1994; LoPiccolo, Heiman, Hogan, & Roberts, 1985), and respect or control (e.g., Gray-Little & Burks, 1983; Ehrensaft, Langhinrichsen-
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Rohling, Heyman, & Lawrence, 1999; Huston, 1983; Whisman & Jacobson, 1990). (See Lawrence et al., 2008 for a detailed review of the literature.) Across these studies of relationship quality, researchers typically examine only one or two domains of dyadic processes per sample, which presumably grossly underestimates the complexity of relationship quality. Moreover, many of these studies did not statistically examine sex differences in relationship quality, which may lead to an incomplete, skewed, or inaccurate conceptualization of intimate relationships and, consequently, to interventions that are limited in their effectiveness. This literature has also suffered from methodological limitations, including measurement issues (such as the use of self-report measures of relational behaviors that may be influenced by social desirability and cognitive dissonance, particularly among couples in new relationships), shared method variance, retrospective data, heterogeneous samples and cross-sectional designs. Consequently, we sought to begin to overcome these limitations and provide a novel way to assess the dimensions of relationship quality.
Dimensions of Relationship Quality Included in the Relationship Quality Interview (RQI) Based on our review, we identified five dimensions of relationship quality: (1) communication and conflict management, (2) inter-partner support, (3) emotional closeness and intimacy, (4) quality of the sexual relationship, and (5) respect, power, and control. We operationalized communication and conflict management as comprising frequency and length of arguments, verbal, psychological and physical aggression during arguments, withdrawal during arguments, emotions experienced and behaviors expressed before, during and after arguments, and conflict resolution strategies. In accord with Cutrona and colleagues’ work (e.g., Cutrona, Russell, & Gardner, 2005), inter-partner support was operationalized as comprising four types of support when one partner has had a bad day, is feeling down, or has a problem: emotional support (talking and listening to each other, holding hands, hugging, letting one’s partner know s/he understands), direct or indirect tangible support (direct support: helping one’s partner solve the problem or make the situation better; indirect support: providing time or resources so that one’s partner is better able to solve the problem him- or herself, e.g., providing childcare), informational support (giving advice, providing one’s partner with information, helping one’s partner think about a problem in a new way), and esteem support (expressing confidence in the partner’s ability to handle things, telling one’s partner s/he is not to blame for a problem). Match between types of support desired and types of support provided, and the extent to which support is offered in a positive or negative manner, are also assessed. Emotional closeness and intimacy was operationalized as comprising emotional closeness (an overall mutual sense of closeness, warmth, affection, and interdependence), quality of the couple’s friendship, and demonstrations of love and affection (quantity and quality of love and affection expressed in the relationship, including verbal and physical expressions of love). We operationalized quality of the sexual relationship as comprising the quality of the sexual relationship (frequency of sexual activity, symmetry in initiation of sexual activity, satisfaction, negative emotions, sexual difficulties, concerns) and sensuality (touching, hugging, cuddling, massage, the extent to which sensuality exists separate from sexual activity in the relationship). Finally, respect, power, and control was
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operationalized as comprising mutual acknowledgement of competence and independence; acceptance and positive regard for the other even when one disagrees with him or her, a/symmetry in decision-making across a variety of areas, partners’ satisfaction with that division of responsibility, and a couple’s ability to negotiate control across a variety of areas (e.g., scheduling one’s own day, controlling money).
The Relationship Quality Interview (RQI) Once we converged upon and operationalized our dimensions of relationship quality, we generated a pool of potential items. A team of six psychology pre-doctoral and doctoral students specializing in couple relationships sorted the items into the different relationship categories. Items were deleted if there was less than 80% agreement among raters on their classification. Next we conducted three pilot studies in which we administered the interview to dating, cohabiting, and married couples; the RQI was revised after each pilot study. The final version of the RQI is described herein. The RQI is a 60-minute semi-structured interview administered indvidually to each partner. After obtaining information on relationship history, participants are asked to describe the quality of their relationship across the five different dimensions over the past six months. Open-ended questions -- followed by a series of closed-ended questions -- are asked to allow novel contextual information to be obtained. During the individual’s description of each dimension of relationship quality, the interviewers probe using detailed behavioral indicators and exemplars of each area. Participants’ responses also guide decisions about which subsequent questions are asked. Interviewers independently rate the relationship on each domain. Ratings may range from 1-5 and scores of .5 (e.g., 3.5) are permissible. We use objective interviewer ratings to control for the possibility that self-reports of relationship functioning might be influenced by factors such as global relationship satisfaction, depression or social desirability. The use of objective ratings also allows us to control for the possibility that couples in the early stages of a relationship (e.g., dating for only a few months, newly married) might experience cognitive dissonance when discussing potential weaknesses or problems in their relationships, which might influence their selfreports of the quality of their relationship.
SECTION 3: RELIABILITY AND VALIDITY OF THE RELATIONSHIP QUALITY INTERVIEW (RQI) In this section we provide preliminary evidence for the reliability and validity of the RQI in dating and newlywed couples. First, we assessed reliability, convergent validity, and divergent validity. Second, we examined the generalizability of the RQI across dating and marital relationships and across men and women. Third, we examined the utility of the RQI to assess risk of relationship distress over and above existing self-report measures and behavioral observation methods. (Please see Lawrence et al., 2008 for a detailed presentation of these analyses.)
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Samples Recruited to Assess Reliability and Validity of the RQI Sample 1 comprised 101 married couples recruited through marriage license records from suburban communities and small towns in Iowa. Couples dated an average of 48 months (SD = 27.79) prior to marriage and 77% of them cohabited. Average estimated annual joint income of couples was between $30,001- $40,000. Husbands’ average age was 25.91 (SD = 3.09) and their modal years of education were 14 years. Wives’ average age was 24.5 (SD = 3.46) and their modal years of education were also 14 years. For 15% of the couples, at least one member of the couple identified him or herself as a member of an ethnic minority group. Sample 2 comprised 91 individuals in heterosexual romantic relationships lasting at least two months. Participants were enrolled in an introductory psychology course at The University of Iowa. They ranged in age from 18 to 27 (M = 18.27 years, SD = 1.03 years) and were predominantly Caucasian/Non-Hispanic (96.7%). Most participants defined their relationships as “seriously dating” (96%). Only 1.1% were cohabiting, and relationship duration ranged from 2 months to 5 years (M = 17.16 months, SD = 13.26). On a 1-5 scale, interviewers’ mean ratings ranged from 3.35 to 4.20 across the two samples and across all five RQI scales. On average, couples’ relationship quality ranged from “good” to “very good,” as expected in samples of dating or newlywed couples. Moreover, scores on all domains yielded normal distributions, suggesting that there was adequate range in relationship quality across participants in each of the five domains.
Reliability Analyses We examined the reliability of the RQI in three ways. First, to assess inter-rater reliability, 20% of the audio-taped interviews were randomly assigned to a second coder. Intra-class correlations were above .70 across all five RQI scales for husbands’ and wives’ interviews in the marital sample and for participants in the dating sample. Second, we examined whether interviewers’ ratings on the RQI scales differed as a function of whether the interviewer was speaking to the husband or the wife of a given couple. There were no significant differences among interviewer ratings based on whether the male or female partner was interviewed (ts(100) ranged from .51 to 1.17, all ns). Third, we examined within-subject associations among RQI scales. Correlations among RQI subscales ranged from .25 to .65, supporting our contention that the subscales are best conceptualized as related dimensions of the underlying construct of relationship quality, yet these subscales capture conceptually distinct (albeit related) dimensions of relationship quality. (There was one exception to this pattern: in the marital sample, Inter-Partner Support and Respect, Power, and Control were strongly correlated, with correlations of .65 and .70 for husbands and wives, respectively.)
Agreement with Self-Report Questionnaires and Behavioral Observations We examined the extent to which RQI interview scales correlated with existing measures -- self-report questionnaires and behavioral observations -- of these same relationship dimensions. We expected correlations between RQI scales and self-report questionnaires, and between RQI scales and behaviorally observed data, to generally be low for two reasons.
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First, our assertion is that the RQI interview provides a more valid measure of relationship quality in each of the assessed domains. Thus we did not operationalize our constructs in the same way as they were operationalized in the existing measures. Second, the RQI is the first interview of relationship quality. Therefore, we cannot examine convergent validity of the RQI by comparing it to an existing interview. Instead we are comparing RQI scales to measures of similar constructs assessed with different methods. This method variance is expected to generate lower correlations than if our method was the same but our constructs differed. First we examined the correlations between the RQI subscales and self-report measures of relationship quality in the relevant domains. Self-report measures included: (a) the Problem Solving Communication (PSC) and Affective Communication (AFC) subscales from The Marital Satisfaction Inventory-Revised (MSI-R; Snyder & Aikman, 1999) to measure negative communication and conflict management patterns, and (b) a modified version of The Support in Intimate Relationships Rating Scale (SIRRS; Dehle et al., 2001) to assess perceptions of support amount from one’s partner and support adequacy (see Barry et al., in press for details and psychometric properties of the revised SIRRS). The RQI scales were weakly to moderately correlated with the self-report questionnaires. Correlations ranged from .24 to .56 in the marital sample, and from .03 to .23 in the dating sample. Next we examined the correlations between the RQI subscales and behavioral observations of relationship quality in the relevant domains. (Behavioral observation data were only available in the marital sample.) Behavioral observation indices of relationship quality included: (a) an inter-partner support interaction task and the Social Support Interaction Coding System (SSICS; Pasch, Harris, Sullivan, & Bradbury, 2002), a system that assesses the behaviors exchanged by partners during a supportive discussion, and (b) a problem-solving interaction task and the Specific Affect Coding System – Revised (SPAFFR; Gottman McCoy, & Coan, 1996), designed to measure positive and negative affect expressed during a problem-solving discussion. Correlations between RQI scales and behavioral observations of related constructs were weak, ranging from .05 to .25, supporting our contention that the RQI captures markedly distinct constructs from what is captured via behavioral observation interaction tasks.
Discriminant Validity Three aspects of discriminant validity were considered. First, Campbell and Fiske (1959) stated that a good convergent/discriminant validity pattern exists when matched variables correlate more highly with each other than with any other variable. Thus we examined whether the inter-correlations among RQI scales were higher than the correlations between RQI scales and measures of similar constructs collected via different methods. In general, this target pattern was clearly obtained for all five RQI scales in both samples. For each RQI scale, the correlations with other RQI scales (convergent validity) were generally larger than correlations with questionnaire or behavioral observation data. This support was evident for husbands and wives, and across marital and dating participants. Three of the four RQI Scales – Emotional Closeness and Intimacy, Inter-Partner Support, and Respect, Power, and Control – clearly met the Campbell and Fiske test for excellent convergent and discriminant validity. In contrast, there was mixed but generally strong evidence regarding the RQI Communication
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and Conflict Management Scale. The scale did not meet Campbell and Fiske’s criteria when compared to self-report questionnaires in the dating sample, nor when compared to behavioral observation data in the marital sample. Moreover, the RQI Communication and Conflict Management Scale was only moderately correlated with the corresponding self-report questionnaires. However, this moderate correlation was similar to the moderate correlations between the RQI Communication and Conflict Management scale and the other RQI scales (which range from .40 to .63); thus, it does meet the Campbell and Fiske criteria in that regard. Second, we examined associations between RQI scales and a measure of global relationship satisfaction (Quality of Marriage Index; Norton, 1983) to determine whether the RQI simply captures satisfaction rather than relationship quality across multiple domains. Correlations were low to moderate for husbands and wives (rs ranged from .35 to .46) and low for dating participants (rs ranged from .002 to .22), supporting our contention that the RQI is not simply a measure of global relationship satisfaction. Third, the associations between the RQI scales and related traits were examined to determine whether RQI scores discriminated between (a) functioning within one’s relationship on a given dimension and (b) individual differences in interpersonal functioning across relationships. For example, we compared the Emotional Closeness and Intimacy scale to measures of global detachment, mistrust, and avoidant attachment. We measured individual differences by administering: (a) the Negative Temperament, Detachment, Mistrust, and Manipulativeness scales from The Schedule for Nonadaptive and Adaptive Personality - 2nd Edition (SNAP-2; Clark, Simms, Wu, & Casillas, in press); (b) the Anger and Hostility Scales from The Buss-Perry Aggression Questionnaire (Buss & Perry, 1992); and the Relationship Scales Questionnaire (RSQ; Griffin & Bartholomew, 1994) and the Experiences in Close Relationships – Revised scale (ECR-R; Fraley, Waller, & Brennan, 2000). Correlations between RQI subscales and individual difference measures of related constructs (e.g., avoidant attachment, mistrust, detachment, negative temperament, hostility) were weak, ranging from .004 to .3 (with one exception at .5), supporting our contention that the RQI scales capture constructs that are unique to one’s current intimate relationship rather than being indicative of individual differences that might be present across multiple types of relationships (e.g., friends, acquaintances, co-workers).
Incremental Validity Analyses Finally, we gathered preliminary evidence for the utility of the RQI to assess risk of relationship distress over and above existing self-report measures and behavioral observation methods. In addition to our assertions that (a) a clinical interview will be more user-friendly for clinicians, and (b) our interview provides a better measure of the constructs of interest (compared to existing self-report questionnaires and behavioral observational data), we also expected the RQI scales to predict global relationship satisfaction over and above these existing measures. We examined the incremental utility of each RQI scale when predicting cross-sectional and longitudinal (three-year) satisfaction for men and women. First we examined the incremental utility of the RQI in explaining cross-sectional relationship satisfaction. In the marital sample, three of the four RQI scales – Emotional Closeness and Intimacy, Inter-partner Support, and Respect, Power, and Control –
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demonstrated incremental explanatory power (bs > 1.44, ps < .05). In the dating sample, two scales -- Emotional Closeness and Intimacy, and Communication and Conflict Management -demonstrated incremental predictive power (bs > .25, ps < .05). Next we examined the RQI’s incremental utility in predicting longitudinal (3-year) relationship satisfaction in the marital sample. Two of the four RQI scales – Emotional Closeness and Intimacy and Respect, Power, and Control – demonstrated incremental utility in predicting husbands’ – but not wives’ – longitudinal marital satisfaction (bs > 2.46, ps < .05).
SECTION 4: CLINICAL IMPLICATIONS OF THE RQI FOR COUPLE ASSESSMENT AND PREVENTION EFFORTS In this section we discuss clinical implications at two levels. First, we discuss the generalizability of the RQI itself based on the data presented in Section 3. Second, we discuss the broader clinical implications of the RQI for improving couple assessment and prevention efforts.
Generalizability of the RQI We examined the generalizability of the RQI in two ways. First we examined its generalizability across men and women. The RQI yielded strong psychometric data for men and women. Second, we found that the RQI demonstrated reliability, validity, and incremental utility across dating and marital relationships. As the proportion of couples who cohabit and/or date for many years prior to marriage increases, greater attention is being given to the study of pre-marital relationships (e.g., Brown & Booth, 1996; Stanley, Rhoades, & Markman, 2006). Additionally, it has been suggested that patterns that develop early in relationships (i.e., even before marriage) are important for individual and dyadic outcomes (Cutrona et al., 2005). Thus, patterns of relationship quality that emerge during courtship likely impact individual and relationship functioning. Despite this potential importance, little work has addressed whether relationship quality functions similarly in dating and marital relationships. As expected, the pattern of findings was stronger in the analyses of the marital sample compared to the dating sample. The longer duration and stronger commitment of the married participants would presumably lead to greater utility of the RQI in such a sample. The next step is to examine the psychometric properties of the RQI in distressed samples of couples, such as in a sample of couples seeking therapy. We would expect the pattern of results to be similar, if not stronger, to those found in the marital sample. More generally, as the intimate relationship becomes more solidified and more central to one’s life, we would expect the RQI to have greater utility and for the interview to demonstrate stronger convergent and divergent validity when administered. There are several ways in which the generalizability of the RQI can be expanded in future research. First, although the RQI was developed as an assessment tool for young couples and to be administered in accord with prevention programs, it seems just as likely that it could be used as part of a standardized assessment protocol for treatment-seeking and/or distressed couples and to guide treatment for those couples. Before we can recommend that the RQI be
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used in this way, we must first assess the reliability and validity of the RQI in distressed, established, and/or treatment-seeking couples. Second, the reliability and validity of the RQI should be examined with same-sex couples and couples at other stages of their relationships (e.g., cohabiting couples, engaged couples, couples experiencing the transition to parenthood). Finally, other dimensions of relationship quality might be worth incorporating more fully into the RQI, such as fun and leisure time and quality of the couple’s friendship.
Implications for Couple Assessment and Prevention Efforts There are several implications of the RQI for couple assessment and intervention efforts. First, the RQI is intended to be used as part of a standardized assessment battery for couple interventions. For example, it can be administered to couples and then incorporated into a feedback session in which relationship strengths/protective factors and relationship risk factors/vulnerabilities are emphasized. By quantifying relative strengths and weaknesses across multiple dimensions of a relationship, feedback may be more palatable to couples. Second, the RQI might function as a motivational tool to increase couples’ participation in prevention programs or treatments. Cordova and colleagues (Cordova et al., 2005; Gee, Scott, Castellani, & Cordova, 2002) developed an indicated intervention program called the Marriage Checkup based on the principles of motivational interviewing. As they describe, prior to dissolution, it is likely that couples that become severely distressed first pass through an at-risk stage in which they experience early symptoms of marital deterioration but have not yet suffered irreversible damage to their marriage. It is during this at risk stage that couples might benefit most from early intervention. To date, they have found evidence for the attractiveness, tolerability, efficacy, and mechanisms of change produced by the Marriage Checkup, as well as its ability to predict marital satisfaction two years later. In line with this important work, it is possible that the RQI could be modified and tested as a motivational interview for at risk couples as well. Third, because the RQI can be used to identify domains of strength and weakness in couples’ relationships, it might be useful as a tool to identify at risk couples for prevention programs. To date, studies of leading preventive interventions have not fared well at recruiting couples at risk for adverse marital outcomes. Published samples have been disproportionately Caucasian, well educated, and middle class (see Carroll & Doherty, 2003, for a review). However, divorce rates are markedly higher among African American couples (70% vs. 47% in Caucasian couples), among couples who do not finish high school (60% vs. 36% for college graduates), and among couples who start marriage with children (rates of divorce are twice as high as couples who marry without children; Raley & Bumpass, 2003). Despite their omission from prevention programs, couples in these high-risk populations report high levels of interest in participating in these interventions (Johnson et al., 2002). In sum, relationship enhancing interventions appear to have failed to test their programs in the populations at greatest risk for distress and divorce. Administering the RQI prior to implementing a prevention program might allow at risk couples to be identified, while simultaneously being used as a motivational tool to encourage these at risk couples to participate in these prevention interventions. Fourth, intervention programs can be better tailored to the needs of specific couples, rather than implementing a “one size fits all” approach. For example, a couple’s RQI data
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may indicate strong quality of communication and conflict management skills but poor quality of inter-partner support. In this case, intervention techniques specific to improving the quality of support in that relationship would presumably be more appropriate, whereas intervention techniques targeting conflict management skills would be unnecessary. This approach seems more beneficial for treating couples and more cost-effective from a health care perspective.
REFERENCES Barry, R.A., Bunde, M., Brock, R.L., & Lawrence, E. (in press). Validity and utility of a multidimensional model of received support in intimate relationships. Journal of Family Psychology. Barry, R.A., Lawrence, E., & Langer, A. (2008). Conceptualization and assessment of disengagement in romantic relationships. Personal Relationships, 15, 297-315. Brown, S. L., & Booth, A. (1996). Cohabitation versus marriage: A comparison of relationship quality. Journal of Marriage and Family, 58, 668-678. Busby, D.M., Holman, T.B., Taniguchi, N. (2001). RELATE: Relationship evaluation of the individual, family, cultural, and couple contexts. Family Relations, 50, 308-316. Buss, A. H., & Perry, M. P. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452-459. Campbell, D.T., & Fiske, D.W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56, 81-105. Carroll, J.S., & Doherty, W.J. (2003). Evaluating the effectiveness of premarital prevention programs: A meta-analytic review of outcome research. Family Relations, 52, 105-118. Christensen, A., & Walczynski, P. T. (1997). Conflict and satisfaction in couples. In R. J. Sternberg & M. Hojjat (Eds.), Satisfaction in close relationships (pp. 249–274). NY: Guilford. Clark, L. (1993). Manual for the Schedule for Nonadaptive and Adaptive Personality. MN: University of Minnesota Press. Clark, L.A., Simms, L.J., Wu, K.D., & Casillas, A. (in press). Schedule for Nonadaptive and Adaptive Personality (2nd ed.). MN: University of Minnesota. Cohen, L.H., Towbes, L.C., & Flocco, R. (1988). Effects of induced mood on self-reported life events and perceived and received social support. Journal of Personality and Social Psychology, 55, 669-674. Cordova, J. V., Gee, C. B., Warren, L. Z. (2005). Emotional skillfulness in marriage: Intimacy as a mediator of the relationship between emotional skillfulness and marital satisfaction. Journal of Social and Clinical Psychology, 24, 218-235. Cutrona, C.E., Russell, D.W., & Gardner, K.A. (2005). The relationship enhancement model of social support. In T.A. Revenson, K. Kayser & G. Bodenmann (Eds.), Couples coping with stress (pp. 3-23). DC: APA. Cutrona, C.E., & Suhr, J.A. (1992). Controllability of stressful events and satisfaction with spouse support behaviors. Communication Research, 19, 154-174. Cutrona, C.E., & Suhr, J.A. (1994). Social support communication in the context of marriage: An analysis of couples’ supportive interactions. In B.R. Burleson, T.L. Albrecht & I.G.
186
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
Sarason (Eds.), Communication of social support: Messages, interactions, relationships, and community (pp. 113-135). CA: Sage. Dehle, C., Larsen, D., & Landers, J.E. (2001). Social support in marriage. American Journal of Family Therapy, 29, 307–324. Ehrensaft, M.K., Langhinrichsen-Rohling, J., Heyman, R.E., O’Leary, K.D., & Lawrence, E. (1999). Feeling controlled in marriage: A phenomenon specific to physically aggressive couples? Journal of Family Psychology, 13, 20-32. Fincham, F.D., & Linfield, K.J. (1997). A new look at marital quality: Can spouses feel positive and negative about their marriage? Journal of Family Psychology, 11, 489-502. First, M.B., Gibbon, M., Spitzer, R.L., & Williams, J.B.W. (1997). Structured Clinical Interview for DSM–IV Axis I Disorders—Clinician version. Washington, DC: American Psychiatric Association. Floyd, F.J., Markman, H.J., Kelly, S., Blumberg, S.L., & Stanley, S.M. (1995). Preventive intervention and relationship enhancement. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of couple therapy (pp. 212-226). NY: Guilford. Fraley, R.C., Waller, N.G., & Brennan, K.A. (2000). An item response theory analysis of selfreport measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365. Gable, S.L., Gonzaga, G.C., & Strachman, A. (2006). Will you be there for me when things go right? Supportive responses to positive event disclosures. Journal of Personality and Social Psychology, 91, 904-917. Gee, C.B., Scott, R.L., Castellani, A.M., & Cordova, J.V. (2002). Predicting 2-year marital satisfaction from partners’ discussion of their marriage checkup. Journal of Marital and Family Therapy, 28, 399-407. Geiss, S., & O’Leary, K. (1981). Therapist ratings of frequency and severity of marital problems: Implications for research. Journal of Marital & Family Therapy, 7, 515-520. George, C., Kaplan, N., & Main, M. (1985). The Berkeley adult attachment interview. Unpublished protocol. University of California, Berkeley. Godoy, R., Reyes-Garcia, V., Tanner, S., Leonard, W.R., McDade, T.W., & Huanca, T. (2008). Can we trust an adult's estimate of parental school attainment? Disentangling social desirability bias and random measurement error. Field Methods, 20, 26-45. Gottman, J., McCoy, K., & Coan J. (1996). The Specific Affect Coding System. In J. Gottman (Ed.) What predicts divorce? The measures (pp. 561). NJ: Erlbaum. Gottman, J.M., Swanson, C., & Murray, J. (1999). The mathematics of marital conflict: Dynamic mathematical nonlinear modeling of newlywed marital interaction. Journal of Family Psychology, 13, 3-19. Gray-Little, B., & Burks, N. (1983). Power and satisfaction in marriage: A review and critique. Psychological Bulletin, 93, 513– 538. Griffin, D.W., & Bartholomew, K. (1994). The metaphysics of measurement: The case of adult attachment. In K. Bartholomew & D. Perlman (Eds.), Attachment processes in adulthood: Henderson-King, D.H., & Veroff, J. (1994). Sexual satisfaction and marital well-being in the first years of marriages. Journal of Social and Personal Relationships, 11, 509–534. Heyman, R.E., Feldbau-Kohn, S.R., Ehrensaft, M.K., Langhinrichsen-Rohling, J., & O’Leary, K.D. (2001). Can questionnaire reports correctly classify relationship distress and partner physical abuse? Journal of Family Psychology, 15, 334–346.
Assessing Relationship Quality
187
Heyman, R.E., Sayers, S.L., & Bellack. A.S. (1994). Global marital satisfaction versus marital adjustment: An empirical comparison of three measures. Journal of Family Psychology, 8, 432-446. Huston, T.L. (1983). Power. In H.H. Kelley, E. Berscheid, A. Christensen, J.H. Harvey, T.L. Huston, G. Levinger, E. McClintock, L.A. Peplau, & D.R. Peterson (Eds.), Close relationships (pp. 169-219). NY: Freeman. Huston, T.L., & Vangelisti, A.L. (1991). Socioemotional behavior and satisfaction in marital relationships: A longitudinal study. Journal of Personality and Social Psychology, 61, 721-733. Jacobson, N.S., & Holtzworth-Munroe, A. (1986). Marital therapy: A social learning/ cognitive perspective. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of marital therapy (pp. 29-70). NY: Guilford. Karney, B. R., & Bradbury, T. N. (1995). The longitudinal course of marital quality and stability: A review of theory, method, and research. Psychological Bulletin, 118, 3-34. Karney, B.R., & Frye, N.E. (2002). "But we've been getting better lately": Comparing prospective and retrospective views of relationship development. Journal of Personality and Social Psychology, 82, 222-238. Kluemper, D.H. (2008). Trait emotional intelligence: The impact of core-self evaluations and social desirability. Personality and Individual Differences, 44, 1402-1412. Kurdek, L. A. (2002). On being insecure about the assessment of attachment styles. Journal of Social and Personal Relationships, 19, 811-834. Larson, J.H., Newell, K., Topham, G., & Nichols, S. (2002). A review of three comprehensive premarital assessment questionnaires. Journal of Marital and Family Therapy, 28, 233-239. Laurenceau, J., Barrett, L.F., & Rovine, M.J. (2005). The interpersonal process model of intimacy in marriage: A daily-diary and multilevel modeling approach. Journal of Family Psychology, 19, 314-323. Lawrence, E., Barry, R.A., Brock, R.L., & Langer, A. (in press). Assessment of marital satisfaction. In H. Reis & S. Sprecher (Eds.), Encyclopedia of Human Relationships. Thousand Oaks, CA: Sage. Lawrence, E., Barry, R.A., Brock, R.L., Bunde, M., Ro, E., Fazio, E., Mulryan, L., Hunt, S., Madsen, L., & Dzankovic, S. (2008). An interview to assess couple functioning across multiple domains: Preliminary support for reliability, convergent and divergent validity, and incremental and predictive validity. Manuscript submitted for publication. Locke, H.J., & Wallace, K.M. (1959). Short marital adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21, 251–255. LoPiccolo, J., Heiman, J.R., Hogan, D.R., & Roberts, C.W. (1985). Effectiveness of single therapists versus cotherapy teams in sex therapy. Journal of Consulting and Clinical Psychology, 53, 287-294. Markey, B., & Micheletto, M. (1997). Instructor manual for FOCCUS. Omaha, NE: Archdiocese of Omaha. McNulty, J.K., O'Mara, E.M., & Karney, B.R. (2008). Benevolent cognitions as a strategy of relationship maintenance: "Don't sweat the small stuff"....But it is not all small stuff. Journal of Personality and Social Psychology, 94, 631-646. Miller, P.J. E., Niehuis, S., & Huston, T.L. (2006). Positive illusions in marital relationships: A 13-year longitudinal study. Personality and Social Psychology Bulletin, 32, 1579-1594.
188
Erika Lawrence, Robin A. Barry, Rebecca L. Brock et al.
Morrison, A.T., & Hunt, H.T. (1996). "Reals", "roles", and demand features: A critical look at interview versus questionnaire measures of subjective states. Canadian Psychology, 37, 112-119. Neff, L.A., & Karney, B.R. (2005). Gender differences in social support: A question of skills or responsiveness? Journal of Personality and Social Psychology, 88, 79-90. Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of Marriage and the Family, 45, 141-151. Olsen, D. H., Fournier, D. H., & Druckman, J. M. ( 1996). PREPARE. Minneapolis, MN: Life Innovations. Osgood, C.E., Suci, G.J., & Tannenbaum, P.H. (1957). The measurement of meaning. Urbana, IL: University of Illinois Press. Pasch, L.A., & Bradbury, T.N. (1998). Social support, conflict, and the development of marital dysfunction. Journal of Consulting and Clinical Psychology, 66, 219-230. Pasch, L.A., Harris, K.M., Sullivan, K.T., & Bradbury, T.N. (2002). The social support interaction coding system. In P. Kerig & D. Baucom (Eds.), Couple observational coding systems. Mahwah, NJ: Lawrence Erlbaum & Associates. Prescott, A., Bank, L., Reid, J. B., Knutson, J. F., Burraston, B. O., & Eddy, J. M. (2000). The veridicality of retrospective reports of punitive childhood experiences. Child Abuse and Neglect, 24, 411-423. Raley, R.K. (2003). The topography of the divorce plateau: Levels and trends in union stability in the United States after 1980. Demographic Research, 8, 245-260. Raselli, C., & Broderick, J.E. (2007). The association of depression and neuroticism with pain reports: A comparison of momentary and recalled pain assessment. Journal of Psychosomatic Research, 62, 313-320. Reynolds, S. K., & Clark, L. A. (2001). Predicting personality disorder dimensions from domains and facets of the five factor model. Journal of Personality, 69, 199–222. Schramm, D.G., Marshall, J.P. Harris, V.W., & Lee, T.R. (2005). After "I do": The newlywed transition. Marriage and Family Review, 38, 45-67. Schumm, W.R., Paff-Bergen, L.A., Hatch, R.C., Obiorah, F.C., Copeland, J.M., Meens, L.D., & Bugaighis, M.A. (1986). Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage and the Family, 48, 381–387. Simpson, J.A., Rholes, W.S., & Nelligan, J.S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434-446. Snyder, D.K., & Aikman, G.G. (1999). Marital Satisfaction Inventory-Revised. In M.E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment. (2nd ed., pp. 1173-1210). Mahwah, NJ: Erlbaum. Snyder, D.K., Heyman, R.E., & Haynes, S.N. (2005). Evidence-based approaches to assessing couple distress. Psychological Assessment, 17, 288-307. Spanier, G.B. (1979). The measurement of marital quality. Journal of Sex and Marital Therapy, 5, 288-300. Stanley, S.M., Rhoades, G.H., & Markman, H.J. (2006). Sliding vs. deciding: Inertia and the premarital cohabitation effect. Family Relations, 55, 499-509. Straus, M., Hamby, S., Boney-McCoy, & Sugarman, D. (1996). Revised Conflict Tactics Scales: Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.
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US Census Bureau Population Division (2007) Race and Hispanic or Latino origin in Iowa’s counties: 2006. Weiss, R.L., & Heyman, R.E. (1990). Marital distress. In A.S. Bellack, M. Hersen, & A.E. Kazdin (Eds.), International handbook of behavior modification and therapy (2nd ed.; pp. 475-501). NY: Plenum. Whisman, M.A., & Jacobson, N.S. (1990). Power, marital satisfaction, and response to marital therapy. Journal of Family Psychology, 4, 202-212. Xu, Y., & Burleson, B.R. (2001). Effects of sex, culture, and support type on perceptions of spousal social support: An assessment of the “support gap” hypothesis in early marriage. Human Communication Research, 27, 535-566.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 9
THE TENDENCY TO FORGIVE IN PREMARITAL COUPLES: RECIPROCATING THE PARTNER OR REPRODUCING PARENTAL DISPOSITIONS? F. Giorgia Paleari University of Bergamo, Italy
Silvia Donato, Raffaella Iafrate and Camillo Regalia Catholic University of Milan, Italy
ABSTRACT Although the tendency to forgive the partner has been shown to enhance personal and relational well-being, little is known about how this tendency originates. One possibility is that the tendency to forgive the partner develops as a function of the forgiveness exchanges people experience within their romantic relationships, thereby leading them to become more and more similar to the partner in their proneness to forgive. Another possible explanation is that social experiences people were exposed to within their own family of origin has led them to gradually internalize parental models and to become more and more similar to their parents in their willingness to forgive. These associations may be particularly evident during emerging adulthood, when engaged couples have to balance their family heritage and the forming of their new couple. The present work aimed at providing initial evidence in support of these hypotheses by investigating in a sample of premarital couples (N=165) and their parents the extent to which young adults’ tendency to forgive the partner was similar to the partner’s tendency to forgive them as well as to their mothers’ and fathers’ tendency to forgive one another. Dyads were the units of analysis and stereotype accuracy was controlled. Results indicate that young adults’ disposition to forgive the partner is similar to that of their partner and of their parents. Gender moderated these associations, as females were more similar to their parents than were males in their disposition to forgive. The findings are consistent with the idea that premarital couples, even though strongly involved in defining their own couple identity, are nonetheless affected by the forgiveness models to which they are exposed within their family of origin.
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INTRODUCTION Within the literature on close relationships, a body of evidence attests that forgiving a romantic partner has potential benefits for the well-being of the relationship and of the victim. In particular, there is evidence that in community couples forgiving the partner reduces psychological aggression, enhances intimacy and commitment in the relationship, promotes constructive communication, and has a positive influence on marital quality over time (Eaton & Struthers, 2006; Fincham & Beach, 2002, 2007; Paleari, Regalia & Fincham, 2005; Tsang, McCullough, & Fincham, 2006). Forgiveness toward the partner has also proven to enhance the victim’s overall mental and physical health (Berry & Worthington, 2001; Karremans, Van Lange, Ouwerkerk, & Kluwer, 2003; see also, Bono, McCullough, & Root, 2008), thereby helping the individual to maintain and restore a valuable close relationship, crucial to the victim’s human need of connectedness. Considering the great amount of attention that has been devoted to partner forgiveness as a predictor of relational and personal well-being, surprisingly little is known about how the tendency to forgive the partner originates. The purpose of the present research is to fill this gap in the literature, focusing particularly on the degree to which the tendency to forgive emerges from an individual’s relationship with an intimate partner and from his or her experiences in the family of origin. The tendency to forgive the partner can be defined as a general propensity to overcome avoidant, resentful or revengeful reactions (i.e., thoughts, feelings, intentions, and behaviors), and to develop benevolent and conciliatory ones, when facing the partner’s offences (e.g., Fincham, Hall, & Beach, 2005; Rye, Loiacono, Folck, Olszewski, Heim, & Madia, 2001; McCullough, Pargament, & Thoresen, 2000). Empirical support for this notion has been found by studies showing that the tendency to forgive the partner entails two correlated dimensions, a positive one, reflecting benevolent and conciliatory dispositions, and a negative one, involving resentful, vengeful, and/or avoidant inclinations (Fincham & Beach, 2002). Evidence of one single factor underlying the two dimensions has also recently been found (Maio, Thomas, Fincham, & Carnelley, 2008). The tendency to forgive the partner is more general than specific acts of forgiveness as it is assumed to be stable across multiple offences occurring within a romantic relationship. At the same time the tendency to forgive the partner is more specific than “forgivingness” (Berry, Worthington, Parrott, O’Connor, & Wade, 2001). Forgivingness is understood as the global disposition to forgive across multiple offences occurring in a variety of relationships and interpersonal situations, thus serving as a basis for more specific responses of forgiveness (Roberts, 1995), whereas the tendency to forgive the partner is linked more tightly to the particular history with the romantic partner (see also McCullough & Witvliet, 2002; Kachadourian, Fincham, & Davila, 2004). The tendency to forgive the partner and “forgivingness” have been shown to be related to personality dimensions such as trait empathy, emotional stability and agreeableness (McCullough & Witvliet, 2002; Mullet, Neto, & Rivière, 2005; Maio et al., 2008) which are known to be influenced by genetic factors (Tsuang, Eaves, Nir, Jerskey, & Lyons, 2005; Flint, 2004). This finding is sometimes used to support the argument that the tendency to forgive may have a biological root, which explains its relative stability across situations. Despite these possible genetic influences, the tendency to forgive the partner is likely to be affected by relationships experienced within one’s social network. In particular we
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maintain that two types of social experiences will be linked to one’s tendency to forgive the partner, namely those shared with the partner himself/herself and those shared within one’s own family of origin. This association may be particularly evident during “emerging adulthood” (Arnett, 2000), a distinct developmental period corresponding to the third decade of life (i.e., ages 20 to 30). During this period dating relationships are generally transformed into more serious romantic relationships (Furman, 2002) and engaged couples, more then ever before, have to acknowledge and balance the different heritage partners received from their families and the forming of their new couple (Cigoli & Scabini, 2006). A first possibility is that the tendency to forgive the partner emerges from partners’ shared experiences with one another, and especially from their forgiveness transactions, with each partner sometimes in the role of offender and other times in the role of victim (Hoyt et al., 2005). The norm of reciprocity suggests that the partner’s typical forgiving or unforgiving responses to one’s own relational transgressions are likely to be important determinants of one’s propensity to forgive future partner offences. Studies on negative reciprocity (e.g., Capaldi, Kim, & Shott, 2007; Cordova, Jacobson, Gottman, Rushe, & Cox, 1993) demonstrate that this norm may be particularly strong in couple relationships. In other words, given that partners’ interdependence is the defining feature of close relationships (Kelley et al., 1983), one’s willingness to forgive the partner is likely to be progressively modulated as a function of the disposition to forgive that the partner shows in the context of ongoing interactions. In this regard, a study by Hoyt and colleagues (2005) found tentative evidence indicating that the propensity to forgive the partner tends to be reciprocated in long term married couples. This evidence suggests that over time an individual’s proneness to forgive the partner may become similar to the partner’s. Another possible explanation for the development of the tendency to forgive the partner involves social experiences within one’s own family of origin. The disposition to forgive the partner may be transmitted across generations not only because of its potential heritable component, but also because of the parents’ role in socialization, a process that clearly continues throughout emerging adulthood (Arnett, 2007). According to Grusec (2002), parental socialization involves three specific goals - a) the development of self-regulation of emotion, thinking, and behavior¸ b) the acquisition of a culture’s standards, attitudes, and values, and c) the development of role-taking skills, strategies for resolving conflicts, and ways of viewing relationships - all of which are closely linked to forgiveness. Forgiveness has been judged of critical importance in strengthening self-regulatory processes through empowering powerless victims (e.g., Ahmed & Braithwaite, 2006) and has been repeatedly conceptualized and empirically examined as a crucial strategy to effectively cope with interpersonal and intergroup conflicts and to restore social relationships (e.g., Fincham, Beach, & Davila, 2004; Hoyt et al., 2005; Roe, 2007). Furthermore, given the high moral value that many religions place on it, forgiveness is viewed as a moral virtue and as a human strength across many cultures (e.g., Friesen & Fletcher, 2007; Rye et al., 2000). Thus, for a variety of reasons, parents may include forgiveness in their socialization practices. The transmission of values and behavioral patterns across generations has often been described in terms of internalization, a process whereby parental and societal values and behaviors are gradually integrated into the child’s self system, resulting in intergenerational similarity. As reviewed by Zentner and Renaud (2007), internalization concepts can be found within different theoretical approaches such as symbolic interactionism (Cooley, 1902; Mead, 1934), psychoanalysis (Freud, 1923/1961; Sandler & Rosenblatt, 1962; Meissner, 1981), and
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social learning (Aronfreed, 1968; Bandura, 1971). Even though parent-child similarity (or congruence) does not necessarily imply internalization, in the traditional sense of accurately perceiving parents’ positions and behaviors and integrating them into a coherent sense of self (Grusec & Goodnow, 1994; Zentner & Renaud, 2007), verifying the existence of such a similarity is undoubtedly the first step to examine whether internalization actually occurs across generations. Extant research provides evidence that parents and children are similar across a wide range of domains, including attitudes (e.g., Cashmore & Goodnow, 1985), values (e.g., Knafo & Schwartz, in press), ideal selves (Zentner & Renaud, 2007), perfectionism (Soenens et al., 2005) and empathy (Soenens, Duriez, Vansteenkiste, & Goossens, 2007). Research based on married offspring also indicates that parent and children are similar in the risk of marital instability (Amato & DeBoer, 2001), in their level of marital conflict, intimacy and individuation (Harvey, Curry, & Bray, 1991; Story, Karney, Lawrence & Bradbury, 2004). To our knowledge, only two studies provide data relevant to the hypothesis that the tendency to forgive is transmitted across generations. These studies, by Mullet and colleagues, show that parents and their adult children tend to be similar both in the conceptualization of forgiveness (Mullet, Girard, & Bakshi, 2004) and in the tendency to grant it (Mullet, Rivière, & Munoz Sastre, 2006). In particular, by distinguishing between different dimensions underlying “forgivingness,” Mullet and colleagues found that mother’s tendency to be resentful as well as fathers’ tendency to avenge or to grant forgiveness depending on contingent circumstances were linked to their children’s corresponding dispositions. Our main goal in the present study was to provide further evidence on forgiveness similarity across generations and across partners, by investigating the extent to which premarital engaged adult children’s tendency to forgive the partner was congruent a) with their parents’ tendency to forgive one another, thereby suggesting a possible internalization process by the children, and b) with their romantic partners’ tendency to forgive them, thereby indicating reciprocity within the premarital couple. We focused on adult children prior to marriage because, as previously observed, they were living a life transition during which they have to balance their family heritage and the forming of their new couple. A significant degree of similarity in the tendency to forgive the partner was expected both across offspring and their parents and across partners. In fact, although premarital partners are still influenced by the culture they inherited from their family of origin, during this period they are deeply involved in defining their couple identity as a separate entity from their familial belonging (Aquilino, 1997; Crespi & Sabatelli, 1997; Cigoli & Scabini, 2006). Along with these considerations, in this particular phase of the family life cycle, we can hypothesise a greater similarity to the partner’s tendency to forgive than to the parents’ ones. A secondary goal was to verify whether intergenerational similarity in the tendency to forgive the partner was moderated by child and parent gender, and by children’s perception of parents as positive models for their lives. A substantial literature suggests that child and parent gender may affect the degree of intergenerational similarity. Compared to males, females tend to develop values, aspirations, behaviors and relationship outcomes more similar to their parents’ ones (e.g., Caspi & Elder, 1998; Zentner & Renaud, 2007), probably because they spend more time in close proximity to their family than males do and are more accurate perceivers of parental positions, owing to their higher ability in adopting others’ points of view (e.g., Cotterell, 1993; Eisenberg, Carlo, Murphy, & van Court, 1995; Eisenberg, Miller,
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Shell, McNalley, & Shea, 1991). Moreover, children are more likely to be similar to their mothers than to their fathers, because mothers, by virtue of spending more time with children and having more intimate relationships with them, tend to have more opportunities to share with them their ideals, attitudes and feelings (e.g., Harach & Kuczynski, 2005). Consistent with these gender patterns, we assumed that the parent-child similarity would be higher for female children than for male ones and for mothers than for fathers. Furthermore, there are reasons to suppose that intergenerational similarity would increase the extent to which children hold a positive view of parents and of what they have transmitted to them. For example, research on racial attitudes demonstrated that racial attitudes parents are willing to express influence their children’s implicit prejudice, depending on children’s level of identification with their parents (Sinclair, Dunn, & Lowery, 2005). Similarly, maternal gender-role beliefs and attitudes are stronger predictors of daughters’ beliefs and attitudes when daughters identify with their mothers (Steele & Barling, 1996). To address the above questions we decided to adopt a dyad-centered or idiographic approach when evaluating similarity (see Luo & Klohnen, 2005; Kenny, Kashy, & Cook, 2006). Much research on partners and parent-child similarity has taken a variable-centered or nomothetic approach, focusing on variables as the unit of analysis. This approach assesses similarity by computing a correlation between the members of a dyad’s scores on the same domain across all dyads in a particular sample (e.g., between mothers’ and children’s scores on the tendency to forgive across all mother-child dyads). This correlation reflects the degree to which members of a dyad tend to be similar in a given sample, but it does not tell us the extent to which any specific dyad is similar or not. Conversely, the dyad-centered approach computes a profile similarity index for every dyad in the sample by correlating each member of a dyad’s scores across all items on a given domain. Thus, the profile similarity index is a characteristic of each dyad, not of the whole sample. Adopting the dyad-centered approach allowed us to treat the profile similarity index as a variable in itself, for example to examine whether it differs across child gender or types of dyads considered (i.e., mother-child, fatherchild, and partner-child) or whether it is related to other variables (e.g., children’s perception of parents as models). More importantly, adopting the dyad-centered approach allowed us to control for the so-called stereotype accuracy 1. Members of a dyad might appear to be similar in their tendency to forgive the partner not only because they are really similar to each other but also because they respond stereotypically, matching the profile of responses of other people in the same cultural group (e.g., Cronbach, 1955; Kenny & Acitelly, 1994). In other words, because both members of a dyad are part of a larger group, in which some responses to forgiveness issues are more typical or normative than others, as a result of shared cultural values, social desirability, and social biases (e.g., Klohnen & Mendelsohn, 1998), their responses are expected to be similar not only because of their own relationship but also because of this stereotype effect. For example, given that forgiveness is an highly desirable value for the Catholic church, which is strongly rooted within the Italian society, people who give stereotypic responses may tend to say that they are forgiving in their relationship. According to Kenny and colleagues (Kenny et al., 2006; Kenny & Acitelli, 1994), stereotype accuracy needs to be removed to uncover the degree of unique similarity between the dyad members. As Kenny and colleagues pointed out, however, both stereotype accuracy and 1
This concept has been referred to also as “stereotype” (Cronbach, 1955; and Kenrick and Funder,1988) and as “stereotype effect” (Kenny and Acitelly,1994).
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uniqueness are sources of dyadic similarity, though they refer to two different aspects of it. As for the purpose of our study, the absence of a unique similarity might not mean the absence of reciprocation or internalization, but a different mechanism through which these processes may take place, namely through partners’ socialization of the broader forgiveness culture in which their relationships are embedded. Moreover, because fathers, mothers and children may hold different views about forgiveness-related issues, we can expect different stereotype effects for these three different groups (Kenny & Acitelli, 1994). Relying upon these considerations, we also verified whether forgiveness responses in the present sample were affected by one single or by multiple stereotype effects and whether controlling for them substantially altered any of the findings related to similarity. With this respect, we expected that, when controlling for stereotype accuracy, the level of similarity across partners and across generations would be still significant, but substantially reduced. On the one hand, we had theoretical reasons to expect that across partners and generations the similarity in the tendency to forgive would not be simply an artefact of stereotype accuracy. On the other hand, previous evidence suggests that controlling for stereotype effects could substantially reduce the level of similarity (see for example Deal, Halverson, & Wampler, 1999). Owing to the lack of literature on the issue, we were not able to predict whether the strength of this expected reduction in similarity would be different in mother-child, father-child, and partnerchild dyads nor whether and how controlling for stereotype accuracy would alter any of the postulated moderating effects of parent/child gender and of child’s perceptions of parents upon similarity. In sum, our review of the existing literature has led us to investigate the following hypotheses. Hypothesis 1: There is a significant similarity in the tendency to forgive the partner between engaged young adult partners and between these partners and their parents. This similarity remains significant, even though reduced, when controlling for stereotype accuracy. Hypothesis 2: Similarity between engaged partners is higher than similarity between partners and their parents. Hypothesis 3: Mother-child similarity is higher than father-child similarity. Hypothesis 4: Parent-daughter similarity is higher than parent-son similarity. Hypothesis 5: Parent-child similarity is positively related to children’s views of parents as models for their life. Specifically, children are more similar to their parents in the tendency to forgive the partner when they perceive parents as positive models for their lives. We also examined whether forgiveness responses were affected by one single or by multiple stereotype effects and whether corrections for it/them would affect the different types of similarity or would change any of the moderating effects described from hypothesis 2 to hypothesis 5.
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METHOD Participants One hundred and sixty-five premarital heterosexual couples and their parents living in the North of Italy participated in the study. Specifically in 135 couples both of the woman’s parents completed their questionnaires (overall 540 participants); in 106 couples both of the man’s parents completed their questionnaires (overall 424 participants) and in 76 couples both parental couples filled in the materials. Among the engaged partners, the average duration of the relationship was 6 years (SD = 3.6). Women’s mean age was 29 (SD = 3.7) and men’s age was 31 (SD = 4.3). Thirty-four percent of the couples were cohabiting; among non-cohabiting partners 60.5% of women and 54.9% of men were living with their parents. The form of household was not significantly related to any of the investigated variables. Although a few offspring ended their formal education with elementary school (6.7% of the women, 15.3% of the men), most reached a terminal high school degree (49.1% women, 60.2% of the men) or a college or university degree (44.2% women, 24.5% men). As for household income, 21% of women and 13.5% of men earned below 1.500 € per month, 61% of women and 64% of men earned between 1.500 and 3.000 €, 13.5% of women and 19% of men earned between 3.000 € and 5.000 €, 4.5% of women and 3.5% of men earned over 5.000 €. Among the parents, the average duration of the marriage was 33.3 years (SD = 5.2). Mothers’ mean age was 57 (SD = 6.7) and fathers’ mean age was 60 (SD = 6.8). Parents’ number of children ranged from 1 to 7 (M = 2, SD = 0.8). Twenty-seven point seven percent of mothers and 25.4% of fathers reached up to elementary school, 65.7% of mothers and 68.2% of fathers reached up to high school degree, and 4.6% of mothers and 6.4% of fathers reached college or university degree. As for household income, 26.5% of parents earned below 1.500 € per month, 55.3% of parents earned between 1.500 and 3.000 €, 15.7% of parents earned between 3.000 € and 5.000 €, and 2.5% of parents earned over 5.000 €. More than the 95% of subjects defined themselves as affiliated with the Catholic Church. However, their degree of religiousness was modestly related to their tendency to forgive (r<|.32|).
Procedure Engaged couples were recruited through advertising in premarital courses. Partners were asked to involve their parents in the study whenever possible. Couples were given a packet of questionnaires that included six separate and distinct versions (one for each partner in the premarital couple and one for each partner in their parents’ couples), together with instructions to complete the questionnaires independently. Subjects were not paid for their completion of questionnaires, as it is not usual in Italy to pay participants when taking part in this kind of research. Engaged couples were included in the present study (67% of the overall couples we got in contact with) when at least one partner returned both his/her parents’ questionnaires .
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Measures In addition to providing demographic information, all participants completed measures assessing their tendency to forgive the partner. Children also filled in items evaluating their parents’ educational role.
Tendency to Forgive the Partner The tendency to forgive the partner when hurt or wronged by him/her was assessed using a modified version of the Marital Offence-Specific Forgiveness Scale (MOFS; Paleari, Regalia, & Fincham, submitted). The MOFS is a 10-item psychometrically robust measure assessing forgiveness toward the partner for a specific offence. In order to make the scale consistent with our goal of assessing dispositional forgiveness items were modified so that they referred to relationship transgressions in general rather than to a single transgression (for example, “Since my partner behaved this way, I have been less willing to talk to her/him” became “When my partner hurts me, I am less willing to talk to her/him for quite a while” and “Although she/he hurt me, I definitely put what happened aside so that we could resume our relationship” became “When my partner hurts me, I quickly put it aside so that we can resume our relationship”). Items were rated on a 6-point Likert-type scale (1= never, 6=always). Four items reflected the tendency to be benevolent and conciliatory toward the partner, four items referred to the tendency to be resentful and to avenge, and the final two items reflect the tendency to avoid the partner. An exploratory factor analysis on these items (factor extraction method: Principal Factors Analysis; rotation method: Direct Oblimin) identified two factors: Unforgiveness, defined by avoidant and resentful items, and Benevolence. All the items had factor loadings greater than |.30|. Unforgiveness explained more than 25% of variance in children’s, mothers’ and fathers’ data, while Benevolence explained more than 20% of variance in children’s, mothers’ and fathers’ data. The correlations between the two subscales ranged from -.38 to -.60. The existence of two correlated dimensions of forgiveness is in line with previous studies on the tendency to forgive the partner as well as on offence-specific and trait forgiveness (Fincham & Beach, 2002; Mullet et al., 2006; Paleari et al., 2005). Both factors were satisfactory reliable in children, mothers and fathers (alpha ≥. 80 and .78 for Unforgiveness and Benevolence, respectively). Parents as Models Children’s perceptions of each parent as a positive model for their lives was evaluated using two items: “Do you think your mother/father has conveyed positive things to you?” and “Do you think your mother/father has been a positive model for your life?”). Respondents expressed their opinions on each of the two items using a 4-point scale (1= not at all, 2=a little, 3=somewhat, 4=very much). The two items were averaged into a “Mother/Father as a model” index (alpha ≥.66 for mothers and .68 for fathers).
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RESULTS Data Analytic Strategy All analyses were conducted separately on the 135 couples in which both of the woman’s parents completed their questionnaires and on the 106 couples in which both of the man’s parents completed their questionnaires, with the exception of the analysis verifying the child gender moderation hypothesis. In this case the analyses were performed on the 76 couples in which both the woman’s and the man’s parents returned complete questionnaires.
Mean Differences on Forgiveness Dimensions Prior to hypothesis testing, we assessed whether Benevolence and Unforgiveness means differed across different roles (young adult child, mother, father, and partner) using the general linear model (GLM) general factorial procedure with repeated measures (see Table1). Generally participants expressed a high proneness to be benevolent and not avoidant nor resentful toward their partners. This could be a consequence of the great value granted to forgiveness by Catholic tradition, deeply embedded in the Italian society. Replicating previous studies on Italian samples (e.g., Fincham et al., 2002), on average mothers were less benevolent than fathers and than engaged men, both when they were their sons or their daughter’s partners. Engaged men’s mothers were also more unforgiving than their husbands, their sons, and their son’s partners. Engaged women’s partners were less unforgiving than women themselves and both women’s parents. Table 1. Means, Standard Deviations, and Role Differences for Major Study Variables
Engaged Women their Partner their Mother their Father GLM Engaged Men their Partner their Mother their Father GLM
Benevolence M (SD) 4.51ab (1.02) 4.73a (1.03) 4.28b (1.11) 4.62a (1.09) F(3,402) =5.54, p = .001 4.81a (1.06) 4.46b (1.06) 4.41b (1.12) 4.66a (1.06) F(3,315) =3.44, p = .017
Note: N=135 for women’s sample and 106 for men’s one.
Unforgiveness M (SD) 2.59b (.84) 2.34a (.85) 2.85b (1.00) 2.63b (.99) F(3,402) =9.07, p = .000 2.37b (.87) 2.53b (.85) 2.97a (1.01) 2.60b (.97) F(3.315) =3.44, p = .017
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Profile Similarity Indexes and Stereotype Adjustment We computed profile similarity indexes via intraclass correlations for each dyad type (child-mother, child-father, and child-partner). Intraclass correlations evaluate the size of similarity between the two members of a dyad by taking into account both the overall mean (level), the variability (spread) and the pattern of differences, or ups and down (shape), of the two members’ responses across forgiveness items. This is meaningful because level, spread, and shape are the three crucial factors influencing the degree of the similarity 2 (Kenny, et al., 2006). Intraclass correlations can range from being highly positive, indicating similarity, to being close to zero, indicating neither similarity nor dissimilarity, to being negative, indicating opposites. After computing the profile similarity indexes, we adjusted intraclass correlations for the stereotype effect, following Kenny and Acitelli (1994). We first computed different stereotypes for engaged women, engaged men, mothers and fathers in order to take into account gender and generation differences. These stereotypes were operationalized by the mean response across subjects for each item. Specifically, we computed the mean across engaged women for each forgiveness item and the mean across engaged men for each forgiveness item; we performed the same procedure for mothers and fathers as well. Because engaged women’s, engaged men’s, mothers’ and fathers’ means were highly correlated (r ≥ .92) indicating a considerable overlap in genders’ and generations’ stereotypes about forgiveness, we finally used a single general stereotype and adjusted intraclass correlations for the overall sample mean. To control for this stereotype effect, we simply subtracted from the individual’s score on each item the sample mean for that item before computing the dyadic indexes3. To verify whether the average level of unadjusted as well as adjusted similarity was above chance (Hypothesis 1), we computed for both forgiveness dimensions a one sample ttest on Fisher r-to-z transformed intraclass correlations4 (see Table 2). As far as unadjusted scores are concerned, engaged women were significantly similar to their partners and to their parents in both benevolence and unforgiveness. Engaged men were similar to their partners in benevolence and unforgiveness and were similar to their fathers in unforgiveness only. It is noteworthy that mean levels of similarity were generally modest but were still significant even after controlling for the stereotype effect, with the exception of womanmother similarity in unforgiveness.
2
To see how level, spread, and shape matter in determining similarity, consider the following examples in which, for simplicity, partner A’s responses are always 2, 3, 5, 5, 3, 2. If partner B’s set of responses is 3, 4, 6, 6, 4, 3, they are similar in both shape and spread but not in level. If partner B’s responses are 5, 3, 2, 2, 3, 5, partners are similar in level and spread but not in shape. If partner B’s set is 1, 3, 6, 6, 3, 1, partners are similar in shape and level but not in spread. 3 The essence of Kenny and Acitelli’s (1994) correction procedure is to remove typical responding from measures of couple similarity (Acitelli, Kenny & Weiner, 2001). Thus, for example, within the child-partner dyad, adjusted Benevolence similarity refers to the unique similarity in a benevolent attitude toward the partner between that person and their own partner, and not the similarity between that person and a general other. 4 Intraclass correlation scores were standardized with the following formula: z = ln[|(r+1)/(r-1)|]/2 (Rosenthal, 1991).
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Table 2. Stereotype adjusted and non-adjusted mean similarities compared with a zero value and with each other Similarity in Benevolence Unadjusted Stereotype adjusted M (SD) M (SD) Z score Z score
t-test Unadj vs Adj
Similarity in Unforgiveness Unadjusted Stereotype adjusted M (SD) M (SD) Z score Z score
t-test Unadj vs Adj
Engaged womanPartner Engaged womanMother Engaged woman-Father Engaged manPartner
.21 (.53) .38*** (.90)
.14 (.56) .30*** (.94)
t=5.31***
.23 (.46) .34*** (.70)
.17 (.48) .27*** (.72)
t=4.70***
.08 (.55) .18* (.86)
.04 (.55) .20* (1.10)
ns
.09 (.48) .13* (.66)
.04 (.47) .08 (.65)
t=4.86***
.19 (.53) .30*** (.80)
.14 (.55) .24** (.82)
t=3.41**
.19 (.47) .26*** (.67)
.14 (.48) .20** (.68)
t=5.38***
.19 (.56) .36*** (.92)
.14 (.59) .29** (.97)
t=6.11***
.24 (.46) .34*** (.68)
t=5.04***
Engaged man– Mother Engaged manFather
.06 (.52) .14 (.75)
.04 (.53) .11 (.76)
t=2.29*
.05 (.49) .08 (.62)
.18 (.48) .27*** (.69) .00 (.49) .01 (.63)
.06 (.51) .11 (.75)
.02 (.52) .07 (.77)
t=3.18**
.15 (.50) .21 (.68)**
.10 (.51) .13* (.68)
t=4.25***
t=4.43***
Note: N=135 for women’s sample and 106 for men’s one. Mean similarities marked by asterisks are the ones significantly different from zero. Values reported in italics are Fisher r-to-z transformed intraclass correlations. T-test analyses were performed on transformed intraclass correlations. + p < .055, *p<.05, ** p<..01,*** p<..001
To verify whether adjusted and not adjusted similarity means were significantly different, we compared them by computing a paired sample t-test on Fisher r-to-z transformed intraclass correlations (see Table 2). As expected, stereotype-adjusted similarities were significantly lower than unadjusted ones. Next we tested whether there was statistically significant variation in profile similarity indexes across dyads in order to perform subsequent moderating analyses. As Kenny and colleagues (2006) noted, moderating analyses can be conducted only if there is enough variation in the similarities indexes, variation which can be tested by analysing the reliability of dyadic indexes. Except for man – mother unadjusted similarity in benevolence (reliability=.53) and for man – father unadjusted similarity in unforgiveness (reliability=.49), all the reliabilities of intraclass correlations were higher than .66 . As indicated by these satisfactory reliabilities, dyads did vary in their levels of similarity enough to perform further analyses.
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Comparing Similarity across Types of Dyads To assess whether mean similarity differed across types of dyads (child-mother, childfather, and child-partner) (Hypotheses 2 and 3) as well as across forgiveness dimensions (benevolence and unforgiveness), we used the general linear model (GLM) general factorial procedure with repeated measures. The GLM analyses were performed on Fisher r-to-z transformed similarity intraclass correlations by entering both the type of dyad and the forgiveness dimension as within-subjects factors. The sphericity assumption was never met for dyad type in these analysis (W(2) ranged from .84 to .87 , p < .05), so the GreenhouseGeisser correction was applied. For engaged women’s unadjusted similarities, we found a main effect for dyad type (F(2, 268)=4.77, p=.013, ηp2=.04 (small effect size)). Examination of post hoc comparisons, performed using Sidak adjustment for multiple comparisons, indicated that this effect was due to woman-father and woman-partner similarities being significantly higher than the womanmother one. No other main effect nor the interaction was significant. However, no main effects nor interaction effect was found for women’s similarities adjusted for stereotype effect. This means that women-father and women-partner similarities were higher than the women-mother one because of a stereotype effect. For engaged men’s unadjusted similarities, we found a main effect for dyad type (F(2, 210)=6.87, p=.006, ηp2=.05 (small effect size)). Examination of post hoc comparisons, performed using Sidak adjustment for multiple comparisons, indicated that this effect was due to man-partner similarity being significantly higher than man-mother one. No other main effect or interaction was significant. The same main effect was found for men’s similarities adjusted for stereotype accuracy (F(2, 210)=4.33, p=.019, ηp2=.04 (small effect size)). This means that man-partner similarities were higher than men-mother ones even after controlling for stereotype effect. The mean level of similarity did not differ across forgiveness dimensions (benevolence and unforgiveness), whereas it differed across types of dyads. In sum, engaged men were more similar to their partners than to their mothers with respect to their tendency to forgive the partner and this difference was not due to a stereotype effect. Engaged women were more similar to their partners and to their fathers than to their mothers with respect to their tendency to forgive the partner but these differences were due to a stereotype effect. Next, we examined whether mean similarities differed not only across dyad types and forgiveness dimensions but also between engaged partners’ gender (Hypothesis 4), by conducting GLM analyses with repeated measures on a restricted subsample (N=76) in which all the subjects (the two partners and both their parental couples) returned completed questionnaires. Dyad type, forgiveness dimension and engaged partners’ gender were entered as within-subjects factors. As before, GLM analyses were performed on Fisher r-to-z transformed intraclass correlations and violation of sphericity assumption was corrected by using Greenhouse-Geisser procedure (see table 3).
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Table 3. Descriptive statistics for Stereotype adjusted and non-adjusted mean similarities on a restricted subsample in which both parental couples returned completed questionnaires
Engaged womanPartner Engaged womanMother Engaged woman-Father Engaged manPartner Engaged man– Mother Engaged manFather
Similarity in Benevolence Unadjusted Stereotype adjusted M (SD) M (SD) Z score Z score
Similarity in Unforgiveness Unadjusted Stereotype adjusted M (SD) M (SD) Z score Z score
.25 (.54) .44 (.91)
.18 (.58) .35 (.97)
.28 (.44) .40 (.68)
.21 (.47) .32 (.71)
.12 (.55) .24 (.87)
.08 (.57) .26 (1.12)
.07 (.46) .12 (.65)
.02 (.45) .06 (.64)
.22 (.54) .35 (.84) .25 (.54) .44 (.91)
.19 (.54) .31 (.83) .19 (.57) .36 (.96)
.18 (.48) .25 (.72) .28 (.44) .40 (.68)
.13 (.49) .20 (.72) .21 (.47) .32 (.71)
.05 (.53) .10 (.74)
.01 (.54) .06 (.74)
.05 (.51) .07(.62)
.00 (.51) .00 (.63)
.03 (.48) .06 (.63)
-.01 (.49) .01 (.65)
.11 (.51) .17 (.71)
.05 (.51) .09 (.71)
Note: N=76. Values reported in italics are Fisher r-to-z transformed intraclass correlations.
For unadjusted similarities, we found a marginally significant main effect for gender (F(1, 75)=3.19, p=.078, ηp2=.04 (small effect size)). Observation of means indicated that this effect was due to women’s similarities being higher than men’s. We also found a main effect for dyad type (F(2, 150)=7.90, p=.002, ηp2=.10 (moderate effect size)). Post hoc comparisons, performed using Sidak adjustment for multiple comparisons, indicated that this effect was due to child-mother similarity being significantly lower than child-father and child-partner ones. Analogous results were obtained when considering similarities adjusted for stereotype effect, we found a marginally significant main effect for gender (F(1, 75)=3.66, p=.060, ηp2=.05 (small effect size) and a main effect for dyad type (F(2, 150)=4.93, p=.018, ηp2=.06 (small effect size). To verify whether children’s perceptions of parents as models were associated with the level of parent-child similarity (Hypothesis 5), Pearson’s correlations were performed between the parents-as-models measure and mother-child and father-child similarity in both unforgiveness and benevolence. No significant association was found. A possible explanation of this result could be that, because the forgiveness construct is highly shaped by one’s own cultural and religious background, children are probably more sensitive to the fact that parents embody a socially desirable model of forgiveness than to a general positive evaluation of their parental role. To test this hypothesis we performed posthoc analyses in which we verified whether similarity between parents and children was associated to the actual level of forgiveness displayed by parents (see table 4).
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Table 4. Pearson Correlations between parent-child similarity indexes and parents’ forgiveness dimensions
Parent Benevolence
Similarity in Benevolence Women-mother Women-father
Men-mother
Men-father
Unadjusted
Stereotype adjusted
Unadjusted
Stereotype adjusted
Unadjusted
Stereotype adjusted
Unadjusted
Stereotype adjuste d
.22*
.19*
.11
.12
.40***
.39***
.24*
.24*
-.16
-.42***
.44***
-.13
-.15
Similarity in Unforgiveness Parent -.26** -.22** -.16 Unforgiveness
Note: N=135 for women’s sample and 106 for men’s one. * p<.05, ** p<..01,*** p<..001
Results revealed that parent-child similarity, especially mother-child similarity, was moderated by the level of forgiveness: the more benevolent and less unforgiving were the parents, the more similar to them were their children, especially sons.
CONCLUSION Forgiveness research is providing more and more evidence about socio-cognitive, relational, and dispositional determinants of forgiveness for specific partner’s offences (e.g., Allemand, Amberg, Zimprich, & Fincham, 2007; Paleari et al., 2005). Given that the generalizability of this evidence to a more global and stable tendency to forgive the partner is by no means assured (McCullough et al., 2000), it is also important to investigate possible precursors of the tendency itself. Drawing on socialization (e.g., Grusec & Goodnow, 1994; Zentner & Renaud, 2007) and forgiveness literature (Mullet al al., 2004; 2006), our study sought to provide further evidence on this issue by investigating in a sample of premarital couples whether young adults’ tendency to forgive the partner was significantly related to their partner’s and to their parents’ tendencies. We argued that the tendency to forgive one’s own partner would be significantly linked to the partner’s typical forgiving or unforgiving responses to one’s own relational transgressions, as implied by the reciprocity norm, as well as to the parents’ tendency to forgive one another, as implied by socialization theories assuming that children internalize parental models. Specifically, our main objective was to verify the extent to which partners are similar to each other and to their parents with respect to their forgiveness disposition, using a dyadcentered approach in order to appropriately analyse the similarity within each dyad and to control for possible stereotype effects. A unique stereotype for the overall sample was revealed by our investigation, suggesting that stereotype accuracy did not differ across genders or generations. Thus, as far as forgiveness toward the partner is concerned, female and male partners as well as young adult and parents share an overlapping typical view of forgiveness within the couple. Controlling for stereotype accuracy significantly lowers the
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level of similarities, proving the existence of a stereotypical way of responding to forgiveness issues among participants. Consistent with our first hypothesis, however, our results demonstrate that, even after controlling for stereotype accuracy, there is a significant though small level of similarity between engaged partners. This evidence mirrors previous studies showing modest levels of reciprocity between partners’ forgiveness (Hoyt et al, 2005). It can be argued that, as observed by Clark (1984) romantic relationships are communal bonds in which partners are not much concerned with ongoing maintenance of equity but rather are more responsive to the needs of the other and of the relationship. It is noteworthy that similarity between partners can be explained not only because they become more and more similar in their reciprocal exchanges of forgiveness, but also because partners select each other based on similarity in many domains, as studies on assortative mating suggested (Luo & Klohnen, 2005). Thus, similarity in forgiveness can be part of the same selection process. A significant level of similarity in the tendency to forgive was also found between children and their parents, even after adjusting for stereotype accuracy. In particular, daughters were found to be similar to their parents in both forgiveness dimensions (Benevolence and Unforgiveness), whereas sons were similar to their fathers only in the Unforgiveness dimension. The latter evidence is consistent with the fact that the level of intergenerational continuity in antisocial behavior is generally stronger for fathers than for mothers (Farrington, Jolliffe, Loeber, Stouthamer-Loeber, & Kalb, 2001; Thornberry, 2003). It is noteworthy that, despite the fact that children and parents are referring to different targets of their forgiveness tendency (i.e. their partners), they are nevertheless uniquely similar about it. This finding is in line with the assumption of intergenerational transmission of forgiveness toward the partner, although it is only a first step to come to this conclusion. On the one hand, the mere similarity between fathers’ and children’s forgiveness does not automatically imply internalization, a process that requires both an accurate perception of parental dispositions and their acceptance by children (Grusec & Goodnow, 1994). On the other hand, similarity doesn’t necessarily mean a parent-to-child transmission but can also stand for a bidirectional process: by expressing their more or less forgiving tendency, children can also influence parents’ ongoing socialization of forgiveness (Kuczynski & Parkin, 2007). In line with this hypothesis, recent evidence on the intergenerational transmission of ideal selves showed the existence of a child-to-parent effect, even though less frequent than the opposite parent-tochild one (Zentner & Renaud, 2007). Partially consistent with our second hypothesis, children were more similar to their partners than to their mothers in their tendency to forgive, but not to their fathers. For daughters however this difference was no longer significant when similarity was adjusted for stereotype accuracy. This indicates that women were not more similar to their own partners’ or fathers’ forgiveness, compared to their mothers’, but to their partner’s and fathers’ responding in a typical fashion about forgiveness. Thus, only engaged men’s tendency to forgive their partner appears more strongly linked to the forgiveness transactions occurring in their couple relationship than to the forgiveness model displayed by their mothers. This result may be partly explained by the fact that males are often reinforced early on to separate themselves from the family and to establish a sense of individuality (Gilmore, 1990; Philpot, Brooks, Lusterman, & Nutt, 1997), whereas females are encouraged to connect and please others with much less emphasis on individuating (Gilligan, 1982). Another possible
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explanation is that in our sample mothers, differently from fathers, showed the lowest tendency to forgive their husbands, thus embodying a socially unacceptable model of forgiveness. Consequently, children tend not to identify with them. As highlighted in post hoc analyses, children, and especially sons, are more likely to reproduce parental models as long as they are positive and socially desirable in the Italian culture. Daughters and sons were not more similar to their mothers than to their fathers. If anything, with unadjusted scores, women were more similar to their fathers than to their mothers, but this difference was no longer significant after stereotype adjustment. This finding is in contrast with our third hypothesis, which drew upon studies showing that children are more likely to share maternal rather than paternal ideals, attitudes and feelings (Harach & Kuczynski, 2005). A possible explanation could be that, compared to the other variables so far investigated, the tendency to forgive the partner is a more interpersonal construct, which has a greater likelihood of being manifested during interactions with the offender. Accordingly, parents’ forgiving or unforgiving intentions toward each other are more likely to be exhibited (and accurately perceived by children) during their mutual interactions, thereby resulting in a more equal involvement of fathers and mothers in their children’s socialization of forgiveness. As for child gender, results showed a marginally significant effect which confirmed our fourth hypothesis. Consistent with previous studies on the intergenerational transmission of individual and relationship variables (e.g., ideals, relational outcomes), daughters are more similar to their parents in their willingness to forgive the partner than sons (e.g., Caspi & Elder, 1998; Zentner & Renaud, 2007). Unexpectedly, children’s perception of parents as models for their lives did not moderate parent-child similarity, thereby disconfirming our fifth assumption. As highlighted in posthoc analyses, when using a more specific measure of the positivity of parents as models (the actual level of forgiveness reported by parents), a direct association with parent –child similarity emerged, suggesting that children may be more sensitive to the fact that parents embody a socially desirable model of forgiveness than to a general positive evaluation of their parental role. Interpretation of the present findings must be tempered by several considerations. First, the use of a convenience sample limits generalizability of results to a broader population. Second, the cross-sectional nature of the present work makes it impossible to verify the direction of effects and specifically to disentangle whether parent-child influence is one- or bi-directional. Moreover, we could not verify the possibility of partners initial selection nor to address the issue of possible changes in similarity across time, while research suggests that partners tend to grow more and more similar to each other over time (Blankenship, Hnat, Hess, & Brown, 1984). Thus, future research should aim at investigating this topic through a longitudinal design. Third, as already noted, because measuring similarity is only the first step to assessing internalization, future research should aim at investigating internalization more closely - especially to verify the role of children’s accuracy in perceiving parents tendency to forgive as well as their acceptance of such models. Fourth, research on the intergenerational transmission of dispositions should also aim at distinguishing between biological/genetic and socialization factors. Finally, only a subset of possible moderators of parent-child similarity were taken into account. Future research is needed to verify the role of other possible factors, such as the quality of children’s relationship with each parent or parents’ parenting practices.
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In summary, our study highlights the existence of similarity in partners and parent–child dyads with regard to forgiveness. Such similarity is due to both a stereotypical way of responding to forgiveness issues among participants and to a unique similarity between engaged partners and between parents and children. Partners’ socialisation of forgiveness seems therefore not only a matter of integrating one’s personal disposition with one’s couple and parental “culture of forgiveness” but also with a broader societal one. Our results provide evidence for a reciprocity between partners’ tendency to forgive each other and for children’s congruence with parents’ tendencies. Thus, even though premarital engaged couples are strongly involved in defining their own couple identity as a separate entity from their familial belongings, they are nonetheless permeated by the forgiveness culture they inherit from their family of origin (Cigoli & Scabini, 2006; Mullet el., 2006). Young adult children, and especially sons, appear to discriminate the type of forgiveness models their parents endorse and are more prone to reproduce them as long as they are positive and socially desirable. Reviewed by Thomas Bradbury (University of California, Los Angeles, US) and Etienne Mullet (Ecole Practique des Hautes Etudes, Paris, France). We’d like to express our gratitude to both of them for their very helpful comments on an earlier version of this chapter.
REFERENCES Allemand, M., Amberg, I., Zimprich, D., & Fincham, F.D. (2007). The role of trait forgiveness and relationship satisfaction in episodic forgiveness. Journal of Social and Clinical Psychology, 26, 199-217. Ahmed, E. & Braithwaite, V. (2006). Forgiveness, reconciliation, and shame: Three key variables in reducing school bullying. Journal of Social Issues, 62(2), 347—370. Amato, P.R., & DeBoer, D.D. (2001). The transmission of marital instability across generations: Relationship skills or commitment to marriage? Journal of Marriage and the Family, 63, 1038–1051. Aquilino, W.S. (1997). From adolescent to young adult: A prospective study of parent-child relations during the transition to adulthood. Journal of Marriage & the Family, 59(3), 670 Arnett, J. J. (2000). adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. Arnett, J. J. (2007). Socialization in emerging adulthood: Frome the family to the wider world, from socialization to self-socialization. In J.E. Grusec and Hastings, P.D. (Eds.). Handbook of socialization (pp.208-231). The Guilford Press: New York. Aronfreed, J. (1968). Conduct and conscience. New York: Academic Press. Bandura, A. (1971). Psychological modeling: Conflicting theories. Chicago: Aldine-Atherton. Berry, J.W., & Worthington, E. L. (2001). Forgivingness, relationship quality, stress while imagining relationship events, and physical and mental health. Journal of Counseling Psychology, 48 (4), 447-455. Berry, J. W., Worthington, E. L., Parrott, III, L. I., O’Connor, L. E., & Wade, N. G. (2001). Dispositional forgivingness: Development and construct validity of the Transgression
208
F. Giorgia Paleari, Silvia Donato, Raffaella Iafrate et al.
Narrative Test of Forgivingness (TNTF). Personality and Social Psychology Bulletin, 27, 1277–1290. Blankenship, V., Hnat, S., Hess, T.G., & Brown, D.R. (1984). Reciprocal Interaction and Similarity of Personality Attributes. Journal of Social and Personal Relationships, 1(4),. 415-432. Bono, G., McCullough, M.E., & Root, L.M. (2008). Forgiveness, feeling connected to others, and well-being: Two longitudinal studies. Personality and Social Psychology Bulletin, 34 (2), 182.195. Capaldi, D.M., Kim, H.K., & Shortt, J.W. (2008). Observed initiation and reciprocity of physical aggression in young, at-risk couples. Journal of Family Violence, 22, 101-111. Cashmore, J. A., & Goodnow, J. J. (1985). Agreement between generations: A two-process approach. Child Development, 56, 493–501. Caspi, A., & Elder, G.H. (1988) Childhood precursors of the life course: Early personality and life disorganization. In E.M. Hetherington, R.M. Lerner, amd M. Perlmutter. Child development in life-span perspective (pp. 115-142). Hillsdale, NJ, England: Lawrence Erlbaum Associates. Caspi, A., & Moffitt, T. E. (1993). When do individual differences matter?. A paradoxical theory of personality coherence. Psychological Inquiry, 4, 247–271. Caspi, A., Roberts, B. W., & Shiner, R. (2005). Personality development: Stability and change. Annual Review of Psychology, 56, 453–484. Cigoli, V. & Scabini, E. (2006). Family identity: Ties, symbols, and transitions. Lawrence Erlbaum Associates Publishers: New York. Clark, M. S. (1984). Record-keeping in two types of relationships. Journal of Personality and Social Psychology, 47, 549–557, Cooley, C. H. (1902). Human nature and the social order. New York: Scribner. Cordova, J. V., Jacobson, N. S., Gottman, J. M., Rushe, R., & Cox, G. (1993). Negative reciprocity and communication in couples with a violent husband. Journal of Abnormal Psychology, 104, 559–564. Crespi, T.D., & Sabatelli, R. M.(1997) Children of alcoholics and adolescence: Individuation, development, and family systems. Adolescence. 32(126), 407-417. Cronbach, L. J. (1955). Processes affecting scores on “understanding of others” and “assumed similarity.” Psychological Bulletin, 52, 177–193. Deal, J.E., Halverson, C.F., & Wampler, K.S. (1999). Parental similarity on child-rearing orientations: Effects of stereotype similarity. Journal of Social and Personal Relationships, 16, 87-102. Eaton, J., & Struthers, C. W. (2006). The reduction of psychological aggression across varied interpersonal contexts through repentance and forgiveness. Aggressive Behavior, 32, 112. Eisenberg, N., Carlo, G., Murphy, B., & van Court, P. (1995). Prosocial development in late adolescence. Child Development, 66, 1179–1197. Eisenberg, N., Miller, P. A., Shell, R., McNalley, S., & Shea, C. (1991). Prosocial development in adolescence: A longitudinal study. Developmental Psychology, 27, 849– 857. Farrington, D. P., Jolliffe, D., Loeber, R., Stouthamer-Loeber, M., & Kalb, L. M. (2001). The concentration of offenders in families, and family criminality in the prediction of boys’ delinquency. Journal of Adolescence, 24, 579–596.
The Tendency to Forgive in Premarital Couples
209
Fincham, F.D. & Beach, S.R. (2002). Forgiveness in marriage: Implications for psychological aggression and constructive communication. Personal Relationships, 9, 239-251. Fincham, F.D., Beach, S.R., & Davila, J. (2004). Forgiveness and conflict resolution in marriage. Journal of Family Psychology, 18, 72-81. Fincham, F.D., Hall, J.H., & Beach, S.R.H. (2005). 'Till lack of forgiveness doth us part: Forgiveness in marriage. In E.L. Worthington (Ed.), Handbook of forgiveness (pp.207226). New York: Routledge. Flint, J. (2004). The genetics of neuroticism. Neuroscience and Biobehavioural Reviews, 28, 307–316. Freud, S. (1961). The ego and the id. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 19, pp. 12–59). London: Hogarth Press. (Original work published 1923). Friesen, M.D., & Fletcher, G, J. O. (2007). Exploring the lay representation of forgiveness: Convergent and discriminant validity. Personal Relationships, 14(2), 209-223. Furman, W. (2002). The emerging field of adolescent romantic relationships. Current Directions in Psychological Science, 11, 177–180. Grusec, J. (2002). Parental socialization and children’s acquisition of values. In M. Bornstein (ed.) Handbook of parenting (pp. 142-168). Mahwah, NJ: Erlbaum. Grusec, J. E., & Goodnow, J. J. (1994). Impact of parental discipline methods on the child’s internalization of values: A reconceptualization of current points of view. Developmental Psychology, 30, 4–19. Harach, L. & Kuczynski, L. (2005). Construction and maintenance of parent-child relationships: Bidirectional contributions from the perspective of parents. Infant and Child Development, 14, 327-343. Hoyt, W.T., Fincham, F.D., McCullough, M. E., Maio, G., & Davila, J, (2005). Responses to interpersonal transgression in family: Forgivingness, forgivability and relationshipspecific effects. Journal of Personality and Social Psychology, 2005, Vol. 89, No. 3, 375–394. Kachadourian, L. K., Fincham, F. D., & Davila, J. (2004). The tendency to forgive in dating and married couples: The role of attachment and relationship satisfaction. Personal Relationships, 11, 373–393. Karremans, J. C., Van Lange, P. A. M., Ouwerkerk, J.W., & Kluwer, E. S. (2003). When forgiving enhances psychological well-being: The role of interpersonal commitment. Journal of Personality and Social Psychology, 84, 1011-1026. Kelley, H. H., Berscheid, E., Christensen, A., Harvey, J. H., Huston, T. L, Levinger, G., McClintock, E., Peplau, L. A., & Peterson, D. R. (1983). Close relationships. New York: Freeman Kelley, H. H., Berscheid, E., Christensen, A., Harvey. J. H, Huston, T. L., Levinger, G., Knafo, A., & Schwartz, S. (in press). Accounting for parent– child value congruence: Theoretical considerations and empirical evidence. In U. Schönpflug (Ed.), Perspectives on cultural transmission. Oxford, England: Oxford University Press. Kenny, D.A., & Acitelli, L. (1994). Measuring similarity in couples. Journal of Family Psychology, 8 (4), 417-431. Kenny, D.A., Kashy, D.A., & Cook, W.L. (2006). Dyadic data analysis. The Guilford Press: New York.
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Klohnen, E. C., & Mendelsohn, G. A. (1998). Partner selection for personality characteristics: A couple-centered approach. Personality and Social Psychology Bulletin, 24, 268–278. Knafo, A., & Schwartz, S. (in press). Accounting for parent– child value congruence: Theoretical considerations and empirical evidence. In U. Schönpflug (Ed.), Perspectives on cultural transmission. Oxford, England: Oxford University Press. Kuczynski, L. & Parkin, C. M. (2007).Agency and Bidirectionality in Socialization: Interactions, Transactions, and Relational Dialectics. In J.E. Grusec and Hastings, P.D. (Eds.). Handbook of socialization (pp.259-283). The Guilford Press: New York. Luo, S., & Klohnen, E. (2005). Assortative mating and marital quality in newlyweds: A couple-centered approach. Journal of Personality and Social Psychology, 88, 304–326. McClintock, E. Peplau, L. A., & Peterson, D. R. (1983). Close relationships. San Francisco: Freeman. Maio, G.R., Thomas, G., Fincham, F.D., & Carnelley, K.B. (2008). Unraveling the role of forgiveness in family relationships. Journal of Personality and Social Psychology, 94 (2), 307–319. McCullough, M. E., Pargament, K. I., & Thoresen, C. E. (2000). The psychology of forgiveness: History, conceptual issues, and overview. In M. E. McCullough, K. I. Pargament, & C. E. Thoresen (Eds.), Forgiveness: Theory, research and practice (pp. 1– 14). New York: Guilford Press. McCullough, M. E., Hoyt, W.T. & Rachal, K.C. (2000) What we knoe (and need to know about assessing forgiveness constructs. In M. E. McCullough, K. I. Pargament, & C. E. Thoresen (Eds.), Forgiveness: Theory, research and practice (pp. 65–88). New York: Guilford Press. McCullough, M. E., & Witvliet, C. V. (2002). The psychology of forgiveness. In C. R. Snyder and S. J. Lopez (Eds.), Handbook of positive psychology (pp. 446-458). New York: Oxford. Mead, G. H. (1934). Mind, self, and society from the standpoint of a social behaviorist. Chicago: University of Chicago Press. Meissner, W. W. (1981), Internalization in Psychoanalysis, International Universities Press, New york. Montemayor, R., & Brownlee, J. (1987). Fathers, mothers and adolescents: Gender-based differences in parental roles during adolescence. Journal of Youth and Adolescence, 16, 289–302. Mullet, E., Girard, M. & Bakshi, P. (2004). Conceptualizations of forgiveness. European Psychologist, 9, 78–86. Mullet, E., Neto, F. & Rivière, S. (2005). Personality and its effects on resentment, revenge, forgiveness, and self-forgiveness. In E. L.Worthington (Ed.), Handbook of forgiveness (pp. 159–182). New York: Brunner/Routledge. Mullet, E., Rivière, S., & Munoz Sastre, M.T. (2006). Relationships between young adults’ forgiveness culture and their parents’ forgiveness culture. Journal of Cultural and Evolutionary Psychology, 4(2), 159–172. Neyer, F. J., & Asendorpf, J. B. (2001). Personality-relationship transaction in young adulthood. Journal of Personality and Social Psychology, 81, 1190–1204. Neyer, F. J., & Lehnart, J. (2007). Relationships matter in personality development: Evidence from an 8-year longitudinal study across young adulthood. Journal of Personality, 75 (3), 535-568.
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Paleari, F.G., Regalia, C., & Fincham, F.D. (2005) Marital quality, forgiveness, empathy, and rumination: A longitudinal analysis. Personality and Social Psychology Bulletin, 31 (5), 1-11. Philpot, C. L., Brooks, G.R., Lusterman, D.D., & Nutt, R. L. (1994) Bridging separate gender worlds: Why men and women clash and how therapists can bring them together. American Psychological Association: Whasington. Roberts, R. C. (1995). Forgivingness. American Philosophical Quarterly, 32, 289-306. Robins, R. W., Caspi, A., & Moffit, T. E. (2002). It’s not just who you’re with, it’s who you are: Personality and relationship experiences across ultiple relationships. Journal of Personality, 70, 925–964. Roe, M. D. (2007). Intergroup forgiveness in settings of political violence: Complexities, ambiguities, and potentialities. Peace and Conflict: Journal of Peace Psychology. 13(1), 3-9. Rye, M. S., Loiacono, D. M., Folck, C. D., Olszewski, B. T., Heim, T. A., & Madia, B. P. (2001). Evaluation of the psychometric properties of two forgiveness scales. Current Psychology, 20, 260–277. Rye, M. S., Pargament, K.I., Ali A., Beck, G.L. Dorff, E.N., Hallisey, C., Narayanan, V., & Williams, J.G. (2000). Religious perspectives on forgiveness. . In M. E. McCullough, K. I. Pargament, & C. E. Thoresen (Eds.), Forgiveness: Theory, research and practice (pp. 17–40). New York: Guilford Press. Sandler, J., & Rosenblatt, B. (1962). The concept of the representational world. Psychoanalytic Study of the Child, 17, 128–145. Sinclair, S., Dunn, E., & Lowery, B.S.(2005).The relationship between parental racial attitudes and children's implicit prejudice.Journal of Experimental Social Psychology, 41(3), 283-289. Soenens, B., Duriez, B., Vansteenkiste, M. & Goossens, L. (2007). The intergenerational transmission of empathy-related responding in adolescence: The role of maternal support. Personality and Social Psychology Bulletin, 33 ( 3), 299-311. Soenens, B., Elliot, A. J., Goossens, L., Vansteenkiste, M., Luyten, P., & Duriez, B. (2005). The intergenerational transmission of perfectionism: Parents’ psychological control as intervening variable. Journal of Family Psychology, 19, 358-366. Steele, J., & Barling, J. (1996). Influence of maternal gender-role beliefs and role satisfaction on daughters' vocational interests. Sex Roles, 34(9-10), 637-648. Tsang, J., McCullough, M.E., & Fincham, F. (2006). The longitudinal association between forgiveness and relationship closeness and commitment. Journal of Social and Clinical Psychology, 25(4), 448-472. Tsuang, M. T., Eaves, L., Nir, T., Jerskey, B. A. & Lyons, M. J. (2005): Genetic influences on forgiveness. In: Worthington, E. L. (ed.): Handbook of Forgiveness. New York: Routledge, 245–258. Zentner, M. & Renaud, O. (2007). Origins of adolescents’ ideal self: An intergenerational perspective. Journal of Personality and Social Psychology, 92 (3), 557–574.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 10
IS THE SEROTONERGIC SYSTEM ALTERED IN ROMANTIC LOVE? A LITERATURE REVIEW AND RESEARCH SUGGESTIONS Sandra J. E. Langeslag* Erasmus Affective Neuroscience Lab, Institute of Psychology, Erasmus University Rotterdam, The Netherlands
ABSTRACT Infatuated individuals think about their beloved a lot. The notions that these frequent thoughts resemble the obsessions of obsessive-compulsive disorder (OCD) patients and that those patients benefit from serotonin reuptake inhibitors (SSRIs), have led to the hypothesis that romantic love is associated with reduced central serotonin levels. In this chapter, the literature on this topic is reviewed and suggestions for future research are made. Previous studies have shown that romantic love is associated with lower blood serotonin levels and with lower serotonin transporter densities, the latter of which has also been observed in OCD patients. Further, SSRIs have been found to decrease feelings of romantic love and the serotonin 2 receptor gene has been associated with the love trait ‘mania’, which is a possessive and dependent form of love. Given that serotonin 2 receptors in the prefrontal cortex have also been implicated in impulsive aggression, this suggests that stalking behavior may be associated with these receptors. In short, the serotonergic system appears to be altered in romantic love indeed. Future research is needed to identify what parts of the serotonergic system, such as which serotonergic projections, brain areas, transmission stages and receptor types, are affected in romantic love and in what way they are altered. Furthermore, challenging the serotonergic system would be useful in determining the causal relationship between central serotonin levels and feelings of romantic love. In addition, future research should specifically investigate
*
Corresponding author: S. Langeslag. Institute of Psychology, Woudestein, T12-45, P.O. Box 1738, NL-3000 DR Rotterdam, The Netherlands. Email address:
[email protected]; Tel: +31 (0)10 408 2663; Fax: +31 (0)10 408 9009
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INTRODUCTION Infatuated individuals and obsessive-compulsive disorder (OCD) patients resemble each other in the sense that they both have obsessions. In general, obsessions are ideas that haunt, hover and constantly invade one’s consciousness (Reber & Reber, 2001). Specifically, OCD patients spend a lot of time thinking about their doubts and fears, whereas infatuated individuals spend as much as 85 percent of the day thinking about their beloved (Fisher, Aron, Mashek, Li, & Brown, 2002). This resemblance, combined with the notion that selective serotonin reuptake inhibitors (SSRIs) can relieve OCD symptoms, led Fisher et al. (2002) to hypothesize that romantic love is accompanied by reduced levels of serotonin in the brain. In this chapter, it will be discussed how this hypothesis relates to the existing literature. In addition, suggestions are made for future research that could put this hypothesis to the test and would increase our knowledge about both the serotonergic system and the neurobiology of romantic love.
LITERATURE REVIEW Kurup and Kurup (2003) have observed that individuals with a predisposition to fall in love had lower blood serotonin levels than did individuals without such predisposition, as evident from the fact that they had never fallen in love and had a conventional arranged Indian marriage. Thus, this study implies that lower serotonin levels are associated with increased trait romantic love. Furthermore, in a case study of a healthy man it was observed that state feelings of love were less intense and of shorter duration when taking an SSRI compared to when taking no medication (Walsh, Victor, & Bitner, 2006). Further, Marazziti, Akiskal, Rossi and Cassano (1999) have shown that infatuated compared to non-infatuated participants had a lower density of the serotonin transporter in blood platelets, a measure that is linked to the density of this transporter in the brain (Rausch et al., 2005). When the same participants were tested again about a year later, the serotonin transporter density in the previously infatuated individual had returned to levels equivalent to the non-infatuated participants. Marazziti et al. also compared the serotonin transporter density in the infatuated participants with this density in OCD patients, and found that these were undistinguishable. Yet, because this serotonin transporter is a membrane protein that transports serotonin from the synaptic cleft back into the presynaptic neuron, a reduced transporter density implies that an increased number of serotonin molecules would be present in synapses. Still, the finding of a reduced transporter density in OCD patients is supported by positron emission tomography (PET) research in which OCD patients compared to control participants had a lower serotonin transporter density in the thalamus and midbrain (Reimold et al., 2007). Given the resemblance between OCD patients and infatuated people, these results lead to the hypothesis that also in infatuated people the density of the serotonin transporter would be reduced in the thalamus and midbrain. In fact, it is very important to consider the locus of
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serotonergic changes in romantic love because the raphe nuclei in the brainstem have serotonergic projections to multiple brain structures such as the cerebellum, hippocampus, amygdala, thalamus, hypothalamus, striatum and neocortex (Kandel, Schwartz, & Jessell, 2000). Changes in the serotonergic system associated with romantic love could occur in all of these projections, only in some projections or even differently in different projections. Take schizophrenia for instance, where dopamine is too abundant in the mesolimbic dopaminergic pathway, but too scarce in the mesocortical dopaminergic pathway (Stahl, 2000). Interestingly, the serotonergic system has also been implicated in impulsivity and aggressive behavior. The serotonergic projection to the prefrontal cortex, that would normally exert inhibitory control, appears dysfunctional in individuals who show impulsive aggression (Davidson, Putman, & Larson, 2000). Given that romantic love is usually not particularly associated with aggressive behavior or impulsivity, this suggests that the prefrontal serotonergic projection may be unaffected by romantic love. Nevertheless, romantic love is sometimes accompanied by stalking behavior that can involve impulsivity and aggression directed towards the stalker’s victim (Meloy & Fisher, 2005). So, the serotonergic projection from the raphe nuclei to the prefrontal cortex may actually play a role in stalking behavior. Besides considering the changes in different projections or brain structures, it is also important to evaluate changes in the serotonergic system at the pharmacological level. For example, serotonergic transmission comprises different stages, such as serotonin synthesis, serotonin release from the presynaptic neuron, binding of serotonin to receptors, enzymatic degradation of serotonin in the synaptic cleft, and serotonin reuptake. Moreover, different receptor types exist, including some autoreceptors that inhibit serotonin release. The SSRIs that can alleviate OCD symptoms appear to mediate serotonergic transmission in several ways. Initially, they block the reuptake of serotonin from the synaptic cleft. The therapeutic effect, however, appears only after a few weeks and is attributed to the subsequent desensitization of the 1A and 1B autoreceptors that results in disinhibition of serotonin release from the presynaptic neuron (Stahl, 2000). Alteration or disruption of serotonergic transmission in romantic love could occur at one or more of the transmission stages and could involve one or more of the different receptor types. The above mentioned findings regarding the serotonin transporter imply changes in the reuptake stage during romantic love. Interestingly, Emanule, Brondino, Pesenti, Re and Geroldi (2007) have not observed an association between serotonin transporter gene polymorphisms and certain love traits. This suggests that the observed differences in the serotonin transporter may occur only during state romantic love. Yet, Emanuele et al. have observed an association between the C516T polymorphism of the gene encoding the serotonin 2A receptor, which is widely distributed throughout the brain, and the love trait ‘mania’. Previously, this polymorphism has been implicated in obsessive-compulsive disorder (Meira-Lima et al., 2004). Moreover, the serotonin 2 receptors in the prefrontal cortex have been implicated in impulsive aggression (Davidson et al., 2000). Given that ‘mania’ is characterized as a possessive and dependent form of love (Lee, 1976), this suggests that stalking behavior may actually be associated with the serotonin 2 receptors that are located in the prefrontal cortex. Finally, besides to obsessive-compulsive disorder and possibly romantic love, a dysfunctional serotonergic system has also been linked to depression (see e.g. D'haenen, 2001). Nevertheless, infatuated participants are rather euphoric than depressed, at least as long as the relationship is satisfactorily. More research is needed to establish the differences and similarities between the serotonergic systems of depressed and infatuated individuals.
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INTERIM SUMMARY Above, four studies regarding the involvement of the serotonergic system in romantic love have been discussed. The results of these studies suggest that the serotonergic system is associated with romantic love although it remains unclear whether central serotonin levels are actually decreased in infatuated individuals as has been hypothesized by Fisher et al. (2002). In addition, the prefrontal serotonergic projection and the serotonin 2 receptor might be associated with the manic, stalking aspect of romantic love.
RESEARCH SUGGESTIONS The review above makes it clear that there are multiple aspects of romantic love that should be considered explicitly in future research. It is important, for example, to specify whether the topic of investigation is trait or state romantic love. Obviously, genetic studies will mostly concern trait romantic love. It is also important to distinguish between requited and unrequited love, the latter of which may be associated with depressive feelings and even stalking behavior in some individuals. Further, the time course of serotonergic changes in romantic love has to be examined, preferably using longitudinal designs. Marazziti et al. (1999) have already shown that serotonin transporter density returns to normal values after a year, but it would be interesting to observe changes at the start of the infatuation or after rejection as well. Hereby it should be kept in mind that changes in the serotonergic system may take some time to occur, in analogy to the changes underlying the therapeutic effects of SSRIs. So how could these issues be investigated? The functioning of the serotonergic system can be assessed by measuring levels of serotonin or its precursor or metabolites in urine, blood or cerebrospinal fluid (in order of invasiveness). Also serum prolactin elevation in response to a single dose of a serotonin agonist or precursor can be used to index central serotonin activity (e.g. Croonenberghs et al., 2007; Muldoon et al., 2007). Further, any causal relationship between serotonin and romantic love could be determined by experimentally manipulating central serotonin levels, for instance by administering a serotonin agonist or antagonist. Alternatively, central serotonin levels can be decreased by acute tryptophan depletion, which can be achieved by having participants consume a beverage containing multiple amino acids except the amino acid tryptophan (e.g. Van der Veen, Evers, Deutz, & Schmitt, 2007), which is the precursor of serotonin. Likewise, central serotonin levels can be increased by using a beverage containing high levels of tryptophan compared to other amino acids (e.g. Bjork, Dougherty, Moeller, Cherek, & Swann, 1999). Finally, the neuroimaging technique PET would be especially suitable for comparing the serotonergic system of infatuated individuals with that of non-infatuated individuals or patients with OCD or depression. In PET studies, a radioactive substance that has a high affinity for a certain binding site is injected, and detectors then measure where in the brain that radioactive substance accumulates. In research concerning the serotonergic system and romantic love, the radioactive substance would be selected for its binding to a certain serotonin receptor or transporter, thereby making it possible to investigate the locus of changes in the different aspects of the serotonergic system.
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CONCLUSION The few studies that have examined the relation between serotonin and romantic love have shown that the serotonergic system is probably dysfunctional in infatuated individuals. However, more research is needed to identify the exact locus of these changes, that is to determine which serotonergic projections, brain areas, transmission stages and receptor types are altered in romantic love. To this end, crosstalk between the different disciplines such as neuroimaging, genetics and pharmacology is needed. Finally, future research will have to specifically investigate the different aspects of love, such as state or trait love, requited and unrequited love and its development in time. Reviewed by Dr. F. M. van der Veen, Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
REFERENCES Bjork, J. M., Dougherty, D. M., Moeller, F. G., Cherek, D. R., & Swann, A. C. (1999). The effects of tryptophan depletion and loading on laboratory aggression in men: time course and a food-restricted control. Psychopharmacology, 142, 24-30. Croonenberghs, J., Wauters, A., Deboutte, D., Verkerk, R., Scharpe, S., & Maes, M. (2007). Central serotonergic hypofunction in autism: results of the 5-hydroxy-tryptophan challenge test. Neuroendocrinology Letters, 28, 449-455. D'haenen, H. (2001). Imaging the serotonergic system in depression. European Archives of Psychiatry and Clinical Neuroscience, 251, II/76–II/80. Davidson, R. J., Putman, K. M., & Larson, C. L. (2000). Dysfunction in the neural circuitry of emotion regulation - A possible prelude to violence. Science, 289, 591-594. Emanuele, E., Brondino, N., Pesenti, S., Re, S., & Geroldi, D. (2007). Genetic loading on human loving style. Neuroendocrinology Letters, 28, 815-821. Fisher, H. E., Aron, A., Mashek, D., Li, H., & Brown, L. L. (2002). Defining the brain systems of lust, romantic attraction, and attachment. Archives of Sexual Behavior, 31, 413-419. Kandel, E. R., Schwartz, J. H., & Jessell, T. M. (2000). Principles of neural science (4th ed.). New York: McGraw-Hill. Kurup, R. K., & Kurup, P. A. (2003). Hypothalamic digoxin, hemispheric dominance, and neurobiology of love and attention. The International Journal of Neuroscience, 113, 721729. Lee, J. (1976). The colors of love (1st ed.). Englewood Cliffs: Prentice-Hall. Marazziti, D., Akiskal, H. S., Rossi, A., & Cassano, G. B. (1999). Alterations of the platelet serotonin transporter in romantic love. Psychological Medicine, 29, 741-745. Meira-Lima, I., Shavitt, R. G., Miguita, K., Ikenaga, E., Miguel, E. C., & Vallada, H. (2004). Association analysis of the cathechol-o-methyltranferase (COMT), serotonin transporter (5-HTT) and serotonin 2A receptor (5-HT2A) gene polymorphisms with obsessivecompulsive disorder. Genes, Brain and Behavior, 3, 75-79.
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Meloy, J. R., & Fisher, H. (2005). Some thoughts on the neurobiology of stalking. Journal of Forensic Sciences, 50, 1472-1480. Muldoon, M. F., Mackey, R. H., Sutton-Tyrrell, K., Flory, J. D., Pollock, B. G., & Manuck, S. B. (2007). Lower central serotonergic responsivity is associated with preclinical carotid artery atherosclerosis. Stroke, 38, 2228-2233. Rausch, J. L., Johnson, M. E., Li, J., Hutcheson, J., Carr, B. M., Corley, K. M., et al. (2005). Serotonin transport kinetics correlated between human platelets and brain synaptosomes. Psychopharmacology, 180, 391-398. Reber, A. S., & Reber, E. (2001). The Penguin dictionary of psychology (3rd ed.). London: Penguin Books. Reimold, M., Smolka, M. N., Zimmer, A., Batra, A., Knobel, A., Solbach, C., et al. (2007). Reduced availability of serotonin transporters in obsessive-compulsive disorder correlates with symptom severity - a [11C]DASB PET study. Journal of Neural Transmission, 114, 1603-1609. Stahl, S. M. (2000). Essential psychopharmacology. Cambridge: Cambridge University Press. Van der Veen, F. M., Evers, E. A. T., Deutz, N. E. P., & Schmitt, J. A. J. (2007). Effects of acute tryptophan depletion on mood and facial emotion perception related brain activation and performance in healthy women with and without a family history of depression. Neuropsychopharmacology, 32, 216-224. Walsh, R., Victor, B., & Bitner, R. (2006). Emotional effects of sertaline: Novel findings revealed by meditation. American Journal of Orthopsychiatry, 76, 134-137.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 11
UPDATE ON PHEROMONE RESEARCH Donatella Marazziti*, Irene Masala, Stefano Baroni, Michela Picchetti, Antonello Veltri and Mario Catena Dell’Osso Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Pisa, Italy
ABSTRACT Pheromones are volatile compounds secreted into the environment (in sweat, urine) by one individual of a species and perceived by another individual of the same species, in which they trigger a behavioral response or physiological change. Besides insects, pheromones have been described in several invertebrate and vertebrate animals; moreover, they have been shown to modulate mating preferences, timing of weaning, learning ability to distinguish poisoning from not-poisoning food, social recognition and level of stress. Several studies suggest that pheromones might play an important role also in mammals, as it has been demonstrated that they can use chemical signals for mate attraction, territorial marking, dominance and probably other functions yet to be identified, amongst which, perhaps, some social behaviors. In humans, several studies have indicated that pheromones may influence reproductive endocrinology and have a positive effect on mood. Menstrual synchrony amongst women sharing the same environment is a long-recognized phenomenon related to pheromones produced in the armpits; these substances are not perceived as having any particolar odour, but nonetheless can influence the lenght of the mestrual cycle through the interference with different hormones. The aim of the present paper is to review the latest data on pheromones with a specific focus on humans and future developments.
*
Author to whom correspondence and reprint requests should be sent: Dr. Donatella Marazziti. Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, 56100 Pisa, Italy. Telephone: +39 050 835412; Fax: +39 050 21581; E-mail address:
[email protected]
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INTRODUCTION Pheromones are substances which are gaining an increasing attention, given their important role in intra-species communication. The term “pheromone” is derived from the Greek “pherein”, to transfer (carry) and “horman” to excite or stimulate. Pheromones are volatile chemical compounds secreted into the environment by an individual through sweat and urines and perceived by another member of the same species, in which they trigger a behavioral or neuroendocrine response, or modulate endocrine states and development (Karlson and Lüscher, 1959). Originally, pheromones were distinguished in releaser, which would elicit an immediate behavioural response, or primer, promoting slower and long-lasting changes to endocrine state and development (McClintock, 2000). However, such a classification seemed to be too limited and other categories were soon proposed (McClintock, 2000; Gulyas et al., 2004): that of signaller pheromones that convey information about the sender, and that of modulator which would influence mood and cognitive processes in humans (Brennan and Zufall, 2006; Ngai, 2006; Sheperd, 2006).
PHEROMONES IN INSECTS The first species where pheromones were described to play a role were insects, as some of their behaviors appeared to be regulated by these compounds. Releaser pheromones provoke immediate behavioral responses upon reception, while primer pheromones cause physiological changes in the animal that ultimately lead to specific behaviors. Chemically identified releaser pheromones are of three basic types: those which cause sexual attraction, alarm behavior and recruitment. Sex pheromones elicit the entire pattern of sexual behavior: therefore a male insect may be attracted to and attempt to copulate even with an inanimate object that carry sex pheromone (Regner and Law, 1968). In one of the most studied animals, that is silkworm moths (Bombyx mori), females attract male mates with the pheromone bombykol, (E,Z)-10,12-hexadecadien-1-ol, which is also the first chemically-identified pheromone (Butenandt et al., 1959). In the male moth’s antennae, a pheromone-binding protein conveys bombykol to a membrane-bound receptor on nerve cells. Males are immediately attracted and move toward females where their excitement increases and leads to the characteristic wing-fluttering. Some authors have shown that Bombyx mori males will respond to air streams containing as little as 200 molecules of bombykol per cm3, so that bombykol results to be one of the most biologically active substances known up-to-now (Boeckh et al., 1965). Besides insects, pheromones have been described in several invertebrate and vertebrate animals; moreover, they have been shown to modulate mating preferences, timing of weaning, learning ability to distinguish poisoning from not-poisoning food, social recognition and level of stress (Curtis et al., 1971; Wyatt 2003; Brennan and Keverne, 2004; Brennan and Kendrick, 2006; Brennan and Zufall, 2006). Vertebrate pheromones present a wide range of chemical forms. Their size and their polarity represent their most significant features and are the major factors determining their volatility in air and solubility in water, respectively. In the terrestrial environment, attractant and alarm pheromones, which by their nature act at a
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certain distance, are typically small and volatile. By contrast, pheromones that convey information about specific individuals are likely to be relatively non-volatile, for instance, proteins or peptides, so that they do not get lost and can be more reliably associated with the sender. The situation is quite different in the aquatic environment where solubility is the most important feature, so that even relatively high molecular weight peptides and proteins can function as attractant (Brennan and Zufall, 2006).
PHEROMONES IN MAMMALS Several studies suggest that pheromones might play an important role also in mammals, as it has been demonstrated that they can use chemical signals for mate attraction, territorial marking, dominance and probably other functions yet to be identified, amongst which, perhaps, some social behaviors. In mammals, a specialized region of the olfactory system called the vomeronasal organ (VNO), also referred to as ‘Jacobson’s organ’, is responsible for pheromone detection. The VNO contains a sensory epithelium constituted from different cell types than olfactory epithelium; interestingly, the two epithelia use different transduction mechanisms based on their expression of G-proteins. The VNO receptors are seven-transmembrane receptors coupled to GTP-binding protein, but appear to activate inositol 1,4,5-trisphosphate signalling as opposed to cyclic adenosine monophosphate. Two multigene families of G protein-linked receptors (V1 and V2), each expressed in a distinct region of the VNO, have been identified. These two families of putative VNO receptors differ not only in their linkage to distinct G proteins, but also in the length of their extracellular NH2-terminal domains. The V1 receptors (V1Rs) are linked to Gαi2, possess a relatively short NH2-terminal, and show a greatest sequence diversity in their transmembrane domains. The V2Rs are linked to Gα0 and comprise a family of about 140 genes distinguished by their long extracellular NH2-terminal that is thought to bind ligands (Keverne, 1999). The neurons of the vomeronasal and olfactory epithelia project to different parts of the central nervous system through several synapses, while suggesting that the two systems exert different functions. In particular, the VNO is located above the hard palate on both sides of the nasal septum and is lined with receptor cells whose axons project to the accessory olfactory bulb; this, in turn, sends its terminals to the hypothalamus which modulates reproductive, defensive and eating behaviors, as well as hormone secretion (Henzel et al., 1988; Keverne, 1999), and also to amygdala, that is undoubtedly involved in the processing of vomeronasal information (Lanuza et al., 2008).
PHEROMONES IN HUMANS VNO appears to be vestigial in some primates, and the accessory olfactory bulb is hardly discernable in humans (Grammer et al., 2005). Some embryological studies demonstrated that the VNO begins to develop in humans, but disappears along with the cartilage encapsulating it well before birth. However, it has been suggested that human VNO is functional and would respond to pheromones (even in picogram amounts) in a sex-specific manner (Monti-Bloch et al., 1998; Smith et al., 1998;
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Grosser et al., 2000). Not surprisingly, the assumption that humans might communicate through pheromones is getting an increasing support by experimental data since three decades (Waltman et al., 1973; Michael et al., 1975, for review: Brennan and Zufall, 2006). The human VNO has a unique ultrastructure, with elongated bipolar microvillar cells that stain with several immunomarkers. These cells show physiological properties similar to chemosensory receptor cells of other mammalian species. The organ's local response, or electrovomerogram, is followed by gender-specific behavioral changes, modulation of autonomic nervous system function, or the release of gonadotropins from the pituitary gland. Functional brain imaging studies revealed consistent activation of the hypothalamus, amygdala and cingulate gyrus-related structures during adult human VNO stimulation (Monti-Bloch et al., 1998). The unique effect attributable to pheromones in humans is the synchronicity of the menstrual cycles in women living together: in fact, the exposure to axillary secretions from women in the late follicular and ovulatory phases have been found to shorten and lengthen, respectively, the cycles of recipient females (Stern and McClintock, 1998). These substances, although not perceived, because they have no odour, nonetheless can provoke this effect, probably through the modulation of different hormones (Cutler et al., 1986; Preti et al., 1986, 2003; Stern and McClintock, 1998). Furthermore, men axillary extracts seem to affect women reproductive state by interference with the frequency of LH release (interestingly, this parameter is an excellent indicator of the release of GnRH from the hypothalamus). In women, the positive action of GnRH on LH release influences the length and timing of the menstrual cycle, and, therefore, fertility. Preti et al., (2003) demonstrated that the application of extracts of male axillary secretions provoked changes of LH pulsatility and mood of women, in the sense that they advanced the onset of the next peak of LH, reduced the subsecutive feeling of tension and increased that of relaxation. These results demonstrate that male axillary secretions might contain one or more constituents that would act as primer and modulator pheromones. From a genetic point of view, different theories of sexual selection have emphasised that females can obtain good genes for their offspring by mating with males whose genes are distant, but complementary to their own, while highlightly the importance of the immunocompetence system (Hamilton et al., 1982; Folstad et al., 1992) and, particularly, of the major histocompatibility complex (MHC) (Wedekind and Furi, 1997; Wedekind, 2002). MHC is a large chromosomal region containing closely linked polymorphic genes that play a role in immunological self/ non-self recognition; the possible mechanism by which this can be achieved is via body odour perhaps relayed by androgen-based pheromones (Jordan and Bruford, 1998). Several experimental evidences showed that women prefer odours from individuals of dissimilar MHC (Jordan and Bruford, 1998). These effects have been hypothesized to influence even their choice of sexual partner in specific contexts. Wedekind et al. (1995) demonstrated that women rated the odour of MHC-dissimilar men as ‘more pleasant’, and this odour was significantly more likely to remind them of their own mate’s odour. However, it is still premature to draw any conclusion on the effects of pheromones on attractiveness which, however, have already been suggested (Black and Biron, 1982; Cutler, 1999; Thornhill and Gangstadt, 1999; Thorne et al., 2002). The main sources of human pheromones are the apocrine glands located in the axillae and pubic region. The high concentration of apocrine glands found in the armpits led to the term ‘axillary organ’, which is considered an independent ‘organ’ of human odour production
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(Grammer et al., 2005). Apocrine glands develop in the embryo, but become functional only with the onset of puberty. At sexual maturation, they produce steroidal secretions derived from 16-androstenes (androstenone and androstenol) via testosterone, and as such, the concentrations of several 16-androstenes is significantly higher in men (Brooksbank et al., 1972). Freshly produced apocrine secretions are odourless, but are transformed into the odorous androstenone and androstenol by aerobic coryeform bacteria (Gower and Ruparelia, 1993). Androstenone has been hypothesized to be a human pheromone, albeit it was first identified like a porcine pheromone (Benton and Wastell, 1986; Pierce et al., 2004). In pigs, an estrus sow tends to respond to exposure to androstenone from a rutting boar by adopting a mating stance (Kline et al., 2007). Putative human pheromones are represented by 4,16 androstadien-3-one (AND) and estra-1,3,5(10),16-tetraen-3-olo (EST): AND, as already mentioned, is a derivate of testosterone, produced in the armpits and secreted in concentrations which are up to twenty times higher in men, as compared with women, while EST is a substance resembling naturally occurring estrogens, synthesized after components present in human sweat (Gower and Ruparelia, 1993; Monti-Bloch and Grosser, 1991; Sobel et al., 1999). In the vagina, aliphatic acids (referred to as copulins) are secreted and their odour changes along the menstrual cycle (Michael et al., 1975). It is now possible to isolate and manufacture synthetic human pheromones and such compounds are often used in research as they are relatively easy to make, convenient to store and easy to apply (Grammer et al., 2005).
EXPERIMENTAL EVIDENCE Experimental evidence supported the involvement of pheromones in some human reproductive behaviours. In an early report, Kirk-Smith et al. (1978) asked 12 undergraduate men and women to rate photographs of people, animals and buildings by using a 159-point bipolar scale (e.g. unattractive–attractive), while wearing surgical masks either impregnated with androstenol or left plain; mood ratings were also assessed. In the presence of androstenol, male and female stimuli were judged as being ‘warmer’ and ‘more friendly’. Van Toller et al. (1983) showed that skin conductance in volunteers exposed to androstenone was higher than that of non-exposed volunteers, thereby providing evidence of a certain physiological effect of pheromone exposure. Benton (1982) reported that androstenol application influenced the self ratings of mood at ovulation, and Grammer (1993) found that women rated androstenone differently along the phases of their menstrual cycle; as a result, it has been hypothesized that the link between sensivity to androstenone and these phases may be related to the evolutionary loss of estrus. Using positron emission tomography (PET) Gulyàs et al. (2004) measured regional cerebral blood flow changes in healthy young women during exposure to androstadienone. The results of this study showed that androstadienone as compared with others odorous substances, activated two large cortical fields: the anterior part of the inferior lateral prefrontal cortex and the posterior part of the superior temporal cortex. These brain areas can be identified as cortical fields underlying other than olfactory function, including various aspects of social cognition and attention.
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While laboratory studies might exert more control over the varying factors involved, of potential greater relevance are studies assessing the effects of pheromones in real-life situations. Cowley and Brooksbank (1991) asked men and women to wear a necklace either containing an opposite-sex pheromone or a control substance while they slept. The next day, they found that women who had worn the male pheromones in their necklace reported significantly more interactions with men than the control group. Two studies employed double blind, placebo-controlled methods and focussed upon the effects of synthetic pheromones on self-reported sociosexual behaviors in young men (Cutler et al., 1998) and women (Mc Coy and Pitino, 2002). The ensuing findings showed that pheromones generally influences the socio-sexual behaviours, in the sense that more pheromones than placebo users increased over baseline in sexual intercourse and sleeping with the romantic partner, in addition, women who used pheromones enhanced also formal date and petting-affection kissing (Mc Coy and Pitino, 2002). Generally speaking, the results of these studies appear to provide impressive, albeit preliminary, evidence for the effects of synthetic pheromones on sexual attractiveness. Pierce et al. (2004), reported a significant relationship between odorant responsivity and self-reports of the influence of odors: people able to smell androstenone more commonly reported odors as having a negative effect on interpersonal relationships than did people anosmic to androstenone. This could indicate that the responsivity to certain odorants may be an important factor affecting human social interaction. A relationship of the repressive coping and defensiveness to the perception to androstenone has also been reported and interpreted as motives to seek social approval and avoid social disapproval since they may relate to diminished awareness of androstenone (Kline et al., 2007). Furthermore, it cannot be ruled out that changes in sexual behavior, attraction drives or higher mental processes which have been described following airborne chemicals in humans, might be related to mood fluctuations reported on the same time (Benton and Wastell, 1986; Cutler et al., 1998; Chen and Haviland-Jones, 1999; Jacob and McClintock, 2000; Bensafi et al., 2003, 2004; Lundström et al., 2003; Lundström and Olsson, 2005). These, in turn, may be ascribed to changes of different neurotransmitters, particularly of serotonin (5-HT) which seems to play a pivotal role in mood regulation (Stahl, 1998; Clark et al., 2005).
CONCLUSION Human socio-sexual interactions are influenced by pheromones, even if they cannot be detected consciously. Pheromones have the potential to influence human behavior and physiology and so there has to be asked the question, in which way the modern striving for cleanliness and odourlessness affects our everyday social lives and human reproductive success in the future. What we know at the moment, as many studies in the last few years have pointed out, is that the human sense of smell has by far been underestimated in the past and that humans, like other animals, use olfactory signals for the transmission of biologically relevant information.
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REFERENCES Bensafi, M; Brown, WM; Khan, R; Levenson, B; Sobel, N. Sniffing human sex-steroid derived compounds modulates mood, memory and autonomic nervous system function in specific behavioural contexts. Behav Brain Res, 2004; 152(1), 11–22. Bensafi, M; Brown, WM; Tsutsui, T; Mainland, JD; Johnson, BN; Bremner, EA. Sex-steroid derived compounds induce sex specific effects on autonomic nervous system function in humans. Behav Neurosci, 2003; 117(6), 1125–1134. Benton, D. The influence of androstenol, a putative human pheromone on mood throughout the menstrual cycle. Biol Psychol, 1982;15, 249–256. Benton, D; Wastell, V. Effects of androstenol on human sexual arousal. Biol Psychol, 1986; 22, 141–147. Black, SL; Biron, C. Androstenol as a human pheromone: no effect on perceived attractiveness. Behav Neural Biol, 1982; 34, 326–330. Boeckh, J; Kaissling, KE; Schneider, D. Insect olfactory receptors. Cold Spring Harb Symp Quant Biol, 1965; 30, 263-280. Brennan, PA; Kendrick, KM. Mammalian social odours: attraction and individual recognition. Philos Trans R Soc Lond B Biol Sci, 2006; 361(1476), 2061–2078. Brennan, PA; Keverne, EB. Something in the air? New insights into mammalian pheromones. Curr Biol, 2004; 14, R81–R89. Brennan, PA; Zufall, F. Pheromonal communication in vertebrates. Nature, 2006; 444, 308– 315. Brooksbank, BWL; Wilson, DAA; MacSweeney, DA. Fate of androsta-4, 16-dien-3-one and the origin of 3a-hydroxy-5a-androst-16-ene in man. J Endocrinol, 1972; 52, 239–251. Butenandt, A; Beckmann, R; Stamm, D; Hecker D. Über den Sexual-Lockstoff des Seidenspinners Bombyx mori. Zeitschrift für Naturforschung B,1959; 14, 283–284. Chen, D; Haviland-Jones, J. Rapid mood change and human odors. Physiol Behav, 1999; 68(1-2), 241-250. Clark, L; Roiser, JP; Cools, R; Rubinsztein, DC; Sahakian, BJ; Robbins, TW. Stop signal response inhibition is not modulated by tryptophan depletion or the serotonin transporter polymorphism in healthy volunteers: implications for the 5-HT theory of impulsivity. Psychopharmacol, 2005; 182, 570–578. Cowley, JJ; Brooksbank, BWL. Human exposure to putative pheromones and changes in aspects of social behaviour. J Steroid Biochem Mol Biol, 1991; 39, 647–659. Curtis, RF; Ballantine, JA; Keverne, EB; Bonsall, RW; Michael, RP. Identification of primate sexual pheromones and the properties of synthetic attractants. Nature, 1971; 232, 396– 398. Cutler, WB. Human sex-attractant pheromones: discovery, research, development, and application in sex therapy. Psychiat Ann, 1999; 29, 54–59. Cutler, WB; Friedmann, E; McCoy, NL. Pheromonal influences on sociosexual behaviour in men. Arch Sex Behav, 1998; 27, 1–13. Cutler, WB; Preti, G; Krieger, A; Huggins, GR; Garcia, CR; Lawley, HJ. Human axillary secretions influence women’s menstrual cycles: the role of donor extracts from men. Horm Behav, 1986; 20, 463–473.
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Folstad, I; Karter, AJ. Parasites, bright males, and the immunocompetence handicap. Am Nat, 1992; 139, 603–622. Gower, DB; Ruparelia, BA. Olfaction in humans with special reference to odourous 16androstenes: their occurrence, perception and possible social, psychological and sexual impact. J Endocrinol, 1993;137, 167–187. Grammer, K. 5-a-androst-16en-3a-on: a male pheromone? A briefreport Ethol Sociobiol, 1993; 14, 201–208. Grammer, K; Fink, B; Neave, N. Human pheromones and sexual attraction. Eur J Obstet Gynecol Reprod Biol, 2005; 118(2), 135–142. Grosser, BI; Monti-Bloch, L; Jennings-White, C; Berliner, DL. Behavioural and electrophysiological effects of androstadienone, a human pheromone. Psychoneuroendocrinol, 2000; 25, 289–299. Gulyas, B; Keri, S; O’Sullivan, BT; Decety, J; Roland, PE. The putative pheromone androstadienone activates cortical fields in the human brain related to social cognition. Neurochem Int, 2004; 44(8), 595–600. Hamilton, WD; Zuk, M. Heritable true fitness and bright birds: a role for parasites. Science, 1982; 218, 384–387. Henzel, WJ; Singer, AG; Stults, JT; Macrides, F; Agosta, WC; Niall, H. The primary structure of aphrodisin. J Biol Chem, 1988; 263, 16682–16687. Jacob, S; McClintock, MK. Psychological state and mood effects of steroidal chemosignals in women and men. Hormon Behav, 2000; 37(1), 57–78. Jordan, WC; Bruford, MW. New perspectives on mate choice and the MHC. Heredity, 1998; 81, 239–245. Karlson, P; Lϋscher, M. ‘Pheromones’: a new term for a class of biologically active substances. Nature, 1959; 183, 55–56. Keverne, EB. The vomeronasal organ. Science, 1999; 286(5440), 716–720. Kirk-Smith, M; Booth, MA; Carroll, D; Davies, P. Human social attitudes affected by androstenol. Res Comm Psychol Psychiatr Behav, 1978; 3, 379–384. Kline, JP; Schwartz, GE; Dikman, ZV. Interpersonal defensiveness and diminished perceptual acuity for the odor of a putative pheromone: androstenone. Biol Psychol, 2007; 74(3), 405-413. Lanuza, E; Novejarque, A; Martínez-Ricós, J; Martínez-Hernández, J; Agustín-Pavón, C; Martínez-García, F. Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala. Brain Res Bull, 2008; 75(2-4),460466. Lundström, JN; Goncalves, M; Esteves, F; Olsson, MJ. Psychological effects of subthreshold exposure to the putative humanpheromone 4, 16-androstadien-3-one. Hormon Behav, 2003; 44(5), 395–401. Lundström, JN; Olsson, MJ. Subthreshold amounts of social odorant affect mood, but not behavior, in heterosexual women when tested by a male, but not a female, experimenter. Biol Psychol, 2005; 70(3), 197-204. McClintock, MK. Human pheromones: primers, releasers, signallers ormodulators? In: Wallen K, Schneider E, editors. Reproduction in context. Cambridge, MA: MIT Press; 2000; 335–420. McCoy, NL; Pitino, L. Pheromonal influences on sociosexual behaviour in young women. Physiol Behav, 2002; 75, 367–375.
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Michael, RP; Bonsall, RW; Kutner, M. Volatile fatty acids, ‘Copulins’, in human vaginal secretions. Psychoneuroendocrinol, 1975; 1, 153–162. Monti-Bloch, L; Grosser, BI. Effect of putative pheromones on the electrical activity of the human vomeronasal organ and olfactory epithelium. J Steroid Biochem Mol Biol, 1991; 39, 573–582. Monti-Bloch, L; Jennings-White, C; Berliner, DL. The human vomeronasal system. A review. Ann N Y Acad Sci, 1998; 855, 373-389. Ngai, J. An extradimension to olfaction. Nature, 2006; 442, 637-638. Pierce, JD Jr; Cohen, AB; Ulrich, PM. Responsivity to two odorants, androstenone and amyl acetate, and the affective impact of odors on interpersonal relationships. J Comp Psychol, 2004; 118(1),14-19. Preti, G; Cutler, WB; Garcia, CR; Huggins, GR; Lawley, HJ. Human axillary secretions influence women’s menstrual cycles: the role of donor extracts of females. Horm Behav, 1986; 20, 474–482. Preti, G; Wysocki, CJ; Barnhart, KT; Sondheimer, SJ; Leyden, JJ. Male axillary extracts contain pheromones that affect pulsatile secretion of luteinizing hormone and mood in women recipients. Biol Reprod, 2003, 68(6); 2107-2113. Regnier, FE; Law, JH. Insect pheromones. J Lipid Res, 1968; 9(5), 541-551. Sheperd, GM. Behaviour: smells, brain and hormones. Nature, 2006; 439, 149-151. Smith, TD; Siegel, MI; Mooney, MP; Burdi, AR; Fabrizio, PA; Clemente, FR. Searching for the vomeronasal organ of adult humans: preliminary findings on location, structure, and size. Microsc Res Tech, 1998; 41, 483–491. Sobel, N; Prabhakaran, V; Hartley, CA; Desmond, JE; Glover, GH; Sullivan, EV; Gabrieli, JD. Blind smell: brain activation induced by an undetected air-borne chemical. Brain, 1999; 122(2), 209-211. Stahl, SM. Essential Neuropsychopharmacology – neuroscientific basis and pratical applications. Cambridge: Cambridge University Press; 1998. Stern, K; McClintock, MK. Regulation of ovulation by human pheromones. Nature, 1998; 392, 177-179. Thorne, F; Neave, N; Scholey, A; Moss, M; Fink, B. Effects of putative male pheromones on female ratings of male attractiveness: influence of oral contraception and the menstrual cycle. Neuroendocrinol Lett, 2002; 23, 291–297. Thornhill, R; Gangstad, SW. The scent of symmetry: a human sex pheromone that signals fitness? Evol Hum Behav, 1999; 20, 175–201. Van Toller, C; Kirk-Smith, M; Lombard, J; Dodd, GH. Skin conductance and subjective assessments associated with the odour of 5a-androstan-3-one. Biol Psychol, 1983; 16, 85– 107. Waltman, R; Tricom, V; Wilson, GE Jr; Lewin, AH; Goldberg, NL; Chang, MMY. Volatile fatty acids in vaginal secretions: human pheromones? Lancet, 1973; 2, 496. Wedekind, C. The MHC and body odors: arbitrary effects caused by shifts of mean pleasantness. Nat Genet, 2002; 31(3), 237. Wedekind, C; Füri, S. Body odour preferences in men and women: do they aim for specific MHC combinations or simply heterozygosity? Proc Biol Sci, 1997; 264(1387),14711479. Wedekind, C; Seebeck, T; Bettens, F; Paepke, AJ. MHC-dependent mate preferences in humans. Proc R Soc Lond B, 1995; 260, 245–249.
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Wyatt, TD. Pheromones and animal behaviour: communication by smell and taste. Cambridge University Press. Cambridge, UK; 2003.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 12
NORMAL AND OBSESSIONAL JEALOUSY: AN ITALIAN STUDY Donatella Marazziti*, Marina Carlini, Francesca Golia, Stefano Baroni, Giorgio Consoli, Mario Catena Dell’Osso Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Italy
ABSTRACT Background: Jealousy is a complex emotion spanning from normality to pathology. The present study aimed to define the boundaries between normal and obsessional jealousy by utilizing a specific self-report questionnaire. Methods: The so-called “Questionnaire of Affective Relationships (QAR)” was administered to 400 university students of both sexes, as well as to 14 outpatients affected by obsessive-compulsive disorder (OCD). The total scores and the responses to each of the 30 items were analyzed and compared. Results: Two hundred and forty-five (approximately 61 %) of the questionnaires given to the students were returned. Statistical analyses revealed that the OCD patients had higher total scores than the healthy students. Moreover, we were able to identify an intermediate group of subjects, consisting of 10 % of the total, who exhibited thoughts of jealousy regarding their partner, but to a lesser degree than the OCD patients. These were labeled as “healthy jealous subjects” because no other psychopathological trait could be observed. in addition, significant intergroup differences in single items were observed. Conclusion: The present study showed that in our population of university students, 10 % of the subjects, although normal, had excessive jealous thoughts regarding their partner. In fact, we could clearly distinguish these subjects from the OCD patients and from the healthy subjects with no jealousy concerns by means of the specific questionnaire developed by us. Probably, they represent a subgroup of jealous , albeit normal, subjects. *
Author to whom correspondence and reprint request are to be sent: Dr. Donatella Marazziti. Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, I-56100 Pisa, Italy. Telephone: +39 050 835412; Fax: +39 050 21581. E-mail address:
[email protected]
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Donatella Marazziti*, Marina Carlini, Francesca Golia et al.
Keywords: jealousy; obsessive-compulsive disorder; healthy conditions; questionnaire of affective relationships; dimensions
INTRODUCTION Jealousy is a complex emotion that both psychological and psychiatric research is still attempting to elucidate; it involves the perception of a threatened or loss of a valued relationship to a rival, either real or imagined. According to its intensity and persistence, it can range, from normal to pathological states (Parker & Barret, 1997). Pathological jealousy can be a reaction to a perceived threat to a relationship (defined as “reactive” jealousy), or a symptom of some organic/toxic condition, such as alcoholism (Shrestha et al., 1985; Micheal et al., 1995), or of some underlying psychiatric disorders, in particular obsessive-compulsive disorder (OCD) or paranoia (Cobb & Marks, 1979; Tarrier et al., 1990; Parker & Barret, 1997). The attention of most researchers has been mainly focused on delusional jealousy, a type of jealousy which, according to Kraft-Ebing (1982), can be distinguished in delusion of infidelity and delusion of jealousy. There is less information on obsessional jealousy, in which there is a quality of obsessional ideation and egodystonia, a feature which can, however, vary from patient to patient. There has been a level of success in treating this category of jealousy as being related to OCD, since standard anti-OCD treatments, such as selective serotonin (5-HT) reuptake inhibitors (SSRIs), have proven to be quite effective (Lane, 1990; Gross, 1991; Stein et al., 1994). Defining the boundary between “normal” and “pathological” jealousy is extremely difficult, a task which represents “a formidable problem” for clinicians (Mullen, 1991), as pathological jealousy is easier to recognize than to define (Tarrier et al., 1990). Any definition of pathological jealousy should include an unfounded suspicion regarding the partner’s fidelity, a suspicion that modifies thoughts, feelings and behavior. Such modified thoughts are, however, not based on reliable empirical evidence, and they unavoidably impair the normal functioning of the individual experiencing them, as well as affect the partner and the relationship. Pathological jealousy leads the subject to actions aimed to “confirm” the suspicions, actions which are readily evident to others, especially to the partner, who finds that his or her whereabouts, actions, and even intentions are constantly being checked (Docherty & Ellis, 1979). Behavioral avoidance of jealousy-provoking situations are also quite frequent. Arguments and accusations can result in verbal and physical violence, and, on occasion, even in murder (Docherty & Ellis, 1979; Tarrier et al., 1990). In addition, the border between normal and pathological jealousy depends very much on the social customs and the historical periods as noted by Mullen (1991), in his fundamental review, a century ago, jealousy was thought of as being socially acceptable, while nowadays, it is perceived as an embarrassing emotion. It should, therefore, be kept in mind that a society or culture considers jealousy to be morbid when it exceeds that level of possessiveness which in that moment is regarded as the norm. Differing perspectives can lead to different interpretations of jealousy. Freud suggested, that jealousy is rooted in the Oedipus, or “brother and sister”, complex, and he made a distinction between “delusional jealousy”, due to homosexual feelings towards the heterosexual partner, and “neurotic jealousy”, arising from heterosexual feelings towards the
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heterosexual partner. Along the evolutionary approach, jealousy is interpreted as an universal and innate experience and response, with positive, albeit different, values in the two sexes: in men it is more linked to the certainty of paternity, while in women to the need of a stable and long-lasting support for child-rearing. The results of a number of studies supported this notion (Buss, 1989; Buss et al., 1992), while showing that men feel more distress than women at possibility of sexual infidelity, while women are more concerned by potential emotional infidelity. However, other studies, which examine the impact of gender on characteristics of jealousy which might be explained not only by evolutionary processes, but also by the influence of socio-cultural factors, have raised doubts about these findings (Buunk et al., 1996). Besides these factors, there may also be neurobiological mechanisms regulating the development, expression and degree of jealousy. Kraepelin (1910) and other early authors claimed that jealousy had its origin in the brain, and he pointed out its presence in cases of neurological disorders and substance abuse. Very little information is currently available regarding the biology of jealousy, although there seems to be some involvement of the attachment system (oxytocin) (Insel & Shapiro, 1992) and of different neurotransmitters, such as serotonin (5-HT) (Insel & Winslow, 1998; Newman, 1998; Marazziti et al., 2003a). The aim of the present study was that of contributing to the definition of the boundary between normal jealousy and obsessional jealousy by means of a specific self-report questionnaire developed by us.
METHODS We administered the self-report questionnaire (see appendix) of jealousy to a group of 400 subjects, composed of university students and local residents of both sexes. We had previously administered a prototypical version of the questionnaire, called “Questionnaire of Jealousy”, to a pilot sample of 30 students, not included in our larger sample of 400, who refused to complete it. Subsequently, we changed the label of the questionnaire in “Questionnaire of Affective Relationships (QAR)”, and immediately all resistance to filling in it vanished: this, in our view, clearly reflects the negative attitude towards jealousy in our modern society. The QAR consists of 30 items; responses are rated on a Likert scale ranging between 1 (least severe) and 4 (most severe). The items were designed in such a way as to assess specific behavior arising from thoughts of jealousy, such as checking a partner’s explanations, friends, or clothes, or limiting a partner’s freedom: they, therefore, explored different features: 1. 2. 3. 4. 5. 6. 7.
concerns about a partner’s behavior (# 1, 2, 3, 4, 5, 6); time spent in concerns/thoughts about a partner’s fidelity (# 8); interference with daily activities and a partner’s outside relationships (# 7, 9, 10) characteristics of the concerns/thoughts (# 11, 12) avoidance behavior (# 15, 16, 17) prevention of a partner’s behavior (# 18, 19); level and quality of sexual activity (# 20, 21, 22, 23)
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Donatella Marazziti*, Marina Carlini, Francesca Golia et al. 8. checking up on a partner’s behavior (# 24, 25, 26, 27, 28, 29, 30).
We specifically directed the subjects to focus on jealousy feelings regarding their current relationships. We used the score of the item # 8 (“time spent on concerns/thoughts about a partner’s fidelity”) as a basis for distinguishing between normal jealousy and obsessive jealousy; more than 1 hour a day was considered a specific threshold, based on a similar item of the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1986). Fourteen patients with OCD (10 female and 4 male: mean age+SD: 29.4+6.5 years), whose main obsession was jealousy, were also administered the QAR. These patients were recruited at the outpatients unit of the “Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie” at the University of Pisa, and met current DSM-IV (APA, 1994) criteria for OCD, with neither a past nor a current history of mood disorders, as assessed by the SCID-IV (First et al., 1997). None of the patients had ever taken drugs, except that three who had taken benzodiazepines and/or neuroleptics in the past. The age (mean+SD) at the onset of OC symptoms was 18+5, and the duration (mean+SD) of the disorder was 10+9 years. The severity of the OC symptoms was evaluated by means of the Y-BOCS: the total score (mean+SD) was 27.5+7.3. The subjects were all free of physical illness, and participated in our study after giving their informed written consent. Statistics. We used one-way analysis of variance (ANOVA) to compare the mean score of Y-BOCS and QAR amongst the groups. Post-hoc comparisons were performed using the Scheffè method. Analysis of covariance (ANCOVA) was used to control for the effect of gender and age. All analyses were carried out using SSPS, version 4.0 (Nie et al., 1998).
RESULTS Two hundred and forty-five (61.2 %) questionnaires, out of the total of 400, were completed. The remaining 155 (38.8 %) were not returned due to either refusal to complete them or to the lack of a partner in a current intimate relationship. One hundred and fifty-nine (64.9%) of the subjects were women while 86 (35.1%) were men, and their age (mean+SD) was 26.0+6.5 years. Two hundred and twenty-one (90.2 %) (142 women and 79 men), out of the total of 245, demonstrated no concerns/thoughts of jealousy: their age (mean+SD) was 25.6+5.9 years. Two hundred and nine were single and 12 married. Twenty-four (9.8 %) (17 women and 7 men), out of the total of 245, were shown as being excessively jealous: their age (mean+SD) was 24.9+4.0 years. Twenty-two were single and 2 married. The total score on the QAR was 42.8+10.7 (range: 17-76) in the first group, 49.9+14.02 (range: 27-82) in the second and 64.9+16.2 (range: 36-90) in the group of OCD patients. As shown in Table 1, significant differences amongst the three groups were observed; in particular, the OCD patients resulted to be more jealous than the excessively jealous subjects, who, in turn, had higher scores than the non-jealous subjects.
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We found also differences amongst the three groups regarding a series of items, except for # 9 (“these concerns, if present, appear to you excessive and unreasonable”) and # 21 (“frequency of sexual intercourse”). The scores of the OCD patients resulted significantly higher than those of the normal jealous subjects, who, in turn, had higher scores than the nonjealous ones, regarding items # 5, 6, 8, 12, 14, 16, 18, 19, 22, 24, 25, 26, 27 and 28. There were similarities between the OCD and the normal jealous subjects, with both groups showing significant differences, as compared with the non-jealous ones, concerning items # 7 (an index of egodystonia), # 23 (fear of not being sexually attractive to a partner) and # 30 (checking the partner’s clothes). The normal jealous subjects were similar to the non-jealous ones, with both groups showing a statistically-significant difference from the OCD patients, for items # 1, 2, 3, 4, 10, 13, 15, 17 and 29. These differences were not explained by differences in gender and age. Table 1. Characteristics of the subjects (mean+SD)
Healthy Jealous Subjects17 F, 7 M OCD Patients 10 F, 4 M Healthy subjects 142 F, 79 M
Age (year) 24.9+4.0
Y-BOCS 6.2+4.3
QAR 49.9+14.0
29.+6.5
27.5+7.3
64.9+16.2
25.6+5.9
2.1+1.4
42.8+10.7
Analysis of variance of the total score of the questionnaire: F test: 27.84, p < 0.0001 Post-hoc significant differences: OCD patients > healthy jealous subjects OCD patients > healthy controls Healthy jealous subjects > healthy subjects OCD patients > healthy jealous subjects > healthy subjects
CONCLUSION There is a main bias in the present study, that should be acknowledged: it was carried out in a sample of university students and local residents, which, as has already been pointed out (Mullen & Martin, 1994), is not representative of the general population; however, most of the published papers on jealousy report results based on samples consisting of students (Mathes, 1986; Micheal et al., 1995; Pines & Friedman, 1997). Notwithstanding this limitation, our study showed some intriguing results. About 10% of the students had a tendency to harbor excessive thoughts of jealousy concerning their partner. This is not a finding which can be easily compared to those of previous studies, since we specifically directed the subjects to focus only on current relationships and the feelings associated with it, without referring to any past experiences. When past experiences were taken into consideration, the percentage of jealous subjects rose, but the level of jealousy was not as extreme (Mathes et al., 1982; Buunk et al., 1985; Mathes, 1986; Paul et al., 1993).
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More important, our questionnaire enabled us to quite clearly distinguish three groups of subjects: the normal subjects, those who were excessively jealous and whom we labeled “normal jealous”, and those patients affected by obsessional jealousy. The results for a number of the items on the questionnaire were significantly different in the three groups, such as the time spent in jealous thoughts/concerns (between 1 and 4 hours a day amongst the normal jealous subjects, and between 4 and 8 hours a day amongst the OCD patients), the ability to remove jealous thoughts out of the mind, the degree to which the relationship was impaired, the degree to which there was an attempt to limit the partner’s freedom, and the checking up on a partner’s behavior. Noteworthy is the fact that healthy jealous subjects were no different from the OCD patients in terms of egodystonia, which may represent a specific index of obsessional preoccupation. The OCD patients did, however, show higher scores than both the normal jealous subjects and the healthy controls with regard to the frequency of preoccupation, suspicion, interference with daily activities, strategies to avoid jealous thoughts/concerns, and the checking for traces of sexual intercourse. It might be concluded that “normal jealous subjects” suffered from a moderate form of OCD, or had an obsessive-compulsive personality or a positive family history of OCD: but we excluded all such possibilities by means of a detailed psychiatric interview and the YBOCS total score that was within the normal range. In addition, the percentage of those “normal jealous” subjects is different from that reported for OCD, which is present in the 2.5 % of the general population (Karno et al., 1988). We believe that, at least in young subjects, our questionnaire is effective in distinguishing three different forms of jealousy, and that even normal jealousy is heterogeneous (Mullen & Martin, 1994; Micheal et al., 1995; Stein et al., 1994). We recently proposed a dimensional model along the “uncertainty/certainty” and “insight/no insight” dimensions, possibly related to the 5-HT system (Marazziti et al., 1999, 2003a, b), spanning from the pole of normality to the opposite pole of delusional severity, where a number of different conditions can be located. It is our opinion that the phenomenon of jealousy may also fit well in this model.
REFERENCES American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press. Buss, D. M. (1989). Sex differences in human mate preferences: Evolutionary hypotheses tested in 37 cultures. Behavioural and Brain Science, 12, 1-49. Buss, D. M., Larsen, R. J., Westen, D., Semmelroth, J. (1992). Sex differences in jealousy: Evolution, physiology, and psychology. Psychological Science, 3, 251-255. Buunk, B. P., Angleitner, A., Oubaid, V., Buss, D. M. (1996). Sex differences in jealousy in evolutionary and cultural perspective: Tests From the Nederlands, Germany and the United States. Psychological Science, 7, 359-363. Cobb, J. P., Marks, I. M. (1979). Morbid jealousy featuring as obsessive-compulsive neurosis; treatment by behavioral psychoterapy. British Journal of Psychiatry, 34, 301305. Docherty, J., Ellis, J. (1979). A new concept and finding in morbid jealousy. American Journal of Psychiatry, 133, 679-683.
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First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. V. (1997). Structured Clinical Interview for DSM-IV Axis I disorder-Patient Edition (SCID-I/P, Version 2.0, 4/97 revision). Biometrics Research Department, New York State Psychiatric Institute. Goodman, W. K., Price, L. H., Rasmussen, S. A. (1986) The Yale Brown Obsessivecompulsive Scale I: development, use and reliability. Archives of General Psychiatry, 46, 1006-1011. Gross, M. D. (1991). Treatment of pathological jealousy by fluoxetine. American Journal of Psychiatry, 148, 683-684. Insel, T. R., Shapiro, L. E. (1992). Oxytocin receptor distribution reflects social organization in monogamous and polygamous voles. Proceedings of the National Academy of Sciences, USA, 89, 5981-5985. Insel, T. R., Winslow, J. T. (1998). Serotonin and neuropeptides in affiliative behaviors. Biological Psychiatry, 44, 207-219. Karno, M., Golding, J. M., Sorenson, S. B. (1988). The epidemiology of obsessivecompulsive disorder in five US Communities. Archives of General Psychiatry, 45, 10941099. Kraepelin, E. (1910). Ein Lehrbuch fur Studierende und Aertze. 8th ed. Leipzig, Germany: Johann Ambrosius Barth. Kraft-Ebbing, R. (1982). Ueber Eifersuchtswahn beim Männe. Journal of Psychiatry and Neurology, 10, 212-231. Lane, R. D. (1990). Successful fluoxetine treatment of pathological jealousy. Journal of Clinical Psychiatry, 51, 345-346. Marazziti, D., Akiskal, H. S., Rossi, A., Cassano, G. B. (1999). Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine, 29, 741-745. Marazziti, D., Di Nasso, E., Masala, I., Baroni, S., Abelli, M., Mengali, F., Mungai, F., Rucci, P. (2003b). Normal and obsessional jealousy: a study of a population of young adults. European Psychiatry, 18, 106-111. Marazziti, D., Rucci, P., Di Nasso, E., Masala, I., Baroni, S., Rossi, A., Giannaccini, G., Mengali, F., Lucacchini, A. (2003a). Jealousy and subthreshold psychopathology: a serotonergic link. Neuropsychobiology, 47, 12-16.Mathes, E. W., Roterr, M. P., Joerger, S. M. (1982). A convergence validity study of six jealousy scales. Psychological Reports, 50, 1143-1147. Mathes, E. V. (1986). Jealousy and romantic love: a longitudinal study. Psychological Reports, 58, 885-886. Michael, A., Mirza, S., Mirza, K. A. H. (1995). Morbid jealousy in alcoholism. British Journal of Psychiatry, 167, 668-672. Mullen, P. E. (1991). Jealousy: The pathology of passion. British Journal of Psychiatry, 158, 593-601. Mullen, P. E., Martin, J. (1994). Jealousy: A community study. British Journal of Psychiatry, 164, 35-43. Newman, J. D. (1998). The physiologic control of mammalian vocalization. New York: Plenum Press. Nie, N. H., Hull, C. H., Steinbrenner, K., Bent, D. H. (1998). Statistical Package for the Social Science (SPSS), (4nd edn), New York: Mc Graw-Hill Company. Parker, G., Barrett, E. (1997). Morbid jealousy as a variant of obsessive-compulsive disorder. Australian and New Zealand Journal of Psychiatry, 31, 133-138.
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Paul, L., Foss, M. A., Galloway, J. (1993). Sexual jealousy in young men and women. Aggressive Behaviour, 19, 401-420. Pines, A. M., Friedman, A. (1997). Gender differences in romantic jealousy. The Journal of Social Psychology, 138, 54-71. Shrestha, K., Reeds, D. W., Rix, K. J. B. (1985). Sexual jealousy in alcoholics. Acta Psychiatrica Scandinavica, 72, 283-290. Stein, D. J., Hollander, M. D., Josephson, S. C. (1994). Serotonin reuptake blockers for the treatment of obsessional jealousy. Journal of Clinical Psychiatry, 55, 30-33. Tarrier, N., Beckett, R., Harwood, S., Bishay, N. (1990). Morbid jealousy: a review and cognitive-behavioural formulation. British Journal of Psychiatry, 157, 319-326.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 13
JEALOUSY, SEROTONIN AND SUBTHRESHOLD PSYCHOPATHOLOGY Donatella Marazziti*, Francesca Golia, Marina Carlini, Stefano Baroni, Irene Masala, Mario Catena Dell’Osso, Giorgio Consoli Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Italy
ABSTRACT Background: Different studies have suggested that some neurotransmitters may play a role in the expression of jealousy. In our study, we utilized the specific binding of 3Hparoxetine (3H-Par) as a peripheral tool to explore the serotonergic system in platelets of healthy subjects with and without jealousy concerns. Methods: Twenty-one subjects with thoughts of jealousy and 21 subjects without jealousy concerns, as revealed by their score at a specific questionnaire (“Questionnaire of Affective Relationships”, QAR), were included in our study. Subjects in the first group were administered a battery of self-report instruments designed to detect the presence of subthreshold psychopathology. The binding of 3H-Par was carried according to a standardized protocol. Results: The results showed a reduced density of 3H-Par binding in the “jealous” subjects, as compared with the “non-jealous” subjects. In addition, most of the subjects of the first group had one or moresubthreshold psychopathological conditions. Conclusion: We concluded that jealousy may be considered an expression of subtle forms of psychopathology, and may provoke an alteration of the serotonergic system, as reflected by the lower density of the platelet serotonin transporter.
Keywords: Jealousy, Serotonin System, Serotonin transporter, Platelets, Subthreshold Psychopathology
*
Author to whom correspondence and reprint request are to be sent: Dr. Donatella Marazziti. Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, via Roma, 67, I-56100 Pisa, Italy. Telephone: +39 050 835412; Fax: +39 050 21581. E-mail address:
[email protected]
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INTRODUCTION Romantic jealousy is a heterogeneous emotion, ranging from normality to pathology, with different degrees of intensity, persistence and insight (Parker and Barrett, 1997), and can be defined as a complex emotional state in which a suspicion, or even conviction, of a partner’s infidelity is the main concern. How to define exactly the boundaries between “normal” and “pathological” jealousy represents “a formidable problem” for clinicians (Mullen, 1991), because recognizing pathological jealousy seems to be easier than defining it (Tarrier et al., 1990). Pathological jealousy may be an extreme reaction to an abnormally-perceived threat to a relationship, or a symptom of an underlying organic/toxic condition, such as alcoholism (Shresta et al., 1985; Michael et al., 1995), or of a psychiatric disorder, such as obsessive-compulsive disorder, mood disorders, separation anxiety and paranoia (Tarrier et al., 1990). Most researchers have focussed their efforts on delusional jealousy, while the other forms of pathological jealousy have received much less attention. From the evolutionary point of view, jealousy is an experience and a response which is both universal and innate with different significance in the two sexes: in men it is driven by the certainty of paternity, while in women by the need of a stable and long-lasting support for childrearing (Buss et al., 1989; 1992). For this reason, it has been suggested that neurobiological mechanisms might regulate the development, expression and degree of jealousy. Early in the last century, Kraepelin (1910) proposed that jealousy has its roots in the brain, while noting its presence in both neurological and substance abuse disorders. The literature on the biology of jealousy is quite meager and, perhaps, involves the attachment system (oxytocin) (Insel and Shapiro, 1992) and different neurotransmitters, such as norepinephrine, opioid peptides, dopamine and serotonin (5-HT), which play a role in pairbonding formation, sexual behavior and the establishment of long-lasting relationships (Newman, 1998). We recently proposed a dimensional model along the “uncertainty/certainty” and “insight/no insight” dimensions, which had permitted the detection of similar reductions in platelet 5-HT transporter proteins in both patients with different psychiatric disorders and normal conditions, such as the early phase of a love relationship (Marazziti et al., 1999). In the current study we applied the same theoretical model to jealousy Therefore, we measured and compared the platelet 5-HT transporter, by means of the 3Hparoxetine binding (3H-Par), in both jealous and non-jealous subjects,who were distinguished on the basis of their scores at a specific self-administered questionnaire (“Questionnaire ofAffective Relationships”, QAR).
METHODS Subjects Our study sample consisted of: a) 21 subjects (14 female and 7 male, mean age +SD: 24.9+4.0 years) who had jealous thoughts; and b) 21 subjects matched by age and gender with group a), selected from a larger group of medical students and residents who completed
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the QAR and were included in a previous study (Marazziti et al., 2003). These were 14 females and 7 males, with a mean age of 25.1+5 years,and were not jealous. A psychiatric interview excluded the presence of a personal or family history of major psychiatric disorders. We then categorized the subjects as “jealous” or “non-jealous” according to how much time the subject spent on thoughts/concerns regard their partner’s fidelity: we considered more than 1 hour a day to be a specific hallmark, based on a similar item in the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) (Goodman et al., 1986). The subjects in group a) were administered a battery of spectrum questionnaires with the aim of detecting the presence of a subthreshold psychopathology (Rucci & Maser, 2000). Furthermore, measurements were repeated in two different years in order to check the stability of the binding parameters. None of the subjects was suffering from a physical illness. All gave their informed written consent to participate in the study, which was approved by the Ethical Committee of the University of Pisa.
Instruments: Questionnaire of Affective Relationships (QAR) The QARis composed by 30 items, and all responses to the questions are assigned a number on a Likert scale from 1 (least severe) to 4 (most severe). The items were specifically designed to permit an evaluation concerning behaviors arising from thoughts of jealousy, such as checking a partner’s explanations, friends, or clothes, or limiting a partner’s freedom (Marazziti et al., 2003). No specific cut-off score has yet been established to discrimate between “jealous” and “nonjealous” subjects because this questionnaire was not yet validated . Therefore, for the purposes of the present study we decided to use just a single item, specifically “time spent on thoughts/ concerns regarding a partner’s fidelity”, to characterize jealous subjects.
Spectrum Instruments We used the following four instruments to better characterize jealous subjects: the mood spectrum self-report (MOODS-SR), the social anxiety spectrum self-report (SHY-SR), the panic-agoraphobia spectrum self-report (PAS-SR) and the obsessive-compulsive spectrum self-report (OBS-SR), which were designed to assess the spectrum of 4 psychiatric disorders, namely mood disorders (unipolar and bipolar disorder), social anxiety disorder, panic disorder and obsessive-compulsive disorder. Excellent psychometric properties were demonstrated by these spectrum instruments, amongst which were high test-retest reliability, good discriminant validity and, for the PASSR, clinical validity in predicting time to response to treatment (Frank et al., 2000; 2002; Shear et al., 2001; Dell’Osso et al., 2002). Following a method described in Frank et al. (2001), we employed Receiver Operating Characteristic Curve (ROC) analysis in determining a cut-off score for these instruments. Subjects meeting at least one of the four spectrum conditions were identified using these cut-off scores. The expert clinical judgment of one of the authors was also used to determine the presence of the spectrum. To define a clinically significant spectrum condition, we
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utilized a combined criterion, defined by exceeding at least one threshold score on the four instruments and being rated clinically positive for the spectrum.
Preparation of Platelet Membranes Venous blood (20 ml) was collected between 8 and 9 a.m. during the months of MarchJune (to avoid the possible interference of circadian and seasonal rhythms, respectively) from subjects who had fasted. The sample was then mixed with 1 ml of anticoagulant 0.15 M EDTA. The biologists who analyzed the blood samples had no knowledge of the subjects’ conditions. We used low-speed centrifugation (200 x g, for 20 min, at 22°C) to obtain platelet-rich plasma. Platelets were precipitated from PRP by centrifugation at 10,000 x g for 10 min at 4°C, and then washed with 8 ml buffer (150 mM NaCl, 20 mM EDTA, 50 mM Tris-HCl, pH 7.5, 4°C). We lysed and homogenized the pellets in 8 ml buffer (5 mM Tris-HCl, 5mM EDTA, pH 7.5, 4°C) with an ultrathurrax homogenizer, which were then centrifuged twice at 30,000 x g for 15 min at 4°C. The ensuing pellet was then stored at -80°C until the assay, which was performed within a week.
3
H-Par Binding
Platelet membranes were suspended in an assay buffer 50 mM Tris, 120 mM NaCl, 5 mM KCl (pH 7.4), and homogenized. The 3H-Par binding was carried out following the method of Marazziti et al. (1996). The incubation mixture consisted of 100 µl of platelet membranes (50-100 µg protein/tube), 50 µl of 3H-Par at six concentrations ranging from 0.01 to 1 nM, and 1850 µl of assay buffer. Specific binding was obtained as the binding remaining in the presence of 10 µM fluoxetine (a gift from Eli-Lilly Co., Indianapolis, USA) as a displacer. All samples were assayed in duplicate and incubated at 22°C for 1 hour. The incubation was halted by adding 5 ml of cold assay buffer. The content of the tubes was immediately filtered under vacuum through glass fibre filters GF/C (Whatman) 2.5 cm in diameter, and washed 3 times with 5 ml of assay buffer. Equilibrium-saturation binding data, the maximum binding capacity (Bmax, fmol/mg) and the dissociation constant (Kd, nM) were analyzed by means of iterative curve-fitting computer programs EBDA (McPherson, 1985). Proteins were measured following Peterson’s method (1977).
Statistics Independent-sample t-test analysis was used to compare the Bmax mean values between the two study groups. We performed analysis of covariance (ANCOVA) to check for the effect of gender and age on differences in mean Bmax values between the groups. All analyses were carried out using SPSS, version 10.
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RESULTS The mean+SD of the QAR total score was 40+11 and 53+12 in the non-jealous and the jealous subjects, respectively, significantly lower in the first than in the second group. Jealous subjects had Bmax values significanly lower than those without jealousy concerns (833+232 vs 1518+229, t-test= -10, df=38, p<0.001). However, no difference in Kd mean values was observed between the two groups (Table 1). Neither age nor gender had an effect on 3H-Par binding parameters. In the group of 21 jealous subjects, who had blood samples collected on two different occasions, the mean Bmax was computed to increase the reliability of the measurement. Of these 21 subjects, 8 had a psychiatric spectrum condition, defined as exceeding at least one of the cut-off scores of the 4 spectrum questionnaires. Specifically, five of these subjects were seen to exceed the threshold for the obsessive-compulsive spectrum, two the panicagoraphobic spectrum, and one the mood spectrum. Three of these subjects had multiple spectrum conditions (Table 2). Although the Bmax values in these 8subjects with a spectrum condition were, on average, lower than in subjects without the spectrum condition, the difference failed to reach statistical significance (t-test=0.74, df=19, p=0.47). Table 1. 3H-Paroxetine binding parameters (Bmax and Kd, mean+SD) in subjects without and with jealousy concerns Bmax 1518+229*
Subjects without jealousy concerns (14 F, 7 M) Subjects with jealousy concerns(14 F, 7 M)
Kd 0.123+0.075
833+232
0.166+0.130
Bmax = fmol/mg protein; Kd = nM; * significant at p<0.001
Table 2. Spectrum conditions in 8 excessively jealous subjects. Subjects 2, 4, 8 exceeded the cut-off score for more than one spectrum PAS-SR
OBS-SR
SHY-SR
MOODS-SR
1
1
76
7
6
2
31
96
100
88
3
52
19
8
49
4
57
68
92
84
5
20
64
53
37
6
40
26
6
26
7
27
34
10
85
23
61 8
13
66
8
8
8 Total
N
8
PAS-SR = panic agoraphobia spectrum (cut-off score 35) OBS-SR = obsessive-compulsive spectrum (cut-off score 59) SHY-SR = social anxiety spectrum (cut-off score 59) MOODS-SR = mood spectrum (cut-off score 61)
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CONCLUSION The limitation of the present study is that the healthy subjects were recruited from a population consisting of university students and local residents, which is not representative of the general population, as it has already been noted (Mullen and Martin, 1994); notwithstanding this fact, a large portion of the published material on jealousy has been collected from studies involving similar groups of subjects (Mathews, 1986; Pines and Friedman, 1997). In any case, our study, yielded some intriguing preliminary results. The evaluation of the platelet 5-HT transporter showed that there was a significant decrease of the platelet 5-HT transporter proteins in subjects with concerns regarding their partner’s fidelity, as compared with those, with no such concerns: the biological measurements, therefore, seemed to support the distinction between the two groups. An interesting fact is that the number of platelet 5-HT transporter proteins in the jealous subjects was similar to that measured in patients with different psychiatric disorders, such as major depression, panic disorder, and obsessive-compulsive disorder, as well as in one normal condition, i.e., romantic love (Marazziti et al., 1999). These findings, taken together, suggest that all these different conditions share “something” reflected by the decreased number of the 5-HT transporter, probably at the level of common dimensions yet to be identified. Support for this assumption can be found in the fact that five subjects with jealousy concerns had an OC spectrum pathology, and in three of these there were other subthreshold symptoms. Two other subjects had panic-agoraphobic spectrum, and one subject had mood spectrum. It must also be noted that, although our approach in determining the presence of a clinically significant spectrum condition was very conservative, another 10, out of the total 21 jealous subjects, met either the clinical or the instrument criterion. Our study, although carried out in a small sample to draw firm conclusions, yielded intriguing findings which would suggest that excessive jealous thoughts/concerns could be the expression of underlying, subthreshold forms of psychopathology, which, although not meeting the full criteria of formal psychiatric disorders, nevertheless impair the normal functioning of an individual and predispose him/her to the development of doubts regarding the partner’s fidelity. Therefore, the spectrum conditions may represent factors of a nonspecific vulnerability, a kind of fragile background that, when triggered by the presence of the love relationship, may lead to excessive jealousy. We tentatively hypothesize that, although jealousy can in any case be seen as a sign or symptom of subthreshold psychopathology and an expression of liability factors, it is activated into becoming clinically relevant by the presence of the different lifetime spectrum symptoms that may shape its presentation (obsessional, depressive, anxious or delusional). A study aimed at addressing this issue is currently ongoing. In addition, it could be hypothesized that the 5-HT dysfunction, reflected by the reduced density of the platelet 5-HT transporter, might be a non-specific biological indicator of the presence of one or more underlying spectrum conditions or dimensions; the identification of these conditions or dimensions, crossing normal and pathological states, will surely be one of the exciting fields of future neuroscientific research.
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REFERENCES Buss, D. M. (1989). Sex differences in human mate preferences: Evolutionary hypotheses tested in 37 cultures. Behavioral and Brain Science, 12, 1-49. Buss, D. M., Larsen, R. J., Westen, D., Semmelroth, J. (1992). Sex differences in jealousy: Evolution, physiology, and psychology. Psychological Science, 3, 251-255. Cassano, G. B., Michelini, S., Shear M. K., Coli, E., Maser, J. D., Frank, E. (1997). The panic-agoraphobic spectrum: A descriptive approach to the assessment and treatment of subtle symptoms. American Journal of Psychiatry, 154, 27-38. Dell’Osso, L., Armani, A., Rucci, P., Frank, E., Fagiolini, A., Corretti, G., Shear, M. K., Grochocinski, V. J., Maser, J. D., Endicott, J., Cassano, G. B. (2002). Measuring mood spectrum disorder. Comparison of interview (SCI-MOODS) and self-report (MOODSSR) instruments. Comprehensive Psychiatry, 43, 69-73. Frank, E., Shear, M. K., Rucci, P., Cyranowski, J. M., Endicott, J., Fagiolini, A., Grochocinski, V. J., Kupfer, D.J., Maser, J. D., Cassano, G. B. (2000). Influence of panic-agoraphobic spectrum symptoms on treatment response in recurrent major depression. American Journal of Psychiatry, 157, 1101-1107. Frank, E., Cyranowski, J. M., Rucci, P., Shear, M. K., Fagiolini, A., Thase, M. E., Cassano, G. B., Grochocinski, V. J., Kostelnik, B., Kupfer, D. J. (2002). Clinical significance of lifetime panic spectrum symptoms in the treatment of bipolar I disorder. Archives of General Psychiatry, 59, 905-911. Goodman, W. K., Price, L. H., Rasmussen, S. A. (1986). The Yale Brown Obsessivecompulsive Scale I: development, use and reliability. Archives of General Psychiatry, 46, 1006-1011. Insel, T. R., Shapiro, L. E. (1992). Oxytocin receptor distribution reflects social organization in monogamous and polygamous voles. Proceedings of the National Academy of Sciences USA, 89, 5981-5985. Kraepelin, E. (1910). Ein Lehrbuch fur Studierende und Aertze. 8th ed. Leipzig, Germany: Johann Ambrosius Barth. Marazziti, D., Rossi, A., Gemignani, A., Giannaccini, G., Pfanner, C., Milanfranchi, A., Presta, S., Lucacchini, A., Cassano, G. B. (1996). Decreased platelet 3H-paroxetine binding in obsessive-compulsive patients. Neuropsychobiology, 34, 184-187. Marazziti, D., Akiskal, H. S., Rossi, A., Cassano, G. B. (1999). Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine, 29, 741-745. Marazziti, D., Di Nasso E., Masala, I., Baroni, S., Abelli, M., Mengali, F., Mungai, F., Rucci, P., Cassano, G. B. (2003). Normal and obsessional jealousy: A study of a population of young adults. European Psychiatry, 18, 106-111. Mathes, E. V. (1986). Jealousy and romantic love: a longitudinal study. Psychological Reports, 58, 885-886. McPherson GA. (1985). Analysis of radioligand binding experiments. A collection of computer programs for the IBM PC. Journal of Pharmacologic Methods, 14, 213-228. Michael, A., Mirza, S., Mirza, K. A. H., Babu, V. S., Vitahyathil, E. (1995). Morbid jealousy in alcoholism. British Journal of Psychiatry, 167, 668-672. Mullen, P. E. (1991). Jealousy: The pathology of passion. British Journal of Psychiatry, 158, 593-601.
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Mullen, P. E., Martin, J. (1994). Jealousy: A community study. British Journal of Psychiatry, 164, 35-43. Newman, J. D. (1998). The physiologic control of mammalian vocalization. New York: Plenum Press. Parker, G., Barrett, E. (1997). Morbid jealousy as a variant of obsessive-compulsive disorder. Australian and New Zealand Journal of Psychiatry, 31, 133-138. Peterson, G. L. (1977). A simplification of the protein assay method which is more generally applicable. Analytical Biochemistry, 83, 356-366. Pines, A. M., Friedman, A. (1997). Gender differences in romantic jealousy. The Journal of Social Psychology, 138, 54-71. Rucci, P., Maser, J. D. (2000). Instrument development in the Italy-USA Collaborative Spectrum Project. Epidemiologia e Psichiatria Sociale, 9, 249-256. Shear, M. K., Frank, E., Rucci, P., Fagiolini, A., Grochocinski, V., Houck, P., Cassano, G. B., Kupfer, D. J., Endicott, J., Maser, J., Mauri, M., Banti, S. (2001). Panic-agoraphobic spectrum: Reliability and validity of assessment instruments. Journal of Psychiatric Research, 35, 59-66. Shrestha, K., Rees, D. W., Rix, K. J. B., Hore, B. D., Faragher, E. B. (1985). Sexual jealousy in alcoholics. Acta Psychiatrica Scandinavica, 72, 283-290. Tarrier, N., Beckett, R., Harwood, S., Bishay, N. (1990). Morbid jealousy: a review and cognitive-behavioural formulation. British Journal of Psychiatry, 157, 319-326.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 14
ADVANCES IN DYADIC AND SOCIAL NETWORK ANALYSES FOR LONGITUDINAL DATA: DEVELOPMENTAL IMPLICATIONS AND APPLICATIONS William J. Burk Leiden University, the Netherlands
Danielle Popp, and Brett Laursen Florida Atlantic University, Boca Raton, Florida, USA
ABSTRACT Interdependence, a central feature of close relationships, presents contemporary scholars with theoretical and statistical challenges. Dyadic and social network analytic techniques have recently been formulated that offer several advantages over previous statistical methods by accounting for various forms of interdependence for longitudinal data collected from both relationship partners. We describe two of these methods: the Actor-Partner Interdependence Model (APIM: Kenny, Kashy, & Cook, 2006) and actorbased models of network-behavioral dynamics (Snijders, Steglich, & Schweinberger, 2007). The APIM partitions variance into estimates of behavioral stability of both dyad members (actor effects), and interpersonal influence (partner effects), while adjusting for initial behavioral similarity between partners. The actor-based models describe dyadic relationships as embedded within a multitude of interconnected dyadic relationships (i.e., social networks). These dynamic models utilize computer simulations to partition variance into parameters that ascribe similarity based on network, dyadic and individual behavioral attributes. To illustrate the applicability of both methods, we describe empirical examples from our recent work using these models techniques.
Relationships with parents and peers are understood to be an important context for development and psychosocial adjustment of children and adolescents (Hartup & Laursen, 1999). Close relationships are characterized by social interactions between dyadic partners that are maintained over an appreciable amount of time (Kelley et al., 1983). This definition
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emphasizes interdependence as a central feature of relationships between family members, friends, and romantic partners (Bugenthal, 2000; Reis, Collins, & Berscheid, 2000). Objective measures of interdependence, such as closeness, intimacy and social support, have gained prominence in the developmental literature (Baumeister & Leary, 1995; Berscheid, 1999; Furman, 1996; Laursen & Bukowski, 1997). Unfortunately, developmental scholars have been slower to appreciate that relational interdependence necessarily implies statistical interdependence (Laursen, Popp, Burk, Kerr, & Stattin, in press; Kenny, 1996). Standard parametric statistical analyses are unable to easily accommodate interdependencies inherent in data collected from or about both relationship partners. Several dyadic data analytic methods have been developed that account for nonindependence (Gonzales & Griffin, 1999; Kashy & Kenny, 2000). In this chapter, we provide an overview of two longitudinal techniques that offer special promise to developmental scholars: actor-partner interdependence models (Kenny, Kashy, & Cook, 2006) and actor-based models of social network and behavioral dynamics (Snijders, Steglich, & Schweinberger, 2007). It is well known that relationship partners tend to be similar on various attitudes, behaviors, and physical characteristics (Lazarsfeld & Merton, 1954). While moderate levels of similarity has been documented for parent-child dyads (Cook & Kenny, 2005; Gonzalez, Cauce, & Mason, 1996; Kim, Conger, Lorenz, & Elder, 2001; Noller & Callan, 1988; Stice & Barrera, 1995), more robust levels of similarity have been reported between youth friendship dyads (Burk & Laursen, 2005; Burk, Steglich, & Snijders, 2007; Kandel, 1978; Popp, Laursen, Kerr, Stattin, & Burk, 2008), and romantic partner dyads (Capaldi & Crosby, 1997; Krueger, Moffitt, Caspi, Bleske, & Silva, 1998; Quinton, Pickles, Maughan, & Rutter, 1993; Rhule-Louie & McMahon, 2007). This similarity, or statistical interdependence, represents the nonindependent or correlated nature of data collected from both participants in a close relationship. Statistical interdependence may be attributed to various distinct sources, including compositional (selection) effects, unilateral and mutual influences, exogenous factors common to both individuals, and measurement error (Kenny, Kashy, & Cook, 2006). Selection and influence have received the lion’s share of empirical attention. Selection emphasizes similarity prior to the initiation of the relationship. Influence emphasizes increased similarities acquired after the initiation of the relationship. The patterns of influence may be further differentiated as unilateral or mutual influence between partners. That is, interdependence observed between relationship partners may be attributed to similarity prior to or after the establishment of the relationship, and increased similarity may be the result of either one partner becoming more similar to the other or both partners become more similar to each other over time. Delineating the relative contributions of different sources of interdependence has become increasingly recognized as fundamental to understanding developmental processes between relationship partners and between dyadic relationships (Laursen et al., in press). Unfortunately, statistical interdependence precludes the use of standard correlational and regression-based methods because these parametric methods assume independent observations. Violations of the independence assumption introduce systematic biases to the standard errors of estimates, thus inflating the significance of standardized test statistics (Kenny, 1995; Kenny, Kashy, & Cook, 2006). Previously, researchers have typically used one of two strategies to avoid these biases. The first approach utilizes aggregate or difference scores to examine dyad-level phenomenon. This solution does allow for the appropriate use of
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conventional parametric statistics and interpretations at the dyadic level of analysis, but eliminates the ability to examine variation that might be attributed to the individual. For example, a parent and child who both report moderate levels of relationship satisfaction have a similar averge level of satisfaction as dyads consisting of one satisfied and one dissatisfied participant. The second strategy involves separately analyzed data for each participant in a relationship. When identical measures are available from both partners, this strategy leads to four separate analyses: two single-reporter analyses (e.g., both predictor and outcome variables reported by one of the dyad members) and two cross-reporter analyses (e.g., predictor reported by one partner and outcome from the other). This solution also avoids biases associated with nonindependence and allows for interpretations at the individual level of analysis, but eliminates the ability to examine variation that might be attributed to the dyad. So, these strategies limit researchers to interpretations at either the individual or dyadic level of analysis. Several analytic techniques have been developed to disentangle similarity attributable to individuals and dyads (Gonzalez & Griffin, 1999; Kashy & Kenny, 2000; Snijders, 2001). Longitudinal applications of these methods represent an important step for developmental researchers, in that, these longitudinal models are capable of delineating specific processes and mechanisms, such as homophilic selection and social influence. We devote the remaining text to describing two dyadic data techniques that are capable of modeling interdependence in longitudinal data, and simultaneously estimating the relative importance of selection and influence processes in the explanation of similarity between dyadic partners. For each method, we provide a non-technical overview of basic model specifications, followed by a description of specific advantages of each modeling technique. To illustrate the applicability of these methods, we include empirical application of these models from our recent work.
ACTOR-PARTNER INTERDEPENDENCE MODEL The Actor-Partner Interdependence Model (APIM: Kenny & Cook, 1999; Kashy & Kenny, 2000) is a dyadic approach that simultaneously estimates the effect of an individual’s predictor variable on his or her own outcome variable (the actor effect) and on his or her partner’s outcome variable (the partner effect), controlling for variance shared across participants (i.e. statistical interdependence). The earliest applications of this method examined concurrent measures of interactions between family members (Cook & Dreyer, 1984; Kenny & La Voie, 1984). However, these methods have been utilized to a greater extend to examine peer relations. Previous studies have examined concurrent interactions among playmates and classmates (Malloy, Sugarman, Montvilo, & Ben-Zeev, 1995; Ross & Lollis, 1989), the quality of play between friends and nonfriends (Simpkins & Parke, 2002), features of friendship quality and disagreements (Burk & Laursen, 2005), and social status within the peer group (Card, Hodges, Little, & Hawley, 2005). In longitudinal APIM applications, the interpretation of actor and partner effects somewhat differs from the concurrent model: Actor effects represent autoregressive stability paths and partner effects represent paths of interpersonal (cross-partner) influence. One of the first empirical applications of APIM procedures examined mother and child reports of the child’s attachment security (Cook & Kenny, 2005). A mother-child dyad represents a
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quintessential distinguishable dyad, because the relationship partners can be easily classified into distinct roles. Procedures for analyzing data from distinguishable dyads are relatively straightforward compared to dyads that lack attributes that readily distinguish individual members (Gonzales & Griffin, 1999; Kashy & Kenny, 2000). APIM procedures have been modified for use with indistinguishable dyads, such as same-sex friends (Olsen & Kenny, 2006; Woody & Sadler, 2005). These procedures include several additional constraints that add to the statistical complexity of this modeling approach. That is, actor and partner effects are constrained to be equal, as are means, intercepts, variances, and covariances. In this manuscript, we focus on APIM procedures for distinguishable dyads. Readers interested in related procedures for indistinguishable dyads are referred to Olsen and Kenny (2006) and Laursen et al. (in press).
U
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Note: a1x = initial stability of individual behavior for Person X. a1y = initial stability of individual behavior for Person Y. a2x = subsequent behavioral stability of Person X. a2y = subsequent behavioral stability of Person Y. p1x = initial partner influence of Person X on behavior of Person Y. p1y = initial partner influence of Person Y on behavior of Person X. p2x = subsequent partner influence of Person X on behavior of Person Y. p2y = subsequent partner influence of Person Y on behavior of Person X. c1 = time 1 dyadic similarity. U = residual variance in behavior of Person X at time 2. V = residual variance in behavior of Person Y at time 2. c2 = time 2 residual similarity. W = residual variance in behavior of Person X at time 3. Z = residual variance in behavior of Person Y at time 3. c3 = time 3 residual similarity. Figure 1. Longitudinal Actor-Partner Interdependence Model for Distinguishable Dyads.
Figure 1 presents a conceptual longitudinal APIM for distinguishable dyads across three time points. The paths are labeled according to traditional APIM terminology, where concurrent estimates of similarity represent dyadic correlations I, stability estimates represent actor effects (a), and influence estimates represent partner effects (p). Time 1 similarity (c1) represents the initial correlation between dyad members’ (Person X and Y) reports of a
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specific behavior. Time 2 similarity (c2) and time 3 similarity (c3) describe correlations between dyad members on the residuals of the outcome behavior. Two actor effects are estimated for each period of change. Initial stability is assessed from time 1 to time 2 for person X (a1x) and for person Y (a1y). Subsequent stability is assessed from time 2 to time 3 for person X (a2x) and person Y (a2y). Two partner effects are also estimated across adjacent time points. Initial influence describes cross-paths between the behavior of person X at time 1 and the behavior of person Y at time 2 (p1x) and between the behavior of person Y at time 1 and the behavior of person X at time 2 (p1y). Subsequent influence describes cross-paths between the time 2 behavior of person X and time 3 behavior of person Y (p2x) and between the time 2 behavior of person Y and the time 3 behavior of person X (p2y). All these effects are modeled simultaneously, so each estimate in the model represents unique effects, partialling out the effects of the other estimates. Neyer (2002) has formulated a multiple groups structural equation modeling procedure to compare actor and partner effects across different types of dyads. This application is wellsuited to investigating homophilic processes in close peer relationships because friendships differ in time of initiation and duration (i.e., they begin and end at different time points). To assess selection, similarity needs to be estimated prior to the establishment of a friendship. In contrast, influence effects need to be estimated after the friendship was established. So, selection and influence cannot be disentangled for friendships reported during the first wave of data collection, because it is impossible to distinguish friendships that were recently established from friendships that were longer lived. However, when three time points are available, selection and influence effects can be estimated for some groups of friendship dyads. For example, dyads whose members were not friends at time 1, but who nominated each other as friends at times two and three (new friends). For these dyads, selection effects are operationalized in terms of dyadic similarity at time 1 (i.e., the time preceding the initiation of the friendship); influence effects are operationalized in terms of changes in similarity at times 2 and 3. Furthermore, partner effects may be used to examine whether changes in similarity may be attributed to unilateral or mutual influence. For illustrative purposes, we briefly describe some findings from a recent study in which we utilized this approach to examine homophilic processes in alcohol use among 545 Swedish adolescent friendship dyads (Popp et al., 2008). In this study, dyads were classified according to initiation and duration of the friendship, and dyad members were distinguished based on their relative age. Continuing with our example of new friends, youth in these friendship dyads were similar in their self-reported alcohol intoxication frequency at time one, thus indicating selection. Similarity increased at times two and three. Initial and subsequent stability estimates revealed the older friend’s drinking behavior was relatively more stable than the younger friend’s drinking behavior. Initial influence estimates revealed the older friend’s drinking behavior at time one predicted changes in their younger friend’s drinking behavior at time two, but the younger friend’s drinking behavior did not predict changes in their older friend’s alcohol use. Subsequent influence estimates indicated mutual influence. That is, the older friend’s drinking behavior at time two predicted changes in the younger friend’s alcohol use at time three and the younger friend’s time two drinking behavior predicted changes in the older friend’s alcohol use at time three. So, for these new friendship dyads, both selection and influence contributed to similarity between friends’ alcohol use. Additionally, influence between dyad members seemed to shift during the course of the friendship, from unilateral influence during the initial stages of the relationship to
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mutual influence. Different patterns of findings emerged for each of the friendship groups in the study, collectively indicating similarity prior to the onset of the friendship, unilateral influence in the initial stages of the friendship, followed by mutual influence between older and younger friendship partners. The longitudinal actor-partner model provides an analytic framework that simultaneously examines interpersonal influences between dyad partners while accounting for the degree of dyadic similarity in both predictor and outcome measures. Furthermore, distinguishing dyad members on the basis of meaningful attributes allows for the delineation of unilateral and mutual influences. We have described models that have been extended to include an additional measurement point and multiple group analyses. These models may also be extended to include additional measures, such as between-dyad and within-dyad variables, as well as various interaction effects including actor-partner interactions (see Kenny, Kashy, & Cook, 2006). The APIM framework has also been extended to incorporate measures from more than two relationship partners (Kenny, Mannetti, Pierro, Livi, & Kashy, 2002). Furthermore, these models may be performed with most standard statistical programs, using either a pooled-regression approach, structural equation modeling, or hierarchical linear modeling software (Kenny, Kashy, & Cook, 2006). Our extensions of the APIM provide additional advantages when investigating close relationships that may differ as a function of initiation and duration, such as friendships. We applied this model to the investigation of two well established mechanisms leading to friendship homophily, and simultaneously examined similarity prior to the relationship (selection) and similarity acquired after the initiation of the friendship (influence) for relationships that emerged after the initial data collection. Applications examining different types of relationships and mechanisms of social influence may also be considered. Overall, the APIM framework provides researchers with a viable analytic tool for modeling interdependence and interpersonal influence in longitudinal dyadic data.
ACTOR-BASED MODELS OF NETWORK-BEHAVIORAL DYNAMICS In some cases, researchers may want to consider dyadic relationships as embedded within larger relational structures comprised of a multitude of interconnected dyadic relationships, referred to as social networks. Within the social network literature, analytic methods have been developed capable of accounting for interdependencies in network data (Carrington, Scott & Wasserman, 2005; Wasserman & Faust, 1994). We focus our discussion on one of these methods, actor-based models of network-behavioral dynamics (Snijders, Steglich, & Schweinberger, 2007; Snijders, Steglich, & Van de Bunt, in press). This modeling approach simultaneously estimates effects describing changes in relationship ties and individual behaviors, while accounting for structural features of the social network. That is, this approach is capable of accounting for statistical interdependence as well as nonindependence due to structural characteristics of dyadic relations (e.g., individuals are allowed to participate in more than one dyadic relationship). The actor-based approach reflects the basic assumption that individuals make decisions about their own relationship ties and their own behaviors according to short-term preferences and constraints (Snijders, 2001; 2005). That is, individuals are presumed to make decisions
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intended to optimize their position in the overall network. These decisions lead to changes in ties directed to others (i.e., selection) and changes in their own behaviors (i.e., influence). It is reasonable to assume that these decisions (and changes) reflect a continuous process, so this approach incorporates the continuous-time Markov chain model initially proposed by Holland and Leinhardt (1977) to model network and behavioral dynamics. So, although data are collected at discrete measurement points, the total observed change between measurement points is decomposed into probabilistic sequences of many small changes (i.e., micro-steps) between observed measurements. These assumptions simplify the dynamic process and reduce the modeling procedure to two smaller tasks: (a) modeling the frequencies of, and opportunities for network changes (network micro-steps) and behavioral changes (behavioral micro-steps), referred to as rate functions; and (b) modeling the preferences and tendencies guiding the types of specific changes in network or behavioral micro-steps, referred to as objective functions. Models of network dynamics and individual behavioral dynamics are separately estimated using transition probabilities associated with all possible combinations of change. The separate models are integrated by allowing changes in network ties to depend on changes in individual behaviors and allowing changes in individual behaviors to depend on changes in network ties. Statistical complexities do not allow for explicit calculations of these models, so parameters are instead estimated using iterative computer simulations within a Markov Chain Monte Carlo approach. So, the estimated model parameters indicate which sequence of network and behavioral micro-steps is most probable, given the observed data.
Network Dynamics Network dynamics are modeled with rate function parameters that represent the frequency of changes in network ties and with objective function parameters that estimate the types of changes. Rate function parameters describe the number of opportunities for change from one measurement point to the next (i.e., micro-steps). These parameters are typically constrained to be equal across each successive period of change. However, these estimates may be permitted to vary as a function of individual attributes or behaviors. The network objective function includes various parameters modeling endogenous effects of network structure and exogenous effects of individual and dyadic covariates. Endogenous network effects include specifications of well-known structural features of network dynamics, such as reciprocity and transitivity (Carrington, Scott & Wasserman, 2005). Reciprocity describes the tendency for actors to reciprocate nominations. Transitivity describes transitive network closure (i.e., the tendency for actors’ nominations to involve triadic relations and larger cohesive group structures). Transitivity may be specified by in various ways, but the most common description is a preference for dyadic relationships to be embedded within cohesive triadic relations (i.e., “my friends are also friends”). Model parameters of transitivity and other effects modeling structural tendencies of social networks are described elsewhere (e.g., Snijders, Steglich, & Van de Bunt, in press). While patterns may vary, reciprocity and some specification of transitivity are well documented as significant predictors of friendship ties and of ties other relational networks based on advice, liking, trust, and cooperation (Lazega, Lemercier, & Mounier, 2006; Van de Bunt, Wittek, & de Klepper, 2003).
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The network objective function also includes exogenous effects of dyadic and individual attributes. Dyadic attributes describe effects specific to pairs of individuals such that each dyadic covariate constitutes a separate network of ties. A dyadic covariate network may be constant or may change over time. The basic parameter estimated for each dyadic covariate describes the tendency for actors with ties in the dyadic covariate network to also have connections in the overall social network. For each individual attribute, three basic parameters may be specified. Attribute ego describes the effect of the attribute on outgoing nominations. Attribute alter describes the effect of the attribute on incoming nominations. Attribute similarity describes the tendency for ties to occur between individuals with similar levels of the attribute. Using participant sex as an example (with males = 0 and females = 1), a positive sex ego effect indicates females have more outgoing nominations than males (i.e., females are more active in the network). A positive sex alter effect indicates that females receive more nominations than males (i.e., females are more popular in the network). A positive sex similarity effect indicates that friendships tend to occur between youth of the same sex (i.e., homophilic selection). These three effects may be similarly interpreted for attributes that consist of more than two levels and for those that change over time. Interactions may be specified between various endogenous network effects and parameters associated with two or more dyadic or individual covariates. Using the sex ego parameter as an example, an interaction between sex ego and reciprocity addresses the question; do females tend to reciprocate friendships more than males? A positive sex ego by reciprocity interaction would indicate that females are more likely to reciprocate friendships than are males. Another potentially interesting set of interactions include the ego parameter of one attribute and the alter effect of a different attribute. Continuing with the example, an interaction between sex ego and the alter effect of, say delinquency, examines whether males or females are more likely to select others with high levels of delinquency. A positive interaction between sex ego by delinquency alter would indicate that females are more likely to nominate individuals with higher levels of delinquency than males. Numerous theoretically interesting questions may be addressed by specifying different interactions between available parameters.
Behavioral Dynamics Behavioral dynamics are specified in a similar manner. Rate function parameters represent the frequency of changes in individual behaviors and objective function parameters estimate the types of behavioral change. Like the rate function parameters for network dynamics, these parameters are also typically constrained to be equal across each successive period of change, but may be permitted to vary as a function of individual attributes or other behaviors. The behavioral objective function includes parameters modeling overall behavioral tendencies, as well as effects of individual attributes that depend on network connections (i.e., social influence). Two basic behavioral tendencies are typically modeled. The linear tendency describes the propensity of individuals to report high levels of a behavior. So, positive values indicate a tendency for individuals to report high levels of an attribute; negative values indicate a tendency for individuals to report low levels of an attribute. The curvilinear tendency describes the quadratic function of the behavior. A positive estimate indicates a self-
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reinforcing or addictive behavior; a negative estimate indicates a self-correcting behavior, or a behavior that provides negative feedback. Perhaps the most interesting aspect of behavioral dynamics involves estimates of social influence. Several different parameters representing social influence can be specified within the actor-based modeling framework. Average influence describes the tendency of actors to adopt the behavior of affiliates with whom they are tied, regardless of the number of connections. Total influence, on the other hand, describes this tendency (to adopt the behaviors of others) as increasing as a function of the number of connections. Finally, average alter describes the tendency for individuals to adopt the average behavioral level of those to whom they are connected. While estimates of these three parameters may be similar within models, each parameter represents different theoretical operationalizations of social influence. As with network dynamics, interactions may be specified between behaviors and endogenous network effects and effects of dyadic and individual attributes. Interactions between parameters representing social influence and attribute ego effects are perhaps the most interesting. Returning to the example involving the sex ego parameter, an interaction between sex ego and average similarity based on delinquency examines whether males or females are more susceptible to delinquent peer influence. A positive interaction would indicate females are more likely to adopt the delinquent behaviors of their friends than males (regardless of the number of friendships). These interactions, as well as the interactions described for network dynamics, offer researchers a promising tool for testing moderators of selection and influence processes. The APIM procedures described earlier may be performed with various statistical methods and conventional social sciences software, actor-based models of network and behavioral dynamics require specialized software. One option for performing these models is the Simulation Investigation for Empirical Network Analyses (SIENA: Snijders et al., 2006). SIENA is one of the statistical modules of StOCNET (Boer et al., 2006), a family of statistical programs for social network analysis. The SIENA homepage (http:// stat.gamma.rug.nl/snijders/siena.html) provides links to many of the references cited in this chapter, as well as technical reports and articles in which actor-based methods are applied to empirical data. Other software options are available (e.g., Handcock, Hunter, Butts, Goodreau, & Morris, 2005). Huisman and Van Duijn (2005) provide an excellent review of the capabilities of these various social network analytic software programs. We briefly describe findings from one of our first studies utilizing these techniques (Burk, Steglich, & Snijders, 2007), which may be found on the SIENA website. In this study we examined selection and influence processes related to minor delinquency in a friendship network of Swedish youth. Nomination and behavioral data were collected from 260 youth annually for four measurements. We found evidence for both homophilic selection based on delinquency (delinquency similarity) and delinquent peer influence (average delinquent influence), controlling for tendencies for reciprocity and transitivity, selection based on school and classroom attendance (dyadic covariate similarity), and homophilic selection based on gender and age (individual attribute similarity). Furthermore, we tested whether delinquent selection and influence were substantially stronger in reciprocating friendship dyads compared to unilateral friendships (using interactions involving reciprocity). We found evidence that homophilic selection did not differ as a function of reciprocity, but delinquent
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influence was significantly stronger in reciprocating friendship compared to unilateral relationships. Actor-based models of network and behavioral dynamics provide several advantages over alternative methods. First, these models do not assume dyads are independent. While dyadic independence may be a logical conclusion in some situations (e.g., married couples), it is not necessarily a realistic assumption when examining youth friendships. Second, these models have been specifically designed to simultaneously estimate homophilic selection and influence processes using all available information. Unlike the APIM extensions described earlier, estimates of selection and influence are based on changes in relationship ties and changes in behaviors of all study participants, thus potentially providing more realistic estimates of selection and influence. Third, these models utilize Markov processes to model network and behavioral changes within a continuous time framework. This provides a more precise estimate of changes in network ties and changes in individual behaviors. Finally, these models provide the needed flexibility to incorporate a myriad of interaction effects testing moderators of network and behavioral dynamics.
CONCLUSIONS Developmental scholars have long appreciated that the dyadic properties of a relationship are key to understanding its significance in individual development. One of these properties, namely statistical interdependence, or the degree of dyadic similarity between relationship partners, biases conventional statistical tests, thus precluding the use of parametric statistical methods. This has resulted in many researchers to underutilize dyadic data. Fortunately, new tools have been developed that make it possible for the first time to incorporate interdependence in developmental research. We have described two such methods that show particular promise: actor-partner interdependence models and actor-based models of networkbehavioral dynamics. Actor-partner and actor-based models both offer advantages over previous analytic strategies for dyadic data, in that, both techniques are capable of accurately modeling statistical interdependence, and structural dependencies in data collected from dyads or several members of small groups. Within a distinguishable dyad approach, the longitudinal actor-partner model provides a framework that allows researchers to delineate unilateral and mutual influences between relationship partners. Our proposed extensions to the APIM (i.e., an additional time point and multiple group analyses) allow for simultaneous assessment of homophilic selection and social influence processes in (friendship) dyads that differ in the time of initiation and duration of the relationship. The actor-based models of networkbehavioral dynamics also allow for the simultaneous assessment of selection and influence processes. In addition, these models account for nonindependence between dyads. That is, this method also models the degree of structural dependence in dyadic relationships that are embedded within larger relational network structures. We have provided an overview of these two techniques, presenting basic definitions and applications of these models. We believe these two approaches represent substantive advances over alternative modeling procedures. Both approaches provide a great deal of analytic flexibility to accommodate more complex models, including multiple predictors and outcomes. Collectively, both methods provide a
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complementary analytic framework that offers researchers new tools for the analysis of dyadic data that better capture the richness and the significance of close relationships.
REFERENCES Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497-529. Berscheid, E. (1999). The greening of relationship science. American Psychologist, 54, 260266. Boer, P., Huisman, M., Snijders, T. A. B., Steglich, C. E. G., Wichers, L. H. Y., & Zeggelink, E. P. H. (2006). StOCNET: An open software system for the advanced statistical analysis of social networks. Version 1.7. Groningen: ICS/Science Plus. Bugenthal, D. B. (2000). Acquisition of the algorithms of social life: A domain-based approach. Psychological Bulletin, 126, 187-219. Burk, W. J., & Laursen, B. (2005). Adolescent perceptions of friendship and their associations with individual adjustment. International Journal of Behavioral Development, 29, 156-164. Burk, W. J., Steglich, C. E. G., & Snijders, T. A. B. (2007). Beyond dyadic interdependence: Actor-oriented models for co-evolving social networks and individual behaviors. International Journal of Behavioral Development, 31, 397-404. Capaldi, D. M., & Crosby, L. (1997). Observed and reported psychological and physical aggression in young, at-risk couples. Social Development, 6, 184-206. Card, N. A., Hodges, E. V. E., Little, T. D., & Hawley, P. H. (2005). Gender effects in peer nominations for aggression and social status. International Journal of Behavioral Development, 29, 146-155. Carrington, P., Scott, J., & Wasserman S. (2005). Models and methods in social network analysis. New York: Cambridge University Press. Cook, W. L., & Dreyer, A. (1984). A social relations model: A new approach to analysis of family-dyadic interaction. Journal of Marriage and the Family, 46, 679-687. Cook, W. L., & Kenny, D. A. (2005). The Actor-Partner Interdependence Model: A model of bidirectional effects in developmental studies. International Journal of Behavioral Development, 29, 101-109. Furman, W. (1996). The measurement of friendship perceptions: Conceptual and methodological issues. In W. M. Bukowski, A. F. Newcomb, & W. W. Hartup (Eds.), The company they keep: Friendship in childhood and adolescence (pp. 41-65). New York: Cambridge University Press. Gonzalez, N. A., Cauce, A. M., & Mason, C. A. (1996). Interobserver agreement in the assessment of parental behavior and parent-adolescent conflict: African American mothers, daughters, and independent observers. Child Development, 67, 1483-1498. Gonzalez, R., & Griffin, D. (1999). The correlational analysis of dyad-level data in the distinguishable case. Personal Relationships, 6, 449-469. Handcock, M. S., Hunter, D.R., Butts, C. T., Goodreau, S. M., & Morris, M. (2005). Statnet: An R package for the statistical analysis and simulation of social networks. Center for Studies in Demography and Ecology, University of Washington.
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Hartup, W. W., & Laursen, B. (1999). Relationships as developmental contexts: Retrospective themes and contemporary issues. In W. A. Collins & B. Laursen (Eds.), The Minnesota Symposia on Child Psychology: Vol. 30. Relationships as developmental contexts (pp. 13- 35). Mahwah, NJ: Erlbaum. Holland, P., & Leinhart, S. (1977). A dynamic model for social networks. Journal of Mathematical Sociology, 5, 5-20. Huisman, M., & Van Duijn, M. A. J. (2005). Software for statistical analysis of social networks. In P. Carrington, J. Scott, & S. Wasserman (Eds.), Models and methods in social network analysis (pp. 270–316). New York: Cambridge University Press. Kandel, D. B. (1978). Homophily, selection, and socialization in adolescent friendships. American Journal of Sociology, 84, 427-436. Kashy, D. A., & Kenny, D. A. (2000). The analysis of data from dyads and groups. In H. T. Reis & C. M. Judd (Eds.), Handbook of research methods in social and personality psychology (pp. 451-477). New York: Cambridge University Press. Kelly, H. H., Berscheid, E., Christensen, A., Harvey, J. H., Huston, T. L., Levinger, G., et al. (1983). Close relationships. New York: Freeman. Kenny, D. A. (1995). The effect of nonindependence on significance testing in dyadic research. Personal Relationships, 2, 65-75. Kenny, D. A. (1996). Models of non-independence in dyadic research. Journal of Social and Personal Relationships, 13, 279-294. Kenny, D. A., & Cook, W. (1999). Partner effects in relationship research: Conceptual issues, analytic difficulties, and illustrations. Personal Relationships, 6, 433-448. Kenny, D. A., & La Voie, L. (1984). The social relations model. In L. Berkowitz (Ed.), Advances in experimental social psychology. Vol. 18 (pp. 141-182). Orlando, FL: Academic Press. Kenny, D.A., Kashy, D.A., & Cook, W.L. (2006). Dyadic data analysis. New York: Guilford Press. Kenny, D. A., Mannetti, L., Pierro, A., Livi, S., & Kashy, D. A., (2002). The statistical analysis of data from small groups. Journal of Personality and Social Psychology, 83, 126-137. Kim, K. J., Conger, R. D., Lorenz, & Elder, G. H., Jr. (2001). Parent-adolescent reciprocity in negative affect and its relation to early adult social development. Developmental Psychology, 37, 775-790. Krueger, R. F., Moffit, T. E., Caspi, A., Bleske, A., & Silva, P. A. (1998). Assortative mating for antisocial behavior: Developmental and methodological considerations. Behavior Genetics, 28, 173-186. Laursen, B., & Bukowski, W. M. (1997). A developmental guide to the organization of close relationships. International Journal of Behavioral Development, 21, 747-770. Laursen, B., Popp, D., Burk, W. J., Kerr, M., & Stattin, H. (in press). Incorporating interdependence into developmental research: Examples from the study of homophily and homogeneity. In N. A. Card, T. D. Little, & J. P. Selig (Eds.), Modeling dyadic and interdependent data in developmental research. Mahwah, NJ: Lawrence Erlbaum Associates. Lazarsfeld, P. F., & Merton, R. K. (1954). Friendship as a social process. In M. Berger, T. Abel, & C. H. Page (Eds.), Freedom and control in modern society (pp. 18-66). Princeton: Van Nostrand.
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Lazega, E., Lemercier, C., & Mounier, L. (2006). A spinning top model of formal structure and informal behaviour: Dynamics of advice networks in a commercial court. European Management Review, 113–122. Malloy, T. E., Sugarman, D. B., Montvilo, R. K., & Ben-Zeev, T. (1995). Children’s interpersonal perceptions: A social relations analysis of perceiver and target effects. Journal of Personality and Social Psychology, 68, 418-426. Neyer, F. J. (2002). The dyadic interdependence of attachment security and dependency: A conceptual replication across older twin pairs and younger couples. Journal of Social and Personal Relationships, 19, 483-503. Noller, P., & Callan, V. J. (1988). Understanding parent-adolescent interactions: Perceptions of family members and outsiders. Developmental Psychology, 24, 707-714. Olsen, J. A., & Kenny, D. A. (2006). Structural equation modeling with interchangeable dyads. Psychological Methods, 11, 1-15. Popp, D., Laursen, B., Kerr, M., Stattin, H. & Burk, W.J. (2008). Modeling homophily over time with an Actor-Partner Interdependence Model. Developmental Psychology, 44, 1028-1039. Quinton, D., Pickles, A., Maughan, B., & Ruter, M. (1993). Partners, peers, and pathways: Assortative pairing and continuities in conduct disorder. Development and Psychopathology, 5, 763-783. Reis, H. T., Collins, W. A., & Berscheid, E. (2000). The relationship context of human behavior and development. Psychological Bulletin, 126, 844-872. Rhule-Louie, D. M. & McMahon, R. J. (2007). Problem behavior and romantic relationships: Assortative mating, behavior contagion, and desistance. Clinical Child and Family Psychology Review, 10, 53-100. Ross, H. S., & Lollis, S. P. (1989). A social relations analysis of toddler peer relations. Child Development, 60, 1082-1091. Simpkins, S. D., & Parke, R. D. (2002). Do friends and nonfriends behave differently? a social relations analysis of children’s behavior. Merrill-Palmer Quarterly, 48, 263-283. Snijders, T. A. B. (2001). The statistical evaluation of social network dynamics. Sociological Methodology, 31, 361–395. Snijders, T. A. B. (2005). Models for longitudinal network data. In P. Carrington, J. Scott, & S. Wasserman (Eds.), Models and methods in social network analysis (pp. 215–247). New York: Cambridge University Press. Snijders, T. A. B., Steglich, C. E. G., & Schweinberger, M. (2007). Modeling the coevolution of networks and behavior. In K. van Montfort, H. Oud, & A. Satorra (Eds.) Longitudinal models in the behavioral and related sciences (pp. 41-71). Mahwah, NJ: Erlbaum. Snijders, T. A. B., Steglich, C. E. G., Schweinberger, M., & Huisman, M. (2006). Manual for SIENA, Version 3. Groningen, The Netherlands: University of Groningen. Snijders, T. A. B., Steglich, C. E. G., & Van de Bunt (in press) Introduction to actor-based models for network dynamics. To appear in Social Networks. Stice, E., & Barrera, M., Jr. (1995). A longitudinal examination of the reciprocal relations between perceived parenting and adolescents’ substance use and externalizing behaviors. Developmental Psychology, 31, 322-334.
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Van de Bunt, G. G., Wittek, R. P. M., & de Klepper, M. C. (2003). The evolution of intraorganizational trust networks: An empirical test of six trust mechanisms. International Sociology, 20, 339–369. Wasserman, S., & Faust, K. (1994). Social network analyses. Methods and applications. Cambridge: Cambridge University Press. Woody, E., & Sadler, P. (2005). Structural equation models for interchangeable dyads: Being the same makes a difference. Psychological Methods, 10, 139-158.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 15
MOTHER-INFANT INTERACTION IN CULTURAL CONTEXT: A STUDY OF NICARAGUAN AND ITALIAN FAMILIES Ughetta Moscardino, Sabrina Bonichini and Cristina Valduga Department of Developmental and Social Psychology, University of Padua, Italy
ABSTRACT Although a common goal for parents is to promote their children’s successful development in a respective society, there is considerable cross-cultural variation in the beliefs parents hold about children, families, and themselves as parents. Previous research suggests that in traditional rural areas across the world, parents highly appreciate interrelatedness in their conceptions of relationships and competence, whereas in urban settings of Western industrialized societies, parents seem to promote independent parent– child relationships from early on. The main purpose of this study is to compare conceptions of parenting and mother-infant interactions in two cultural contexts that may be expected to hold different beliefs about parent-child relationships: Nicaraguan farmer families and middle-class Italian families. Fifty-six mothers from central Nicaragua (n = 26) and northern Italy (n = 30) and their infants aged 0-14 months participated in the study. Mothers were interviewed regarding their childrearing beliefs and behaviors, and were videotaped interacting with their infants during a free play session. Maternal responses were qualitatively analyzed using a thematic approach; maternal behaviors were coded into one of the following categories: social play, object play, motor stimulation, verbal stimulation, and face-to-face interaction. Findings indicated that: 1) Nicaraguan mothers emphasized interdependence and connectedness to other people in their socialization goals, whereas Italian mothers placed greater focus on childrearing strategies consistent with a more individualistic orientation; 2) Nicaraguan mothers exhibited a higher overall frequency of behaviors related to motor stimulation and faceto-face interaction, whereas Italian mothers were more likely to engage in social play, object play, and to emit a greater overall number of verbal behaviors towards their infants
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Ughetta Moscardino, Sabrina Bonichini and Cristina Valduga during the free-play session. Our results suggest that parents’ conceptions of childcare reflect culturally regulated norms and customs that are instantiated in parental behavior and contribute to the structuring of parent-child interactions from the earliest months of life, thus shaping developmental pathways of infants and children. Implications for theory on the psychology of relationships as well as for clinical practice are discussed.
INTRODUCTION A universal goal for parents is to promote their children’s successful development in a specific eco-cultural context according to their values, norms, and expectations related to childcare and childrearing (Bornstein, 1991; Harkness and Super, 1996; LeVine, 2002; Weisner, 2002; Whiting and Edwards, 1988). However, there is considerable cross-cultural variation in how parents socialize their infants to become competent adults later in life. Parents’ ideas about children, families, and caregiving, or parental ethnotheories (Harkness and Super, 2006), reflect broader cultural models that inform parental behavior and contribute to the structuring of physical settings, daily activities, and social interactions, thus influencing children’s development from the earliest months of life (Bornstein et al., 1999; Rogoff, 2003; Super and Harkness, 2002). For the developmental phase of infancy, two major cultural models have been proposed to study parental beliefs and behaviors in different cultural communities: the model of “individualism/independence” and the model of “collectivism/interpedendence” (Hofstede, 1991; Kağitçibaşi, 1997; Markus and Kitayama, 1991; Triandis, 1995). These terms describe differing sociocultural orientations at the cultural as well as the individual level that may serve as heuristic devices to characterize parental belief systems and practices (Greenfield and Suzuki, 1998; Shweder et al., 1998). The model of individualism/independence can be found in educated families living in Western industrial and post-industrial information societies (Kağitçibaşi, 2005; Keller et al., 2006; Triandis et al., 1988). In this model, the self is conceived as a unique, autonomous, and separate entity; personal needs and goals are central, and relationships with others are built based on personal choice. Societies that have been described as individualistic include the United States (Harkness, Super, and van Tijen, 2000; Harwood, Schölmerich, Schulze, and Gonzalez, 1999) and other West European countries, such as Germany (Citlak et al., 2008; Keller et al., 2005a). The collectivism/interdependence model is common among rural traditional subsistence-based farmer families in non-Western cultures (Greenfield, Keller, Fuligni, and Maynard, 2003; LeVine et al., 1994). In this model, the self is defined in terms of heteronomy and relatedness; group goals are more important than individual goals, and interpersonal relationships are highly valued. Norms and duties regulate social relationships, and harmony is maintained through the respect of roles and obligations (Kağitçibaşi, 2005; Keller et al., 2004). Societies sharing this broad cultural orientation comprise East Asian countries such as China (Chao and Tseng, 2002), India (Saraswathi, 1999), and Japan (Rothbaum et al., 2000; Markus and Kitayama, 1991), but also traditional rural areas in Africa (Keller et al., 2005a; Nsamenang and Lamb, 1994; Ogunnaike and Houser, 2002) and Latin America (Bornstein and Cote, 2001; Harwood et al., 1999; Triandis et al., 1988). Although the two models are derived from research conducted in a relatively limited number of sociocultural settings (Harwood et al., 2002; Nsamenang and Lamb, 1994), and intracultural variation must be taken into account (Harkness et al., 2000; Harwood, Schölmerich, and
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Schulze, 2000; Palacios and Moreno, 1996), their definitions have been refined and successfully applied in multiple cultural environments to analyze parents’ conceptions of relationships and competence (Bornstein and Cote, 2001; Markus and Kitayama, 1991). Some authors suggest that parents provide different types of stimulation consistent with their own views of child development and competence during free-play situations with their infants, thus linking broad cultural models to interactional styles and socialization strategies (Bornstein et al., 1999; Keller et al., 2004). In particular, the model of independence is expressed in a distal parenting style characterized by frequent face-to-face interaction, exclusive dyadic attention, contingency to positive signals, and object play; developmentally, this pattern leads to an autonomous agency as it enhances the infant’s sense of separateness and increases the awareness of causality (Keller et al., 2005b). Solitary play with objects also contributes to the development of an independent self (Harwood et al., 1999). The model of interdependence is primarily supported by a proximal parenting style characterized by physical contact and stimulation, warmth, shared attentional focus, and sensitivity to the infant’s negative signals; these behaviors have been related to the development of a heteronymous agency, as they enhance relational closeness and a sense of belonging to the community (Kağitçibaşi, 1997; LeVine et al., 1994). The present study aims to compare childrearing beliefs and behaviors in two particular communities within cultures assumed to embody different cultural models: Central Nicaraguan farmer families and North Italian middle-class families. Based on Hofstede’s (1991) multinational studies of cultural values, we expect Nicaragua to express a collectivistic/interdependent orientation, whereas Italy is assumed to represent an individualistic/independent orientation1. In the following paragraphs we briefly describe the sociocultural background of the two communities included in our study.
NICARAGUAN FARMERS’ FAMILIES The Republic of Nicaragua is the largest country in Central America, but it is also the least densely populated in comparison with neighboring Honduras and Costa Rica. In 2008, an estimated 5.79 million people lived in Nicaragua (CIA World Factbook, 2008a). Due to the Spanish conquest and a complex combination of socio-demographic factors, 69% of the Nicaraguan population is Mestizo (people of mixed European and American Indian ancestry), with the remaining being Europeans (17%), Creoles and/or Africans (9%), and Amerindians (5%). Traditionally, the religion of the majority is Roman Catholic, but evangelical Protestants and Mormons have been rapidly growing since the 1990s. Popular religion centers around the saints, who are perceived as intermediaries between human beings and God (Gilbert, 1993). Economy is primarily based on agriculture, but light industry (maquila), banking, mining, fisheries, tourism, and general commerce are increasing. Nicaragua’s agrarian economy has 1
Geert Hofstede has developed a classification system in which 50 countries and three geographical regions are ranked for their national individualism, with lower values indicating higher levels of individualism, and viceversa (e.g., rank 1 = USA, rank 53 = Guatemala). Although Nicaragua is not included in this system, neighboring Costa Rica ranks 42, whereas Italy ranks 6. More information is available at www.clearlycultural.com/geert-hofstede-cultural-dimensions/individualism.
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historically been based on the export of cash crops such as coffee, bananas, sugar, beef, and tobacco (CIA World Factbook, 2008a). Since 1980, education is free from ages seven to twelve, but the educational system is underfunded and generally inadequate, with only 18% of the total national budget invested in primary, secondary, and higher education (Gilbert, 1993). At the time of the Sandinista Revolution in 1979, the educational system was one of the poorest in Latin America, but a series of large-scale literacy campaigns reduced the overall illiteracy rate from 50% to 13% (Gilbert, 1993). In Nicaraguan society the nuclear family forms the basis of family structure, but women are highly dependent on the support system formed by sisters, mothers, grandmothers, and other relatives (Espinoza, 2002). The extended family and godparents play a powerful role in the social, economic, and political relations of Nicaraguans due to the enduring lack of stability of other societal institutions (Lamontagne, Engle, and Zeitlin, 1998). In particular, the set of relationships between a child’s parents and his/her godparents (“compadrazgo”) serves to establish strong bonds of ritual kinship with persons unrelated by blood or marriage, thus influencing the individual’s status in the larger society. Although stable monogamous unions and strong patriarchal authority at home are deeply ingrained cultural values, many Nicaraguan households are headed by women (Gilbert, 1993). Infants are primarily raised by the mother with the help of the extended kin, whereas the father rarely participates directly in childcare and childrearing (Espinoza, 2002). Like in other countries with high infant mortality rates, physical proximity between mother and baby is fostered through cosleeping and breastfeeding on demand, especially during the infancy period (LeVine et al., 1994). Traditional parenting beliefs and expectations reflect Hispanic values emphasizing harmonious relationships between family members, which are achieved through the early socialization of obedience, respect, and cooperation (Harwood et al., 1999; Leyendecker, Lamb, Harwood, and Schölmerich, 2002; Moscardino and Bonichini, 2007; Varela et al., 2004). Previous research reports that Central American mothers frequently engage in physical stimulation to exercise their infants’ motor skills (Bornstein and Cote, 2001), and consider body contact as a very important means to transmit positive affect (Keller et al., 2005a).
ITALIAN MIDDLE –CLASS FAMILIES Today, Italy counts more than 59 million inhabitants and has the 7th –highest GDP among the world economies (CIA World Factbook, 2008b). After the Second World War, the country experienced an economic boom that led to substantial migration from rural to metropolitan areas, with approximately two thirds of the population now living in urban settings. The literacy rate in Italy is 98% overall, and school is mandatory for children aged 6 to 16. The vast majority of Italians (90%) are Roman Catholic, although only about one-third of these practice their religion. The Catholic Church is no longer officially the state religion; however, it still influences the country’s political affairs partly because of the Holy See’s location in Rome. Italy’s economic system is characterized by the presence of small and medium-sized companies, with a marked difference between a developed industrial north, dominated by private companies, and a less developed agricultural south.
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Italians generally live in nuclear families, although frequent contacts with the extended family are common. A majority of women participate in the labor force and receive support from health and social services in their everyday lives (Saraceno, 2003). Italian society shares cultural norms and values of many other Western societies emphasizing individualism and independence, especially in the northern regions (Bornstein, Cote, and Venuti, 2001). Cosleeping is uncommon, as infants are expected from early on to sleep through the night in a separate room; however, health professionals highly recommend breastfeeding across the first six months of life to promote children’s physical and psychological well-being (Moscardino, Nwobu, and Axia, 2006). Family socialization practices and formal schooling are directed to the promotion of children’s creativity and self-expression. Parents encourage assertiveness, independence, and social competence during the early years of childhood, since interpersonal skills and being able to establish social interactions are viewed as desirable characteristics in this cultural context (Casiglia, Lo Coco, and Zappulla, 1998; Gandini and Edwards, 2001). Infant liveliness and activity are highly valued as they are considered indicators of good physical health (Axia and Weisner, 2002; Harkness et al., 2006; Hsu and Lavelli, 2005). In addition, parents’ childrearing beliefs emphasize emotional closeness, social openness, autonomy, and serenity in the home environment (Axia, Bonichini, and Moscardino, 2003). North Italian mothers tend to engage in both social and object play during interactions with their infants to foster autonomous exploration as well as socio-emotional competence (Axia and Weisner, 2002; Bornstein et al., 2001). To summarize, the first goal of this study was to analyze childrearing beliefs and developmental goals among rural Nicaraguan and middle-class Italian mothers of young infants. Consistent with previous research suggesting that Central American culture can be described as more interdependent/collectivistic (Keller et al., 2005a; Leyendecker et al., 2002), whereas North Italian culture can be described as more independent/individualistic (Bornstein et al., 2001; Hofstede, 1991), we expected that mothers in the two groups would differ in their parenting conceptions according to these broad sociocultural constructs. The second goal of our study was to investigate similarities and differences in both frequency and duration of maternal behaviors in a free-play session in the two groups. Based on foregoing comparative studies of mother-infant interaction during free play, we expected that Nicaraguan mothers representing an interdependent cultural model would engage in physical and motor stimulation more often and for longer periods of time than the Italian mothers. Conversely, we expected that Italian mothers supporting an independent cultural model would engage in face-to-face contact, social stimulation, and object play more often and for longer periods of time compared to Nicaraguan mothers.
METHOD Participants Fifty-six families from the two cultural communities volunteered to participate in the study. The central Nicaraguan sample consisted of 26 mother-infant dyads, and the north Italian sample of 30 dyads. The rationale for the selection of the two cultures is based on
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differing cultural conceptions of relationships and competence that may be attributed to interdependent and independent worldviews. The 26 Nicaraguan mothers lived in the rural area of Waslala, a municipality located 245 km north of Managua, the capital of Nicaragua. About a quarter of the country’s agriculture takes place in this region. Most families made their living from farming and trading, and educational attainment was generally lower than in the Italian sample. This group is assumed to represent an interdependent cultural model (Kağitçibaşi, 1997; Leyendecker et al., 2002). The 30 urban Italian mothers lived in Vicenza, a middle-sized industrial city in the northeastern Veneto region. This area is today among the wealthiest and most industrialized regions of Italy, with high annual economic growth and a very dynamic economy. Most participants had achieved a high level of education, were relatively older, and had slightly fewer children than the Nicaraguan sample. This sociodemographic profile has been described as characteristic for women with an independent cultural model (Harwood et al., 1999; Keller et al., 2004). All mothers had one firstborn infant between the ages of 0 and 14 months. There were no group differences in the age of each mother’s child (M = 8.43 months), and approximately equal number of girls and boys were recruited in each sample. The average age of mothers was 29 (SD = 6.74) years, ranging from 17 to 43 years. An overview of the sociodemographic characteristics of the samples is presented in Table 1. Analyses were performed on 9 demographic variables (child’s age, mother’s age, number of children, percent firstborn infants, percent male infants, mother’s education in years, maternal employment status, mother’s marital status, and religious background). Results indicated that participants differed on just three demographic variables: Nicaraguan mothers were significantly younger (t = -4.8, df = 54, p <.001), received less education (t = -3.81, df = 53, p < .001), and were less likely to report their religious background as Catholic (X2 = 30.6, df = 2, p < .01) than their Italian counterparts. Although these characteristics differed markedly between the two groups, they are in line with the standards of the participating women’s respective populations and thus may be viewed as an integral part of their sociocultural backgrounds. The selection of equivalent samples would have prevented us from accurately representing the sociocultural environment of the study participants. Table 1. Demographic characteristics of participants
Characteristic Child’s age (months) Mother’s age No. of children Firstborn (%) Male (%) Mother’s education (years) Percent mothers employed Percent mothers married Religious background (%) None Catholic Protestant
Nicaraguan (n = 26) M SD 8.7 3.4 25.1 5.9 2.1 1.4 50 57.7 9.3 2.9 50.0 84.6
Italian (n = 30) M 8.2 32.4 1.8 46.7 36.7 12.3 56.7 96.7
38.5 30.8 30.8
0 100
SD 3.2 5.5 0.9
3.0
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RECRUITMENT AND PROCEDURE Similar participant recruitment procedures were employed in the two cultural settings. Specifically, samples were recruited by contacting the local health care centers. A number of participants were personally contacted by members of the research team and asked to participate. Parents were informed that we were interested in their ideas about parenting and childrearing practices in different cultures. Families were then contacted by phone or in person, and an appointment for the home visit was set up according to the mothers’ preference. In each site, mothers were interviewed and observed at home in their native language by trained female research assistants. After a warming-up and a familiarization phase, mothers provided their informed consent, completed a socio-demographic questionnaire, and were asked to participated in a semi-structured interview concerning their beliefs and expectations about child health, care, and development. Next, mothers were videotaped interacting with their infants during a free-play session. Interviews were administrated to the full sample. The Nicaraguan audiotapes were transcribed and translated from Spanish into Italian by two bilingual, bicultural research assistants according to standard back translation techniques. For microanalyses of the videotaped mother-infant interactions, the data of 41 mothers (n = 23 Nicaraguan, n = 18 Italian) could be used and were included in the present study.
MEASURES Maternal childrearing beliefs. The Nicaraguan and Italian mothers’ cultural beliefs and practices were addressed in an in-depth, semi-structured interview used in previous crosscultural research on children and families (Harkness et al., 2006; Moscardino et al., 2006). This technique allows to collect information on ideas, beliefs, opinions, and attitudes concerning specific topics the investigator is interested in (Axia et al., 2003; Super and Harkness, 1999). The interview focused on the following areas: family ecology (e.g., subsistence base, housing conditions), use of social/health care services, support and social network, experience of pregnancy and childbirth, childcare beliefs and practices, descriptions of the infant, and developmental goals. Although the questions were predetermined, length of time spent discussing each topic and the ordering of questions varied according to participant verbosity and responses to previously asked questions. Interviews usually lasted an average of 60 min (range = 30-90 min); they were tape-recorded and transcribed verbatim for further analyses. All interviews were analysed using a thematic approach to gain insight into caregivers’ subjective experiences relating to infant health, care, and development (Miles and Huberman, 1994). This type of analysis involves a systematic and objective encoding of qualitative data into categorical data, the extraction of patterns, and the description of observations derived from the data (Boyatzis, 1998). In particular, for the purpose of this study we will describe recurrent themes in maternal responses concerning three broad areas of parenting and child development: conceptions of the infant, daily routines and activities, and developmental goals. For each interview, the recurrent themes or concepts relating to these areas were identified. Verbatim quotations are used to illustrate the women’s responses on relevant
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themes. All data were coded by the first author and a graduate-level research assistant. In cases of disagreement, original transcripts were re-examined and discussed until coding agreement was reached. Mother-infant interactions. Since our purpose was to examine a setting in each culture that allowed us to observe similarities and variations in parent-child relationships, we decided to focus on mother-infant free-play situations. All mothers were asked to play with their infants as they normally would when not involved in caregiving or other activities and were then videotaped for 10 minutes. This time span was chosen because in infants of that age, it has proven to adequately reflect the ability to sustain attention during a play situation (Keller et al., 2004). To obtain culturally relevant information on maternal ocializat in the two cultural environments, we did not give the mothers any indications about the type and content of play. The videocamera was focused on both the mother’s and the infants’ heads as well as upper trunks to facilitate subsequent microanalytic coding of the interactions. The videotaped observations were continuously coded to record the onset and offset of specific maternal and infant ocializat using coding schemes adapted from previous comparative research on mother-infant interaction during free play (Bornstein and Cote, 2001; Harwood et al., 1999; Keller et al., 2005a). In this study, we coded: (a) the frequency of maternal and infant ocializat, defined as the proportion of times each ocializa occurred during the play session on the total number of observed ocializas; (b) the duration of maternal and infant ocializat, defined as the proportion of time mothers and their infants spent in each ocializa on the total duration of all ocializat. The occurrence of discrete ocializati events was coded with a microanalytic event-sampling technique. Table 2 presents the six ocializati categories for mothers as well as their definitions. Table 2. Categories used to code mother-infant interactions during free-play in the two cultural settings Behavior Social play
Object play Physical/motor stimulation Verbal stimulation Face-to-face interaction Infant plays alone
Description The mother engages in verbal or physical ocializa to amuse her infant and to elicit positive vocalizations and smiles. Objects and/or toys may be involved, but only if they are not used in their original function (e.g., blanket for “peek-a-boo”). It includes singing, tickling, clapping hands, directing the infant’s attention to herself or others (e.g., siblings). The mother attempts to stimulate her infant’s attention with an object/toy; introduces a new object/toy while the infant is playing; plays with the infant. The mother physically or verbally encourages her infant to walk, stand, sit, crawl, dance, step. It includes holding upright, tossing, shaking, lifting up, positioning, and massaging the infant. The mother encourages her infant to engage in a specific play activity (e.g., “Do you want to read a book?”, “Let’s play with the ball”). It does not include maternal requests to fetch objects/toys to be used during play (e.g., “Go and get the ball”). The mother is positioned in front of her infant in a way that allows face-to-face interaction; mother and infant simultaneously look at each other’s face from a close distance (i.e., within 1 meter) . The mother watches without intervening physically and/or verbally while her infant is involved in some play activity.
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Although we were primarily interested in mothers’ ocializat in this study, to control for the possibility that group differences in maternal ocializa reflected differences in infant behavior we also examined the following infant behaviors: (1) cry/fuss; (2); smile; (3) vocalize; (4) look at mother; (5) look at object; (6) wander away. Each cultural sample was coded by trained research assistants who were native speakers. Inter-coder agreements between the research assistants and the first author were calculated on over 25% of the Nicaraguan and Italian videotapes using Cohen’s Kappa. In the Nicaraguan sample, interrater reliabilities for maternal and infant behaviors averaged .90 (range = .80.99) and .94 (range = .80-.99), respectively; in the Italian sample, Cohen’s Kappas for maternal and infant behaviors reached a level of .92 (range = .90-.97) and .93 (range = .92.94), respectively.
RESULTS Maternal Childrearing Beliefs Conceptions of the child. To understand women’s ideas and expectations regarding their own children, we asked them how they would describe their infants to a person who does not know him/her. Interestingly, Nicaraguan mothers mostly focused on physical characteristics, such as “beautiful”, “chubby”, “small”, “big”, “dark-skinned”, “has straight hair”, “moves around a lot”. However, when explicitly asked to describe behaviours and qualities of their infants, our study participants also used expressions like “playful”, “friendly”, “happy”, “cheerful”, “smiling”, “does not cry much”. Overall, their expressions mostly referred to social and emotional skills. Six mothers used the term “angry” (enohado) in relation to their child’s difficulty, suggesting that stubbornness, inflexibility, and low manageability were considered negative characteristics of the infant’s personality. In particular, one mother explained: “He has his moments of anger, because when he is holding something and I take it away, he starts to hit me. Otherwise he likes to play, he laughs a lot, but sometimes he really gets angry (…) Children are always easy when you love them. But if you do not love them, if you leave them alone, if you do not care for them, then they will become difficult” (ID 4)
When asked about the ocializa displayed in front of unfamiliar people, most mothers (14 of 26) said that their children easily approached strangers, whereas another 10 mothers reported that their infants started to cry, became serious, and searched for physical closeness. Only in one case, the child needed some time to observe the unfamiliar adult and then eventually approached him/her. In comparison with the Nicaraguan mothers, Italian mothers’ descriptions of their infants were multifaceted and referred to several domains (i.e., physical, social, emotional, and cognitive). The most frequently mentioned qualities included: “smiling”, “joyful”, “sunny character”, “good”, “sweet”, “affectionate”, “extrovert”, “strong-willed”, “curious”, “smart”, “alert”, “active”, “independent”, and “self-confident”. In general, infants were described as being happy, funny (simpatico), determined, and lively (vivace). Our Italian study participants particularly emphasized the dimensions of sociability and activity:
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When asked about their infants’ difficulty, only 4 of 30 mothers considered their own child to be difficult. These infants were described as being persistent, stubborn, and difficult to manage because of their determination in obtaining something. In contrast, easy infants were defined as “good-tempered”, “distractable”, and “sociable”. Accordingly, most of our Italian participants (24 of 30) reported that their infants easily approached strangers. One mother said: “She likes to interact with everyone…when we join with the extended family and other relatives, she does not get scared or cries, but she starts greeting people, and if someone wants to hold her, she will go!” (ID 7)
Only 6 mothers described their infants as being wary and seeking the mother’s proximity in front of an unfamiliar adult: “She fist observes the person, then she may even want to be held, but after a while she starts to cry”; “He looks into people’s eyes, and only if they smile, he will smile back”. Daily routines and activities. Another relevant area of parent-child relationships concerns the organization of daily routines. In particular, we asked our participants to describe their ideas and practices related to the structuring and scheduling of their infants’ everyday activities (e.g., feeding, sleeping, playing). In some cases (7 of 26), Nicaraguan mothers preferred to feed their infants on demand and were not interested in imposing a schedule: “There are no rhythms because she eats and sleeps, and everytime I nurse her she takes my milk, so every day is different”; “Sometimes he sleeps in the morning, other times in the evening…the truth is that he does not have a schedule”. In other cases, mothers emphasized the importance of putting the baby on a schedule to foster his/her physical health: “My attention is always devoted to him, because he needs to eat always at the same time”; “I pay attention that he sleeps and rests, because this will make him grow more”. When asked about bedtime routines, the vast majority of mothers (20 of 26) preferred to cosleep with their infant in the same bed for a variety of reasons: “it is more comfortable to feed the baby during the night”; “in our culture, a mother sleeps with her child until 2-3 years of age”; “they need to feel the mother’s presence”. Most infants fell asleep during breastfeeding/nursing, but some mothers used other strategies such as rocking, singing a song, and playing to make their infant fall asleep. In terms of stimulation and play, most women said that they stayed at home with their children except for those who were employed in the labor market; these mothers usually took their infant to the workplace, where they often lay him/her in a hammock to easily monitor and check on the baby. Only one women talked about play activities in the context of caregiving: “Early in the morning when she wakes up, I breastfeed her, and then she falls asleep again…Then she wakes up, and this is the time we have fun together (…) In the afternoon I breastfeed her again, then I bath her, change her diaper…when she becomes active it is a moment of enjoyment for us.” (ID 10)
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Italian mothers’ ideas about regularity and scheduling of their infants’ daily activities were as diverse as the answers given. The majority of our study participants (17 of 30) put their babies on a schedule in order to promote a sense of psychological stability and serenity: “I try to put her on a schedule because I think that this will make her feel more comfortable and calm”; “You need to give them a schedule so that they learn how to self-regulate”. In some cases (8 of 30), mothers preferred to adjust to their infants’ biological rhythms, whereas in others (5 of 30) there was no need to provide any input because the baby seemed to have autonomously developed his/her own schedule. All mothers highlighted the importance of teaching the child to sleep in his/her own room from early on, but in particular circumstances (e.g., mother falls asleep during nighttime breastfeeding, infant wakes up many times during the night) some infants slept in their parents’ bed. Although daily activities primarily centered around childcare (i.e., feeding, sleeping, changing diaper), Italian mothers’ descriptions also referred to play and to moments of reciprocal entertainment: “In the afternoon my children take a nap, then I wake them up and we go to pick up their sister at the kindergarten, and then I am there for them…we play, draw, paint, spend time outside, take walks, and do all kinds of play activities together.” (ID 16)
Developmental goals. When asked about the most important thing for their children’s development, Nicaraguan mothers’ responses mainly focused on health-related aspects, such as “nutrition”, “breastmilk”, “preventing sickness”, “cleanliness”, and “clothing”. However, these women also emphasized warmth and affection, good manners, respect of family members, and education: “The most important thing is to give her nutrition and take care of her…then she must learn to respect the family, to go to school…all these things.” (ID 2)
Interestingly, only one mother highlighted the importance of play in addition to caregiving: “Health is very important, and I must do everything so that he does not get sick…but I also would like to provide the opportunity for him to play and have toys”. Italian mothers’ responses mainly focused on the affective dimension of family relationships, including serenity of the home environment, socialization/calmness, emotional closeness between family members, and a good relationship with the partner. One mother commented: “The most important thing for her is a serene atmosphere at home…and a positive, optimistic family climate (…). I want her to have dreams, and to grow up thinking that it is possible to make dreams come true. I believe that everything comes as a consequence, both physically and mentally.” (ID 8)
In contrast to the Nicaraguan women, our Italian participants rarely considered health and nutrition as primary developmental goals.
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MOTHER-INFANT INTERACTIONS Preliminary analyses. Prior to data analysis, univariate and multivariate distributions of all dependent variables were examined for normalcy, homogeneity of variance, and outliers (Tabachnick and Fidell, 1996). Because not all maternal and infant behaviors were normally distributed, nonparametric tests were used in all analyses. To control for the potentially confounding effects of (a) infant sociodemographic variables (i.e., infant’s age, gender, and birth order), and (b) maternal sociodemographic variables (i.e., mother’s age and years of education) on our dependent variables, Mann Whitney U-tests and Spearman correlations were performed separately in each cultural group. Since no statistically significant effects emerged, these variables will not be discussed further. Infant socialization. Cross-cultural comparisons using Mann-Whitney U-tests revealed that infant socialization between the two groups differed on just two variables. In particular, compared to Nicaraguan infants, Italian infants vocalized more (Z = -3.28, p < .001) and spent more time retreating out of mother’s arm length during free play (Z = -3.23, p < .001). These few differences suggest that cultural variations in maternal socialization are not attributable to cultural variations in infant socialization. Given that our primary interest concerns maternal socialization, the analyses described below will exclusively focus on maternal variables. Maternal socialization. To investigate cultural differences in mothers’ ocializat with their infants during free-play, we compared the frequency and duration of each maternal ocializa across the two groups. Figures 1 and 2 show the average frequency and duration of each maternal ocializa observed during the free-play session. 0,25 Nicaraguan Italian
Mean frequency (%)
0,2
0,15
0,1
0,05
0 Social play
Object play
Physical stimul.
Verbal stimul.
Maternal behavior
Figure 1. Mean frequency of maternal behaviors during free play.
Face-toface
Infant plays alone
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0,4 Nicaraguan
0,35
Italian
Mean duration (%)
0,3 0,25 0,2 0,15 0,1 0,05 0 Social play Object play Physical stimul.
Verbal stimul.
Face-to- Infant plays face alone
Maternal behavior
Figure 2. Mean duration of maternal behaviors during free play.
Results of the Mann-Whitney U-tests indicated that, compared to Nicaraguan mothers, Italian mothers were more likely to engage their infants in social play (Z = -2.40, p < .016) and object play (Z = -3.33, p < .001), and provided verbal stimulation more often and for longer periods of time during the observation (Z = -4.42, p < .0001, and Z = -4.77, p < .0001, respectively). In addition, Italian mothers watched their infants while playing alone more frequently and for longer periods of time than did Nicaraguan mothers (Z = -4.82, p < .0001, and Z = -4.90, p < .0001, respectively). Conversely, compared to Italian mothers, the Nicaraguan mothers physically stimulated their infants more frequently and for longer periods of time (Z = -3.71, p < .0001, and Z = 4.05, p < .0001, respectively), and interacted via face-to-face positions more and longer (Z = 2.67, p < .01, and Z = -1.98, p < .05, respectively).
CONCLUSION AND IMPLICATIONS The main goals of the present study were to describe parental conceptions of childrearing and childcare and to evaluate similarities and differences in mothers’ socialization during free-play in two cultural groups assumed to have differing sociocultural orientations – Nicaraguan farmer families and Italian middle-class families. Overall, our findings support the idea that broad cultural values of collectivism/interdependence and individualism/independence are linked to parents’ beliefs and developmental expectations, which in turn contribute to variation in observed mother-infant interaction. Consistent with an interdependent worldview, Nicaraguan mothers’ cultural beliefs and socialization goals emphasized interconnectedness, socio-emotional competence, respectfulness, and obedience. Conversely, in accordance with a more individualistic orientation, Italian mothers emphasized assertiveness, autonomy, self-confidence, and self-
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esteem. These values emerged in mothers’ conceptions of the child as well as in the description of their everyday activities and developmental expectations. Nicaraguan mothers highly appreciated infant expressions of positive affect, socio-emotional competence, and physical characteristics, whereas socialization and anger outbursts were considered two problematic features associated with low manageability of the child. Daily routines and activities mainly centered around protection and nurturing, although we found some heterogeneity in the beliefs and attitudes related to breastfeeding. Indeed, previous studies reported high variability in the duration of breastfeeding in rural areas of Nicaragua, partly because of mothers’ differing sociodemographic characteristics (Sakisaka et al., 2006). Developmental expectations focused on health-related aspects of childcare (i.e., nutrition, preventing sickness, cleanliness), but Nicaraguan mothers also viewed good manners, education, and respect of family members as important socialization goals. Overall, this pattern reflects the values of familismo, respeto, and socialization held by Latino parents of most national origins (Halgunseth, Ispa, and Rudy, 2006). Familism may be described in terms of feelings of closeness with family members, strong sense of loyalty to the family, mutual reliance on extended kin for instrumental and emotional support, and priority of the family over individual needs (Calzada and Eyberg, 2002). Respect is an important means to maintain harmonious relationships within the group by showing respectfulness of others and obedience to authority. The childrearing goal of socialization refers to the importance of raising a child who has qualities reflective of good manners and high morals, including honesty, politeness, respectfulness, and responsibility. Together, these values are frequently described as distinguishing characteristics of Hispanic communities with an interdependent sociocultural orientation (Halgunseth et al., 2006). In describing their infants, Italian mothers highly valued the characteristics of liveliness, activity, sociability, and independence; child difficultness was associated with irritability, persistence, and low soothability. Daily activities mostly involved caregiving routines, but infants were also exposed to social and cognitive stimulation, especially during play with other family members. Although a majority of mothers expected their children to self-regulate and sleep through the night in their own room from early on, co-sleeping sometimes occurred on special occasions. Developmental goals included providing a serene home environment, building emotionally close relationships within the family, and instilling self-confidence through an optimistic attitude toward the self and others. Together, Italian mothers’ childrearing beliefs reflect the cultural values of personal choice, intrinsic motivation, selfesteem, and self-maximization, which are common in many cultures that are considered to emphasize individualism (Tamis-Lemonda et al., 2007). These values are associated with the overarching goal of autonomy, and describe individuals who assert their personal preferences, are internally driven to achieve their goals, feel good about themselves, and achieve their full potential. Parents sharing these childrearing beliefs encourage their children to develop into unique, autonomous beings through the transmission of optimism and self-esteem as they are viewed as crucial determinants of happiness and psychological well-being (Miller, Wang, Sandel, and Cho, 2002). Despite these differences in broad sociocultural orientations, commonalities also emerged in Nicaraguan and Italian mothers’ childrearing beliefs. For example, children’s socioemotional competence and family connectedness were mentioned as two important aspects in both groups. This finding may be explained by the fact that cultures can be individualistic in some aspects and collectivistic in others (Harkness et al., 2000). The case of Italy is
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particularly interesting in this respect. Although in Hofstede’s (1991) classification system Italy has been ranked almost as individualistic as the United States, several authors suggest that this individualism primarily refers to interpersonal relationships outside the extended family (Attili, Vermigli, and Schneider, 1997). Italians’ sense of psychological identity is strongly related to the extended family and, to some extent, to members of their socialization or clans (Saraceno, 2003). As a consequence, Italian parents socialize their children to learn how to manage social relationships, to easily approach others, and to express their emotions during interpersonal interaction as a means to promote social assertiveness (Casiglia et al., 1998; Gandini and Edwards, 2001). In addition, the nuclear family is viewed as a ‘secure base’ that gives the child emotional stability and promotes a sense of psychological wellbeing, thus facilitating exploration and openness to the external world (Axia et al., 2003). Maternal socialization during free-play were coherent with the broad cultural values of interdependence and individualism expressed in mothers’ childrearing beliefs. In particular, Nicaraguan mothers engaged more frequently and for longer periods of time in physical and body stimulation during the observation than did Italian mothers. Conversely, Italian mothers engaged their infants more frequently and for longer periods of time in verbal stimulation, and spent more time in both social and object play than did the Nicaraguan mothers. In addition, Italian mothers watched their infants play alone without intervening more frequently and for longer periods of time than did the Nicaraguan mothers. This pattern confirms the findings of previous research indicating that parents who support an interdependent worldview exhibit a proximal parenting style involving physical closeness and motor stimulation, whereas parents who support an independent worldview display a distal parenting style involving increased verbal input and extensive use of objects to direct the infant’s attention to the external world (Keller et al., 2005b). From this perspective, infant solitary play can be deemed an expression of the mothers’ effort to encourage autonomy and foster independent exploration to stimulate the child’s sense of agency and self-efficacy (Harwood et al., 1999). Interestingly, we found that Italian mothers engaged their infants in social and object play for longer periods of time than did the Nicaraguan mothers, but no significant group difference emerged in the frequency of these socialization during the free-play session. In other words, the incidence of maternal socialization involving stimulation with objects/toys and social interaction was similar across the two cultural groups. These results are consistent with previous research, which found that Central American mothers engaged in both social and didactic socialization during free play interactions with their infants (Bornstein and Cote, 2001). Contrary to our expectations, Nicaraguan mothers engaged in face-to-face-interactions with their infants more frequently and for longer periods of time compared to Italian mothers. This finding may be attributable to the fact that overall Italian infants were more frequently involved in object and solitary play compared to their Nicaraguan counterparts, and thus their attention was oriented more toward toys/objects than to the mothers’ eye gaze (see Figure 3). In contrast, Nicaraguan infants more frequently experienced body stimulation and physical contact, which often implied face-to-face exchanges and mutual eye contact from a close distance (see Figure 4). More research would be needed to examine parenting socialization and their relations to each other in these cultural sites using representative samples. There are limitations of this study that warrant mention, such as the small sample size of just 53 mothers, which prevents us from generalizing our results to the Nicaraguan and Italian population. Since group differences become more robust with sample size, future research in
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this domain may include larger number of mothers to replicate our findings. In addition, there may be important parenting socialization not emerging from the free-play sessions that nonetheless play an important role in Nicaraguan and Italian parents’ socialization process. Indeed, investigators have found that parental beliefs and practices vary across situations (Harwood et al., 1999; Leyendecker et al., 1997), although these variations often show a cultural patterning that is consistent with broader socialization goals. Further studies need to include multiple activity settings (e.g., feeding, social interaction, teaching) to assess whether maternal socialization differs according to the specific context in which it is observed. Finally, it is important to remember that individuals in a culture are not uniformly individualist or collectivist (Oyserman, Coon, and Kemmelmeier, 2002), and that parents in different cultural environments can endorse similar developmental goals (Harkness et al., 2000). Despite we focused on particular communities within cultures that can be characterized by specific sociodemographic profiles and value systems, thus considering the fact that there is also considerable intracultural variability, researchers need to address the dynamic coexistence of individualism and collectivism in cultures and individuals across settings and time (Tamis-LeMonda et al., 2007).
Figure 3. Object play and verbal stimulation during free play in an Italian family.
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Figure 4. Physical stimulation and face-to-face interaction during free play in a Nicaraguan family.
This study contributed to our understanding of the relation between broad cultural values, parental childrearing beliefs, and mothers’ socialization during free play with their young infants. We showed that the cultural model of interdependence is reflected in socialization goals emphasizing social connectedness, respect, and obedience, and is supported by a proximal parenting style involving physical and motor stimulation. In contrast, the cultural model of independence is expressed in childrearing beliefs focusing on autonomy, uniqueness, and separateness, and is supported by a distal parenting style characterized by verbal, social, and object stimulation. Considering that societies are becoming increasingly multicultural, our findings have at least two implications for clinicians working with families from culturally diverse backgrounds. First, parents’ conceptions of relationships and competence are profoundly influenced by cultural norms and expectations that vary widely both within and across cultures, thus challenging the notion of “normative” parenting. Health professionals need to be culturally sensitive and avoid possible misinterpretations due to an ethnocentric perspective that views differences of ethnic and minority groups in terms of deficits when compared to the mainstream culture. Second, a methodological approach
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combining the use of qualitative (i.e., semi-structured interviewing) and quantitative assessment techniques (i.e., socialization observations) may be an effective way to identify cultural patterns in parents’ childrearing beliefs and practices, since self-report questionnaires are often subject to reporting biases related to social desirability and therefore may provide an unrealistic picture of parental ideas, expectations, and socialization goals. To conclude, more intra-cultural and cross-cultural research is needed to study the contextual determinants of parent-child relationships in order to increase our knowledge of different pathways leading to children’s successful development in specific ecocultural niches.
ACKNOWLEDGEMENTS The authors wish to thank all the mothers and infants who participated in the study. We also gratefully acknowledge Lucia Zurlo for her help in data collection and coding, and Gianmarco Altoè for statistical assistance.
REFERENCES Attili, G., Vermigli, P., and Schneider, B. H. (1997). Peer acceptance and friendship patterns among Italian schoolchildren within a cross-cultural perspective. International Journal of Behavioral Development, 21(2), 277-288. Axia, G., Bonichini, S., and Moscardino, U. (2003). Dalle narrative parentali ai dati quantitativi. Etnoteorie parentali in famiglie italiane e nigeriane immigrate in Italia [From parental narratives to quantitative data. Parental ethnotheories in Italian and Nigerian immigrant families in Italy]. In C. Poderico, P. Venuti, R. Marcone (Eds.), Diverse culture, bambini diversi? (pp. 119-139) [Different cultures, different children?]. Milan: Unicopli. Axia, G., and Weisner, T. S. (2002). Infant stress reactivity and home cultural ecology of Italian infants and families. Infant Behavior and Development, 140, 1-14. Bornstein, M. H. (Ed.) (1991). Cultural approaches to parenting. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Bornstein, M. H., and Cote, L. (2001). Mother-infant interaction and acculturation: I. Behavioral comparisons in Japanese American and South American families. International Journal of Behavioral Development, 25, 549-563. Bornstein, M. H., Cote, L. R., and Venuti, P. (2001). Parenting beliefs and socialization in northern and southern groups of Italian mothers of young infants. Journal of Family Psychology, 15 (4), 663-675. Bornstein, M. H., Haynes, M. O., Pascual, L., Painter, K. M., and Galperin, C. (1999). Play in two societies: pervasiveness of process, specificity of structure. Child Development, 70, 317-331. Boyatzis, R. E. (1998). Transforming qualitative information: thematic content analysis and code development. Thousand Oaks, CA: Sage.
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Calzada, E. J., and Eyberg, S. M. (2002). Self-reported parenting practices in Dominican and Puerto Rican mothers of young children. Journal of Clinical Child and Adolescent Psychology, 31(3), 354-363. Casiglia, A. C., Lo Coco, A., and Zappulla, C. (1998). Aspects of social reputation and peer relationships in Italian children: a cross-cultural perspective. Developmental Psychology, 34(4), 723-730. Chao, R., and Tseng, V. (2002). Parenting of Asians. In M. H. Bornstein (Ed.), Handbook of parenting: Social conditions and applied parenting (2nd ed., Vol. 4, pp. 59–93). Mahwah, NJ: Lawrence Erlbaum Associates. CIA World Factbook (2008a). Nicaragua. Retrieved April 4, 2008, from https://www.cia.gov/library/publications/the-world-factbook/geos/nu.html. CIA World Factbook (2008b). Italy. Retrieved April 4, 2008, from https://www.cia.gov/library/publications/the-world-factbook/geos/it.html. Citlak, B., Leyendecker, B., Schölmerich, A., Driessen, R., and Harwood, R. L. (2008). Socialization goals among first- and second-generation migrant Turkish and German mothers. International Journal of Behavioral Development, 32, 56-65. Espinoza, H. (2002). The relationship between family structure and exclusive breastfeeding prevalence in Nicaragua. Salud Pública de México [online], 44(6), 499-50. Retrieved April 21, 2008, from http://scielo.unam.mx/scielo.php?script=sci_arttextandpid=S003636342002000600002andlng=esandnrm=iso. Gandini, L., and Edwards, C. P. (Eds.) (2001). Bambini: the Italian approach to infanttoddler care. New York: Teachers College Press. Gilbert, D. (1993). The society and its environment. In T. Merrill (Ed.), Nicaragua: a country study. Federal Research Division, Library of Congress Country Studies. Retrieved March 30, 2008, from http://lcweb2.loc.gov/cgi-bin/query/r?frd/cstdy:@field(DOCID+ni0030). Greenfield, P. M., Keller, H., Fuligni, A., and Maynard, A. (2003). Cultural pathways through universal development. Annual Review of Psychology, 54, 461-490. Greenfield, P. M., and Suzuki, L. (1998). Culture and human development: implications for parenting, education, pediatrics, and mental health. In I. E. Sigel, and K. A. Renninger (Eds.), Handbook of Child Psychology. Vol. 4: Child Psychology in practice (5th ed., pp. 1059-1109). New York: Wiley. Halgunseth, L. C., Ispa, J. M., and Rudy, D. (2006). Parental control in Latino families: an integrated review of the literature. Child Development, 77(5), 1282-1297. Harkness, S., Moscardino, U., Bermúdez, M. R., Zylicz, P. O., Welles-Nyström, B., Blom, M., Parmar, P., Axia, G., Palacios, J., Super C. M. (2006). Mixed methods in international collaborative research: the experiences of the International Study of Parents, Children and Schools. Cross-Cultural Research, 40 (1), 65-82. Harkness, S., and Super, C. M. (Eds.) (1996). Parents’ cultural beliefs systems: their origins, expressions, and consequences. New York, NY: Guilford Press. Harkness, S., and Super, C. M. (2006). Themes and variations: Parental ethnotheories in Western cultures. In K. Rubin and O. B. Chung (Eds.), Parenting beliefs, socialization and parent-child relations: a cross-cultural perspective (pp. 61–79). New York: Psychology Press. Harkness, S., Super, C. M., and van Tijen, N. (2000). Individualism and the ’Western mind’ reconsidered: American and Dutch parents’ ethnotheories of the child. In S. Harkness, C.
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Raeff, and C. M. Super (Eds.), Variability in the social construction of the child. New Directions for Child and Adolescent Development, 87, 23-39. Harwood, R. L., Leyendecker, B., Carlson, V. J., Asencio, M., and Miller, A. M. (2002). Parenitng among Latino families in the US. In M. H. Bornstein (Ed.), Handbook of parenting, vol. 4: Social conditions and applied parenting (2nd ed., pp. 21-46). Mahwah, NJ: Lawrence Erlbaum Associates. Harwood, R. L., Schölmerich, A., Schulze, P. (2000). Homogeneity and heterogeneity in cultural belief systems. In In S. Harkness, C. Raeff, and C. M. Super (Eds.), Variability in the social construction of the child. New Directions for Child and Adolescent Development, 87, 41-57. Harwood, R. L., Schölmerich, A., Schulze, P., and Gonzalez, Z. (1999). Cultural differences in maternal beliefs and behaviors: A study of middle-class Anglo and Puerto Rican mother-infant pairs in four everyday situations. Child Development, 70, 1005-1016. Hofstede, G. (1991). Cultures and organizations. Software of the mind. London: McGrawHill. Hsu, H.-C., and Lavelli, M. (2005). Perceived and observed parenting behavior in American and Italian first-time mothers across the first 3 months. Infant Behavior and Development, 28, 503-518. Kağitçibaşi, C. (1997). Individualism and collectivism. In J. W. Berry, M. H. Segall and C. Kağitçibaşi (Eds.), Handbook of cross-cultural psychology, vol. 3: Social behavior and applications (2nd ed., pp. 1-49). Boston, MA: Allyn and Bacon. Kağitçibaşi, C. (2005). Autonomy and relatedness in cultural context: implications for family, parenting, and human development. Journal of Cross-Cultural Psychology, 36(4), 403422. Keller, H., Borke, J., Yovsi, R., Lohaus, A., and Jensen, H. (2005a). Cultural orientations and historical changes as predictors of parenting socialization International Journal of Behavioral Development, 29(3), 229-237. Keller, H., Kärtner, J., Borke, J., Yovsi, R., and Kleis, A. (2005b). Parenting styles and the development of the categorical self: a longitudinal study on mirror self-recognition in Cameroonian Nso and German families. International Journal of Behavioral Development, 29(6), 496-504.. Keller, H., Lamm, B., Abels, M., Yovsi, R., Borke, J., Jensen, H., Papaligoura, Z., Holub, C., Lo, W., Tomyama, A. J., Su, Y., Wang, Y., and Chaudhary, N. (2006). Cultural models, socialization goals, and parenting ethnotheories: a multicultural analysis. Journal of Cross-Cultural Psychology, 37, 155-172. Keller, H., Lohaus, A., Kuensemueller, P., Abels, M., Yovsi, R., Voelker, S., Jensen, H., Papaligoura, Z., Rosabal-Coto, M., Kulks, D., and Mohite, P. (2004). The Bio-Culture of Parenting: Evidence From Five Cultural Communities. Parenting: Science and Practice, 4(1), 25-50. Lamontagne, J. F., Engle, P. L., and Zeitlin, M. F. (1998). Maternal employment, child care, and nutritional status of 12-18-month-old children in Managua, Nicaragua. Social Science and Medicine, 46(3), 403-414. LeVine, R. A. (2002). Contexts and culture in psychological research. New Directions for Child Development, 96, 101-106.
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LeVine, R. A., Dixon, S., LeVine, S., Richman, A., Leiderman, P. H., Keefer, C. H., and Brazelton, T. B. (1994). Child care and culture: lessons from Africa. New York: Cambridge University Press. Leyendecker, B., Lamb, M. E., Schölmerich, A., and Fricke, D. M. (1997). Contexts as moderators of observed interactions: a study of Costa Rican mothers and infants from differing socioeconomic backgrounds. International Journal of Behavioral Development, 21, 15-34. Leyendecker, B., Lamb, M. E., Harwood, R. L., and Schölmerich, A. (2002). Mothers’ socialization goals and evaluations of desirable and undesirable everyday situations in two diverse cultural groups. International Journal of Behavioral Development, 26(3), 248-258. Markus, H. R., and Kitayama, S. (1991). Culture and the self. Implications for cognition, emotion, and motivation. Psychological Review, 98, 224-253. Miles, M. B., and Huberman, A. M. (1994). Qualitative data analysis. Beverly Hills, CA: Sage. Miller, P. J., Wang, S., Sandel, T., and Cho, G. E. (2002). Self-esteem as folk theory: a comparison of European American and Taiwanese mothers’ beliefs. In C. S. TamisLeMonda, and R. Harwood (Guest Editors), Special Issue of Parenting: Science and Practice: Parental Ethnotheories: Cultural Practices and Normative Development, 2, 209-239. Moscardino U., and Bonichini S. (2007). Cultural conceptions of infant health and development among Bolivian immigrant mothers in Italy. In P. Liamputtong (Ed.), Childrearing and infant care issues: A cross-cultural perspective (pp. 221-234). New York, NY: Nova Science Publishers. Moscardino, U., Nwobu, O., and Axia, G. (2006). Cultural beliefs and practices related to infant health and development among Nigerian immigrant mothers in Italy. Journal of Reproductive and Infant Psychology, 24(3), 241-255. Nsamenang, A. B., and Lamb, M. E. (1994). Socialization of Nso children in the Bamenda grassfields of Northwest Cameroon. In P. M. Greenfield and R. R. Cocking (Eds.), Crosscultural roots of minority development (pp. 133-146). Hillsdale, NJ: Lawrence Erlbaum Associates. Ogunnaike, O. A., and Houser, R. F. (2002). Yoruba toddlers’ engagement in errands and cognitive performance on the Yoruba Mental Subscales. International Journal of Behavioral Development, 26(2), 145-153. Oyserman, D., Coon, H., and Kemmelmeier, M. (2002). Rethinking individualism and collectivism: evaluation of theoretical assumptions and meta-analyses. Psychological Bulletin, 128, 3-72. Palacios, J., and Moreno, M. C. (1996). Parents’ and adolescents’ ideas on children: origin and transmission of intracultural diversity. In S. Harkness and C. M. Super (Eds.), Parents’ cultural belief systems: their origins, expressions, and consequences (pp. 215253). New York: Guilford Press. Rogoff, B. (2003). The cultural nature of human development. New York: Oxford University Press. Rothbaum, F., Pott, M., Azuma, H., Myiake, K., and Weisz, J. (2000). The development of close relationships in Japan and the United States: paths of symbiotic harmony and generative tension. Child Development, 71, 1121-1142.
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Sakisaka, K., Wakai, S., Kuroiwa, C., Cuadra Flores, L., Kai, I., Mercedes Aragòn, M., and Hanada, K. (2006). Nutritional status and associated factors in children aged 0-23 months in Granada, Nicaragua. Public Health, 120, 400-411. Saraceno, C. (2003). Mutamenti della famiglia e politiche sociali in Italia [Family changes and social policy in Italy]. Bologna: Il Mulino. Saraswathi, T. S. (Ed.) (1999). Culture, socialization and human development: theory, research and applications in India. New Delhi: Sage. Shweder, R. A., Goodnow, J., Hatano, G., LeVine, R. A., Markus, H., and Miller, P. (1998). The cultural psychology of development: one mind, many mentalities. In R. M. Lerner (Ed.), Handbook of child psychology. Vol. 1: Theoretical models of human development (5th ed., pp. 865-937). New York: Wiley. Super, C. M., and Harkness, S. (1999). The environment as culture in developmental research. In T. Wachs and S. Friedman (Eds.), Measurement of the environment in developmental research (pp. 279–323). Washington, D.C.: American Psychological Association. Super, C. M., and Harkness, S. (2002). Culture structures the environment for development. Human Development, 45, 270-274. Tabachnick, B. G., and Fidell, L. S. (1996). Using multivariate statistics (3rd Ed.). New York: Harper Collins. Tamis-LeMonda, C. S., Way, N., Hughes, D., Yoshikawa, H., Kahana Kalman, R., and Niwa, E. (2007). Parents’ goals for children: the dynamic coexistence of individualism and collectivism in cultures and individuals. Social Development, 17(1), 183-209. Triandis, H. C. (1995). Individualism and collectivism. Boulder, CO: Westview Press. Triandis, H. C., Bontempo, R., Villareal, M., Asai, M., and Lucca, N. (1988). Individualism and collectivism: cross-cultural perspectives on self-ingroup relationships. Journal of Personality and Social Psychology, 54, 323-338. Varela, R. E., Sanchez-Sosa, J. J., Riveros, A., Vernberg, E. M., Mitchell, M., and Mashunkashey, J. (2004). Parenting style of Mexican, Mexican-American, and Caucasian-Non-Hispanic families: social context and cultural influences. Journal of Family Psychology, 18(4), 651-657. Weisner, T. S. (2002). Ecocultural understanding of children’s developmental pathways. Human Development, 45(4), 275-281. Whiting, B. B. and Edwards, C. (1988). Children of different worlds. The formation of social behavior. Cambridge, MA: Harvard University Press.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 16
“IT’S SATURDAY…I’M GOING OUT WITH MY FRIENDS”: SPENDING TIME TOGETHER IN ADOLESCENT STORIES Emanuela Rabaglietti and Silvia Ciairano1 Department of Psychology, University of Torino, Italy
ABSTRACT During adolescence, peer relationships and friendships are relevant contexts for cognitive and social development [Bukowski, Newcomb and Hartup, 1996] and for future adult adjustment [Hartup and Stevens, 1999]. We also know that people, and particularly adolescents, by way of narration and autobiographic construction, can define and attribute meaning to their self and their relationships with others. Bruner and colleagues [Amsterdam and Bruner, 2000; Bruner, 2002] pointed out that individuals construct stories to attribute meaning and order to daily life events. By narrating one’s own story it is possible to organise episodic memory, to shape the recollection of events, and to build reality [Smorti and Pagnucci, 2003]. Specifically in friendship relationships, narrative autobiographic experiences represent specific interpretative modalities used by adolescents to give meaning to the self and the others within these relationships. In this study, which is based on adolescent narrations, we explored adolescent leisure-time behaviour in the company of friends, specifically on Saturday afternoons. We were also interested in identifying the self markers [Bruner, 1986; 1997], by which adolescents perceive themselves and others, and attribute meaning to their own experiences. Finally, we would like to investigate the relationship between the Self markers and some indicators of well-being (e.g. positive self-perception and expectations of success), social self-efficacy, adulthood (e.g. value of autonomy), and discomfort (e.g. feelings and sense of alienation). Participants included thirty adolescents (11 girls and 19 boys) aged 14 to 20 years (M= 15.8; D.S.= 1.4) attending two different types of high school (43% lyceum, 57% technical and vocational) in the northwest of Italy. The adolescents were asked to write a essay on the subject: “It’s Saturday…I’m going out with my friends”. 1
[email protected].
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Emanuela Rabaglietti and Silvia Ciairano We analysed the essays using thematic analysis of content as well as Bruner’s [1986; 1997] system of self markers. The following profiles summarise our findings. Most of the adolescents go out on Saturday and they have fun, talk, share convivial activities and sometimes also illegal activities (particularly boys) with their friends. Adolescents use frequently especially the Self markers of Agency (97%), Commitment (87%), Coherence (80%) and Social references (83%). Girls use the subjective aspects of Self markers, such as Qualia and Evaluation on the bases of expectations, more frequently than boys. Older adolescents use Agency and Resources more frequently than younger adolescents. Finally, Resources and Evaluation are related to positive self-perception and Social references is linked to Social self efficacy. This study has some limitations, such as the limited number of participants and the specificity of the essay, which make it impossible to generalise these findings to adolescent social life. Nevertheless, the findings can contribute to a better understanding of the meaning that peers and friends assume in adolescence.
INTRODUCTION Peer Relationships and Friendships in Adolescence We know that during adolescence, relationships with significant peers are redefined and assume new meaning. More specifically, adolescents’ relationships with their peers become increasingly important: these relationships are characterised by greater levels of intimacy compared to childhood relationships and in the adolescent social network peers and friends acquire a central position, becoming as important as relationships with parents [Bukowski, Newcomb and Hartup, 1996]. In the past few years, several studies have shown that being able to build and maintain satisfactory relationships with peers and friends is a relevant indicator of mental and physical well-being and an important protective factor against psychosocial risk throughout the entire life span, and particularly in adolescence [Hartup and Stevens, 1997; Berndt, 2004; Rubin, Bukowski and Parker, 2006]. According to Hartup [1993], peer relationships and friendships are one of the most important developmental contexts for adolescents. This scholar [1989; 1993] showed that friendship provides a context in which boys and girls have the opportunity to develop social, cognitive, and emotional capabilities and experience new types of relationships characterised by parity and symmetry, and behavior models. Furthermore, high quality relationships - in terms of support, intimacy, and reciprocity - with friends and peers in general encourage the maintenance of ties and contribute to psychosocial adjustment [Fonzi and Tani, 2000]. High quality friendships are related to the regulation of emotions [Gauze, Bukowski, Aquan-Assee and Sippola, 1996], social competence [Buhrmester, 1990], problem solving [Brendgen, Bowen, Rondeau and Vitaro, 1999], and school success and adjustment [Berndt and Keefe, 1995]. Some of our previous research showed that, in adolescence, supportive friendships, compared to conflictual relationships, are related to higher levels of psychosocial well-being and lower levels of aggression towards peers. More specifically, friendship patterns characterized by support and sharing of thoughts, feelings, and behavior represent a positive social context in which adolescents can strengthen their self-confidence, expectations for the future, and social competence [Rabaglietti, Roggero, Settanni and Ciairano, 2007]. However, adolescent friends also share in mild transgression
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against adult rules, such as lying and disobedience [Ciairano, Rabaglietti, Roggero, Bonino and Beyers, 2007]. Therefore, relationships with peers and friends seems to be the relational experiences that, through support and social comparison, provide adolescents with an opportunity to learn new social definitions, to build and/or strengthen their social capabilities, and to experiment with their own identity and different social roles [Jackson and Rodriguez-Tomé, 1993]. The present study builds on the theoretical framework mentioned previously, which examines relationships with friends and peers as an adolescent developmental context. We asked the adolescents who participated in this study to write about themselves and their friends and how they spend their time together on Saturday afternoons. This activity gave the adolescents an important opportunity to narrate a portion of their daily lives and focus on themselves. In particular, they were invited to write a portion of their autobiography containing relevant self markers.
Narration and Adolescence In recent years, the construtivistic paradigm of knowledge and the concept of narration have become increasingly important in various scientific disciplines, such as anthropology, history, sociology, and psychology. “According to the constructivist paradigm, the process of acquiring knowledge [...] is a constructive process that takes place always starting from the inner point of view of the individual [...], likewise a narration that reconstructs events according the point of view of the narrator [Smorti, 2000, p. 515, translation by the author]. Therefore within the constructivist paradigm, stories become “universal ways” [Smorti, 1997, p.10] by which individuals convey and attribute meaning to events throughout their lives. Such stories fulfil a crucial role particularly during adolescence, when boys and girls must face the universal developmental task of constructing their own identity. While universal, the developmental task of constructing individual identity may be confronted in many different ways depending on the characteristics and resources of the individual and his or her life context [Bonino, Cattelino and Ciairano, 2005]. Some scholars interested in the role of stories and narratives during the life course [see for instance: Cohler, 1982; Bruner, 1990; and McAdams, 1997] state that, through narration, human beings define who they are along time, synthesising synchronic and diachronic elements into a construction that assumes the shape of a story [Aleni Sestito, 2004b]. In the narration of one’s own experience, the process of re-interpretating events, which individuals do to maintain a sense of coherence, is very important. According to Cochran [1997], narration requires “emplotment” that is the process individuals use to place themselves as actors in significant, productive, and satisfying stories. Thus, it is the process that allows people to attribute meaning to their identities. According to this perspective, narration becomes an instrument used to achieve continuity and, at the same time, adjust to change. More specifically, narration of the self or self-biography is the main way in which people attribute meaning to the events of their lives, and, consequently, coherence and continuity to their personal identity. We achieve coherence and continuity both by modifying our story and by making our actions congruent to the story. Therefore, a narration “is not only what collects and ocializa the experience, but what produces it, too” [Smorti, 1997, p. 32; translation by the author]. In fact, “life stories are
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based on biographical facts, but they go considerably beyond the facts as people selectively appropriate aspects of their experience and imaginatively construe both past and future to construct stories that make sense to them and to their audiences, that vivify and integrate life and make it more or less meaningful” [McAdams, 2001, p. 101]. Life stories tell about the past and are directed at the future, leading human actions. According to Bruner [1991; 1994], the “life story” represents a “dialogic act” that is the result of negotiating meaning with others. The efforts of the narrator provide coherence and construct the plot of his or her own meanings. This negotiation is made possible by the fact that the narrator and his or her interlocutors share the same cultural context and, consequently, can share the meanings of experience. People organise their experiences, especially memories of events, mainly in the form of narratives. These narratives include human motivations, beliefs, and justifications for behaving or not behaving in a certain way. In this sense narratives are conventional forms that are culturally transmitted and constrained by the individual’s level of mastery with personal experience. Through narration, individuals try to understand, and to interpret their own and others’ actions. In this process, they also try to link actions to the thoughts of the actor, to face contradictory and unexpected events, and to re-construct an ordered “canonicity” [Bruner, 1991]. Within this perspective, Trzebiński [1997] stated that knowledge about the self is organised in narrative schemas and these narrative schemas give people a fundamental instrument for interpreting the most important events in their reality. This scholar identified three main features of stories about the Self, defined as processes that put facts, events, and situations that are relevant for the Self in a narrative plot. First, such stories tell something about events or actions that is relevant for the individual; therefore, they are strictly linked to his/her intentions and emotions. Second, people have a central role in the stories they narrate: they affect the course of events with their actions, and, in turn, are affected by these events. Finally, the events and the facts of an individual’s story, because of the way they are described, outline his/her self identity within his/her life context; in other words, they give meaning and assure continuity to the experiences that are relevant for the self [Trzebiński, 1997, p.62; translation by the author]. Stories about the self lead to the construction of a “narrative representation of self”, where “the most salient episodes of life […] are organised and mentally represented as stories. These stories about the self are stored in the memory and can be activated and reconstructed as real systems of the working memory, in order to elaborate new information relevant for the self [Trzebiński, 1997, p. 61, translation by the author]. The process of narration is particularly important during adolescence, when boys and girls must attribute meaning, coherence, and continuity to their lives while facing a rapid sequence of physical, psychological, and social changes. At the same time, adolescents must reorganise their self concept, integrating distinctive features of subjective experience with the evaluation of objective aspects. As suggested by McAdams [2001], adolescents and youth living in contemporary societies begin to reconstruct their personal past, to perceive the present, and to anticipate the future in terms of an internalised and evolving self-story, an integrative narrative of the Self that provides them with unity and purpose. Adolescents, who are construing their own future, who are dreaming of tomorrow, who are revising their own childhood dreams, need to test their potential in the present and they test themselves with the means available to them: one of these means is self narration. The adolescent reorganises his/her own story by way of self-
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biography, and “constructs the Self like a text” [Smorti, 1997, p.32] in order to recognise and to preserve his/her sense of identity. The adolescents who participated in this study were all students and they tried to construct a portion of their reality linking different components. With their stories, they described a part of the Self that, as in most of human life, takes place daily within a shared culture. To narrate one’s own story means to attribute sense and continuity to one’s own experiences, and the reconstruction of the past promotes the construction of a “platform” of meanings; this platform is used to both interpret the present experience and to facilitate self definition [Smorti, 1997]. This narrative process implies the necessity to combine the need for normalisation with the need for differentiation. Through normalisation, individuals reconstruct the parts of themselves that they share with others, which Ricoeur [1990] defined as “idem” identity. On the one hand, normalisation or “idem” identity enables the individual to experience a sense of belonging (to his/her community, culture, etc). On the other hand, the individual may risk feeling that his/her story is too predictable or uninteresting. For this reason, the individual adds some critical events in the self story, which Bruner [1990] called breaking of “canonicity”: unexpected events are inserted which create a lack of balance and make the story more interesting, but the individual still perceives the self story as personal. In this way he/she constructs the other aspect of identity, which Ricoeur [1990] called “ipse”. The aspects of “idem” and “ipse” identity refer respectively to stability and change of self. Autobiographical construction is the privileged context in which these aspects integrate and balance with each other [Smorti, 1997]. When the individual narrates his/her personal story, he gives meaning to his/her actions. In addition to narrating the self, the individual presents himself/herself to others in the way he/she perceives to be most appropriate to a particular situation. For this reason, autobiographical narration can be considered an essential tool for unravelling the dynamics of the process of identity construction as an expression of the concept of the Self [Aleni Sestito, 2004b]. As mentioned previously, Bruner’s seminal work [see for example: 1986; 1990; 1997] highlighted the importance of using narration and particularly autobiography as a possible methodology for investigating relevant aspects of Self. Furthermore, the constructivistic theory [Bruner, 1991; 1997] represents an interesting starting point for analysing the self dimensions that are particularly crucial for the individual during a specific developmental phase. The present study is based on this theory. Bruner [1997] stated that self markers are relevant indicators within narrations about the self. These markers are essentially signals pointing to the way individuals perceive and collocate themselves within their relational, social, and cultural context. Bruner [1997] proposes the following indicators of selfhood: 1) Agency: refers to acts of free choice, to voluntary actions, and free initiative to pursue one’s own aims. 2) Commitment: refers to the active participation, which goes beyond impulsive behaviour, of the actor; as opposed to inconsistency, it signifies perseverance and delay of gratification. 3) Resources: represented by all the elements (power, goods, privileges) that an actor has at his/her disposal in order to carry out his/her aims; this includes both external resources, such as power, social legitimacy, and sources of information, as well as inner resources, like patience, long term perspective, and forgiveness.
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Emanuela Rabaglietti and Silvia Ciairano 4) Social references: the features that constitute the actor’s social context; references used to legitimise or evaluate goals, commitments, and allocation of resources. 5) Evaluation: the actor’s explicit evaluation of events in relation to his/her expectations. 6) Qualia: delimits feelings, emotions, and other indicators of the subjective self; from the point of view of other people they range from posture to verbal expression; from the point of view of the actor they indicate mood, and fatigue. 7) Reflexivity: refers to metacognitive aspects of the Self, or rather the act of reflecting upon, constructing, and evaluating the Self. 8) Coherence: refers to a kind of integrity between behaviour, commitments, investments, and evaluation. 9) Positional marker expresses the way in which the individual places himself/herself in time, space, or social order.
The narrative world places the general human condition in a particular situation, and “sites the experience in a time and in a space” [Bruner, 2002, p. 36; translation by the author]. One of main tools for constructing the Self in the world is through the narration of the life story. Narration changes form at different stages of development with the same story being interpreted in different ways and on different levels by individuals at different ages. Children explain the plot of a story in terms of actions accomplished, while adolescents linger over the feelings of the characters in the story [Feldman, Bruner, Kalmar and Renderer, 1994]. Besides, adolescents interpret and organise the story through human complications: the characters in adolescents’ stories, like their young narrators, face crucial events and moments.
The Present Study This study is part of a wider longitudinal project aimed at investigating peer relationships, friendship quality, leisure activity in adolescents, and relationships with both psychosocial well-being and risk behaviour using both quantitative (self-report questionnaire) and qualitative (essays and interviews) instruments [Ciairano et al., 2007; Rabaglietti and Ciairano, in press]. In the present study, we investigated adolescents’ stories about how they spend their Saturdays with friends, seeking to understand the meanings adolescents attribute to the different experiences that characterise their friendship relationships. In particular, we looked at the way the adolescents spent their time together. We attempted to answer the question: “what does the typical Saturday of an adolescent look like?”, or more precisely, “what and how do adolescents tell about their Saturday?”. In order to answer this question, we first identified in the adolescents’ narratives the general context in which they meet their friends in terms of time, people, activity, and place. This description gives us the general framework for collocating peer relationships. Second we identified Bruner’s nine Self markers [1997], which are agency, commitment, resources, social references, evaluation, qualia, reflexivity, coherence, and positional marker, with the aim of acquiring, through these descriptions, some significant clues about the way the adolescents perceive themselves within peer relationships.
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In both cases, we also analysed gender and age differences. With respect to gender, we hypothesised differences in the way boys and girls tell their stories. More specifically, we expected to find that boys narrate their leisure time with friends in general terms and that they refer to the Self markers of commitment and resources more frequently than girls. We expected to find that girls narrate more emotional and relational aspects of the ways they spend time with friends and that they would refer more frequently to the Self Markers of evaluation, social references, qualia, and reflexivity more frequently than boys. Along the same lines as the previous findings of Haden, Fivush and Reese [1997] and Bruner [1998], our expectations regarding gender differences were based on differences in socialisation processes, which still today are more likely to stress emotional aspects in girls and exploration and commitment in boys. With respect to age, we expect to find differences between younger and older adolescents not in the general description of the context, but rather in the way they refer to the Self aspects. More specifically, also based on the findings of previous studies [Harter, 1985; Roggero, Rabaglietti and Ciairano, 2006], we hypothesise that, with age, adolescents’ Self-portraits in their relationships with friends become richer in interpersonal elements in terms of sharing feelings and thoughts. Finally, we investigate the relationship between the Self markers identified previously and some indicators of well-being (in terms of positive self-perception and expectations of success), social self-efficacy, adulthood (expressed by value of autonomy), and discomfort (depressive feelings and sense of alienation). According to Bruner [1997] and Mc Lean, Pasupathi and Pais [2007], self story and autobiography represent a way to express the stability and continuity of Self, especially during adolescence when boys and girls face the task of constructing an identity. Through the autobiographical construction of a fragment of their life, adolescents must shape a Self that is coherent for four poles: temporal, biographic, causal, and thematic [Habermas and Bluck, 2000]. We hypothesise that the Self markers of agency, commitment, coherence, evaluation, and positional - in other words the markers that refer to subjectivity in experiences with others - are related to well-being, social self-efficacy, adulthood, and discomfort in the adolescents.
Participants Thirty adolescents (11 girls and 19 boys) participated in this study. They ranged in age from 14 to 19 years (M= 15.8; D.S.= 1.4; median 16 yrs; 47% were younger than 16 yrs), and attended two different types of high schools (43% lyceum, 57% technical and vocational) in the northwest of Italy. In accordance with Italian law and the ethical code of the Association of Italian Psychologists, we obtained informed consent for participation in the study from the parents of the underage children and from all the adolescents. The participants were randomly extracted from the complete list of participants in the broader study [see: Ciairano et al., 2007], in order to construct a little group balanced for gender, age and type of high school. We found no differences between the participants extracted for this qualitative study and the whole sample in terms of relevant sociodemographic aspects, such as parental education level and employment status and the integrity of the family.
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The two instruments used in the present study, which are the essays and a self-report questionnaire, were administered at school by trained researchers. Teachers were not present during the examination procedure. Finally, no incentive was used to recruit participants.
Procedure and Instruments To collect the data, we developed and administered an instrument [“It’s Saturday…I am going out with my friends” Rabaglietti, Roggero and Ciairano, 2005] through which boys and girls could tell, in a written text, about how they spend their leisure time with friends. To provide direction for the narration, we selected a title that was broad enough to allow the participants to tell about how they spend time together, while defining and delimiting the theme within the established theoretical borders. The same participants also completed the questionnaire “Being together in adolescence. My friends, my health and I” [Ciairano, Rabaglietti and Roggero, 2004], the responses to which provided data about well-being, social self-efficacy, adulthood, and discomfort. In order to maintain anonymity, adolescents identified their composition and questionnaire with a personal code. Once completed individually by the adolescents, both instruments were returned in an unmarked envelope.
Measures Thematic Content Analysis We analysed the adolescent compositions by way of thematic content analysis. That is first we coded each category and second we assembled these categories in descriptive macroand micro-categories. As explained above, we first analysed the general context in which the adolescents meet their friends in terms of time, people, activity, and place. The macro-category of “time” consists of the following micro-categories: Saturday afternoon, Saturday evening, implicit and non-specific references to Saturday. “People” refers to the people the adolescents usually spend time with: generic friends, best friends, friends from their neighbourhood, classmates, a non-specific “us”, and family. “Activity” refers to the activities adolescents take part in and the way they entertain themselves, including: convivial activities like eating and drinking; playing board games, role games, videogames, and sports; taking pleasure in spending time together; playing and/or listening to music; talking about specific subjects like school, romantic relationships, events, their future, and non-specific topics like culture, science, religion, or silly, unimportant things; and finally, watching television. Lastly “place” refers to the place where adolescents usually meet. These can include public places like a bar, pub, disco, or cinema; a private place like their home, their friends’ home, or the place where they play music; different public places where the adolescents roam from one to the next; or finally different areas of their own homes of friends’ homes.
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We identified Bruner’s nine Self markers [1997], defined as follows: 1) Agency refers to free choices and voluntary actions such as: “obviously I’m going to dress well”, “it always takes me an hour to get to them”. 2) Commitment is represented by those aspects that express adherence to a real or intended line of action: “My friends and I usually meet at home”, “we all decide together”. 3) Resources are those elements that can support and promote actions, for example: “We’re all hoping that summer will bring something good”, “then, with our parents or on motorcycles. 4) Social references are those elements tied to the social and affective network that constitute the object in which subjectivity of the Self is reflected and on which the adolescent bases his/her evaluations: “I’m happy to have been with my friends..........when the whole group is there”. 5) Evaluation refers to the expression of the adolescents’ judgements: “it is always hard to meet up”, “but when I go out, I usually have a lot of fun”. 6) Qualia refers to the physical and/or psychological characteristics that contribute to defining the subjectivity of the Self: “I juggle and make animal shapes out of balloons and play some “Harry Potter-type” games.”, “I’m not one to go out very often”, “all of us are good in school”. 7) Reflexivity is shown by the ability to reflect on the Self: “the important thing is to be together”. 8) Coherence and constancy are the aspects that express Self continuity – in the individual or group – in the narration: “by now it’s a set date so we don’t even have to talk about it anymore”, “we always talk a lot because we go to three different schools”. 9) Positional marker refers to the position of the Self within the individual’s spatialtemporal or social order: “till now, this [referring to a centre of aggregation] has been our meeting place”, “the friends I go out with have almost the same tastes as I do”. Two independent coders categorised the texts. We calculated the proportion of agreement between the two coders, which was very high (92%). Furthermore, the cases in which there was disagreement were all resolved. Successively, we calculated the frequency of the different categories cited by each adolescent. Well being, social self-efficacy, adulthood, and psychological discomfort We considered well-being as positive self-perception and expectation for success. Positive self-perception was assessed with nine items reflecting the adolescents’ perceptions of their ability to do well in school, to resist peer pressure, to be attractive to the opposite sex, to cope with problems and to learn new life skills, and of being satisfied with their relationships with the opposite gender, and with themselves in general. Responses on a 4point Likert scale ranged from (1) “not at all”, to (4) “very” Cronbach’s alpha =.70). Expectation for success (assessed with nine items, reflecting adolescents’ expectations for success in school, relationships, work, community, and health. Responses on a 5-point Likert scale ranged from (1) “very low”, to (5) “very high”. Cronbach’s alpha =.79). Social selfefficacy refers to the ability to become part of and feel at ease in a group. It was assessed with 13 items reflecting adolescents’ ability to participate in group discussions, learn new sports
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and be good at physical activities and individual and team sports, to fulfil friends’ expectations, to accomplish one’s own aims, to make new friends, to state one’s opinion in a group, to work in a group, to say what one thinks even if others do not agree, to defend one’s own rights, and to get oneself out of trouble. Responses on a 4-point Likert scale ranged from (1) “not at all” to (4) “very”. Cronbach’s alpha =.80). Value on autonomy, which we equated to orientation to adulthood, was assessed with four items reflecting the adolescent’s value on being autonomous in the use of their free time and money, and in choosing clothes, films, and books. Responses on a 4-point Likert scale ranged from (1) “not at all” to (4) “very”. Cronbach’s alpha =.67). We considered adolescent’s discomfort as depressive feelings and sense of alienation. Depressive feelings was assessed with 5 items reflecting the adolescent’s feelings of being down, hopeless, worried, depressed, and alone. Responses on a 4-point Likert scale ranged from (1) “not at all” to (4) “very”. Cronbach’s alpha =.82. Sense of alienation (assessed with 4 items, reflecting adolescents’ feelings of being left out of things other kids do, being unsure about who he/she is, not having a clear idea of what other people expect from him/her, and feeling that hardly anything in life means very much to him/her. Responses on a 4-point Likert scale ranged from (1) “strongly disagree” to (4) “strongly agree”. Cronbach’s alpha =.72).
Analysis Strategy As explained previously, we started by coding the narrative compositions and then proceeded to explore the adolescents narratives about Saturdays spent with friends in terms of general context (in terms of time, people, activity, and place), and Self markers (agency, commitment, resources, social references, evaluation, qualia, reflexivity, coherence, positional marker. We performed a series of descriptive analyses calculating the frequencies of the presence (1) or absence (0) of each single micro-category. In other words, we considered only whether the adolescent referred to this aspect or not and not how many times. We made this decision in order to minimise the potential biasing effect of the adolescents’ writing capabilities. Finally, we used t-test analysis to highlight gender and age differences and to investigate the relationships between Self markers and well-being, social self-efficacy, adulthood, and discomfort.
Results The General Context of Going out with Friends on Saturday With respect to “time”, 57% of the adolescents said they went out on Saturday evening, 2 27% on Saturday afternoon; 37% did not refer specifically to Saturday . We found no gender differences. However, age differences were found for going out in the afternoon [t-test(28)=1.54, p<.005]: older adolescents (M=.44, D.S.=.63) go out more than younger (M=.14, D.S.=.37). 2
These categories are not reciprocally exclusive. Thus the total percentage is more than one hundred.
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With regard to “people”, 47% of adolescents mentioned going out with friends in general and 17% with best friends; 23% referred to meeting with friends from their neighbourhood, and 20% with classmates. 63% of adolescents mentioned generically “our group of friends”. Finally, 3% said they spent Saturdays with their family, and another 3% 3% said they didn’t have a group of friends. Girls (M=.45, D.S.=.69 vs. Boys: M=.05, D.S.=.23) [t-test(28)=2.36, p<.0001], and older adolescents (M=.38, D.S.=.62 vs. Younger: M=.00, D.S.=.00 [ttest(28)=2.26, p<.005] referred to a best friend more often than the others. The description of the “activity” carried out with friends varied. The adolescents spend time with their friends sharing in convivial activities like eating and drinking (37%), joking around and having fun (50%), just enjoying each other’s company (47%), or playing or listening to music (17%). Girls (M=.82, D.S.=.98 vs. Boys: M=.42, D.S.=.51; t-test(28)=1.47, p=.072) and younger adolescents (M=.64, D.S.=.36 vs. Older: M=.50, D.S.=.52; ttest(28)=.53, p=.087) mentioned to take pleasure in spending time together slightly more often than the others. Furthermore, in the company of friends, adolescent discuss a variety of different topics: school (37%), relationships with peers of the opposite sex and romantic relationships (33%), and the external side of the self, such as clothes and cars (50%). However, the adolescents also talk about news, politics, and current events (43%), personal aspects tied to their future (37%), and cultural, scientific, and religious subjects (20%). Finally, they also talk about silly, unimportant things (37%). Some age differences were found: younger adolescents talk more often than older adolescents about silly and unimportant things (M=.57, D.S.=.65 vs. Older: M=.25, D.S.=.45; F=5.02, t-test(28)=1.60, p<.033). While fairly uncommon, time with friends may also be spent playing board games and role games (10%), videogames (13%), or physical and sport activities, like five-a-side football and ping-pong (10%). Sport activities were mentioned exclusively by boys (M=.16, D.S.=.38 vs. Girls: M=.00, D.S.=.00; F=11.66, t-test(28)=-1.39, p<.002), while only older adolescents referred to board and role games (M=.25, D.S.=.58 vs. Younger: M=.00, D.S.=.00; t-test(28)=-1.62, p<.001). Another activity, characteristic only of older adolescents was watching shows and films on television (M=.13, D.S.=.34 vs. Younger: M=.00, D.S.=.00; t-test(28)=-1.37, p<.004), or renting films (7%). Finally, some adolescents also referred to illegal activities carried out with friends, such as racing cars or motorcycles, or using soft drugs (7%). These types of activities were mentioned exclusively by boys (M=.11, D.S.=.31 vs. Girls M=.00, D.S.=.00; t-test(28)=-1.10, p<.019). As for the “place” where they spend their Saturdays with friends, adolescents mentioned public places such as pubs (33%), coffee bars and ice-cream parlours (37%), pizzerias and restaurants (33%), the cinema (23%), discos (20%), and video arcades (7%). Girls referred more often than boys to discos (M=.45, D.S.=.69 vs. Boys M=.11, D.S.=.32; t-test(28)= 1.91, p<.001), cinemas (M=.45, D.S.=.69 vs. Boys M=.16, D.S.=.38, ttest(28)=1.54, p<.007), coffee bars and ice-cream parlours (M=.64, D.S.=.67 vs. Boys M=.26, D.S.=.45; t-test(28)= 1.82, p<.050). Coffee bars and ice-cream parlours were also mentioned more often by younger adolescents (M=.57, D.S.=.65 vs. Older M=.25, D.S.=.45; t-test(28)=1.60, p<.033), and video arcades were mentioned by boys only (M=.11, D.S.=.32 vs. Girls M=.00, D.S.=.00; ttest(28)=-1.09, p<.019).
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When adolescents said they meet in private places, they referred especially to their own homes or to their friends’ homes (27%), and in a much smaller percentage, to a practice room where they play music (3%). Older adolescents mentioned meeting in people’s homes more often (M=.44, D.S.=.63 vs. Younger: M=.14, D.S.=.36; t-test(28)=-1.54, p<.005); while only younger adolescents met in music rooms (M=.07, D.S.=.27 vs. Older M=.00, D.S.=.00; ttest(28)=1.07, p<.028). When adolescents roam from place to place on Saturday they usually do so in their neighbourhood (53%), but they also go to towns and villages nearby (27%). No differences for gender and age were found.
Self Markers in the Adolescent Narratives Through our second classification we identified units of written text in the adolescents’ narratives about their leisure time spent with friends that we interpreted as referring to Bruner’s nine Self markers [1997]. We recorded whether each adolescent referred to a specific Self marker never (0), once (1), or more than once (2). We can observe through standardised means (Table 1) that the indicators of Self markers used most frequently are agency, coherence, social reference, positional marker, and commitment. Agency (I’ll talk about it first [with the girls who are on the bus with me], girl, 16 yrs) was cited by 97% of the adolescents (20% once, 77% more than once), commitment (in a few minutes it was decided [that we would meet at my house], girl, 15 yrs) by 87% (40% once, 47% more than once), and coherence ([…to see a film], and to end the night we go to a pizzeria, girl, 14 yrs) by 80% (20% once, 60% more than once). We found similar percentages for the indicators of social reference ([and we usually meet up] with the others from our group, girl, 18 yrs), which were used by 83% (20% once and 63% more than once), and positional marker ([…who I go out with] they have about the same tastes as I do, girl, 16 yrs; [we talk about everything] that could be of interest to 17-18-years-olds, boy, 17 yrs), which was cited by 73% (33% once, 40% more than once). The indicator of reflexivity also deserves attention (I have to be honest…My philosophy on life is like a giraffe: keep your feet on the ground and your head in the clouds. girl, 16 yrs); this marker was included by 67% of the adolescents (23% once, 44% more than once). In terms of gender differences (Table 2), we found that qualia, which refers to the more subjective aspects of one’s and/or others’ Self (...about how dissatisfied I’ve been feeling lately, girl, 18 yrs; I’m not one to go out very often, girl, 15 yrs), was emphasised more often by girls than by boys [t-test=1.60(28), p<.008]. Another sphere of the Self, which evaluates events based on one’s own expectations (And who says that young people have to go to the disco to have fun?, girl, 16 yrs), was also referenced more often by girls [t-test=.76(28), p<.005]. Furthermore, while the difference is tendential and not significant [t-test=.82(28), p=.090], we found that girls also mentioned social references (Some of my friends and I, [we made an agreement], girl, 15 yrs) more frequently than boys. Some age differences in the use of Self markers were also found (Table 3). In particular, the indicators of agency (Usually, my friends and I meet…, boy, 18 yrs) [t-test=-.01(28), p<.033], evaluation (To meet is ever difficult, boy, 16 yrs) [t-test=-1.27(28), p<.019], and resources (“our ‘organization’ [referring to the group of friends] plans to…”, girl, 18 yrs) [ttest=-1.34(28), p<.006] were more common among older adolescents. We also found a tendential, though not significant, difference for reflexivity [t-test=-1.45(28), p=.086], (I think it’s the time that I appreciate the most, , boy, 18 yrs; What is important is to stay together,
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girl, 16 yrs), which is also more frequent among older adolescents, revealing that older adolescents seem more likely than younger adolescents to refer to metacognitive aspects of the Self. Table 1. Mean and standard deviation of quotations for nine Self markers Self Markers
M (SD)
Agency Commitment Resources Social references Evaluation Qualia Reflexivity Coherence Positional marker
2.93 (1.74) 1.67 (1.24) .63 (1.06) 2.80 (2.39) 1.47 (1.91) .83 (1.42) 1.93 (2.33) 1.90 (1.42) 1.40 (1.22)
M (SD) standardized .42 (.25) .33 (.25) .16 (27) .35 (.30) .21 (.27) .17 (.28) .22 (.26) .38 (.28) .35 (.31)
Range of quotation 0-7 0-5 0-4 0-8 0-7 0-5 0-9 0-5 0-4
Table 2. Mean and standard deviation of quotations for nine Self markers – Gender differences (t-test) Self Markers
Agency Commitment Resources Social references Evaluation Qualia Reflexivity Coherence Positional marker
M (DS) Male
Female
2.68 (1.80) 1.42 (1.26) .42 (1.01) 2.53 (2.14) 1.26 (1.45) .53 (1.02) 1.42 (2.27) 1.63 (1.34) 1.42 (1.31)
3.36 (1.63) 2.09 (1.14) 1.00 (1.09) 3.27 (2.83) 1.82 (2.56) 1.36 (1.86) 2.82 (2.27) 2.36 (1.50) 1.36 (1.12)
t-test (df)
p
1.03(28) 1.45(28) 1.46(28) .82(28) .76(28) 1.60(28) 1.63(28) 1.38(28) -.12(28)
.91 .75 .36 .090+ .050 .008 .83 .38 .65
Note: Values in bold are significant + p<.10
Table 3. Mean and standard deviation of quotations for nine Self markers – Age differences (t-test) Self Markers
Agency Commitment Resources Social references Evaluation Qualia Reflexivity Coherence Positional marker
M (DS) Younger
Elder
2.92 (2.16) 1.93 (1.38) .36 (.63) 2.43 (2.41) 1.00 (1.24) .64 (1.39) 1.29 (1.54) 2.00 (1.36) 1.43 (1.28)
2.95 (1.34) 1.44 (1.09) .88 (1.31) 3.13 (2.41) 1.88 (2.30) 1.00 (1.46) 2.50 (2.78) 1.81 (1.51) 1.38 (1.20)
Note: Values in bold are significant. + p<.10.
t-test (df)
p
-.01(28) 1.10(28) -1.34(28) -.78(28) -1.27(28) -.68(28) -1.45(28) .36(28) .12(28)
.033 .45 .006 .69 .019 .56 .086+ .16 .71
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Relationships between Self Markersand Well-Being, Social Self-Efficacy, Adulthood, and Discomfort Using t-tests, we compared the adolescents who cited Self markers with those who did not in terms of well-being (positive self-perception and expectation for success), social selfefficacy (belief in their ability to manage and lead a group situation), adulthood (value on autonomy), and discomfort (depressive feelings and sense of alienation). In Table 4 we reported all the mean values and statistical indexes. However, in the following section, only the tendential (p<.10) and significant (p<.05) findings are mentioned. Table 4. Comparison between adolescents who quote (1) and those who do not quote (0) a specific Self-Marker: t-test Self Markers
V.D.
M(DS) 1 (quote)
Agency
Commitment
Resources
Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation
25.91 (3.09) 33.15 (5.00) 41.02 (5.29) 13.43 (1.66) 11.41 (2.94) 8.41 (2.56) 25.92 (3.28) 33.60 (4.79) 40.79 (5.09) 13.13 (1.90) 11.56 (3.36) 8.73 (2.74) 25.55 (1.69) 35.20 (2.92) 39.10 (4.60) 13.30 (2.03) 11.30 (2.49) 8.20 (2.39)
0 (no quote) 26.07 (3.95) 34.86 (2.48) 38.86 (6.73) 12.93 (2.56) 11.93 (4.18) 9.36 (2.73) 26.13 (3.35) 33.85 (3.01) 38.75 (9.14) 14.50 (1.23) 11.38 (1.79) 8.00 (1.08) 26.15 (3.81) 32.73 (5.06) 41.23 (6.03) 13.33 (1.84) 11.65 (3.53) 8.85 (2.71)
t-test (df)
p
.11(28)
.43
.86(28)
.20
-.89(28)
.37
-.62(28)
.16
.37(28)
.18
.84(28)
.60
.11(28)
.94
-.14(28)
.57
.11(28)
.062+
1.38(28)
.49
-.11(28)
.21
-.52(28)
.073+
.47(28)
.012
-1.43(28)
.31
.98(28)
.29
.03(28)
.64
.28(28)
.079+
.64(28)
.44
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Table 4. Continued Self Markers
V.D.
M(DS) 1 (cita)
Social references
Evaluation
Qualia
33.94 (4.32) 40.70 (5.33) 13.36 (1.95) 11.46 (3.31)
25.20 (3.44) 31.60 (5.75) 39.60 (7.51) 13.10 (1.59) 11.90 (2.70)
Sense of alienation
8.58 (2.70)
8.90 (1.56)
Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation
34.36 (3.99) 39.77 (5.33) 13.45 (1.97) 11.05 (3.55)
25.85 (3.76) 32.83 (5.11) 41.10 (5.92) 13.15 (1.84) 11.95 (3.22) 8.95 (2.65) 26.05 (3.45) 33.08 (4.90) 40.95 (5.87) 13.24 (1.86) 11.82 (3.01)
8.59 (3.09)
8.66 (2.33)
26.15 (1.95) 35.00 (2.89) 39.35 (5.03) 13.65 (1.99) 10.70 (3.08) 8.00 (2.56) 25.77 (5.33)
p
-.56(28)
.88
-1.05(28)
.51
-.39(28)
.68
-.28(28)
.84
.28(28)
.80
.25(28)
.27
-.24(28)
.037
-1.24(28)
.28
.80(28)
.45
-.69(28)
.86
1.02(28)
.58
.75(28)
.95
.22(28)
.20
-.74(28)
.89
.55(28)
.74
-.30(28)
.66
.63(28)
.72
.06(28)
.58
0 (non cita)
Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings
26.10 (3.24)
t-test (df)
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Emanuela Rabaglietti and Silvia Ciairano Table 4. Continued
Self Markers
V.D.
M(DS) 1 (cita)
Reflexivity
Coherence
Positional marker
35.38 (2.97) 40.50 (4.94) 12.85 (3.01) 10.15 (2.94)
25.26 (3.69) 32.15 (5.13) 40.53 (6.23) 12.59 (2.97) 11.93 (4.18)
Sense of alienation
7.73 (2.37)
9.32 (2.59)
Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings Sense of alienation
26.67 (2.72) 34.44 (4.30) 41.39 (4.79) 12.97 (2.04) 10.64 (3.11) 8.00 (2.22) 26.82 (2.76) 34.55 (3.52) 41.55 (4.71) 13.30 (2.11) 10.93 (3.06) 7.98 (2.45)
p
-1.34(28)
.075+
-2.03(28)
.19
.01(28)
.28
.01(28)
.016
2.21(28)
.83
1.73(28)
.42
-1.52(28)
.21
-1.33(28)
.68
-1.50(28)
.072+
1.25(28)
.49
1.98(28)
.89
1.69(28)
.15
-2.69(28)
.41
-2.10(28)
.077+
-1.72(28)
.039
.10(28)
.10
1.78(28)
.86
2.51(28)
.88
0 (non cita)
Positive selfperception Expectation for success Social selfefficacy Value on autonomy Depressive feelings
26.85 (2.36)
t-test (df)
24.88 (3.75) 32.21 (4.79) 39.21 (6.66) 13.83 (1.49) 12.88 (2.91) 9.58 (2.88) 23.56 (3.39) 30.81 (6.11) 37.69 (7.18) 13.38 (1.03) 13.19 (3.09) 10.44 (2.13)
Note: Values in bold are significant. + p<.10.
DISCUSSION AND CONCLUSIONS This study contributes to the growing body of research about youth and peer relationships. We made a precise request, asking a small group of high school students to tell us how they spend an important part of their leisure time (Saturdays) with their friends.
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From the narrative compositions of the adolescents, we first extrapolated four main spheres linked to going out with friends, i.e. time, people, activities, and place. Most of the adolescents mentioned spending time with friends on Saturday, which is implicit in our request. However, they also specified when (e.g. in the evening), with whom (e.g. friends, class and schoolmates, and friends from their same or a different neighborhood, and where (public places like pubs, discos, the cinema, and/or private places like their own house or their friends’ houses). The common denominator is the desire to be together. When they are together, the adolescents talk about their school experiences, but school is not the main topic of conversation; they prefer to talk about music, recent events, sex, and they really just like to have fun. The adolescents also mentioned, though only a small percentage, activities that they themselves defined as illegal and non-conventional, like smoking joints or racing cars and motorcycles. In the adolescents’ stories, these activities are presented as a way to spend time together and they assume the meaning of testing one’s own limits, as highlighted by Jessor and colleagues [1991; 1998] and Bonino and colleagues [2005]. The world depicted in these adolescents’ stories seems to circumscribe the social life of an individual who deliberately pursues amusement. However, adolescent life cannot be classified or generalized as superficial, considering the small portion of their lives these adolescents were asked to describe; this aspect certainly represents one of the major limitations of our study. In the future, we would like to examine different and broader portions of adolescent life. Furthermore, considering the limited size of our sample, a greater number of participants would be needed to collect a sufficient number of narrations and ensure a representative sample. Our next step was to extrapolate the indicators of Self Markers from the adolescent narrations. The findings offered a profile of adolescents who want to be active (agency) and to commit (commitment), who try to give coherence (coherence) to their Self and life within a social position, which is typical of adolescence (positional marker) because it is marked by significant peers and friends (social references). The adolescents showed their desire to be with peers, to laugh, to joke, and to talk, comparing points of view, and getting to know each other better. As hypothesised, sharing pleasant time with friends seems most important for girls; this finding confirms the findings of numerous previous studies that have pointed out that girls appreciate friendship relationships characterised by sharing and intimacy more than boys [Berndt, 1996; Shulman, Laursen, Kalman and Karpovsky, 1997; Crosnoe, 2001]. Moreover, it can also be hypothesised that the subjective aspects of the Self fit better with feminine characteristics. In fact, qualia of the Self, evaluation and social references were indicated more often in girls’ narrations; on the contrary of our hypothesis, reflexivity not is different by gender. As expected, we also found that the adolescents’ narrations were articulated differently at different ages. At older ages, the Self-portrait in friendships is enriched with interpersonal elements and reflection; in fact, among older adolescents we found evidence of agency, evaluation, resources, and reflexivity more often when compared to younger adolescents. On one hand, this phenomenon may reflect intentional actions and initiatives and the pursuit of personal aims while sharing leisure time with friends. On the other hand, this phenomenon points to individual judgment and metacognitive strategies, and to external or inner resources, which are part of the Self definition. Our hypothesis regarding relationships between some of the more subjective Self markers and well-being, social self-efficacy, adulthood, and discomfort was also, at least in part,
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confirmed. Though we found no associations with agency, the adolescents showed a more positive self-perception particularly when they mentioned reflexivity and evaluation, and higher expectations of success when they referred to positional marker. Self-reflection by the adolescents seemed related to a lower value on autonomy. When the stories were marked by commitment and coherence, adolescents also showed higher levels of social self-efficacy. Further, although referring to commitment seems also related to higher sense of alienation, an association was found between narratives mentioning resources and lower depressive feelings. This study clearly has several limitations. In addition to those mentioned previously, we must also examine the theoretical decision to interpret our findings based on Bruner’s classification as there may well be alternative explanations. However, our study also has some merits. First, our study confirmed the findings of previous researches [see for instance: Palmonari, Pombeni and Kirchler, 1990; Kirchler, Pombeni and Palmonari, 1991; Larson and Richards, 1998] that, in the process of Self definition, the adolescents attribute sense, coherence, and continuity to their life, also within the context of peer and friendship relationships. During this process of Self definition, the adolescent can also elaborate a hypothetical dimension of Self representation, which drives him or her to define several possible selves, considered as desired, hoped for, or feared aspirations, expectations, aims, and ideals [Aleni Sestito, 2004a]. With this in mind, identity development can be equated to a narrative construction of the Self. Through narration and autobiography, individuals can represent their own existence, giving it meaning within a specific cultural context, and they can transform in explicit what is implicit. In addition, in telling their stories, individuals can be heard and recognised by others [Bruner, 1990, 2002; Aleni Sestito, 2004b]. In autobiography, individuals aim to construct their own Self while simultaneously narrating it to themselves or to others. They outline a Self image based on personal interpretation and their own idea of the world, although their personal interpretations and ideas are always affected by the symbolic and cultural systems of reference [Bruner, 1991; Aleni Sestito, 2004b]. In this way, the adolescents who participated in our study, by writing about Self, leisure time, and friends, attempted to attribute meaning and coherence to both the events and experiences that characterise their friendship relationships. To live adolescence means being able to live in the present with the future on the horizon: taking time today to choose which road to take, without setting a strict itinerary. But, if the expectations of the outside world become overwhelming, living in the present becomes the only option, preventing adolescents from developing the ability to fully capture the meaning of the present. We should be paying close attention to the current generation of adolescents, because they seem to lack a place in which they can be heard and receive the answers they are looking for. Particularly it seems important to help the adolescents to build relationships among the inner dimension (their thoughts and experiences), the external dimension (social events, and culture), and finally the symbolic dimension (the way people describe and place value on things they’ve experienced) in order to construct new ways of linking all these aspects to form mature thoughts and actions.
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REFERENCES Aleni Sestito L. ( 2004a), Lo sviluppo della rappresentazione di sé. In L. Aleni Sestito (Eds), Processi di formazione dell’identità in adolescenza (pp. 89-108), Napoli (IT): Liguori. Aleni Sestito, L. (2004b). L’approccio narrative all’identità: costruzione del sé come narrazione di sé. In L. Aleni Sestito (Eds), Processi di formazione dell’identità in adolescenza (pp.113-138). Napoli (IT): Liguori. Amsterdam, A.G. and Bruner, J. (2000). Minding the law. Cambridge (MA): Harvard University Press. Berndt, T.J. (1996). Exploring the effects of friendship quality on social development. In W.M. Bukowski, A.F. Newcomb and W.W. Hartup (Eds), The company they keep: Friendship in childhood and adolescence (pp. 346-365). New York: Cambridge University Press. Berndt, T.J. (2004). Friendship and three A’s (aggression, adjustment, and attachment). Journal of Experimental Child Psychology, 88, 1-4. Berndt, T .J. and Keefe K. (1995). Friend’s influence on adolescents’ adjustment to school. Child Development, 66, 1312-1329. Bonino, S., Cattelino, E. and Ciairano, S. (2005). Adolescents and risk. Milano (IT): Springer. Brendgen, M., Bowen, F., Rondeau, N. and Vitaro, F. (1999). Effects of Friends’ Characteristics on Children’s Social Cognitions. Social Development, 8, 41-51. Bruner, J. (1986). Actual mind, possible worlds. Cambridge (MA): Harvard University Press. Bruner, J. (1990). Acts of meanings. Cambridge (MA): Harvard University Press. Bruner, J. (1991). La costruzione narrative della “realtà”. In M. Ammaniti and D.N: Stern (Eds), Rappresentazioni e realtà (pp. 17-42). Bari (IT): Laterza. Bruner, J. (1994). The remembered self. In U. Neisser and R. Fivush (Eds), The remembering self: construction and accuracy in the self-narrative (pp. 41-54). Cambridge: Cambridge University Press. Bruner, J (1997). A Narrative Model of Self-Construction. Annals New York Academy Of Sciences, pp. 145-161. Bruner, J (1998). What Is a Narrative Fact? Annals of the American Academy of Political and Social Science, 560, 17-27. Bruner, J. (2002). La fabbrica delle storie. Bari: Laterza. Buhrmester, D. (1990). Intimacy of friendship, interpersonal competence, and adjustment during preadolescence and adolescence. Child Development, 61, 1101-1111. Bukowski, W.M., Newcomb, A.F. and Hartup, W.W. (1996, Eds). The company they keep: Friendships in childhood and adolescence. Cambridge: Cambridge University Press. Ciairano, C., Rabaglietti, E.and Roggero, A. (2004). Being together in adolescence. My friends, my health and I. Questionnaire. Torino (IT): Laboratorio di Psicologia dello Sviluppo, Dipartimento di Psicologia, Università di Torino Ciairano, S., Rabaglietti, E., Roggero, A., Bonino S. and Beyers W. (2007). Patterns of adolescent friendships, psychological adjustment and antisocial behavior: The moderating role of family stress and friendship reciprocity. International Journal Behavioral Development, 31 (5), 419-428. Cochran, L. (1997). Career Counselling: A Narrative Approach: Thousand Oaks (CA): Sage.
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Cohler, B.J. (1982). Personal narrative and the life corse. In P.B. Baltes and K.W. Schaie (Eds) Life Span Development and Behavior (vol. 4, pp. 205-241). New York: Academic Press. Crosnoe, R. (2000). Friendships in childhood and adolescence: The Life Course and new directions. Social Psychology Quarterly, 63, 377-391. Feldman, C., Bruner, J., Kalmar, D. and Renderer, B (1994). Plot, plight and dramatis: Interpretation at three ages. In E. Scholmick, W.F. Overton and O.S. Palermo (Eds), The nature and ontogenesis of meaning (pp. 255-278). Hillsdale (NJ): Erlbaum Fonzi, A., Tani, F. (2000). Amici per la pelle. Le caratteristiche dei legami amicali nell’adolescenza. In G.V. Caprara, A. Fonzi (a cura di), L’età sospesa (pp. 90-120). Firenze (IT): Giunti. Gauze, C., Bukowski, W. M., Aquan-Assee, J. and Sippola, L. (1996). Interaction between family environment and friendship and association with self perceived well-being during early adolescence. Child Development, 67, 2201-2216. Habermas, T. and Bluck, S. (2000). Getting a life: the emergence of the life story in adolescence. Psychological Bulletin, 126(5), 748-769. Haden, C.A., Fivush, R. and Reese, E. (1997). Lo sviluppo narrative nel contesto sociale. In A. Smorti (Eds), Il Sé come testo (pp. 133-152). Firenze (IT): Giunti. Harter, S. (1985). Competence as a dimension of a self-evaluation. Toward a comprehensive model of self worth. In R. Leahy (Eds.), The development of the Self (pp. ). New York: Academic Pres. Hartup, W.W. (1989). Social relationships and their developmental significance. American Psychologist, 44, 120-126. Hartup, W.W. (1993). Adolescents and their friends. In B. Laursen (Ed), Close Friendships in Adolescence (pp. 3-22). San Francisco CA: Jossey-Bass Inc.. Hartup, W.W. and Stevens, N. (1997). Friendship and adaptation in the life course. Psychological Bulletin, 121, 355-370. Hartup, W.W. and Stevens, N. (1999). Friendship and adaptation across the Life Span. Current Directions in Psychological Science, 8, 76-79. Kirchler, E., Pombeni, M. L. and Palmonari, A. (1991). Sweet sixteen…Adolescents’ problems and peer group as source of support. European Journal of Psychology of Education, 6, 393-410. Jackson, A.E. and Rodriguez-Tomé, H. (1993, Eds). Adolescence and its social worlds. Hove, UK: Lawrence Erlbaum. Jessor, R. (1998, Eds.). New perspectives on Adolescent Risk behavior. New York: Cambridge University Press. Jessor, R., Donovan, J.E. and Costa, F.M. (1991). Beyond adolescence: problem behavior and young adult development. New York: Cambridge University Press. Larson, R. and Richrds, M. (1998). Witing for weekend: Friday and Saturday night as emotional climax on the week. In A.C. Crouter and R. Larson (Eds), Temporal rhythms in adolescence: Clocks, calendars, and the coordination of daily life. New directions for Child and Adolescent development n° 82 (pp. 37-51). San Francisco. Jossey-Bass Inc., Publishers. McAdams, D.P. (1997). The stories we live. New York: Guilford. McAdams, D.P. (2001). The Psychology of Life Stories. Review of General Psychology, 5(2), 100-122.
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McLean, K.C., Pasupathi, M. and Pais, J.L. (2007). Selves creating stories creating selves: a process model of self-development. Personality and Social Psychology Review, 11(3), 262-278. Palmonari, A., Pombeni, M. L. and Kirchler, E. (1990). Adolescents and their peer groups: A study on the significance of peers, social categorization processes, and coping with developmental tasks. Social Behaviour, 5, 33-48. Rabaglietti, E., Roggero, A. and Ciairano, C. (2005). It’s Saturday…I am going out with my friends. Composition Instrument. Torino (IT): Laboratorio di Psicologia dello Sviluppo, Dipartimento di Psicologia, Università di Torino. Rabaglietti, E., Roggero, A., Settanni, M. and Ciairano S. (2007). Modelli relazionali amicali, attività e benessere in adolescenza:uno studio longitudinale. Età Evolutiva, 87, 86-93. Rabaglietti, E. and Ciairano S. Quality of friendship relationships and developmental tasks in adolescence. Cognition, Brain and Behaviour, in press. Ricoeur, P. (1990). Soi-Méme comme un autre. Paris: Seuil. Roggero, A., Rabaglietti, E. and Ciairano, S. (2006). Il mio gruppo di amici. Le relazioni con i coetanei nella promozione del benessere in adolescenza. Psicologia della Salute, 3, 4966. Rubin, K. H., Bukowski, W. W. and Parker, J. G. (2006). Peer Interactions, Relationships, and Group. In W. Damon, N. Eisenberg and R. M. Lerner (Ed), Handbook of child psychology. (Sixth Edition) (pp. 619-699). New York, NY: Wiley. Shulman, S., Laursen, B., Kalman, Z. and Karpovsky, S. (1997). Adolescent intimacy revisited. Journal of Youth and Adolescence, 26, 597-617. Smorti, A. (1997). Sé e narrazione. In A. Smorti (Eds), Il Sé come testo (pp.3-45). Firenze (IT): Giunti. Smorti, A. (2000). Pensiero narrativo. In S. Bonino (Eds), Dizionario di Psicologia dello sviluppo (pp. 515-517). Torino (IT): Einaudi. Smorti, A. and Pagnucci, A. (2003). Le parole dell’amicizia: studiare le relazioni amicali attraverso le storie. Età Evolutiva, 75, 88-96. Trzebiński, J. (1997). Il Sé narrativo. In A. Smorti (Eds), Il Sé come testo (pp.60-82). Firenze (IT): Giunti.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 17
PREVENTION OF THE NEGATIVE EFFECTS OF MARITAL CONFLICT: A CHILD-ORIENTED PROGRAM Patricia M. Mitchell, Kathleen P. McCoy, E. Mark Cummings∗, W. Brad Faircloth and Jennifer S. Cummings University of Notre Dame, South Bend, Indiana, USA
ABSTRACT A psycho-educational program for advancing children’s coping skills and reactions to marital conflict was evaluated. Families with a child between the ages of 4 and 8 were randomly assigned to one of three groups: 1) parent program only; 2) parent and child program; or 3) self-study (control group). Parents in the parent-only and parent-child groups received the same psycho-educational program. Only children in the parent-child group received the child program which consisted of four visits in which children learned about marital conflict and family relationships; were taught about emotions and different levels of emotions; and were given tools for coping with conflict that would help them react in optimal ways for their development. Analyses suggested the promise of a child program for older children (ages 6-8) with regard to improved emotional security about marital conflict. However, consistent with other research, simply educating children about coping with marital conflict had minimal effects on outcomes associated with conflict between the parents.
The negative effects of marital conflict on children are well-documented. Children from high conflict homes are more likely to display externalizing disorders, such as excessive aggression, non-compliance, and delinquency (Cummings, Goeke-Morey, and Papp, 2003; Grych and Fincham, 2001), as well as distressed emotional responses, including depression, anger, and fear in response to marital conflict (Cummings, Goeke-Morey, Papp, and ∗
Correspondence should be addressed to Dr. E. Mark Cummings, Department of Psychology, Haggar Hall, University of Notre Dame, Notre Dame, IN 46556, phone: (574) 631-3404, fax: (574) 631-1825,
[email protected].
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Dukewich, 2002; Grych and Fincham, 2001). At the same time, it is how marital conflict is handled by the parents, rather than the fact that conflict occurs, that has negative developmental consequences for the child. Specifically, Cummings and Davies (1994) defined various characteristics of marital conflict that have both negative and positive consequences on the developmental trajectories of children, which are categorized as constructive or destructive depending on the children’s reactions (Goeke-Morey, 1999). The effects of marital conflict are related to how children interpret the conflict and how they react (emotionally and behaviorally). The emotional security theory (EST; Davies and Cummings, 1994; Cummings, Schermerhorn, Davies, Goeke-Morey, and Cummings, 2006) posits that children appraise conflict situations in relation to their own security about their family and personal well-being. The impact on child adjustment occurs through three interrelated processes. The first process, emotional reactions to conflict, consists of children’s overt emotional expressions as well as physiological arousal in the face of conflict. If a child’s emotional security is threatened by parental discord, for example, children may respond by expressing emotions such as fear or anger. The second component is children’s cognitive appraisals of marital conflict. Children may see conflict as a threat to their representations and expectations of family relationships, raising questions about the security of their family. Finally, the third component of EST is regulation of exposure to conflict. Emotionally insecure children, for instance, may attempt to end or reduce their exposure to conflict by intervening in order to stop the discord. Children may also remove themselves from the situation to avoid witnessing parental discord (Cummings and Keller, 2005; Cummings, Davies, and Campbell, 2000). All three components are important aspects of how marital conflict impacts children and thus are possible targets for intervention. In light of this evidence of the negative effects of marital conflict on children, a goal is to develop prevention programs to possibly change these outcomes. One direction is to develop programs for children to help them cope better with marital conflict. Few efforts have been made to directly help children by educating them about family conflict. Previous prevention programs have focused primarily on married couples and the education of parents experiencing conflict and divorce. The Premarital Relationship Enhancement Program (PREP; Markman, Jamieson, and Floyd, 1983; Markman, Floyd, Stanley, and Storaasli, 1988), for instance, aims to educate engaged and married couples on the importance of constructive communication, and to provide approaches towards improvement. PREP successfully promotes a well-functioning marital relationship for couples to maintain healthy interactions over time (Stanley, Markman, St. Peters, and Leber, 1995; Markman, et. al,, 1983). However, this program does not focus on the other members of the family outside of the married couple. Similarly, the Kids in Divorce and Separation Program (K.I.D.S; Shifflett and Cummings, 1999) provided education on the effects of conflict and divorce for parents. Again, although this program was successful in improving parents’ knowledge of the effects of conflict on children and in decreasing destructive conflict over time (Shifflett and Cummings, 1999), this program was aimed towards parents and did not contain a child component. The Family Conflict Intervention Program (FCIP; Lindsay, Pedro-Carroll, and Davies, 2001), however, did contain a child component. This program attempted to directly help children avoid the negative effects of conflict by teaching children to use optimal coping skills when witnessing discord between their parents. The primary goals of FCIP were to help children identify and express conflict-related feelings and to cope with the stress of
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interparental conflict by teaching problem-solving skills and enhancing positive selfperception. This program was successful in helping children to recognize the negative impact of conflict on their own well-being and teaching them to better express their emotions and feelings. In a separate program focused on improving the effects of conflict and divorce on children, Wolchik and colleagues attempted to change children’s “putative mediators” (i.e. coping skills, parent-child relationship quality, etc.) in relation to adjustment and marital conflict and divorce (Wolchik, et. al., 2000; Wolchik et. al., 2002). While there was limited support for the additive benefit of a child component found in this study, they did find some support for working with children in relation to coping in response to marital conflict and divorce. They also found working with both mothers and children in prevention programs can help alleviate the negative outcomes that may result when children witness ongoing destructive conflict (Wolchik et al, 2002). The current program is similar to FCIP and the studies by Wolchik and colleagues in that it focuses on providing children with information about conflict and attempting to teach children optimal self-regulation. At the same time, the current program is a component of a larger education program focusing on intervening with both children and parents in relation to specific processes of the emotional security theory (Cummings, Faircloth, Mitchell, Cummings, and Schermerhorn, 2008; Faircloth and Cummings, in press). The parent education portion of the program attempted and succeeded in improving parents’ understanding of the effects of conflict on their children as well as their relationships with one another (Cummings et al, 2008). The child component directly worked with children to change and improve their coping skills and responses when witnessing marital discord. Children learned how to change their own behaviors and emotional reactions to interparental conflict in order to promote optimal developmental outcomes (Cummings, et. al., 2008). The combination of both programs was intended to provide additive benefits for the entire family system.
MARITAL CONFLICT AND CHILDREN’S SELF-REGULATION Children’s emotional, cognitive, and behavioral reactions to conflict are related to their overall development (Cummings, et. al., 2006). Thus, teaching children how to better self regulate in these three domains might be expected to improve their developmental outcomes. Baumeister (1997) defines self-regulation as the “processes by which the self alters its own responses, including thoughts, emotions, and behaviors” (p. 146). To impact children’s outcomes and reactions, it is necessary to teach them how to better handle and interpret their emotions and behaviors when faced with stressful situations that threaten their emotional security. In other words, teaching children how to regulate their emotions, cognitions, and behaviors may improve multiple dimensions of coping, and in turn lead to optimal results for children. This is the goal of the child component of the present prevention program.
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Emotional Regulation Emotional regulation involves both the act and expression of feelings (Philippot and Feldman, 2004; Cassidy, 1994). Children are sometimes not explicitly taught how to label emotions and emotional reactions and may therefore act out in inappropriate ways as a result of both confusion and arousal. Additionally, children may express emotions that are immediately beneficial for the situation, but may prove to be detrimental as time goes on. When witnessing conflict, for example, a child may cry when her parents fight as a way of distracting her parents from the argument. Although this may be immediately beneficial because it ends the fight, this coping mechanism could lead to ongoing depressive or anxiety symptoms as a result of the emotional drain (Cummings, Davies, and Campbell, 2000; Nicolotti, El-Sheikh, and Whitson, 2003). Finally, many children may conceptualize the emotional expressions of their parents as proper expressions of emotional arousals. Yet, by doing so, during periods of heightened negative and intense marital discord, children are learning less optimal ways to express their own emotions (Crockenberg and Langrock, 2001; Grych and Cardoza-Fernandes, 2001). Therefore, in order to help children cope both with their emotions and stressful situations, they must first learn how to label emotions and to recognize which emotions are beneficial for both short and long term development. Also, they must gain the ability to separate their own emotions and emotional expressions from that of others.
Cognitive Regulation As EST emphasizes, how children perceive marital conflict in relation to their personal well-being and the family’s functioning plays a large role in both how they feel and react to conflict situations (Cummings et. al, 2006; Cummings, et. al, 2003; Grych and Fincham, 2001). Children may interpret conflict as a threat to the functioning of the family, which then causes them to react in negative ways in order to end the conflict (see also Grych and Fincham, 1990). The properties of the conflict, the context in which it is occurring, and the child’s initial levels of emotional arousal may each play a role in how the child responds to the conflict (Cummings, et. al., 2003; Harold, Shelton, Goeke-Morey, and Cummings, 2004; Cummings and Davies, 1994). Children need to learn how to recognize their cognitions when faced with conflict and how these cognitions affect both their emotions and behaviors (Krohne, Pieper, Knoll, and Breimer, 2002). Training in cognitive regulation could provide children with alternative solutions and various problem-solving skills to better deal with interparental discord.
Behavioral Self-Regulation As Lengua and colleagues (1999) explain, “behavioral control would be important for the planning and effective implementation of coping strategies, which require inhibition of immediate responding” (p. 18). Self-regulation includes individuals’ abilities to control their extrinsic reactions to situations and contexts based on input from both emotions and cognitions. Children high in behavioral self-regulation may be better able to control their
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behavior in reaction to stressful situations presented. In order to behave adaptively when faced with conflict, children must possess the ability to recognize that their parents’ fights are not their fault and that marital discord is not a problem they can fix or should become involved in (Nicolotti, et. al, 2003; Cummings et al, 2006; Cummings, et. al, 2000).
CURRENT STUDY This paper examines the effectiveness of an empirically-based prevention program that teaches parents how to handle conflict in constructive ways and also teaches children how to optimally respond to marital conflict. A topical issue for prevention work in the area of families is whether a child component adds to the benefits of programs geared towards the parents. As mentioned above, past research has shown limited support for the additive benefits of a child component aimed at improving children’s coping skills in the face of adversity. For example, Wolchik and colleagues examined the effectiveness of prevention programs for families of divorce and compared mother-only programs with combined programs for mothers and their children. According to longitudinal follow-up studies, there were few added benefits of programs aimed at teaching children how to cope with conflict and divorce (Wolchik et. al., 2002; Wolchik et. al., 2000). Particularly, the child components of these prevention programs did not significantly impact children’s adjustment over time. Despite these past findings, this paper examines the effectiveness of a psycho-educational program for children in concert with a psycho-educational program for parents. This child component is based on theory in relation to children’s emotional, behavioral, and cognitive reactions to conflict. The teachings of this component aim to positively impact children’s coping skills in the face of interparental conflict. We hypothesize that prevention education for children will be beneficial for the adjustment of children over time and in preventing the negative effects of marital conflict, although we are aware of the limited support for such findings. Furthermore, we expect that the age of the child participating in the program may affect the retention of information over time. Therefore, age will be considered as a factor of analyses in the current report.
Methods Participants Families were recruited from the South Bend and Mishawaka, IN, areas by a variety of means, including: informational flyers posted in day care centers and elementary schools; recruitment brochures sent home with the children in area schools and day care centers; and informational booths at family fairs in the community. Criteria for inclusion in the study required that couples be married or cohabitating for at least 3 years and that they have a child between the ages of 4 and 8. Interested families were asked to contact the project office to receive detailed information about the project and to arrange participation. The racial breakdown for the children in the current sample was as follows: 72% of the children were Caucasian, 6% were African American, 5% were Asian, and 17% were reported to be Biracial. Four families did not report on the racial identity of their children. These statistics
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are representative of the surrounding counties. Families received monetary compensation for their participation in the project and free child-care was offered to parents for those children not participating in the child portion of the project.
Procedure Approximately one hundred couples were randomly blocked into one of three groups using a sampling without replacement procedure: 1) a parent-only group (n = 24); 2) a parentchild group (n = 33); and 3) a self-study group (n= 33). After registering to participate in the program, parents in all three groups completed the pre-intervention measures. Parents in the two treatment conditions took part in a manualized psycho-educational program, while members of the self-study group were given two books titled Not in Front of the Children (Harold, Pryor, and Reynolds, 2001), and Adventures in Parenting (NICHD, 2001). Parents assigned to the self-study group were also given a syllabus along with suggested readings from the books to complete on their own. All adult participants in each group completed the assessment packets before the program began, and then approximately four weeks after their initial entry into the program and again at six-months and 1-year follow-up sessions. Similarly, all participating children in the three groups completed assessments at the preintervention, post-intervention, and follow-up visits. However, only the children in the parentchild group participated in four educational visits and booster sessions at six-months and oneyear. Parent Component The parent educational portions of the parent-only and the parent-child groups were identical. Multi-media presentations of materials were given, including PowerPoint slides, videotaped clips, trivia games, and other engaging activities. Information about numerous topics, including the effects of marital conflict on children, children’s emotional security about family relationships, parenting behaviors, and optimal communication skills for married couples was presented to participating parents. Also, at each session, couples practiced communication skills with a communication coach. These weekly practice sessions focused on turning destructive arguments into constructive discussions, as well as working towards conflict resolution. Additionally, at the end of each educational session, couples were asked to complete weekly diaries about their marital conflicts in the home. The couples were asked to complete one diary for each of the four weeks. Child Component Children in the parent-child group took part in a number of different activities over the course of four visits in order to promote optimal coping and emotional regulation in response to marital conflict. Multiple topics were covered over the course of the four visits, including the labeling and expression of emotions, the normality of marital conflict in all families, and optimal behavioral, emotional and cognitive reactions to interparental conflict for children. Multiple methods were used to teach the children these ideas, including coloring, games, and role plays. Also, a book written primarily for this project, Twilight at Twyckenham, was read to the children to help explain the concepts of emotions, cognitions, and behaviors in response to interparental conflict. This book focuses on the different types of conflict that arise between parents and how children feel about these arguments, as well as how they cope and
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react to such discord. Additionally, throughout most of the program, research assistants used puppets while interviewing the younger children as an age appropriate tool for teaching the concepts of the program.
Measures Parent Reports of Children’s Adjustment The Child Behavior Checklist (CBCL; Achenbach, 1991) was used to asses children’s internalizing and externalizing symptomatology. Parents are asked to rate a list of behaviors (i.e. “worries” or “destroys his/her own things”) as being either (0) not true, (1) somewhat true, or (2) very true of their child over the past six months. In the current project, the mean test-retest reliability across all subscales is very good (r = .85), while internal consistencies for the internalizing, externalizing, and total problem subscale scores (α = .89; α = .92; α = 95, respectively) have been well established (Achenbach and Rescorla, 2000). The Security in the Marital Subsystem-Parent Report inventory (SIMS-PR, Davies, and Forman, 2002) was used to assess child emotional security from the parents’ perspectives. This measure consists of a total of 37 items used to assess children’s direct involvement, behavior dysregulation and negative emotional reactivity in response to interparental conflict. Each item is assessed using a 5-point ordinal scale from (1) not at all like him/her to (5) a whole lot like him/her. Mother and father reports were scored for each of the five subscales: emotional reactivity (i.e. “appears sad”), behavioral dysregulation (i.e. “yells at family members”), avoidance (i.e. “tries to stay away from us”), involvement (i.e. “tries to distract us by bringing up other things”), and somantic reactivity (i.e. acts as if he/she feels nauseous). This measure has good reliability, with α’s ranging from .74 to .88 for both mothers and fathers in the current project. Children’s Self-Reports of Adjustment Children’s internalizing symptoms were assessed using the Child Symptom Inventory (CSI; Reynolds, 1980). This 15-item measure is a revised version of the Children’s Manifest Anxiety Scale (CMAS; Castaneda, McCandless, and Palermo, 1956). Children are asked to answer yes, sometimes, or no to each statement depending on how much each statement sounds like them. Sample items include, “I get nervous when things do not go the right way for me” and “I do many things wrong”. For the current project, only the internalizing scale for this measure was used due to the results of a principal components analysis. The reliability coefficient for this scale in the current project is .83. Children’s Self-Reports of Reactions to Marital Conflict Children’s emotional security in reaction to conflict was assessed using the Security in the Interparental Subsystem Scale (SIS; Davies, Forman, Rasi, and Stevens, 2002). This is a 27-item measure consisting of five subscales: emotional reactivity (e.g., “When your parents argue do you feel scared?”), involvement (e.g., “When your parents argue do you try and help your dad?”), dysregulated involvement (e.g, “When your parents argue do you tell them to stop?”), avoidance (e.g., “Do you try and be really quiet when your parents argue?”), and somatic reactivity (e.g., “Does your tummy hurt when your mom and dad argue?”). The
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subscales for this measure have shown satisfactory internal consistencies (α’s range from .52 to .89) and test-retest reliabilities (α range from .59 to .87; Davies, Forman, Rasi, and Stevens, 2002). Internal consistencies for this project range from .75 to .88. In order to further assess children’s emotional and cognitive responses to marital conflict, the Children’s Perceptions of Interparental Conflict Scale–Youth (CPIC-Y, Grych et. al., 1992) was used. This 34 item scale has shown acceptable internal consistency (α range from .61 to .83) and has three subscales related to children’s perceptions of marital conflict: conflict properties (e.g., “When my parents have disagreements they yell at each other.”), threat (e.g, “When my parents argue, I’m afraid that something bad will happen.”), and selfblame (e.g., “When my parents argue it’s usually because I did something wrong.”). Because of the age of the children participating in the project, puppets were used to administer this measure in order to help the children better understand the questions and concepts. Each of these subscales (conflict properties, threat, and self-blame) has good test-retest reliabilities in the current project (α = .85; α =.89; α = .64, respectively).
RESULTS Analysis Plan Due to the structure of the data, multiple types of analyses were run to examine the effectiveness of the child component. To begin, multivariate analysis of covariance (MANCOVA) was used to examine if differences existed between groups on the child measures. According to Rausch, Maxwell, and Kelley (2003), this test (using the pre-test score as the covariate) provides the most statistical power to detect treatment effects compared to other tests of repeated measures designs and gives more “statistically precise confidence intervals around population group mean differences” (p. 473). Furthermore, to test if there were any differences between groups while controlling for child age, hierarchical linear modeling (HLM; Bryk and Raudenbush, 1992) was used.
Tests of Efficacy Using MANCOVA Tests of differences between the parent-child treatment group and the parent-only treatment group and the self-study control group using MANCOVA did not yield any significant results. Each variable for the children’s perceptions of parental conflict and their adjustment outcomes were examined. The pre-test score for each variable was used as the covariate to analyze differences between groups for the post-test and follow-up assessments on the same measure.
HLM To further examine the possible efficacy of the child program, hierarchical linear models were run. The main purposes of these models were to examine if children’s perceptions of
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conflict between their parents, as well as the parents’ perceptions of their children’s adjustment, changed based on the group they were in and the age of the participating child. Because the variables in the current study were expected to vary over time depending on the group involvement and age of the children, the variables were treated as time-varying predictors in the level one models and group membership was controlled for in the level two models. Once these models had been examined, age was then added as a variable of interest to examine if the older children in the parent-child group were more successful at retaining the information presented compared to the younger children in the same group. The level one equation for the models controlling for group took the following general form: Level 1 Yij = π0 β1 (TIME) + r Level 2 equations took on the following form: β0 = γ00 + γ01 (GROUP) + µ0 β1 = γ10 β2 = γ20 Children in the parent-child group did not significantly differ from those children in the parent-only and self-study groups on self-report or parent report measures of coping and adjustment. At the same time, children’s self-reports of negative perceptions of marital conflict (F (88) = -2.84; p < .01); tendencies to engage in behavioral dysregulation in response to marital conflict (F (88) = -2.65; p < .01); and self-blame in response to marital conflict (F (88) = -4.9; p < .01), lessened over time for the participants as a whole. Post-hoc analyses indicated that these variables decreased over time only for the children in the parentchild group, albeit not significantly. These variables did not decrease over time for the other groups as indicated by post-hoc analyses. Further analyses examined whether responding changed over time according to group and the ages of the children. For example, younger children may not understand and retain the information presented to them as successfully as the older children in the project. Children were split into two groups depending on their age: younger children (ages 4 and 5) were put in one group, while older children (ages 6 to 8) were placed in a second group. Then, age was included as a variable in the level one linear model: Level 1 example with age: Involvement= β1 (TIME) + β2 (AGE) + r The level two models were the same as above and controlled for group membership. There were significant differences for some of the variables examining emotional security in relation to marital conflict depending on the age of the children. For example, children’s selfreports of dysregulation in response to conflict significantly decreased for older children (ages
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6 to 8 at the start of the program) in the parent-child group (F (16) = -2.93, p< .01), but not for the younger children (ages 4 and 5) in the same group. The same was true for children’s reports of involvement in conflict for the older children (F(16) = -3.11, p< .01), as well as self-blame in response to conflict (F (16) = -4.72, p< .01). These results were not found for younger children in the parent-child groups. Thus, older children in the treatment group were able to retain and utilize the information presented to them in the program when compared to younger children. None of these comparisons were significant for the parent-only and selfstudy groups.
DISCUSSION Despite the well-documented impact that conflict has on children’s development, little has been done to educate children about these effects and to provide them with coping skills in response to stressful family situations. Because conflict has been found to impact children through behaviors, cognitions, and emotions (Cummings et al, 2006; Grych and Fincham, 2001), teaching children how to react in these ways may ameliorate impact on their adjustment. However, the effectiveness of including a child component in addition to a parent program has been an area of debate. Research has focused on psycho-educational programs for parents in order to improve marital discord (Markman, et. al, 1983; Goodman, Bonds, Sandler, and Braver, 2004; Markman, et. al, 1988). Specifically, the current study examined the effectiveness of a child component within a larger psycho-educational program for parents aimed at preventing the negative effects of conflict on the family system. Parents were provided with communication skills training and information on conflict and family, while a subset of children in one of the prevention groups were given information and tools regarding optimal coping skills in the face of conflict. According to results, older children in the parent-child treatment group (ages 6 to 8) evidenced increased emotional security about marital conflict and less involvement in marital conflict over time. Moreover, follow-up analyses indicated no benefits in this regard for the other groups, and younger children in the parent and child group. Thus, information provided in the child component was successful in helping relatively older children adapt in terms of feelings of emotional security and reactions in relation to marital conflict. Also, separate analyses examining the parent component revealed that educating parents about the effects of marital discord on children can positively impact children’s outcomes over time (Cummings, et al, 2008). These findings are consistent with other programs suggesting limited benefits from a child component for marital conflict and children (Wolchik et al., 2000). Specifically, while Wolchik and colleagues did not find many additive benefits when including a child component in the larger prevention programs, they did find that educating children about coping in the face of family adversity impacted children’s responses to conflict over time (Wolchik et al, 2002; Wolchik et al, 2000). Several factors may account for the limited findings. First, children’s adjustment and emotional security is affected by marital conflict because marital conflict is to some extent an actual threat to children’s safety and well-being. Relatedly, Bowlby (1973) posited that children’s emotional security about family relations is based on children’s actual experiences with threatening events or loss. Given this fact, there is
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little that children can do to reshape the threat to family posed by marital conflict and it would be unrealistic for them to view conflict as no longer threatening because of learning about coping with conflict. Second, relatively advanced cognitive capacities may be needed for children to understand how to cope better with marital conflict. That is, to the extent that coping responses are an overreaction or could be improved, children may benefit further as they get older in terms of learning to use information about putting interparental conflict in better perspective, such as children understanding that conflict is not their fault. The finding that children 6-8 (the oldest group) were the only ones to show improvement is consistent with this interpretation. At the same time, marital conflict is to some extent related to children’s behavior problems and how the children handle family conflicts (Jenkins, Simpson, Dunn, Rashbash, and O’Connor, 2005). Thus, supplementing components to help children cope, older children may also benefit from training that focuses on how to handle their own conflicts more constructively. For example, children learning to respond pro-socially, rather than aggressively or angrily, may also improve marital conflict (Schermerhorn, Cummings, and Davies, 2005). Given the level of family discord during adolescence, and the relations between adolescent-parent difficulties and marital conflict (Erel and Burman, 1995), prevention programs that include components for adolescents to learn how to handle conflicts better may be especially promising. Despite the findings to date, there are bases for believing that programs targeting children as well as parents are more likely to be successful. Although it has been difficult for researchers to find significant results when adding child components to family prevention or intervention programs (Wolchik, et. al, 2000) , providing families with additional and different information for multiple family members is likely to increase the efficacy of prevention efforts (Borkowski, Smith, and Akai, 2007). Also, because the family is a system with multiple interacting and functioning parts (Cox and Paley, 2006), intervening with these different parts is likely to promote a healthy and well-functioning family system.
LIMITATIONS Although there were interesting results regarding older children participating in the child component, there were some limitations of the current study that merit mention. To begin, the sample size of the parent-child group was small and likely contributed to the lack of significant findings, especially for the comparisons about treatment and control conditions. In particular, it is difficult to establish enough power for analyses with a small sample size (Maxwell and Delaney, 2000). Moreover, the lack of significant comparisons between groups means that the findings should be interpreted with caution. Also, although the older children seemed to benefit from the program, significant results were not found for the younger children participating in the program. It could be that older children are better able to understand the concepts presented and also better able to retain the information due to their levels of social and cognitive development. This finding indicates that children above the age of six would be more ideal participants in studies of this nature. Another limitation that merits attention is in relation to the measures used in the current study. Because of the nature of the education program for children, one limitation was the
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lack of program specific measures. Specifically, because we taught children optimal tools for coping with conflict and family relationships, it would have been beneficial to measure their understanding and retention of these concepts over time using measures created specifically for the project. A measure that asked specific questions regarding the material presented in the parent-child treatment group may have yielded more significant results in relation to children’s positive development and marital conflict and family factors. This was the case for the parent program of the same study. When asked specific questions about what the participants were taught, their knowledge of the concepts significantly predicted change in their marital conflict behaviors over time (Cummings, et al, 2008). Finally, a child only group would help to possibly separate confounds present due to parent treatment and indicate whether the results were solely from children’s participation in the program, rather than the combined effects from both parents and children.
FUTURE RESEARCH Despite these limitations, the current program was successful in helping some children avoid the negative consequences that may arise in the face of marital discord. Future goals include adapting this program for older children, including adolescents, and adapting the information for different groups, including religious and ethnically diverse communities. Because conflict is an inevitable part of all relationships, children and adolescents could also learn how to better communicate with their parents, peers, and romantic partners. Therefore, communication skills training for children, in addition to training for the parents, is a promising goal for future programs.
REFERENCES Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychiatry. Baumeister, R. F. (1997). Esteem threat, self-regulatory breakdown, and emotional distressas factors in self-defeating behavior. Review of General Psychology, 1,145-174. Borkowski, J. G., Smith, L. E., and Akai, C. E. (2007). Designing effective preventionprograms: How good science makes good art. Infants and Young Children: AnInterdisciplinary Journal of Special Care Practices, 20, 229-241. Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. New York,NY: Basic Books. Bryk, A. S., and Raudenbush, S. W. (1992). Hierarchical linear model: Applications and dataanalysis methods. Thousand Oaks, CA: Sage Publications. Cassidy, J. (1994). Emotion regulation: Influences of attachment relationships. Monographs of the Society for Research in Child Development, 59, 228-283. Cox, M. J., and Paley, B. (2003). Understanding families as systems. Current Directions in Psychological Science, 12, 193-196. Crockenberg, S., and Langrock, A. (2001). The role of emotion and emotional regulation in children’s responses to interparental conflict. Interparental conflict and child
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development: Theory, research and applications. (pp. 129-156). New York, NY: Cambridge University Press. Cummings, E.M. and Davies, P.T. (1994). Children and marital conflict: The impact of family dispute and resolution. New York, NY: Guilford Press. Cummings, E. M., Davies, P. T. and Campbell, S. B. (2000). Developmental psychopathology and family process: Theory, research, and clinical implications.New York, NY: Guilford Press. Cummings, E. M., Faircloth, B. F., Mitchell, P. M., Cummings, J. S., and Schermerhorn, A. C. (2008). Evaluating a brief prevention program for improving marital conflict in community families. Journal of Family Psychology. Cummings, E.M., Goeke-Morey, M.C., Papp, L.M., and Dukewich, T.L. (2002). Children’s responses to mothers and fathers’ emotionality and conflict tactics during marital conflict in the home. Journal of Family Psychology, 16, 478-492. Cummings, E.M., Goeke-Morey, M.C., and Papp, L.M. (2003). Children’s responses to everyday marital conflict tactics in the home. Child Development, 74, 1918-1929. Cummings, E. M., and Keller, P. S. (2006). Marital discord and children’s emotional self regulation. In J. N. Hughes, D. K. Snyder, and J. Simpson (Eds.) Emotion regulation in couples and families: Pathways to dysfunction and health (pp. 163-182). Washington DC: American Psychological Association. Cummings, E.M., Schermerhorn, A.C., Davies, P.T., Goeke-Morey, M.C., and Cummings, J.S. (2006). Interpersonal discord and child adjustment: Prospective investigations of emotional security as an explanatory mechanism. Child Development, 77, 132 152. Davies, P., and Cummings, E.M. (1994). Marital conflict and child adjustment: An emotional security hypothesis. Psychological Bulletin, 116, 387-411. Davies, P., and Forman, E. M. (2002). Children’s patterns of preserving emotional security in the interparental subsystem. Child Development, 73, 1880-1903. Davies, P. T., Harold, G. T., Goeke-Morey, M. C., and Cummings, E. M. (2002). Child emotional security and interparental conflict. Monographs of the Society for Research in Child Development, 67(3, Serial No. 270). Davies, P. T., Forman, E. M., Rasi, J. A., and Stevens, K. (2002). Assessing children’s emotional security in the interparental relationship: The Security in the Interparental Subystem Scales. Child Development, 73, 544-562. Faircloth, B. F., and Cummings, E. M. (in press). Evaluating a parent education program for preventing the negative effects of marital conflict. Journal of Applied Developmental Psychology. Goeke-Morey, M. C. (1999). Children and marital conflict: Exploring the distinction between constructive and destructive marital conflict behaviors (emotional security). Dissertation Abstracts International, 60 (6-B), 2984. Goodman, M., Bonds, D., Sandler, I. and Braver, S. (2004). Parent psychoeducational programs and reducing the negative effects of interparental conflict following divorce. Family Court Review, 42, 263-279. Grych, J. H., and Cardoza, F. S. (2001).Understanding the impact of interparental conflict on children: The role of social cognitive processes. Interparental conflict and child development: Theory, research and applications. (pp. 157-187). New York, NY: Cambridge University Press.
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Grych, J. H., and Fincham, F. D. (2001). Interparental conflict and child development: Theory, research and applications. In J. H. Grych and F. D. Fincham (Eds.) New York, New York: Cambridge University Press. Grych, J. H., and Fincham, F. D. (1990). Marital conflict and children’s adjustment: A cognitive-contextual framework. Psychological Bulletin, 108, 267-290. Grych, J. H., Seid, M., and Fincham, M. (1992). Assessing marital conflict from the child’s perspective: The Children’s Perception of Interparental Conflict Scale. Child Development, 63, 558-572. Harold, G., Pryor, J. and Reynolds, J. (2001). Not in front of the children? How conflict between parents affects children. London, One Plus One Marriage and Partnership Research. Harold, G. T., Shelton, K. H., Goeke-Morey, M.C., and Cummings, E. M. (2004). Marital conflict, child emotional security about family relationships and child adjustment. Social Development, 13, 350-376. Jenkins, J., Simpson, A., Dunn, J., Rasbash, J., and O’Connor, T. G. (2005). Mutual influence of marital conflict and children’s behavior problems: Shared and nonshared family risks. Child Development, 76, 24-39. Krohne, H. W., Pieper, M., Knoll, N., and Breimer, N. (2002). The cognitive regulation of emotions: The role of success versus failure experience and coping dispositions. Cognition and Emotion, 16, 217-243. Lengua, L. J., Sandler, I. N., West, S. G., Wolchik, S. A., and Curran, P. J. (1999). Emotionality and self-regulation, threat, appraisal and coping in children of divorce. Development and Psychotherapy, 11, 15-37. Lindsay, L. L., Pedro-Carroll, J. L., and Davies, P. T. (2001). The family conflict intervention program: Curriculum for support groups with second and third grade children. Unpublished manuscript. Markman, H. J., Floyd, F. J., Stanley, S. M., and Storaasli, R. D. (1988). Prevention of marital distress: A longitudinal investigation. Journal of Consulting and Clinical Psychology, 56, 210–217. Markman, H. J., Jamieson, K., and Floyd, F. (1983). The assessment and modification of premarital relationships: Preliminary findings on the etiology and prevention of marital and family distress. In J. Vincent (Ed.), Advances in family interventions, assessment and theory (Vol. 3). Greenwich, CT: JAI Press. National Institute of Child Health and Human Development. (2001). Adventures in parenting (DHHS Publication No. ADM 00-4842). Washington, DC: U.S. Government Printing Office. Nicolotti, L., El-Sheikh, M., and Whitson, S. M. (2003). Children’s coping with marital conflict and their adjustment and physical health: Vulnerability and protective functions. Journal of Family Psychology, 17, 315-326. Philippot, P. and Feldman, R. S. (2004). The regulation of emotion of emotion. Mahwah, NJ: Lawrence Erlbaum Associates, 415 pp. Rausch, J. R., Maxwell, S. E., and Kelley, K. (2003). Analytic methods for questions pertaining to a randomized pretest, posttest, follow-up design. Journal of Clinical Child Adolescent Psychology, 32, 467-486.
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Schermerhorn, A. C., Cummings, E. M., and Davies, P. T. (2005). Children’s perceived agency in the context of marital conflict: Relations with marital conflict over time. Merrill-Palmer Quarterly, 51, 121-144. Shifflett, K., and Cummings, E. M. (1999). A program for educating parents about the effect of divorce and conflict on children: An initial evaluation. Family Relations, 48, 79-89. Stanley, S. M., Markman, H. J., St. Peters, M., and Leber, B. D. (1995). Strengthening marriages and preventing divorce: New directions in prevention research. Family Research, 44, 392-201. Wolchiks, S.A., Sandler, I.N., Millsap, R.E., Plummer, B.A., Greene, S.M., Anderson, E. R., et. al. (2002). Six-year follow-up of preventive interventions for children of divorce: A randomized controlled trial. Journal of the American Medical Association, 288: 18741881. Wolchik, S. A., West, S. G. Sandler, I. N., Tein, J.-Y., Coatsworth, D., and Lengua, L. et al. (2000). An experimental evaluation of theory-based mother and mother-child programs for children of divorce. Journal of Consulting and Clinical Psychology, 68, 843-856.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 18
MOTHER-INFANT BONDS: THE EFFECTS OF MATERNAL DEPRESSION ON THE MATERNAL-CHILD RELATIONSHIP Deana B. Davalos, Alana M. Campbell and Amanda L. Pala Colorado State University, Colorado, USA
ABSTRACT The mother infant bond has long been recognized as being crucial in multiple areas of infant development. The value that is placed on this relationship is recognized across the world and across groups of varying socioeconomic status. The multitudes of variables that are thought to be influenced by the mother infant relationship are impressive, even staggering. Research suggests that, depending on the level of bonding or lack thereof, infants may suffer outcomes as severe as irreversible neuropsychological deficits or development of long-standing psychopathology. However, others have argued that the effects are likely much more subtle, but certainly still important. During the last two decades there has been an increase in research focusing on the effects of maternal depression on the mother infant bond. Research in this field has apparently developed out of; a recognition of a relatively higher prevalence of postpartum maternal depression than once believed and recurring observations of differences in mother/infant relationships or infant behavior associated with maternal postpartum depression. The infant behaviors that have been implicated as resulting from this theoretically compromised mother infant relationship have included slight, transient effects on sociability and affective sharing to results suggesting significant increases in irritability, cognitive delays, behavioral problems, and difficulties with attachment, among others. Longitudinal data suggest that while some problems appear to resolve relatively quickly, there are some characteristics that endure long after infancy. Specifically, some researchers have argued that children and even adolescents who experienced problems bonding with their depressed mothers are at significantly greater risk of experiencing a variety of psychological symptoms, including depression, anxiety, and problems with addiction. Again, this view is controversial and others in the field link these increased risks to other factors such as low socioeconomic status or marital discord. While there appears to be consensus among most researchers in recognizing that there are likely effects of postpartum depression on
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Deana B. Davalos, Alana M. Campbell and Amanda L. Pala mother infant bonding that affect early development, there is little consensus regarding the specific details of these effects. In our review, we will systematically analyze research focusing on the effects of postpartum depression on the mother infant bond and those variables that are believed to be affected from potential difficulties in this bond.
INTRODUCTION The mother infant bond has long been recognized as being crucial in multiple areas of infant development (Beardslee et al., 1983; Cummings and Cicchetti, 1990). The value that is placed on this relationship is recognized throughout the world and across socioeconomic status (Narayanan, 1987). The multitudes of variables that are thought to be influenced by the mother infant relationship are impressive, even staggering. Research suggests that, depending on the level of bonding or lack thereof, infants may suffer outcomes such as cognitive deficits, interpersonal difficulties, or the development of long-standing psychopathology (Downey and Coyne, 1990; Gunning et al., 2004; Orvaschel, Walsh-Allis and Ye, 1988). Others have argued that the effects are likely much more subtle, but certainly still important. During the last two decades there has been an increase in research focusing on, possibly one of the most prevalent threats to the mother infant bond, maternal depression. Research in this field has apparently developed out of the recognition of a higher prevalence of postpartum maternal depression than once believed and recurring observations of differences in mother/infant relationships or infant behavior resulting from maternal postpartum depression. The infant behaviors which have been implicated as resulting from this theoretically compromised mother infant relationship have included slight, transient effects on sociability and affective sharing to results suggesting significant increases in irritability, cognitive delays, behavioral problems, and difficulties with attachment, among others (Cogill et al., 1986; Sharp et al., 1995; Murray et al., 1996). Longitudinal data suggest that while some problems appear to resolve relatively quickly, there are select characteristics that endure long after infancy. Specifically, some researchers have argued that children, adolescents, and even young adults who experienced problems bonding with their depressed mothers are at significantly greater risk of experiencing a variety of psychological symptoms, including depression, anxiety, and problems with addiction (Ensminger et al., 2003; Peisah, Brodaty, Luscombe, and Anstey, 2004; Timko et al., 2008). Again, this view is controversial and others in the field link these increased risks to factors other than maternal depression, such as low socioeconomic status or marital discord. While there appears to be consensus among most researchers in recognizing that there are likely effects of postpartum depression on mother infant bonding that affect early development, there is little consensus regarding the specific details of these effects. In this review, we will systematically analyze research focusing on the effects of postpartum depression on the mother infant bond and those variables which are believed to be affected from potential difficulties in this relationship. In this report, we will review systematically postpartum depression and its effect on the mother-infant bond. Maternal depression has received increasing attention during the past several years due to interest in the possible implications for both mother and child. However, confounding variables that may also affect children of depressed mothers present a limitation that systematically appears in the maternal depression literature. For example, results from various
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studies suggest that the following variables may all have an effect on children’s well-being, regardless of maternal depression; marital status, socio-economic status, low social support, maternal daily stressors, family adversity, quality of childcare (Belsky, 1984; Downey and Coyne, 1990; Hall and Farel, 1988; Rutter and Quinton, 1984). Furthermore, there are difficult issues involved in trying to identify the effects of depression when the onset of symptoms can be vague or difficult to identify. While some mothers with depression only experience depressive symptoms during the postpartum period, there are also mothers who meet diagnostic criteria for depression throughout both the prepartum and postpartum period (Dietz, Williams, Callaghan, Bachman, Whitlock, and Hornbrook, 2007). Given that there are distinct consequences for infants and children exposed to maternal depression during the prenatal period, it is often difficult to ascertain what is a product of postpartum maternal depression instead of maternal depression with an earlier onset during pregnancy. While a large number of the outcome variables associated with depression during the prenatal period have focused on physiological indices related to prenatal exposure to elevated neurotransmitters and cortisol levels (Davis, et al., 2007; Field, et al., 2004; Field, 1995; Jones, et al., 1998; Lundy, et al, 1999), the effects of postpartum depression have tended to emphasize the role of compromised bonding between infant and mother and resulting psychological and cognitive outcomes. To understand the importance of identifying maternal depression and the possible effects on both mother and child, it is critical that one first understands the prevalence of this condition. While it has been argued that perinatal depression is likely grossly underreported, estimates suggest that 8% to 52% of women experience postpartum depression. When one adds those women with children who have experienced depressive symptoms, that estimate consistently jumps to over 50% of women (Baker-Ericzen et al., 2008; Heneghan, Silver, Bauman and Stein, 2000; Horowitz, 2007; Lanzi, Pascoe, Keltner and Ramey, 1999; McLennan and Kotelchuck, 2000; McLennan and Offord, 2002; Moss and Plewis, 1977). The World Health Organization has posited that for women of child-bearing age, depression is the leading cause of disease burden worldwide (World Health Organization, 2001). And while unfortunate, researchers have argued that mothering young children increases the risk of depression and that, childbirth in particular, is the time when women are most prone to develop psychiatric disturbance (Brockington and Kumar, 1982; Murray and Lopez, 1996). In addition, there appears to be specific risk factors associated with those mothers of young children who endorse the highest rates of depression, including; never being married, achieving less than a high school education, under 25 years of age, specific racial status, and low socioeconomic status (Hall, 1990). Surveys focusing on women bringing in children for pediatric care have estimated that 15% to 40% of mothers report depressive symptoms (Kahn, Wise, Finkelstein, Bernstein, Lowe, and Homer, 1999; Kemper, 1994). Given that maternal depression borders on epidemic proportion and considering the fact that when we are able to recognize depression and treat it effectively, the duration may be reduced significantly, there is increasing need to understand maternal depression and the outcomes that may result from depression in both mother and child (Beck and Gable, 2000). The description of maternal depression varies significantly in the literature. Defining maternal depression varies from self-reports, subjective ratings from clinicians or family members, to structured clinical interviews. In addition, women who are included in maternal depression studies vary from individuals who have suffered from severe depressive symptoms for years to others who appear to have more transient mild symptoms of depression. Lastly, it
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is often unclear whether the symptoms of depression that are reported in the women with depression during the perinatal period are related to their perinatal status or represent longterm depression that simply carries over into the perinatal period. The unifying theme for the studies presented in this chapter is that they reflect a wide range of outcome variables that are thought to result from maternal depression.
MATERNAL DEPRESSION OUTCOME VARIABLES Physical Health and Injury Over the years, researchers have uncovered a number of physical differences which appear to distinguish offspring of depressed mothers compared to those of non-depressed mothers. Many of these characteristics appear as early as infancy. Among these are elevated heart rates associated with sympathetic arousal during interactions with their depressed mothers (Field, 1984) and lower vagal tone suggestive of lowered parasympathetic activity during interactions (Porges et al., 1982), both suggesting an elevated degree of stress in these infants with their mothers. While some argue that these characteristics may be inherent in these children from birth, there are compelling findings suggesting that interaction with the depressed mother exacerbates physiological deficits. For example, a number of these physiological indices are not present in infants when they are separated from their mothers and observed with strangers, even when their external observable behavior is unchanged. However, there are other measures which appear to be more chronic, regardless of the presence of the depressed mother during assessment. . For example, infants with depressed mothers exhibit elevated cortisol levels across multiple measurement times, suggesting that infants most likely experience chronic stress (Gunnar et al., 1984; Tennes, Downey and Vemadakis, 1977). Dawson, Frey, Self, et al. (1999) furthered the argument that there are likely static physiological conditions in these infants leading to increased stress and chronic negative outcomes. Specifically, the researchers hypothesized that the atypical brain activity that has been observed in infants of depressed mothers may reflect a tendency to experience more frequent and possibly more intense negative affect in addition to a lack of appropriate self-regulatory strategies that are used to modulate negative emotions. Furthermore, the reduced frontal brain activation (EEG) is likely associated not only with cognitive deficits that will be addressed later, but also contribute to difficulties with inhibition and emotional regulation (Ashman, Dawson and Panagiotides, 2008). That infants of depressed mothers may be predisposed to experience more frequent and greater negative affect while also lacking sufficient self-regulatory strategies to modulate these negative emotions lends further support to the idea that there may be multiple factors pointing towards chronic stress in infants of depressed mothers. This perceived relationship between maternal depression and increased stress in their offspring has been of great interest to researchers and has been studied across multiple physical outcome variables. One condition that has been studied in depth is asthma. Given that asthma is considered by many to be a stress-sensitive illness, researchers have questioned the relationship between asthma and psychological distress, specifically focusing on depression (Shalowitz, Berry, Quinn and Wolf, 2001). The autonomical dysregulation model
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of asthma proposed by Miller and Wood (1997) suggests that depressive states involve autonomic nervous system dysregulation that may be associated with vagally mediated asthma episodes (Waxmonsky et al., 2006). This model is consistent with past studies which have found a link between high internalizing symptoms and asthma severity (Goodwin et al., 2004; Klinnert et al., 2000; Ortega et al., 2002; Padur et al., 1995; Vila et al., 1998; Wamboldt et al., 1998) and research suggesting higher than average rates of depression in children and those children’s mothers who present at hospitals for asthma symptoms (Waxmonsky et al., 2006). Given these findings, a natural question that arises is whether children of depressed mothers may be at greater risk for developing asthma and/or exhibit greater asthma activity. While it remains controversial whether there is a direct relationship between maternal depression and asthma disease activity, research findings suggests that there is higher prevalence of asthma in children of depressed mothers and that there appears to be an indirect relationship between maternal depression and increased child internalizing symptoms (e.g. depressive and anxiety symptomatology) that result in increased asthma activity (Lim, Wood and Miller, 2008; Shalowitz, Berry, Quinn and Wolf, 2001). Furthermore, there is strong evidence that maternal depression is associated with internalizing disorders (Beardslee, Versage and Gladstone, 1998; Weissman et al., 2006), suggesting that maternal depression may play an important role in child asthma as well as a number of other conditions which involve internalizing symptoms. A different, possibly more controversial, area of research in maternal depression focuses on issues such as the increased prevalence of accidents, injuries, and doctors’ appointments in children of depressed mothers. There are numerous studies suggesting overall poorer physical health in children of depressed mothers, greater number of headaches and stomachaches, higher rates of medical problems, and even higher rates of mortality in the offspring of depressed parents in longitudinal studies following participants into middle age (Billings and Moos, 1983; Weissman, Gammon et al., 1987; Weissman, Wickramaratne et al., 2006; Zuckerman, Stevenson and Bailey,1987). However, there is slightly more controversy surrounding whether children of depressed mothers have more accidents, more physical injuries and greater frequency of doctor’s visits. Lewsinsohn, Olino, and Klein (2005) found that children of mothers with depression had greater occurrences of treatment for illness. Schwebel and Brezausek (2008) found that chronic levels of severe maternal depression were associated with increased risk of injury in infants and toddlers (up to age three). This finding was robust even when the researchers controlled for SES, sex of the child, child temperament, externalizing behavior, and parenting. It should be noted, however, that the risk for injury was not noted when mothers endorsed less severe symptoms of chronic maternal depression. Brown and Davidson (1984) also demonstrated a higher rate of accidents in children of depressed mothers as compared with children of nondepressed mothers. However, they point out that other studies noting similar results have introduced the possible role of maternal psychotropic medication use at the time of the child’s injury, reporting that 26% of the depressed mothers were receiving prescribed psychotropic medication at the time of injury (Hyman, 1978). Others have argued that a more feasible explanation of increased medical care and increased injuries in children of depressed mothers focuses on the fact that these children may be more likely to have growth failure (both height and weight) due to “failure to thrive” (O’Brien et al., 2004). Past studies suggest that low maternal self-esteem and depressive mood are important factors associated with growth failure (Evans, Reinhart and Succop, 1972). These characteristics often viewed as a
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failure to thrive appear to be related to poor maternal affect and poor child-rearing. However, the relationship between maternal depression and infant growth outcomes is poorly understood with possibilities including; infant growth ‘failure’ may negatively affect maternal mood, children of mothers with depression may be more likely to be identified with “failure to thrive” due to increased health-seeking behaviors by the mother, difficulty breastfeeding and poor mother-child interaction, or the established relationship between antenatal depression and low infant birth weight (Stewart, 2007).
Cognition and Language While many of the physical outcome variables studied in the maternal depression literature are assessed early in development, often at infancy, the outcome measures associated with cognition and language development are often assessed later in development. While there appears to be ample evidence suggesting that children of mothers with depression may exhibit developmental delays and some degree of cognitive and functional impairment, there is quite a bit of variability in the literature (Beck, 1998). There are clearly certain situations that may lead to different outcomes or select variables that lead to diverse effects. Among these, researchers have identified two main variables that may affect outcome the most: the age of the child at which the onset of maternal depressive symptoms appear and the gender of the child. Some research results suggest that the first two years are the most critical in terms of mother/infant bonding and the potential impairment of cognitive development (Cogill et al., 1986). Others argue that cognitive impairments are less a function of timing and more likely associated with the gender of the offspring. For example, poor cognitive performance resulting from maternal depression has been found to be selectively limited to sons in some studies, specifically finding that boys of depressed mothers have poorer educational attainment (Ensminger et al., 2003). Others argue that while there are clearly cognitive and linguistic variables that appear to be affected by maternal depression, it is less clear whether this relationship is direct or mediated by another variable. For example, some studies find direct associations between poorer cognitive functioning and maternal depression (e.g. Teti et al., 1995) but others show an association only in the context of family adversity or, as mentioned previously, only for boys (e.g., Murray, 1992; Murray et al., 1996; Sameroff et al.,1993). More general findings have appeared across genders. There are widespread language difficulties and specific cognitive deficits that span early childhood to late adolescence. In terms of language, persistent maternal depression has been associated with delayed language development (e.g. counting objects, naming colors) in children approximately three years of age (Kahn, Zuckerman, Bauchner, Homer and Wise, 2002). Other studies assessing the same age range have noted poor verbal comprehension, poor linguistic functioning, and difficulties with expressive language (NICHD Early Child Care Research Network, 1999). In addition, there are a number of cognitive outcome measures that may surface later in development, possibly after the mother’s depression has resolved. For example, children who have been exposed to maternal depression at age three exhibit deficient reading even at age eight (Hopkins, Marcus, and Campbell, 1984). These difficulties can also persist much later, with studies suggesting that children whose mothers have had persistent depression are more likely to drop out of high school (Ensminger et al., 2003).
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Failure to complete school is not the only education-related variable that has been noted in the literature. Children of depressed mothers tend to show more difficulty with schoolreadiness (NICHD Early Child Care Research Network, 1999). From teacher reports, these children are more often described as more aggressive, angry, defiant, and uncooperative than are other children (Alpern and Lyons-Ruth, 1993). However, it has been argued that the more external, behavioral problems that have been repeatedly noted by teacher ratings in the literature tend to minimize internalizing symptoms, often reported by family members, such as fear, anxiety, and physical complaints (Bird, Gould and Staghezza, 1992). Instead, given the teachers' instructional role, they are more likely to report these children’s behaviors such as aggression, hostility, and hyperactivity, which disrupt classroom routines. While there are multiple theories about why maternal depression is related to compromised cognitive and linguistic development, it has been suggested that it is likely due to a combination of factors. Many of these include indirect influences that may be more related to the child’s environment in the home of a depressed mother (e.g. high stress, limited resources, etc.) while others focus more on the relationship between the mother and child. These mother/child variables range from poor modeling of enriched language and engaged problem solving by the depressed mother to more general issues such as reduced maternal sensitivity to the child’s needs and reduced level of engagement with the child (Hay, 1997; NICHD Early Child Care Research Network, 1999).
Psychological Effects and Behavioral Correlates The last facet of development that has arguably received the most attention in the maternal depression literature is the psychological and behavioral correlates of exposure to maternal depression. While there is definite controversy in the literature regarding the types and the extent of pathology that may be associated with maternal depression, the majority of literature suggests that there are likely at least transient psychological effects and behaviors that result from exposure to maternal depression. For decades, researchers have highlighted the relationship between parental depression and higher rates of depression in their offspring. These rates vary significantly from study to study, 10% to 33% in some studies, 2-6 times greater than in control groups in other studies, with all noting a significant increase in the odds of these children becoming depressed at some point in their life (Beardslee, Keller and Klerman 1985; Downey and Coyne, 1990; Lieb et al., 2002; McKnew, Cytryn, Efron, Gershon and Bunney, 1979; Weissman, Prusoff, Gammon, Merikangas, Leckman and Kidd, 1984; Weissman et al., 1987; Welner, Welner, McCrary and Leonard, 1977; Williams and Corrigan, 1992). However, the increase in psychopathology is not limited to depression. Children of depressed mothers are also more likely to suffer from other types of clinical disorders including anxiety disorders, attention deficit hyperactivity disorder, conduct disorder and substance abuse, among others (Fendrich, Warner and Weissman; 1990; Hammen, Burge, Burney and Adrian, 1990; Orvaschel, Walsh-Allis and Ye, 1988; Weissman, Warner, Wickramaratne, Moreau and Olfson, 1997; Weissman et al., 1997). In addition, children of depressed mothers, not only have higher rates of psychopathology, but receive higher levels of treatment for psychiatric disturbance (Hammen, Gordon, Burge, Adrian, Jaenicke, and Hiroto, 1987; Klein, Clark, Dansky and Margolis, 1988; Klein et al., 1985; Orvaschel, Welsh-Allis and Weijai, 1988;
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Weissman, 1988). In longitudinal studies spanning 10-20 years, children of depressed mothers have been found to use more mental health resources during their lifetime and were more likely to report that they had obtained mental health assistance in the past year (Weissman et al., 2006). Others who have studied the relationship between maternal depression and pathology in their children agree that there is an increase in psychopathology, however, it appears to vary as a function of exposure and chronicity. When mothers/offspring are assessed at two separate time periods (e.g. spanning months to years), children whose mothers reported depressive symptoms at both ages exhibited significantly elevated rates of hostile behavior problems in the classroom and at home. However, children of mothers who were previously, but not currently, depressed exhibited significantly more anxious and withdrawn behavior at school and at home, while, lastly, children of recently depressed mothers were noted as exhibiting more hyperactivity and demanding behavior. These higher rates of psychopathology have been noted not only when compared to controls, but also when compared to children of non-depressed mothers or mothers with “medical conditions” (Weisman et al.,1984; Zelner and Rice, 1988). Furthermore, these differences appear to persist over time, even decades. In studies spanning 25-32 year followups of adult children of depressed mothers, researchers have found that their risk for specific disorders such as depression, anxiety, social impairment, and substance disorder were significantly increased compared to controls (Ensminger et al., 2003; Peisah, Brodaty, Luscombe and Anstey, 2004). And often, the emergence of pathology did not surface until years following the initial exposure to maternal depression. For example, the period of highest incidence for major depressive disorder was found to be between ages 15 and 20 years (Weissman, Wickramaratne, Nomura, Warner, Pilowsky and Verdeli, 2006). Outcome variables outside the realm of diagnosable mental illness have also been found, specifically in terms of behaviors that appear to be relatively latent until adolescence when children of depressed mothers are described as showing elevated patterns of defiant, rebellious, and withdrawn behavior (Weissman and Siegel, 1972). One interesting facet of this area of research is the control groups that have been selected as comparison groups for the mothers with depression. Even when researchers use psychiatric comparison groups, such as mothers with schizophrenia, poor affect regulation and poor affective development continue to appear at greater levels in offspring of mothers with depression (Cytryn, McKnew, Bartko, Lamour and Hamovitt, 1982; Sameroff and Seifer, 1983). While negative affective outcome variables appear to be greater in children of depressed mothers compared to other psychiatric populations, other studies suggest that the children of depressed parents cannot usually be distinguished from the children of schizophrenic parents on behavioral or attentional measures (Orvaschel, Weissman and Kidd, 1980). These detrimental effects of perceiving one’s mother to be depressed have even been witnessed when non-depressed mothers have simply simulated depression. The infants of the mothers with “simulated depression” quickly exhibit high levels of distress. It should be noted that research in “simulated depression” suggests that the distressed behavior observed by the infants was selectively limited to the children of the non-depressed mothers, while the infants of the depressed mothers appeared to be rather unaffected. Results were interpreted as suggesting that infants of depressed mothers may become accustomed to flattened affect and lower activity, decreasing their distress over time (Cohn and Tronick, 1983; Field, 1984).
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What may be one of the least suspected findings in these studies was that the infants of clinically depressed mothers were not only negatively affected by the depressed mood of their mothers, but they also appeared to have a negative effect on the nondepressed mothers participating in the study (Field et al., 1988). Specifically, the nondepressed mothers (blind to the infants’ group) appeared to exhibit more depressed symptoms and less optimal interaction with the infants of depressed mothers. The finding which suggests that infants of depressed mothers actually affected the nondepressed mothers in a negative way is not surprising considering the behaviors that often characterize these offspring. The types of behaviors that have been described in infants and young children of depressed mothers include; disengaged and intrusive interaction styles, withdrawn behavior, looking away, and reduced positive affect (Cohn, Matias, Tronick, Connell and Lyons-Ruth, 1986). A substantial literature has focused on these variables and how they affect relationships. Specifically, there has been research focusing on the relationship within and outside of the mother/child dyad, with both types of relationships thought to be affected by exposure to maternal depression. Within the dyad, depressed mothers and their infants have been shown to have less positive interaction (Field, 1980). Unfortunately, the reduction in positive interaction appears to generalize beyond the interactions between infants with their depressed mothers to others, including non-depressed mothers with whom the infants were not familiar. These findings suggest that the infants' depressed style of interacting with their mothers may generalize to nondepressed adults (Field et al., 1988). There is also evidence that these children have more difficulty in their relationships with their siblings and peers, specifically, children of depressed mothers have been described as exhibiting excessive rivalry with peers and siblings for attention (Weissman, Paykel and Klerman, 1972) and impatient, deviant, and withdrawn behavior in their interactions (Weintraub, Neale and Liebert, 1975). Other behaviors that have been noted in offspring of mothers with depression that are associated with altered patterns of interactions with others include increased self-regulatory behaviors such as head and gaze aversion which are thought to develop out of a desire to reduce the negative affect that is experienced when mothers are unresponsive. Research focusing on children of depressed mothers consistently illustrates this widespread difficulty regulating emotions. For example, children whose mothers reportchronically high levels of depression have a difficult time learning to control behavior and modulate impulses when upset (Zahn-Waxler et al., 1990). This poor modulation of emotions is exhibited in increased aggression and acting out. Specifically, Zahn-Waxler et al. (1990) report that toddlers of depressed mothers showed increased out-of-control aggression when interacting with peers and were rated higher on externalizing problems at the age of five. These externalizing behaviors have been noted in multiple studies, often characterized by significantly higher rates of hostile behavior at home and school. These behaviors appear to persist and have been noted in studies focusing on older children also, in which offspring of depressed mothers have been found to have more adjustment problems in early and middle childhood (Hammen, 1992; Lyons-Ruth, Easterbrooks and Cibelli, 1997). In terms of the etiology of these aberrant behaviors, there has been ongoing debate whether psychological symptoms that appear in children of depressed mothers represent genetic contribution, effects of parenting styles of the depressed mother or whether there may be modeling in terms of the child adopting traits and attributes from the depressed mother.
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Recent research suggests that it is likely that multiple factors contribute to psychological attributes in children of depressed mothers. Lim and colleagues (2008) interviewed children and adolescents ages 7-17 and found a direct relationship between maternal depression and increased depressive symptomatology measured using the Children’s Depression Inventory and the Child Depression Rating Scale-Revised (CDRS–R) and increased anxiety symptoms, both state and trait, using the State-Trait Anxiety Inventory for Children (STAIC-T; STAICS). In addition, maternal depression indirectly affected these psychological variables via negative parenting (e.g. intrusiveness, neglect/distancing, and harsh discipline). Kochanska, Kuczynski, Radke-Yarrow, and Darby-Welsh (1987) have also found that in terms of parenting, depressed mothers are less effective than nondepressed mothers in setting limits on their toddlers, and this was reflected in fewer compromise solutions to conflict solutions. Depressed mothers have also been found to be less likely to follow through when they do set limits, leading to less compliance and increased conflict between mother and child. This difficulty with compliance has been noted in a number of studies, with some noting higher rates of “passive noncompliance” associated with less mature expressions of age-appropriate interaction and autonomy (Kuczynski and Kochanska, 1990). Lastly, mothers with depression may tend to use more guilt in their interactions with the children when they are unable to persuade them to comply via more positive routes. Furthermore, evidence suggests that there are long-standing effects of these guilt-inducing behaviors. Children of well mothers show prototypic expressions of “adaptive guilt” which is thought to involve themes of responsibility and reparation. In contrast, expressions of guilt in children of depressed mothers have been described as aberrant, distorted, and unresolved, indicating that these children may develop different patterns of guilt expression, and likely, may be made to feel guilty for different reasons from the control children (Zahn-Waxler, Kochanska, Krupnick and McKnew, 1990). Some have speculated that the lack of consistency in parenting that is often seen in mothers with depression may exacerbate other behaviors that are often observed in this population. Specifically, behavioral problems (such as difficulty being managed, difficulty playing with other children, and having frequent tantrums) may result from both a genetic predisposition and parenting styles that do not foster proper affect regulation (Kahn, Zuckerman, Bauchner, Homer and Wise, 2002). However, there is evidence that suggests that not all mothers with depression exhibit these deficits in parenting (Frankel and Harmon, 1996), and that the effects of maternal depression on children can be mediated by interventions and specific parenting techniques. For example, research suggests that mothers suffering from depression who engaged in parenting education had children who fared better on certain outcome measures. Specifically, mothers enrolled in parenting education focusing on anticipatory guidance techniques, or techniques which focus on anticipating children’s emerging needs at different developmental stages, are believed to have children with fewer behavioral problems during early school-age years than mothers not receiving parent education. These mothers were described as more proactive in their parenting and appeared to exhibit less negative affect, use less guilt in their parental interactions, have more secure attachments, and appeared to be more consistent with their young children (Campbell and Cohn, 1997; Zahn-Waxler et al.,1990).
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CONCLUSION During the last decade, there has been increased interest and concern about the prevalence of maternal depression. Researchers and policy-makers alike appear to recognize the importance of this condition and the far-reaching effects that maternal depression has on children and families. While not specific to only maternal depression, the U.S. Surgeon General has pointed out that the impact of maternal mental health on children is vastly underrecognized (Office of the Surgeon General, 1999). It becomes clear when one systematically assesses the literature that there are social and practical limitations that have made research in the area of maternal depression and the effects on offspring difficult. One of the primary barriers for researchers in their quest to understand maternal depression and the prevalence of this condition is the fact that depression, for many, carries a stigma. When one adds the fact that there are additional expectations about motherhood, in terms of mothers themselves believing that the period of time following the birth of their child should be filled with happiness and reward compounded by society placing these same expectations on mothers, the reporting of depression during this period is likely vastly underreported (Coleman, Nelson and Sundre, 1999; Douglass and Michaels, 2004; O’Reilly, 2005). There is a significant amount of literature which reports that even if mothers would discuss their postpartum depression, there are multiple barriers in terms of having them adequately assessed by their physicians. There are a number of reasons that are reported by physicians to explain the lack of screening for depression. Some physicians are not aware of appropriate screening tools. Others worry that adding depression screening to their visits will be both time-consuming and expensive and, in the worst case, they may be put in a position where they have to make decisions about how to treat mothers with depression (BakerEriczen, Mueggenborg, Hartigan, Howard and Wilke, 2008; Seehusen, Baldwin, Runkle and Clark, 2005). Studies have shown that a large number of pediatricians acknowledge concern about addressing depression with new mothers due to possible judgments and stigma that may be associated with maternal depression. Physicians have argued that identification and assessment may be more feasible and desired if they had services to which they could refer these mothers. However, these doctors and other researchers have highlighted the point that even when mothers are successfully identified, they may be hesitant to seek assistance due to perceived judgment (Heneghan, Morton and DeLeone, 2007; McIntosh, 1993; Richards, 1990). Even in ideal situations, when mothers are successfully identified and willing to seek treatment, new barriers arise in terms of accurately diagnosing and providing the proper treatment. Research suggests that postnatal depression is complex and likely involves a variety of subtypes that should be considered when determining treatment. Watson et al. (1984) suggest that women with postnatal depression could be classified into as many as six categories with others supporting this argument given the vast etiologies of depression during the postnatal period (Cooper and Murray, 1998). These proposed different categories of postnatal depression have widespread implications in terms of treatment and research alike. In terms of treatment, researchers have argued that, given the different types of depression in this population, personalized client-centered approaches are the most appropriate rather than a blanket approach of drug treatment paired with talk therapy (McIntosh, 1993).
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In terms of research, different types of depression, levels of pathology, and duration of symptoms have all been found to effect outcome variables in different ways. When one tries to analyze the literature systematically, it quickly becomes apparent that these variables have not been well-assessed across studies and have likely led to much of the disparity in the literature. For example, the aspect of chronicity of symptoms alone is associated with very different outcomes in the mother/child relationship depending on when the symptoms first appear and how long those symptoms persist. Many researchers argue that parenting and bonding appears especially impaired when maternal depression symptoms are chronic; this is compared to women whose symptoms may be equally long in duration but are intermittent with breaks during which depressive symptoms remit (Ashman, Dawson, and Panagiotides 2008; Campbell et al., 1995). Similarly, while some researchers have argued that the first six months of parenting and bonding appear to be selectively involved in poor outcome for children of depressed mothers, others have argued that negative consequences of maternal depression are specifically associated with cases in which symptoms persist beyond the immediate postpartum period, specifically following the first year of life and beyond (Horwitz, Briggs-Gowan, Storfer-Isser and Carter, 2007). There are clearly a number of other limitations that enter the picture that may be even more difficult to extricate from the outcome variables that are associated with maternal depression. Probably the most notable variable is whether mothers who report postpartum depression may have had a predisposition for depression existing before the perinatal period. The question of whether offspring of mothers with postpartum depression may have genetic predisposition for depression remains (Sullivan, Neale and Kendler, 2000). Depression in the offspring of depressed parents is generally thought to be due to an interaction between genetic factors and environmental factors, including stressors in the family and the social context (Ensminger et al., 2003). However, approximately 40–50% of the relationship between mothers’ and children’s depressive symptoms are thought to be due to genetic linkage (Rende et al., 1993; Kendler, 1995). If this is so, one has to wonder what the extent of this predisposition may have on bonding or other outcome measures that are independent of their mother’s symptomatology during early development or whether this predisposition is specifically exacerbated by their mother’s depressive symptoms. The other issue that arises when this “interaction” between genes and environment is addressed involves the difficulty that researchers encounter when they attempt to understand this proposed 50-60% of variance that is not due to genetics. The non-genetic variables that ideally should be assessed in studies focusing on the effects of maternal depression on mother infant bonding are extensive and often difficult to assess. For example, multiple studies suggest that the negative effects of maternal depression on their offspring may be due to what we view as more direct influences, such as responding to mothers’ sadness or lack of energy or their difficulty parenting (Downey and Coyne, 1990; Cummings and Davies, 1994; Johnson et al., 2001). However, children may also exhibit negative symptoms due to secondary variables that not only affect them negatively but also contribute to their mother’s symptoms. These secondary variables range from social disadvantage, economic instability, dysfunctional family dynamics, low social support, maternal daily stressors, or insufficient childcare (Adrian and Hammen, 1993; Belsky, 1984; Downey and Coyne, 1990; Forehand et al., 1998; Hall and Farel, 1988; Rutter, 1990; Rutter and Quinton, 1984). Last, but not least, is the vastly under-examined role of marital status, level of marital discord, and the father’s role in both the depressed mother’s life and in the offspring’s quality of life. Downey and Coyne (1990) once described the
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spouses of depressed mothers as “shadowy figures.” There are multiple studies suggesting that the mates of depressed mothers may, in many cases, contribute to the pathology of the mother and to their offspring. Specifically, research suggests that mothers with depression may select mates with mental illness who contribute to pathology in offspring and who also contribute to marital discord (Downey and Coyne, 1990). However, there is equal, if not more, empirical support to suggest that “well” fathers may actually provide a buffer between negative effects of maternal depression on the child (Keller et al., 1986; Tannenbaum and Forehand, 1994). In addition, there are a wide range of studies suggesting that many of the negative outcomes associated with maternal depression appear to be selectively associated with mother’s depression, but not with paternal depression, even when the father had been diagnosed with clinical depression. For example, behavioral problems, physical injury, physical illness, and a variety of other negative outcome variables have been found to be selectively involved in maternal depression but absent in cases of paternal depression (Kahn, Brandt and Whitaker, 2004; Peisah, Brodaty, Luscombe and Anstey, 2005). While this area of research is lacking, there is enough empirical support to suggest that future research focusing on the role of the spouse in both the depressed mother’s life and the life of the offspring is warranted.
CONCLUDING REMARKS Maternal depression is a condition that has received increasing attention over the past few decades. What appears consistent in the literature is the fact that more must be done in terms of treatment and research in this population. What also appears clear in the literature is that there are multiple layers of barriers that often stand in the way of achieving research and treatment goals with this population. Multiple studies suggest that fear of stigma and embarrassment related to maternal depression may be two of the greatest barriers to getting assistance to this population. While the ideal solution to these barriers would be to reduce stigma and be accepting of maternal depression, very little progress towards this goal has been achieved over the past few decades. As researchers and policy makers work toward educating the public about maternal depression, the treating clinicians may have to focus on getting mothers to seek help for the benefit of their offspring and for the benefit of their relationship with their children. There is substantial evidence, spanning decades, that suggests that the children of depressed mothers pay a great cost in terms of their physical, cognitive, and psychological development for untreated maternal depression. There is also a wealth of literature suggesting that the maternal/child bond is typically compromised whether acutely or chronically as a result of maternal depression. It becomes quickly apparent that new attempts at intervention are needed to help get mothers and their offspring get the assistance they need. Nylen and colleagues (2006) captured the needs of this population when they wrote, “The challenge now is to devote continued attention to process and outcome variables as well as to creative manners of designing and implementing interventions such that the propensity of women and infants in need of help are able to access and receive quality mental health services.”
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REFERENCES Alpern, L.,and Lyons-Ruth, K. (1993). Preschool children at social risk: Chronicity and timing of maternal depressive symptoms and child behavior problems at school and at home. Development and Psychopathology, 5, 371-387. Ashman, S. B., Dawson, G., and Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20, 55-77. Baker-Ericzen, M. J., Mueggenborg, M. G., Hartigan, P., Howard, N., and Wilke, T. 2008). Partnership for Women’s Health: A new-age collaborative program for addressing maternal depression in the postpartum period. Families, Systems, and Health, 26, 30-43. Beardslee, W. R., Bemporad, J., Keller, M. B., and Klerman, G. L. (1983). Children of parents with major depressive disorder: A review. American Journal of Psychiatry, 54, 1254-1268. Beardslee, W. R., Keller, M. B., and Klerman, G. L. (1985). Children of parents with affective disorders. International Journal of Family Psychiatry, 6, 283-299. Beck, C. T. (1998). A checklist to identify women at risk for developing postpartum depression. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27, 39-46. Beck, C. T., and Gable, R. K. (2000). Postpartum Depression Screening Scale: Development and psychometric testing. Nursing Research,49, 272-282. Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55, 83-96. Brockington, I. F. and Kumar, R. (1982). Motherhood and mental illness. London: Academic Press. Brown, G. W. and Davidson, S. (1978). Social class, psychiatric disorder of mothers and accidents to children. Lancet, 1, 378. Chilcoat, H. D. and Breslau, N. (1997). Does psychiatric history bias mothers' reports? An application of a new analytic approach. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 971-979. Cogill, S. R., Caplan, H. L., Alexandra, H., Robson, K. M., and Kumar, R. (1986). Impact of maternal postnatal depression on cognitive development of young children. British Medical Journal, 292, 1165-1167. Cohn, F., Matias, R., Tronick, E.Z., Connell, D., and Lyons-Ruth, D. (1986). Face-to-face interactions of depressed mothers and their infants. In E Z Tronick and T Field (Eds.), Matemal depresston and infant disturbance (pp 31-45) San Francisco Jossey-Bass. Cohn, J. F., and Tronick, E. Z. (1983). Three-month old infants' reaction to simulated matemal depression. Child Development, 54, 185-193. Coleman, P., Nelson, E. S., and Sundre, D. L. (1999). The relationship between prenatal expectations and postnatal attitudes among first-time mothers. Journal of Reproductive and Infant Psychology, 17 (1), 27-39. Cooper, P.J., Murray, L. (1998). Postnatal depression. BMJ, 316, 1884-1886. Cummings, E. M., and Cicchetti, D. (1990). Towards a transactional model of relations between attachment and depression. In M. T. Greenberg, D. Cicchetti, and E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 339-372). Chicago: University of Chicago Press.
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Davis, E. P., Glynn, L. M., Schetter, C. D., Hobel, C., Chicz-Demet, A., and Sandman, C. (2007). Prenatal exposure to maternal depression and cortisol influences infant temperament. Journal of the American Academy of Child and Adolescent Psychiatry, 46 (6), 737-746. Dawson, G., Frey, K., Self, J., Panagiotides, H., Hessl, D.,Yamada, E., et al. (1999). Frontal brain electrical activity in infants of depressed and nondepressed mothers: Relation to variations in infant behavior. Development and Psychopathology, 11, 589-605. Dietz, P., Williams, S., Callaghan, W., Bachman, D., Whitlock E., Hornbrook, M. (2007). Clinically identified maternal depression before, during, and after pregnancies ending in live births. American Journal of Psychiatry, 164 (10), 1515-1520. Douglass, S. and Michaels, M. W. (2004). The mommy myth. The idealization of motherhood and how it has undermined women. New York: Free Press.
Downey G., and Coyne, J. C. (1990). Children of depressed parents: An integrative review. Psychological Bulletin, 108, 50-76. Ensminger, M. E., Hanson, S. G., Riley, A. W., and Juon, H. (2003). Maternal psychological distress: Adult sons' and daughters' mental health and educational attainment. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1108-1115. Evans, S. L., Reinhart, J. B., and Succop, R. A. (1972). Failure to thrive. Journal of the American Academy of Child Psychiatry, 11, 440-457. Fendrich, M., Warner, V., and Weissman, M. M. (1990). Family risk factors, parental depression, and psychopathology in offspring. Developmental Psychology, 26, 40-50. Field, T. (1980) Interactions of high-risk infants. Quantitative and qualitative differences In D. B. Sawin, R. C. Hawkins, L. Walker, and J. Penticuff (Eds.), Current Perspectives on psychosocial risks dunng pregnancy and early infancy (pp. 120-143). New York: Brunner/Mazel. Field, T. (1984) Early interactions between infants and their postpartum depressed mothers. Infant Behavior and Development, 7, 527-532. Field, T., Diego, M., Dieter, J., Hernandez-Reif, M., Schanberg, S., Kuhn, C., Yando, R., and Bendell, D. (2004). Prenatal depression effects on the fetus and the newborn. Infant Behavior and Development, 27, 216-229. Field, T., Healy, B., Goldstein, S., Perry, S., Bendell, D., Schanberg, S., Zinunerman, E. A., and Kuhn, C. (1988). Infants of depressed mothers show "depressed" behavior even with nondepressed adults. Child Development, 59, 1569-1579. Field, T., Diego, M.., Hernandez-Reif, M., Yanexy, V., Gil, K., Schanberg, S., Kuhn, C., and Gonzalez-Garcia, A. (2004). Prenatal predictors of maternal and newborn EEG. Infant Behavior and Development, 27, 533-536. Garmezy, N. and Devine, V. (1984). Project competence: The Minnesota studies of children vulnerable to psychopathology. In N. F. Watt, E. J. Anthony, L. C. Wynne, and J. E. Rolf (Eds.): Children at Risk for Schizophrenia (pp. 289-309). Cambridge: UK: Cambridge University Press. Goodwin, R. D., Fergusson, D. M., Horwood, L. J. (2004). Asthma and depressive and anxiety disorders among young persons in the community. Psychological Medicine, 34, 1465-1474. Green, M. (1994). Diagnosis, management, and implications of maternal depression for children and pediatricians. Current Opinion in Pediatrics, 6, 525-529.
334
Deana B. Davalos, Alana M. Campbell and Amanda L. Pala
Gunnar, M. R., Malone, S., and Fish, R. D. (1984). Psychobiology of stress and coping in the human neonate studies of adrenocortical activity response to stress. In T. Field, P. M. McCabe, and N. Schneiderman (Eds.), Stress and coping (pp. 179-196). Hillsdale, N. J.: Erlbaum. Gunning, M., Conroy, S., Valoriani, V. Figueiredo, B., Kammerer, M. H., Muzik, M., Glatigny-Dallay, E., and Murray, L. (2004). Measurement of mother–infant interactions and the home environment in a European setting: Preliminary results from a crosscultural study. The British Journal of Psychiatry, 184, 38-44. Hall, L. A. (1990). Prevalence and correlates of depressive symptoms in mothers of young children. Public Health Nursing, 7, 71-79. Hall, L. A. and Farel, A. M. (1988). Maternal stresses and depressive symptoms: Correlates of behavior problems in young children. Nursing Research, 37, 156-161. Hammen, C., Burge, D., Burney, E., and Adrian, C. (1990). Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Archives of General Psychiatry, 47, 1112-1117. Hammen, C., Gordon, D., Burge, D, Adrian, C., Jaenicke, C., and Hiroto, D. (1987). Maternal affective disorders, illness, and stress: risk for children's psychopathology. American Journal of Psychiatry, 144, 736-741. Hay, D. F. (1997). Postpartum depression and cognitive development. In L. Murray and P. Cooper (Eds.), Postpartum depression and child development (pp. 85-110). New York: Guilford Press. Heneghan, A. M., Silver, E. J., Bauman L. J., Westbrook L. E, and Stein R. E. (1998). Depressive symptoms in inner-city mothers of young children: Who is at risk? Pediatrics 1998; 102:1394. Heneghan, A. M., Silver, E. J., Bauman, L. J., and Stein, R. E. (2000). Do pediatricians recognize mothers with depressive symptoms? Pediatrics, 106, 1367-1373. Heneghan, A. M., Morton, S., DeLeone, N. L. (2007). Pediatricians’ attitudes about discussing maternal depression during a pediatric primary care visit. Child: Care, Health and Development, 33 (3), 333-339. Hopkins J., Marcus, M., Cambell, S. B. (1984). Postpartum depression a critical review. Psychological Bulletin, 95, 498-515. Horwitz, S. M., Briggs-Gowan, M. J., Storfer-Isser, A., and Carter, A. J. (2007). Prevalence, correlates, and persistence of maternal depression. Journal of Women’s Health, 16 (5), 678-691. Hyman, C. A. (1978). Non-accidental injury. Health Visitors, 51, 168-172. Jones, N. A., Field, T., Fox, N. A., Davalos, M., Lundy, B., and Hart, S. (1998). Newborns of mothers with depressive symptoms are physiologically less developed. Infant Behavior and Development, 21 (3), 537-541. Kahn, R. S., Brandt, D., and Whitaker, R. C. (2004). Combined effect of mothers' and fathers' mental health symptoms on children's behavioral and emotional well-being. Archives of Pediatric and Adolescent Medicine, 4(158) 721-729. Kahn, R., Wise, P., Finkelstein, J., Bernstein, H., Lowe, J., and Homer, C. (1999). The scope of unmet maternal health needs in pediatric settings. Pediatrics, 103, 576-581. Kahn, R. S., Zuckerman, B., Bauchner, H., Homer, C. J., and Wise, P. H. (2002). Women’s health after pregnancy and child outcomes at age 3 years: A prospective cohort study. American Journal of Public Health, 92, 1312-1318.
Mother-Infant Bonds
335
Keller, M.B., Beardslee, W.R., Dorer, D.J., Lavori, P.W., Samuelson, H., and Klerman, G.R. (1986). Impact and severity and chronicity of parental affective illness on adaptive functioning and psychopathology in children. Archives of General Psychiatry, 43, 930937. Kemper, K.J. (1994). Family psychosocial screening: should we focus on high-risk settings? Developmental and Behavioral Pediatrics, 15, 336-341. Klinnert, M. D., McQuaid, E. L, McCormick, D., Adinoff, A. D., and Bryant, N. E. (2000). A multimethod assessment of behavioral and emotional adjustment in children with asthma. Journal of Pediatric Psychology, 25, 35-46. Lanzi, R. G., Pascoe, J. M., Keltner, B., and Ramey, S. L. (1999). Correlates of maternal depressive symptoms in a national Head Start program sample. Archives of Pediatrics and Adolescent Medicine, 153, 801-807. Lewinsohn, P. M., Olino, T. M., and Klein, D. N. (2005). Psychosocial impairment in offspring of depressed parents. Psychological Medicine, 35, 1493-1503. Lieb, R., Isensee, B., Hofler, M., Pfister, H., and Wittchen, H. (2002). Parental major depression and the risk of depression and other mental disorders in offspring: A prospective longitudinal community study. Archives of General Psychiatry, 59, 365-374. Lim, J., Wood, B. L., and Miller, B. D. (2008). Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity. Journal of Family Psychology, 22, 264-273. Lundy, B.L., Jones, N. A., Field, T., Nearing, G., Davalos, M., Pietro, P.A., Schanberg, S., and Kuhn, C. (1999). Prenatal depression effects on neonates. Infant Behavior and Development, 22(1), 119-129. Luoma, I., Koivisto, A. M., Tamminen, T. (2004). Fathers' and mothers' perceptions of their child and maternal depressive symptoms. Nordic Journal of Psychiatry, 58, 205-211. McIntosh, J. (1993). Postpartum depression: Women's help-seeking behavior and perceptions of cause. Journal of Advanced Nursing, 18, 178-184. McKnew, D. H., Cytryn, L., Efron, A. M., Gershon, E. S., and Bunney, W. E. (1979). Offspring of patients with affective disorders. British Journal of Psychiatry, 134, 148152. McLennan, J. D., and Kotelchuck, M. (2000). Parental prevention practices for young children in the context of maternal depression. Pediatrics, 105, 1090-1095. McLennan, J. D., and Offord, D. R. (2002). Should postpartum depression be targeted to improve child mental health? Journal of the American Academy of Child and Adolescent Psychiatry, 41, 28-35. Miller, B. D. and Wood, B. L. (2003). Emotions and family factors in childhood asthma: Psychobiological mechanisms and pathways of effect. In E.S. Brown (Ed.), Social and Psychological Factors and Psychosomatic Syndromes (pp.131-160) Dallas: Karger. Moss, P. and Plewis, I. (1977). Mental distress in mothers of preschool children in inner London. Psychological Medicine, 7, 614-652. Murray, L., and Cooper, P. J. (2003). Intergenerational transmission of affective and cognitive processes associated with depression infancy and the pre-school years. In I. Goodyear (Ed.), Unipolar depression: A lifetime perspective (pp. 17-46). Oxford, England: Oxford University Press.
336
Deana B. Davalos, Alana M. Campbell and Amanda L. Pala
Murray, C. J. L., and Lopez, A. D. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press. Murray, L., Hipwell, A., Hooper, R., Stein, A., and Cooper, P. (1996). The cognitive development of 5-year-old children of postnatally depressed mothers. Journal Child Psychology and Psychiatry, 37, 927-935. Narayanan, I. (1987). Early mother–infant interaction: Global perspectives and developing country concerns. Journal of Tropical Pediatrics, 33, 120-123. NICHD Early Child Care Research Network. (1999). Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 month. Developmental Psychology, 35 (5), 1297-1310. Nylen, K. J., Moran, T. E., Franklin, T. L., and O’Hara, M. W. (2006). Maternal depression: A review of relevant treatment approaches for mothers and infants. Infant Mental Health Journal, 27 (4), 327-343. O'Brien, L.M., et al. (2004). Postnatal depression and faltering growth: A community study. Pediatrics, 113, 1242-7. O’Reilly, A. (Ed.). (2004). From Motherhood to Mothering. Albany: State University of New York Press.
Office of the Surgeon General. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Office of the Surgeon General. Ortega, A. N., Huertas, S. E., Canino, G., Ramirez, R., Rubio-Stipec, M. (2002). Childhood asthma, chronic illness, and psychiatric disorders. Journal of Nervous and Mental Disorders, 190, 275-281. Orvaschel, H., Walsh-Allis, G., and Ye, W. (1988). Psychopathology in children of parents with recurrent depression. Journal of Abnormal Child Psychology, 16, 17–28. Orvaschel, H., Weissman, M. M., and Kidd, K. K. (1980). The children of depressed parents; The childhood of depressed patients; Depression in children. Journal of affective disorders, 2, 1-16. Padur, J. S., Rapoff, M. A., Houston, B. K., et al. (1995). Psychosocial adjustment and the role of functional status for children with asthma. Journal of Asthma, 32, 345-353. Peisah, C., Brodaty, H., Luscombe, G., and Anstey, K. (2004). Children of a cohort of depressed patients 25 years later: Psychopathology and relationships. Journal of Affective Disorders, 82, 385–394. Peisah, C., Brodaty, H., Luscombe, G., and Anstey, K. (2005). Children of a cohort of depressed patients 25 years later: Identifying those at risk. Australian and New Zealand Journal of Psychiatry, 39, 907–914. Porges, S. W., McCabe, P. M., and Yongue, B. G. (1982). Respiratory-heart rate interactions: Psychophysiological implications for pathophysiology and behavior. In J. T. Cacippo and R. E. Petty (Eds.), Perspectives in cardiovascular psychophysiology (pp. 233-260). New York, NY: Guilford. Richards, J. P. (1990). Postnatal depression: A review of recent literature. British Journal of General Practice, 40, 472-476. Rutter, M., and Quinton, D. (1984). Long-term follow-up of women institutionalized in childhood: Factors promoting good functioning in adult life. British Journal of Developmental Psychology, 2, 191-204. Schwebel, D. C. and Brezausek, C. M. (2008). Chronic maternal depression and children's injury risk. Journal of Pediatric Psychology, 1-9.
Mother-Infant Bonds
337
Seehusen, D. A., Baldwin, L., Runkle, G. P., Clark, G. (2005). Are family physicians appropriately screening for postpartum depression? The Journal of the American Board of Family Physicians, 18, 104-112. Shalowitz, M. U., Berry, C. A., Quinn, K. A. and Wolf, R. L. (2001). The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice. Ambulatory Pediatrics, 1, 185-193. Sharp, D., Dale, F.H., Pawlby, S., Schmucker, G., Allen, H., and Kumar, R. (1995). The impact of postnatal depression on boy’s intellectual development. Journal of Child Psychology and Psychiatry, 36: 1315-1336. Stewart, R. C. (2007). Maternal depression and infant growth: A review of recent evidence. Maternal and Child Nutrition, 3 (2), 94-107. Tannenbaum, L. and Forehand, R. (1994). Maternal depressive mood: The role of the father in preventing adolescent problem behaviours. Behaviour Research and Therapy, 32, 321325. Tennes, K., Downey, K., and Vemadakis, A. (1977). Urinary cortisol excretion rates and anxiety in normal 1-year-oId infants. Psychosomatic Medicine, 39,178-187. Timko, C., Cronkite, R. C., Swindle, R., Robinson, R. L., Turrubiartes, P., and Moos, R. H. (2008). Functioning status of adult children of depressed parents: A 23-year follow-up. Psychological Medicine, 38, 343-352. Tronick, E.Z., and Gianmo, A.F. (1986). The transmission of maternal disturbance to the infant. In E.Z. Tronick and T. Field (Eds.), Matemal depression and infant disturbance. San Francisco: Jossey-Bass. Vila, G., Nollet-Clemencon, C., de Blic, J., Mouren-Simeoni, M. C., and Scheinmann, P. (1998). Asthma severity and psychopathology in a tertiary care department for children and adolescents. European Child and Adolescent Psychiatry, 7, 137-144. Wamboldt, M. Z., Fritz, G., Mansell, A., McQuaid, E. L., and Klein, R. (1998). Relationship of asthma severity and psychological problems in children. Journal of American Academy of Child and Adolescent Psychiatry, 37, 943-950. Watson, J. P., Elliott, S. A., Rugg, A. J., Brough, D.I. (1984). Psychiatric disorder in pregnancy and the first postnatal year. British Journal of Psychiatry, 144, 453-462. Waxmonsky, J., Wood, B. L., Stern, T., Ballow, M., Lillis, K., Cramer-Benjamin, D., Mador, J., and Miller, B. D. (2006). Association of depressive symptoms and disease activity in children with asthma: Methodological and clinical implications. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 945-954. Weintraub, S., Neale, J. M., and Liebert, D. E. (1975). Teacher ratings of children vulnerable to psychopatholgy. American Journal of Orthopsychiatry, 45, 839-845. Weissman, M. M., Gammon, G. D., John, K., Merikangas, K. R., Warner, V., Prusoff, B. A., and Sholomskas, D. (1987). Children of depressed parents: Increased psychopathology and early onset of major depression. Archives of General Psychiatry, 44, 847-853. Weissman, M. M., Paykel, E. S., and Klerman, G. L. (1972). The depressed woman as a mother. Social Psychology, 7, 98-108. Weissman, M. M., Prusoff, B. A., Gammon, G. D., Merikangas, K. R., Leckman, J. F., and Kidd, K. K. (1984). Psychopathology in the children (ages 6-18) of depressed and normal parents. Journal of American Academy of Child Psychiatry, 23, 78-84. Weissman, M. M. and Siegel R. (1972). The depressed woman and her rebellious adolescent. Social Casework, 53, 563-570.
338
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Weissman, M. M., Warner, V., Wickramaratne, P., Moreau, D., and Olfson, M. (1997). Offspring of depressed parents: 10 years later. Archives of General Psychiatry 54, 932940. Welner, Z., Welner, A., McCrary, M. D., and Leonard, M. A. (1977). Psychopathology in children of inpatients with depression: A controlled study. Journal of Nervous and Mental Disorders, 164, 408-413. Williams, O. B. and Corrigan, P. W. (1992). The differential effects of parental alcoholism and mental illness on their adult children. Journal of Clinical Psychology, 48, 406-414. World Health Organization. A message from the Director General. 2001. Available from: URL: http://www.who.int/whr/2001/ dg_message/en/index.html. Zahn-Waxler, C., Iannotti, R. J., Cummings, E. M., and Denham, S. (1990). Antecedents of problem behaviors in children of depressed mothers. Development and Psychopathology, 2, 271-291. Zahn-Waxler, C., Kochanska, G., Krupnick, J., and McKnew, D. (1990). Patterns of guilt in children of depressed and well mothers. Developmental Psychology, 26, 51-59. Zelner, R. and Rice, J. (1988). School-aged children of depressed parents: A blind and controlled study. Journal of Affective Disorders, 15, 291-302. Zuckerman, B. S., and Beardslee, W. R. (1987). Maternal depression: A concern for pediatricians. Pediatrics, 79, 110-117. Zuckerman, B., Stevenson, J., and Bailey, V. (1987). Stomachaches and headaches in a community sample of preschool children. Pediatrics, 79 (5), 677-682.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 19
SOCIAL NETWORKS AND PSYCHOSOCIAL FUNCTIONING AMONG CHILDREN AND ADOLESCENTS COPING WITH SICKLE CELL DISEASE: AN OVERVIEW OF BARRIERS, CONSIDERATIONS, AND BEST PRACTICES Rebecca H. Foster,1 HaNa Kim,1 Robbie Casper,2 Alma Morgan,2 Wanda Brice2 and Marilyn Stern1,2 1
Department of Psychology, Virginia Commonwealth University 2 Department of Pediatrics, Virginia Commonwealth University Richmond, Virginia, United States of America
ABSTRACT Over 70,000 individuals in the United States are diagnosed with sickle cell disease, yet relatively little attention has been paid to this group when compared to those diagnosed with other chronic illnesses such as asthma, cystic fibrosis, diabetes, or cancer. Like most major chronic illnesses, sickle cell disease influences familial and social relationships in numerous and ever-changing ways. Advances in sickle cell disease treatments and improved survival rates have resulted in dramatic shifts in relationship networks and psychosocial adaption for each child diagnosed. Several primary areas of concern have been identified for children and families facing sickle cell disease such as disruptions to educational and socialization processes, sudden changes in medical conditions including the persistent threat of pain crises, existential anxieties about death, the wide range of emotions that are often present in managing with the various stages of the disease and treatment, the overarching developmental trajectory of the child, and coping with having a serious illness or caring for a child with a serious illness. Literature has cited and research continues to find evidence of challenges faced by these children and adolescents including ways in which family functioning, social acceptance by peers, interactions with siblings, parenting style used in the home, and daily anxieties and pressures can play integrated roles in shaping life-long relationships and overall quality of life. Because sickle cell disease predominantly affects minority groups within the
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Rebecca H. Foster, HaNa Kim, Robbie Casper et al. United States, families and medical professionals also must consider the cultural needs of each patient in order to promote best practices for treatment and the development of sustained, healthy relationships. While these noted challenges tend to be constant foci for all concerned with caring for and working to develop optimal relationships among individuals diagnosed with sickle cell disease, many individuals and families coping with a sickle cell disease diagnosis seem to function quite well when adaptive coping and supportive networks are present and persistent. This chapter will investigate how the many relationships that exist within the social context of a child’s world are impacted by sickle cell disease. An overview will be provided examining dynamics between parents, the children diagnosed with sickle cell disease, and their peers and siblings in terms of the challenges faced and the relationship strengths displayed. Cultural influences and means of improving life-long relationships will be explored. Lastly, currently implemented interventions promoting positive relationships will be discussed as well as future directions for research and intervention studies.
INTRODUCTION Each year in the United States about 1 in every 400 to 500 African Americans born will be diagnosed with some form of sickle cell disease (Gustafson, Bonner, & Hardy, 2006; Lutz, Barakat, Smith-Whitley, & Ohene-Frempong, 2004). While African Americans are most likely to be affected, individuals of Mediterranean, Caribbean, South and Central American, Arabian, and East Indian descent can be affected as well. Generally speaking, sickle cell disease constitutes a group of chronic inherited blood disorders caused by an autosomal recessive genetic deficit in which hemoglobin (Hb) S is atypical (Gustafson et al., 2006). Certain adverse conditions, such as emotional stress, fever, dehydration, and extreme temperatures cause the red blood cells to become stiff and rigid, or sickle-shaped. These sickle-shaped cells are unable to pass through the blood vessels easily, thus blocking blood flow and oxygen. Such events set the stage for numerous complications to develop including chronic anemia, recurrent pain (or vaso-occlusive crises), low exercise tolerance, altered splenic functioning, compromised pulmonary functioning, increased vulnerability to infection, late onset of puberty, growth delays, enuresis, and poor vascular circulation. Poor vascular functioning, in turn, may lead to strokes resulting in organ and brain damage (Gustafson et al., 2006; Mitchell, Lemanek, Palermo, Crosby, Nichols, & Powers, 2007). Approximately 5-10% of individuals with sickle cell disease will endure cerebrovascular accidents; another 11-20% will suffer at least one silent stroke. The most common and often most severe form of sickle cell disease is the homozygous condition known as sickle cell anemia (Hb SS), which results from two abnormal genes for hemoglobin S. Sickle cell hemoglobin C (Hb SC) and sickle β-thalassemia are also relatively common. While medical advances have dramatically improved the life expectancy of what was once considered a fatal childhood illness, sickle cell disease continues to be considered a life-limiting illness with a median life expectancy in the mid-40s for those with Hb SS and the mid-60s for those with Hb SC (Platt et al., 1994). With increased life expectancy rates comes the need for improving adaptation and quality of life among children and adolescents with sickle cell disease, their families, and all others comprising their social networks (Atkin & Uhmad, 2001; Baskin, 1998). Although some sickle cell disease patients and families adjust relatively well to life coping with sickle cell
Social Networks and Psychosocial Functioning among Children and Adolescents … 341 disease, nearly all face periodic challenges in various domains of daily living (Barbarin & Christian, 1999; Baskin et al., 1998; Ohaeri, Shokunbi, Akinlade, & Dare, 1995; Wagner et al., 2004). While the biomedical challenges associated with sickle cell disease are ongoing and overwhelming at times, psychosocial and developmental struggles, both chronic and acute, are equally evident. These struggles come from a broad range of sources including but not limited to family functioning, peer relationships, interactions with siblings, parenting styles and emotional states, and daily anxieties and pressures related to communication with school environments and medical professionals. Any and all of these can play integrated roles in shaping life-long relationships and overall quality of life. Furthermore, because sickle cell disease predominantly affects minority groups within the United States, families and medical professionals also must consider the cultural needs of each patient in order to promote best practices for treatment and the development of sustained, healthy relationships. While the potential roadblocks associated with the development of optimal relationships and daily functioning among individuals diagnosed with sickle cell disease may seem abundant, many individuals and families coping with a sickle cell disease diagnosis seem to function quite well when adaptive coping and supportive networks are present and persistent. This chapter will investigate how the many relationships that exist within the social context of a child’s world are impacted by sickle cell disease. An overview of the available literature will be provided, examining patient and family relationship dynamics and adaptation to chronic illness, perceptions of peer relationships, sickle cell disease within the academic setting, and relationships in the medical setting. Cultural influences and means of improving life-long relationships will be explored. The chapter concludes with a discussion of currently implemented interventions promoting positive familial, peer, academic, and medical relationships and suggestions for future directions in research and intervention studies.
RELATIONSHIPS IN SICKLE CELL DISEASE: REVIEW OF THE LITERATURE Relationship Dynamics within the Family Unit Coping with Sickle Cell Disease: A Focus on the Patient Children and adolescents with sickle cell disease face numerous challenges related to overall development (e.g., Barbarin & Christian, 1999; Battle, 1984; Morgan & Jackson, 1986; Serjeant, 1992; Wright & Phillips, 1988). Because the illness unfolds within the constantly changing contexts of lifespan development, how sickle cell disease is handled greatly depends on an individual’s culture and current developmental stage (Gustafson et al., 2006). Reaching typical developmental markers can be compromised due to pain crises or other complications at any given time and can result in modified identity and autonomy development, increased risk of academic setbacks, and disruptions in social skill attainment. Research suggests that individuals growing up chronically ill are two to three times more likely to experience difficulties in social relationships (Creswell et al., 2001). Normal developmental processes become magnified and may result in a heightened propensity for social isolation (Boice, 1998). Developing the social self-efficacy to create and maintain peer and romantic relationships can be challenging (Gentry, Varlik, & Dancer, 1998).
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Adolescents with sickle cell disease may be especially likely to experience difficulties in social adaptation and relationship development. This increased potential for difficulty in social adaptation is due, in part, to the already complex developmental changes occurring in these groups within sociodevelopmental domains, which are further disrupted by a sickle cell experience (Holmbeck, 2002; Ungerer, Horgan, Chaitow, & Champion, 1988). Although researchers are beginning to understand the importance of conceptualizing children and adolescents as populations with unique perceptions and needs, study of these individuals using strong methodologies and analytical techniques remains limited. Children and adolescents with sickle cell disease may be inundated by psychological manifestations of the disease such as psychological distress and negative mood (Gil et al., 2003) and lower levels of self-esteem (Davis, 1995). In a study of urban-dwelling children with sickle cell disease, approximately one fourth of the sample reported experiencing feelings of anxiety and depression (Barbarin, Whitten, & Bonds, 1994). Ievers, Brown, Lambert, Hsu, and Eckman (1998) reported nearly identical outcomes when 30% of parents of children and adolescents diagnosed with sickle cell disease reported that their children were less well adjusted than typically developing children. Thompson and colleagues (1999) also indicated that 25% of their 289 child participants endorsed having some type of internalizing or externalizing behavior problem. Those reporting behavior problems were more likely to report poorer family support as well as higher family conflict. Other studies have acknowledged similar results, but most have been quick to add that the majority of children and adolescents with sickle cell disease are not clinically depressed (Barlow & Ellard, 2005; Burlew, Telfair, Colangelo, & Wright, 2000). Burlew and colleagues’ study (2000) showed somewhat different and additionally optimistic findings when rates of symptoms of anxiety among adolescents with sickle cell disease were reported to be slightly lower than norms for high school students. Child rearing practices can influence reported feelings of depression and anxiety (Gustafson et al., 2006). Studies have consistently found that parental cognitions including beliefs, appraisals, expectations, and attributions impact the sociocultural environment within the household and relate to child and adolescent internalizing and externalizing behaviors (Barbarin, Whitten, Bond, & Conner-Warren, 1999; Hocking & Lochman, 2005; Ievers et al., 1998; Thompson et al., 1999). Despite the acknowledgement of these relationships, additional research points out that parents of children and adolescents with and without sickle cell disease appear to have similar parenting styles (Noll, McKellop, Vannatta, & Kalinyak, 1998). This findingt further raises the question of whether merely being in a family with a chronic illness will negatively affect adaptation and relationship development. In general, children and adolescents with better means of social support are more likely to display success in developing long-term, healthy relationships and adaptive functioning to stressors (Hocking & Lochman, 2005; Ievers et al., 1998). Promoting well-being of parents and early interventions that build self-confidence in social domains may be two important factors that can increase the likelihood that a child or adolescent with sickle cell disease will develop a strong, supportive social network.
Coping with Sickle Cell Disease: A Focus on the Parents Much of the responsibilities of raising a child or adolescent with sickle cell disease inevitably falls on the parents or caregivers. The balancing act of raising a child, working, and keeping up with daily expenses are difficult in and of themselves. Because a chronic illness
Social Networks and Psychosocial Functioning among Children and Adolescents … 343 acts as an ongoing stressor, the added burden of managing a child’s sickle cell diagnosis in combination with the struggles of daily life can often become overwhelming (Gustafson et al., 2006). More specifically, parents report that their social and personal life is more limited, and maintaining employment can be difficult (Mitchell, Lemanek, Palermo, Crosby, Nichols, & Powers, 2007). Overall, a child or adolescent living with a chronic illness such as sickle cell disease can dramatically change family dynamics and interrupt marital and parent-child relationships. Healthy family functioning can serve to buffer chronically ill children and their healthy siblings from undesirable outcomes related to associated illness stressors (Barakat, Patterson, Tarazi, & Ely, 2007). Among caregivers, chronic illness has been found to increase parental time demands and self-reported exhaustion (Barakat et al., 2007). Parents often report concerns about the long-term uncertainty of the child’s physical well-being; feelings of worry, sorrow, and anger; and the limited availability of emotional resources. Due to the inherited nature of the illness, feelings of guilt and shame may take varying forms on multigenerational levels (Helps et al., 2003). Caregiver demands and relationship dynamics with the affected child or adolescent can shift suddenly and dramatically from caring for a relatively healthy child to coping with severely limiting symptomatology unexpectedly. Parents must assume the roles of managing pain at home and assisting with the medical regimen while navigating the child’s responses to and perceptions of the illness. Studies on parental and overall family functioning when coping with sickle cell disease report a variety of findings ranging from results suggesting relatively poor functioning to those reporting that families with sickle cell disease adapt and cope quite well (Barakat et al., 2007). In general, the literature indicates that those families with lower levels of conflict, higher levels of organization, and more structure fair better over time. However, differences in functioning could be based on illness demands, socioeconomic risk, developmental delays, and/or cultural variations in family functioning. This includes social identity, racial attributions, experiences with discrimination, religiosity, and support from the extended family (Barbarin et al., 1999). Furthermore, parent-child relationships change over time. As a child ages, he or she becomes more autonomous and takes over the role of managing his or her sickle cell disease. In a 2007 study by Barakat and colleagues, parents of adolescents with sickle cell disease reported more difficulties with caregiver roles and parent-child relationships than did parents of preschool-aged children diagnosed with sickle cell disease. Authors hypothesized that because the parent of a preschool-aged child assumes 100% responsibility for care, it may be easier for these parents to know how to respond to parenting stressors and sickle cell crises, whereas the parent of an adolescent may not be certain of how to balance the adolescent’s responsibility for self-care with the parent’s desire to intervene. A parent’s sense of control over the quality of the parent-child relationship can be influenced by a number of factors (Barakat, Lutz, Nicolaou, & Lash, 2005). Having an internal locus of control (i.e., feeling that control of event outcomes is derived from within) is related to lower levels of parenting frustration and higher levels of parenting self-efficacy. Because these parents display higher levels of confidence, they are less likely to rely on medical professionals for the care of their child in times when they are capable of handling the illness symptoms. In Barakat and colleagues’ 2005 study of 31 caregivers, parents of a child diagnosed with sickle cell disease were less likely to report an internal locus of control as compared to parents of children diagnosed with congenital heart disease. Parents who reported an internal locus of control also reported better quality of life, especially in terms of
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self-competence and adaptive family functioning. Overall, when the executive parental system is effective and open to modeling emotional support, the family unit copes better and maintains stronger cohesive relationships (Barbarin et al., 1999). This system must include strong leadership, appropriate use of power differentials between parents and children, an ability to make decisions that are in the best interest of the entire family, and an ability to distribute resources (e.g., time, attention, money) fairly. In a related study, family competence was defined by Kell, Kliewer, Erickson, and Ohene-Frempong (1998) as the “ability of the family to manage the stressors they confront, including effective emotion management and problem management” (p. 302). Competent parents are able to make the child feel cared for and safe. In turn, feeling safe reduces anxieties surrounding the threat of the illness. Competent parents are also better able to improve self-esteem, which reduces anxieties about the actual illness threat, and convey that relational support is available. Kell and colleagues (1998) aimed to look at the influence of family competence in child adjustment using a family systems approach. Eighty adolescents (ages 12 to 18 years) and their parents participated. Results showed that higher family competence was associated with fewer internalizing and externalizing behaviors among adolescents, especially among younger adolescents and girls. Enhanced family competence also predicted parental reports of fewer somatic complaints in females with sickle cell disease. While much remains unknown in terms of parental needs and parent-child relationships in coping with and adapting to a sickle cell disease diagnosis, the available literature clearly shows that many factors relate to positive family dynamics and parental functioning among families coping with sickle cell disease. Unfortunately, many other common factors such as increased stressors and time demands can hinder long-term secure relationships. Based on what is known and what remains uncertain, additional studies will be necessary to determine best practices for accommodating the needs of these families.
Coping with Sickle Cell Disease: A Focus on the Siblings Just as the patient and parents are affected by a child or adolescent’s sickle cell disease diagnosis and the course of treatment, the daily lives, experiences, and long-term outcomes of healthy siblings growing up in a family that has a child or adolescent coping with sickle cell disease may be altered, for better or for worse, in a variety of ways (Royal, Headings, Molnar, & Ampy, 1995). Because of the important roles each family member plays within the overarching family dynamic, examination of how siblings cope with a child or adolescent family member diagnosed with sickle cell disease may carry serious implications for lifelong well-being. While many researchers and clinicians have argued the importance of understanding siblings’ relationships and adaptation to a having a sibling diagnosed with sickle cell disease, empirical research results are grossly lacking. One early study explicitly exploring the psychosocial adjustment of siblings without sickle cell disease took place in 1987 (Treiber, Mabe, & Wilson, 1987). Researchers indicated that studies conducted over the prior 30 years suggested that healthy siblings of children with a chronic illness were at greater risk or experiencing guilt, anger, anxiety, and rejection due to the increased amount of time, resources, and attention given to the ill child (Barlow & Ellard, 2005; Treiber et al., 1987). In Treiber and colleagues’ research (1987), 13 sickle cell disease patients and their healthy siblings were compared. Results indicated that healthy siblings were at an increased risk of adjustment problems as compared to the sibling with sickle cell
Social Networks and Psychosocial Functioning among Children and Adolescents … 345 disease. Levels of distress were associated with the healthy sibling’s reports of adjustment problems. Maternal depression and anxiety symptomology were associated with sibling adjustment as well. Healthy siblings displayed higher levels of depression and inability to cope with the illness as compared to siblings with sickle cell disease, and attempts were made to avoid coping. However, the sickle cell disease and healthy siblings did not report clinically significant levels of distress as compared to normative data. Research conducted within the last 15 years has paralleled the results of Trieber and colleagues’ 1987 study. Although the research is sparse, there appears to be a consensus that while some concerns are evident, levels of functioning seem to be comparable to the general population (e.g., Noll, Yosua, Vannatta, Kalinyak, Bukowski, & Davies, 1995) with some research going so far as to suggest impressive levels of resilience within the healthy sibling groups (Royal et al., 1995). A 1995 study by Noll and colleagues examined peer relationships among healthy siblings of sickle cell disease patients. Social competence of the healthy siblings was compared to a matched sample of classroom peers. Analyses revealed no significant differences in social reputation or social acceptance between the two groups. Another 1995 study discussed the overarching importance of sibling relationships due to the common genetic background, shared cultural heritage, and common family experiences (Royal et al., 1995). Healthy siblings growing up in a household with another child coping with a chronic illness or disability may show enhanced tolerance for human differences, acknowledgement of the importance of good health, compassion, and knowledge about societal injustices and stereotypes. Based on this, Royal and colleagues (1995) hypothesized that healthy siblings may show certain resiliencies that promote more adaptive coping. When 20 healthy siblings were interviewed about coping and family functioning, 90% of those who displayed a solid knowledge base regarding sickle cell disease were considered very resilient. Those from smaller, two-parent families of higher socioeconomic status also showed higher levels of resilience. Healthy siblings reporting more resilient behavior indicated more favorable attitudes toward their parents’ child rearing practices. Though much remains unknown about the relationships and overall functioning among healthy siblings of those with sickle cell disease, several factors have been identified that may allow healthy siblings to adapt and feel supported within their families and larger social networks. Culture may be one of the most influential among these factors (Royal et al., 1995). While African American families may face heightened economic burden and disparities in health care, they also show extensive strengths within the family unit. Parents often instill a deep sense of dedication to family members, which includes an expectation that siblings care for and support one another. While having a sibling with sickle cell disease may cause additional burdens to the healthy siblings at times, feelings of responsibility to the well-being of the family may circumvent any hardships associated with chronic illness.
Relationships and Perceptions of Acceptance within Peer Groups Literature on peer relationships among children and adolescents is varied and, at times, is contradictory. In social settings, adolescents with sickle cell disease tend to face issues of peer acceptance and social competency more frequently than their healthy counterparts (Brown, Armstrong, & Eckman, 1993). Additionally, much of the extant literature shows that adolescent and child patients exhibit a less positive self-image in terms of their social selves in
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comparison to healthy peers (Ohaeri et al., 1995; Rodrigue, Streisand, Banko, Kedar, & Pitel, 1996). These individuals may have difficulty making friends and often report lower levels of competence when developing relationships (Burlew, 2002; Rodrigue et al., 1996). In addition to difficulty
making friends, sickle cell disease patients also have concerns regarding actual and perceived physical effects of their illness (Ohaeri et al., 1995). Males may be affected more negatively than females due to delayed growth and inability to engage in certain physical activities that typically promote bonding among boys and adolescent males (Hocking & Lochman, 2005). Regardless of gender, disrupted daily activity due to pain may negatively impact the development of typical social skills and interactions with peers (Rodrigue et al., 1996). Concerns may influence perceptions of attractiveness and confidence in seeking out and maintaining peer and romantic relationships. Among children and adolescents with sickle cell disease, those who feel more stressed by their chronic illness status often are more anxious in social situations and fear negative evaluations (Wagner et al., 2004). Limitations in the quantity and quality of social interactions and poorer development in the ability to read social cues, including a reduced ability to cope, have been cited as potentially promoting higher levels of social anxiety (Boni, Brown, Davis, Hsu, & Hopkins, 2001; Wagner et al., 2004). Results of a qualitative study indicated similar findings suggesting that the burden of disease significantly reduces social well-being (Thomas & Taylor, 2002). Furthermore, studies with small sample sizes of children and adolescents reported that those with sickle cell disease feel less accepted by their peers, socially isolated, and anxious in academic environments (Gentry & Varlik, 1997; Lemanek, Horwitz, & Ohene-Frempong, 1994). Girls with sickle cell disease were perceived as being less well-liked, and boys with sickle cell disease were perceived as being less aggressive than their healthy peers (Noll et al., 1996). However, these children did not seem to have trouble maintaining their emotional well-being (Barbarin & Christian, 1999; Noll et al., 1996). Other studies have reported somewhat opposing findings with teachers, parents, and health care professionals rating children and adolescents as being as socially competent and accepted as their healthy peers (Noll, Ris, Davies, Bukowski, & Koontz, 1992; Lemanek et al., 1994). Noll and his colleagues (1992) reported that when matched by age, gender, and race, children with sickle cell disease and their healthy peers were rated similarly with respect to social reputation. In 2007, Noll, Reiter-Purtill, Vannatta, Gerhardt, and Short completed a controlled replication of their previous social acceptance studies. Thirty-nine children diagnosed with sickle cell disease, between the ages of 8 and 15, were matched to healthy classroom peers. When compared to the healthy children, those with the disease were rated by their teachers to be more prosocial and less aggressive. Although healthy peers reported their sickle cell counterparts to have fewer friends, to be less athletic, to miss more school, and to be sick more often, those with sickle cell disease were liked just as well as other healthy peers. While they were selected less often as the best friend among healthy peers, the children and adolescents with sickle cell disease were perceived as being just as physically desirable and academically competent as their healthy peers. Scores for emotional well-being were similar across groups. At the conclusion, the authors cautioned that results from previous studies suggesting less aggressive behavior among males may be spurious due to limitations in sample size. Despite teacher and parents reports of comparable levels of social functioning between sickle cell children and adolescents and their healthy peers, further investigation into these complex peer relationships and social networks is warranted.
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Relationships with Health Care Professionals On average, children with sickle cell disease experience pain episodes five to seven times per year and require hospitalization one to two times per year for pain, fever, or other medical complications (Walco & Dampier, 1990). Aside from hospitalizations, children must participate in regular health care maintenance visits specifically designed for children diagnosed with sickle cell disease. To date, there is no cure for sickle cell disease except for possible bone marrow transplantation (Todd, Green, Bonhman, Haywood, & Ivy, 2006). A bone marrow transplant may be difficult to achieve due to problems finding an appropriate match. If a match is found and transplant occurs, the recipient must successfully survive the various medical risks such as infection, major bleeding, organ failure, and transplant rejection (Hsu, 2001). Because bone marrow treatment continues to be somewhat rare, most children and adolescents with sickle cell disease and their families must learn how to cope with the burdens of living with a chronic disease throughout their lifespan. While doing so, they must also try to avoid the pitfalls that often accompany persons of color as they interact within the health care system. The health care provider (HCP) must be attuned to the various stressors that go with having a chronic illness and should be aware of how living with sickle cell disease can add to the health care burden. A trusting, respectful relationship serves as a springboard for achieving a state of optimal health and well-being for children and adolescents with sickle cell disease and their families. It is important for the HCP to have an understanding of components that stimulate a positive therapeutic alliance between the patients, families, and health care team that is based on mutual respect, open communication, honesty, and trust. Patients with sickle cell disease should also be aware of their role and responsibility in achieving a strong partnership with their HCP as they learn to live with the chronicity of the disease. Though the National Heart, Lung, and Blood Institute (1995) has published guidelines on the principles and standards of care for children and adolescents diagnosed with sickle cell disease, families coping with this chronic illness continue to encounter challenging situations when seeking medical care from health care providers. As previously reported, the majority of patients with sickle cell disease in the United States are of African American descent. Many also hold dual memberships in an economic underclass as well as a chronic disease group (Barbarin & Christian, 1999). Additional burdens often coexist in economically distressed groups that serve as barriers to care. Poor access to health care is one such barrier. For example, non-pharmacologic modalities for chronic pain and chronic illness may be unavailable, unaffordable, or not covered by health insurers of sickle cell patients (Shapiro, 1999). It is important for the health care provider to not only be well versed in the basic pathophysiology of sickle cell disease but also to be cognizant of the barriers to health care that often plague patients with sickle cell disease (Barbarin & Christian, 1999). Limited access to health care is often a primary barrier. Ineffective communication between the HCP and patient can serve as an obstacle as well. Ineffective communication may result from a difference in the culture and socioeconomic position of the HCP and patient. In the United States, most patients with sickle cell disease are of African ancestry whereas the majority of HCPs in developed nations are not. This socioeconomic difference may contribute to much of the cross-racial and cross-cultural ineffective communication patterns (Barbarin & Christian, 1999; Shapiro, 1999).
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Another major element contributing to obstacles to health care in the sickle cell disease population is in the area of pain and pain management. Pain is often the most frequent incident that brings sickle cell patients into a face-to-face interaction with the HCP. Poor management of pain can serve as a catalyst in propagating an ineffective, distrustful relationship between the HCP and patient (Shapiro, 1999; Waldrop & Mandry, 1995). There are several factors related to pain management that may contribute to the creation of a distrustful relationship. Many HCPs believe that patients with sickle cell disease who request narcotic pain relief will become addicted and drug seeking. Waldrop and Mandry (1995) noted that it is common for HCPs to believe that analgesic addiction is more common among sickle cell disease patients than among sufferers of other chronic pain conditions. These beliefs are fueled during occasions when the HCP witnesses seemingly contradictory behaviors in the report of pain from the patient and his or her level of activity. In other words, the HCP may witness a patient describing severe pain while simultaneously engaging in activities that are inconsistent with the image of a person in a severe pain state. For example, the child or adolescent patient may be observed watching television, talking on the phone, or playing video games during an inpatient hospitalization. The HCP may perceive that the patient is exaggerating his or her pain intensity in order to obtain additional narcotics. Though this may be true for some patients, many patients engage in such activities to cope and distract themselves through a pain episode. The patient may sleep after receiving pain medication only to awaken complaining of unrelenting pain. While the act of sleeping is often equated with pain relief among patients with sickle cell disease, using sleep as a gauge for pain relief may be inappropriate due to the sedative properties of narcotics (Marlowe & Chicella, 2002). Although some patients with sickle cell disease do become addicted to narcotic pain medication, addiction rates coincide with rates observed within the general population. Despite many HCPs’ beliefs, the frequency of drug addiction in patients with sickle cell disease is only about 1-3% (Marlowe & Chicella, 2002). Several published articles on pain management among sickle cell disease patients state that “the report of pain by any patient must be considered accurate” (Sutton, Atweh, Cashman, & Davis, 1999, p. 284). However, the American Pain Society Bulletin (1999) published a statement reporting that “patients with sickle cell disease may have to withstand accusations of faking the pain or engaging in drug seeking behavior.” When patients receive suboptimal pain management and encounter stigmatizing care from the HCP, the therapeutic relationship between the patient and HCP becomes jeopardized (Maxwell, Streetly, & Bevan, 1999). If the patient believes that the HCP doubts or does not take seriously reports of pain, or if the patient perceives that the HCP is suspicious of the motives for seeking pain management, an adversarial relationship quickly forms and may be nearly impossible to overcome (Sutton et al., 1999). The accumulated feelings of mistrust fail to accomplish the task of heightening the level of rapport necessary to optimize the patient’s quality of life and may result in a lifelong tendency to avoid seeking needed health care. Listening to the needs of the patient and the family is crucial in developing the therapeutic alliance. In a study by Mitchell and colleagues (2007) designed to assess health care service delivery, 53 parents, who hadchildren between the ages of 7 and 13 with sickle cell disease, expressed a need for increased support, education, and sensitivity to parents and patients. The authors recommend that practitioners attempt to understand the patient and family’s experience of the disease in order to help strengthen patient-practitioner relationships. Health care practitioners also should receive education and training related to
Social Networks and Psychosocial Functioning among Children and Adolescents … 349 the care of patients with sickle cell disease based on parents’ expressed need for improved staff training. Results of the study indicated that during emergency room visits, parents expressed feelings of anger and frustration at the lack of experience and training of hospital staff members. Parents were additionally frustrated by the perceived limited attention that sickle cell disease receives in comparison to other chronic pediatric illnesses. Understanding the pathophysiology, treatment, and complications of sickle cell disease is important so that HCPs can provide optimal care (National Heart, Lung, and Blood Institute, 1995). Thus, physicians, nurses, social workers, and other members of the health care team must equip themselves with the knowledge and skills needed to treat this population. This multidisciplinary care must include professionals who are not only knowledgeable about the medical and physical aspects of sickle cell disease but specifically trained to understand the numerous individual, family, and societal dynamics involved in comprehensive care (Helps et al., 2003; Mitchell et al., 2007). Building a trusting relationship between the HCP and patient that promotes optimal health and well-being for the patient is a reciprocal effort. Both the HCP and the patient share a responsibility in this construction process though the HCP bears the responsibility of taking the first steps toward building a healing and lasting relationship with the patient (Glajchen, 1999). The following are crucial steps that the HCP should take during this relationship building process. It is recommended that the HCP: 9. Take a personal inventory of his or her knowledge base regarding the ramifications of living with a chronic illness, particularly sickle cell disease. 10. Encourage the patient and family to actively participate in their health care program by offering educational materials on the medical aspects of sickle cell disease, complications of the disease, and how sickle cell disease symptoms manifest in the patient (National Heart, Lung, Blood Institute, 1995). Be prepared to offer referrals for psychosocial, family, and academic resources as well. Patients who actively adhere to their medical regimens and participate in their care are less likely to utilize the emergency room in non-emergent situations, and those who engage in positive thinking practices are more likely to know how to appropriately care for themselves during pain crises (Barbarin & Christian, 1999). 11. Recognize that African Americans living with the chronicity of sickle cell disease are also at risk of encountering barriers to health care by virtue of belonging to particular racial and socio-economic classes. 12. Understand his or her role in influencing the delicate HCP-patient relationship, especially in the area of pain management. 13. Realize the deleterious effects that sub-optimal pain management can have on the HCP-patient relationship. 14. Acknowledge that the delivery of sub-optimal pain management to patients with sickle cell disease has caused undue suffering in this population. 15. Be aware that “compassionate and appropriate analgesic care for sickle cell patients is consistent with pain relief being a human rights issue and the under treatment of pain as fundamentally a medical error” (Todd et al., 2006, p. 455).
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The previous recommendations can serve as a platform for the HCP to examine his or her attitudes and beliefs and to recognize how his or her personal belief system can influence relationships with patients. Education is the key to altering belief systems and changing behavior. The patient and patient’s family must also share the responsibility in forming a mutually trusting relationship with the HCP. It is recommended that the patient and family: 1. Verbally communicate to provide the HCP with accurate, complete information about current conditions and symptoms. 2. Participate in the health care process by asking questions about the plan of care. He or she may benefit from requesting additional educational resources if there are aspects of care that are not fully comprehended during medical visits. 3. Share thoughts and experiences about what may help with personal care. Most HCPs are willing to work with the patient and family to create a workable care plan that can accommodate the patient’s needs and lifestyle. 4. Follow the plan of care developed mutually by the patient, family, and HCP. This includes showing up for appointments and tests when scheduled. Regular health care maintenance is imperative in promoting optimal health. 5. Understand that going to the emergency room for treatment during acute pain episodes and then neglecting follow-up care and maintenance check-ups could potentially send a negative message to the health care team. Further, non-compliance with follow-up care may serve to create misconceptions about drug-seeking behaviors in sickle cell patients. Both the HCP and patient play an instrumental role in achieving a mutually trusting relationship with each other. This relationship is reciprocal, dynamic, and often fragile. It requires ongoing efforts from both the provider and patient in order to be successful. Success translates to the establishment of a therapeutic relationship that facilitates optimal health and well-being for children and adolescents living with sickle cell disease and their families.
Relationships within the Academic Setting The recurrent physical symptoms associated with sickle cell disease, including the debilitating and recurrent pain crises, may warrant frequent medical attention that can interfere with regular school attendance (Barlow & Ellard, 2006; Wagner, Connelly, Brown, Taylor, Rittle, & Wall-Cloues, 2004). Frequent school absences can cause conflict between families and school personnel (Barakat et al., 2007). Neurological deficits and learning disabilities, which affect one quarter to one third of individuals with sickle cell disease, further exacerbate academic difficulties and may help to explain academic differences between these adolescents and healthy controls beyond school absenteeism (Fowler, Whitt, & Lallinger, 1988; Noll et al., 2001; Schatz & McClellan, 2006). Regardless of the severity of disease symptoms or neuropsychological deficits, a child or adolescent diagnosed with sickle cell disease desires normalcy (The Virginia Sickle Cell Awareness Program, 2006). One way in which a child finds this normalcy is by attending school. School provides academic enrichment, offers the opportunity to build relationships
Social Networks and Psychosocial Functioning among Children and Adolescents … 351 with peers and school staff, and enables the child to participate in extra-curricular activities. While many of the symptoms or characteristics of sickle cell disease may be apparent as the child attends school, he or she can still experience academic success and have meaningful relationships within the school setting (Barbarin & Christian, 1999). By providing educational in-services to staff and peers, educational plans with appropriate accommodations, and advocacy training, children are able to attend school on a regular basis and find the normalcy that they desire while concurrently managing sickle cell disease. When a child or adolescent with sickle cell begins a new school year, the teachers, school nurse, administrators, and other support staff working with the child or adolescent should be educated on sickle cell disease (The Virginia Sickle Cell Awareness Program, 2006). This educational training should begin when the child enters kindergarten and be repeated at the beginning of each school year because research suggests cognitive decline over time among children and adolescents diagnosed with sickle cell disease (Thompson et al., 2003). School staff cannot be expected to be knowledgeable about the disease if proper education or an inservice is not provided (The Virginia Sickle Cell Awareness Program, 2006). By educating teachers and staff working with the child, they will have a basic understanding of the disease and the proactive measures needed to help the student prevent a pain episode at school. Such measures include the importance of drinking fluids throughout the day to prevent dehydration, allowing the student restroom or clinic passes when needed, and making allowances for a modified workload and extended time to make-up work and complete tests when experiencing pain or not feeling well. Education also will help physical education teachers to understand why the child cannot go outside in extreme temperatures or why strenuous exercises and long distance running can precipitate a pain crisis. In-services are important in not only providing education about the disease but enabling the child and teachers to communicate effectively for a successful and positive academic experience. Through open communication, rapport can be established in which the child feels comfortable discussing his or her medical condition, and the teachers can be creative in providing subtle supports that will assist the child while still providing normalcy (The Virginia Sickle Cell Awareness Program, 2006). Supportive interactions with teachers, administrators, and staff will help the child or adolescent feel that he or she has someone to talk with regarding potentially sensitive topics such as necessary school absenteeism or the physical manifestations of sickle cell disease. Proper education about sickle cell disease to school staff would also allow the school clinic to serve as a safe haven where the child can report physical symptoms of pain or discomfort. The school nurse can help to evaluate when a particular symptom warrants immediate medical or parental attention or if the child simply needs to rest. Since, in most cases, the school nurse is more knowledgeable about sickle cell disease than any other school staff member, he or she can help the child educate others and work with colleagues and child study teams when the child is experiencing academic difficulty and requiring additional academic support. Providing educational in-services are important to teachers and support staff as well as the child’s classmates (The Virginia Sickle Cell Awareness Program, 2006). Ideally, children and adolescent peers would provide ample support for a fellow classmate dealing with a chronic illness; however, children often have questions and are inexperienced in managing their reactions to a classmate who might be perceived as different. When a classmate is absent from school on a regular basis or for a week or longer several times in a school year, children start to question why their peer does not have to attend school. They often ask if their peer is
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required to complete his or her class work or homework or whether he or she will fail due to missing too many days. Other questions may be related to visible physical manifestations of sickle cell disease: “When he or she does attend school, why are the whites of his or her eyes yellow?” “Why is he or she smaller than the other kids in his or her class?” “Why is he or she allowed to carry a water bottle and drink during class?” “Why does he or she go to the bathroom during class when I have to wait until break or until class is over?” “Why does he or she not have to run the mile during physical education class?” “Why does he or she get to wear sweats outside for gym rather than a gym suit?” and “Why is everyone so secretive when I ask about my friend?” These types of questions represent those that are raised when classmates are provided in-services regarding the health condition of a classmate with sickle cell disease. Adults expect children and adolescents to be supportive; however, when children are not educated about the disease or illness, they tend to shy away or ask inappropriate questions, which can be damaging to the child with sickle cell disease and the rest of the class (The Virginia Sickle Cell Awareness Program, 2006). When in-services are provided in an ageappropriate manner, sickle cell disease can be explained beginning with diagnosis, symptoms, treatment, and ways to be supportive. Thus, the child with sickle cell disease and his or her classmates can be comfortable around one another by dispelling any myths about the disease (e.g., sickle cell disease is contagious) and helping the child’s classmates understand how to be a good friend and offer support when needed. In turn, the child with sickle cell disease will feel more comfortable talking about his or her disease with others and advocating for his or her needs. Healthy and positive relationships that develop as a result will be sustained throughout the child’s school career. In order for the student with sickle cell disease to receive accommodations to be successful in the school environment, educational plans can be written (The Virginia Sickle Cell Awareness Program, 2006). Through the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act, students with chronic illnesses such as sickle cell disease can qualify for special services. Once a referral is made by the parent or school, the child study team meets to determine the appropriate evaluations or interventions that should be put in place before finding the child eligible for services. The child study team meeting is an opportunity for the patient and family to educate others about sickle cell disease and advocate for services and accommodations needed. This meeting is an important opportunity for relationships to be established in which team members are working toward what is in the best interest of the child. Children and adolescents with sickle cell disease must begin learning at a very young age about their disease. While the attention and executive functioning deficits that often accompany a sickle cell disease diagnosis can complicate a child or adolescent’s ability to manage his or her disease effectively, it is necessary for the child to learn how to selfadvocate (Barakat et al., 2007; The Virginia Sickle Cell Awareness Program, 2006). With assistance from parents, teachers, and close friends, the child will slowly learn his or her strengths and weaknesses. The child will learn to identify what causes pain episodes, as well as alternatives to specific activities that might precipitate a crisis. As the child grows and matures, he or she will develop skills in communicating effectively with teachers and friends about the disease and resources and supports needed. In addition, through guidance of parents, teachers, and others, the child or adolescent will learn that he or she never has to be embarrassed or ashamed about his or her disease. If a child is expected to fail, he or she most
Social Networks and Psychosocial Functioning among Children and Adolescents … 353 likely will fail (Barbarin & Christian, 1999). Therefore, academic success, with the appropriate accommodations and support, should be expected. Close relationships and successful advocacy training will enable the child or adolescent with sickle cell disease to be confident, possess self-esteem, and feel good in body, mind, and spirit.
INTERVENTIONS IN SICKLE CELL DISEASE CARE Biopsychosocial models of adaptation to sickle cell disease highlight the complex interactions of a variety of factors and resulting effects at the individual and family levels. The most notable models are the social-ecological system theory (Bronfenbrenner, 1979), disability-stress-coping model (Wallander & Varni, 1992), and transactional stress and coping model (Thompson, Gil, Burbach, Keith, & Kinney, 1993). Though these models vary in their conceptual framework of understanding adaptation in children and adolescents diagnosed with sickle cell disease, all three acknowledge the importance of family factors in adjustment to a chronic illness. The complexity of managing sickle cell disease has fueled research on developing psychosocial interventions aimed at incorporating contextual, disease, and individual factors. Families and community members must work fluidly in order to help the child reach developmental milestones for adequate development. Given the complex nature of development coupled with managing a chronic illness, parents would greatly benefit from utilizing the support of community members, friends, and extended family to raise their child. However, there is lack of research on the effects of pediatric sickle cell disease intervention at the family, medical, and academic levels (Kaslow & Brown, 1995). Flexible intervention strategies are especially necessary in the sickle cell disease population to adapt to cultural, socioeconomic, and individual factors of each family because most intervention studies are conducted within largely Caucasian populations (Schwartz, Radcliffe, & Barakat, 2007).
Interventions within the Family Context The complexity of managing sickle cell disease in a child or adolescent falls heavily on the family, underscoring the importance of implementing family-based interventions. At the most basic level, family members, particularly parents or main caregivers, must have an understanding of the disease itself (Kaslow & Brown, 1995). A series of focus groups, part of a larger mixed method study evaluating perceptions of sickle cell disease awareness, revealed that health care providers, community members, and sickle cell disease patients alike believed that there was limited awareness about sickle cell disease in community settings and that most of the burden of sickle cell disease education fell upon health care providers (Treadwell, McClough, & Vichinsky, 2006). A helpful guideline in creating and implementing familybased interventions for sickle cell patients was created by Kaslow and Brown (1995) based on the identified needs. These guidelines, calling for a more culturally sensitive multidisciplinary approach, help to alleviate the heavy burden on health care providers of being soley responsible for disseminating sickle cell disease education to patients and their families.
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Kaslow and Brown’s (1995) manualized intervention, developed under a larger clinical research study, incorporates cultural and developmental factors in treating families with a child diagnosed with sickle cell disease. Though the intervention is in a fairly standardized form for consistent implementation, the authors encourage users to account for differences among families in sickle cell disease knowledge, psychological and medical sequelae, and stress management. Furthermore, because sickle cell disease largely affects African Americans, incorporating cultural factors into family interventions is crucial. Kaslow and Brown (1995) cite empowerment as essential to success in implementing interventions in African American families. By educating families about sickle cell disease and providing useful communication and problem-solving tools, family members are adequately equipped to successfully manage having a child with sickle cell disease in a wide variety of settings. Addressing financial difficulties of families is often a challenge but important in understanding potential issues of compliance in health care. The multidisciplinary health care team must be aware that some parents or caregivers may struggle to meet even the basic necessities of the family and thus, may be forced to forgo a follow-up appointment to manage the demands of the rest of the family. To address this issue, medical staff members could develop a point system in which families are rewarded for full medical compliance with basic necessities such as school supplies (Kaslow & Brown, 1995). In their guidelines, Kaslow and Brown (1995) recommended 6 to 12 interventions sessions for each family, with the length and frequency of each session based upon the content of the meeting. Key members of the family should be encouraged to attend sessions. Kaslow and Brown break down a typical 6-session format: 1. Session 1: Basic sickle cell disease education is provided for the family members in attendance using age-appropriate presentations. The family is also given an easy-toread pamphlets with helpful illustrations. The language and the way in which the information is presented may vary slightly depending on the family, allowing educators to tailor each session. 2. Session 2: This session focuses on prevention of medical issues that may arise in the child. Family members are supplied with techniques to help lower the chances of a medical crisis. Games and homework may supplement the session. 3. Session 3: Pain management techniques are addressed as well as ways to successfully manage and cope with stress. Attention is given to all family members so that each person can learn how to relax and deal with stressful situations that may arise. 4. Session 4: Family members are asked to communicate their personal thoughts and feelings with one another during this session. Taking into account cultural and individual family factors, the educator respects the boundaries of each family member and the decision not to share thoughts or feelings by a member. 5. Session 5: Through role play, family members learn about the ways in which positive family relationships can be enhanced through adaptive coping and providing support to or receiving support from family and friends. 6. Session 6: During the final session, information gathered from the prior five sessions is reviewed. Progress of the family is also evaluated to emphasize the strengths that each family member has to offer. Referral sources and an open-door policy are
Social Networks and Psychosocial Functioning among Children and Adolescents … 355 provided for each family should psychological and education support be needed in the future. Kaslow and Brown’s (1995) intervention represents one of the few studies offering a substantial multi-level intervention to families that promotes both family relationship development and caring for basic medical needs. While practice-based evidence research has flourished in adult populations, it is fairly limited in the pediatric chronic disease population (Collins et al., 1997). As such, little is known about the complexities of creating and implementing effective psychological interventions in children or adolescents diagnosed with a chronic illness . A comprehensive family-oriented intervention in the pediatric sickle cell population was developed by Collins and colleagues (1997) based on recommendations made by the American Psychological Association’s (1995) guidelines for efficacy studies. Six treatment sessions were developed for families, covering topics such as disease education, health care, and effective coping strategies. Families were randomly assigned to the intervention group or control group and later compared to determine the efficacy of the intervention. Collins and colleagues discussed the numerous obstacles involved in developing an intervention for low-income, African American families coping with a chronic illness such as finding pre-existing efficacious interventions on which to build new interventions, meeting inclusion criteria, and adherence to manualized treatment. While additional intervention studies are warranted to further develop efficacious psychoeducational interventions for children and adolescents with sickle cell disease and their family members, findings from studies such as Kaslow and Brown (1995) and Collins and colleagues (1997) offer the beginnings of how to provide quality educational resources and adaptation strategies for these families.
Interventions within the Academic Domain To date, no intervention studies were found that examined relationship development and the promotion of academic success within the academic setting. If such interventions are developed, it is important to consider that level of socioeconomic status (SES) generally predicted above and beyond any other factor related to academic achievement (Scott and Scott, 1999) and likely represents a variable warranting intense investigation. Further, socioeconomic status levels determined whether adolescents engaged in adaptive or maladaptive coping mechanisms to manage the stresses of the disease. Scott and Scott (1999) found that adolescents diagnosed with sickle cell disease who face neuropsychological problems suffer from cognitive and academic disadvantages related to both medical and sociocultural variables. Findings by Buchanan and colleagues (1993) corroborates results found in the Scott and Scott (1999) study, suggesting that academic difficulties are affected by specific non-health problems such as cultural disparities and socioeconomic status. Matched healthy controls tended to perform higher in this area, highlighting the need for psychoeducational support for these students.
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Interventions within the Medical Setting The history of medical research in African American communities is burdened with tainted political agendas and mistreatment of African Americans, most notably the notorious Tuskegee Syphilis Study conducted between 1932 and 1972 (Centers for Disease Control and Prevention, 2008). Sickle cell trait screening, implemented in the 1970s, was perceived by African American communities as the basis for discrimination and oppression (Markel, 1992). Because it is unclear how much of a role historical events such as these play into African American perceptions about the medical community, the underlying goal of researchers and practitioners should aim to build adequate rapport and trust. Individuals who are diagnosed with sickle cell disease or have close friends or families affected by the disease report the need for counselors who are deemed trustworthy (Treadwell et al., 2006) and appear as a credible resource (Williams, 2003). Research shows that individuals at high risk for sickle cell disease, specifically African Americans, lack adequate knowledge about the nature of the disease, leading to many misconceptions and poor relationships with health care providers. In a community-based survey evaluating accurate knowledge and information sources on sickle cell disease and trait, the majority of the 316 participants had accurate basic knowledge about the nature of sickle cell disease (Treadwell et al., 2006). However, only 13% of participants correctly defined sickle cell disease and only 16% knew their own sickle cell trait status. Clearly, a greater emphasis on basic education about the nature of sickle cell disease and sickle cell trait is needed as the foundation for successful interventions, particularly in hospital settings. A review of the practice-based evidence in managing physical symptoms show that cognitive behavioral therapy (CBT) has been widely used with children (Christie & Wilson, 2005). The use of manuals in chronic illness populations have become the norm for intervention strategies and for good reason. Manuals provide standardized methods of delivering interventions that allow for groups to be compared, allow for replication of procedures, increase retention of information presented during the intervention, and allow ease of training for research staff members. Intervention formats also promote open discussions on topics that might have been otherwise overlooked. Currently, there are several manuals that provide how to implement specific behavioral techniques in adolescent and pediatric populations (Christie & Wilson, 2005). The flexibility of CBT allows cultural and contextual factors to be taken into account when working with children and adolescents of various backgrounds, highlighting the adaptability and flexibility of these techniques. A review study examining the efficacy of CBT interventions in an adolescentsickle cell disease population demonstrated that behavioral techniques worked moderately well, especially in managing pain (Chrisie & Wilson, 2005). Anie, Green, Tata, Fotopoulos, Oni, and Davies (2002) and Gil and colleagues (1997) have published treatment manuals to help adolescents and children deal with sickle cell disease. Anie and colleagues (2002) focused on providing psychoeducation in addition to using therapeutic tools to help challenge negative thought processes whereas Gil and colleagues. focused primarily on pain management and useful tools to deal with sickle cell crises. Both allow educators to teach patients new pain management skills and strategies for self-advocacy in addition to building lasting rapport with patients.
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FUTURE DIRECTIONS AND RECOMMENDATIONS Although the literature on positive adaptation and promoting healthy relationships among children and adolescents diagnosed with sickle cell disease continues to grow in the pediatric literature, more work is needed to fully understand and predict the probability of adaptive outcomes for all patients and family members impacted. Research must be methodologically rigorous and translatable. Much of the research presented in this chapter utilized small sample sizes and mixed child and adolescent age groups. Efforts must be made to assess these age groups independently due to differences in developmental needs concerning relationship dynamics (Holmbeck, 2002). Measures must be age-appropriate as well. Culture always needs to be at the forefront of research design and the interpretation of results (Barbarin & Christian, 1999), especially because many standardizing assessment tools do not have valid and reliable norms for minority groups (Thompson et al., 1999). Although the literature continues to support the preface that psychosocial factors such as family functioning and social relationships are better predictors of adjustment to illness and quality of life than medical factors (Lutz et al., 2004), little effort has been made to use knowledge related to specific salient factors to change patient relationship development and overall functioning for the better. Studies need to ask the children and adolescents for their perspectives rather than solely relying on parent and teacher reports; parental perspectives of child and adolescent functioning tend to over-estimate symptoms of mental health disorders (Barlow & Ellard, 2005). Better means of assessing parent perspectives of self and family functioning are needed as well. For example, as Barakat and colleagues (2005) noted in their recommendations, more accurate assessment of parenting beliefs within the clinic setting related to locus of control would enable health care professionals to intervene in order to discuss the real and perceived family relationship vulnerabilities that may be at risk. Therapists need to consider systemic family cognitive patterns that may result to maladaptive coping patterns (Helps et al., 2003). There exists a need to determine automatic negative assumptions that hinder family adaptation and to use a cultural milieu to modify patterns in a culturally sensitive manner. Strengths displayed within families provide just as much valuable information as identifying barriers to relationship development and quality of life. Efforts must be made to seek out the positives and learn from families that are doing well. Christie and Wilson (2005) highlighted the difficulties and efficacy of psychological interventions in the pediatric chronic illness population, citing the bustling hospital environment and transportation issues. The authors suggest that interventions implemented in hospital settings must be flexible in order to adapt to the constantly changing medical environment. Further, medical staff members who are part of the patient’s care must be integrated into interventions as a way to help increase the efficacy of psychological treatments. Cognitive behavioral treatments (CBT) have not been extensively used in pediatric sickle cell disease populations, and the manualized nature of this therapeutic tool allows it to be adapted to specific chronic disease populations. Though Christie and Wilson caution against generalizing techniques found to work in one medical population to another, the flexible nature of CBT approaches allows for great potential to be used in a wide variety of populations. Finally, in a technology dominated society, new methods of meeting patients’ needs are under ongoing development. Creative websites aimed at increasing basic knowledge about
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sickle cell disease are beneficial to the family and the child diagnosed with the disease. An animated website at sicklecellkids.org offers interactive ways for adolescents and children to learn more about the medical aspects of disease, dispel widespread myths, and provide resources for patients and their family. In addition, the website offers several quizzes for the user, which help gauge his or her knowledge about the topic of sickle cell disease. Websites such as these could offer a fun and creative educational tool for adolescents and children to use on their own or with a family member to help increase sickle cell knowledge, normalize the disease, promote peer relationships and academic success, and understand the medical aspects of sickle cell disease.
CONCLUSIONS Sickle cell disease is a chronic illness that affects individuals throughout their entire lives. Children, adolescents, and families managing this disease often face challenging and complex situations in numerous aspects of relationship formation and psychosocial development. Healthy relationships with family members, peers, health care practitioners, and school personnel are of vital importance by providing a significant source of support during the care of the patient. Developing lasting social networks requires acknowledgement of the barriers to optimal adjustment and connections with individuals willing to educate themselves to the medical, socioeconomic, and cultural variables that interact within the patient’s life. Continued improved outcomes for children and adolescents with sickle cell disease will require methodologically rigorous research designs to determine additional factors promoting adaptive social skill development, unconditional familial support, increased involvement within the school setting, well-trained multidisciplinary care teams, and ongoing selfadvocacy training. The information available to date also clearly suggests the need to develop additional intervention studies and resources available to families coping with sickle cell disease.
REFERENCES Anie, K. A., Green, J., Tata, P., Fotopoulos, C. E., Oni, L., & Davies, S. C. (2002). Self-help manual assisted cognitive behavioural therapy for sickle cell disease. Behavioural and Cognitive Psychotherapy, 30, 451-458. Atkin, K., & Uhmad, W. I. U. (2001). Living a ‘normal’ life: Young people coping with thalassaemia major or sickle cell disorder. Social Science & Medicine, 53, 615-626. Barakat, L. P., Lutz, M. J., Nicolaou, C., & Lash, L. A. (2005). Parental locus of control and family functioning in the quality of life with sickle cell disease. Journal of Clinical Psychology in Medical Settings, 12, 323-331. Barakat, L. P., Patterson, C. A., Tarazi, R. A., & Ely, E. (2007). Disease-related parenting stress in two sickle cell disease caregiver samples: Preschool and adolescent. Family Systems & Health, 25, 147-161.
Social Networks and Psychosocial Functioning among Children and Adolescents … 359 Barbarin, O. A., & Christian, M. (1999). The social and cultural context of coping with sickle cell disease: I. A review of biomedical and psychosocial issues. Journal of Black Psychology, 25, 277-293. Barbarin, O. A., Whitten, C. F., & Bonds, S. (1994). Estimating rates of psychosocial problems in urban and poor children with sickle cell anemia. Health & Social Work, 19, 113-119. Barbarin, O. A., Whitten, C. F., Bond, S., & Conner-Warren, R. (1999). The social and cultural context of coping with sickle cell disease: III. Stress, coping tasks, family functioning, and children’s adjustment. Journal of Black Psychology, 25, 356-379 Barlow, J. H., & Ellard, D. R. (2006). The psychosocial well-being of children with chronic disease, their parents and siblings: An overview of the research evidence base. Child: Care, Health, & Development, 32, 19-31. Baskin, M. L., Collins, M. H., Brown, F., Griffith, J. R., Samuels, D., Moody, A., et al. (1998). Psychosocial considerations in sickle cell disease (SCD): The transition from adolescence to young adulthood. Journal of Clinical Psychology in Medical Settings, 5, 315-341. Battle, S. F. (1984). Chronically ill children with sickle cell anemia. In R. W. Blum (Ed.), Chronic illness and disabilities in childhood and adolescence. Orlando, FL: Grune & Stratton. Beale, I. L. (2006). Scholarly literature review: Efficacy of psychological interventions for pediatric chronic illness. Journal of Pediatric Psychology, 31, 437-451. Boice, M. M. (1998). Chronic illness in adolescence. Adolescence, 33, 927-939. Boni, L. C., Brown, R. T., Davis, P. C., Hsu, L., & Hopkins, K. (2001). Social information processing and magnetic resonance imaging in children with sickle cell disease. Journal of Pediatric Psychology, 26, 309-319. Booker, M. J., Blethyn, K. L., Wright, C. J., & Greenfield, S. M. (2006). Pain management in sickle cell disease. University of Birmingham. Unpublished manuscript. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Brown, R. T., Armstrong, F. D., & Eckman, J. R. (1993). Neurocognitive aspects of pediatric sickle cell disease. Journal of Learning Disabilities, 26, 33-45. Burlew, K. (2002). Empirically derived guidelines for assessing the psychosocial needs of children and adolescents with sickle cell. Social Work in Health Care, 36, 29-43. Burlew, K., Telfair, J., & Colangelo, L. (2000). Factors that influence adolescent adaptation to sickle cell disease. Journal of Pediatric Psychology, 25, 287-299. Centers for Disease Control and Prevention (January 2008). Retrieved June 4, 2008, from http://www.cdc.gov/tuskegee/timeline.htm. Chen, E., Cole, S. W., & Kato, P. M. (2004). A review of empirically supported psychosocial interventions for pain and adherence outcomes in sickle cell disease. Journal of Pediatric Psychology, 29, 197-209. Christie, D., & Wilson, C. (2005). CBT in paediatric and adolescent health settings: A review of the practice-based evidence. Pediatric Rehabilitation, 8, 241-247. Collins, M. H., Loundy, M. R., Brown, F. L., Hollins, L. D., Aldridge, Y, Eckman, J., et al. (1997). Applicability of criteria for empirically validated treatments to family interventions for pediatric sickle cell disease. Journal of Developmental and Physical Disabilities, 9, 293-309.
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Creswell, C., Christie, D., & Boylan, J. (2001). Ill or adolescent? Developing group work on an adolescent medicine unit. Clinical Child Psychology and Psychiatry, 6, 351-362. Davis, C. (1995). Sickle cell anemia: An overview posing an employment quandary. Vocational Evaluation and Work Adjustment Bulletin, 28, 20-23. Fowler, M. G., Whitt, J. K., & Lallinger, R. (1988). Neuropsychologic and academic functioning of children with sickle cell anemia. Journal of Clinical Child Psychology, 9, 213-220. Gil, K. M., Anthony, K. K., Carson, J. W., Redding-Lallinger, R., Daeschner, C. W., & Ware, R. E. (2001). Daily coping practice predicts treatment effects in children with sickle cell disease. Journal of Pediatric Psychology, 26, 163-173. Gil, K. M., Carson, J. W., Porter, L. S., Ready, J., Valrie, C., Redding-Lallinger, R., et al. (2003). Daily stress and mood and their association with pain, health-care use, and school activity in adolescents with sickle cell disease. Journal of Pediatric Psychology, 28, 363373. Gil, K. M., Wilson, J. J., Edens, J. L., Workman, E., Ready, J., Sedway, J., et al. (1997). Cognitive coping skills training in children with sickle cell disease pain. International Journal of Behavioural Medicine, 4, 364-377. Gentry, B. F., Varlik, L., & Dancer, J. (1997). Children’s perceptions of psychosocial factors related to sickle cell disease. Perceptual and Motor Skills, 85, 1409-1410. Gentry, B. F., Varlik, L., & Dancer, J. (1998). Adolescent’s perceptions of psychosocial factors related to sickle cell disease. Perceptual and Motor Skills, 86, 626. Glajchen, M. (1999). Living with sickle cell disease: From suffering to empowerment. American Pain Society Bulletin, 9 (4). Gustafson, K. E., Bonner, M. J., & Hardy, K. K. (2006). Biopsychosocial and developmental issues in sickle cell disease. In R. T. Brown (Ed.), Comprehensive handbook of childhood cancer and sickle cell disease: A biopsychosocial approach (pp. 431-448). New York, NY: Oxford University Press. Helps, S., Fuggle, P., Udwin, O., & Dick, M. (2003). Psychosocial and neurocognitive aspects of sickle cell disease. Child and Adolescent Mental Health, 8, 11-17. Hocking, M. C., & Lochman, J. E. (2005). Applying the transactional stress and coping model to sickle cell disorder and insulin-dependent diabetes mellitus: Identifying psychosocial variables related to adjustment and intervention. Clinical Child and Family Psychology Review, 8, 221-246. Holmbeck, G. N. (2002). A developmental perspective on adolescent health and illness: An introduction to the special issues. Journal of Pediatric Psychology, 27, 409-416. Hsu, L. (2001). Treatment of sickle cell disease with bone marrow transplantation. Retrieved on May 27, 2007, from http://www.drspock.com/article/0,1510,5074,00.html?r=related. Ievers, C. E., Brown, R. T., Lambert, R. G., Hsu, L., & Eckman, J. R. (1998). Family functioning and social support in the adaptation of caregivers of children with sickle cell syndromes. Journal of Pediatric Psychology, 23, 377-388. Kaslow, N. J., & Brown, F. (1995). Culturally sensitive family interventions for chronically ill youth: Sickle cell disease as an example. Family Systems Medicine, 13, 201-213. Kell, R. S., Kliewer, W., Erickson, M. T., & Ohene-Frempong, K. (1998). Psychological adjustment of adolescents with sickle cell disease: Relations with demographic, medical, and family competence variables. Journal of Pediatric Psychology, 23, 301-312.
Social Networks and Psychosocial Functioning among Children and Adolescents … 361 Lutz, M. J., Barakat, L. P., Smith-Whitley, K., & Ohene-Frempong, K. (2004). Psychological adjustment of children with sickle cell disease: Family functioning and coping. Rehabilitation Psychology, 49, 224-232. Markel, H. (1992). The stigma of disease: Implications for genetic screening. American Journal of Medicine, 93, 209-215. Marlowe, K. F., & Chicella, M. F. (2002). Treatment of sickle cell pain. Pharmacotherapy, 22, 484-491. Maxwell, K., Streetly A., & Bevan D. (1999). Experiences of hospital care and treatment seeking for pain from sickle cell disease: Qualitative study. British Medical Journal, 318, 1585-1590. Mitchell, M. J., Lemanek, K., Palermo, T. M., Crosby, L. E., Nichols, A., & Powers, S. W. (2007). Parent perspectives on pain management, coping, and family functioning in pediatric sickle cell disease. Clinical Pediatrics, 46, 311-319. Morgan, S. A., & Jackson, J. (1986). Psychological and social concominants of sickle cellanemia in adolescents. Journal of Pediatric Psychology, 11, 429-440. National Heart Lung and Blood Institute. (1995). Management and therapy of sickle cell disease. National Institutes of Health Publication No. 96-2117. Washington, DC: U.S. Government Printing Office. Noll, R. B., McKellop, J. M., Vannatta, K., & Kalinyak, K. (1998). Child-rearing practices of primary caregivers of children with sickle cell disease: The perspective of professionals and caregivers. Journal of Pediatric Psychology, 23, 131-140. Noll, R. B., Ris, M. D., & Davies, W. H. (1992). Social interactions between children with cancer or sickle cell disease and their peers: Teacher ratings. Journal of Developmental & Behavioral Pediatrics, 13, 187-193. Noll, R. B., Stith, L., Gartstein, M. A., Ris, M. D., Grueneich, R., Vannatta, K., et al. (2001). Neuropsychological functioning of youths with sickle cell disease: Comparison with nonchronically ill peers. Journal of Pediatric Psychology, 26, 69-78. Noll, R. B., Yosua, L. A., Vannatta, K., Kalinyak, K., Bukowski, W. M., & Davies, W. H. (1995). Social competence of siblings of children with sickle cell disease. Journal of Pediatric Psychology, 20, 165-172. Ohaeri, J. U., Shokunbi, W. A., Akinlade, K. S., & Dare, L. O. (1995). The psychosocial problems of sick cell disease sufferers and their methods of coping. Social Sciences & Medicine, 40, 955-960. Pannell, D.G. (1999). Living with sickle cell disease: From suffering to empowerment. American Pain Society Bulletin, 9(4). Platt, O. S., Brambilla, D. J., Rosse, W. F., Milner, P. F., Castro, O., Steinberg, M. H., et al. (1994). Mortality in sickle cell disease: Life expectancy and risk factors for early death. New England Journal of Medicine, 330, 1539-1644. Rodrigue, J. R., Streisand, R., Banko, C., Kedar, & Pitel, A. (1996). Social functioning, peer relations, and internalizing and externalizing problems among youths with sickle cell disease. Children’s Health Care, 25, 37-52. Royal, C. D., Headings, V. E., Molnar, E. T., & Ampy, F. R. (1995). Resilience in siblings of children with sickle cell disease. Journal of Genetic Counseling, 4, 199-217. Schatz, J., & McClellan, C. B. (2006). Sickle cell disease as a neurodevelopmental disorder. Mental Retardation and Developmental Disabilities Research Reviews, 12, 200-207.
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Schwartz, L. A., Radcliffe, J., & Barakat, L. P. (2007). The development of a culturally sensitive pediatric pain management intervention for African American adolescents with sickle cell disease. Children’s Healthcare, 36, 267-283. Scott, K. D., & Scott, A. A. (1999). Cultural therapeutic awareness and sickle cell anemia. Journal of Black Psychology, 25, 316-335. Serjeant, G. R. (1985). Sickle cell disease. Oxford: Oxford University Press. Shapiro, B. S. (1999). Pain in sickle cell disease. International Association for the Study of Pain, 10, 1-2. Sutton, M., Atweh, G. F., Cashman, T. D., & Davis, W. T. (1999). Resolving conflict: Misconceptions and myths in the care of the patient with sickle cell disease. The Mount Sinai Journal of Medicine, 66, 282-285. The Virginia Sickle Cell Awareness Program (2006). Understanding sickle cell disease: A handbook for school personnel. Virginia Department of Health. Richmond, VA. Thomas, V. J., & Taylor, L. M. (2002). The psychosocial experience of people with sickle cell disease and its impact on quality of life: Qualitative findings from focus groups. British Journal of Health Psychology, 7, 345-363. Thompson, R. J., Armstrong, F. D., Kronenberger, W. G., Scott, D., McCabe, M. A., Smith, B., et al. (1999). Family functioning, neurocognitive functioning, and behavior problems in children with sickle cell disease. Journal of Pediatric Psychology, 24, 491-498. Thompson, R. J., Armstrong, F. D., Link, C. L., Pegelow, C. H., Moser, F., & Wang, W. C. (2003). A prospective study of the relationship over time of behavior problems, intellectual functioning, and family functioning in children with sickle cell disease: A report from the cooperative study of sickle cell disease. Journal of Pediatric Psychology, 28, 59-65. Thompson, R. J., Gil, K. M., Burbach, D. J., Keith, B. R., & Kinney, T. R. (1993). Role of child and maternal processes in the psychological adjustment of children with sickle cell disease. Journal of Consulting and Clinical Psychology, 61, 468-474. Todd, K. H., Green, C., Bonhman, Jr., V. L., Haywood, Jr., C., & Ivy, E. (2006). Sickle cell disease related pain: Crisis and conflict. The Journal of Pain, 17, 453-458. Treiber, F., Mabe, P. A., & Wilson, G. (1987). Psychological adjustment of sickle cell children and their siblings. Children’s Health Care, 16, 82-89. Ungerer, H. A., Horgan, B., Chaitow, J., & Champion, G. D. (1988). Psychosocial functioning in children and young adults with arthritis. Pediatrics, 81, 195-202. Wagner, J. L., Connelly, M., Brown, R. T., Taylor, L., Rittle, C., & Wall-Cloues, B. (2004). Predictors of social anxiety in children and adolescents with sickle cell disease. Journal of Clinical Psychology in Medical Settings, 11, 243-252. Walco, G. A., & Dampier, C. D. (1990). Pain in children and adolescents with sickle cell disease: A descriptive study. Journal of Pediatric Psychology, 15, 643-658. Waldrop, R. D., & Mandry, C. (1995). Health professional perceptions of opioid dependence among patients with pain. American Journal of Emergency Medicine, 13, 529-531. Wallander, J. L., & Varni, J. W. (1992). Adjustment in children with chronic physical disorders: Programmatic research on a disability-stress-coping model. In A. M. LaGreca, L. Siegal, J. L. Wallander, & C. E. Walker (Eds.), Stress and coping with pediatric conditions (pp. 279-298). New York: Guilford Press.
Social Networks and Psychosocial Functioning among Children and Adolescents … 363 Williams, P. B. (2003). HIV/AIDS case profile of African Americans: Guidelines for ethnicspecific health promotion, education and risk reduction activities for African Americans. Family Community Health, 26, 289-306. Wright, H. H., & Phillips, L. G. (1988). Psychosocial issues in sickle cell disease. In A. F. Coner-Edwards & J. Spurlock (Eds.), Black families in crises: The middle class. New York, NY: Brunner/Mazel.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 20
PARENTING AND CHILDREN’S INVOLVEMENT IN BULLYING AT SCHOOL Ken Rigby University of South Australia
Research into bullying amomg children has suggested that parents can play an important role in reducing the risk of their children becoming involved in bully/victim problems at achool .and can take steps to enable their children to cope more effectively (Smith and Myron-Wilson, 1998; Stelios, 2008; Rigby 2008). At the same time, it should be acknowledged that parental influence is limited by such factors as their child’s genetic endowment (Ball et al., 2008) peer pressure at school and unpredictable life events. (Harris, 1998). What parents can do to reduce the risk or impact of bullying on children can be considered under these headings: 6) 7) 8) 9) 10)
Early childhood parenting Parenting style with older children Parents promoting skills that are helpful in reducing the risk of Parents assisting children who are being bullied at school Parents providing emotional and social support when children are bullied
EARLY CHILDHOOD PARENTING Early childhood experiences can have a significant effect on the quality of children’s relations with others at school.. Close and effective parental bonding can make it more likely that one’s child will subsequently enjoy feelings of confidence and security, as opposed to feeling generally anxious or distrustful of others. When young children become securely attached to care-givers, the risk of subsequent involvement in bully/victim problems at school, is significantly reduced (Troy and Stroufe, 1987). Further, it is known that premature
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exposure for long periods of time to inadequate childcare facilities can produce high levels of stress in young children with negative consequences for the child’s later peer relations (Manne, 2005).
PARENTING STYLE Research has shown that an authoritarian or over-controlling style of parenting, can also put children at greater risk of becoming bullies at school, especially if the parents who are seen by their children as uncaring (Rigby, Slee and Cunningham, 1999). ‘Under-controlling’ or unduly permissive parenting can also have undesirable effects. In one US study, reported by Curtner-Smith et al., (2000) boys aged 10-13 years who reported that their mothers tended not to monitor or supervise their behaviour, for example in knowing their children’s whereabouts outside the home, were more likely to be identified by their peers at school as bullies. A further factor that may result in subsequent bullying behaviour is an incapacity of some parents to forgive their children for perceived transgressions (Ahmed and Braithwaite, 2006). Children can be ‘overprotected’ by kindly, well-meaning parents who provide a socalled ‘enmeshed’ family situation. (Bowers, Smith and Binney, 1992) Having little experience of a diversity of people, such children may find it hard to adjust to school life and become prominent targets for bullying.
PARENTS PROMOTING APPROPRIATE SKILLS The development of social skills can help to reduce the likelihood that a child will be bullied at school (Fox and Boulton, 2005). .These include the capacity to act assertively, rather than aggressively, during interactions with peers, especially in situations that might otherwise lead to a child being bullied. Parents may help children to make friends, in part by modelling ways of behaving positively with others and also by providing children with opportunities to interact with their peers, for instance by inviting to their home children with whom their children can make friend under supervised conditions. Repeated conflicts between siblings in a family are associated with aggressive behaviour at school, and need to be controlled. However such conflicts can provide opportunities for parents to teach their children constructive conflict resolution skills that contribute to more armies relations with peers at school (Duncan, 2005) A frequently suggested antidote to being bullied is for a child to develop the capacity to act aggressively when challenged. For this reason parents may encourage their children to participate in power sports such as boxing, weight lifting and rugby. However, it has been found that children who engage in such sport are more likely than others to become involved in bully/victim problems at school (Endressen and Olweus, 2005) The development of appropriate social skills can provide a more useful means of coping with potentially conflictual situations.
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PARENTS ASSISTING CHILDREN WHO ARE BEING BULLIED Parents have the opportunity to assist children who are being bullied at school once they become aware of it. Unfortunately many children, estimated in England at around 60%, do not tell their parents (Smith and Shu, 2000). Hence to help such children it is necessary for parents to establish relationships with them such that they will disclose if they are being bullied at school. This may occur if the parents are perceived as interested in the matter and perceived as both motivated and able to help. Parents who simply direct their children to ‘stand up to the bully’ or alternatively offer to protect them by allowing them to stay at home commonly do not help to improve the situation. Listening sympathetically to a child’s concerns about being bullied is an essential starting point. Subsequently parents can explore various strategies such as acting more assertively, avoiding certain threatening situations, seeking help from friends or teachers . When such strategies fail it becomes necessary to visit the school and to ask for help.
PARENTS PROVIDING EMOTIONAL AND SOCIAL SUPPORT WHEN CHILDREN ARE BULLIED As is well known, children who are repeatedly victimised by peers at school commonly experience low levels of mental health, as indicated by measures of depression, anxiety and suicidal ideation (Rigby, 1999; Rigby and Slee, 1999; Bond et al., 2001). Research with Australian adolescent school children suggests that the provision of social support for chronically victimised children can reduce the negative health effects. (Rigby, 2000). Such emotional support can be provided by parents who become aware that their child is being bullied. This can not only reduce the negative impact of being bullied, but also help to make children less anxious, depressed or alienated and therefore more capable of resisting attempts by peers to victimise them.
REFERENCES Ahmed, E and Braithwaite, V. (2006) Forgiveness, reconciliation and shame: Three key variables in reducing school bullying. In Brenda Morrison and Eliza Ahmed (eds). Restorative Justice and Civil Society Journal of Social Issues, p 347- 370. Ball, H.A., Arseneault, L., Taylor, A., Maughan, B., Avshalom C. and Moffitt, T.E. (2008) Genetic and environmental influences on victims, bullies and bully-victims in childhood Journal of Child Psychology and Psychiatry 49, 104–112 Bond, L., Carlin, J.B., Thomas, L., Ruin, K., and Patton, G. (2001). Does bullying cause emotional problems? A prospective study of young teenagers. British Medical Journal, 323, 480–484. Bowers, L. Smith, P. K and Binney, V. (1992). Cohesion and power in the families of children involved in bully/victim problems at school. Journal of Family Therapy, 14, 371-387
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Curtner-Smith, M.E.. (2000) Mechanisms by which family processes contribute to school-age bullying. Child Study Journal, 30, 169-186. Duncan, R D. (2004) The impact of family relationships on school bullies and victims. P 227244. In Dorothy Espelage and Susan Swearer (Eds) Bullying in American schools. London: Erlbaum Endresen, I.M. and Olweus, D (2005). Participation in power sports and anti-social involvement of preadolescent and adolescent boys . Journal of Child Psychology and Psychiatry 46 pp. 468-478. Fox, C. L. and Boulton, M J. ( 2005) The social skills problems of victims of bullying: Self, peer and teacher perceptions. British Journal of Educational Psychology, 75 313-328. Harris, J.R. (1998). The Nurture Assumption. New York: Free Press Manne, A. (2005). Motherhood: How should we care for our children? Allen and Unwin. Rigby, K. (1999) Peer victimisation at school and the health of secondary students. British Journal of Educational Psychology, 22, 2, 28 – 34 Rigby, K. (2000) Effects of peer victimisation in schools and perceived social support on adolescent well-being Journal of Adolescence, 23.1.57-68 Rigby, K.and Slee, P.T. (1999) Suicidal ideation among adolescent school children, involvement in bully/victim problems and perceived low social support Suicide and Lifethreatening Behaviour, 29, 119-130. Rigby, K., Slee. P.T. and Cunningham, R. (1999) Effects of parenting on the peer relations of Australian adolescents. Journal of Social Psychology,139, 387-388. Rigby K (2008) Children and bullying. How parents and Educators can reduce bullying in schools. Boston: Blackwell-Wiley Smith, P. K., Myron-Wilson, R.(1998) Clinical Child Psychology and Psychiatry, 3. 405-417. Smith, P.K and Shu S (2000) What good schools can do about bullying. Childhood 7, 193212. Stelios, G (2008) Bullying and victimization at school: the role of mothers.British Journal of Educational Psychology, 78, 109-125. Troy, M. and Stroufe, L. A. (1987). Victimization among preschoolers: Role of attachment relationship history. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 166-172.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 21
NEUROBIOLOGY OF SOCIAL BONDING Donatella Marazziti*, Alessandro Del Debbio, Isabella Roncaglia, Carolina Bianchi, Liliana Dell’Osso Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Pisa, Italy
ABSTRACT Social bonding development is fundamental for several animals, particularly for humans who are the most immature at birth, for its relevant impact upon survival and reproduction. Several neural and endocrine factors, most of which are still largely unknown, may modulate reproductive behaviors, mother-infant attachment and adultadult bonding. Consequently, we aimed to review the neurobiological correlates of attachment in both animals and humans. MEDLINE and Pub-Med (1970-2008) databases were searched for English language articles using the keywords attachment, neuropeptides, neurotrophins, pair bonding, social behavior. We reviewed papers that addressed the following aspects of attachment neurobiology: 1) Infant-mother attachment; 2) Mother-infant attachment; 3) Adult-adult pair bonding formation; 4) Human bonding. Oxytocin and vasopressin, two neurohypophyseal peptides, are known to be involved in the attachment process. Oxytocin is supposed to facilitate a rapid conditioned association to maternal odor cues, while linking environmental cues to the infant's memory of the mother. While oxytocin plays a role in the onset of maternal behavior in rats, vasopressin seems to influence paternal behavior in praire voles. Parental behavior development requires also gonadal steroids action. In adults, oxytocin and vasopressin may contribute to pair bonding process by modulating the neuroendocrine response, behaviors and emotions associated to preference formation and pair bonding. Recently, even neurotrophins have been suggested to play a role in social bonding. In conclusion, although the neurobiological basis of social attachment is mainly based on animal data, preliminary findings suggest that the same mechanisms may occur also in humans and would involve multi-sensory processing, complex motor responses *
Corresponding author: Donatella Marazziti, MD; Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Via Roma 67, 56100 Pisa, Italy. Tel:+39 050 835412; Fax:+39 050 21581; E-mail:
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INTRODUCTION The attachment theory was first developed by the British psychoanalyst John Bowlby (1907-1990) [1,2,3] who analized the experience of separation of infants from their parents. He observed that separation led to distinctive behaviors such as crying, clinging and protesting in order to restore proximity to their parents. Contemporary psychoanalysts explained these manifestations as immature defense mechanisms to repress emotional distress, while Bowlby proposed that they represent adaptive responses to separation from a primary attachment figure (the so-called “caregiver”) who provides support, protection, and care.. Feeding, sleeping and locomotion are fundamental, but attachment is probably the most important process for human survival, as that are very immature at birth and that could not survive if they were not “social animals”. The brain systems promoting social bonds probably evolved to mobilize the maternal care in mammals. The helpless of mammal newborns, their dependence upon maternal nutrition and the necessity of proximity to parental body to keep warm, therefore, required the evolution of a new motivational system to stimulate and sustain maternal behavior. According to Bowlby, the quality and quantity of maternal care received during infancy are fundamental for the development of adult social competence and ability to cope with stressful situation and aggressiveness. In addition all other types of social bonds seem to have evolved from motivational systems that stimulate maternal behavior in mammals. Bowlby hypothesized that the attachment should have solid genetic and biological bases, but only in the last three decades, several studies have begun to investigate these aspects. With the exception of pharmacological studies in maternal monkeys [4] and recent human imaging studies [5], investigations of neural systems involved in attachment have so far used non-primate mammals, such as praire voles and precocial ungulates. Recent evidences show that two neurohypophyseal peptides, oxytocin and vasopressin, are relevant in the formation of social relationships. Oxytocin seems to be implicated in several physiological, behavioral and pharmacological aspects of social attachment, such as learning, memory, parturition, lactation, maternal and sexual behavior. Moreover, the role of these hormones seems to be gender- specific: oxytocin mediates behavioral aspects in females, while vasopressin in males. Different neurotransmitters have been also implicated in the attachment process: prolactin, opioids, dopamine, GABA and serotonin [6,7]. Furthemore, in the last years a growing body of research has been investigating the role of neurotrophins (NTs) in the development of attachment.
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INFANT-MOTHER AND MOTHER-INFANT ATTACHMENT The newly hatchet chicks show a visual imprinting: they present a long-lasting tendency to follow the mother or objects similar to the mother. A region within the intermediate medial part of the hyperstriatum ventrale (IMHV) of their brain is important for the acquisition and the early consolidation of the memory of an imprinted visual stimulus [8]. An adjacent region, the mediorostral neostriatum [9], presents exclusively auditory imprinting [10]. Visual or auditory imprinting provokes an early and persistent increase of the presynaptic release of amino acids and ultrastructural postsynaptic modifications in specific cortical regions [8]. Rat pups recognize the mother through an olfactory process which implies noradrenergic pathways [11] and are conditioned by stimuli associated to maternal odours and care [12], while oxytocin seems to facilitate the learning of social stimuli (like maternal ones). In humans, children at the birth form a tie with caregivers which will continue to influence the emotional relations also in adulthood. Oxytocin and vasopressin systems are influenced by early social experiences. In mammals, the interaction child-mother has deep effects on behavior and can determine long-lasting neuro-anatomical and neuro-endocrine modifications. The early experiences can affect the neurogenetic respose to stress in adulthood, as a persistent alteration of hypothalamic-pituitary-adrenal (HPA) axis has been demonstrated as a result of early stressful events [13,14]. Early experiences, like birth, breastfeeding and other aspects of mother-child interaction, would produce short-term and longterm behavioral modification probably mediated by oxytocin [15]. Oxytocin and vasopressin levels are increased by pleasant social experiences like odours and caresses. A marked production of oxytocin receptors have been found (in rodents and in primates) in limbic areas during the first two weeks after birth. Neuroendocrine factors associated with gestation, delivery and breast-feeding induce the step from avoidance to approach behaviors. In rat brain, several areas seem crucial in determining maternal behavior: medial preoptic area (MPOA), the overlying bed nucleus of the stria terminalis (BNST), the lateral habenula and the ventral tegmental area (VTA) [6,16,17]. In the rat, oxytocin and prolactin have been shown to mediate the maternal behavior: e.g., it has been demonstrated that oxytocin injection in lateral ventriculi of rat nulliparous and ovariectomized female induces it [18]. Estrogens are fundamental in modulating oxytocin neurotransmission. Physiological variations of sexual steroids during pregnancy provoke, just before delivery, an increase of oxytocin receptors in two limbic areas, the BNST and the ventro-medial nucleus of hypothalamus, while determining the onset of maternity [19]. In rat females, the initiation of maternal care is facilitated by lesions that reduce olfactory processing [20]. During delivery, the oxytocin release reduces mitral and granule cell firing in the olfactory bulb, while inhibiting the olfactory stimuli processing and facilitating approach behaviors [21,22]. Up-to-now, the role of oxytocin in the development of maternal behavior in humans has not been studied systematically. Some authors showed that breast-feeding, within one hour from birth, when oxytocin levels are elevate, could induce the formation of a stable and long-term attachment relationship between mother and child, with a benefical effect on child development [23]. In the post-partum, rat female cares for any pups placed in its nest and shows a generic, not selective attachment; on the contrary, sheep presents more rigorous and selective models of maternal attachment, while refusing, in the post-partum, any lamb that is not its own. Until
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now, brain areas mediating the effects of oxytocin on maternal behaviour have not been identified, but recent studies suggest a certain region specificity [24,25,26]. The role of olfactory stimuli is supported by a series of experiments: within 24 hours from the delivery the odour of the own lamb enhances the intracellular concentration of glutamate and GABA in the olfactory bulb [27]. Such neurochemical modifications within the olfactory bulb are influenced by sexual steroids [28]. Mother separation is an animal model of early stress, which is used to study the development of depression-like behaviors in adults [29,30,31]. A growing body of data suggests the involvement of a neurotrophin (NTs), the Brain-Derived Neurotrophic Factor (BDNF), in stress-related hippocampal degeneration [32]. BDNF is a protein involved in the differentiation, survival of peripheral and central neurons, and in the modulation of synaptic plasticity; recently, it has become the focus of increasing attention, given its putative role in the pathophysiology of different neuropsychiatric disorders [33,34]. Examination of BDNF mRNA levels in the brain of rats separated from his mother at birth provoked different effects in short and long-term, respectively. A short-term increase in gene expression of BDNF has been observed in prefrontal cortex and hyppocampus [35,36], while a reduced gene BDNF expression in long-term observations, specifically in prefrontal cortex [36]. The regulation of BDNF expression in hippocampus of adult rats separated from the mother seems thus, to be time-dependent. [37]. A recent study examined the effects of early isolation rearing on cell proliferation, survival and differentiation in the dentate gyrus of the guinea pig, while showing that it reduces hippocampal cell proliferation, by reducing BDNF expression, and hampers migration of the new neurons to the granule cell layer, by altering the density and morphology of radial glia cells [38]. The wide reduction of the number of granular cells following isolation rearing emphasizes the role of environmental stimuli as key modulators in neurogenesis. On the contrary, studies on models of early social enrichment (e.g. being reared in a communal nest) found a highly stimulating effect on adult neuronal plasticity, which on the other side seems to be associated with increased anxiety and depression-like behaviors during the adulthood [39]. On the whole, some data suggest that NTs could act as mediators to translate the effects of external manipulation on brain development. Changes in the NT level during the critical stages of development may result in long-term changes of neuronal plasticity and lead to greater vulnerability to aging and psycopathology [35].
ADULT PAIR BONDING Approximately 5% of mammals are monogamous and biparental [40,41]. The voles (microtine rodents) have demonstrated to be an excellent model for molecular and cellular studies of complex social behaviors [42]; two species of North America have been widely compared for neuronal differences: prairie voles, that are monogamous and montane voles that are promiscuous. Praire voles generally form stable bond after mating [42]. Mating determines the release of oxytocin and vasopressin that seems to be involved in this process [43]. Oxytocin and vasopressin injection in the central nervous system facilitates the insorgence of monogamous
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behaviors in praire voles even when they have not the opportunity to mate [44,45]; on the contrary, the administration of vasopressin and oxytocin antagonists before mating inhibits the appearance of long lasting bonds [44,46]. The antagonists do not alter mating itself, but prevent the development of the partner preference which normally praire voles show after mating. These observations suggest that in praire voles both neurohypophyseal peptides are necessary and sufficient to form pair bonding. On the contrary, neither oxytocin nor vasopressin have relevant effects on social behavior of montane voles [44,47]. Although the expression of these neuropeptides is similar between the two species, differences have been found in the regional distribution of their receptors [48,49]. In monogamous voles, in fact the oxytocin receptors are expressed particularly in the nucleus accumbens, in the pre-limbic cortex and in the ventral pallidum, regions that are associated with reinforcement and conditioning. On the contrary, montane voles have a few oxytocin and vasopressin receptors in these areas, but elevated in the lateral septum. In praire voles, the oxytocin receptor blockade in the nucleus accumbens inhibits the formation of the partner preference, while the hyperexpression of V1a receptors for vasopressin in the ventral pallidum facilitates it [50]. This hypothesis is supported by the observation of an analogous distribution of vasopressin receptors in monogamous rats and in primates, while the regional distribution of such receptors in rodents and primates, which do not present pair bonding, seems to be different [51]. Probably, the release of oxytocin and vasopressin during mating leads to the activation of reward circuits in monogamous species, but not in the promiscuous ones. However, it is interesting to underline that, in montane voles, there is an increase of the oxytocin receptors in the post-partum, phenomenon that is associated with the onset of nursing behaviors towards the pups [48]. Recent studies have highlighted the importance of the nucleus accumbens and the D2 dopaminergic receptors of this area in determining the formation of the partner preference in praire voles [52,53]. The administration of D2 agonists sistemically or directly in the nucleus accumbens seems to facilitate the partner preference, while D2 antagonists would inhibit it. It is possible that these neuropeptides or mating activate the mesolimbic circuit that is involved in the reward effects of psychostimulants. Recent studies in rats suggest that dopaminergic effects on reinforcement mechanisms could be mediated by the potentiation of glutamatergic transmission towards nucleus accumbens [54]. Monogamous species probably have a selective predisposition to be conditioned by social stimuli, which is partially mediated by oxytocin and vasopressin. Some authors, while hypothesizing the existence of a molecular basis of monogamy, focused their attention on the different neuroanatomical distribution of receptors among different vole species. Regions codifying for oxytocin and vasopressin receptors are essentially the same in monogamous and in nonmonogamous species, although remarkable differences in the 5’ flanking region of the V1a receptor gene have been found [55]: these would contribute to the tissue specificity of genic expression. Therefore, oxytocin and vasopressin could represent the link between the neuroendocrine response to mating, the formation of partner preference and, finally, pair bonding. In addition, there is consistent evidence that implicates both oxytocin and vasopressin in social recognition or social memory [56, 57 ]. Oxytocin knockout mice present all maternal behaviors, but show a severe social amnesia, without other evident cognitive deficits [58]. In oxytocin-knockout mice, social stimuli determine a normal level of activation of c-fos gene in the olfactory bulb, but not in the medial amigdala nor in bed nucleus of stria terminalis and MPOA. The medial nucleus of amigdala in mouse brain is rich in oxytocin receptors; in oxytocin-knockout mice, oxytocin injection in this nucleus, but not in the
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olfactory bulb, restores the social recognition [59]. Therefore, it is possible that the absence of partner preference in praire voles treated with oxytocin and vasopressin antagonists derives from the inability to recognize the partner rather than to form pair bonds. It has been demonstrated that dopamine inhibitor administration before the preference test does not interfere with the recognition ability, while after mating would inhibit the consolidation of the partner memory [52]. Male exposure has been proved to modulate the neurogenesis in adult female prairie voles [60]. Two days of male exposure significantly increased the number of 5-bromo-2'deoxyuridine (BrdU)-labeled cells in the amygdala and hypothalamus of female prairie voles in comparison to a social isolation condition or female exposure. Overall, these data indicate that the effects of social environment on neuron proliferation in adult female prairie voles carry out in a stimulus- and site-specific manner.
HUMAN BONDING In the human brain oxytocin receptors are concentrated in several dopamine-rich regions, especially the substantia nigra and globus pallidus, as well as the preoptic area [61]. Whereas this pattern of distribution is similar to that of monogamous species, oxytocin and vasopressin receptors have not been found in the ventral striatum and in the ventral pallidum, areas that generally result particularly rich in oxytocin and vasopressin receptors in monogamous voles and monkeys [62]. The activity in the brain of adult subjects was scanned by means of fMRI, while they were viewing pictures of their partners, and compared with the activity produced by pictures of friends of similar age, sex and duration of friendship as their partners. From the comparison emerged that looking at pictures of the partners evokes a bilateral activation of the anterior cingulate cortex (Area 24 of Broadman), the medial insula (Area 14 of Broadman), the caudate nucleus and the putamen [5]. Such pattern of activation differs from those found in previous studies of visual attention, sexual arousal and other emotional states, while it is similar to the preliminar results of a a fMRI study on mothers who were listening to the crying baby [63]. Studies on human attachment show that brain areas activated when viewing or listening to a loved object are the same that are activated in euphoric states induced by psychostimulants [64]; this suggests that circuits that regulate attachment perhaps evolved from reward pathways. A recent study showed that in romantic attachment anxiety and oxytocin are significantly and positively linked, that is, the higher the oxytocin level the higher the score of the anxiety scale of the Experiences in Close Relationships (ECR) [65]. This report, in accordance with previous observations in animal studies that showed anxiolitic properties of oxytocin [66,67], suggests that in humans oxytocin may reduce the anxietyrelated to romantic relationship, while evoking relation and wellbeing sensations [68,69,70,71]. A recent study investigated for the first time the peripheral levels of NTs in subjects in love [72]. Subjects who had recently fallen in love and two control groups, consisting of subjects who were either single or were already engaged in a long-lasting relationship, were compared for plasma NGF, BDNF, NT-3 and NT-4 levels. NGF levels were significantly higher in the subjects in love than in the control subjects. A significant positive correlation was found between NGF levels and the intensity of romantic love, as assessed with the
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passionate love scale. In 39 subjects who maintained the same relationship after 12-24 months, but were no longer in the same mental state of the first evaluation, plasma NGF levels were decreased and not different from those of the control groups. Overall, these results suggest that some behavioral and/or psychological features associated with falling in love could be related to increased NGF levels. This NT could play a role in molecular mechanism of romantic love, acting as a modulator of different endocrine functions. From a larger prospective, NTs may be involved in social relationships, directly or modulating stress-related symptoms. Human romantic love has been finally addressed by a genetic perspective [73]. When looking at the associations between markers in neurotrasmitter genes (the serotonin transporter gene, 5-HTT; the serotonin receptor 2A, 5HT2A; the dopamine D2 receptor gene, DRD2; and the dopamine D4 receptor gene, DRD4) and the six styles of love as conceptualized by Lee [74] (Eros, Ludus, Storge, Pragma, Mania and Agape), it emerged in both sexes the TaqI A variant of DRD2 was significantly correlated with “Eros” (a loving style characterized by intense emotional experiences based on the physical attraction to the partner), as well as the C516T 5HT2A polymorphism correlated significantly with "Mania" (a possessive and dependent romantic attachment, characterized by self-defeating emotions). Further studies are warranted to investigate the possible genetic loading on human loving styles.
CONCLUSION Social bonding is a complex process that involves several cognitive, behavioral and emotional variables. From a neurobiological point of view, the neurohypophyseal peptides oxytocin and vasopressin appear to be crucial for the formation of social relationships, including infant attachment, parental care and adult pair bonding; the hypothesized mechanism links oxytocin and vasopressin, stimulated by social interactions, to dopamine pathways associated with the reward systems. Latest investigations are focusing on NTs, while suggesting their putative role in translating the effect of social interactions on brain development and neuroplasticity.
REFERENCES [1] [2] [3] [4]
[5] [6]
Bowlby, J. Attachment and Loss. Vol. 1: Attachment. New York: Basic Books, 1969. Bowlby, J. Attacchment and Loss. Vol. 2: Separation. New York: Basic Books, 1973 Bowlby, J. Attachment and Loss. Vol. 3: Loss, Sadness and Depression. New York: Basic Books, 1980 Martel, FL; Neviscon, CM; Rayment, FD; Simpson, MJ; Keverne, EB. Opioid receptor blockade reduces maternal affect and social grooming in rhesus monkeys. Psychoneuroendocrinology 1993; 18: 307-21. Bartles, A; Zeki, S. The neural basis of romantic love. Neuroreport 2000; 11: 3829-34. Numan, M. Maternal behavior. In: Knobil E, Neill J, editors. The Physiology of Reproduction. New York: Raven Press 1994, 221-302.
376 [7] [8] [9]
[10]
[11] [12]
[13]
[14] [15] [16] [17] [18]
[19]
[20]
[21]
[22]
[23]
Donatella Marazziti, Alessandro Del Debbio, Isabella Roncaglia et al. Winslow, JT; Insel, TR. Serotoninergic modulation of the rat pup's ultrasonic vocal development: studies with MDMA. J Pharmacol Exp Ther 1990; 254: 212-20. Horn, G. Visual Imprinting and the neural mechanisms of recognition memory. Trends Neurosci 1998; 21: 300-5. Metzger, M; Jiang, S; Braun, K. Organization of the dorsocaudal neostriatum complex: a retrograde and anterograde tracing study in the domestic chick with special emphasis on pathways relevant to imprinting. J Comp Neurol 1998; 395: 380-404. Bredenkotter, M; Braun, K. Changes of neuronal responsiveness in the mediorostral neostriatum/hyperstriatum after auditory filial imprinting in the domestic chck. Neuroscience 1997; 76: 355-65. Sullivan, R; Wilson, D. The locus coeruleus, norepinephrine, and memory in newborns. Br Res Bull 1994; 35: 467-72. Johnson, B; Leon, M. Spatial distribution of [14 C]2-deoxyglucose uptake in the glomerular layer of the rat olfactory bulb following early odor preference learning. J Comp Neurol 1996; 376, 557-66. Heim, C; Owens, MJ; Plotsky, PM; Nemeroff, CB. Persistent changes in corticotropinreleasing factor systems due to early life stress: relationships to the patophysiology of major depression and post-traumatic stress disorder. Psychopharmacol Bull 1997; 33: 2, 185-92. Mirescu, C; Gould, JDE. Early life experience alters response of adult neurogenesis to stress. Nature Neurosci 2004; 7: 841-6. Carter CS. Developmental consequences of oxytocin. Physiol Behav 2003; 79: 383-97. Corodimas, KP; Rosenblatt, JS; Morrell, JI. The habenular complex mediates hormonal stimulation of maternal behavior in rats. Behav Neurosci 1992; 106: 853-65. Numan, M; Sheehan, TP. Neuroanatomical circuitry for mammalian maternal behavior. Ann NY Acad Sci 1997; 807: 101-25. Pedersen, CA; Prange, AJ. Induction of maternal behavior in virgin rats after intracerebroventricular administration of oxytocin. Proc Natl Acad Sci USA 1979; 76: 6661-5. Caldwell, JD; Walker, CH; Pedersen, CA; Barakat, AS; Mason, GA. Estrogen increases affinity of oxytocin receptors in the nedial preoptic area-anterior hypothalamus. Peptides 1994; 15: 1079-84. Fleming, AS; Rosenblatt, JS. Olfactory regulation of maternal behavior in rats:II. Effects of peripherally induced anosmia and lesions of the lateral olfactory tract in pupinduced virgins. J Comp Physiol Psychol 1974; 86: 233-46. Landgraf, R; Neumann, I; Russel, J; Pittman Q. Push-pull perfusion and microdialysis studies of central oxytocin and vasopressin release in freely moving rats during pregnancy, parturition and lactation. NY Acad. Sci 1992; 652: 326-39. Yu, GZ; Kaba, H; Okutani, F; Takahashi, S; Higuchi, T. The olfactory bulb: A critical site of action for oxytocin in the induction of maternal behavior in the rat. Neuroscience 1996; 72: 1083-8. Kennell, JH; Jerauld, R; Wolfe, H; Chesler, D; Kreger, NC; Mcalpine W. Maternal behavior one year after early and extended post-partum contact. Develop Med Child Neurol 1974; 16: 172-9.
Neurobiology of Social Bonding
377
[24] Kendrick, KM; Levy, F; Keverne, EB. Importance of vaginocervical stimulation for the formation of maternal bonding in primiparous and multiparous parturient ewes. Physiol Behav 1991; 50: 595-600. [25] Kendrick, KM; Levy, F; Keverne, EB; Chapman, C; Baldwin BA. Microdialysis measurement of oxytocin, aspartate, GABA and glutamate release from the olfactory bulb of sheep during vaginocervical stimulation. Brain Res 1988; 442: 171-7. [26] Kendrick, KM; Keverne, EB; Chapman, C; Baldwin, BA. Intracerebroventricular oxytocin stimulates maternal behavior in the sheep. Neuroendocrinology 1987; 46: 5661. [27] Kendrick; KM, Levy, F; Keverne, E. Changes in the sensory processing of olfactory signals induced by birth in sheep. Science 1997; 256: 833-6. [28] Guevara-Guzman, R; Barrera-Mera, B; De La Riva, C; Kendrick, K. Release of classic neurotransmitters and nitric oxide in the rat olfactory bulb, evoked by vaginocervical stimulation and potassium, varies with the oestrus cycle. Eur J Neurosci 2000; 12: 808. [29] Hall, FS. Social deprivation of neonatal,adolescent, and adult rats has distinct neurochemical and behavioral consequences. Crit Rev Neurobiol 1998; 12: 129-62. [30] Ladd, CO; Huot, RL; Thrivikraman, KV; Nemeroff, CB; Meaney, MJ; Plotsky, PM. Long-term behavioral and neuroendocrine adaptations to adverse early experience. Prog Brain Res 2000; 122: 81-103. [31] Arborelius, L; Hawks, BW; Owens, MJ; Plotsky, PM; Nemeroff, CB. Increased responsiveness of presumed 5-HT cells to citalopram in adult rats subjected to prolonged maternal separation relative to brief separation. Psychopharmacology (Berl) 2004; 176: 248-55. [32] Duman, RS; Monteggia, LM. A neurotrophic model for stress-related mood disorder. Biol Psychiatry 2006; 59: 1116-27. [33] Duman, RS; Heninger, GR; Nestler, EJ. A molecular and cellular theory of depression. Arch Gen Psychiatry 1997; 54: 597-606. [34] Piccinni A, Marazziti D, Catena M, Domenici L, Del Debbio A, Bianchi C, Mannari C, Martini C, Da Pozzo E, Schiavi E, Mariotti A, Roncaglia I, Palla A, Consoli G, Giovannini L, Massimetti G, Dell'Osso L. Plasma and serum brain-derived neurotrophic factor (BDNF) in depressed patients during 1 year of antidepressant treatments. Journal of affective disorders 2008; 105:279-83. [35] Cirulli, F; Berry, A; Alleva, E. Early disruption of the mother-relationship: effects on brain plasticity and implications for psychopatology. Neurosci Biobehav Rev 2003; 27: 73-82. [36] Roceri, M; Citrulli, F; Pessina ,C; Peretto, P; Racagni, G; Riva, MA. Postnatal repeated maternal deprivation produces age-dependent changes of brain-derived neurotrophic factor expression in selected rat brain regions. Biol Psychiatry 2004; 55: 708-14. [37] Greisen, MH; Altar, CA; Bolwig, TG; Whitehead, R; Wortwein, G. Increased adult hippocampal brain-derived neurotrophic factor and normal levels of neurogenesis in maternal separation rats. J Neurosci Res 2005, 79: 772-78. [38] Rizzi, S; Bianchi, P; Guidi, S; Ciani, E; Bartesaghi, R. Neonatal isolation impairs neurogenesis in the dentate gyrus of the guinea pig. Hippocampus 2007; 17 (1): 78-91.
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Donatella Marazziti, Alessandro Del Debbio, Isabella Roncaglia et al.
[39] Branchi, I; D’Andrea, I; Sietzema, J; Fiore, M; Di Fausto, V; Aloe, L; Alleva, E. Early social enrichment augments adult ippocampal BDNF levels and survival of BrdUpositive cells while increasing anxiety- and “depression”- like behavior. J Neurosci Res 2006; 83 (6): 965-73. [40] Kleiman, DG. Monogamy in mammals. Q Rev Biol 1977; 52: 39-69. [41] Dewsbury, DA. Symposium on motivation. In American Zoology. Nebraska Univ Press, Lincoln, Nebraska, 1988:1-50. [42] Carter, C; DeVries, A; Getz, L. Physiological substrates of mammalian monogamy: The praire vole model. Neurosci Biobehav Rev 1995; 19: 303-14. [43] Witt, DM. Oxytocin and rodent sociosexual responses: from behavior to gene expression. Neurosci Biobehav Rev 1995; 19: 315-24. [44] Winslow, JT; Shapiro, LE; Carter, CS; Insel, TR. Oxytocin and complex social behaviours: species comparisons. Psychopharmacol Bull 1993; 29: 409-14. [45] Williams, J; Insel, T; Harbaugh, C; Carter, C. Oxytocin admistered centrally facilitates formation of partner preference in female praire vole (Michrotus ochrogaster) J Neuroendocrinol 1994; 6: 247-50. [46] Insel, TR; Huilihan, TJ. A gender specific mechanism for pair bonding: oxytocin and partner preference formation in monogamous voles. Behav Neurosci 1995; 109:782-9. [47] Young LJ; Winslow, JT; Nilsen, R; Insel, TR. Species differences in V1a receptor gene expression in monogamous and nonmonogamous voles: behavioral consequences. Behav Neurosci 1997; 111: 599-605. [48] Insel, TR; Shapiro, LE. Oxytocin receptor distribution reflects social organization in monogamous and polygamous voles. Proc Natl Acad Sci USA 1992; 89: 5981-5. [49] Insel, TR; Wang, Z; Ferris, CF. Patterns of brain vasopressin receptor distribution associated with social organization in microtine rodents. J Neurosci 1994; 14: 5381-92. [50] Pitkow, LJ; Sharer, CA; Ren, X; Insel, TR; Terwilliger, EF; Young LJ. Facilitation of affiliation and pair-bond formation by vasopressin receptor gene transfer into the ventral forebrain of a monogamous vole. J Neurosci 2001; 21 (18): 7392-6. [51] Young, LJ. Oxytocin and vasopressin receptor and species –typical social behaviors. Horm Behav 1999; 36: 212-21. [52] Wang, Z; Yu, GZ; Cascio, C; Liu, Y; Gingrich, B; Insel, TR. Dopamine D2 receptormediated regulation of partner preferences in female praire voles: a mechanism of pair bonding. Behav Neurosci 1999; 113: 602-11. [53] Gingrich, B; Liu, Y; Cascio, C; Wang, Z; Insel TR. Dopamine D2 receptors in the nucleus accumbens are important for social attachment in female praire voles. Behav Neurosci 2000; 114: 173-83. [54] Everitt, B; Parkinson, JA; Olmstead, MC; Arroyo, M; Robledo, P; Robbins, TW. Associative process in addiction and reward: the role of amygdala-ventral striatal subsystems. Ann N Y Acad Sci 1998; 877: 412-38. [55] Young, L; Nilsen, R; Waymire, K; MacGregor, G; Insel, T. Increased affiliative responses to vasopressin in mice expressing the V1a receptor from a monogamous vole. Nature 1999; 400: 766-8. [56] Carter, CS; Witt, DM; Shneider, J; Harris, L; Volkening, D. Male stimuli are necessary for female sexual behavior and uterine growth in praire voles (Microtus ochrogaster). Horm Behav 1987; 21: 74-82.
Neurobiology of Social Bonding
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[57] Kovacs, GL; Telegdy G. In: Amico J & Robinson AG, editors. Oxytocin: clinical and laboratory studies. Elsevier, NewYork 1985:395-371. [58] Ferguson, J; Aldag, J; Winslow, J; Insel, TR; Young, LJ. Neural activation in the socially amnestic mouse. Soc Neurosci 2000; 30: 373.8. [59] Ferguson, J; Young, L; Hearn, E; Insel, T; Winslow, J. Social amnesia in mice lacking the oxytocin gene. Nature Genet 2000; 25: 284-8. [60] Fowler, CD; Liu, Y; Ouimet, C; Wang, Z. The effects of social enviroment on adult neurogenesis in the female praire vole. J Neurobiol 2002; 51 (2): 115-28. [61] Loup, F; Tribolet, E; Dubois-Dauphin, M; Dreifuss, JJ. Localization of high-affinity binding sites for oxytocin and vasopressin in the human brain. An autoradiographic study. Brain Res 1991; 555: 220-32 [62] Wang, Z; Toloczeko, D; Young, LJ; Moody, K; Newman, JD; Insel, TR. Vasopressin in the forebrain of common marmosets (Callithrix Jaccus): Studies with in situ hybridisation, immunochemistry and receptor autoradiography. Brain Res 1997; 768: 147-56. [63] Lorberbaum, JP; Newman, JD; Dubno, JR; Horwitz, AR; Nahas, Z; Teneback, CC; Bloomer, CW; Bohning, DE; Vincent, D; Johnson, MR; Emmanuel, N; BrawmanMintzer, O; Book, SW; Lydiard, RB; Ballenger, JC; George, MS. Feasibility of using fMRI to study mothers responding to infant cries. Depress Anxiety 1999; 10: 99-104. [64] Breiter, HC; Gollub, RL; Weisskoff, RM; Kennedy, DN; Makris, N; Berke, JD; Goodman, JM; Kantor, HL; Gastfriend, DR; Riorden, JD; Mathew, RT; Rosen, BR; Hyman, SE. Acute effects of cocaine on human brain activity and emotion. Neuron 1997; 19 (3): 591-611. [65] Marazziti, D; Dell’Osso, B; Baroni, S; Mungai, F; Catena, M; Rucci, P; Albanese. F; Giannaccini, G; Betti, L; Fabbrini, L; Italiani, P; Del Debbio, A; Lucacchini, A; Dell’Osso, L. A relationship between oxytocin and anxiety of romantic attachment. Clinical Pract Epidemol Mental Health 2006; 2: 28. [66] Bale, TL; Davis, AM; Auger, AP; Dorsa, DM; McCarthy, MM. CNS region-specific oxytocin receptor expression: importance in regulation of anxiety and sex behavior. J Neurosci 2001; 21: 2546-52. [67] Windle, RJ; Gamble, LcE; Kershw, YM; Wood, SA; Lightman, SL; Ingram, CD. Gonadal-steroid modulation of stress-induced hypotalamo-pituitary-adrenal activity and anxiety behavior: role of central oxytocin. Endocrinology 2006; 147 (5): 2423-31. [68] Carter, CS. Oxytocin and sexual behavior. Neurosci Biobehav Rev 1992; 16: 131-144. [69] Uvnas-Moberg K. Physiological and endocrine effects of social contact. Ann N Y Acad Sci. 1997; 807: 146-63. [70] Insel, TR; Young, LJ. The neurobiology of attachment. Nat Rev Neurosci 2001, 2: 129136. [71] Heinrichs, M; Baumgartner, T; Kirschbaum, C; Ehlert, U. Social support and oxytocin interact to suppresscortisol and subjective responses to social stress. Biol Psychiatry 2003; 54: 1389-98. [72] Emanuele E; Politi, P; Bianchi, M; Minoretti, P; Bertona, M; Geroldi, D. Raised plasma nerve growth factor levels associated with early-stage romantic love. Psychoneuroendocrinology 2006; 31: 288-94.
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[73] Emanuele E, Brondino N, Pesenti S, Re S, Geroldi D. Genetic loading on human loving styles. Neuroendocrinol Lett. 2007; 28 (6): 815-21. [74] Lee J.A. The colors of love. Prentice Hall, New York, Bantam Books, 1976.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 22
COOPERATIVE AND NON-COOPERATIVE BEHAVIOR IN PAIRS OF CHILDREN: THE RECIPROCAL EFFECTS OF SOCIAL INTERACTION IN THE ONGOING CONSTRUCTION OF A PLAY SEQUENCE Emanuela Rabaglietti, Fabrizia Giannotta, Silvia Ciairano* Department of Psychology, University of Torino, Italy
ABSTRACT We know that some social interactions begin and end cooperatively, while others start aggressively and end up even more so. We also know that in some social interactions one of the partners might initially behave either cooperatively or competitively and aggressively towards the other partner, who may respond with the opposite type of behavior. However, over time, as the relationship evolves, behavioral patterns may change as each partner adapts to the behavior of the other. We think that as social interactions evolve over time, it is possible to identify two phases: first, a reciprocal exploration phase, and second, an adjustment phase. Investigating very short term social interaction sequences of about ten minutes, we concluded that these two phases last about five minutes each. The present study investigates the relationships between cooperative and noncooperative or competitive behavior in pairs of children in the ongoing process of interaction during a ten-minute play sequence. To reach our goal, we first divided the time of the play sequence (10’) in two phases and looked at the differences between the first and second phase (5’ each). Second, we divided the pairs of children in three groups: i) initially high in cooperation; ii) initially high in competition; iii) initially high in both. Third, we looked at the outcomes using both linear and logistic regression analyses. We hypothesised that: a) initially prevalent cooperative behavior is more likely to end in cooperation; b) initially prevalent competitive behavior is more likely to end in
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Emanuela Rabaglietti, Fabrizia Giannotta and Silvia Ciairano competition; c) initially mixed social interactions (both cooperative and competitive) are more likely to end in abandonment of the interaction and doing nothing. Our sample is composed of 125 pairs of children. 69% (N=86) of the pairs were composed of same-sex children, while the remaining 31% (N=39) were mixed. The individuals within each pair were the same age. 35% of the pairs (N =44) were eight years old, 38% (N =48) were ten years old, and 27% (N=33) were twelve years old. We observed the cooperative and competitive behavior of both the partners. The task was to finish a puzzle in ten minutes. Our findings confirmed only our first two hypotheses. We found that initially mixed situations were also more likely to end in cooperation. These findings underline the importance of intervention programs aimed at promoting social and cooperative skills in children to avoid starting negative social cycles or patterns.
INTRODUCTION Peer Relationships It is now widely acknowledged that peer relationships can promote an individual’s cognitive, affective, and social development. However, how and why this happens is still a topic of discussion in current developmental psychology [Bukowski, Newcom & Hartup, 1996; Fonzi, 1996; Rubin, Bukowski & Parker, 2006]. In fact, despite their high social and psychological relevance we do not know much about the processes that lead children to choose different interactive strategies and to learn to modulate their behavior with respect to their peers [Pepitone, 1980; Fonzi, 2003]. The relevance of a deeper understanding of children’s social relationships with peers has its roots in the fact that human beings are intrinsically social, or in other words, they are biologically built to live with other people and to face the challenges of living in a group. As we know, the social interactive strategies used by people are not always adaptive, but we still lack knowledge about the underlying processes that lead us to more or less successful social interactions. One important reason for this lack of knowledge is that, in developmental psychology, the importance of peer relationships for individual development emerged only recently. More precisely, it emerged only after we had abandoned the traditional idea, promoted by both Piaget and Freud [Rutter & Rutter, 1993], of development that goes from the individual to the social level, and after we had acknowledged the precocious and complex social competence of children [Schafer, 2004]. The idea that the child begins life as an essentially asocial and egocentric being and that through socialization he/she is able to establish successful social relationships has been surpassed. Rather, we now believe that the child, who is active in establishing social relationships from the very beginning, enters progressively into wider social networks. We also know that people construct relationships based on personal goals, cognitive skills, and social demands. Thus, every change in a relationship can be considered both the result of ongoing social processes and a factor that can promote further cognitive and social development [Laursen & Bukowski, 1997]. On one hand, relationships with significant others, including those between a child and their peers, reflect the psychological needs of the participants. On the other hand, these relationships contribute to the construction, particularly
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during childhood, of the patterns and prototypes of future relationships [Bowlby, 1988; Hazan & Shaker, 1987]. Furthermore, it is known that greater social cognition, in terms of both cognitive capabilities and perspective-taking skills, facilitates a better understanding of relational dynamics [Selman, 1980; Youniss, 1980; Dunn & Plomin, 1990]. Finally, we are aware that that wider social experiences and opportunities contribute to increasing personal interest in social exchanges and attention to their quality and equity [Kelley & Thibaut, 1978; Laursen & Bukowski, 1997]. Vygotskij’s historical-cultural model strongly contributed to this change in perspective. In fact, Vygotskij [1978] stated that all psychological functions are first inter-psychic, or rather they begin within a social relationship, and only later become intra-psychic, meaning that they belong to the individual. According to this theoretical model, social contexts, including peer relationships, have a structuring role in development. The constructivist paradigm incorporated and extended these issues with the neo-Piagetian scholars [Doise & Mugny, 1981; Mugny & Carugati, 1987; Doise, Deschamps & Mugny, 1991]. Social interaction became the basic component for acquiring and building new capabilities, based on the ideas that a child is able to assess the ineffectiveness of his/her thoughts and that he/she can achieve more advanced thinking through social comparison with peers. Cognitive development consists of a “social building of intelligence” and inter-individual conflict - in other words socio-cognitive conflict - fulfils a propulsive role. This conflict, which originates in social interactions as a result of different ways of thinking, produces an imbalance that is useful in gaining an awareness of perspectives other than one’s own. Acknowledging the precocious social competence of children represented a further crucial contribution. Some ecological studies carried out in children’s life contexts - at home and in kindergarten - underlined that children, from infancy, are active subjects with cognitive, behavioral, and emotional competencies, and that they are able to actively interact with adults and peers [Schneider, 2000]. Social competence is the skill of attaining personal goals within social interaction and of maintaining positive relationships under different circumstances [Rubin, Bukowski & Parker, 2006]. We consider social competence as the result of a compromise between the need for self-realization and social adjustment and as the expression of the “self-other” dualism of each individual within a social and interpersonal context [Röhrle & Sommer, 1994; Rubin, Bukowski & Parker, 2006]. Very early on, children are capable of actively participating in social interactions with peers [Hartup, 1979, 1989; Dunn, 2004]. With time, children build more complex social relationships, such as friendships [Fonzi, 1996; Bombi, 2000; Bukowski, Newcomb & Hartup, 1996]. Observational research conducted in kindergartens [Verba, Stambak & Sinclair, 1982; Bonica, 1983, 1989, 1990; Verba, 1993; Bonica in press] underlined the complexity and vitality of peer interactions. As opposed to what scholars had previously hypothesised, this research showed the parallel development of interest by children in both physical objects and peers. Other research carried out in the family context [see: Dunn, 1988; Baumgartner & Tallandini, 2002] highlighted that during the third year of life, children are able to understand even complex emotional states experienced by others and to build a representation, although partial, of their own and other people’s mental states. Finally, from an early age, children demonstrate altruistic behavior, such as soothing a crying playmate or offering him/her one’s own favourite toy [Pines, 1980].
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The progressive increase in knowledge about different features of children’s social lives has lead scholars to go well beyond the idea of a substantially aggressive and egocentric child. Children are able to consider the intentions and wishes of other people and to help and comfort them at a much earlier age than Piaget had hypothesised. Rather than being centred only on him/herself, the child has the ability, although partial, to decentralize from him/herself and open up to other people. Therefore, children are clearly characterized by a very precocious and complex social competence [Dunn, 1988]. This new perspective has encouraged scholars to analyse the characteristics of children’s interactive strategies and, more specifically, to examine the factors and circumstances that promote the use of positive sociability strategies, such as altruistic and pro-social behavior and cooperation [Pepitone, 1980].
Cooperation Cooperation is a type of social interaction characterised by specific features. It requires the presence and the definition of a common goal among all the participants in the interaction, with each participant behaving in order to reach this common goal. This is opposed to altruistic or pro-social behavior in which one participant works for the benefit of the other, and to competition, in which the participants work against one another. Moreover, cooperation requires the coordination of individuals’ actions through planning in pairs or groups. Individuals’ contributions must be complementary and the partners must assume correlated roles. The ability to coordinate one’s actions with the actions of others means that everyone achieves his/her goal while gaining the perspective of the others in the group. Verbal communication between people engaged in a common effort may facilitate coordination even of different personal perspectives. Finally, a cooperative social interaction is characterized by a positive or at least neutral affective tone among the participants. During childhood, cooperation has a positive influence and plays a crucial role particularly in cognitive development [Smith & Craig 2002]. Cooperation with peers is essential for learning [Perret-Clermont, 1979]. The effort of sharing a goal with a partner requires a child not simply to adapt to the ideas and competencies of other people, but rather to work out a solution that considers the needs of all those involved. Cooperation may also strengthen the ability to work with others and view situations from other perspectives. As a circular process, the social capabilities the child acquires through cooperation can further promote his/her social development and adjustment. Competition differs from cooperation essentially with respect to the nature of its aim: participants act with only their own interests in mind, working against the other participants. However, although cooperation and competition lie at opposite ends of the continuum of human social strategies [Fonzi, 2003] they are not actually opposing realities since cooperation does not consist only of positive aspects and competition does not include only negative ones. In fact, sharing a common aim with other individuals using a cooperative strategy does not imply this aim is intrinsically positive. In the same way, competition does not necessarily imply overpowering other people. Additionally, the social comparison aspect of competition can be useful in the development and integration of one’s system of knowledge about oneself, others, and reality, as well as offering an opportunity to experiment
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with one’s own abilities. Competition may assume a positive role when it does not involve fighting against others, but rather fighting against the constraints imposed by reality and against one’s own limits. Competition may also contribute to self-realization and the development of personal capabilities and it may teach us how to confront frustrating situations. However, competition can carry out this positive role only when social comparison is characterized by both appreciation of the others involved and respect for social rules. Conversely, competition is maladaptive when the limit to exceed is represented by other people, when one is unable to consider the equal rights of others to be appreciated and gain self-realization, and when one is willing to use any means to achieve success. Peer relationships are privileged scenarios for cooperative strategies, particularly when children have full responsibility for the interaction. The assumption of personal responsibility by the children promotes their active role in managing interpersonal dynamics, such as seeking negotiation strategies and defining a goal that satisfies all the participants. Furthermore, we know that different factors, such as individual or contextual characteristics, may alternatively promote the use of cooperative strategies by children, or interfere with their use. In general, a distinction can be made between internal factors, like cognitive and affective factors, and external factors, such as social and situational factors. However, it is always necessary to bear in mind that these factors constantly interact with one another during the ongoing course of a social interaction in ways that we only partially understand.
Cognitive, Affective, and Social Factors that Can Promote Cooperation We know that there is a strong link between cognitive factors, such as thinking, and cooperative interactive social strategies. Thinking allows people to find a variety of solutions to the same problem. Furthermore, thinking allows people to distance themselves from reality on an emotional level as well. The ability to look beyond the reality of the present situation and come up with new solutions that take into account the needs of different people is precisely what cooperation requires. Recent studies have also demonstrated a strong relationship between cooperation and the capacity for inhibitory control, which is associated with the executive functions of the frontal and pre-frontal cortex [Nigg, Quamma, Greenberg & Kusché, 1999; Decety, Jackson, Sommerville, Chaminade & Meltzoff, 2004]. Inhibitory control, as it relates to flexibility in thinking, is the capacity to go beyond previously acquired or automatic responses and to modify one’s own behavior when faced with changing situations. Some of our research showed a positive relationship between flexible thinking and competence in cooperation during childhood and early adolescence. In their social interactions with peers, children with high flexibility in thinking use more cooperative, less competitive, and less neutral social strategies than children with low flexibility. Flexibility in thinking seems to facilitate the reconstruction of the current situation by imagining alternative solutions and overcoming more rigid, narrow perspectives [Ciairano, Bonino & Miceli, 2006]. Furthermore, flexibility in thinking also seems to have some long-term effects on the cooperation of children and early adolescents [Ciairano, Petra & Settanni, 2007]. However, the capacity to decentralise from the current situation and the ability to view the situation from other perspectives than one’s own are necessary but not sufficient in order
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to behave cooperatively. In fact, these same capabilities are also required when competing. Cooperation, however, is also influenced by affective and social factors. Cooperation requires the capacity to find a balance between the internal and external world, balancing the need for self-realization with the need for social bonds. We know that some emotional factors in particular may lead to more primitive, less adaptive strategies like aggression, or to more advanced, adaptive strategies, such as cooperation. For instance a negative emotional condition, such as the perception of powerlessness due to a specific danger or to general uncertainty, is more likely to lead to aggression than to cooperation. When levels of stress, fear, or anxiety are very high, the appearance of primitive, immature, and/or insufficiently structured actions becomes more probable. Conversely, positive emotional conditions, such as a feeling of security and mastery, may promote the use of more advanced and adaptive conduct, like cooperation. Some situational factors can also carry out a crucial role in modulating cooperation in children. Among these factors, we know that the availability of physical and psychological resources, fair distribution of benefits and rewards for personal and collective performance, and impartial social comparison can promote cooperation. Conversely, lack of resources and unequal distribution of benefits can contribute to the creation of a highly competitive climate [Tassi, 2002; Richard, Fonzi, Tani, Tassi, Tomada & Schneider, 2002]. Social comparison is relevant in the definition of individual capacity. Bandura [1997] showed a link between social comparison and self-efficacy. Self-efficacy emerges both by testing one’s own capacity to achieve certain tasks, and by having adequate ability levels with respect to those of the other people. On the one hand, social comparison can promote a competitive climate. On the other, the comparison between one’s own performance in a task and the performance of others can promote cooperative solutions when the context values intrinsic motivation, such as developing new competencies or improving personal performance, instead of extrinsic motivation. Intrinsic motives, along with the certainty that all participants will have a turn to be successful, represent positive experiences for children. Among the social factors that can promote cooperation in children, we must also consider the educational style of their parents and teachers, how strict or rigid they are, and the way these adults typically intervene in children’s peer relationships [Bonino, 2003; Fonzi & Tassi, 2003]. These factors can operate directly, fostering children’s social development by rewarding some behaviors and punishing others. However, the same social factors can also operate indirectly by promoting feelings of self-confidence or, conversely, lack of selfconfidence. Furthermore, adults’ educational styles can also affect the cognitive processes of children by promoting, more or less effectively, the capacity to decentralise from their personal perspective, and the ability to seek adaptive social responses that are cognitively mediated and less primitive, as opposed to aggression. On these theoretical bases, a cooperative form of learning has been extensively introduced in the schools. Cooperative learning originated from the construct of democratic education, introduced by Dewey [1916], and is also meant to promote progress in social life. This educational model is based on peer exchange and the process of “co-construction” of ideas, which derives from this exchange [Sullivan, 1953; Youniss, 1980]. In a collaborative context where equality is valued, children can gain new knowledge together and can validate cognitive strategies consensually. Children can learn by thinking and creating projects alongside their peers, which require common effort and commitment. Within these
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relationships children can also experience collaboration and cooperation as modalities of social interaction: ideas are discovered together, within a cooperative climate, where everyone can use the ideas of his/her classmates to complete one’s own thinking [Slavin, 1983; Johnson & Johnson, 1987].
THE PRESENT STUDY Considering the importance of cooperation and its deep roots in human nature, what is the contribution of the initial phase of the interaction (the partner may start behaving more or less cooperatively or competitively) in forming either a positive cycle of cooperation or, conversely, a vicious cycle of competition during children’s social interactions? Very few, if any, studies have investigated this aspect from a psychological point of view. We found only some economic and social-biological research on the topic. According to mathematicians and economists, cooperation is a convenient social strategy only if all the participants cooperate [to see Game Theory: Fudenberg & Tirole, 1991; Myerson, 1991]. Otherwise, the risk of losing rather than gaining is too high and the individual is more likely to select different strategies. According to social-biologists [to see Alcock, 1975, 2001; Freeman, 2002], cooperation (although in social-biology cooperation is often considered synonymous with altruism or prosocial behavior) is convenient only when we can gain an indirect advantage for our goodness of fit, in terms of increasing the probability of the survival of our genes. This can explain why animals are more willing to help individuals who share part of their genetic inheritance. In our opinion, these two perspectives are too narrow to be applied to cooperation between children. Furthermore, they do not help us to understand the underlying processes of social interaction. We also feel that there are probably great advantages to cooperating with somebody who appears likely to cooperate. Furthermore, it is not unlikely that children think it is more appropriate to act competitively when the partner also uses competition. However, these two perspectives do not help us to disentangle what happens when social interaction consists of both cooperative and competitive strategies. It seems plausible that under these particular conditions, the social interaction may end with the participants leaving the interactive field, for instance doing nothing, as suggested by the Theory of Learned Inactivity or Learned Helplessness (Peterson, Maier & Seligman, 1993; Overmier, 2002). However, the intrinsic social nature of human beings cannot be disregarded and different solutions are certainly possible. The present study investigated the relationships between cooperative and non-cooperative or competitive behavior in pairs of children in the ongoing process of interaction during a play sequence of ten minutes. We know that some social interactions both begin and end cooperatively. Other interactions start aggressively and end even more aggressively. In some social interactions one of the partners may initially behave either cooperatively or competitively and aggressively towards the other partner, who may respond with the opposite type of behavior. However, as the relationship evolves, something may change in the behavioral patterns because each partner may adapt to the behavior of the other and we are interested in discovering more about this phenomenon.
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Emanuela Rabaglietti, Fabrizia Giannotta and Silvia Ciairano More precisely this study is aimed at answering the following three research questions: 1. Are pairs who are cooperative at the beginning of the play sequence more likely to be cooperative in the second phase of play as well? 2. Are pairs who are non-cooperative or competitive in the beginning of the play sequence more likely to show non-cooperative behaviors in the second phase of play as well? 3. How do children who began the sequence with both cooperative and competitive behaviors behave in the second phase of play?
We hypothesised that: a) initially prevalent cooperative behavior is more likely to end in cooperation; b) initially prevalent competitive behavior is more likely to end in competition; c) initially mixed social interactions (both cooperative and competitive) are more likely to end in abandonment of the task, doing nothing.
Participants This study is part of wider project about cooperation in childhood [see also Ciairano, et al., 2007]. In this paper, we will consider only the second wave of this wider project. 125 couples of children participated at the study. The 69% (N=86) was same-sex couples (38%, N=47 only boys; 31%, N=39 only girls), while the remaining 31% (N=39) consisted of mixed couples. With regard to the age, the individuals within each couple shared the same age. Specifically, the 35% (N of couples=44) was eight year old, the 38% (N of couples=48) was ten year old, and the 27% (N of couples=33) was twelve year old. All the parents of the children gave informed consent for their children’s participation, in accordance with the Italian law and the ethical code of the Association of Italian Psychologists. All the instruments were administered in the school by trained researchers and teachers were not present during the examination procedure. Finally, no incentive was used to recruit participants.
Procedure Within each classroom, children were paired randomly (extracting their names). As consequence of that, the formed couples were either homogeneous (69%, N=86) or heterogeneous (31%, N=39) with regard to the gender. The randomization of individuals within classroom instead of within school was due to the fact that it was the only possible strategy accepted by the principals. Indeed, we were not allowed to mix people from different classroom groups. Finally, this is also why the couples were homogeneous as far as age concerned. They were asked to build a puzzle together. They had ten minutes to do so. During this time, they were observed by a researcher (blind to the purpose of the study), who coded their actions as cooperative, non cooperative o competitive, and neutral. For this purpose a structured checklist was built up. The checklist contained the temporal information in the columns, whereas the rows identified the behavioral categories [see for more details,
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Ciairano, Bonino, & Miceli, 2006]. It was not possible to find a high number of schools that easily allowed for filming children while playing. As consequence, no objective measure of inter-rather reliability was available for the whole area of observation. However, we managed to film the execution of the puzzle task in a school. The videos, representing the 20% of the total number of observations were coded by two independent observers (blind to the scope of the study). So that, we can calculate a percentage of consensus, which was very high (95%).
Measures Cooperation: The Puzzle Task To measure the degree of cooperation among children, we proposed a task near as much as possible their normal life: play with a puzzle. This task permitted us to observe the children’s behavior in a natural context, such as school, and at the same time in a quite structured situation. Within the same class group, couples were formed randomly and they were invited to play with a puzzle. The number of puzzle pieces was different according to the age of participants: 49 pieces for eight years old children; 60 pieces for ten years old children; 70 pieces for eleven years old children. The researcher presented two different puzzles for each pair, asking to choose what they preferred to build up. After the choice, the researcher gave the following instruction: “Now, you have to try to finish the puzzle together. You will have ten minutes”. After that, the observation started. We observed both verbal and non-verbal cooperative behavior. However, in this study we will focus only on the non-verbal cooperative actions, excluding the verbal ones. To categorize cooperative actions, we used a comprehensive checklist, based on a preliminary pilot study. The categories we used were: 1) cooperative actions – behavior directed towards reaching a common goal with the partner (e.g. showing a piece, offering a piece, accepting a piece); 2) non-cooperative or competitive – behavior directed explicitly against reaching a common goal with the partner (e.g. removing the piece of the puzzle that the partner has just built); 3) neutral – behavior involving neither attempts to share with the partner nor fighting against him/her (e.g. solitary play, watching the other child playing). An observer (blind to the motive of the study) coded every minute the number of actions as cooperative, non cooperative, and neutral, using a checklist. So doing, we got 10 indicators of cooperative, non cooperative or competitive, and neutral actions within a minute. For the purpose of this study the neutral actions were not used.
Measures A Typology of Cooperative Behavior Using the score of cooperative and non cooperative actions in the first phase of the play, we built up a typology of cooperative behavior for describing the behavior of the couple. First of all, we summed up the amount of cooperative behavior of each individual within a couple. So doing, we obtained a score of cooperative behavior of the couple within each minute. Then, the scores of the first five minutes of observations were summed up. We adopted a
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similar procedure for non cooperative behavior. Moreover, the same modus operandi was used for the scores of the second five minutes of observations. Afterward, each couple was classified as high (from half standard deviation above the average to the maximum), low (from the minimum to half standard deviation below the average), or intermediate (in the middle, that is from values greater than half standard deviation below the average and values lower than half standard deviation above the average) with respect to both cooperative and non cooperative or competitive actions. Then, we created a typology that took together these informations about cooperative and non cooperative actions in the first five minutes of playing. We called “non cooperative” couples those ones who had many non cooperative actions and few or average cooperative actions. “Cooperative couples” were those who had high levels of cooperative behavior and low or average levels of non cooperative behavior. “Mixed couples” had high or average levels of both cooperative and non cooperative behavior. Finally, “no behavior” couples were low both in cooperative and non cooperative behavior. Finally, we built up the same typology for the observations of the last fifth minutes of the play.
Analyses To explore whether cooperative couples at the beginning of the play (T1) were more likely to show cooperative behavior in the second phase of the play (T2) and whether non cooperative couples were more likely to show non cooperative behavior, we performed a MANOVA. The typology of prevalent behavior at T1 was entered as independent variable, while the couple’s score of cooperative and non cooperative behavior at T2 were entered as dependent variables. So doing, we explored whether the amount of cooperative behavior at T2 was higher in the couples that showed cooperative behavior at T1, and vice versa, whether the amount of non cooperative behavior at T2 was higher in non cooperative couples at T1. With regard to the third research question, we dichotomised the typology regarding the first phase of the play. Mixed couple at the beginning of the play were coded as 1, while the remaining couples were coded as 0. We also dichotomised the typology regarding the second phase of the play. “No behavior” couples were coded as 1, while the remaining couples were coded as 0. Then, we performed a logistic regression. We entered, as dependent, the dichotomous variable of people who gave up playing at T2, while the amount of cooperative and non cooperative behavior, and the dichotomous variables of mixed couples at T1 were entered as independent. So doing, we were able to say whether the condition of being a mixed couple at the beginning of the play influenced to being in the “no behavior” condition at the end of the play.
RESULTS Descriptive Information With regard to the amount of cooperative behavior in the couple, in general the percentage seemed to decrease in the second part of the play (T1: M=16.28, sd=13.42, T2: 21.32, sd=16.49; t=5.3, p<.00).
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On the contrary, percentage of non cooperative behavior remained stable in both times (T1: M=14.58, sd=8.13; T2: M=13.91, sd=10.37; t=1.36, n.s.). In the typology of behavior at T1, we found out 39 non cooperative couples (31%) at T1, 37 cooperative couples (30%), 20 mixed couples (16%), 29 no behavior couples (23%). Table 1. Mean and standard deviation of amount of children’ cooperative and non cooperative behaviour at T2 by typology of behaviour at T1 (MANOVA) Group
Typology at T1 Cooperative Non cooperative Mixed No behaviour *
Cooperative behaviour T2 M (SD)
Non cooperative behaviour T2 M (SD)
Sample N
38.83a (14.81) 9.87 b (6.97) 19.55c (12.73) 15.58 bc (11.04)
3.32a (4.14) 24.23b (8.01) 13.95c (5.81) 13.51c (6.92)
37 39 20 29
Same letter means equal means
Table 2. Logistic regressions, predictors of being classified a no behaviour couple at T2 Predictors Cooperative behaviour T1 Non cooperative behaviour T1 Being classified a mixed couple at T1 *
No behaviour couple T2 B coefficient -.08* -.15* .41
Standard Error .03 .05 .59
Exp(B) .92 .86 1.65
p<.05
Table 3. Logistic regressions, predictors of being classified a mixed couple at T2 Predictors Cooperative behaviour T1 Non cooperative behaviour T1 Being classified a mixed couple at T1 *
Mixed couple T2 B coefficient -.10* -.12* .48
Standard Error .037 .056 .59
Exp(B) .90 .88 1.61
p<.05.
No differences by gender (couple of girls, couple of boys, mixed couples) were found in the distribution of this typology (Chi square=4.4, n.s.). Finally, no differences by age were found in typology of behaviors at T1 (Chi square=6.6, n.s.). Thus, the distribution of couples into the fourth categories was not related to the gender and the age of the couples.
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Cooperative and non Cooperative Couples at T1 A MANOVA model was used to test the first and the second hypotheses. The multivariate analysis of variance revealed a significant multivariate main effect of the typology on cooperative and non cooperative behaviors at T2 (F(6, 238)=42.16, p<.00). With respect to univariate tests, as shown in table 1, cooperative couples at T1 scored higher on cooperative behavior at T2 than non cooperative, mixed and no behavior couples at T2 (F(3,121)=43.42, p<.00). Moreover, non cooperative couples at T1 scored higher on non cooperative behavior at T2 than the others couples (F(3,121)=66.39, p<.00). Thus, the amount of cooperative behavior at the end of the program was found to be related to how individuals interacted at the beginning of the play: cooperative couples were more likely to remain cooperative, while non cooperative couples were more likely to keep on with non cooperative behaviors. Table 4. Logistic regressions, predictors of being classified a non cooperative couple at T2 Predictors
Non cooperative couple T2
Cooperative behaviour T1 Non cooperative behaviour T1 Being classified a mixed couple at T1 *
B coefficent -.07 -.29** .59
Standard Error .06 .08 .75
Exp(B) .92 .86 1.80
p<.05 p<.01
**
Table 5. Logistic regressions, predictors of being classified a cooperative couple at T2 Predictors Cooperative behaviour T1 Non cooperative behaviour T1 Being classified a mixed couple at T1 + *
Cooperative couple T2 B coefficent .14* -.20+ 1.35+
Standard Error .04 .10 .84
Exp(B) 1.15 .81 3.86
p=.10 p<.05
Mixed Couples at T1 To test the third hypothesis, we performed a logistic regression model (see table 2). Controlling for the initial levels of cooperative and non cooperative behavior, we found out that being a mixed couple at T1 did not increase the likelihood to be in the no behaviors condition at T2 (Exp(B)=1.65, n.s.). Then, we performed three other logistic regressions to explore whether being in the mixed couple at T1 was related to being a cooperative, non cooperative, or a mixed couple at T2, again controlling for the initial levels of cooperative
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and non cooperative behaviors (see Tables 3, 4, and 5). We found out that being a mixed couple at T1 did not predict being a non cooperative couple (see table 4, Exp(B)=1.80, n.s.), nor a mixed couple at T2 (see Table3, Exp(B)=1.61, n.s.). However, being a mixed couple at T1 marginally increased the likelihood of being a cooperative couple at T2 (see table 5, Exp(B)=3.86, p=.10). Thus, our hypothesis was not confirmed, couples who showed both non cooperative and cooperative behaviors at T1 were slightly more likely to adopt cooperative behavior at T2.
DISCUSSION AND CONCLUSION The present study was aimed to investigate the interaction strategies in dyads to reach a common goal. Particularly, we observed the phenomena of cooperative and non cooperative behaviors among children’s couples who were assigned the task of building up a puzzle. The couples who started with cooperative behavior since the very beginning showed the highest level of cooperation also at the end of the play. On the contrary, non cooperative couples remained non cooperative also in the second part of the play. Thus, it seemed that the behaviors chosen at the beginning of the interaction remained stable up to the end of the interaction. Regarding to cooperative actions, we know from literature [Pepitone, 1980] that cooperation is a strategy that promotes sociality. This kind of strategy involves a process of negotiation resulting in shared behaviors. Those behaviors go beyond the individual needs and desires in order to get a common goal. This implies cognitive and social abilities. Indeed, cooperation requires perspective taking [Flavell, 1968; Nelson & Kagan, 1972], the ability to decentralize oneself [Bearison, Dorval, LeBlanc, Sadow & Plesa, 2002], and flexibility of thought [Ciairano et al, 2007]. Given that cooperation is the best strategy for the assigned task, it is reasonable to think that if people are able to cooperate since the beginning, they are likely to keep on this behavior up to the end. This would explain the stability of cooperative behavior during the play. At the same time, couples who were non cooperative at the beginning remained non cooperative until the end of the play. One may hypothesize that this happened for two reasons. First, both children in the couples did not have adequate levels of the required cognitive and social skills to cooperate. Second, one might hypothesize that other mechanisms related to peer relationship are at work in the stability of competition. Particularly, one should notice that the couples consisted of children from the same classroom. That means that children have already got to know each other. As the assignment in the couples was random, it is also likely that some dyads lacked the minimum level of “attractiveness” [Abecassis, Hartup, Haselager, Scholte & Van Lieshout, 2002; Gifford-Smith & Brownell, 2003], which they need to build a positive relationship. This might explain the presence of non cooperative behavior in the non cooperative couples since the beginning. Thus, the lack of cooperation and the presence of aversive behavior in some couples might be due either to cognitive deficit, or to the kind of previous relationship. Besides, there are couples who showed both cooperative and non cooperative behavior at the beginning of the play. Unexpected, these couples were likely to end up in the cooperative condition. However, the amount of cooperative behavior in the second phase of the play was
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higher in couples of children who were cooperative at the beginning of the play than in mixed couples. Nevertheless, mixed couples at the beginning of the game were likely to increase their level of cooperative behavior and to decrease the non cooperative actions so that they ended up as cooperative in the second phase of the play. Initially, children actively tried different types of strategies. After having experienced both, children turned to cooperation, probably because they recognised that cooperation was the best solution to reach their goal. One might hypothesize that a kind of social cognitive conflict [Mugny & Doise, 1978] occurred in these couples. Children in dyads negotiated and regulated their actions. They moved from an initial phase where they tried to balance and to experiment “individualistic” (non cooperative) and “social” (cooperative) behavior. This kind of experimentation generates a social confrontation [Moscovici, 1976], which on its side leads to raising the consciousness of the other’s perspective. Being conscious of the different perspective of the partner is the one of the requirement to start cooperating and it might be responsible of the shift toward cooperation. Thus, after an initial phase of conflict and after having explored different possibilities, children in mixed couples chose the cooperative strategies as the best ones to finish the puzzle. It would have been interesting also to investigate what would happen in the future social interaction of our mixed couples that is whether or not they will start with cooperation the next social interaction. This study has some limitations though. First of all, it was not possible to establish whether the behavior of one component of the couple influences the behavior of the other. Future studies should investigate the reciprocal effects of both partners of the interaction. Second, as abovementioned, it was not possible to know the kind of relationship of members of the couples before starting the assigned task. The previous relationship between the partners might have influenced the willingness to cooperate. Future research should investigate the result of the puzzle task distinguishing clearly between couples of friends and non friends. This new research might be interesting to know whether the cooperation skills are related to some features of the previous relationship between the partners or whether a willingness to cooperate is there independently from previous relational condition. However, our study has also some strength. It showed that the human social interactions involve much more than economic immediate gains or genetic advantages. Cooperation is not only the result of a favourable and cooperative starting: it might be also the result of an initial experimentation of different social strategies. Thus, a situation of social and cognitive conflict might be fruitful for the social development and not only for the cognitive development. From an applied perspective, this finding suggests us that mixing up more or less cooperative children in the same group is not detrimental for the cooperative individuals, and rather it may be beneficial for the individuals who are more likely to use aversive social strategies. Besides, our findings also underlined the negative potential sequence of a non cooperative starting. When the children used only non cooperative strategies at the beginning of the interaction, it seems very unlikely that they change their behavioral pattern along the play. Thus, preventing the starting of these negative social cycles seems very important from an applied perspective. Children can continue with their competition also when the task would suggest them to use cooperation in order to finish the construction of the puzzle. Summarising, human beings are particular social animals: the fact they can think seems to disentangle kind of preferred social interaction from its gains. Therefore, thinking gives us a lot of advantages. Unfortunately, it gives us also a lot of responsibility in selecting the most
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adaptive social strategy and the capacity of assuming this responsibility seems to differ in the individuals at least from childhood and early adolescence.
REFERENCES Abecassis, M., Hartup, W. H., Haselager, G. J. T., Scholte, R. H. J. & Van lieshout, C. F. M. (2002). Mutual antiphaties and their Significance in Middle Childhood and Adolescence. Child Development, 73(5), 1543-1556. Alcock, J. (1975). Animal Behavior: an Evolutionary Approach. Sunderland, MA: Sinauer. Alcock, J. (2001). The triumph of Sociobiology. Oxford, UK: Oxford University Press. Bandura, A. (1997). Self-efficacy. The exercise of control. New York: W.H. Freeman and Company. Baumgartner, E. & Tallandini, M.A. (2002). Competenze sociali e relazioni tra pari. Età Evolutiva, 73, 33-84. Bearison, D. J., Dorval, B., LeBlanc, G., Sadow, A. & Plesa, D. (2002). Collaborative Cognition: children negotiating ways of knowing. Westport, Conn: Ablex Pub. Bombi, S. (2000, Eds). Amicizia e dintorni. Età Evolutiva, 67, 28-71. Bonica, L. (1983). L’autonomia del bambino durante il gioco. In S. Mantovani & T. Musatti (Eds), Adulti e bambini: educare e comunicare – La ricerca in asilo nido (pp.70-80). Bergamo, Italy: Juvenilia. Bonica, L. (1989). La risoluzione dei conflitti tra bambini: la similarità umana come facilitatore della competenza psicosociale. Pedagogia clinica, 6, 30-32. Bonica, L. (1990). Négotiations interpersonnelles et jeux de fiction. In Stambak M. & Sinclair H. (Eds), Les jeux de fiction entre enfants de 3 ans (pp.113-150). Paris: PUF. Bonica, L. (in press). Gruppi di gioco come sistemi dinamici. Interazioni triadiche e comprensione della mente nel secondo anno di vita. Bergamo, Italy: Edizioni Junior. Bonino, S. & Ciairano, S. (1997). Effetto Stroop e capacità di inibire l'automatismo: Una ricerca in campo evolutivo. Giornale Italiano di Psicologia, 3, 587-603. Bonino, S. & Ciairano, S. (1998). Cooperazione e Nomina dei pari: Una misura di competenza sociale. Età Evolutiva, 59, 21-32. Bonino, S. & Ciairano, S. (2000). Flessibilità di pensiero e competenza sociale nella fanciullezza e preadolescenza: Un’indagine sulla capacità di inibizione. Età Evolutiva, 65, 18-32. Bowlby, J. (1988). A Secure Base. London: Routledge. Bukowski, W. M. Newcomb, A. F. & Hartup, W. W. (1996, Eds). The company they keep: Friendships in childhood and adolescence. Cambridge, UK: Cambridge University Press. Ciairano, S., Bonino, S. & Miceli, R. (2006). Cognitive flexibility and social competence from childhood to early adolescence. Cognition, Brain, Behavior, 10(3), 343-366. Ciairano, S., Petra, L. & Settanni, M. (2007). A two-year longitudinal study of inhibitory abilities in relation to social competence during early school years. Journal of Abnormal Child Psychology, 35(3), 335-345. http://dx.doi.org/10.1007/s10802-006-9094-z. Decety, J., Jackson, P. L., Sommerville, J. A., Chaminade, T. & Meltzoff A. N. (2004). The neural bases of cooperation and competition: An fMRI investigation. NeuroImage, 23, 744-751.
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Dewey, J. (1916). Democracy and education. New York: The Macmillan Company. Doise, W. & Mugny, G. (1981). Le développement social de l’intelligence. Paris: Inter Editions. Doise, W., Deschamps, J. C. & Mugny, G. (1991). Le conflit socio-cognitif. Paris: Armand Colin. Dunn, J. (1988). The beginnings of social understanding. Cambridge, MA: Harvard University Press. Dunn, J. & Plomin R. (1990). Separates lives. Why siblings are so different. New York: Basic Books. Dunn, J. (2004). Children’s Friendships. The beginnings of Intimacy. Oxford, UK: Blackwell Publishing Ltd. Flavell, J. H. (1968). The development of role-taking and communication skills in children. New York, : Wiley. Freeman, S. (2002). Biological Science. Upper Saddle River, NJ: Prentice Hall. Fonzi, A. (1996, Eds). L’amicizia tra bambini. Età Evolutiva, 54, 70-116. Fonzi, A. (2003, Eds). Cooperare e competere tra bambini. Firenze, Italy: Giunti. Fonzi, A. & Tassi F. (2003). Gli stili educativi dell’adulto e la cooperazione tra bambini. In A. Fonzi (Eds), Cooperare e competere tra bambini (pp. 77-92). Firenze, Italy: Giunti. Fudenberg, D. & Tirole, J. (1991). Game Theory. Cambridge, MA: MIT Press. Gifford-Smith, M. E., Brownell, C. A. (2003). Childhood peer relationships: Social acceptance, friendships, and peer networks. Journal of School Psychology, 41, 235-284. Hartup, W. W. (1979). The social worlds of childhood. American Psychologist, 34, 944-950. Hartup, W. W. (1989). Social relationships and their developmental significance. American Psychologist, 44, 120-126. Hazan, C. & Shaver, P. R. (1987). Conceptualizing romantic love as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. Johnson D. W. & Johnson R. T. (1987). Learning together and alone. Englewoods Cliffs, NJ: Prentice-Hall. Kelley, H. H. & Thibaut, J. W. (1978). Interpersonal Relations: A Theory of Interdependence. New York: John Wiley & Sons Laursen, B. & Bukowski, W. M. (1997). A Developmental Guide to the Organisation of Close Relationships. International Journal of Behavioral Development, 21(4), 747-770. Myerson, R. B. (1991). Game Theory: Analysis of Conflict. Cambridge, MA: Harvard University Press. Moscovici, S. (1976). Social influence and social change. London: Academic Press. Mugny, G. & Doise, W. (1978). Socio-cognitive conflict and structure of individual and collective performances. European Journal of Social Psychology, 8, 181-192. Mugny, G., Carugati, F. (1987). Psicologia sociale dello sviluppo. Firenze, Italy: GiuntiBarbera. Nelson, L. L. & Kagan, S. (1972). The star-spangled scramble. Psychology Today, 6, 53-56, 90-91. Nigg, J. T., Quamma, J. P. Greenberg, M. T. & Kusché, C. A. (1999). A two-years longitudinal study of neuropsychological and cognitive performance in relational to behavioral problem and competencies in elementary school children. Journal of Abnormal Child Psychology, 27(1), 51-63.
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Overmier, B. (2002). On Learned Helplessness. Integrative Physiological and Behavioral Science, 37(1), 4-8. Piaget, J. (1975). L’équilibration des structures cognitives: Etude d’épistémologie génétique XXXIII. Paris: PUF. Pepitone, E. (1980). Children in cooperation and competition. Toward a developmental social psychology. Lexington, Mass: Lexington Books. Perret-Clermont, A.N. (1979). La construction de l’intelligence dans l’interaction sociale. Bern, Suisse: Peter Lang. Peterson, C., Maier, S. F. & Seligman, M. E. P. (1993). Learned Helplessness: A theory for the Age of Personal Control. New York, US: Oxford University Press. Pines, M. (1980). Il buon samaritano a due anni. Psicologia contemporanea, 41, 9-16. Richard, J. F., Fonzi, A., Tani F., Tassi F., Tomada G. & Schneider B. H. (2002). Cooperation and Competition. In P.K. Smith & H. H. Craig (Eds.), Blackwell Handbook of Childhood Social Development (pp. 515-532). Oxford, UK: Blackwell Publishers Ltd. Röhrle, B. & Sommer, G. (1994). Social support and social competence: Some theoretical and empirical contributions to their relationship. In F. Nestmann, K. Hurrelmann (Eds), Social Networks and Social Support in Childhood and Adolescence (pp. 111-128). Berlin, Germany: Walter de Gruyter. Rubin, K. H., Bukowski, W. & Parker, J. G. (2006). Peer Interactions, Relationships, and Group. In W. Damon (Ed), Handbook of child psychology (pp. 619-699). New York: Wiley. Rutter, M. & Rutter, M. (1993). Developing mind. New York: Basic Book. Schneider, B.H. (2000). Friends and enemies. London, UK: Arnold,. Schaffer, H. R. (2004). Child Psychology. Oxford, UK: Blackwell. Selman, R. L. (1980).The growth of interpersonal understanding: Developmental and clinical analyses. New York: Academic Press Slavin, R. E. (1983). Cooperative Learning. New York: Longman. Smith P. K. & Craig H.H. (2002, Eds.), Blackwell Handbook of Childhood Social Development. Oxford, UK: Blackwell Publishers Ltd. Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: Norton. Tassi F. (2002b). Competizione e cooperazione. In S. Bonino (Eds), Dizionario di psicologia dello sviluppo (pp. 134-137). Torino, Italy: Einaudi. Vygotskij, L.S. (1978). Mind in society. Cambridge, MA: Harvard University Press. Verba, L. (1993). Construction and sharing of meanings in pretend play among young children. In M. Stambak & H. Sinclair (Eds.), Pretend play among 3 year-olds (pp. 8893). Hillsdale, N.J: Erlbaum. Verba, M., Stambak, M. & Sinclair, H. (1982). Physical knowledge and social interaction in children from 18 to 24 months of age. In E. G. Forman (Ed.), Action and thought. From sensorimotor schemes to symbolic operations (pp.267-296). New York: Academic Press. Youniss, J. (1980). Parents and peers in social development: A Sullivan-Piaget perspective. Chicago, IL: University of Chicago Press.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 23
SOCIAL RELATIONSHIPS AND PHYSICAL HEALTH: ARE WE BETTER OR WORSE OFF BECAUSE OF OUR RELATIONSHIPS? Julianne Holt-Lunstad Department of Psychology, Brigham Young University, Provo, Utah 84602, USA
Briahna Bushman Department of Psychology, Brigham Young University, Provo, Utah 84602, USA
ABSTRACT When asked, “What is necessary for your happiness?” or “What is it that makes your life meaningful?” most people mention before anything else-- satisfying close relationships with family, friends, or romantic partners (Berscheid, 1985). Relationships with others form a pervasive role in our everyday lives and are generally regarded as emotionally satisfying. Although it may not be surprising that social relationships are associated psychological benefits, there is also evidence to suggest that these relationships have beneficial effects on physical health and/or the lack of meaningful relationships may be detrimental (Berkman, 1995; Cohen, 1988; House, Landis, & Umberson, 1988). In fact, reviews of the literature indicate that a lack of meaningful relationships is associated with increased risk for morbidity and mortality from a variety of causes (Berkman, 1995; House, Landis, & Umberson, 1988). Importantly, both the quantity and quality of social relationship can affect health and mortality. Overall, research suggests that having more and better quality relationships is associated with beneficial effects on health, while fewer and negative relationships are associated with detrimental effects on health (see Uchino, 2006 for a review). Therefore, a complete understanding of health-related consequences of social relationships requires simultaneous consideration of both the negative and the positive aspects of social experience. In this chapter, the health consequences of social relationships will be examined. This chapter will proceed by first, reviewing definitions of social support; second, a brief review of the substantial body of evidence that has linked social relationships with health benefits will be provided; third, the chapter will also include a brief review of the
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Julianne Holt-Lunstad and Briahna Bushman evidence showing the negative side of relationships (e.g., negativity and conflict within relationships is associated with negative health outcomes); and finally, the bulk of the chapter will focus on a relatively newer line of research that examines relationships that are characterized by both positive and negative aspects (ambivalent relationships). Because research has examined the positive and negative aspects of relationships separately, less is known about relationships that are not entirely positive or negative-but a mix of both negative and positive feelings. The remainder of this chapter will (1) define ambivalent relationships and provide theoretical and empirical justification for examination of ambivalent relationships; (2) summarize evidence linking ambivalent relationships to both mental and physical health outcomes; (3) provide evidence regarding maintenance of ambivalent relationships; and (4) propose future research. Thus, this chapter will summarize empirical research on the health impact of social relationships characterized by mixed-feelings (ambivalence). This data on ambivalent relationships will be presented in the context of the larger literature on social relationships and physical health and highlight the need for new directions in social relationships research.
SOCIAL SUPPORT DEFINED The way in which social support has been examined varies considerably across studies. Despite the vast diversity in methods, social support is usually conceptualized in such a way as to refer to the structures of an individual’s social life or the more explicit functions that they may serve (Uchino 2004; Feldman & Cohen, 2000). Structural aspects of relationships often refer to the size or diversity of one’s social network. Studies that examine structural aspects often operationalize social support in terms of one’s marital status, the number of relationships within one’s social network, or the types of relationships one might have (e.g., family member, coworkers, ties to community, religious affiliations, etc). Previous research suggests that structural aspects of social support are important through their provision of a sense of self identity, appropriate norms for behavior, and greater meaning or worth to life (Umberson, 1987; Stryker & Burke, 2000). One of the clearest illustrations of the benefit of a social structure is that of marriage. Marriage has increased benefits for health through a number of possible means. Married individuals tend to live longer, and are usually happier than single counterparts (Gump, Polk, Karmarck, & Shiffman, 2001; Ditzen et al., 2007; Grewen, Gridler, Amico, & Light, 2005). One possible reason for this effect is the sense of identity that the marital role of being a spouse provides, creating greater meaning and purpose for life. Further, marriage can influence health behaviors in a positive way through normative influence such as regulating a specific diet, encouraging doctors visits, or encouraging the avoidance of risky behaviors, just to name a few. Although these structural factors of relationships are important, the quality of these relationships is also important. Relationships serve important functions. For instance, relationships may be influential by providing good advice (informational support); helping you feel better about yourself (emotional support); directly providing aid, such as loaning you money or giving you a ride to the airport (tangible support); or just ‘hanging out” with you (belonging support). It is important to note, that these functional aspects of social support can
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be assessed in terms of objectively “received support” or the perceptions of others willingness to help (i.e., perceived support). Although these are all legitimate ways of measuring social support they are obviously measuring different sub-constructs. Therefore social support can generally be conceptualized according to three sub-constructs: (1) the degree of embeddedness or integration in a supportive network; (2) the actual interactions that are intended to be supportive; (3) the beliefs and perceptions of support held by the individual. Since these measures are focused on different sub-constructs it is not surprising that there are low correlations between these types of measures (typically between .20 and .30; Barrera, 2000). However, while the effects may differ, all have been associated with physical health outcomes (Uchino, 2004).
THEORETICAL MODELS LINKING SOCIAL SUPPORT TO HEALTH While a number of different mechanisms underlying this relationship have been proposed, most of the models linking social support to health outcomes are variants of what are termed stress-related and direct effect models (Uchino, 2004, Cohen et al., 2000). The most prominent stress-related perspective is the buffering model which predicts that social support is health promoting as it diminishes or “buffers” the negative effects of stress in a person’s life. In comparison, the direct effect models operate across a wide range of circumstances and suggest that social support is beneficial regardless of life stress (Uchino, 2004; Cohen, 2004).
Stress Related Models of Social Support The stress buffering hypothesis has been the primary model considered by psychologists interested in health interventions (Cohen et al., 2000; Cohen, 2004). The buffering model suggests that social relationships “buffer” or protects individuals from the potentially pathogenic influence of stressful events. Stress is thought to influence health by both promoting behavioral coping responses detrimental to health, and by activating physiological systems such as the sympathetic nervous system and the hypothalamic pituitary-adrenalcortical axis (Cohen, Kessler, & Gordon, 1995). This protection can occur in two ways. First, support may intervene between the event and the stress reaction. Presumably before we would experience a stress reaction we must first appraise the event as stressful (i.e., harm, threat, or challenge; Lazarus, 1966). The perception that others may provide resources and/or bolster one’s perceived ability to cope with the event may alter the appraisal of the situation as being highly stressful. Likewise, social support may intervene between the stress reaction and any illness. This can occur by minimizing the impact of the stressful reaction by providing a solution to the problem, minimizing its perceived importance, encouraging healthy behaviors, and/or by “tranquilizing the neuroendocrine system so that people are less reactive to perceived stress” (Cohen and Wills, 1985). However, according to this theoretical model, when there is little or no stress, social support may have few physical or mental health benefits. Therefore, this model emphasizes the role of social relationships in coping with stress.
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Direct Effects Models of Social Support The second proposed pathway is the main effects model which maintains that social support is generally beneficial independently of stress. Rather than emphasizing the buffering effects of support in times of stress, the direct effects models emphasize the overall benefits of merely being embedded in a social network (Berkman, 1995; Cohen et al., 2000; Cohen and Wills, 1985; Uchino, 2004; Cohen, 2004). The evidence to support these direct effects tend to originate from more structural measures of support, as they tap into the existence of a variety of social roles and ties as well as an individual’s integration within these differing relationships (Uchino, 2004). One suggested mechanism through which support may directly affect health is suggested by identity theorists who argue that being part of a social network is health protective because it gives individuals meaningful roles that provide esteem and purpose to life (Thoits, 1983; Cohen, 2004). Reviews suggest there may be evidence consistent with both models (Cohen & Wills, 1985; but also see Barerra, 1986). There is evidence for a buffering model when the social support measure assesses the perceived availability of interpersonal resources that match the needs elicited by stressful events. Evidence for a main effects model is found when the support measure assesses a person’s degree of integration in a large social network. Suggesting that both conceptualizations of social support may be correct in some respects, but each represents a different process through which social support may affect well being. However it should be noted that while the stress-buffering model has received significant support in cross-sectional studies, it is increasingly being criticized for the failure to find such effects in prospective studies (Burton, Stice, & Seeley, 2004). Thus, despite the fact that the stress-buffering hypothesis is widely accepted it may have limited explanatory power relative to the main effects model.
SOCIAL RELATIONSHIPS AND PHYSICAL ILLNESS Epidemiological research indicates that supportive relationships may significantly protect individuals from various causes of mortality (Berkman, Leo-Summers, & Horwitz, 1992; Brummet et al, 2005). For instance, in a review of several large prospective studies examining mortality risk from all causes, the evidence indicates that age-adjusted mortality rates are higher among individuals with relatively low social integration than individuals high in social integration (House et al, 1988). These associations hold even when controlling for standard control variables such as age and initial health status. Importantly, controlling for initial health status helps clarify the direction of the association between social support and mortality risk. For example, it could be that illness leads to social isolation either through social withdrawal, because you’re too sick to leave the house or when you’re sick you just don’t feel like being around others, or through social rejection (sick people aren’t very fun to be around, or illnesses such as HIV may be stigmatizing). Therefore, it is possible that illness leads to social isolation. However, the review found that regardless of initial health status or age, persons with higher social contact had lower mortality rates. In fact, the evidence linking social relationships to mortality was
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comparable to the evidence linking standard risk factors such as smoking, exercise, and diet to mortality (House et al, 1988). Likewise, in a prospective study by Blazer (1982) it was found that the magnitude of the relationship between social support and risk of mortality was greater when measures of perceived support were analyzed than were measures of social contact. Thus, it appears that having many social connections is highly associated with mortality risk, but that perceived social support is also strongly associated with mortality rates. There is also considerable evidence suggesting that social support is inversely related to the prevalence and incidence of the most common cause of death in the U.S.-- cardiovascular heart disease (Broadhead et al., 1983; House, Landis, & Umberson, 1988). Levels of social support among myocardial infarction (or Heart attack) patients predicted mortality after controlling for severity of disease, co-morbidity, functional status, as well as the standard cardiac risk factors such as smoking and exercise (Berkman, Leo-Summers, & Horowitz, 1992). Likewise, evidence that patients who are socially integrated or receive high social support are more likely to recover from heart attack, need less time in the hospital, and are less likely to experience a recurrence of symptoms (Berkman, 1995). Hence, social support appears to influence the development and clinical impact of CHD. To summarize, epidemiological studies suggesting that both the quantity and quality of one’s relationships predicts lower all-cause mortality (see reviews by Berkman et al., 2000; House et al., 1988, Uchino, 2004). The links between social relationships and health are most evident for cardiovascular mortality (Berkman et al., 1992; Brummett et al., 2001; OrthGomer, Rosengren, & Wilhelmsen, 1993), with some studies showing links with lower cancer (Ell, Nishimoto, Medianski, Mantell, & Hamovitch, 1992; Welin et al., 1992) and HIV mortality (Lee & Rotheram-Borus, 2001). Thus, we have good evidence that an association between social relationships and physical health does exist.
IMPORTANCE OF RELATIONSHIP QUALITY These epidemiological data are often taken as evidence for the health benefits of social relationships; however, even close relationships are not entirely positive. Although social relationships can be sources of warmth, caring, nurturance, and understanding, they can also be sources of conflict, criticism, jealousy, and rejection (Major et al, 1997). Research from the Terman Life Cycle study suggests that past negativity in social relationships predicts greater mortality (Friedman et al., 1995; Tucker, Friedman, Wingard, & Schwartz, 1996). Likewise, unhappy marriages are associated with greater morbidity and mortality (Robels & Kiecolt-Glaser, 2003). Therefore, a complete understanding of health-related consequences of social relationships requires simultaneous consideration of both the negative and the positive aspects of social relationships. Some relationships are characterized by a blend of both positive and negative aspects. For example, although you may love this person or enjoy this persons company much of the time, he/she can also be frustrating, demanding, blaming, competitive, or inconsiderate. Whether it is a colleague, a friend, in-laws, a roommate, or a family member—many individuals have people in their social network that might fit this description. In fact, prior research among both college age and older adult samples has found that roughly half of one’s social network
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was made up of such relationships (Uchino et al, 2001). So, where do these relationships fit within such definitions? They are not entirely positive, nor are they entirely negative.
AMBIVALENT RELATIONSHIPS AND HEALTH Although it is clear that many relationships are not entirely supportive or positive, the majority of studies in this area have assumed a sort of homogeneity in regard to the relationships being studied. Thus relationships have been looked at unidimensionally as either positive and supportive or negative and unsupportive. The positive and negative aspects of relationships, however, are separable dimensions (Finch, Okun, Barrerra, Zautra, & Reich, 1989; Fiore, Becker, & Coppel, 1983; Kiecolt-Glaser, Dyer, & Shuttleworth, 1988; Ruehlman & Karoly, 1991), meaning that they can coexist with one another. Consequently, this accounts for the mixed feelings of both positivity and negativity that many people experience in their social relationships (Uchino, Holt-Lunstad, Uno, & Flinders, 2001). Overall, supportive relationships have been found to have beneficial effects on morbidity and mortality, while the research suggests that negative relationships do not have the protective health benefits of positive relationships and have been linked to detrimental effects on health (Bloor, Uchino, Hicks, & Smith, 2004; House, Umberson, & Landis, 1988; Lepore, 1992). However, there is very little research examining relationships which contain both high positivity and high negativity and whether people may benefit from the positivity that exists in these relationships or if the concurrent negativity would be more salient.
Ambivalent Relationships Theoretical Model and Definitions Data suggests that any given social network member may differ in the degree to which they are perceived as being positive and/or negative (Holt-Lunstad, J., Uchino, Smith, OlsenCerny, & Nealy-Moore, 2003; Cacioppo & Berntson, 1994). The following organizational framework has been proposed (see figure 1). For example, a social network member that is primarily a source of social support would represent the high positivity / low negativity corner (e.g., a friend you can always count on). A network member that is primarily a source of negativity or what we label a socially aversive relationship would represent the low positivity / high negativity corner (e.g., an unreasonable supervisor). Those low in both positivity and low negativity are labeled as social indifference and may represent a network member that is characterized by relatively low levels of social interactions (e.g., fellow students in a class, fellow church goers). A relatively unique aspect of this conceptualization for the social relationships and health literature is represented in the high positivity / high negativity corner or what we label a socially ambivalent network tie. Social ambivalence refers specifically to a social network member that one feels both positively and negatively towards (e.g., an overbearing mother, a competitive friend, a volatile romance). As stated earlier, there is evidence to suggest that more and better relationships have a positive impact on health, while fewer and negative relationships are associated with detrimental effects on health. Thus, it was unclear whether we might benefit from the positive
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aspects of ambivalent relationships (e.g., Abbey, Abramis, & Caplan, 1985); or whether a negativity bias might exist, such that the negative aspects of these relationships is more salient (e.g., Sandler & Barrera, 1984)—thereby leading to negative effects on health.
Figure 1. Model of social relationships incorporating the positive and negative aspects of social relationships (Uchino, Holt-Lunstad, Uno, & Flinders, 2001).
Why Ambivalence May Influence HEALTH Although it may be possible that people may benefit from positivity that exists in these relationships, there is reason to believe that the negativity may be influential. One important reason why an examination of ambivalent ties, separate from supportive and aversive ties, may be important is that a network filled with ambivalent ties may entail significant interpersonal stress (i.e., stress enhancing hypothesis). If a social network member is primarily a source of negativity, one may habituate to the aversive relationship by using specific coping strategies (e.g., discounting or avoidance). However, an ambivalent network member who you feel particularly positive and negative towards is in theory less predictable and thus may be associated with more heightened interpersonal stress (Mason, Frankenhouser, 19??). Likewise, interactions with an ambivalent network member may be ambiguous and not very clear-cut, so efforts to understand these interactions may lead to increased ruminative thinking (Gal & Lazarus, 1975; Kaloupek & Stoupakis, 1985). An additional pathway in which social relationships are thought to have an effect on health is by buffering the negative effects of stress (i.e., the support interference hypothesis). It is thought that relationships that are supportive can help one cope with the stresses in their lives and therefore, one might be less likely to suffer the negative effects of stress. However, individuals may be less likely to seek support from ambivalent relationships or may not benefit from support received. Regardless of the explanation there appears to be reason to believe that ambivalent relationships may not have the same effect as supportive relationships.
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Ambivalence Studies I will present a line of studies that has examined the multiple dimensions of social relationships and its association to health-relevant physiological processes. More specifically, these studies address the question: “does social ambivalence have unique effects on health from what is predicted by supportive and aversive social relationships?” It is noteworthy that this is a relatively new line of research. Social relationships are complex and there are potentially a number of factors that are involved, including individual differences, relationship type, etc. Likewise, health is also a very broad concept and there may be a number of factors contributing to health outcomes, which may also differ depending on the specific health end-point. Given this, it is important to start by acknowledging that these factors that are important. However, the studies presented here represent the critical first steps in this line of research. Although there are a number of ways in which health outcomes could be examined, perhaps one of the most compelling first steps would be to examine the impact on cardiovascular functioning since CHD is the number one cause of death in the U.S. for both men and women. You may have thought to yourself “how do we get from our day-to-day interactions with our relationships to dying of heart disease?’ One way this can occur is through elevations in BP either during the time of the interaction or long term consequences of repeated interactions. These alterations in cardiovascular function may then impact CHD risk. Cardiovascular functioning was assessed by either examining cardiovascular reactivity in the lab (for review see Smith & Ruiz, 2002) or ambulatory blood pressure in one’s everyday life (Verdecchia et al 1994; Kikuya et al, 2005). Importantly, preliminary research suggests that the positivity and negativity within social relationships may predict these changes in cardiovascular functioning.
Network Ambivalence, Age, and Reactivity In order to test whether ambivalent relationships were beneficial or detrimental, one of the first studies focused on the association between the extent of ambivalent relationships within one’s network and age-differences in cardiovascular function. Specifically, we assessed the different categories depicted in figure 1 using the social relationships index (SRI; see Uchino et al., 2001; Campo, Uchino, Holt-Lunstad, Vaughn, Reblin, & Smith, under review; for scale validation information) according to the total listed number of individuals in one’s network who were only sources of support, aversion, indifference, or ambivalence. The influence of these categories was examined among a sample of adults between the ages of 30 and 70 (men and women) while they performed an acute stress protocol (Uchino et al., 2001). Consistent with prior research there was cardiovascular evidence for the benefits of having socially supportive ties; however, there was also a significant interaction between age and ambivalent ties. Individuals with high numbers of ambivalent network ties showed greater heart rate reactivity, and a greater shortening of PEP reactivity (indicating greater sympathetic activation of the heart) as a function of age. In comparison, age did not predict heart rate or PEP reactivity for individuals characterized by a relatively low number of ambivalent network members. These results were independent of demographic variables, task performance, affect, health behaviors, and other categories of relationships (e.g., number of supportive ties). Thus, these data provided support for the model depicted in figure 1, as well
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as a developmental process involving social ties, aging, and disease. Of course, longitudinal evidence will be needed to provide stronger evidence for such a model.
The Influence of Ambivalent Relationships within Daily Life We were also interested in the link between the different categories of relationships (supportive, aversive, ambivalent, & indifferent) and cardiovascular functioning by assessing BP during everyday social interactions (Holt-Lunstad et al., 2003). Ambulatory BP is somewhat different from blood pressure taken in a clinic or lab in that the monitor is portable and worn on the participant throughout the day. Rather than 1 or even a few readings taken in a clinic, several readings are taken in the natural environment that the person normally experiences. Importantly, studies suggest that elevated ambulatory BP may be a stronger predictor of cardiovascular outcomes, including overall morbidity and mortality (Perloff, Sokolow, & Cowan, 1983) than are clinic blood pressure readings. It was predicted that interactions with supportive network members (i.e. primarily positive relationships) would be associated with the lowest ambulatory BP, while interactions with ambivalent network members would be associated with the highest ambulatory BP levels, irrespective of relationship type. In this study, male and female volunteers underwent a 3-day ambulatory blood pressure (ABP) assessment where a reading was taken approximately 5 minutes into each social interaction. After each interaction, participants completed a standard diary that also included ratings of the quality of the relationship in terms of how positive and negative they normally felt toward the interaction partner. Consistent with prior research interactions with people rated as primarily positive were associated with greater ratings of intimacy, greater selfdisclosure, higher positive affect, and lower negative affect. In comparison, interactions with negative relationships predicted lower levels of self-disclosure, less positive affect, and higher negative affect. Consistent with the framework depicted in figure 1, significant statistical interactions for relationship positivity and negativity emerged in predicting ambulatory SBP and ambulatory DBP. The highest ABP was found when participants were interacting with a person they felt relatively high levels of both positivity and negativity (ambivalence). Importantly, the effect of ambivalent relationships was not only higher than interactions with supportive relationships; it was also higher than interactions with aversive relationships. It is also important to note that this statistical interaction remained significant while statistically controlling for structural characteristics of the relationship (i.e., familial / non-familial classification). Thus, ambivalence seems to be bad regardless of the relationship type. These findings suggest that interactions with ambivalent relationships may have detrimental effects on ambulatory cardiovascular functioning, and perhaps ultimately, cardiovascular health. Ambivalent Relationships: Stress Enhancing or Support Interference? As stated earlier ambivalent relationships might be associated with higher cardiovascular functioning because they are associated with greater interpersonal stress or because individuals may not be able to benefit from support from ambivalent relationships. Unfortunately, although this study did assess the quality of the interaction, the exact nature of the interaction was unclear-- whether or not the individual was actually seeking support from the person they were interacting with or having a casual conversation. Therefore, the next
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study utilized a laboratory paradigm to isolate specific dimensions of social relationships and its relation to psychological and physiological processes. This study was designed to examine the nature of the interaction. Prior research has primarily examined social support as a coping resource in times of stress, however, we seek out our relationships during both the good times and the bad (Gable, Reise, & Impett, 2004), and it is predicted that the quality of one’s relationship will influence our responses to these situations. Specifically, (1) if individuals are unable to benefit from support from ambivalent relationships during times of need or stress then we should see increased reactivity to disclosing negative events; (2) however, if ambivalence is a general source of stress, then we would expect increased reactivity to both positive and negative events. In this study, participants were randomly assigned to bring in either a supportive or ambivalent friend, and randomly assigned to talk with their friend about either a positive or negative event. Testing was divided into two sessions. For the first session participants were asked to complete the Social relationships index (SRI), to assess the participant’s perception of their friend within negative, positive, and neutral contexts. Based on these ratings we were able to identify friends in their network that would be classified as either supportive or ambivalent. During the second session participants brought their friend (unaware of the assigned condition) with them to the laboratory. We first got a baseline measure of resting cardiovascular function. Then, as a neutral comparison to the event discussion, the participant and friend were instructed to discuss what they do during a normal weekday with each other for four minutes. After which, a second baseline was obtained. Finally, participants and their friend discussed either the positive or negative experience (depending on random assignment to outcome condition) while cardiovascular assessments were obtained. The social interaction was structured so that participants and their friend alternated speaking for one minute each. The participant spoke regarding their personal feelings about the event, while the friend was asked to simply respond as they would naturally. Preliminary analyses showed that ambivalent friends were viewed as significantly more dominant than supportive friends. No relationship-based differences in reactivity were found when participants discussed a neutral topic with their friend. However, there was a significant interaction between relationship quality and the event topic on SBP reactivity. As predicted by the support interference hypothesis, participants exhibited the greatest levels of SBP reactivity when disclosing a negative event to an ambivalent friend. Although our results appear more consistent with the support interference hypothesis, it is possible that seeking support from an ambivalent friend during negative life events is in itself stress-enhancing and can contribute to support interference. In addition, other results suggested more subtle ways in which ambivalent friends may be stressful. State anxiety was elevated for individuals who were with an ambivalent friend throughout the entire study (including relaxation/baseline periods). Also, analyses of baseline levels of cardiovascular activity showed that participants anticipating interacting with ambivalent friends had significantly higher heart rate, an effect driven by lower parasympathetic control of the heart (as indexed by RSA). Thus, these data may indicate a reduced ability to regulate aspects of the cardiovascular system in the presence of such ambivalent ties.
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Ambivalent Relationship Maintenance Given the potential negative effects of ambivalent relationships, it may be important to understand the potential extent of their influence. There is growing evidence that relationships for which we have mixed feelings may be common and pervasive. Ambivalent relationships appear to be so common that the vernacular term “frenemy” has become commonplace. For example, there are television sit-com episodes devoted to “frenemies” and a recent internet search of the term “frenemy” resulted in over 50,000 hits. When systematically examining social networks of both undergraduate and community samples, ambivalent relationships are found among all relationship types (e.g., spouse, family members, friends, co-workers, and social acquaintances) and individuals report roughly equivalent proportions of supportive and ambivalent relationships (Uchino et al., 2001). Prior research has also demonstrated that supportive and ambivalent ties occur more frequently in individuals’ networks than aversive ties (Fingerman, Hay, & Birditt, 2004; Newsom, Rook, Nishishiba, Sorkin, & Mahan, 2005; see also Rook, 2001). Likewise, the frequency of contact with ambivalent relationships was found to be similar to amount of weekly contact with supportive relationships (Holt-Lunstad et al. 2007). Thus, ambivalent relationships may be both common and detrimental. If ambivalent relationships are potentially detrimental, why don’t people end these relationships? While some relationships (e.g., family, work) aren’t as easy to exit as others, we found similar frequency distributions of supportive and ambivalent friendships (HoltLunstad et al., 2007)—presumably a voluntary relationship. Thus, a recent study was designed to examine the potential reasons for why individuals would maintain their ambivalent friendships, as well as how these friendships are maintained (Bushman & HoltLunstad, under review). Specifically we examined the influence of external and internal maintenance factors, as well as intimacy and distancing in relationship maintenance within ambivalent and supportive friendships. Participants included male and female undergraduates, who were randomly assigned to rate either a supportive or ambivalent friend on these measures of relationship maintenance. Results suggest that ambivalent relationships are not maintained primarily due to obligation or external barriers, but rather are viewed as voluntary associations maintained primarily because of internal factors such as personal commitment to the relationship. Results also suggest that the positive aspects of ambivalent friendships are either redeeming or impede termination. Likewise, for women, both ambivalent and supportive friendships were being maintained in a significantly more intimate manner than were men’s. Due to the stressful nature of ambivalent relationships, women’s intimacy with their ambivalent friends may have serious implications for health outcomes. Despite the positive aspects of ambivalent friendships, this study also found that relational distancing, both physical (staying away from the individual) and emotional (not self disclosing), was utilized significantly more frequently as a coping technique within ambivalent friendships than within supportive friendships. Distancing was originally studied in regard to aversive or purely negative relationships that would not be categorized as friendships, thus the finding that distancing was significantly used in ambivalent friendships is an interesting finding in regard to relationships that are being classified by participants as “friendships.” Since this study assists in outlining some of the techniques currently used in coping with these relationships, the above findings help to create a starting point for
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examining the most adaptive and effective relationship maintenance strategies for both men and women who are interacting in such friendships.
CONCLUSIONS In summary, these studies were guided initially by two questions regarding the specificity of the association between social relationships and health. First, are ambivalent relationships associated with health relevant processes? Our results provide further evidence that blood pressure is one potential physiological mechanism linking social support and health, and importantly find that this association is moderated by the extent of concurrent negativity within the relationship. Also, we were able to find these associations both in a naturalistic setting and then complemented by our data from a tightly controlled study. Second, under what conditions does ambivalence seem to be important? Although supportive and ambivalent relationships are equivalent on perceptions of positivity, our data suggests that individuals may be unable to benefit when seeking support from ambivalent relationships. In addition, although more research is needed, these studies suggest that ambivalent social relationships may have adverse effects. Based on these findings, we next attempted to address why people might maintain partially negative and potentially detrimental relationships. Surprisingly, it appears that such relationships are not maintained due to obligation but rather are maintained willingly; and intimately for women. Given our findings on the extent with which ambivalent relationships occupy one’s network, level of contact, and maintenance, suggest that the influence of these relationships may not be isolated but rather may have a more pervasive impact. Overall, these data may have important implications for the conceptualization and assessment of social relationships in the health domain. Much of the prior research on social relationships and health has only assessed one dimension (typically positivity or social support). Even in studies where both dimensions were assessed, researchers have typically examined the effects of one dimension by statistically controlling for the other (e.g., Finch & Zautra, 1992; Fiore et al., 1983). According to the model presented in figure 1, however, high negativity includes both social aversion and social ambivalence, whereas high positivity includes both social support and social ambivalence. This point may be especially important to consider in developing effective social support interventions (Finch et al., 1989). Our results suggest that implementing a support intervention (without regard to extent of positivity and negativity within that relationship) would be a mistake. Overall, this data suggests that prior conceptualizations of social relationships were perhaps too simplistic. Rather, a multidimensional approach to the study of social relationships may be effective in predicting cardiovascular functioning (so as to better understand the underlying associations between social relationships and morbidity and mortality).
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IMPORTANT AREAS OF FURTHER RESEARCH Despite these promising results, there are several important issues that need further examination. First, prospective studies are needed to track the time course of the physiological changes that occur as a result of social relationships. Second, at this stage in the research the classification of ambivalence is very broad. For example, the joint positivity and negativity could be the result of being given mixed messages during interactions; or, it could be a summary schema of a long history of some negative interactions and some positive interaction. Likewise, it is possible that ambivalence may be a result of having specific aspects of the relationship that are positive and knowing that other specific aspects are upsetting; or, it may be unpredictable when the person may be positive or upsetting. Given the broad conceptualization, it may be important to clarify what aspects of ambivalence may be more detrimental than others. In particular, if upsetting aspects may be identified coping mechanisms may be better utilized to mitigate any potential adverse influences. The identification of effective coping may be particularly important given that there is reason to believe that people do not exit these relationships. Although emotional distancing was used more among ambivalent than supportive relationships, it is possible that this may not be effective in reducing negative health effects. For example, prior research has also shown that individuals were more anxious and less able to relax in the mere presence of their ambivalent friends (Holt-Lunstad, Uchino, Smith, & Hicks, 2007). Therefore, if individuals are not limiting contact with ambivalent relationships, it is possible that despite such strategies relationships still have an impact through cognitive processes (e.g., rumination and emotional suppression). Future studies that directly test these issues may be able to identify and elucidate the most effective coping methods. Third, it may be important to determine whether there are typical relationships in which ambivalence is more prevalent or more detrimental? Conceivably, some relationships are easier to exit than are others. It is much harder to sever ties with family members than it is to leave friendships. Although our findings suggest that ambivalent relationships are maintained voluntarily rather than out of obligation, because this study focused on friendships we can’t draw firm conclusions about other relationship types. Likewise, ambivalence within a marriage or familial ties may be more detrimental than within a friendship due to differences in importance and amount of contact. Future studies that directly examine these issues are needed. Fourth, there are many important individual differences such as gender, age, and personality all of which are important to examine. For example, women in our culture are socialized to maintain and nurture interpersonal relationships to a greater extent than are men. In fact prior research shows that women are more likely to seek out, and give support than are men (Carver, Scheier, & Weintraub, 1989; Rosario et al., 1988). However, because of this social pressure to maintain relationships women may be less likely to exit bad relationships. While currently we have found no evidence of gender differences in terms of the influence of ambivalent relationships, it does appear that women may attempt to maintain their relationships more intimately. Another important point to specify is the physiological pathways. While finding a significant relationship between the quality of one’s relationships and blood pressure was an important first step in understanding the pathways in which social relationships influence
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health, blood pressure is a multiply determined end-point. As such it may be useful to identify particular patterns of cardiovascular functioning (e.g., patterns associated with sympathetic and parasympathetic activation) which may be useful in understanding more specific physiological mechanisms. Finally, the health consequences of psychological, behavioral, and physiological mechanisms need further examination to clarify the implications for health. There are many pathways in which social relationships may influence health outcomes. Although we have focused on the cardiovascular pathway, the immune and endocrine pathways are also important. Given the immune system is our first line of defense in fighting off disease, demonstrating a link between ambivalent relationships and immune functioning will provide strong evidence to support the hypothesis that social ambivalence may influence our health. Likewise, emerging data on immune-related inflammatory processes also provides a promising avenue for greater integration among these diverse physiological systems and disease states. Most research linking social support to immune processes has emphasized its potential role in cancer, HIV, and infectious diseases more generally (Uchino et al., 1996). There is now increased emphasis on how inflammatory immune processes may influence the atherosclerotic processes (Ross, 1999). The establishment of such links will be important due to the need to model integrative mechanisms (e.g., immune system influencing cardiovascular risk via inflammation). Such future investigations may help clarify the pathogenic mechanisms responsible for the long-term health cost and benefits of specific dimensions of social relationships—such that we can utilize the benefits of social relationships to promote positive health outcomes.
REFERENCES Abbey, A., Abramis, D. J., & Caplan, R. D. (1985). Effects of different sources of social support and social conflict on emotional well-being. Basic and Applied Social Psychology, 6 (2), 111-129. Barrera, Jr., M. (1986) Distinctions between social support concepts, measures, and models. American Journal of Community Psychology, 14 (4), 413-445. Barrera, Jr., M. (2000). Social support research in community psychology. In J. Rappaport and E. Seidman (Eds.) Handbook of Community Psychology (pp. 215-245). N. Y.: Kluwer Academic/Plenum Publishers. Berkman, L. (1995). The Role of Social Relations in Health Promotion. Psychosomatic Medicine, 57, 245-254. Berkman, L. F., and Glass, T. (2000). Social integration, social networks, social support, and health. In L. Berkman and I. Kawachi (Eds.), Social epidemiology (pp. 137-173). New York: Oxford. Berkman, L.F., Leo-Summers, L., & Horwitz, R.I. (1992). Emotional support and survival after myocardial infarction. Annals of Internal Medicine, 117, 1003-1009. Berscheid, E. (1985). Interpersonal attraction. In G. Lindzey & Aronson, E. (Eds.). Handbook of Social Psychology (3rd ed.) San Francisco: Freeman. Blazer, D.G. (1982). Social support and mortality in an elderly community population. American Journal of Epidemiology, 115, 684-694.
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Bloor, L. E., Uchino, B. N., Hicks, A., & Smith, T. W. (2004). Social Relationships and Physiological Function: The Effects of Recalling Social Relationships on Cardiovascular Reactivity. Annals of Behavioral Medicine, 28 (1), 29-38. Broadhead, W. E., Berton, H. K., Sherman, A. J., Wagner, E. H., Schoenbach, V. J., grimson, R., Heyden, S., Tibblin, G., & Gehlbach, S. H. (1983). The epidemiologic evidence for a relationship between social support and health. American Journal of Epidemiology, 117, 521-537. Brummett, B. H., Mark, D. B., Siegler, I. C., Williams, R. B., Babyak, M. A., ClappChanning, N. E., & Barefoot, J. C. (2005). "Perceived social support as a predictor of mortality of coronary patients: Effects of smoking, sedentary behavior, and depressive symptoms." Psychosomatic Medicine, 67, 40-45. Burton, E., Stice, E. & Seeley, J.R. (2004). A prospective test of the stress-buffering model of depression in adolescent girls: No support once again. Journal of Consulting and Clinical Psychology, 72, 689-697. Bushman, B.B. & Holt-Lunstad, J. (2008). Understanding social relationship maintenance among friends: Why we don’t end those frustrating friendships. Unpublished manuscript. Brummett, B. H., Barefoot, J. C., Siegler, I. C., Clapp-Channing, N. E., Lytle, B. L., Bosworth, H. B., Williams, R. B., Jr., and Mark, D. B. (2001). Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. Psychosomatic Medicine, 63, 267-272. Cacioppo, J. T., & Berntson, G. G. (1994). Relationship between attitudes and evaluative space: A critical review, with emphasis on the separability of positive and negative substrates. Psychological Bulletin, 115, 401-423. Campo. R., Uchino, B.N., Holt-Lunstad, J., Vaughn, A., Reblin, M., & Smith, T.W. (2008). The Assessment of Positivity and Negativity in Social Support Networks: Reliability and Validity of the Social Relationships Index. Unpublished manuscript. Carver, C. S., Scheier, M. R, & Weintraub, J. K. (1989). Assessing coping strategies; A theoretically based approach. Journal of Personality and Social Psychology, 56, 1-17. Cohen, S. (1988). Psychosocial models of the role of social support in the etiology of physical disease. Health Psychology, 7, 269-297. Cohen, S. (2004). Social relationships and health. American Psychologist, 59, 676-684. Cohen, S., Kessler, R. C., and Gordon, L. U. (1995). Measuring stress: A guide for health and social scientists. New York: Oxford University Press. Cohen, S., Underwood, L. G., and Gottlieb, B. H. (2000). Social support measurement and intervention. New York: Oxford. Cohen, S. & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310-357. Ditzen, B., Neumann, I. D., Bodenmann, G., Dawans, B., Turner, R. A., Ehlert, U., Heinrichs, M. (2007). Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology, 32, 565-574. Ell, K., Nishimoto, R., Medianski, L., Mantell, J., and Hamovitch, M. (1992). Social relations, social support and survival among patients with cancer.Journal of Psychosomatic Research, 36, 531-541. Feldman, P. & Cohen, S. (2000). Social support. In A. E. Kazdin (Ed.), Encyclopedia of Psychology. New York: Oxford University Press.
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Finch, J. F., Okun, M. A., Barrera, M., Zautra, A. J., and Reich, J. W. (1989). Positive and negative social ties among older adults: Measurement models and the prediction of psychological distress and well-being. American Journal of Community Psychology, 17, 585-605. Finch, J. F., & Zautra, A. J. (1992). Testing latent longitudinal models of social ties and depression among the elderly: a comparison of distribution-free and maximum likelihood estimates with nonnormal data. Psychological Aging, 7 (1), 107-118. Fingerman, K. L., Hay, E. L., & Birditt, K. S. (2004). The best of ties, the worst of ties: close, problematic, and ambivalent social relationships. Journal of Marriage and Family, 66 (3), 792-808. Fiore, J., Becker, J., & Coppel, D. B. (1983). Social network interactions: A buffer or a stress? American Journal of Community Psychology, 11, 423-439. Friedman, H.S., Tucker, J.S., Schwartz, J.E., Tomlinson-Keasey, C., Martin, L.R., Wingard, D.L., & Criqui, M.H. (1995). Psychosocial and behavioral predictors of longevity: The aging and death of the "Termites". American Psychologist, 50, 69-78. Gable, S.L., Reis, H.T., & Impett, E.A. (2004). What do you do when things go right? The intrapersonal and interpersonal benefits of sharing positive events. Journal of Personality and Social Psychology, 87, 228-245.
Gal, R., & Lazarus, R. S. (1975). The role of activity in anticipating and confronting stressful situations .Journal of Human Stress, 1 (4), 4-20. Grewen, K. M., Girdler, S. S., Amico, J., & Light, K. C. (2005). Effects of Partner Support on Resting Oxytocin, Cortisol, Norepinephrin, and Blood Pressure Before and After Warm Partner Contact. Psychosomatic Medicine, 67, 531-538. Gump, B. B., Polk, D. E., Kamarck, T. W., and Shiffman, S. M. (2001). Partner interactions are associated with reduced blood pressure in the natural environment: Ambulatory monitoring evidence from a healthy, multiethnic adult sample. Psychosomatic Medicine, 63, 423-433. Holt-Lunstad, J., Uchino, B. N., Smith, T. W. & Hicks, A. (2007). On the importance of relationship quality: The impact of ambivalence in friendships on cardiovascular functioning. Annals of Behavioral Medicine 33, 1-12. Holt-Lunstad, J., Uchino, B., Smith, T. W., Olson-Cerny, C., & Nealey-Moore, J. B. (2003). Social Relationships and Ambulatory Blood Pressure: Structural and Qualitative Predictors of cardiovascular Function During Everyday Social Interactions. Health Psychology, 22 (4), 388-397. House, J. S., Landis, K. R., and Umberson, D. (1988). Social relationships and health. Science, 241, 540-545. Kaloupek, D. G., & Stoupakis, T. (1985). Coping with a stressful medial procedure: Further investigation with volunteer blood donors. Journal of Behavioral Medicine, 8 (2), 131148. Kikuya, N., Ohkubo, T., Asayama, K., Metoki, H., Obara, T., Saito, S., Hashimoto, J., Totsune, K., Hoshi, H., Satoh, H., Imai, Y. (2005). Ambulatory blood pressure and 10year risk of cardiovascular and noncardiovascular mortality. Hypertension, 45, 240-245. Kiecolt-Glaser, J. K., Dyer, C. S., & Shuttleworth, E. C. (1988). Upsetting social interactions and distress among Alzheimer’s disease family caregivers. American Journal of Community Psychology, 16 (6), 825-837.
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Kikuya, M., Ohkubo, T., Asayama, K., Metoki, H., Obara, T., Saito,S., Hashimoto, J., Totsune, K., Hoshi, H., Satoh, H., & Imai, Y. (2005). Ambulatory Blood Pressure and 10Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study. Hypertension, 45, 240-245. Lazarus, R. S. (1966). Psychological Stress and the Coping Process. Ney York: McGrawHill. Lee, M., and Rotheram-Borus, M. J. (2001). Challenges associated with inreased survival among parents living with HIV. American Journal of Public Health, 91, 1303-1309. Lepore, S. J. (1992). Social Conflict, Social Support, and Psychological Distress: Evidence of Cross-Domain Buffering Effects. Journal of Personality and Social Psychology, 63 (5), 857-867. Major, B., Zubek, J. M., Cooper, M. L., and Richards, C. (1997). Mixed messages: Implications of social conflict and social support within close relationships for adjustment to a stressful life event. Journal of Personality and Social Psychology, 72, 1349-1363. Newsom, J. T., Rook, K. S., Nishishiba, M., Sorkin, D. H., & Mahan, T. L. (2005). The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60, 304312 Orth-Gomér, K., Rosengren, A., and Wilhelmsen, L. (1993 ). Lack of social support and incidence of coronary heart disease in middle-aged Swedish men. Psychosomatic Medicine, 55, 37? 43. Perloff, D., Sokolow, M., and Cowan, R. (1983). The prognostic value of ambulatory blood pressure. Journal of the American Medical Association, 249, 2793-2798. Robles, Theodore F.; Kiecolt-Glaser, Janice K. (2003). The physiology of marriage: pathways to health. Physiology & Behavior, 79, 409-416. Rook, K. S. (2001). Emotional Health and Positive Versus Negative Social Exchanges: A Daily Diary Analysis. Applied Developmental Science, 5 (2), 86-97. Rosario, M., Shinn, M., Morch, H., & Huckabee, C. B. (1988). Gender differences in coping and social supports; Testing socialization and role constraint theories. Journal of Community Psychology, 16, 55-69. Ross, R. (1999). Mechanisms of disease: Atherosclerosis An inflammatory disease. New England Journal of Medicine, 340, 115-126. Ruehlman LS, Karoly P. (1991). With a little flak from my friends: Development and preliminary validation of the Test of Negative Social Exchange (TENSE). Psychological Assessment. 3, 97–104. Sandler, I. N,., & Barrera, Jr. M. (1984). Toward a multimethod approach to assessing the effects of social support. American Journal of Community Psychology, 12 (1), 37-52. Smith, T.W., & Ruiz, J.M. (2002). Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice. Journal of Consulting and Clinical Psychology, 70, 548-568. Stryker, S., and Burke, P. J. (2000). The past, present, and future of an identity theory. Social Psychology Quarterly, 63, 284-297. Thoits, P. A. (1983). Multiple identities and psychological well-being: A reformulation and test of the social isolation hypothesis. American Sociological Review, 48, 174-187.
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Tucker, J.S., Friedman, H.S., Wingard, D.L., & Schwartz, J.E. (1996). Marital history at midlife as a predictor of longevity: Alternative explanations to the protective effects of marriage. Health Psychology, 15, 94-101. Uchino, B.N. (2004). Social support and physical health: Understanding the health consequences of our relationships. New Haven, CT: Yale University Press. Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29, 377-387. Uchino, B.N., Cacioppo, J.T., & Kiecolt-Glaser, J.K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119, 488-531. Uchino, B. N., Holt-Lunstad, J., Uno, D., & Flinders, J. B. (2001). Heterogeneity in the social networks of young and older adults: Prediction of mental health and cardiovascular reactivity during acute stress. Journal of Behavioral Medicine, 24, 261-382. Umberson, D. (1987). Family Status and Health Behaviors: Social Control as a Dimension of Social Integration. Journal of Health and Social Behavior, 28 (3), 306-319. Verdecchia, P., Porcellati, C., Schillaci, G., Borgioni, C., Ciucci, A., Battistelli, M., Guerrieri, M., Gatteschi, C., Zampi, I., Santucci, A., et al. (1994). Hypertension, 24 (6), 793-801.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 24
LIVING IN DISCREPANT WORLDS: EXPLORING THE CULTURAL CONTEXT OF SEXUALITY AMONG TURKISH AND MOROCCAN MALE ADOLESCENTS Barbara C. Schouten* and Chana van der Velden1 Department of Communication, the Amsterdam School of Communications Research, University of Amsterdam, the Netherlands
ABSTRACT A high percentage of Turkish and Moroccan male adolescents in the Netherlands is sexually active. At the same time, they frequently engage in risky sexual behavior, which makes them vulnerable to HIV/STDs infection. To be able to design culturally appropriate health promoting interventions, more knowledge about the factors that influence their sexual behavior is needed. Therefore, this paper reports on a qualitative study that aims to increase our understanding of the influences on Turkish and Moroccan adolescent male sexuality within a broader interest in HIV/STD prevention. Seven focus groups with 29 Moroccan and 20 Turkish boys, aged between 14 and 18 years, were conducted. Analysis of the data highlighted several factors that may hinder condom use, such as lack of knowledge, lack of perceived risk, peer norms, lack of parent-adolescent communication about sexuality, and lack of self-efficacy toward buying condoms. Results also show some significant differences between the Turkish and Moroccan adolescents. Turkish adolescents are more conservative toward sexuality, they stick more strongly to cultural traditions and they have less knowledge about HIV/STDs than Moroccan adolescents. Moroccan adolescents experiment more frequently with sex. Therefore, they may be at higher risk of getting infected with HIV/STDs. The findings of our study provide a fertile starting point for designing culturally appropriate and effective health education programs in the field of safe sex promotion for ethnic minority adolescents.
*
Corresponding address: B.C. Schouten. Department of Communication, The Amsterdam School of Communications Research (ASCoR), University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands. Phone: +31 (0)20 5253879; Fax: +31 (0)20 525 3861; e-mail:
[email protected]
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Keywords: sexual health; condom use; ethnic minorities; adolescents; HIV/STDs; focus groups
INTRODUCTION Within a relatively short time span both the number of adolescents that are sexually active and the diversity of sexual practice have increased significantly (Feldman & Rosenthal, 2002). In the Netherlands, the percentage of adolescents which has had sexual intercourse is in particular high among Turkish and Moroccan boys: around 40% of them have had sexual intercourse between 12-18 years, as compared to 20% of Dutch teenagers (de Graaf, Meijer, Poelman, & Vanwesenbeeck, 2005). Results of a few studies also indicate that Turkish and Moroccan males engage in more risk-taking during their sexual activities. For instance, Turkish men more frequently visit prostitutes and use condoms less frequently than either Dutch or Surinam men (Hooykaas, van der Velde, van der Linden, van Doorum, & Coutinho, 1991). Furthermore, Turkish and Moroccan adolescents have less knowledge about safe sex practices, HIV and other sexually transmitted diseases (STDs), and less intention to use condoms than Dutch adolescents (van Eijk, 2001, Kraemer, van Driel, & van der Sluis, 2005). Additionally, available epidemiologic data suggest that the number of people infected with HIV/STDs is rapidly increasing in Turkey and Morocco, in particular among heterosexuals (Duyan & Yildirim, 2003; Elmir, Naida, Ouafae, Rajae, Amina, & Rajae, 2002), placing Turkish and Moroccan adolescents who visit their countries of origin during the holidays at risk of contracting HIV/STDs there. Taken together, these facts make Turkish and Moroccan male youth in the Netherlands vulnerable to getting infected with HIV/STDs. Prevention activities targeted at these groups are necessary as they may lead to the adoption of safer sex practices. However, compared to other recognized high-risk groups, such as homosexuals, prostitutes and adult migrant groups (Kocken, Voorham, Brandsma, & Swart, 1996; Martijn, de Vries, Voorham, Brandsma, Meis, & Hospers, 2004), prevention targeted at Turkish and Moroccan teenagers is still in its infancy. As previous research indicates that health education campaigns targeted at the general adolescent population are significantly less effective for Turkish and Moroccan teenagers than for Dutch teenagers (e.g., von Bergh & Sandfort, 2000), it is of vital importance to design culturally sensitive health education programs on the topic of sexuality for Turkish and Moroccan youth. To be able to develop such programs though, far more in-depth knowledge should be gained about which factors influence their sexual behavior. Therefore, this paper reports on a qualitative study that aims to increase our understanding of the influences on Turkish and Moroccan adolescent male sexuality within a broader interest in HIV/STD prevention among these groups.
ISLAMIC CULTURE AND SEXUALITY Unlike Christianity, Islam has a mainly positive view of sexuality; the Koran preaches pleasure for both partners and sexuality is seen as a divine gift (Heemelaar, 2000; Obermeyer, 2000). It is thought that men are more able to devote themselves to Islam when their sexual desires are fulfilled. Hence, sexuality is regarded as the fulfillment of a religious duty, not
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only in terms of reproduction, but also because it leads to a peaceful and harmonious state of mind. In the same vein, men should not get too emotionally attached to their spouses, as this may interfere with their dedication to Islam (Combs-Schilling, 1989). Thus, while sexual enjoyment takes place between men and women, love is reserved for God. There is, of course, one major precondition for practicing sexuality in Islam: it should be expressed within the confines of marriage. Islamic sexual ethic proscribes all premarital sexual activity. Outside marriage heterosexual encounters are fornication (zina) (Obermeyer, 2000). Hence, both men and women should remain virgin until marriage. The positive attitudes toward sexuality as expressed in Islamic religion stand in sharp contrast with the often fundamentally inegalitarian double standards for men and women regarding sexual behavior in many Muslim societies (Obermeyer, 2000; Pels, 2000). Most notable is the double standard with regard to the virginity norm. For men, having sex before and outside marriage is accepted as long as it is practiced behind closed doors. As many Islamic societies are also macho cultures, male sexuality is seen as proof of virility and strength. In contrast, ritual wedding ceremonies display proof of the bride’s virginity (and groom’s virility), and make it clear that women are to a far greater extent judged by their sexual conduct and purity of body than men. A clear example of the double virginity standard is the fact that in Morocco for men their profession is filled out on the marriage certificate under the heading legal status, while for women it is filled out whether or not they are virgin (Heemelaar, 2000). Hence, women are under a lot of pressure to keep their virginity until marriage. Another double standard in many Muslim societies concerns homosexuality. In Islamic religion, homosexuality is regarded as sinful. As it does not lead to reproduction, it is considered a perversion and is forbidden under Muslim law. In practice though, there is a lot of tolerance toward homosexual activities in Muslim societies, partly because women are sexually not readily available. As long as it conforms to certain standards, such as the division of active and passive roles among older men and adolescent boys, it seems to be accepted. The tolerance toward homosexuality is purely physically oriented though. Having a homosexual identity is haram and not allowed (Obermeyer, 2000). Although Turkish and Moroccan youth in the Netherlands are not raised in Muslim societies and are constantly exposed to western values regarding sexuality, their interpretation of these values is partly based on interactions with their families. These family relationships are characterized by experiences that are based in traditional Turkish and Moroccan culture (Pels, 1998). Furthermore, research has shown that a majority of Moroccan and Turkish adolescents in the Netherlands identify themselves as Muslim (Phalet & ter Wal, 2004). They still attach great importance to Islam in their personal and sexual lives. For instance, around 75% of Turkish and Moroccan youth is of the opinion that sex is only allowed within the confines of marriage. In contrast, only 16% of Dutch adolescents agree with this opinion (Kraemer et al., 2005). An obvious similarity between sexuality among Turkish and Moroccan adolescents in their countries of origin and the Netherlands is the importance attached to virginity before marriage and the accompanying double standard for girls and boys (Pels, 1998). That is, while daughters should remain virgin until marriage, parents often turn a blind eye to the sexual behavior of their sons. As long as their sons deal with sex according to certain rules of conduct, such as not confronting their parents with their sexual behavior, they are privately allowed to have sex before marriage. It is equally important to refrain from having sexual
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encounters with girls from their own group (i.e. Moroccan or Turkish girls), as this poses a threat to the virginity norm and may induce honour-related violence. Dutch girls do not belong to the in-group and are not seen as marriage candidates for their sons. As a result, many Turkish and Moroccan boys experiment sexually with Dutch girls before they marry someone from their own group (Pels, 1998). Due to sex being forbidden before marriage, sexuality is not a topic of discussion in most Turkish and Moroccan families in the Netherlands. Not only is it considered indecent and disrespectful for adolescents to talk about sex with their parents, parents also fear that talking with their children about sexuality may stimulate sexual activity, which corresponds with the fact that “Islamic religious authorities strongly oppose the methods of AIDS prevention adopted in western countries, especially the use of the condom and sex education inasmuch as they assume and encourage free sex” (Francesca, 2002, p.389). Scarce research indeed indicates that parent-adolescent communication about sexuality is practically non-existent in Muslim families in the Netherlands (Kraemer et al., 2005; Schouten, van den Putte, Pasmans, & Meeuwesen, 2007). Hence, Turkish and Moroccan youth will probably not get the same amount of education from their family as Dutch youth, and this should be taken into account when designing HIV/STD prevention programs for them. For instance, it is likely that the smaller amount of knowledge Turkish and Moroccan teenagers have about safe sex practices as compared to Dutch youth (see below) is at least partly attributable to the absence of sex communication within the home. Hence, Turkish and Moroccan adolescents might need to be given more information about safe sex during HIV/STD prevention programs than their Dutch counterparts.
DETERMINANTS OF UNSAFE SEX BEHAVIOR AMONG TURKISH AND MOROCCAN YOUTH The growing concern about the spread of HIV/STDs among heterosexuals has led to a substantial body of literature on (determinants of) heterosexual sexual behavior in general and condom use specifically (for an excellent meta-analysis see Sheeran, Abraham, & Orbell, 1999). In sharp contrast, only scarce research has been carried out which has specifically focused on the sexual behavior of Turkish and Moroccan youth. The main results of the few studies carried out so far will be summarized below. With regard to knowledge levels, previous research has consistently shown that Turkish and Moroccan teenagers have less knowledge about HIV/STDs than their Dutch counterparts (von Bergh & Sandfort, 2000; Hendrickx, Lodweijckx, van Royen, & Denekens, 2002; Kraemer et al., 2005). Although most of them know about the existence of HIV/Aids and the importance of condom use in preventing infection with HIV, there is far less knowledge about other STDs. Furthermore, they have many misconceptions about the means of transmission and symptoms of STDs. Some study results suggest a relation between the lack of knowledge and a lack of sex communication at home (e.g., Kraemer et al., 2005), but more research is needed before conclusions about a possible relationship can be drawn. Results of Turkish and Moroccan studies with regard to knowledge levels are about the same: insufficient knowledge about HIV/STDs is noticeable, in particular when it comes to modes of transmission and symptoms (Aral & Fransen, 1995; Gökengin, Yamazhan, Özkaya, Aytuĝ, Ertem, Arda et al.,
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2003, Manhart, Dialmy, Ryan, & Mahjour, 2000; Savaser, 2003; Ungan & Yaman, 2003). One Moroccan study reported that the various STDs are considered to be different points on a continuum of severity rather than separate diseases (Manhart et al., 2000). Some positive associations between knowledge levels and other variables which have been reported in a couple of Turkish studies are parents’ educational level and more democratic family relations in which sexuality is more comfortably discussed (Gökengin et al., 2003, Savaser, 2003). Some misconceptions that center on the perceived vulnerability of Turkish and Moroccan adolescents seem to be prevalent as well. For instance, condom use is often associated with prostitutes and casual sex, and is thought to be unnecessary in serious relationships and marriage (Aral & Fransen, 1995; Manhart et al., 2003). Furthermore, Moroccan adolescents frequently report that they can know in advance whether a girl is free of disease, based on her looks (e.g. Hendrickx et al., 2002). The selection of so-called “clean” girls protects them against STDs and makes the use of condoms during sexual intercourse redundant. Closely related to the notion of cleanliness is the still popular idea that HIV/STDs merely affect marginal individuals, such as homosexuals and commercial sex workers (Aral & Fransen, 1995). Biological immunity (e.g. Turkish men are strong) and fatalistic thinking (e.g. you cannot prevent diseases, as they come from Allah) are also mentioned as reasons not to use condoms (Aral & Fransen, 1995). Other barriers toward condom use that have been reported are a negative attitude toward condom use, costs of buying condoms, and fear of talking about using a condom with a sex partner (von Bergh & Sandfort, 2000; Gökengin et al., 2003; Manhart et al., 2003; MCA communicatie, 2002). For instance, Turkish and Moroccan boys mentioned reduced sexual pleasure when using a condom during sex. Furthermore, they may be hesitant to actually buy them, not only because of costs but also because of feelings of embarrassment. This hesitancy might also be present when it comes to bringing condom use during sex up for discussion (von Bergh & Sandfort, 2000). Hence, the so-called interaction competencies might be lower among Moroccan and Turkish boys than among Dutch boys, further decreasing the chance of actually using condoms during sexual intercourse. Although the studies summarized above have yielded some valuable insight into possible determinants of unsafe sex among Turkish and Moroccan youth, there are some important shortcomings that warrant further research. First, most studies cited above were carried out in Turkey and Morocco. Generalizing the results of these studies to the Turkish and Moroccan adolescent population in Western countries may be inappropriate. Second, the European studies were, with the exception of one of them, quantitative in nature. The questionnaires used in these studies were based on factors that are known to be of influence in Western populations, but may have left out specific factors that may be relevant within the Turkish and Moroccan culture. For instance, none of the studies investigated the influence of family values with regard to condom use, while it is well-known that social norms are more important than attitudes in influencing behavior in these cultures (Triandis & Trafinow, 2001). To be able to identify culture-specific beliefs, one should make use of qualitative methods. Third, the only qualitative study on this topic investigated Moroccan adolescents, but not Turkish adolescents (i.e. Hendrickx et al., 2002), making a comparison between different ethnic minority groups impossible. To fill these gaps, our study used a qualitative method to explore and describe the cultural context in which sexuality of Turkish and Moroccan male adolescents is shaped. In doing so, we aimed to identify similarities and differences regarding (unsafe) sexual behavior between Turkish and Moroccan adolescents.
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METHODS Study Context The study was conducted in Amsterdam, the capital city of the Netherlands, where a relatively high percentage of inhabitants is of Moroccan and Turkish origin (respectively around 9% and 5%). The focus groups were conducted at Turkish and Moroccan youth centers in May and June 2007, all by the same moderator (CvdV). Ethical approval for the study was obtained by the Ethical Research Committee of the Amsterdam School of Communications Research. Table 1. Age and educational level of the participants
Age - 14 - 15-16 - 17-18 Going to school? - Yes - No (unemployed) Level of education - lower secondary professional education - intermediate vocational education - higher secondary general education - higher vocational education
Moroccan boys
Turkish boys
3 8 18
2 5 13
26 3
17 3
16 8 1 1
12 5 -
Participants Research participants consisted of 29 Moroccan and 20 Turkish boys, aged between 14 and 18 years (see Table 1). The boys were recruited from three Moroccan and two Turkish youth centers, where group leaders invited the boys to participate. None of the boys refused to participate. Focus groups were separately run for the Turkish and the Moroccan boys, resulting in three Turkish groups and four Moroccan groups. All participants belonged to the second generation immigrants; they were all born in the Netherlands, and could speak the Dutch language. All boys lived at home with their parents and were unmarried. Each group consisted of six to eight participants, which is in line with earlier recommendations on optimal group sizes of focus groups (Bischoping & Dykema, 1999). At the end of each focus group, participants filled out a brief questionnaire to collect some personal data and were paid a small amount for their participation (12 Euro).
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Research Method All focus groups took place in the youth centers where the boys were recruited. Our choice for running the focus groups in the youth centers was determined both by practical reasons and by reasons related to the content of our study. First, the boys often gather in these youth centers after school and are not required to travel to another place to participate, thereby enhancing the likelihood of partaking in the discussions. Second, the boys are all familiar with the place and familiar with each other as they constitute pre-existing groups, which has the advantage that participants share their daily lives and can easily relate to each other’s comments and stories. Hence, expressed beliefs about sexuality can be more readily checked against actual behavior and challenged in case there is a gap between the two (for a similar point of view, see Kitzinger, 1995). Indeed, both the sharing of common experiences and the challenging of each others comments happened regularly during the discussions. An important advantage of focus groups over individual interviews is that they are sensitive to cultural values and group norms, and are therefore particularly suited for research with ethnic minorities. The interaction inherent of groups facilitates revealing information about such social norms and enhances the discussion of taboo topics, because the less inhibited members of the group often break the ice for shyer participants. Focus group “participants can also provide mutual support in expressing feelings that are common to their group but which they consider to deviate from mainstream culture” (Kitzinger, 1995, p.299). For instance, in Islamic culture a well-known “deviation” from Western culture are beliefs about homosexuality. These views are more likely to be expressed in the context of a group of like minded people than in the less “safe” setting of an individual interview. Due to the sensitive nature of the topic and in order to prevent possible macho-behavior, focus group interviews were moderated by a Dutch female moderator (CvdV). It was decided to use a non-Moroccan/ non-Turkish moderator, because previous research has indicated that it might be safer to express feelings about sexuality to people belonging to a different ethnic group than to people of the own ethnic group (Hendrickx et al., 2002). All interviews were tape recorded and verbatim transcripts were made. The groups lasted between one and one and a half hour.
Discussion Topics The choice of the topics for discussion was based on a literature study (see table 2). Both authors reviewed all questions for relevance and conclusiveness. The topics were divided in six themes: knowledge about STDs, attitudes and beliefs about (unsafe) sexual behavior, selfefficacy, education on sexuality, social norms, and sexual behavior. The order of discussing the topics was in such a way that less sensitive, more “factual” topics were discussed first (i.e. knowledge), in order to create an atmosphere in which the boys felt safe to talk about more personal issues later on. However, the order of topics was not fixed but followed the natural flow of the discussion. The moderator of the groups ensured that all topics were discussed. The discussions were concluded with free question sessions, during which the boys could ask questions (the moderator did not answer any questions during the discussions) and express their feelings about the discussion. Overall, these sessions revealed that the boys found the discussions a positive though unusual experience. They felt free to speak about things they
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seldom talk about and some commented that this would be their preferred mode for receiving education on sexuality. Table 2. topic list used in the discussions 1. Knowledge - Which STDs do you know? - How are STDs transmitted? - Knowledge about prevention. 2. Attitudes and beliefs - Risk perception. Is perception of risks different in different situations, with different sexual partners? - Advantages/disadvantages of condom use - Beliefs about carrying condoms - Fatalism 3. Self-efficacy - With regard to buying condoms - With regard to using condoms - With regard to talking about condom use with girls 4. Social norms - What do friends think about unsafe sex? - Is having (unsafe) sex stimulated by friends? - What are the social norms with regard to having sex with girls from different ethnic groups (i.e. Dutch, Moroccan, Turkish, other). - What do parents think about premarital sex? - Religious norms 5. Sexual behavior - Risk behavior, when, in which situations? - Differences in sexual behavior with different kind of partners? - Homosexual behavior? - Relationships - At what age first time sex? 6. Education - What kind of sexual education did the boys get? - From whom and when? - Whom are the boys talking to about sexuality? About which topics, in which situations? - Communication about sexuality with family members. - Which sources do the boys use to inform and educate themselves? - Preferences and needs for education.
Analysis Method As qualitative research “is concerned with describing, interpreting and understanding the meanings which people attribute to their existence and to their world” (Cutcliffe & McKenna, 1999, p.375), the first stage of the analysis involved the close reading and re-reading of the transcripts of the discussions. The goal of this stage was to arrive at a description of commonalities and differences between the Turkish and Moroccan groups in terms of the content of the texts. Thus, a so-called “large-sheet-of-paper” approach was followed by
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breaking the transcripts down into broad content segments and categorizing them in themes and sub themes (Catterall & Maclaran, 1997). Catterall and Maclaran (1997) refer to this type of analysis as the “snapshot” approach where data analysis results in “individual photographs (segments of text)”. As the value of focus group data to a great extent lies in the interaction between participants though, in the second stage of the data analysis close attention was paid to how the boys talked about the topics and how they responded to each other. This analysis of the process was carried out by both reading the transcripts and listening to the tapes and jotting down notes about such things as tone of voice, emotional engagement, disagreements, etcetera. In addition to the categorization of themes or “snapshots”, this results in capturing the “moving picture” of the story of the focus group discussion (Catterall & Maclaran, 1997), and allows for a more in-depth interpretation and understanding of the findings.
RESULTS Sexual Behavior A majority of the Turkish and Moroccan participants is sexually active. They have had various sexual partners, mostly Dutch girls. The onset of sexual intercourse is on average around 14 year, but some of them were as young as 12 years of age or even younger. The high number of sex partners is partly caused by the fact that it is quite common to visit prostitutes. One Moroccan boy remarked that “I think the first time is always with a prostitute”, and a Turkish boy stated that if a boy cannot score a girl on the street because he is not a player, he has to go to a prostitute. A lot of Turkish boys and some of the Moroccans confessed that they had unsafe sex sometimes, but most of them said that they use a condom when having a one-night stand. Within steady relationships, they do not use a condom when their girlfriend is taking birth control pills. Having a steady relationship does not preclude sexual activity with others though; most of them admit that they cheat on their girlfriends. A noticeable difference between the two groups is that Turkish boys more often have relationships, while the Moroccan teenagers predominantly experiment with casual sex partners. They say that they hardly ever fall in love with a girl and find it easy to separate sex from love (“we’re just playing at the playground”, Moroccan boy). This difference might be related to the fact that the Turkish adolescents are generally more conservative when it comes to sexuality (see below), and consequently, sex and love more often go hand in hand among Turkish adolescents than among Moroccan adolescents. During the group discussions, anal sex was hardly talked about. Like masturbation, it is clear that it is a taboo topic. Both are forbidden by Islam, and although some boys admit to masturbate, they all say to regret it afterwards. Some worry about the consequences of masturbation and think that they will be punished for it in some way: MB1 (Moroccan boy 1): If a boy masturbates, hairs will grow at his hands. Isn’t that true? MB2: Ha ha, no that’s not true. MB3: Yeah sure man, it’s true.
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Dutch girls are regularly shared among the boys; they are send on to friends, so that several boys can have sex with the same girl. They feel that friends should have the same pleasure as they had and girls are therefore easily shared among each other. Such girls have a reputation at school or in the neighborhood as “easy girls” and are called “love of the neighborhood” or “ploughers”. They are regarded as whores and not respected by the boys.: MB1: Love of the neighborhood. The one who hasn’t had sex for the longest time deserves a slut. MB2: Yeah, some girls from the neighborhood are taken by everyone. MB3: They have sex for a packet of cigarettes, a breezer... MB2: I call them breezer sluts. When asked whether they think all Dutch girls are like this, most of them indicate that they indeed do think so: CvdV: TB: CvdV: TB:
Are a lot of girls like this? Yes, a lot. But are all Dutch girls whores or can they also be decent girls? No, not all of them. But most of them are.
Knowledge about HIV/STDs With regard to knowledge about the transmission and prevention of STDs, most boys know that they can get infected with HIV/STDs when they have sex without condoms. When asked which STDs they knew, all Moroccan participants mentioned that they have heard about HIV and aids from school or the media. Knowledge about other STDs was less, although Chlamydia was relatively frequently mentioned. In contrast, only some of the Turkish boys knew about HIV, and none of them could bring up any other STDs. Overall then, knowledge was worse among the Turkish group as compared to the Moroccan group: TB1
(Turkish boy 1): I really don’t know what STD means. Perhaps if I get a little bit more information. CvdV: Could you help him out? TB2: Diseases that kill you. TB3: It means that you get diseases from chicks. A majority of the Turkish and Moroccan boys was unaware of the fact that unprotected oral or anal sex can also lead to HIV/STDs. Furthermore, they expressed many misconceptions about having (unsafe) sex, such as “oral sex can be harmful for the lungs”, “if you have sex in the snow your sperm cells will die, won’t they?”, “if you kiss people with pimples on the cheek, you can get sick”, and so on. In addition, some misconceptions about birth control pills were present in both groups. Some of the boys wrongly assumed that when a girl takes birth control pills or a morning-after pill, they are protected against contracting diseases. The fact that they asked a lot of questions to the moderator about modes of
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transmission and prevention indicates that they feel insecure about their knowledge levels and are motivated to learn more about this topic.
Attitudes and Beliefs One of the necessary conditions for people to engage in safe sex practices is that they at least feel personally vulnerable to HIV/STD infections. However, both the Moroccan and the Turkish boys do not think that the risks in the Netherlands are high. In contrast, perceived risk about getting infected in Turkey or Morocco is much higher, partly because many boys have unprotected sex with prostitutes during their holidays in these countries. As one of the Turkish boys remarked “there [In Turkey], risks are high”. Another boy agreed with him by stating that risks in Turkey are “very high, they do not use condoms over there”. In general, when talking about risks, the boys make a sharp distinction between “sluts” and “decent girls”, and feel confident that they can select a “decent girl”, based on her appearance and previous sexual behavior. When the girl is not a virgin anymore, some boys ask her about the number of previous sex partners she has had. When the girl has had several, she is considered unclean and a slut. In these cases, a condom is often used. Thus, many boys are convinced that their selection abilities reduce the risk of HIV/STD infections, because they know with whom they are doing it with: MB:
Two years ago, beach party, nice ladies. I don’t drink, but she did, and one thing led to another. I didn’t get a test afterwards, but the chance that she was infected with HIV was 0%. CvdV: How do you know? MB: I found out that she had been married. She was recently divorced, and I was the second one who had had her. I don’t think anything has happened. She was not one of those chicks who sleep around. A few did not agree with the low risk perceptions as expressed by the majority, and felt that they had to correct them in some way: MB1: Here in the Netherlands, it is safe. MB2: Safe? Get lost. You cannot trust anyone here. Just use a condom boy. Besides the low risk perceptions, other factors that might decrease condom use are the negative beliefs associated with condom use. In both the Turkish and Moroccan groups, the most frequently mentioned disadvantage of condom use was the reduced feeling during sexual intercourse and the diminishment of sexual pleasure. Or, as one of the boys remarked: “It is less pleasant. It feels like my penis is imprisoned”. A lot of the Moroccan boys also thought condoms are too expensive. Almost none of the Turkish boys mentioned the price of condoms as a disadvantage, which might be a reflection of the higher socio-economic status of Turkish people in the Netherlands as compared to the Moroccans. Both the low perceived vulnerability and the diminished feeling associated with condom use might function as barriers to actually using condoms during sexual intercourse. However, both the Turkish and Moroccan boys express a lot of fear of unwanted pregnancies. During
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the group discussions it became clear that condoms are primarily used for preventing pregnancy, and not so much to prevent HIV/STDs, because when a girl gets pregnant the boy may be forced to marry her. In fact, a few boys actually had experiences with pregnancies. Because of their focus on preventing pregnancies, when a girl is on birth control pills, condom use is sometimes considered over the top. However, condom use may be enhanced when the girl is not trusted: TB1: A friend got a blow-job by a desperate girl which was totally in love with him. She kept the sperm in her mouth and put it into her pussy afterwards. Then, she got pregnant. TB2: Don’t take any risks when a girl is in love with you. Sperm stays alive for three days. When asked who should be responsible for carrying condoms with them, most participants think that the boy is mainly the one who should take care that a condom is available, in particular when they go out during the weekend. “Before you go out, you just take them with you: perfume, gel, money, condom” (Moroccan boy). They feel that it is not only necessary to carry a condom for themselves, but also to be able to help out a friend who might need it. In a steady relationship however, most boys think that both parties share responsibility for carrying condoms with them.
Self-efficacy Self-efficacy, or the extent to which one is convinced one can successfully execute behavior that is required to produce certain outcomes (Bandura, 1977), has been found to be positively related to actual condom use (e.g. Godin, Gagnon, Lambert, & Conner, 2005; Sheeran et al., 1999). Besides self-efficacy toward using condoms, the literature on safe sex behavior has also identified self-efficacy toward buying condoms and self-efficacy toward talking about using a condom with a sex partner as possible predictors of actual condom use. The level of Moroccan and Turkish boys’ self-efficacy clearly depends on the specific behavioral aspect in question. In general, they reported low levels of self-efficacy with respect to buying condoms, but seemed to have more confidence in using them and discussing condom use with girls. Most boys said that buying condoms makes them feel embarrassed, in particular when the counter-assistant in the drugstore is a Muslim girl wearing a headscarf. Besides feelings of embarrassment, fear of running into family members or acquaintances was frequently mentioned too. The Turkish boys reported more hesitancy in this regard than the Moroccan boys, probably because they are monitored more closely by their parents and other family members, and hence, are more afraid to get caught. To solve this problem, some send someone else to buy condoms for them, such as older brothers or friends, while others get their condoms from condom dispensers. A few Turkish boys mentioned going to other neighborhoods to buy condoms:
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In multicultural neighborhoods with a lot of Turkish and Moroccan people, I don’t go there. I have my favorite store, I go to Amsterdam-South, where Dutch people are.
Technically speaking, using condoms is not regarded as something difficult. After two or three times practicing, the boys know how it works. However, the Moroccan participants say that they regularly experience situations in which they have less control over using a condom, such as when they drink too much alcohol or when they are very horny. In these situations, the chance of having unsafe sex is much higher than usual. Contrary to findings of previous research (e.g. von Bergh & Sandfort, 2000), the socalled interaction competencies of both groups of boys seem to be sufficient. Discussing condom use with girls is seen as self-evident. Within steady relationships, the boys talk with their girlfriends about whether or not to use a condom and who is responsible for buying them. Bringing condom use during sex up for discussion is more difficult among younger boys and during one-night stands.
Social Norms The Turkish participants were generally more conservative than the Moroccan participants, in particular with regard to the virginity standard for women. They could not imagine marrying someone who is not a virgin. The Moroccan boys were less strict, and some indicated that it is not necessary for them to marry a virgin. Or, as one of them said: if you yourself are not a virgin anymore, you cannot demand that your spouse is. In general though, the double standard with regard to the virginity norm was commonly expressed during the discussions. Few boys think that they should abstain from sex until marriage, as they feel sex is normal and natural. Furthermore, they frequently mentioned that there is no objective way to proof that a man is not a virgin anymore, making it unnecessary to abstain from sex until marriage: “with girls you will find out that she is not a virgin anymore, with boys this is not the case” (Moroccan participant). The double standard toward virginity is also reflected in the fact that most parents give their sons far more freedom than their daughters. They are allowed to go out late at night, while their sisters should stay in after dark. Although the participants believe that their parents hope they will remain virgin until marriage, they also state that their parents are probably aware of the fact that they are sexually active. As long as sexual activities are not openly done or discussed, they are tolerated. As it is strictly forbidden for many Muslim girls to engage in any form of sexual activity before marriage, most Turkish boys prefer to have sex with Dutch girls. They seem to be very afraid of the consequences when they get caught with a Turkish girl. A Turkish girl that has lost her virginity can use this to force the boy into marriage, or even worse, it might induce honour-related violence. Although exact numbers on honour-induced violence are not available in the Netherlands, the Dutch media have repeatedly reported on cases in which people have been attacked because they violated the honour of Turkish families. Hence, the Turkish boys rather not take any risks:
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The Moroccan boys are less afraid of having sex with Moroccan girls, probably because in their community honour-related violence does not take place as much as in the Turkish community. In fact, many believe that more and more Moroccan girls have sex before marriage, and reported that they secretly had sex with them. However, because Moroccan girls still like to stay virgin until marriage, they often prefer anal sex, which the boys do not particularly like, partly because it is forbidden according to Islam. Hence, just like the Turkish boys, the Moroccan boys mainly have sex with Dutch girls. When discussing the topic of homosexuality with the focus group participants, some indications for a double standard emerged among the Moroccan boys, but not among the Turkish boys. That is, although both groups expressed very negative attitudes toward homosexuals, they also said homosexual behavior happened frequently among Moroccans, but not among Turks. Despite the fact that Moroccans openly mention the existence of homosexual behavior though, the opinions they express about homosexuality are far more negative than the opinions of the Turkish boys. Almost all say it is unnatural and disgusting, and one of the Moroccan boys even states that “if you are homosexual you should get a death sentence and fall down from the highest building there is”. A few disagreed and feel that everyone should life their own life: MB1: It’s unacceptable [homosexuality]. MB2: What do you mean with unacceptable? Are you a radical or something? I think it is acceptable; I have a friend too who is gay. Among friends, having safe or unsafe sex is not a topic of discussion. A majority of the boys feel that someone’s sex-life is private, and should not be discussed in detail. The reluctance to talk about sex was also evident during the group discussions with the Turkish boys. They were quite timid, in particular the younger ones, and it was obvious that most of them were not used to talking about sexuality with others. The Moroccan boys were more assertive, and felt less embarrassed to discuss their sex-lives. Although the participants claimed that they do not talk about condom use with friends, a few mentioned that they learned in an indirect way that some friends have unsafe sex. However, they withhold judgments about it and say that everyone should decide for themselves what they do (what should I think about it? If he finds it pleasant [sex without condoms], why not; Moroccan boy). Although they do not talk much with their friends about their sex-lives, having sex is mutually stimulated. It is regarded as cool to “score” girls and to have regularly sex with different girls. The boys also express a lot of macho-behavior toward each other. Not having a girlfriend seems to be against the norm (“It is normal to have a girlfriend. It’s part of life”. Turkish boy), and peer-pressure is common:
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MB: If you walk by with a girl, then they will ask: hey, did you already have sex with her? She looks good! When was the last time you got laid?
Education The boys hardly discuss sexual matters with their parents. Even if parents know that their son has a girlfriend (most keep relationships secret from their family), they do not talk about it. Only one or two Turkish boys said that they can talk with their mother about love, but even then, sexual topics are taboo. In a few cases, such as when a condom has been found by one of the parents, the father briefly addresses the topic of safe sex. The boys themselves do not want to communicate about sexuality with their parents as well, partly out of embarrassment, partly out of respect for their parents. A few of them are aware that there are no religious reasons for not talking about sexuality, and that the Koran outlines that young people should be educated about sexuality to prepare them for marriage. But as a rule, parents do not give their sons any sexual education. MB1: MB2:
Did you know that the Islam says that sexuality should be discussed in order to educate children? My grandpa only says: stay away from girls.
If the boys discuss their sexual lives, it is with their friends or family members from their own generation and gender, such as older brothers and cousins. However, most do not talk to others about sex; they feel it is a private matter. Because of the lack of communication at home, to get some sexual education most of the Turkish and Moroccan teenagers are dependent upon other information sources. A lot, but not all of them, have received some sexual education at high school. They are taught about it by means of books, leaflets, and sometimes video. They discussed the content of the materials with their teacher, who also often has demonstrated how to use a condom. Most boys liked the videos and discussions, but the written materials are found quite boring. Furthermore, as a lot of the boys start early with sex, they feel the school-based education is often too late for them and should be given earlier. The internet is an often used medium to gather more information about the technical aspects of sexuality, such as facts about virginity and pregnancy: TB: Just open the internet and write “can you get pregnant when you have sex without a condom?”. And then you read the site which offers the most information. Almost none of the participants use the internet to search for information about HIV/STDs. Pornographic sites are regularly visited, which may explain why the internet is often used secretly. The same holds true for television. Rarely do the boys watch programs with an educational content; erotic programs are often watched though. When asked which kind of education they prefer, most participants say that they find talking about sexuality more effective than reading about it, which might be a reflection of the fact that Turkey and Morocco are traditionally predominant oral cultures. A woman is preferred over a man, and a few propose to use prostitutes or people with Aids as educators.
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In general, the younger participants indicate that they have a greater need for education and information than the older ones. The fact that almost all boys ask a lot of questions during the group discussions and have low levels of knowledge however, suggests that more specific education would be no luxury for the older boys as well.
CONCLUSION The results of our study show that there are a number of noteworthy differences between Turkish and Moroccan teenagers. For instance, Turkish boys have more conservative views regarding some aspects of sexuality, such as the virginity of their future bride. Because Turkish people in the Netherlands strongly identify with their ethnic group (see also Pels, 2004) there is also more social control present, which may result in sticking more strongly to traditional norms. For instance, having sex with a Turkish girl is perceived as extremely risky, because of possible acts of revenge from the girl’s family. Moroccan groups on the other hand are more loosely defined and there is less social control, making honour-induced violence less likely to take place. Therefore, they can more readily have sex with Moroccan girls, albeit still in secret. In general, results of our group discussions give the distinct impression that, overall, Moroccan adolescents more frequently experiment with sex than Turkish boys, placing them at higher risk of getting infected with HIV/STDs. Our focus group discussions point to a number of similarities between the Turkish and Moroccan group as well. The lack of knowledge has been repeatedly found and may be an important barrier in practicing safe sex. The embarrassment felt when discussing sexual matters in the Turkish focus groups may not only be an indication that communicating about sex is taboo, but might also reflect this lack of knowledge. Moreover, the participants asked many questions about a wide variety of subjects, suggesting that they feel insecure about their current levels of knowledge and are curious and motivated to learn more. As communication at home is practically non-existent, information about sexuality should be transferred through other communication channels, such as peers and mass media. School-based education can be an effective way to enhance knowledge levels as well, as long as it is brought about in a vivid and oral manner. As many boys start with sex at an early age, it is recommended to introduce these programs at an earlier phase in the school curriculum than is usually done though. Although the focus group participants are aware that having sex without a condom can result in HIV/STDs infection, their perceptions of the actual risks are rather low. They often referred to the high risks in Turkey and Morocco to contrast the “safe” situation in the Netherlands. Furthermore, most boys do not feel personally vulnerable to HIV/STDs infections, because they have confidence in their ability to select a partner who is clean and free of disease. This finding corresponds with previous research (Henndrickx et al., 2002), and may prevent them from using condoms with partners they actually know very little about. In addition, condom use is often refrained from in relationships in which the girl is on birth control pills, largely because condom use is more strongly related to preventing unwanted pregnancies than to prevention of HIV/STDs. As these relationships may very quickly be judged as steady, and many boys are not faithful to their steady girl, this may augment the chance of not using condoms in possible high-risk situations. In essence, the sharp and unrealistic distinction these boys make between decent, clean girls on the one hand and sluts
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on the other hand, may give rise to practicing unsafe sex with so-called “clean” girls and should be addressed in health prevention programs. In contrast with previous studies, we did not find much evidence for difficulties in bringing up condom use with sex partners. The often mentioned lack of interaction competencies in earlier research (e.g. von Bergh & Sandfort, 2000; de Graaf et al., 2005) did not seem to be present among our focus group participants. This discrepancy in findings might be explained by the possibility that the interaction competencies among Turkish and Moroccan adolescents have actually improved during the last couple of years. Factors that have been shown to be related to stronger interaction competencies are a better social integration, more knowledge about HIV/STDs, a strong focus on sex and a positive body image (de Graaf et al., 2005). It is possible that some of these aspects have increased the last couple of years, thereby increasing interaction competencies. Equally possible is that the difference in outcome is attributable to a selection bias: the adolescents who participated in our study were perhaps more competent with respect to interacting with girls than the average Turkish/Moroccan teenager. Discussing sexuality during focus group sessions presupposes a certain ability and willingness to communicate about this topic. As such, the boys who participated in our study might have been more competent overall in this respect than the average participant of survey research. Further quantitative research is needed to establish whether the interaction competencies have actually increased or not. Some other important factors that were identified during the discussions as possible barriers to condom use were a negative attitude toward condom use because of reduced pleasure, financial (mainly mentioned by Moroccan teenagers) and psychological obstacles in buying condoms, and loss of control when being under the influence of alcohol (mainly mentioned by Moroccan teenagers). Although the impact of alcohol use on lack of condom use has been well-documented, it was somewhat surprising to find this to be an aspect of significance in this particular sample, because drinking alcohol is forbidden in Islam. In practice though, the Moroccan participants do drink alcohol when going out during the weekend, and might find themselves in high-risk situations in these cases. Health promotion programs should therefore address alcohol drinking and sexual activity together, and research should be conducted to determine the prevalence of drinking and sexual activity among Moroccan and Turkish youth. Finally, a last aspect that is worth referring to in health promoting interventions on safe sex is the social pressure of peers to have sex. There seems to be a social norm that it is cool to score girls, share girls, and have sex on a regular base. In contrast, there is no social norm toward having safe sex. Condom use is hardly discussed among peers, as it is considered to be a private affair. This strong focus on macho-behavior should be addressed and if possible, reversed. To conclude, our analysis of the focus group discussions with Turkish and Moroccan teenage boys has pointed to a range of factors that places their sexual health at risk. Some of the identified factors correspond with previous (survey) evidence, such as the low levels of knowledge and the absence of perceived vulnerability of getting infected with HIV/STDs. Other factors are inconsistent with previous findings, such as our results with regard to the interaction competencies of the Moroccan and Turkish boys. By running focus groups with both Turkish and Moroccan adolescents, we were able to focus on areas of similarities and differences between both groups, which may provide health educators with some clues on how to effectively tailor safe sex programs for these teenagers. To decrease the chance of HIV/STDs infections among these groups, it is essential to develop such culturally
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appropriate health education programs. The present study can be seen as a first step in getting closer to this aim.
REFERENCES Aral, S.O., & Fransen, L. (1995). STD/HIV prevention in Turkey: planning a sequence of interventions. Aids education and prevention, 7(6): 544-553. Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2):191-215. Bayar, N., & Sayil, M. (2005). Brief report: risk-taking behaviors in a non-western urban adolescent sample. Journal of adolescence, 28(5): 671-676. Bergh, M.Y.W.von, & Sandfort, T.G.M. (2000). Veilig vrijen en condoomgebruik bij Turkse, Marokkaanse, Surinaamse en Antilliaanse jongeren en jong-volwassenen [safe sex and condom use among Turkish, Moroccan, Surinam and Antillean adolescents and young adults]. Utrecht: NISSO/Utrecht University Bischoping, K., & Dykema, J. (1999). Toward a social psychological programme for improving focus group methods of developing questionnaires. Journal of official statistics, 15(4): 495-516. Catterall, M., & Maclaran, P. (1997). Focus group data and qualitative analysis programs: coding the moving picture as well as the snapshots. Sociological Research Online, 2(1), http://www.socresonline.org.uk/socresonline/2/1/6.html Combs-Schilling, M.E. (1989). Sacred performances; Islam, sexuality and sacrifice. New York: Columbia University Press. Cutcliffe, J.R., & McKenna, H.P. (1999). Establishing the credibility of qualitative research findings. Journal of advanced nursing, 30(2): 374-380. Duyan, V., & Yildirim, G. (2003). Letter to the editor: A brief picture of HIV/Aids in Turkey. Aids patient care and STDs, 17(8): 373-375. Eijk, C. van (2001). Advies communicatiestrategie allochtonen; Communicatieadvies soapreventie onder allochtonen, 2001-2003 [Recommendation communication strategy STD prevention for immigrants]. Utrecht: MCA Communicatie. Elmir, E., Nadia, S., Ouafae, B., Rajae, M., Amina, S., & Rajae E.A. (2002). HIV epidemiology in Morocco: a nine-year survey (1991-1999). International journal of STD & Aids, 13(12): 839-842. Feldman, S.S. & Rosenthal, D.A. (2002). Talking sexuality: parent-adolescent communication. San Fransisco: Jossey-Bass. Francesca, E. (2002). Aids in contemporary Islamic ethical literature. Medicine and Law, 21(2): 381-394. Godin G., Gagnon, H., Lambert, L., & Conner, M. (2005). Determinants of condom use among a random sample of single heterosexual adults. British journal of health psychology, 10(1):85-100. Gökengin, D., Yamazhan, T., Özkaya, D., Aytuğ, S., Ertem, E., Arda, B., & Serter, D. (2003). Sexual knowledge, attitudes, and risk behaviors of students in Turkey. Journal of school health, 73(7): 258-263.
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Graaf, H. de, Meijer, S., Poelman, J., Vanwesenbeeck, I. (2005). Seks onder je 25e [Sex below your 25th year]. Utrecht: Rutgers Nisso Groep. Heemelaar, M. (2000). Socialisatie in allochtone culturen [Socialisation in migrant cultures]. Houten/Diegem: Bohn Stafleu van Loghum. Hendrickx, K., Lodweijckx, E., van Royen, P., & Denekens, J. (2002). Sexual behavior of second generation Moroccan immigrants balancing between traditional attitudes and safe sex. Patient education and counseling, 47(1): 89-94. Hooykaas, C., Velde, F.W. van der, Linden, M.M.D. van der, Doorum, G.J.J. van, & Coutinho, R.A. (1991). The importance of ethnicity as a risk factor for STDs and sexual behavior among heterosexuals. Genitourinary medicine, 67(5): 378-383. Kitzinger, J. (1995). Qualitative research: introducing focus groups. British medical journal, 311(7000): 299-302. Kocken, P., Voorham, T., Brandsma, J., Swart, W. (1996). Effects of peer-led AIDS education aimed at Turkish and Moroccan male immigrants in the Netherlands: a randomized controlled evaluation study. The European journal of public health, 11(2): 153-159. Kraemer T. van Driel E, & van der Sluis Y.(2005).Wat vind jij daar nou van? Allochtone en autochtone jongeren over partnerkeuze en seksualiteit [Opinions of ethnic minoritiy and Dutch adolescents about choice of partner and sexuality]. Utrecht: Rutgers Nisso Groep. Manhart, L.E., Dialmy, A., Ryan, C.A., & Mahjour, J. (2000). Sexually transmitted diseases in Morocco: gender influences on prevention and health care seeking behavior. Social science and medicine, 50(10): 1369-1383. Martijn, C., Vries, N.K. de, Voorham, T., Brandsma, J., Meis, M., & Hospers, H.J. (2004). The effects of AIDS prevention programs by lay health advisors for migrants in the Netherlands. Patient education and counseling, 53(2): 157-165. MCA Communicatie (2002). Inventarisatie aidsbestrijding onder allochtonen [inventory aids prevention among migrants]. Utrecht: Aids Fonds. Obermeyer, C.M. (2000). Sexuality in Morocco: changing context and contested domain. Culture, health & sexuality, 2(3): 239-254. Pels, T. (1998). Opvoeding in Marokkaanse gezinnen in Nederland: de creatie van een nieuw bestaan [Upbringing in Moroccan families in the Netherlands: the creation of a new life]. Assen: van Gorcum. Pels, T. (2000). Muslim families from Morocco in the Netherlands: gender dynamics and fathers’ roles in a context of change. Current sociology, 48(4): 75-93. Phalet, K., & Wal, J. ter (2004). Moslim in Nederland [Muslim in the Netherlands]. Den Haag: Sociaal Cultureel Planbureau. Savaser, S. (2003). Knowledge and attitudes of high school students about AIDS: A Turkish perspective. Public health nursing, 20(1): 71-79. Schouten, B.C., van den Putte, B., Pasmans, M., Meeuwesen, L. (2007). Parent-adolescent communication about sexuality: the role of adolescents’ beliefs, subjective norms and perceived behavioral control. Patient education and counseling, 66(1): 75-83. Sheeran, P., Abraham, C., Orbell, S. (1999). Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychological bulletin, 125(1): 90-132. Sociaal Cultureel Planbureau (2005). Jaarrapport integratie 2005 [yearly report on integration]. Den Haag: SCP/WODC/CBS.
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Triandis, H.C. & Trafimow, D. (2001). Culture and its implications for intergroup behavior. In R. Brown & S.L. Gaertner (Eds), Blackwell Handbook of Social Psychology: Intergroup processes. Oxford: Blackwell Publishers Ungan, M., & Yaman, H. (2003). Aids knowledge and educational needs of technical university students in Turkey. Patient education and counseling, 51(2): 163-167.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 25
HIV/AIDS PREVENTION ON MEXICAN ADOLESCENTS: THE SYNTHESIS OF TWO THEORIES CONSIDERING THE INTERPERSONAL, INDIVIDUAL, AND PSYCHOLOGICAL INFLUENCES Raquel A. Benavides-Torres1, Georgina M. Núñez Rocha2, Esther C. Gallegos Cabriales1, Claude Bonazzo3, Yolanda Flores-Peña1, Francisco R. Guzmán Facudo1 and Karla Selene López García1 Universidad Autónoma de Nuevo León; Nuevo León, México 1 Instituto Mexicano del Seguro Social; Nuevo León, México2 University of Texas at Austin; Texas, USA3
ABSTRACT In Mexico, HIV/AIDS is a complex public health issue that carries significant psychosocial, socio-political, and economic repercussions. Adolescence is a period of development that not only encompasses physical and social changes, but also psychological. Adolescents engaging in unprotected sexual activities during this stage of development are at risk of contracting HIV infections. This paper posits that the Theory of Planned behavior has shown to be helpful in guiding research in HIV/AIDS prevention, but remains limited in the inclusion of ecological influences. Hence, this limitation is addressed using the Ecodevelopmental Theory. Therefore, this paper aims to develop a model based on the Theory of Planned Behavior and the Ecodevelopmental Theory that will explain HIV/AIDS prevention within the context of Mexican adolescents using concepts from both theories and the empirical evidence available. Three types of influences were identified during the process of theory synthesis: a) Interpersonal influences from the microsystem were parent communication about sex and peer influences; b) Individual influences included HIV/AIDS knowledge, gender (female), and age; and c) psychosocial influences consisted of perceived behavioral control for sexual health behaviors, subjective norms (gender roles), positive HIV attitudes, and sexual intentions. Results provide insight into the complex dynamics of the synthesis of the two aforementioned theories with respect to HIV/AIDS prevention. Communication about sex
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Keywords: HIV/AIDS prevention, adolescents, interpersonal influences, individual influences, psychosocial influences
Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) first appeared in the 1980s and quickly became a pandemic illness. Since then, more than 25 million people have died of AIDS worldwide. Every day around 6,800 people become infected with HIV (Joint United Nations Program on HIV/AIDS [UNAIDS] and The World Health Organization [WHO], 2007). In Mexico, as in other Latin American countries, HIV/AIDS is a complex public health problem which has repercussions in psychosocial, socio-political, and economic areas (United States Agency for International Development [USAID], 2005). The proportion of HIV-positive people in Mexico is 4.4 per 100,000 and has remained stable for 12 years (Secretaría de Salud, 2005). Most HIV/AIDS cases in Mexico resulted from homosexual and bisexual transmission. However, heterosexual transmission is increasing at a high rate and now accounts for 39% of total cases (Santos et al., 2003; Instituto Nacional de Geografia en Informática [INEGI], 2004). In the last decade, HIV/AIDS was the 17th highest cause of death in Mexicans aged 15 to 29, yet now it is the fourth highest cause of death in this group (INEGI, 2005). Considering that a person can be infected with HIV for 2 to 10 years without displaying any symptoms of AIDS, many of these infections may have occurred during adolescence (UNAIDS, PAHO, UNICEF, & WHO, 2004). Adolescence is a period of development that not only includes physical and social elements, but also emotional. It is a time when youths are extremely vulnerable and they must come to grips with their changing bodies. With the development of secondary sex characteristics, sexuality becomes an increasing concern for adolescents and the manner in which they respond to these changes contribute to their overall identity and sexual health. In urban areas, the mean age for first sexual intercourse is 16.7 years (Gayet & Solis, 2007; González-Garza, Rojas-Martínez, Hernández-Serrato, & Olaiz-Fernández, 2005). The use of condoms at this age is not a primary concern because the focus tends to center on unwanted pregnancies rather than HIV/AIDS prevention. It is imperative to better understand how adolescents become involved in risky sexual behaviors regarding HIV infections, since the rate of contracting AIDS is increasing rapidly among adolescents (Santos et al., 2003). In efforts to understand this problem, the Secretaria de Salud (Health Secretariat, 2002) created a
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program for HIV/AIDS prevention for Mexican adolescents, but the appropriate framework for Mexican population remains missing in this project. Nowadays, health professionals’ efforts toward understanding this specific phenomenon have been meticulous. Some of these efforts have delineated the role of each participant in the health care team to carry out actions against HIV/AIDS. Using multidisciplinary theories may help to better understand the phenomenon of HIV/AIDS prevention regarding Mexican adolescents (Villarruel, Bishop, Simpson, Jemmott, & Fawcett, 2001). A cursory review of the literature reveals that HIV/AIDS prevention studies frequently used two models to guide their research: the Theory of Planned Behavior (Ajzen, 1991) and the Ecodevelopmental Theory (Bronfenbrener, 1979). It is important to mention that most of the work has focused on people in the United States, but knowledge on how to translate this data with regard to Mexican adolescents will provide a significant contribution in the fight against HIV/AIDS in Mexico. Therefore, this paper aims to develop a new model based on the Theory of Planned Behavior and the Ecodevelopmental Theory that offers an explanation of HIV/AIDS prevention within the context of Mexican adolescents.
MODEL DEVELOPMENT PROCESS The process of theory synthesis for theory development described by Walker and Avant (2005) was used to construct the model of HIV/AIDS prevention in Mexican adolescents. Prior to carrying out the theory synthesis process, two additional activities were performed. The first activity consisted on reviewing the two theory analyses conducted by Rew (2005) on the Theory of Planned Behavior (p. 237) and the Ecodevelopmental Theory (p. 76) in order to determine if these two theories were suitable to represent this phenomenon. The second activity focused on the examination of the theoretical prepositions and concepts of interest from each theory to organize the theory synthesis process.
THEORY OF PLANNED BEHAVIOR The Theory of Planned Behavior is an extension of the Theory of Reasoned Action (Ajzen & Fishbein, 1980). The principal assumption in the former theory suggests that a person’s behavior is determined by his/her intention to perform the behavior; thus the best predictor of behavior is intention (Ajzen, 1991). Intentions implicitly rely on the motivational factors that influence the adolescents’ sexual behavior; motivations imply the willingness and hardiness of the adolescents’ degree of planning regarding performing the sexual behavior (Ajzen, 1991). This intention is determined by the person's beliefs about the outcomes of the behavior and beliefs about what other people think the person should do (Ajzen & Fishbein, 1980). A belief is a degree of certainty one has that something is true. Moreover, beliefs surrounding the carrying out of a particular behavior are a function of the salient information gathered from the positive and negative evaluations of the consequences of a human behavior (Ajzen, 1991). The theory of planned behavior is composed by a limited number of psychological variables: intentions, attitudes, subjective norms, and perceived behavioral control
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(Albarracin, Johnson, Fishbein, & Muellerleile, 2001). Different studies have shown that the theory of planned behavior is useful for explaining the phenomenon of HIV/AIDS prevention (Bennett & Bozionelos, 2000; Bogart, Cecil, & Pinkerton, 2000; Cooke & Sheeran, 2004; De Wit, Stroebe, De Vroome, Sandfort, & Van Griensven, 2000; Hagger & Chatzisarantis, 2005; Jemmott, L., Jemmott, J., & Villarruel, 2002).
ECODEVELOPMENTAL THEORY The Ecodevelopmental Theory was created based on the Social Ecology Theory (Bronfenbrenner, 1979), the Structural System Theory (Minuchin & Fishman, 1981), multisystems intervention (Henggeler & Borduin, 1990), and lifespan development approaches (Baltes, Reese, & Nesselroad, 1977). The theory allows for examining the influences on sexual behaviors within various environmental and developmental contexts. The use of this theory is appropriate because it states the protective and risk factors do not operate in isolation (Rew, 2005). Bronfenbrenner’s theory defines “layers” of environment, each having an effect on an adolescent’s development. It is important to mention that these layers interact with each other and that adolescent behaviors may be explained by a combination and interaction of the various systems. The microsystem contains the structures with which the adolescent has direct contact. At this level, relationships have an impact in two directions: from the adolescent and toward the adolescent. These bi-directional influences occur among all levels of environment. Both the interaction of structures between and within layers are important to this theory. Bi-directional influences are strongest and have the greatest impact on the adolescent. After reviewing both theory analyses, we can conclude that the theory of planned behavior has shown to be helpful for guiding research in HIV/AIDS prevention, but remains limited in the inclusion of interpersonal influences. As Walker and Avant (2005) have stated, one of the purposes of theory analysis is to determine the necessity of creating a new theory. Hence, this limitation will be addressed using the ecodevelopmental theory. Concepts from both theories will guide the development of a new model for HIV/AIDS prevention in Mexican adolescents using the empirical evidence available. The method of theory synthesis was selected for this development.
LITERATURE REVIEW This review utilizes the recommendations for literature reviews set out by Cooper (1998). The literature search included all documents that contained the following words in either English or Spanish: HIV prevention, AIDS prevention, or HIV/AIDS prevention, and adolescents and Mexico in the title, abstract, and/or keywords. The search included databases such as Academic Search Premier, Cinahl, Medline, PsycInfo, PubMed, PsycArticles, Health Source, Sociological Collection, and Google Scholar. This search identified 91 items of interest, but after thorough examination of the content, most showed only epidemiologic data about HIV or AIDS in Mexico and omitted factors associated with sexual behaviors. Publications should meet the following criteria: a) a publication year from 1995 to 2008, b)
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the presentation of empirical data associated with sexual health behaviors for HIV/AIDS prevention, and c) comprise of journal articles with peer review or published governmental reports. After this process, a total of 50 articles were excluded from the analysis because they failed to meet the keywords, the criteria above, or did not include Mexican adolescents as a target population.
DATA EXTRACTION A total of 41 studies were systematically reviewed, with the publication years ranging from 1995 to 2008. Twenty five of the studies were carried out in school settings or with students, and the rest with adolescents in general. The ages of the adolescents ranged from 10 to 20 years. All studies included descriptive statistics in their analyses, more than half (56%) included inferential statistics in their analyses, three studies had a quasi-experimental design, and the rest experimental design. Only 11 of the studies were guided by a framework. The following section will describe the synthesized information according to category influences (interpersonal, individual, and psychosocial) and their association with sexual health behaviors for HIV/AIDS prevention.
Note: (+) indicates positive associations, (-) indicates negative associations, and (?) unknown associations. PBC=perceived behavioral control, SHB=sexual health behaviors, GR=gender roles. Figure 1. The model of HIV/AIDS prevention on Mexican Adolescents.
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THEORY SYNTHESIS Theory synthesis is a strategy aimed at constructing theory, i.e. an interrelated system of ideas from empirical evidence (Walker & Avant, 2005). Sources of empirical evidence included all studies (41 publications) focused on the concept of sexual behaviors in HIV/AIDS prevention in the Mexican population. A literature review was conducted to identify the variables selected from the microsystem of the ecodevelopmental theory (interpersonal and individual influences) and the theory of planned behavior (psycosocial influences: attitudes, subjective norms, perceived behavior control, and intentions,) and their links with HIV/AIDS prevention. The model of HIV/AIDS prevention regarding Mexican adolescents is presented in Figure 1.
THE MODEL OF HIV/AIDS PREVENTION REGARDING MEXICAN ADOLESCENTS Interpersonal Influences Parent–child communication about sex plays an important role in adolescent sexual health (Benavides, Bonazzo, & Cruz, 2007). Adolescent girls who had talked frequently with their mothers about sexual concerns had lower probabilities of begining sexual activity, and higher probabilities of using contraception for those who were sexually active (Pick & Palos, 1995). Other studies explored the factors associated with sexual experiences in adolescents. Reported data included a higher percentage of parent–child communication in females as compared with males and females also perceived it as being more clear and direct than did males. Communication about sex was found to have a significant influence on the use of contraceptives (Benavides, Torres, & Bonazzo, 2006; Huerta, 1999). In addition, those adolescents who received information from their parents about sexuality were more likely to have higher levels of knowledge about HIV/AIDS (Tapia et al., 2004). From a qualitative perspective, Stern, Fuentes, Lozano, and Reynoso (2003) reported that male adolescents in their study received counseling from their mothers about sexuality. Communication about sex represents an inclination in relation to gender. Females prefer to talk with their mothers whereas males have a preference to talk with their fathers (Gayet, Rosas, Maguis, & Uribe, 2002). Another study mentioned that most adolescents receive information about sex from their teachers and when they have specific sexual issues, they look for counseling from their parents (Pineda, Ramos, Frias, & Cantu, 2000). Friendship is important in adolescents’ development and peers have a significant influence on adolescents’ behavior (Pennsylvania State University, 2002). Youths prefer to receive information from peers rather than from adults because they feel more confident when talking about sex with adolescents of a similar age (Family Health International, 1997). Another study involving work with adolescents found that the perception of a permissive environment was a predictor of sexual activity. Adolescents who were aware of fellow peers engaging in sexual activity were more likely to engage in sexual risky activities such as the use of alcohol and unprotected sex (Rasmussen, Hidalgo, & Alfaro, 2003). Adolescents who were influenced by friends, boyfriend, and/or girlfriend regarding sex had a higher probability
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of engaging in sexual activity (Stewart et al., 2001). Hence, interpersonal influence such as communication about sex is positively related to sexual health behaviors in HIV/AIDS prevention, to being female, and to knowledge about HIV/AIDS. Peer influence was negatively related to sexual health behaviors for HIV/AIDS prevention.
Individual Influences Sexual activity has a significant increase related to age. Adolescents at 12 years of age reported almost no sexual activity, but more than half have had sex at 19 years of age (Gayet, Juarez, Pedrosa, & Magis, 2003; Gayet & Solis, 2007). Congruent with this finding, Martinez (2003) and the Population Council (2002) found that older adolescents are more likely to engage in sexual activity and less likely to use condoms. The use of condoms during first intercourse was significantly different according to gender. One in two males versus one in five females used a condom during their first sexual intercourse. Today, however, those females report higher percentages of condom use than do males (Gayet et al., 2003; Torres, Walker, Gutiérrez, & Bertozzi, 2006). Another study found that, when controlling for age, males were more likely to be sexually experienced and to have sexual knowledge than females. In addition, when controlling for the probability of having had sex over the three months prior to questioning, females were more likely to have had unprotected sex than were males (Martinez et al., 2004). Further findings suggest that the mean age at which sex takes place before 15 years of age is higher for boys than it is for girls (Stewart et al., 2001). A study reveals that knowledge about HIV/AIDS is a predictor for condom use when controlling for gender (male) and high socioeconomic status (Villasenor, Caballero, Hidalgo, & Santos, 2003). Another study shows that males with higher levels of knowledge about HIV/AIDS increased the likelihood of condom use. On the other hand, females with higher levels of knowledge were more likely to have only one lifetime sexual partner (Tapia et al., 2004). This finding was contradictory to another study that found knowledge to be unrelated to sexual behaviors (Robles, Piña, & Moreno, 2006). In relation to knowledge about sexually transmitted diseases (STDs) between sexually active adolescents, one quarter of males versus one half of females know at least one method of protecting against STDs (Caballero, Villasenor, & Hidalgo, 1997; Gayet, et al., 2003). This was inconsistent with other studies that affirm that males knew more about HIV and STDs than did females (Givaudan, Van de Vijver, Poortinga, Leenen, & Pick, 2007; Madrazo, Castellanos, Huerta, Tarazco, & Marco, 2007; Torres, Walker, Gutierrez, & Bertozzi, 2006). Thus, we can conclude from the individual influences that there is an unclear relationship of HIV/AIDS knowledge and sexual behaviors and being female. Gender (female) is positively correlated with sexual behaviors and perceived behavioral control, but their relationship is unclear with subjective norms. Age was positively correlated with subjective norms, but negatively correlated with sexual health behaviors.
Psychosocial Influences Attitudes toward performing a behavior are a function of cognitive belief structures with two subcomponents: an individual’s beliefs surrounding carrying out a particular behavior
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and the positive and negative evaluations of those consequences (Ajzen, 1991). Males were more likely to agree somewhat or completely with the perception that condoms make sex less exciting, romantic, pleasurable, and make them appear too experienced than were females after controlling for age and sexual experience. In general, males held more negative attitudes about condoms than did females (Martinez, Melbourne, Hovell, et al., 2004). Another study involving a focus group showed that adolescents do not believe that AIDS is a homosexual disease. The focus group believed that AIDS was a fatal disease that could be prevented and that using condoms was very important. More than half of the participants indicated that adolescents do not know how to use a condom (Villarruel, Gallegos, Loveland, & Duran, 2003). Adolescents’ attitudes with respect to people living with HIV were related to being unhealthy and participants did not think that HIV-positive adolescents should continue in school (Stewart et al., 2001). In addition, adolescents with negative attitudes such as “condoms reduce pleasure” were less likely to have risky sexual health behaviors than those with positive attitudes (Gallegos, Villarruel, Loveland, Ronis, & Zhou, 2008; Perez & Pick, 2006; Robles, Piña, & Moreno, 2006). One study found that adolescents with high levels of sexual knowledge have more positive attitudes about condoms such as “the condom protects me form HIV” (Posada, 2008). Subjective norms include the perception of approval or disapproval when performing an action (Rosengard et al., 2001). Most of the literature that related to subjective norms explored sexual behaviors in relation to gender. Going beyond biological aspects, gender role includes masculine and feminine behavioral norms differentiated by sex (Tolman, Striepe, & Harmon, 2003). In a qualitative study on masculinity and sexual health, male adolescents described that being seen as “macho” implies being responsible, respecting females, and providing for their family. Male adolescents described that using condoms depended on their sexual partner. For example, it is more likely that they will use a condom if they have sex with “easy” girls than if they have sex with their girlfriend (Stern et al., 2003). Another qualitative study discussed the aspects related to gender roles and condom use: females are disadvantaged with an unfavorable reputation if they carry condoms and suggest their use. On the other hand, boys think that contraception is a feminine matter and stated that “a man can go as far as a woman wants” therefore, every unwanted consequence is a women’s responsibility (Castro, 2000). Gayet et al. (2003) in a quantitative study showed that in general females and males think that boys should propose condom use. The association between gender roles and gender is unclear because both males and females perceive roles in relation to gender. Perceived behavioral control includes an adolescent’s confidence as regards to performing a specific action (Notani, 1998). Students from an urban area in Mexico had low levels of self-efficacy in sexual behaviors regarding HIV/AIDS prevention. This study explored the perceived capacity for abstinence, talking with partners about sexual history, and the use of condoms. Findings suggested that female adolescents have significantly higher levels of self-efficacy for the aforementioned activities than do males (Martinez, Blumberg, et al., 2004; Lopez, 1998). Moreover, after controlling for age and sexual experience males reported less self-efficacy in refusing to have sex without a condom than did females (Marinez, Melbourne, et al., 2004). In addition, adolescents with higher levels of self-efficacy regarding AIDS prevention are more likely to delay sexual activity, use condoms, and practice abstinence (Lopez & Rubia, 2001). In another study it was reported that adolescents´
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control beliefs about condom use was associated to adolescent intention for condom use (Gallegos, Villarruel, Loveland, Ronis, & Zhou, 2008). The Theory of Planed Behavior affirms that the best predictor of behavior is intention (Ajzen, 1991; Ajzen & Fishbein, 1980). In Mexico, researchers have focused more on the study of adolescents’ sexual behaviors and their related factors but only few researches with Mexican adolescents have studied their intentions for sexual behaviors. Studies reported score means below the midpoint and reported that in general Mexican students had low intentions to avoid unprotected sex in future encounters (Martinez-Donate et al., 2004; Pergallo et al., 2005). Diaz-Loving and Villagran-Vazquez (1999) found that 20% of the variance in sexual behavior was predicted by adolescents’ intention for condom use. Other studies found that adolescent’s intentions to use condoms for vaginal, oral, and anal sex was related the sexual behaviors (condom use) (Patterson, Semple, Fraga, Bucardo, Davila-Fraga, & Strathdee, 2005; Piña, Corrales & Rivera, 2008). Some studies have investigated adolescent’s intentions in terms of gender. Males have reported less intention to avoid unprotected sex compared to females however, females tend to engage in risk behaviors despite having stronger intentions (Givaudan, Van de Vijver, Poortinga, Leenen & Pick, 2007; Martinez-Donate et al., 2004). One study found that 24% of the variance of the intention of condom use was explained in females with regular partners (Diaz-Loving & Villagran-Vazquez, 1999). In addition, female adolescents perceptions of what significant others desired of them, perceptions of general social norms, and whether they were sexually active predicted intentions to have sex (Flores, Tschann, & Marin, 2002). Other studies have focused on adolescent’s intentions for sexual behaviors and their related factors. Behavioral attitudes, norms, and intentions to engage in sexual behavior vary depending on both the sexual practice and the belief that condom use makes sex safer. In addition, behavioral beliefs about the utility of condom use and about the pleasure of condom use found to be the primary predictor of intentions to use condoms with occasional sex partners (Diaz-Loving & Villagran-Vazquez, 1999). Moreover, attitudes and subjective norms about the use of condoms are reliable predictors of intentions to perform healthy behaviors in adolescents. Adolescents’ self-efficacy and attitudes have a direct effect on adolescent’s intention to use condoms and partner communication in adolescents with and without sexual experience (Givaudan, Van de Vijver, Poortinga, Leenen & Pick, 2007). Therefore, from the analysis of the psychosocial variables we can say that perceived behavioral control and positive attitudes are positively correlated to intentions and sexual health behaviors. In the case of subjective norms, it was positively correlated with intentions but not with sexual behaviors. Finally, high intentions to use condoms influence sexual health behaviors.
CONCLUSIONS AND IMPLICATIONS This paper hypothesized a more sophisticated representation of HIV/AIDS prevention in Mexican adolescents. This theory synthesis allows for a better understanding of the connections among concepts related to sexual health behaviors in HIV/AIDS prevention. In conclusion, interpersonal, individual, and psychological influences are directly or indirectly related to sexual health behavior in HIV/AIDS prevention. Future research is recommended on those unknown factors, from associations between “being female and gender roles” and
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“gender roles and positive attitudes on HIV/AIDS prevention”. There was no association found in the evidence that showed that subjective norms are related to sexual health behaviors. This finding is contradictory with Hankins, French, and Horne (2000), who found that subjective norms are one of the predictors of a behavior. Therefore, more research including the unknown associations between gender, knowledge, subjective norms, and attitudes is also recommended. This theoretical model suggests different possibilities for future research toward confirmation of those associations reported. In addition, more research should be conducted into the specific mediators and moderators for the proposed relationships. Variables in the model were taken from two different theories; hence, explorations regarding their interactions in one model are suggested. This theory synthesis reviewed recent literature and finds that there is still a gap between the multiple components that intervene for HIV/AIDS prevention in adolescents. The Ecodevelopmental Theory was helpful to understand the concepts that are involved in the adolescents´ social environment to further understand their psychosocial aspects. Considering that this synthesis used the theory of planned behavior and the ecodevelopmental theory it may be possible to design different interventions at varying levels according to the adolescents´ needs to fight against HIV/AIDS in Mexico.
REFERENCES Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Ajzen, I. (1991). “The theory of planned behavior”. Organizational Behavior and Human Decision Processes 50: 179-211. Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127, 142-161. Baltes, P. B., Reese, H. W., & Nesselroad, J. R. (1977). Lifespan developmental psychology: Introduction to research methods. Monterey, Ca.: Brooks-Cole. Benavides, R., Bonazo, C. & Cruz, E. (2007). HIV Prevention Model Based in Parent-Child Communication about Sex in Hispanic Population. En Colombus, F. (Eds.), Family Relations: Behavioral, Psychological and Sociological Aspects. Hauppauge, NY, EE. UU.: Novapublishers Benavides, R., Torres, R., & Bonazo, C. (2006). HIV prevention based in parent-child Communication about sex in Hispanic Population. Journal of Hispanic Health Care, 23,.81-94. Bennett, P., & Bozionelos, G. (2000). The theory of planned behaviour as predictor of condom use: A narrative review. Psychology Health & Medicine, 5, 307-326. Bogart, L. M., Cecil, G., & Pinkerton, S. D. (2000). Hispanic adults' beliefs, attitudes, and intentions regarding the female condom. Journal of Behavioral Medicine, 23, 181-205. Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and desings. Cambridge, MA: Harvard University press
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Caballero Hoyos, R., & Villasenor Sierra, A. (2001). El estrato socioeconomico como factor predictor del uso constante de condon en adolescentes. Salud Publica de Mexico, 35, 531538. Caballero, H. R., Villasenor, S. A., & Hidalgo, S. A. (1997). Fuentes de informacion y su relacion con el grado de conocimientos sobre SIDA en adolescentes de Mexico [Sources of information and their relationship with the level of knowledge about AIDS among adolescents in Mexico]. Cadernos de Saude Publica, Rio de Janeiro, 31(4), 351-359. Castro-Vazquez, G. (2000). Masculinity and condom use among Mexican teenagers: the escuela nacional preparatoria No. 1’s case. Gender and Education, 12(4), 479-492. Cooke, R., & Sheeran, P. (2004). Moderation of cognition–intention and cognition–behaviour relations: A meta-analysis of properties of variables from the theory of planned behaviour. British Journal of Social Psychology, 43, 159-186. Cooper, H. M. Synthesizing Research : A Guide for Literature Reviews Applied Social Research Methods Series Vol. 2. Thousand Oaks, Calif. Sage Publications, Inc., CA. EE. UU. 1998. De Wit, J. B. F., Stroebe, W., De Vroome, E. M. M., Sandfort, T. G. M., & Van Griensven, G. J. P. (2000). Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The Theory of Planned Behavior and the InformationMotivation-Behavioral-Skills Model. Psychology & Health, 15, 325- 340. Díaz-Loving R. & Villagrán-Vázquez G. (1999). The Theory of Reasoned Action Applied to Condom Use and Request of Condom Use in Mexican Government Workers Applied Psychology Internal Review 48(2), 139-151 Family Health International (1997). Using Peer Promoters in Reproductive Health Programs for Young Adults. Retrieved from http://fhi.org/en/Youth/YouthNet/ Publications/ FOCUS/InFOCUS/peerpromoters.htm Flores, E., Tschann, J. M., & Marin, B. V. ‘(2002), Latina adolescents: predicting intentions to have sex, Adolescence, 37, 659-679. Gallegos, C. E., Villarruel, M. A., Loveland-Cherry, C., Ronis, L. D., Zhou, Y. (2008). Intervención para reducir riesgo en conductas sexuales de adolescentes: un ensayo aleatorizado y controlado. Salud Pública de México, 50 (1), 59 - 66. Gayet, C., Juarez, F., Pedrosa, L., & Magis, C. (2003). Uso del condón entre adolescentes mexicanos para la prevención de enfermedades de transmisión sexual. Salud Pública de México, 45(s5), s632-s640. Gayet, C., Rosas, C., Magis, C., & Uribe, P. (2003). Con quien hablan los mexicanos adolescentes sobre SIDA. Salud Pública de México, 44, 122-128. Gayet, C. & Solís, P. (2007). Sexualidad saludable de los adolescentes: la necesidad de políticas basadas en evidencias. Salud Pública de México, 49, 47-51. Givaudan, M., Van de Vijver, F., Poortinga, Y. H., Leenen, I. & Pick, S. (2007). Effects of a school-based skills and HIV-prevention program for adolescents in Mexican high schools. Journal of applied social psychology, 37(6), 1141-1162. González-Garza, C., Rojas-Martínez, R., Hernández-Serrato, M., & Olaiz-Fernández, G. (2005). Perfil del comportamiento sexual en adolescentes mexicanos de 12 a 19 años de edad. Resultados de la ENSA 2000. Salud Pública de México, 47(3), 209-218. Hagger, M. S., & Chatzisarantis, N. L. D. (2005). First- and higher- order models of attitudes, normative influence, and perceived behavioural control in the theory of planned behaviour. British Journal of Social Psychology, 44, 513-535.
448
R. A. Benavides-Torres, G. M. Núñez Rocha, E. C. Gallegos Cabriales et al.
Hankins, M., French, D., & Horne, R. (2000). Statistical guidelines for studies of the theory of reasoned action and the theory of planned behaviour. Psychology & Health, 15, 151161. Henggeler, S., & Borduin, C. (1990). Family therapy and beyond: A multisystemic approach to treating the behavior problems of children and adolescents. Pacific Grove, CA: Brooks/Cole. Huerta-Franco, R. (1999). Factors associated with the sexual experiences of underprivileged Mexican adolescents. Adolescence, 34, 389-401. INEGI (2004). Anuario Estadístico, Nuevo León. Aguasaclientes, México: Author. INEGI (2005). Anuario Estadístico por entidad federativa. Aguasaclientes, México: Author. Jemmott, L.S., Jemmott, J. B., & Villarruel, A. M. (2002). Predicting intentions and condom use among Latino college students. Journal of the Association of Nurses in AIDS Care, 13(2), 59-69. Lopez, F. (1998). Sida comunicación y Educación. Presentation in the II World Meeting on Media Education. São Paulo, Brasil 18-23 Mayo. Lopez, F. & Rubia, J., (2001). Validación de una escala de auto-eficacia para la prevención del SIDA en adolescentes. Salud Pública de México, 43, 421-432. Madrazo, J. M., Castellanos, G., Huerta, M. T., Tarasco, M. & Marco, J. (2007). Enfermedades de transmisión sexual y uso del condón para prevenirlas: percepción en estudiantes universitarios. Medicina y ética, 2, 151-164. Marinez H. (2003). Salud del adolescente. Salud Publica de Mexico, 45(s1), 3-4. Martinez-Donate, A., Blumberg, E., Hovell, M., Sipan, C., Zellner, J., & Hughes, S. (2004). Risk for HIV infection among adolescents in the border city of Tijuana, Mexico. Hispanic Journal of Behavioral Science, 26, 407-425. Martinez-Donate, A. P., Melbourne F., Hovell, E. J., Blumberg, J. A., Zellner, C. L., Sipan, A. M., & Carrizosa, C. (2004). Gender Differences in Condom-Related Behaviors and Attitudes Among Mexican Adolescents Living on the U.S.-Mexico Border. AIDS Education and Prevention, 16, 172-186. Mexican Institute of Youths (2002). Encuesta Nacional de la Juventud 2002. Retrieved from http://www.imjuventud.gob.mx/encuesta_contenido.asp Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press Notani, A. S. (1998). Moderators of perceived behavioral control's predictiveness in the theory of planned behavior: A meta-analysis. Journal of Consumer Psychology, 7, 247271. Orthopsychiatry, 74(4), 545-58. Patterson, T., Semple, S., Fraga, M., Bucardo, J., Davila-Fraga, W., & Strathdee, S. (2005) An HIV prevention intervention for sex workers in Tijuana, Mexico: a pilot study Hispanic Journal of Behavioral Sciences, 27, 82 - 100. Pennsylvania State University (2002). Resources on adolescent development. Retrieved from http://www.indiana.edu/~iuepsyc/topics/r_ado.htm Perez, B. C., Pick, S. (2006). Conducta Sexual en Adolescentes Mexicanos. Revista Interamericana de Psicología, 50(003), 333-340 Peragallo, N., DeForge, B., O'Campo, P. (2005). A randomized clinical trial of an HIV-riskreduction intervention among low-income Latina women. Nursing Research, 54, 108118.
HIV/AIDS Prevention on Mexican Adolescents
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Pick, S. & Palos, P. A. (1995). Impact of the family on the sex lives of adolescents. Adolescence, 30, 667-665 Pineda, J., Ramos, M., Frias, M., & Cantu, P. (2000). Encuesta sobre salud reproductiva en estudiantes adolescentes de educación media superior en Monterrey. Revista Salud Pública y Nutrición, 1(4), pp. Piña, J. A., Corrales, A. E. & Rivera, B. M. (2008). Variables psicológicas como predoctores de conductas de prevención relacionadas con la infección por VIH. Colombia Médica, 39(1), 16-23. Piña, J. A., Robles, B. M. & Rivera, B. M. (2007). Instrumento para la evaluación de variables psicológicas y comportamientos sexuales de riesgo en jóvenes de dos centros universitarios de México. Rev Panam Salud Pública 22(5), 295-303. Population Council (June, 2002). Youth and HIV/AIDS. Retrieved from www.popcouncil. org/horizons Posada, L. M. B. (2008).Conocimientos y Actitudes sobre el uso del Condón en adolescentes que acuden y no acuden a prácticas de salud. Revista Electrónica de Portales Médicos, Recuperado el 14 de Abril de 2008, de http://www.portalesmedicos.com/publicaciones /articles/952/1/Conocimientos-y-actitudes-sobre-el-uso-del-condon-en-adolescentes-queacuden-y-no-acuden-a-platicas-de-salud.html Rasmussen, B., Hidalgo-San Martin, A., & Alfaro-Alfaro, N. (2003). Comportamientos de riesgo de ITS/SIDA en adolescentes trabajadores de hoteles de Puerto Vallarta y su asociación con el ambiente laboral. Salud Pública de México, 45(s1), s81-s91. Robles, S., Piña, J. A. & Moreno, D. (2006). Determinantes del uso inconsistente del condón en mujeres que tienen sexo vaginal, oral y anal. Anales de Psicología, 22(2), 200-204. Rosengard, C., Adler, N. E., Gurvey, J. E., Dunlop, M. B., Tschann, J. M., Millstein, S. G., & Ellen, J. M. (2001). Protective role of health values in adolescents' future intentions to use condoms. Journal of Adolescent Health, 29, 200-207. Santos-Preciado, J. H., Villa-Barragan, J. P., Garcia-Aviles, M. A., Leon-Alvarez, G., Quezada-Bolanos, S., & Tapia-Conyer, R. (2003). La transición epidemiologica de las y los adolescentes en México. Salud Pública de México, 45(s1), s140-s147. Secretaria de Salud (2002). Programa de Atención a la Salud de la Adolescencia. Secretaría de Salud (1st. Ed.), Cd México: México. Stern, C., Fuentes-Zurita, C., Lozano-Trevino, L., & Reynoso, F. (2003). Masculinidad y salud sexual y reproductiva: un estudio de caso con adolescentes de la ciudad de México. Salud Pública de México, 45(s1), s34-s43. Stewart, H., McCauley, A., Baker, S., Givaudan, M., James, S., Leenen, I., Pick, S. et al., (2001) Reducing HIV Infection Among Youth: What Can Schools Do? Key Baseline Findings from Mexico, Thailand, and South Africa. Retrieved from http://www. populationcouncil.com/pdfs/horizons/schoolsbsln.pdf Tapia-Aguirre, V., Arillo-Santillan, E., Allen, B., Angeles-Llerenas, A., Cruz-Valdez, A, & Lazcano- Ponce, E. (2004). Associations among condom use, sexual behavior and knowledge about HIV/AIDS. A study of 13,293 public school students. Archives of Medical Research, 35, 334-343. Tolman, D., Striepe, M., & Harmon, T. (2003). Gender matters: Constructing a model of adolescent sexual health. Journal of Sex Research, 40(1), 4-10.
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Torres, P., Walker, D., Gutiérrez, J. & Bertozzi, S. (2006). Estrategias novedosas de prevención de embarazo e ITS/VIH/SIDA entre adolescentes mexicanos. Salud Pública de México, 48(4), 308-316. Joint United Nations Program on HIV/AIDS [UNAIDS] and the World Health Organization [WHO] (2007). HIV infection rates decreasing in several countries but the global number of people living with HIV continue to rise. AIDS Epidemic Update, Retrieved from http://w3.unaids.org/en/Publications/default.asp. UNAIDS, PAHO, UNICEF, & WHO. (2004). Epidemiological Fact sheet on HIV/AIDS and sexual transmitted diseases. Retrieved from http://www.unaids.org /EN/other/ functionalities/Search.asp United States Agency for International Development. (2005, March 31). Study Shows Corporations in Mexico Make Strides In Dealing with HIV/AIDS in the Workplace. Retrieved June 26, 2005, from http://www.usaid.gov/locations/ latin_america_caribbean/ country/mexico/mexico_hiv.html Rew, L. (2005). Adolescent health: a multidisciplinary approach to theory, research, and intervention. Thousand Oaks, CA: Sage Publications, Inc. Tapia-Aguirre, V., Arillo-Santillan, E., Allen, B., Angeles-Llerenas, A., Cruz-Valdez, A, & Lazcano- Ponce, E. (2004). Associations among condom use, sexual behavior and knowledge about HIV/AIDS. A study of 13,293 public school students. Archives of Medical Research, 35, 334-343. Villarruel, A. M., Bishop, T. L., Simpson, E., Jemmott, L. S., & Fawcett, J. (2001). Borrowed theories, shared theories, and the development of nursing knowledge. Nursing Science Quarterly, 14, 158-163. Villarruel, A., Gallegos, E., Loveland, C., & Duran, M. (2003). La uniendo fronteras: collaboration to develop HIV prevention strategies for Mexicana and Latino Youth. Journal of Transcultural Nurse, 14, 193-206. Villaseñor-Sierra, A., Caballero-Hoyos, R., Hidalgo-San Martín, A, & Santos-Preciado, J. (2003). Conocimiento objetivo y subjetivo sobre el VIH/SIDA como predictor del uso de Walker, L.O., & Avant, K. C. (2005). Strategies for theory construction in nursing, (4th ed.). Upper Saddle River, NJ: Prentice-Hall.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 26
ADOLESCENTS WITH CANCER: ADJUSTMENT AND SUPPORTIVE CARE NEEDS Luisa M. Massimo Department of Pediatric Hematology and Oncology G. Gaslini Scientific Children’s Hospital, Genoa, Italy
ABSTRACT Adolescence is a difficult in-between age, even in good health, and any kind of illness can alter this situation. Living with a high risk disease for several years during adolescence requires the activation of psychological defense mechanisms, cognitive functions, perception, acceptance, memory, communication, judgment, and emotions, which taken together mean good coping. The successful evolution of the coping process ultimately leads to good quality of life and adaptation. Over the last few years, physicians and clinical psychologists have endeavored to provide a good psychosocial status to their patients, especially those with cancer and those undergoing painful and distressing treatments. At our institution we chose to use the "narrative" approach with our sick adolescents, since it would appear to be the most suitable in individual encounters. There is often the need to overcome an important barrier through a friendly approach. Narrative medicine, more than others, lends itself to the intimate knowledge of the person being examined. Listening and talking through a patient/doctor alliance are the first steps towards true psychological healing. Over the last few years we have chosen this sort of dialogue with our adolescent patients, since they turn to us both seeking the physicians who know them well and a space where they can talk openly. The narrative approach requires time, willingness and an appropriate setting. In addition, the supportive care needs of these youngsters with cancer are often brought up in these encounters and this suggests the extent to which these needs may remain unmet. The dialogue that takes place following the “narrative” approach allows us to obtain detailed personal information and insight into the values and abilities of each subject. Undoubtedly, some psychosocial disorders can be prevented. Nowadays, pediatricians, supported by psychologists and other specialists, can create an alliance with the parents and the sick adolescents in order to adequately face pitfalls that may become the source of disorders in their physical, cognitive, emotional and behavioral development, and especially with regards to post-
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INTRODUCTION Relationships, mostly with sick persons, are tricky. Some of them need to be constantly and carefully nurtured, others are scarcely interesting, others work easily, but all of them require give and take. Physicians must always keep this reality in mind in their daily work with patients and their families. Healthy and sick people, no doubt, have different ways of responding to the environment, and for adolescents this mechanism can be more highlighted and even over-stressed. Adolescence is a very special time of life both in normality and in particular situations such as illness. Most transformations take place at this time of life, and there is often a discrepancy in physical and cognitive maturity. Several healthy adolescents have behavioral difficulties, parents are often very worried, and they become more and more distressed and lose confidence with their son or daughter. There is also an evolutionary break down, a period in which somatic and psychic evolution run along different paths and at different speeds. Both contracting a potentially lethal disease and facing hard treatment create strong interference in the growth and in the identity process. Adolescents affected by a severe disease, who undergo high risk treatment may experience stress, pain, extreme frustration, depression, and anger. In this large spectrum of emotions several conditions and situations must be taken into account and examined carefully.
ADOLESCENTS WITH CANCER. THEIR NEED FOR UNDERSTANDING Almost all adolescents and young adults being treated for leukemia and cancer express a desire or need for information about their illness, treatment and long-term effects, as well as about family counseling, sexuality and intimacy, infertility and options for having children in the future [1,2]. They demand detailed explanations in order to achieve better understanding of their situations. Needs may differ by age and gender, and mostly by the type of cancer and the severity of therapy. Some of them also wish to receive guidance about physical exercise and fitness, camp programs, nutrition, social help, transportation. More recent needs for both patients and parents concern the use of internet sites for cancer education or appropriate support for their age [3]. Many wish to receive up-to-date news through patient services and advocacy organizations. Very often adolescents express the need for psychological counseling for themselves and their families. In addition, they often feel the need for supportive care that is more suitable for youngsters their age, which suggests the extent to which these needs may remain unmet. The care provided by the family and by friends, together with their own personal satisfaction that their needs have been met, play very important roles in the health status and in the physical functioning of the adolescents 4]. Physicians must look at these many problems from the patient's viewpoint in order to provide truly total therapy and care to their young cancer patients. In order to achieve good coping
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and adjustment, this must include careful planning of resources, supportive care programs and services, together with a psychosocial assessment of the whole family. It would be important to carry out detailed investigations on the unmet needs felt by sick adolescents in order to understand and to facilitate their adjustment and coping with the new condition, and to avoid post-traumatic stress [5].
ADOLESCENTS AND CANCER: DISCREPANCY IN APPEARANCE AND INSIGHT To communicate their feelings, adolescents often choose to write their experiences, just as young children like to draw. This means of expression may be preferred, not only because the age allows it, but also because it is easier and more impersonal [6,7]. Nevertheless, we must bear in mind the self-indulgence, enjoyment and satisfaction that authors derive from narrating. The use of narrative style allows one to open up and makes it easier to express one’s own feelings; moreover, the act of writing helps to organize and analyze emotions. The process of narrating can generate an equilibrium of social, emotional, and behavioral attitudes. The story creates a fantastic world disjoined from realty, and through symbolism allows the narrator to assume a new, more impersonal and rational, perspective of real life. An adolescent is usually at grips with his/her new-found senses of body perception and selfesteem. A debilitating disease only aggravates this emotional storm [8,9]. Therefore, any space or vehicle, like a story, becomes an outlet to share their experience. Writings emerging from these settings have proven both significant and indicative of the perception of the disease and the associated hopes and fears. Some adolescents tackle their fears and speak about the impotence and loneliness they feel when faced with the challenge of hospitalization and treatment, by doing so they feel the possibility and the ability to overcome their ordeal. Some reveal a deep fear of the future, of abandon and of death. Each story narrated by adolescents highlights the feeling of impotence they harbor from being faced with the disease and the lack of any choice. An awareness of and attention to such writings will enhance the physician’s cultural understanding and will add important elements, thereby allowing a deeper exploration of feelings and of the adolescents’ coping environment [10,11]. Sometimes, they try to restore some semblance of normality in their own life, inducing an acceptance of the situation above and beyond the disease. Letting adolescent patients tell their story with little or no influence or interruption is germane to the physician’s task to grasp a sense of the cultural and emotional situation they need to share. The stories are fantasy, but they shed valuable light on the events that evoked them. As said before, adolescents need both information about their condition and the time and space to elaborate their reactions and emotions. Understanding this need, and thereby attempting to contain and subdue the patient’s sense of helplessness, involves the physician’s ability to share and make the patient feel involved in the decision making process about his/her treatment. This is especially true when patients who have been ill since a younger age may have grown into more conscious, discerning individuals, and when recent onset youngsters may have already achieved a certain degree of self-awareness. Chemotherapy side effects, too, may induce catastrophic feelings with fantasies. In my experience, several off-treatment adolescents show a high frequency of panic attacks and post-traumatic stress. In these cases it is very important that physicians and
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other health care professionals improve their listening skills. Interpersonal communication is an essential tool that demands flexibility of style, in-depth knowledge, and the ability to recognize and resolve barriers that hinder dialogue. At times, persistence is required. The adolescent must be made to feel comfortable enough to speak openly. Stories can provide valuable keys that allow us to know whether or not errors in understanding are a cause of distress, whether he or she feels alone and whether an atmosphere filled with love, security, hope, and honesty needs to be created and nurtured. There is a strong need to create departments which are suitable for patients of that age, and not only for those suffering from cancer, because in many hospitals adolescents may well be too old for the pediatrician, and yet too young for the adult practitioner.
CRISIS IN QUALITY OF LIFE AND IDENTITY PROCESS Our experience with adolescents who have already undergone or are undergoing treatment for leukemia and cancer also consists of psychodynamic interviews. This is an active listening technique whereby the doctor is apparently only asking. Interpersonal communication skills are an essential tool requiring flexibility of style and in depth knowledge of the matter [12]. In our interviews we follow a patient-centered method. Each adolescent must feel comfortable enough to speak about him/herself. Many questions are medically oriented, but at the same time we take the whole family into consideration in order to obtain a complete scenario including social and psychological information. As I said before, we always try to recognize and resolve barriers to communication. In many cases persistence pays off and we overcome the adolescent's reluctance to speak about his/her feelings, family, past, problems. The literature on the identity process in adolescents with severe non genetic diseases such as cancer who undergo high risk therapy is very scarce. Most of the papers written in medical journals and chapters of books on pediatric oncology are important and reveal personal experiences and feelings. Each of them enriches those who are dedicated to this field. Over the last thirty years psychologists have acquired a great deal of experience in Bone Marrow Transplantation Units, where the long-term, strict isolation, the painful conditions due both to the illness and to the diagnostic and therapeutic procedures, and the uncertainty about the results, place a very high degree of stress on the feelings and awareness of youngsters. The data obtained from observations and interviews reveal that the most disturbing facts regard the fragmentation of the ego, fantasies about death and above all about sexual identity when the donor is of the opposite gender. We have observed a high frequency of panic attacks as well. Some of the patients who had been cured of their malignancy suffered from persisting psychological distress such as self isolation, failure to engage in problem-solving efforts, low levels of personal resources concerning their future, behavioral disengagement, persisting psychological distress and difficulties in coping with uncertainty about their future as healthy adults. An important relationship with the family environment was observed, involving psychological maladjustment of the adolescent and parents or siblings, and behavioral difficulties between the patient and the parent taking care of him/her during hospitalization. Other important factors are related to the parents’ and siblings' psychological state when diagnosis and suggestions about treatment are communicated and
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discussed. Some problems are linked to the choice of the donor from among family members or to the obliged choice of an unrelated donor and his/her nationality, blood group, gender, while others are related to the impossibility of establishing contact between the donor and the recipient. Some other factors are related to the disease and to hospitalization, such as the unpredictable duration, altered temporal perception, distance from home and school, and self isolation. The onset of complications and side effects may induce a catastrophic feeling with fantasies about them, assuming the worst. The same may happen with the treatment of the complications, with the fear of having to be admitted to the Intensive Care Unit, and with the feeling of death. Furthermore, spreading gossip in the ward can play a role in distorting medical information about the health and death of other patients who are friends of the adolescent. Patients with low levels of cognitive appraisal and social support are more threatened, and their coping potential is lower than those who are more competent. Their reaction may include feelings of great discomfort, followed by difficult adjustment, posttraumatic stress, and even mental disorders.
THE TRULY HEALTHY ADOLESCENT AND YOUNG ADULT CURED OF CHILDHOOD CANCER Treatment approaches over the last 30 years have dramatically increased the survival rate in childhood cancer which is currently above 75%. Researchers have also investigated the delayed effects linked both to therapies and to the psychosocial implications of the disease in an effort to improve the therapeutic protocols and treatment of the sequelae, and to prevent them. The most commonly identified effects include an increased incidence of organ defects, growth retardation, sterility, second malignancies, neuropsychological damage, and cognitive deficits [13]. Published evidence on the quality of life of childhood cancer survivors, albeit plentiful, mostly measures their current perception of prominent indicators such as social life, education, occupation, marriage, and fertility [14-17]. Great emphasis is now also being placed on the post-traumatic stress that both the former patient and his/her parents may suffer [5,19,20,21]. Through questionnaires and interviews, most interviewers are able to provide important pictures of the survivors' lives, although the answers may not always depict their true reality. Only few surveys have longitudinally followed off-treatment patients from childhood to adulthood in an attempt to detect differences in their perceptions then and now as compared to the normal population of the same age and status [22]. The relationship between the physician and the sick child often unveils difficulties regarding understanding. Long ago, when a high percentage of patients died, the most common approach that physicians took towards them consisted in general and superficial discussions, without ever looking carefully at their futures, at their education, or trying to make plans for their adulthood. Now, several of those cured children are adults who are facing the difficulties of every-day life. Recently, our curiosity prompted us to investigate the feelings of a group of adult survivors of childhood cancer whom we had had the opportunity to know better when they were sick several years earlier [22]. Through a personal, friendly, narrative approach, we were able to listen to each one of them talk about their lives now and about their past. The meetings were conversational, relaxed, and confidential in order to avoid communication
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barriers. This was not a research project designed for any specific purpose, and the encounters did not have any scientific objectives. The main aim was to establish a new kind of easy communication with their former physicians. This experience was important to help them get in touch with their own feelings and behavior. It also taught us the need for a natural, honest, and direct relationship between the physician and the sick child through empathic exchange and discussion starting from the very onset of the disease. Talks with our early survivors, now between 30 and 40 years of age, revealed that they still suffer from distress and anxiety about something unknown that they had to endure but that they were not able to internalize and to transform into a positive event that happened during their life. Then we extended our investigation to more recently cured adolescents and young adults. Our experience taught us that it is better and easier to speak to the children directly, without any interference from their parents, and to avoid dangerous fantasies which are often worse than reality itself [14,22]. Sick children and adolescents with cancer therefore deserve increased personal care, mainly from their physicians. Through careful listening and communication it is possible to actively involve the child and his/her whole family. It must always be kept in mind that this personal, narrative approach requires time, willingness and an appropriate setting. In Europe, teams named ELTEC (Early and Late Toxicity Educational Committee) were established among experts of the International BFM Study Group to study and follow-up all the long-term survivors of childhood cancer and leukemia. In October 2006, at a meeting that took place in Erice (Sicily), we organized an International Workshop on “Long term survivors of childhood cancer: cure and care. “ At that time we established the so-called “Erice Statement [23]. This meeting was an attempt to establish communication among people involved in several areas related to long term survivors of childhood cancer, i.e., pediatric oncologists, epidemiologists, psychologists, nurses, parents and Parents’ Associations, and adults cured of childhood cancer, two of whom were physicians. The workshop involved forty-five experts from 15 European and North American countries. The combined efforts of the six groups led to the drawing up of the “Erice Document on cure and care of survivors of childhood cancer” which summarized the groups' conclusions and included a preamble and 10 statements. Below is a report of the conclusions given by Prof. JJ Spinetta, who was the coordinator of the last joint Session: “What happens to survivors of childhood cancer twenty years and more after treatment? There are three different areas of concern: the medical, the social, and the psychological. From the medical perspective, there is an increasing concern with the long-term medical and physical sequelae in young adults and adult survivors of childhood cancer. From the social perspective, the focus is primarily on how society views survivors of childhood cancer. There are many countries that view them as damaged goods, less healthy than their peers, less able to pursue normal careers. These attitudes impose on survivors severe societal restrictions on work, military service, and health support. The psychological perspective is concerned with the level of psychological functioning of young adults who were treated for cancer as children. Do survivors bear the burden of the illness in a way that keeps them from fully engaging in life or have survivors learned from their experience to be more adaptive and resilient than their peers?” [24]. In conclusion, as a pioneer of Pediatric Oncology, I suggest we should not look at the future of survivors who are cured of childhood cancer pessimistically, but rather, we should look at the entire field in a positive way [25].
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I believe that in the future, survivors will have two possible outcomes which will be related to the risk of disease and treatment. Those who suffered from low and standard risk disease will achieve and enjoy a normal life, while those who underwent very aggressive treatment, with or without stem cell transplantation, might have to cope with a more vulnerable life. I recommend to follow closely the patients and their families, starting from the time of diagnosis and carrying on throughout the whole treatment period with continuous psychological support, and to try to empower them and to strengthen their coping ability [25]. Due to the high number of survivors who are already adolescents or in their adult age, several scientists are now planning how physicians and the whole professional team will have to behave in the future in order to guarantee the best results when curing and caring for patients [26,27]. We must emphasize the need to consider this new population as being an especially vulnerable one. We must provide both survivors and caregivers with better education about the whole problem, mostly in an effort to prevent and to treat late effects, as well as to influence at-risk behavior, while always keeping in mind the main aim, which is to promote health.
REFERENCES [1]
Bleyer, A; Albritton, K. Special considerations for the young adult and adolescent. In Kufe, DW; Pollock, RE; Weichselbaum, R. (eds) Cancer Medicine. Hamilton, Ontario: Decker BC; 2003; 2414-2422. [2] Harris, KA. The informational needs of patients with cancer and their families. Cancer Practice 1998, 6, 39. [3] Rideout, V. Generation Rx.com: How Young People Use the Internet for Health Information. Henry J. Kaiser Family Foundation. Menlo Park, CA. 2001. [4] National Cancer Institute. Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer. Report of the Adolescent and Young Adult Oncology Progress Review Group. Bethesda: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute and the Live Strong Young Adult Alliance; 2006. [5] Hobbie, WL; Stuber, M; Meeske, K; Wissler, K; Rourke, MT, Ruccione, K; Hinkle, A, Zakaz, AE. Symptoms of posttraumatic stress in young adult survivors of childhood cancer. J Clin Oncol 2000, 18, 4060-4066. [6] Wilkie, V. Narrative based medicine essential in communication skill training. Br Med J 1999, 318, 28. [7] Charon, R. Narrative and Medicine. N Eng J Med 2004, 350, 862-864. [8] Charon, R. Narrative medicine: Form, Function, and Ethics. Ann Intern Med 2001, 134, 83-87. [9] Greenhalgh, T; Hurwitz, B. Narrative based medicine: why study narrative? Br Med J 1999, 318, 48-50. [10] Grinyer, A. The narrative correspondence method: what a follow-up study can tell us about the longer term effect on participants in emotionally demanding research. Qual Health Res 2004, 14, 1328-1341.
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[11] DasGupta, S; Charon R. Personal Illness narratives: Using reflective writing to teach empathy. Acad Med 2004, 79, 351-356. [12] Coupey, SM. Interviewing adolescents. In Adolescent Medicine Pediatr Clin North America 1997, 44, 1349-1364. [13] Garrè, ML; Gandus, S; Cesana, B; Haupt, R; De Bernardi, B; Pomelli, A; Ferrando, A; Stella, G; Vitali, ML; Picco, P; Nantron, M; Dallorso, S; Boni, L; Massimo, L. Health status of long-term survivors after cancer in childhood. Am J Ped Hemat Oncol 1994; 16,143-152. [14] Caprino, D; Wiley, TJ; Massimo, L. Childhood cancer survivors in the dark. J Clin Oncol 2004, 22, 2748-2750. [15] Zebrack, BJ; Casillas, J; Nohr, L; Adams, H; Zelzer, LK. Fertility issues for young adult survivors of childhood cancer. Psychoncol 2004,13, 689-691. [16] Robison, LL; Mertens, AC; Boice, JD; Breslow, NE; Donaldson, SS; Green, DM; Li, FP; Meadow, AT; Mulvihill, JJ; Neglia, JP; Nesbit, ME; Packer, RJ; Potter, JD; Sklar, CA; Smith, MA; Stovall, M; Strong, LC; Yasui, Y; Zelzer, LK. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol 2002, 38, 229-239. [17] Hudson, MM; Mertens, AC; Yasui, Y; Hobbie, W; Chen, H; Gurney, JG; Yeazel, M; Recklitis, CJ; Marina, N; Robison, LR; Oeffinger, KC. Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Am Med Assoc 2003, 290,1583-1592. [18] Di Gallo, A; Amsler, F; Gwerder, C; Burgin, D. The years after: a concept of the psychological integration of childhood cancer. Support Care Cancer 2003, 11, 666673. [19] Bruce, MA. systematic and conceptual review of post-traumatic stress in childhood cancer survivors and their parents. Clin Psychol Rev 2006, 26, 233-256. [20] Lee, YL. The relationship between uncertainty and post-traumatic stress in survivors of childhood cancer. J Nurs Res 2006, 14, 133-142. [21] Santacroce, SJ; Lee, YL. Uncertainty, post- traumatic stress, and health behavior in young adult childhood cancer survivors. Nurs Res 2006, 55, 259-266. [22] Massimo, LM; Wiley, TJ; Bonassi, S; Caprino, D. Longitudinal psychosocial outcomes in two cohorts of adult survivors from childhood acute leukemia treated with or without cranial radiation. Minerva Pediatr 2006, 58: 1-7. [23] Haupt, R; Spinetta, JJ; Ban, I; Barr, RD; Beck, JD; Byrne, J; Calaminus, G; Coenen, E; Chesler, M; D’Angio, GJ; Eiser, Ch; Feldges, A; Gibson, F; Lackner, H; Masera, G; Massimo, LM; Magyarosy, E; Otten, J; Reaman, G; Valsecchi, MG; Veerman, AJP; Penn, A; Thorvildsen, A; van den Bos, C; Jankovic, M. Long term survivors of childhood cancer: cure and care. The Erice Statement. Eur J Cancer 2007, 10, 10161018. [24] Spinetta, JJ. personal communication. [25] Massimo, LM. Over 15 years of ELTEC (Early and Late Toxicity Educational Committee): a report of the international BFM Study Group – A Comment. Pediatr Blood Cancer 2007, DOI 10.1002.
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[26] Bhatia S, Meadow AT. Long term follow up of childhood cancer survivors: future directions for clinical care and research. Pediatr Blood Cancer 2006, 46, 143-148. [27] Goldsby, RE; Taggart, DR; Ablin, AR. Surviving childhood cancer: the impact on life. Pediatr Drugs 2006, 8, 71-84.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 27
THE QUALITY OF CARING RELATIONSHIPS Tineke A. Abma*, Barth Oeseburg, Guy A. M. Widdershoven and Marian Verkerk University of Maastricht, Netherlands
ABSTRACT In healthcare, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations. Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue, they will better be able to attune their care to the needs of patients. We will illustrate this with the stories of three women with Multiple Sclerosis. Their narratives of identity differ from the narratives that caregivers and others use to understand and identify them. Since identities give rise to normative expectations in all three cases there is a conflict between what the women expect of their caregivers and vice-versa. These stories show that the quality of care, defined as doing the right thing, at the right time, in the right way, for the right person, is dependent on the quality of caring relationships.
INTRODUCTION It is not uncommon that expectations between patients and their healthcare professionals’ conflict. This creates tensions in the caring relationship. The purpose of this chapter is to understand these tensions from a care-ethical perspective (Tronto, 1993; Walker, 1998; Held, 2006). From a care-ethical perspective a good patient-professional relationship requires a *
Correspondence Address: Dr. Tineke A. Abma. University of Maastricht, Health, Ethics and Society/School for Public Health and Primary Care, PO box 616, 6200 MD Maastricht. Tel: 043-3881132; Email:
[email protected]
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process of negotiation and shared understanding about mutual normative expectations (Verkerk and Widdershoven, 2005).Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue they will better be able to attune their care to the needs of patients (Kagan, 2008). We will illustrate this with the stories of three women with Multiple Sclerosis (MS): Ann, Kathy and Jane (pseudonyms). MS is a chronic progressive neurological disease with profound effects on all facets of life: physical, cognitive and emotional, work, social activities, financial status and family functioning (Kraft, 1999; Boeije, et.al., 2002). Living with MS is a matter of balancing different and sometimes conflicting activities. Care for persons with a chronic disease like MS is complex and healthcare professionals are not always familiar with the disease and special needs of these patients (Rothman and Wagner, 2003). In the cases presented there is a clash of expectations which leads to tensed relationships between the disabled women and their professionals. The chapter consists of the following parts: We start off with sections on the theoretical framework and methodology. In the following sections the stories of Ann, Kathy and Jane will be presented. Their narratives illuminate the normative expectations towards themselves, others and vice versa. In an analysis we will investigate how conflicting normative expectations are grounded in diverging narratives of identity. Finally, we discuss how the findings can be used in helping healthcare professionals to build up caring relationships which are adjusted to the uniqueness of disabled persons.
A CARE ETHICAL PERSPECTIVE ON RELATIONSHIPS This chapter is based on Margaret Walker’s expressive-collaborative view of morality. Walker (1998) describes morality as situated in social practices, which makes morality fundamentally interpersonal. Moral life is centred around relationships. In interactions people jointly construct and maintain moral orders. This process takes place against a background of (moral) understandings about what people are supposed to do, expect and understand. Walker states that these ‘understandings’ – ideas about who we are and how to handle various situations – are expressed through practices of responsibility. Walker does not understand responsibility in legal terms, but redefines the concept of responsibility as ‘whom I care about’. With the emphasis on care as a central element of responsibility Walker’s view of morality resonates with Joan Tronto’s (1993) normative theory on the ethics of caring. Responsibility includes the notion of responding; listening, being attentive and answering in response to the needs of others. Walker does, however, not describe when and what should be done by whom to whom. The specific interpretation of the question who is responsible to whom, for what is context-bound and depends on the particular circumstances and the people involved in the situation. Commonly we speak about the ‘division’ of responsibilities. This implies a focus on the outcome of a negotiation process over who does what to whom. Walker rather concentrates on the process of negotiation over responsibilities between human actors when she talks about the assignment, acceptance and deflection of responsibilities. Walker’s moralepistemology implies that the assignment of responsibilities is shaped and defined by
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normative, often moral expectations. These normative expectations are expressed in narratives of identity. Narratives of identity, as Walker (1998) understands them, are the complicated interactions of the first-person stories by which one makes sense of oneself and the thirdperson stories that others use to identify one. Often, the third-person stories are different from those that figure into one’s self-conception and it is the clash between these different narratives of identity that creates tensions in the relationships between patients and their professionals.
MULTIPLE CASE STUDY Since normative expectations are grounded in stories, we followed a multiple case study approach in our research on the division of responsibilities for chronically ill. The research team collected case stories from fifteen MS patients and one or two of their health care professionals (n=24). These stories were later used as input for two focus groups: one among MS patients and one among healthcare professionals. We choose to have a mix of cases with regard to the stage of the illness (MS patients living at home with minimal disabilities; those going for a treatment to a rehabilitation centre; severely disabled MS patients hospitalized within a nursing home). The case study ended when no more new insights were added to the existing data set (‘saturation’). The interviews had the character of a 'natural' conversation structured by the issues coming up during conversation (Reissman, 1993). The interviewer did not start with a list of predefined topics, but began with an open question. MS patients were asked what happened when they became ill, health care professionals how they handled a specific care situation. The interviews lasted about two hours. The interviews were tape-recorded, transcribed in their entirety and analyzed following a narrative approach (Lieblich, et.al., 1998). Besides the content of the stories, the narrative structure and linguistic elements (discourse, metaphors) were addressed in the analysis. It is common within the qualitative research tradition to give respondents the opportunity to discuss one’s findings and to see whether or not they recognize the interpretation made by the interpreter(s). This so-called 'member check' is a helpful procedure to check the credibility of one’s findings (Meadows and Morse, 2001). Ann and Kathy responded to and approved to our interpretation of their stories. In the case of Jane it was, however, not possible to get a response, given her bad condition. She preferred not to be consulted and died several months after the interview in a nursing home. The verification of the findings was also enhanced because the stories were were analyzed by various members in the research team and discussed in team meetings. This strategy for verification is known as ‘inter-rated reliability’ (Meadows and Morse, 2001). Furthermore, methodological choices were discussed with two independent professors. This is known in the literature as ‘peer debriefing’ (Guba and Lincoln, 1985) and helps to identify blind spots. In the next three sections we describe the normative expectations of the women with MS.
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ANN Ann is a sportive looking woman in her thirties who has MS for more then seventeen years. Ann presents herself as someone who has learned to live with MS. She talks in terms of ‘decisions’ she has made and makes – as if she is fully in control - and emphasizes the importance of being able to have freedom of choice. Ann states, for example, that it is very important for her to choose and decide what she likes. In her words: ‘I will not do the things that are giving me no energy, that are drowning me.’ She also emphasizes that she has taken the initiative to select her own caregivers. When she heard the diagnosis she left her neurologist and GP and went to search for new ones. She explains: ‘I thought if I have to live with MS then I have to have caregivers who I can live with.’ Ann found health care professionals who she appreciates and with whom she can work together in a more or less horizontal relationship. She knew what she was looking for – people she could trust - and was well aware of her own needs. Ann also knows how to communicate her wishes (‘I am capable to formulate my need for help’ ) and considers this part of her responsibility in the communication with professionals. Making deliberate choices and articulating needs are important elements of how Ann sees herself. For quite some time Ann found satisfaction in becoming an active member of the Dutch Multiple Sclerosis Association (MSVN), but recently she is more critical of her voluntary work: ‘Yes, of course, I got many compliments, but you cannot buy your bread with compliments’. What frustrates her is the fact that she doesn’t have a professional career. Ann lost her job at the age of 28 years when she was diagnosed with MS. In those days in the Netherlands it was generally accepted that MS meant getting on insurance. Reintegration was not considered to be part of the treatment. This was a good solution for her employer, but it turned out to be a disaster for Ann. She found an alternative in her voluntary work for the MSVN, but discovered later on that her identity entails more than being a woman with MS: ‘I am not solely an MS patient I am also Ann who wants to do other things in life, in my spare time. I do not always want to be involved with MS that is just a part of me.’ Ann’s narrative of identity is thus built around becoming a woman with a profession again. She wants to be recognized by others as a professional, and not solely as an MS patient. Finding an appropriate job is, however, complicated. Ann compares it with a ‘real crusade’. It is here that she expects support from others, among them employers: ‘I need support from employers for this part in my life … I also need others to support me. Contacts, networks, information, institutions and whatever is needed.’ In her narrative of identity Ann envisions herself as a professional woman, but she readily acknowledges her vulnerability as an MS patient. This vulnerability is not only related to work, in other domains of life she also encounters problems. Ann’s narrative of identity creates normative expectations towards herself and others. Ann takes on a lot of responsibility for her own health and welfare. She is the one who make decisions, who is in charge. What is able to do herself, she will take on. Yet, there are parts in life that she cannot completely control, and where she expects acknowledgement, help and support from others, especially from employers. Employers and others, however, have difficulties to identify Ann as someone who requires support to realize her identity as a professional woman. It is the clash between the different narratives of identity that creates tensions between Ann and others.
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KATHY Kathy is in her forties and was diagnosed with MS more than twenty years ago. She lives alone in the Northern part of the Netherlands. At home she is mobile without using equipment. Outside her house Kathy uses a wheelchair or a booster. She only makes use of domestic assistance. When Kathy was diagnosed with MS she worked fulltime, but over a period of several years working hours have been gradually reduced. She now works two afternoons per week. Since the last two years Kathy has frequently been on sickness leave because her condition has worsened. Due to the spasticity in both hands and her fatigue she wonders whether or not she is able to continue her work. In Kathy's opinion work is important; it gives her status, a meaningful place in society. Recently Kathy experiences, however, problems as a result of her worsening condition. She even cannot maintain social contacts with friends and family. She wonders what to do, and consults her general practitioner. He has given her the advice to continue work, because he is worried that Kathy will have no social life anymore, if she is going to give up her job. The solution offered by the GP is, however, not satisfying Kathy, because it does not take into account how important relationships with family and friends are for her. Kathy’s disappointment also refers to the inattentiveness of the GP to her need for understanding and support. She does not expect the ready-made solution her GP offers, but assistance to come to her own solution based on a better understanding of her own situation. A psychologist in a near-by rehabilitation centre is able to attend to her expectations. After several meetings with the psychologist Kathy comes to the conclusion that maintaining contacts with friends and family is more important for her than continuing her job. So she decides that it is better to get on insurance. The psychologist enabled Kathy to reach a solution that is fine-tuned to Kathy’s situation and identity.
JANE Jane is in her fifties, not married, and lives in a one-person room in a nursing home. Lately she has suffered from various bacterial diseases, so that she almost died. Now she mainly stays in bed with oxygen, a tube in her nose, a catheter and an anti decubitus mattress. She is able to drink from a special mug, but can not put up make up herself, is not able to wash herself, can not move herself from one side to the other. She needs assistance and help for everything. Jane was diagnosed with MS at the age of eighteen. The disease is progressive and soon she gets into a wheelchair. During those years she is very angry, continuously wondering ‘Why does this happen to me?’ What troubled her most was that people were ignoring her because she was sitting in a wheelchair. She notices: I am perfectly able to talk for myself. Although she expects he would learn to cope with the situation, she loses her boyfriend. She also loses her work, although she manages to work as a bookkeeper in the first two years of her illness. In 1971 she gets on insurance. With the help of a home care nurse and specialized family help her mother looks after her for many years.
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Then a period starts in which she often stays in hospitals, undergoing all kinds of treatments and cures. In 1979 she is blind for one day and night. Immediately she calls her doctor at the local hospital. He ensures her she will be hospitalized if the situation lasts for more than several days. When the situation becomes urgent he, however, informs her he will do nothing. Jane no longer trusts him and decides to go to a neurosurgeon in an academic hospital. Jane thus presents herself as someone who knows what she wants and who is able to make decisions concerning her life. Jane’s self-conceptualization creates certain expectations towards others, such as the wish to be taken seriously. Conflicts emerge when others identify her as docile, because she sits in a wheelchair. Yet, she has also satisfying relationships with others; her mother, family members and recently the residents in the nursing home. She experiences moral support from these people. Lately Jane needs extra assistance and help. She experiences a lot of misunderstanding among the nurses. They do not always understand when she is tired. She also misses respect and loving attention from the nurses. It is frustrating that she almost always has to wait for help. She compares it with the way she was treated at home: ‘It is a matter of asking again and again, and that I can not cope with, because I wasn’t used to that at home.’ She also notices that nurses get irritated when she asks them, for example, to give her something she can’t fetch. Besides the lack of attentiveness to her needs Jane is also critical about the expertise of the health care professionals. Jane is physically dependent, but does not act in a dependent way. She presents herself – in line with her story of who she was in the past - as being articulate and critical. Given her narrative of identity she expects support and help with her daily routine, but also wants acknowledgement as a person who gives direction to her life. The health care professionals do not perceive her in the way she sees herself. They identify her as being dependent and expect her to behave dependent – uncomplaining and grateful for anything that is done for her. Jane does not live up to these expectations, and the caregivers find her troublesome. Her demanding nature, her lack of docility and her quite articulate complaints are driving the nurses crazy. Again we see how conflicting narratives of identity create problems between MS patients and their caregivers.
IDENTITY AND RELATIONSHIPS In this analysis we reflect on the above stories and how the narratives of identity of these women differ from narratives that others use to understand and identity them, and how this creates tensions in the caring relationships. Narratives of identity are complex interactions between self-conceptualizations and perceptions others use to identity us. Ann presents herself as being in charge of her life and illness. The autonomy and self-determination she enacts in relation with her caregivers does, however, not work in relation to her employers. This is the other part of Ann’s identity: she is also vulnerable and dependent on other human beings, information and institutions. This narrative of identity creates the expectation that others will give her assistance and support, especially when it comes to finding a job and to realize her future identity as a professional woman. Ann experiences, however, that others do not identify her as being vulnerable. As a result, she does not receive the help she expects and needs.
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Kathy presents herself as being independent. She has always worked, is articulate about her needs and takes the initiative to visit a rehabilitation centre. Autonomy has always been an important value in her life. Difficulties start when her condition gets worse. Then the coordination of work and social life becomes complicated. Kathy expects support and understanding from her GP which he is not able to offer. He identifies Kathy as someone who cannot make her own decisions, and expects she will be satisfied with his solution to continue work. Her psychologist is better able to assist her by helping her to make her own conclusion, thus respecting her identity as an autonomous woman. Jane also presents herself as being independent, articulate and critical. She is complaining about the quality of care, expressing her needs and standing up for herself. Autonomy has always been an important value in her life; Jane, for example, chose her own doctor, which can be seen as an example of self-determination. Conflicts emerge when others identify her as docile and dependent. In the nursing-home the nurses and doctor expect Jane to act uncomplaining and grateful. Her demanding nature and her quite articulate complaints are considered as troublesome. Again we see how conflicting narratives of identity creates a clash of expectations. While Ann experiences that others do not identify her as being vulnerable, Kathy and Jane experience that others are not able to see them as being autonomous. In all cases normative expectations are in conflict, which creates tensions in the patient-professional relationship.
CONCLUSION Walker’s moral epistemology offers an innovative methodology to understand caring relationships in terms of the coordination of normative expectations between patients and professionals. The tales of the women with MS show that tensed relationships occur as a result of conflicting normative expectations, grounded in conflicting narratives of identity. Sorting out normative expectations in order to reach a shared understanding of who is responsible to whom and for what, requires that professionals caring for people with MS listen to their stories. In stories patients express how they see themselves. Walker’s theoretical perspective also helps professionals to understand the uniqueness of MS patients. The narratives show that although the women had a similar medical condition, the meaning they endowed to their situation was very different. There is a tendency in health care to use protocols and standards. The results of our analysis show that care recommendations must be tailored according to individual needs of patients. The particular needs of patients can be understood through interaction and communication. Health care professionals caring for persons with MS should at least ask themselves the following questions: a) how do I identify the needs of my patient? and b) what responsibility do I have for this patient ? In order to answer these questions, they should pay attention to the way patients see themselves. So, health care professionals should create a space for patients to develop and tell their stories. The standard-question “How are you?” should be redefined in terms of “Who are you?” Professionals should ask themselves who the person is, they encounter, how this person sees him/herself and what kind of expectations this generates. Professionals have a special responsibility in this regard given the vulnerability and dependency of patients. Professionals are the ones who should elicit patients’ expectations
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thereby showing that this information is a valuable and necessary contribution to their care (Oeseburg and Abma, 2006). Furthermore, professionals should be aware and responsive to the fact that the expectations of similar groups of patients can be very different, as the stories of the women with MS show. People describe themselves in different ways; even one person can change his or her image of self during the illness process. Listening and understanding is very important, but often hard to practice for health care professionals. Kathy’s GP does not consider listening as part of his job. He wants to act and finds it very difficult to respond adequately to the uncertainty Kathy experiences. Although he senses that she is suffering, he is unable to create a space for her feelings of grief and powerlessness. The psychologist had a very different approach and did not suppress Kathy’s feelings and emotions. Giving space to suffering implies that one deliberately does not act. The focus shifts from instrumental values to the intrinsic values of attentiveness, being present and being related to the patient (Tronto, 1993). This is hard to practice for those health care professionals who define their identity in terms of being an expert. Creating a space for emotions and feelings of patients requires that one redefines one’s self-image as a health care professional. Being a good health care professional is not only a matter of technical expertise, but includes the moral virtues of being there and listening.
REFERENCES Boeije HR, Duijnstee MS, Grypdonck MH, Pool (2002) A. Encountering the downward phase: biographical work in people with multiple sclerosis living at home. Soc Sci Med 55: 881-893. Held, V. (2006) The Ethics of Care – Personal, Political and Global, Oxford University Press. Kagan, P.N. (2008) Listening: Selected perspectives in theory and research, Nurs Sci Q, 21: 105-110. Kraft GH. (1999) Rehabilitation still the only way to improve function in multiple sclerosis. The Lancet 354: 2016-2017. Lieblich, A., R. Tuval-Mashiach and T. Zilber (1998) Narrative analysis, Reading, analysis and interpretation, Thousand Oaks, Sage. Meadows, L, M and J. M. Morse (2001). Constructing Evidence within a Qualitative Project, In: Morse, J.M., J.M. Swanson and A.J. Kuzel (eds), The Nature of Qualitative Evidence (p. 187-201), Thousand Oaks, Sage. Oeseburg, B. and T.A. Abma (2006) Care as a mutual endeavour, Medicine, Health Care and Philosophy, 9: 349-357. DOI 10.1007/s11019-006-0003-6. Reissman, C.K. (1993) Narrative Analysis, Qualitative Research Methods Series, 30, Newbury Park, Sage. Rothman, AA and Wagner, EH (2003) Chronic illness management: what is the role of primary care?Ann Intern Med. 138(3):256-6). Stake, R.E. (1994). Case Studies, In: Denzin, N.K. and Y.S. Lincoln (Eds.) The Handbook for Qualitative Research, Thousand Oaks, SAGE, p. 236-247. Tronto, J. (1993), Moral Boundaries. New York: Routledge.
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Verkerk, M. and G. Widdershoven (eds.) (2005), Over zorg gesproken, Wiens verantwoordelijkheid? [Talking about care, Whose responsibility?] NWO/Ethiek en beleid, Stichting Drukkerij C. Regenboog. Walker, M.U. (1998) Moral Understandings, New York: Routledge.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 28
AN ATTACHMENT-BASED PATHWAYS MODEL DEPICTING THE PSYCHOLOGY OF THERAPEUTIC RELATIONSHIPS Geoff Goodman* Long Island University, Brookville, New York, USA
ABSTRACT Throughout the history of psychotherapy, clinical theoreticians have evoked various metaphors to depict the therapist-patient relationship. With the advent of attachment theory and other advances in developmental psychology in the 1950s and 1960s, a new therapeutic metaphor was born: the caregiver-infant attachment relationship. This metaphor has yielded a number of insights into the process of psychotherapy and the nature of the interactions in which the therapist and patient engage. The first objective of this article is to illuminate both the advantages and disadvantages of using this metaphor to depict the psychology of therapeutic relationships. One distinction between this metaphor and the therapeutic relationship is the state of development of mental structures in the infant versus the patient. Whereas the caregiver is behaving in response to the infant’s emotional cues not contextualized by an interactional history of expectations to guide these cues, the patient enters into a therapeutic relationship with a complex and intricate interactional history of expectations. This asynchrony between the caregiverinfant attachment relationship and the therapist-patient relationship requires the therapist to behave in sometimes noncomplementary ways to challenge and interpret these transferential patterns rather than simply responding to emotional cues, as a caregiver would do. These interactional expectations, typically organized around definable patterns of behavior in the therapeutic relationship, are “often neither conscious and verbalizable nor repressed in the dynamic sense” (Lyons-Ruth, 1999, p. 589), and thus pose challenges to traditional psychotherapy models that rely exclusively on symbolization to produce therapeutic change. This new understanding of therapeutic change forces *
Correspondence concerning this article should be addressed to Geoff Goodman, Ph.D., Clinical Psychology Doctoral Program, Long Island University, 720 Northern Blvd., Brookville, NY 11548 (516-299-4277 (O), 516-299-2738 (F),
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Each of us carries with us into our therapy office a metaphor—conscious and unconscious—of our relationship with our patients. This metaphor varies from patient to patient, and varies within the same patient across the span of treatment. Nevertheless, the broad parameters of this metaphor probably remain constant, both within and across patients, and depend on the quality of our own attachment patterns and broader influences. Each theoretical perspective also inaugurates and sanctions its own ready-made therapeutic metaphors that we also use to help us construct our own. By examining these therapeutic metaphors, we can learn something about our representations of ourselves as therapists in relationship with our patients and evaluate whether and in what ways these metaphors serve or hinder our patient’s interests. Freud (1912b) offered the therapeutic metaphor of the surgeon-patient relationship to his disciples and fellow psychoanalysts. Freud (1915) elaborated on this metaphor in his paper on transference-love, in which he seemed to be defending against the intensity of his female patients’ professions of love with a sterile, rigid set of technical guidelines. Humanistic psychologist Carl Rogers (1977) offered a radically different therapeutic metaphor of the person-person relationship, whose egalitarianism stands in stark contrast to Freud’s authoritarianism (see also Vitz, 1977). We might consider Rogers’s therapeutic metaphor a reaction to the rigidity of classical psychoanalytic technique in vogue at the time. With the advent of attachment theory (e.g., Bowlby, 1973, 1980, 1982, 1988) and the psychoanalytic study of mother-infant interaction (e.g., Bowlby, 1958, 1973, 1980, 1982; Mahler, Pine, & Bergman, 1975; Stern, 1977, 1985, 1995; Winnicott, 1960, 1965), a new therapeutic metaphor was born: the caregiver-infant attachment relationship. Contemporary psychoanalysts are using this metaphor to illuminate aspects of the therapist-patient relationship obscured by the Freudian metaphor such as the therapeutic components of nonverbal interactions between therapist and patient, the corrective emotional experience (Alexander & French, 1946), and the noncomplementarity of the therapist-patient match (Bernier & Dozier, 2002). Bowlby (1977b, 1988) applied his own ideas about human attachment to the metaphor of the mother-infant relationship. He believed that the primary purpose of the therapist is to provide the patient with a secure base from which he or she can explore himself or herself and his or her relationships with others. In attachment theory, the secure base in the person of the caregiver serves the function of providing protection for the infant as he or she explores the environment. The caregiver’s safe haven, a complementary concept, serves the function of comfort when internal or external threats to homeostasis cause the infant to become distressed. Concepts similar to secure base identified by other writers include conditions of safety (Weiss & Sampson, 1986), atmosphere of safety (Schafer, 1983), and background of
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safety (Sandler, 1960). The therapeutic relationship proceeds when the patient uses the therapist to explore oneself and one’s relationships with others and for comfort when confronted by distressing internal and external threats. Attachment theory and research have spawned the application of still other facets of the caregiver-infant attachment relationship to the therapist-patient relationship (Amini et al., 1996; Diamond et al., 1999; Diamond, Clarkin, et al., 2003; Diamond, Stovall-McClough, et al., 2003; Farber, Lippert, & Nevas, 1995; Holmes, 1996, 1998; Lyons & Sperling, 1996; Mackie, 1981; Mallinckrodt, 2000; Mallinckrodt, Gantt, & Coble, 1995; Mallinckrodt, King, & Coble, 1998; Mallinckrodt, Porter, & Kivlighan, 2005; Mitchell, 1999). Parish and Eagle (2003) identified seven facets: proximity seeking, separation protest, stronger/wiser, availability, strong feelings, particularity, and mental representation. Proximity seeking refers to the infant’s need to seek proximity to the caregiver for protection when faced with an internal or external danger (Bowlby, 1982). Parish and Eagle (2003) did not define proximity seeking for the therapist-patient relationship; however, we might regard a patient’s request for additional sessions after a therapist or patient vacation as an adult form of proximity seeking. Separation protest refers to the distress experienced by the infant when separated from the caregiver and the infant’s protest against it (Bowlby, 1982). In the therapist-patient relationship, the patient might protest against a therapist’s upcoming vacation. One of the ingredients of an attachment relationship, according to Bowlby (1977a), is that the infant perceives the caregiver as stronger or wiser than he or she does. Similarly, in the therapistpatient relationship, the patient perceives the therapist as having knowledge of the patient’s problems and ways to resolve them that exceed the patient’s own knowledge. Availability refers to the caregiver’s emotional and physical availability to meet the infant’s attachment needs (Bowlby, 1982). The therapist also meets the patient’s emotional needs through attentive listening, regularly scheduled appointments, interpretations that foster a sense of being understood, and many other manifestations of therapist availability unique to each therapist-patient dyad. An infant also expresses strong feelings toward a caregiver (Bowlby, 1982). The infant is looking for the caregiver to facilitate the regulation of these strong feelings so that he or she can begin to tolerate them. The patient also looks to the therapist for assistance with strong feelings stimulated by the therapist-patient relationship. Freud (1915) described the patient’s strong feelings of romantic love for the therapist, although he did not view them as products of an attachment relationship. Particularity refers to the preference for the primary caregiver over other persons, which begins practically from birth. Infants at 10 days have shown a preference to feed from the primary caregiver over a substitute (Burns, Sander, Stechler, & Julia, 1972). Patients demonstrate the same preference for their therapists. A therapist covering for a vacationing therapist meets with the vacationing therapist’s patient only in an emergency. In other words, therapists are not interchangeable. Mental representation refers to the child’s reliance on an internalized image of the caregiver for comfort or guidance in the caregiver’s absence (Bowlby, 1973; Mahler et al., 1975). The patient also relies on this internalized image of the therapist in certain situations outside therapy. When one of my patients diagnosed with borderline personality disorder gets an urge to drink alcohol, an image of my asking her what she is feeling at that moment comes into her mind. Mental representation resembles safe haven as an internalized image of comfort when internal or external threats arise.
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Another clinical concept from the psychoanalytic literature thought to reflect facets of an attachment relationship between the therapist and patient is the “working alliance” (e.g., Greenson, 1965; Mackie, 1981). Freud (1912a) foreshadowed the concept in his discussion of the dynamics of transference. He defined three components of transference: a negative component, a positive component, and an “unobjectionable” component (p. 105). The first two components are unconscious, and serve as resistances to the treatment, while the third component consists of friendly or affectionate feelings admissible to consciousness, which serves the treatment as its “vehicle of success” (p. 105). The unobjectionable positive transference represents “a belief in the value of treatment, based on widely held views of analysis as a discipline and of the analyst as a professional practitioner [which] facilitates the work” (Greenberg, 2001, p. 367). Greenberg (2001) has questioned whether Freud’s concept has stood the test of time and has argued that the patient enters treatment seeking a relationship rather than a professional practitioner who simply relieves symptoms. Regardless of whether the patient is seeking a practitioner or a relationship, the concept seems to encompass a sense of trust in the benevolence of the therapist who “exhibits a serious interest” in and “sympathetic understanding” for the patient over time and establishes a “proper rapport” with him or her (Freud, 1913, pp. 139, 140). Using Parish and Eagle’s (2003) list of attachment concepts applicable to the therapist-patient relationship, strong feelings, stronger/wiser, secure base, and availability either are implicitly or explicitly present in Freud’s original idea. Freud (1913) suggested that the patient’s attachment to the therapist is a prerequisite for the emergence of the unconscious components of transference: “[The patient] will of himself form such an attachment and link the doctor up with one of the imagos of the people by whom he was accustomed to be treated with affection” (pp. 139, 140). The link between the unobjectionable positive transference and the caregiver-infant attachment relationship is implied. Freud’s (1912a) original concept re-emerged in the literature as “the therapeutic alliance” (Zetzel, 1956) and “the working alliance” (Greenson, 1965). These terms were defined as capturing elements of the real relationship to the therapist not distorted by transference. Horvath and Greenberg (1989) later sought to measure this working alliance by constructing the Working Alliance Inventory (WAI), which consists of three subscales—task, goal, and bond. “Task” refers to the level of agreement between the therapist and patient about what to do in sessions. “Goal” refers to the level of agreement about the desired outcome of treatment. “Bond” refers to the level of positive personal feelings between patient and therapist. The “bond” subscale most closely resembles Freud’s (1912a) original definition of the unobjectionable positive transference. Research has repeatedly identified the working alliance as highly predictive of successful treatment outcome (Bordin, 1994; Horvath & Symonds, 1991; Luborsky, 1994; Martin, Garske, & Davis, 2000; Safran & Moran, 2000). Recently, the concept of the working alliance has been associated with the concepts of secure attachment and transference because all three concepts seem to reflect similar mental representations, affects, and strategies for affect regulation (e.g., defensive processes and interaction structures) activated by the relationship with the therapist and its correspondence with relationships with past caregivers (Bradley, Heim, & Westen, 2005; Westen & Gabbard, 2002). Whether these concepts conceptually overlap or operate at different levels of abstraction is a matter of debate (see below). Of course, every metaphor has a breaking point—a point at which the contours do not precisely fit. Such is the case with the metaphor of the caregiver-infant attachment
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relationship. The therapist is not a caregiver per se, nor is the patient an infant. The therapist provides a service paid for by the patient, which takes place in a limited time. These treatment arrangements ironically both allow the metaphor to exist and immediately invalidate it. One of my patients diagnosed with borderline personality disorder revealed a fantasy—concretely experienced by her as an expectation—that therapists should not charge for their services. In fact, in her mind, therapists have taken a vow of poverty like Mother Theresa to conduct this work. By informing her that I would be raising my fee next year, I was invalidating this fantasy. She immediately reminded me that she had abruptly ended her previous treatment when she discovered that her therapist, who wanted to raise the patient’s fee to $80 per session, drove a Mercedes-Benz. The fantasy of the all-nurturing, selfless caregiver conflicts with the reality of the professional aspects of the relationship. We are still working on this issue of my projected fee increase and its meanings for her. The therapeutic relationship is unique because of financial, temporal, spatial, logistic, and ethical boundaries—boundaries that do not exist in the caregiver-infant relationship (Farber et al., 1995; Goodman, 2006). We can imagine an Orwellian world in which the mother says to the infant, “Time’s up! You’ve had your fill of milk for the day.” Or, “Stop being a baby and get off my lap!” Or, “You can’t sleep in my bed; you’ll get too used to that!” Anyone familiar with ferberization techniques (Ferber, 1990, 2006) will recognize the sound of these statements offered by some behaviorally oriented psychologists already applying the model of the therapeutic relationship to child rearing practices well suited to the regimented corporate world these children are being fitted for. The establishment of boundaries such as time, money, and perhaps most importantly, therapist availability between sessions structures the therapeutic relationship in interesting ways. The expectations of contact-maintenance, caressing, fondling, holding, and primary caregiver preoccupation—all provided to the infant gratis—do not apply in the therapeutic context. These arrangements—unique to the therapeutic relationship—might differentially affect patients according to their quality of attachment. A preoccupied patient (entangled in parental relationships from childhood) might respond to these boundaries with indignation and resentment and create an interaction structure in which he or she perceives the caregiver/therapist as withholding of emotional supplies. A dismissing patient (dismissing of the importance of parental relationships from childhood), on the other hand, might feel a sense of relief that strict therapeutic boundaries are in place—at least until the defensive processes against closeness with the therapist are analyzed. The therapeutic boundaries established by the therapist—fee, schedule, unavailability outside of session, lack of physical contact—are unilateral decisions that structure the responses that patients of various attachment patterns will have toward the therapy. These parameters do not exist in the caregiver-infant relationship. As therapists, we must be aware of the differential effects of these parameters on our patients, which can provide us with diagnostic and attachment-related information and strategies for intervention. The manner in which we establish and maintain these boundaries reflects our own use of secondary attachment strategies (deactivating/dismissing vs. hyperactivating/preoccupied), which interact with our patients’ strategies to create unique interaction structures that can facilitate or hinder the treatment. In addition to the parameters inherent to every therapeutic relationship, factors such as gender and race also make important contributions to the construction of the therapeutic relationship that might interact with the patient’s quality of attachment in interesting ways. Following the work of Jessica Benjamin (1987), the resolution of the Oedipus complex for
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little boys in Western society often results in a rigid identification with the father and a wholesale repudiation of the mother, and by extension, women, femininity, and dependency. Whereas the mother in infancy is typically perceived as the all-powerful primary caregiver— the secure base and safe haven—this mental representation of the mother changes as the infant enters the preschool years. Boys no longer perceive her as all-powerful and allprotecting—the hallmarks of felt security—but rather as a diminished presence in the household in comparison with the father. This transformation of the maternal representation could have an impact on the patient’s perception of the female therapist. One might be less likely to feel secure in a therapeutic relationship with a woman whom society has deemed “less than.” Farber and Geller (1994) have observed, “Our culture seemingly ‘allows’ women to serve as protectors of infants and young children but not to inhabit roles that require the provision of wisdom, strength, or protection of adults” (p. 206). How might this clinical situation interact with the patient’s attachment pattern to create a particular interaction structure? Perhaps having a female therapist would exacerbate the feelings of insecurity of the preoccupied patient and elicit the devaluing tendencies of the dismissing patient. Alternatively, a female therapist might provide a welcome contrast to a diminished maternal representation from childhood. These hypotheses need to be submitted to empirical testing before any definitive conclusions can be drawn regarding the interaction between the patient’s quality of attachment and the therapist’s gender. It is instructive to consider these issues, however, as we observe our patients forming specific attachment relationships to us. Similarly, the therapist’s race also makes an important contribution to the construction of the therapeutic relationship. Bowlby’s (1977a) imperative that the infant seek an attachment figure perceived as stronger or wiser becomes complicated when applied to the therapeutic relationship because by the time the patient reaches our office, he or she has already had a series of socialization experiences in the wider world that shape their perceptions of us as therapists situated in a particular gender, race, and class. Can an African-American therapist provide a secure base for a white patient who has been chronically exposed to the pervasive injustices visited upon African-Americans in this country? Certainly, African-American therapists can provide a secure base and safe haven for white patients, but for some white patients, their socialization process into the dominant culture—that still contains vestiges of racism—might present challenges to perceiving a therapist from a historically oppressed culture as stronger or wiser. The reaction of a white patient to a therapist of color might also depend on that patient’s attachment quality. A preoccupied patient’s insecurity and a dismissing patient’s devaluing tendencies might be elicited in this arrangement. Conversely, a patient from a historically oppressed culture might have difficulty trusting in a white therapist, who belongs to a culture historically identified with wielding its authority to oppress rather than to help. This dynamic can be construed in different ways, depending on the patient’s attachment quality. Financial disparities between therapists and patients also stimulate both conventional and idiosyncratic assumptions about social class, privilege, and access to valued commodities such as education, medical coverage, and an affluent living environment. These disparities can provoke feelings of admiration, competitiveness, envy, worthlessness, grandiosity, devaluation, anxiety, or guilt—in us as well as our patients. McWilliams (1999) has solved this problem for herself by charging her wealthy professional patients whatever fee they charge in their own professions. Which feelings are likely to emerge in treatment because of
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financial disparities depends in part on the patient’s preferred attachment strategy and our own. We as therapists need to pay attention to how such nonattachment dynamics interact with pre-existing attachment patterns in both our patients and ourselves to produce unique interaction structures. One of the most important differences between the therapist-patient relationship and the caregiver-infant attachment relationship is the difference in the mental organization of the patient versus the infant. Infant internal working models consist of expectations of caregiver responses to situations that activate the infant’s attachment system (loss, separation, fear, stress, injury, fatigue, illness, and punishment) as well as the infant’s responses to these caregiver responses (Bowlby, 1973; Main, Kaplan, & Cassidy, 1985). Episodic memories of these caregiver responses are consolidated into semantic memory, a more generalized, abstract memory that permits expectations to form. From these expectations, the infant can begin to predict future responses and adjust his or her behavior accordingly to increase the probability of terminating the attachment system when activated and eventually returning to exploration. These initial expectations, constructed through the accumulation of early experiences of caregiver-infant interaction when the attachment system is activated, form the foundation of the internal working model (see also Stern, 1985, pp. 97-99). Eventually, these expectations become generalized across interactions with other persons over time and become organized into a personality organization with its own quality of self and object representations, preferred defensive processes, pattern of relating with others, and affect regulation strategy (Goodman, 2002). An infant, however, lacks this sophisticated mental organization. When a patient enters treatment with us, we are interacting with someone who has already developed a sophisticated mental organization that that patient wants to change. The infant, however, has no such historically structured mental organization. The expectations of caregiver responsiveness are just beginning to form through countless caregiver-infant experiences day after day. In other words, “the infant is developing his or her past” (Tronick et al., 1998, p. 297). This conceptual difference between the infant’s and patient’s mental organizations becomes problematic when the patient applies his or her historically developed internal working model to the therapist as caregiver. According to Dozier and Bates (2004), “Expectations of the therapist may have little to do with the therapist’s actual availability, thus, the therapist must be more than sensitive to the client’s needs” (p. 173). The patient signals attachment needs according to the pre-existing template formed during interactions with the original caregiver, not necessarily according to the way the therapist would be naturally inclined to respond to those needs. From an attachment perspective, one of the primary tasks of psychotherapy is to change these expectations so that a patient will develop new expectations—culminating in a conscious or unconscious awareness—that his or her wishes and affects will always find containment in the mind of the therapist. The therapist is not helping an infant develop expectations of containment from scratch but rather helping a patient change current expectations—already formed over years of experience with the original caregiver—to facilitate both self-containment of affect and mutual containment of affect through interdependence with significant others. Consistent with this reasoning, Dozier and Tyrrell (1998) suggest that “the mother’s task is easier than the therapist’s because she need not compensate for the failures of other attachment figures... .The task of therapy is often made more difficult because of the client’s
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previous experiences with unavailable or rejecting caregivers” (p. 222). Caregivers of infants placed in foster care most clearly illustrate this conundrum. Often abused or neglected, these infants are placed with caregivers who need to be not only sensitive to their needs but also therapeutic; in other words, “[foster] mothers need to see their infants as needy even though the behavioral evidence might suggest otherwise” (p. 244). Thus, the metaphor of the caregiver-infant attachment relationship does not precisely fit the parameters of the therapistpatient relationship because of 1) the patient’s historically determined internal working model (i.e., mental organization) and 2) the therapist’s therapeutic task that transcends mere emotional sensitivity and encompasses a corrective emotional experience (Alexander & French, 1946). Another difference between the metaphor of the caregiver-infant attachment relationship and the therapist-patient relationship is the patient’s acquisition and use of language. While the infant communicates through nonverbal channels such as crying, smiling, frowning, and gesturing, the patient communicates through symbolic play or language (in most forms of psychotherapy). Indeed, Freud (1910) labeled his treatment “the talking cure” (p. 13) at the suggestion of a patient. Of course, interpretation, mediated by language, is also the vehicle he used to cure the patient. Lacan (1977) believed that the language of the father, or “the third,” broke up the symbiotic relationship of mother and infant and facilitated differentiation. Symbolization creates a distance between the signifier—the word or other symbolic representation—and the signified—the thought or feeling behind the word or other symbolic representation. The communication that occurs between the caregiver and infant, however, is presymbolic. The mechanisms by which this presymbolic communication is processed in the infant’s mind are not precisely known. Members of the Process of Change Study Group in Boston have attempted to unravel this mystery. They have classified this early experience of communication as “relational procedural knowledge” and the later experience of communication as “symbolic knowledge” (e.g., Lyons-Ruth, 1999; Stern et al., 1998; Tronick et al., 1998). This group has suggested that relational procedural knowledge—the knowledge about relationships that an infant acquires in close, face-to-face interactive communication with a caregiver—develops prior to symbolic knowledge—the knowledge about relationships represented through verbal communication. Both kinds of knowledge continue to develop throughout the course of childhood. Classical psychoanalysis has targeted the domain of symbolic knowledge for therapeutic change; however, this method ignores the domain of implicit procedural knowledge formed prelinguistically. This presymbolic form of knowledge comprises the essence of attachment patterns manifested by 12-month-old infants with expressive vocabulary words numbering in the single digits. Implicit procedural knowledge tends to reveal itself in therapist-patient interaction structures not readily available to symbolic representation—known by contemporary psychoanalysts as “enactments” (McLaughlin, 1991). According to this group, sustained therapeutic change occurs primarily within the domain of implicit relational knowledge, not verbally mediated symbolic knowledge: “Retranscription of implicit relational knowing into symbolic knowing is laborious, is not intrinsic to the affect-based relational system, is never completely accomplished, and is not how developmental change in implicit relational knowing is generally accomplished” (LyonsRuth, 1999, p. 579). Thus, psychotherapy, according to this point of view, needs to conform to the metaphor of the caregiver-infant attachment relationship by emphasizing change in the nonsymbolic, procedural forms of knowledge.
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Working from the same assumptions, Eagle (2003) offered a pessimistic view of therapeutic change occurring within the domain of implicit procedural knowledge: “Procedural rules are especially recalcitrant....[They] do not change that readily—even in successful treatment” (pp. 45, 46). Instead, he and Wolitzky (2006) suggested that therapeutic change through interpretation and acquisition of insight (“second order change,” p. 14) occurs more frequently than therapeutic change through implicit procedural knowledge (“first order change,” p. 14). Insight into the causal processes associated with maladaptive patterns of behavior can serve to limit these behaviors, but the desire to engage in these behaviors usually remains because first-order change has not occurred. While these theoreticians have perhaps diminished the exclusive importance of “the talking cure” in favor of the contributions that therapist-patient enactments can make to therapeutic change, other theoreticians have argued that caregiver-infant communication can serve the purposes of intrapsychic connectedness and differentiation for the infant—even before language acquisition. Benjamin (2002) described a pattern of communication that the caregiver and infant simultaneously create and surrender to, which Aron (2006) has since labeled, “a rhythmic third” (p. 356). This third quality of the interaction between the caregiver and infant creates a sense of connectedness between the dyadic partners. Benjamin (2004) contrasted this rhythmic sense of connectedness with a sense of differentiation originating in the caregiver’s marking of the infant’s affective displays. Gergely (2000; see also Fonagy, Gergely, Jurist, & Target, 2002) has suggested that the sensitive caregiver mirrors the infant’s negative affective displays in such a way that the infant “knows” that the caregiver is not actually experiencing the same affect but rather is recognizing and empathizing with the infant’s affect. He labeled this experience “marking.” A caregiver’s unmodulated mirroring of the infant’s affective experience (as when the caregiver expresses fright when the infant expresses a fearful response), or not mirroring the infant’s affective experience at all (as when the caregiver ignores the infant’s fearful response), would equally threaten the infant’s sense of security. In other words, the caregiver might exaggerate some aspect of the infant’s affective display to mark it as belonging to the infant rather than the mother, but signifying that the mother understands what the infant is experiencing. Marking is the process through which the caregiver contains and metabolizes the infant’s dysregulated affects (for an object relations perspective on the same phenomenon, see Bion, 1962, 1967). These repeated experiences of marking facilitate intrapsychic self-object differentiation and affect regulation for the infant before the acquisition of language occurs. It is unclear whether marking unarticulated affective displays would have the same differentiating and affect-regulatory properties after the acquisition of language. Aron (2006) suggested that the therapist’s verbally mediated reflections on the patient’s thoughts and feelings—presented in modulated form that resembles marking—allow the patient to identify with an image of the therapist thinking about her. Fonagy et al. (2002) might modify this conceptualization by suggesting that the patient identifies instead with a more modulated image of herself contained in the therapist’s mind, which the patient then internalizes as an integrated self-representation. Both these conceptualizations apply the idea of marking, borrowed from the caregiver-infant relationship, to linguistic communication between the therapist and patient. If marking occurs during the presymbolic period of relational procedural knowing, then how can language—symbolic communication—“speak” to this layer of human experience?
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Lyons-Ruth (1999) tried to answer this question with evidence from the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996), which purports to measure “enactive procedural representations” (Lyons-Ruth, 1999, p. 585). The interviewee reveals these representations in verbal dialogue on the AAI but does not necessarily symbolically represent them—“even though they may be symbolically represented by the observing researcher or psychoanalyst” (p. 585). Therapeutic change, then, would occur when the therapist uses language as a vehicle to produce the marking of dysregulated affects to facilitate their modulation and containment. Thus, the metaphor of the caregiver-infant attachment relationship might still be relevant to the therapist-patient relationship if we view language as a conduit for communicating both connectedness and differentiation to facilitate the patient’s affect regulation and self-object differentiation. The following clinical example illustrates this process in the therapist-patient relationship. A therapist who marks a patient’s feelings of resentment toward a family member places the feelings in an intentional frame of reference without himself or herself becoming resentful. The modulated manner in which the therapist talks about the resentment—understands the intentions of all parties involved—suggests to the patient that the therapist both understands the resentment (which facilitates connectedness between patient and therapist) while not himself or herself reacting with resentment (which facilitates differentiation between the patient and therapist). The patient begins to identify with either an image of the therapist thinking about him or her (Aron) or an image of himself or herself contained in the therapist’s mind (Fonagy and his colleagues). The patient then internalizes either image or both images to facilitate affect regulation. The therapist’s use of language to communicate with and change the implicit procedural level of knowledge requires both symbolic and nonsymbolic mental processing. Although “procedural systems influence and are influenced by symbolic systems through multiple cross-system connections” (LyonsRuth, 1999, p. 580), these neurocognitive and affective pathways are not clearly understood by psychoanalysts or attachment researchers. Functional magnetic resonance imaging (fMRI), positron emission tomography (PET scan), and other neuroimaging techniques are beginning to reveal these interconnections using clever, sophisticated research methodologies (Schore, 2003). The final important difference between the metaphor of the caregiver-infant attachment relationship and the therapist-patient relationship concerns the difference between the infant’s feelings toward the caregiver and the patient’s feelings toward the therapist. We label the infant’s feelings “attachment” and the patient’s feelings “transference.” Are these phenomena conceptually identical, overlapping, or separate? If they are separate, do they mutually influence each other or operate as parallel systems? While a conceptual relation between the infant’s attachment to the caregiver and the patient’s working alliance with the therapist has received a general endorsement in the literature (see above), a conceptual relation between attachment and transference seems more equivocal. Whether young children develop transference in psychotherapy stimulated theoretical battles between the Kleinians and Anna Freudians in London in the middle of the last century. Melanie Klein (1927) routinely observed transference in her analysis of young children, while Anna Freud (1946) argued that transference in children does not occur because their “attachment” to their parents precludes any transfer of libido onto anyone else. This dispute has been settled in favor of transference; contemporary child psychoanalysts generally recognize transference phenomena in child psychotherapy (e.g., Altman, Briggs, Frankel,
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Gensler, & Pantone, 2002). If even young children can experience transference in psychotherapy, then can young children also become attached to their therapists? Or does the emergence of transference indicate that an attachment relationship has formed? According to attachment theory (Howes, 1999), infants form attachments to one or a few persons significantly involved in their care, particularly in the attachment-activating situations mentioned above. These attachment relationships become hierarchically organized according to preference. For example, a female toddler might generally prefer sitting on her father’s lap when her mother and father are present, but she might prefer the mother’s lap instead after a bad spill or a frightening noise. The infant, however, might prefer the father to the grandmother or some other ancillary caregiver during similar attachment-activating moments. Clearly, we would include the mother and father on any short list of attachment figures, who have provided care for the infant during the organization of the attachment system, which lasts until 18 to 24 months of age (Ainsworth, Bell, & Stayton, 1974). Can subsequent attachments form? Dozier and her colleagues (Dozier, Stovall, Albus, & Bates, 2001) found that infants placed in foster care even after 18 months reorganized their attachment behavior around the emotional availability of their new caregivers. It is not known, however, whether these infants reorganize their attachment behaviors yet again when they are placed back with their biological mothers. Do remnants of these older mental organizations continue to linger and influence later behaviors? In psychotherapy, the child patient is entering into a relationship with a potential attachment figure while maintaining an attachment to the parents. Unlike foster care, in which biological mothers perform little or no caregiving and foster mothers are solely responsible for the caregiving, the parents of the child patient continue their secure-base provision. In other words, the child establishes an attachment relationship with the therapist while maintaining an attachment relationship with the parents. Where does the child therapist place on the hierarchy of attachment figures who have been present in the child’s life since the moment of birth? I have used child psychotherapy to illustrate this problem of attachment to the therapist because the child does become attached to the therapist in spite of primary attachments to the parents. Just this morning, the mother of a 9-year-old male patient with oppositional defiant disorder in once-per-week psychotherapy called to tell me that a car had run over his dog. The first thing he said to his mother after learning about the unfortunate news was that he wanted to speak to me. I characterize this reaction as an attachment behavior to seek vocal proximity with me. In the same manner, adult patients become attached to therapists even though they might be involved in emotionally significant relationships. If we acknowledge that attachment is a regular part of the psychotherapy relationship, then how do we understand transference and its role in psychotherapy? Few authors have contributed to our understanding of these phenomena. One group (Henry & Strupp, 1994; Mackie, 1981; Mallinckrodt et al., 2005) has argued that attachment and the working alliance are conceptually identical concepts in the sense that the spirit of “proper rapport” (Freud, 1913, p. 139) attaches the patient to the therapist and allows them to engage in a common task with a common goal (Horvath & Greenberg, 1989). In addition, some authors among this group have suggested that the attachment or working alliance represents aspects of the “real,” ego-based relationship with the therapist, while the transference represents aspects of the distorted, unconscious fantasies of early caregivers transferred onto the therapist. The problem with this position, as I see it, is that an insecure
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attachment to the therapist can include distorted, unconscious processes such as forgetting payment, coming late to session, or dismissing one’s feelings toward the therapist. In addition, fantasies of crawling inside the therapist’s womb or blasting off into outer space (a common fantasy of an anxious-avoidant child patient of mine) seem to contain an obvious residue of attachment and the defensive processes against it. A second group (Eagle, 2003; Lyons-Ruth, 1999; Slade, 1999) has hypothesized a conceptual equivalence between attachment and transference because implicit procedural knowledge, the essence of internal working models, is attributed to the therapist-patient relationship and the person of the therapist. For example, Eagle (2003) has regarded “transference patterns... as most representative of early procedural knowledge and rules” (p. 46), which Lyons-Ruth (1999, p. 585) has characterized as internal working models of attachment. Slade (1999) has modified the definition of transference so that it refers to the patient’s “primary mode of relatedness” (p. 588) rather than the classical idea of a transfer of wishes and fears onto the therapist. The pattern of relating to an attachment figure, rather than the unacceptable aspects of the patient’s own personality, is transferred onto the therapist and enacted in the therapist-patient relationship. A third group (Bordin, 1994; Bradley et al., 2005; Diamond, Clarkin, et al., 2003; Parish & Eagle, 2003; Szajnberg & Crittenden, 1997) has taken the position that attachment shares elements of both the working alliance and transference and that, indeed, these phenomena mutually influence each other. Most of these authors have suggested that a positive working alliance is conceptually equivalent to a secure attachment, while a negative working alliance is conceptually equivalent to an insecure attachment. A positive transference usually occurs in the context of a secure attachment, while a negative transference usually occurs in the context of an insecure attachment. Yet a secure attachment can protect the treatment from the destructive effects of the negative transference. Diamond, Clarkin, et al. (2003) distinguished secure-base behavior in the therapist-patient relationship (the working alliance) from “recapitulated states of mind with respect to early attachment figures in the relationship with the therapist” (the transference; p. 170). Bradley et al. (2005) considered all three concepts virtually interchangeable. I will present my own theoretical formulation of the relations among these three concepts. The working alliance includes nonattachment components, such as therapist-patient agreement on the tasks and goals of treatment, as well as a potential attachment component, the collaborative bond or rapport between the therapist and patient. This rapport, however, is not necessarily related to attachment in which the therapist is considered a secure base or safe haven. During the administration of the AAI, the interviewee’s level of collaboration with the interviewer contributes to the attachment classification (Main & Goldwyn, 1994). Yet no one would suggest that the interviewee has formed an attachment to the interviewer, who is usually a stranger. The level of collaboration between the interviewee and interviewer depends on the interviewee’s state of mind with respect to his or her attachment history with the childhood caregivers and on the interviewer’s own level of collaboration, based on his or her attachment history. In psychotherapy, a patient can collaborate with the therapist on their common tasks and goals without developing an attachment to him or her in the sense of relying on the therapist as a secure base or safe haven. It takes a history of therapist caregiving, delivered over months of exposure, to form an attachment to the therapist. In my view, treatment approaches such as cognitive-behavioral therapy offer skills training, not caregiving per se. A working
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alliance is formed, yet only in rare instances would a patient treated in one of these approaches form an attachment to the therapist. Thus, a working alliance is a necessary but not sufficient condition for an attachment to form—regardless of whether the attachment is secure or insecure. The quality of the working alliance depends on the patient’s state of mind with respect to attachment to the historical caregivers and on the therapist’s own state of mind with respect to his or her own attachment history (Tyrrell et al., 1999), not on the patient’s state of mind with respect to attachment to the therapist (see Figure 1). As discussed below, noncomplementary states of mind between the therapist and patient produce a greater working alliance than complementary states of mind. The reasons for this finding are not clearly understood, but one theory is that a therapist with a noncomplementary state of mind is better equipped to facilitate the patient’s affect regulation than a therapist with a complementary state of mind. “Transference” refers to the process of transferring onto a contemporary person feelings that originally applied, and still unconsciously apply, to a person from childhood in whom the person had made an emotional investment (Freud, 1912a). The person from childhood, however, does not have to be a caregiver. Freud (1912a) stated that the “father-imago,” or father object representation, represents one childhood prototype on which transference is based, “but the transference is not tied to this particular prototype: it may also come about on the lines of the mother-imago or brother-imago” (p. 100). We know from attachment theory that an attachment is formed to a person who gives care in situations in which the attachment system is activated (see earlier discussion). Unless a sibling is sufficiently older to provide such care, we would not expect a sibling to use another sibling as a secure base. Thus, siblings do not form attachments to each other in this restricted sense of the word “attachment.” Consequently, the phenomenon of transference cannot be conceptually equivalent to the phenomenon of attachment. Indeed, there is positive and negative transference and maternal and paternal transference (Freud, 1912a) and more recently, organizationally based transference: psychopathic, paranoid, and depressive transference (Kernberg, 1992) and idealizing and mirroring transference (Kohut, 1971). Furthermore, patients can exhibit different transferences at different times of the treatment or even in a single session. Kernberg and his colleagues (1989) have discussed the rapidly oscillating transferences of patients with borderline personality disorder: at one moment, the patient might be casting the therapist in the role of a persecutor, the next moment, a longed-for caregiver, and the moment after that, a defiant child. Kernberg and his colleagues have articulated these oscillations using the language of projection of and identification with affectively linked pairs of self and object representations from childhood. Each role portrayed by the therapist also arouses distinct countertransference reactions because the therapist has temporarily identified with the projected self or object representation. Bowlby (1980) and others (Grossmann, Grossmann, & Waters, 2005; Hamilton, 2000; van IJzendoorn, 1995; Waters, Merrick, Treboux, Crowell, & Albersheim, 2000) have characterized the attachment construct as generally stable over time and resistant to change. Thus, if transference can fluctuate (sometimes rapidly in a single session) and can consist of feelings originally experienced with noncaregivers, then one must conclude that transference and attachment are conceptually independent entities. Indeed, therapists’ ratings of their patients’ negative transference were associated with patients’ ratings of their secure attachment to the therapist (Woodhouse, Schlosser, Crook, Ligiero, & Gelso, 2003).
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I want to argue that the attachment to the therapist, developed in the context of a working alliance (see above), in turn provides a context for the entire range of transference experiences in the therapist-patient relationship (see Figure 1). Previously (Goodman, 2002), I argued that the preoccupied/hyperactivating and dismissing/deactivating internal working models represent two distinctly different personality organizations organized at a borderline level. According to Kernberg (1986), both borderline personality disorder and most narcissistic personality disorders (especially antisocial personality disorder) are organized at a borderline level. Borderline personality organization falls midway between the neurotic and psychotic levels of personality organization (Kernberg, 1996). What distinguishes the narcissistic personality disorders from borderline personality disorder is the presence of the pathological grandiose self. The pathological grandiose self is an admixture of idealized object representations and real and idealized self-representations that compensates for a lack of integration of a normal self-concept observed in borderline personality organization, which accounts for the paradox of relatively good ego functioning and surface adaptation in the presence of primitive defensive processes, such as splitting, and contaminated, barren object relationships. I drew comparisons between borderline psychopathology and the preoccupied/hyperactivating internal working model, and between narcissistic psychopathology and the dismissing/deactivating internal working model, and provided modest empirical evidence for these assertions (for recent evidence, see Westen, Nakash, Thomas, & Bradley, 2006). Briefly, borderline psychopathology shares with the preoccupied/hyperactivating internal working model the features of extreme affect dysregulation, caregiver enmeshment, hostile dependence on significant others, and fear of abandonment. Conversely, narcissistic psychopathology shares with the dismissing/deactivating internal working model the features of affect dysregulation, dismissal or devaluation of the emotional importance of object relationships, counterdependence on others, and denial of vulnerability. These two personality organizations lack integration and complexity at the representational level and share some of the same primitive defensive processes such as splitting (Goodman, 2002, p. 66). I also argued that self and object representations are the building blocks of these personality organizations; their level of integration and complexity reflects the overall level of the personality organization. Transference-countertransference paradigms are affectively linked pairs of self and object representations, with one representation identified with the patient and the other projected onto the therapist (Kernberg et al., 1989). These paradigms exist within a particular personality organization. For example, a psychopathic transference (Kernberg, 1992) is associated with the pathological grandiose self in a borderline personality organization. This transference consists of projecting the self-representation onto the therapist, whom the patient perceives as dishonest, exploitative, and ruthless. I am suggesting that this transferencecountertransference paradigm could exist only within a dismissing/deactivating internal working model. Other constellations of self and object representations belong to the domain of a preoccupied/hyperactivating internal working model. For example, the patient’s projection onto the therapist of an infantile, dependent self-representation compels the patient to behave toward the therapist in a controlling-caregiving manner.
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Common tasks of therapy
Patient’s attachment history
Patient’s attachment to therapist Working alliance Therapist’s caregiving of patient
Therapist’s attachment history
Common goals of therapy
Transferencecountertransference paradigms (interaction structures)
Situational events (e.g., vacation)
Phase of treatment
Figure. Pathways Model of Working Alliance, Patient's Attachment ot Therapist, Therapist's Caregiving of Patient, and Transference-Countertransference of Paradigms.
I am proposing that the personality organization constrains the range of representational pairs and, thus, the transference-countertransference paradigms that could emerge in a treatment. The personality organization/internal working model is therefore a necessary but not sufficient condition for a transference-countertransference paradigm to form (Figure 1). In other words, the personality organization determines the level of quality, complexity, and integration of the affectively linked pairs of self and object representations manifested in the therapist-patient relationship; however, other variables such as the therapist’s personality organization/internal working model, quality of caregiving (see below), phase of treatment, and situational events (e.g., the therapist’s vacation) also determine which representational pairs become activated. I want to add here that the patient’s attachment system both activates and is activated by the therapist’s caregiving system, reciprocal to and parallel with the attachment system. The caregiving system, according to George and Solomon (1999), is activated when the caregiver perceives “internal or external cues or stimuli... as frightening, dangerous, or stressful for the child” associated with situations such as “separation, child endangerment, and the child’s verbal and nonverbal signals of discomfort and distress” (p. 652). In the therapist-patient relationship, this caregiving takes the form of attentive listening; verbalization of affects, needs, and the processes that inhibit the reception of caregiving; empathy; limit-setting; affective containment; and mentalization, to name a few. These and other caregiving behaviors facilitate the patient’s use of the therapist as a secure base and safe haven. George and Solomon (1999) discovered four patterns of caregiving analogous to the four patterns of attachment. It is believed that caregivers’ own attachment histories determine the quality of caregiving for their children. I am arguing that the therapist’s caregiving of the patient mediates the influence of the therapist’s own attachment history on the patient’s attachment to him or her. In addition, the patient’s attachment and therapist’s caregiving systems mutually influence each other (Figure 1).
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Thus, I am proposing a framework for understanding these relational phenomena (Figure 1). The patient’s and therapist’s attachment histories with childhood caregivers, as well as their common tasks and goals, determine the quality of the working alliance, which, along with their attachment histories, determines the formation of an attachment with the therapist and caregiving of the patient, which, along with other variables such as phase of treatment and situational events, determines the range of transference-countertransference paradigms activated in the therapist-patient relationship. These transference-countertransference paradigms can in turn influence the quality of the working alliance (Bordin, 1994), which in turn influences the attachment to the therapist and caregiving of the patient. A negative transference, for example, might disrupt an already tenuous collaboration between the therapist and patient, contaminate the patient’s perception of the therapist as a secure base and safe haven and the therapist’s self-perception as these functions, and result in termination of the treatment. This event is most likely to occur among those patients who rely on extremely unmodulated dismissing/deactivating or preoccupied/hyperactivating attachment strategies that dramatically increase the likelihood of affect dysregulation and resultant impulsive behavior when potentially dysregulating circumstances occur such as a narcissistic injury or a perceived threat of abandonment. Psychoanalysis has traditionally targeted the transference-countertransference paradigms as the intervention point of entry by translating the patient’s enactments, symptoms, associations, fantasies, dreams, and other clinical material related to the therapist into symbolic knowledge through their verbal interpretation. As indicated earlier, however, some psychoanalytic and attachment theoreticians are beginning to question the exclusivity and even the primacy of symbolic knowledge as a vehicle of therapeutic change: “Representational change may be set in motion... without necessarily assigning privileged status to a particular dimension, such as interpretation” (Lyons-Ruth, 1999, p. 601). According to Lyons-Ruth (1999), “development does not proceed only or primarily by moving from procedural coding to symbolic coding... .Making the unconscious conscious does not adequately describe developmental or psychoanalytic change” (pp. 579, 590). Thus, we might question whether targeting transference-countertransference paradigms is the only method or even the most efficient method for producing therapeutic change. I am suggesting that implicit procedural knowledge embodied in the patient’s internal working model—“often neither conscious and verbalizable nor repressed in a dynamic sense” (Lyons-Ruth, 1999, p. 589)—can also change through the therapist’s reliable provision of a secure base—a nonsymbolic procedural response aimed at this level of relational knowing. Although the verbal translation of unconscious, split-off self and object representations can facilitate the integration of the patient’s internal working model/personality organization and restore affect regulation, other, nonsymbolic interventions can also target the internal working model for therapeutic change. In summary, I have argued that the metaphor of the caregiver-infant attachment relationship captures only certain features of the therapist-patient relationship—most importantly, the caregiver functions of secure base and safe haven. The metaphor appears to break down when the financial, temporal, spatial, logistic, and ethical boundaries of treatment are considered. I also noted the vast differences between the infant’s and patient’s fund of implicit procedural knowledge and linguistic knowledge. Finally, I discussed the difference between the infant’s attachment to the caregiver and the patient’s working alliance and transference to the therapist. I proposed that the working alliance and transference-
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countertransference paradigms are both conceptually independent of attachment phenomena embodied in internal working models but reflect the level of personality organization (psychotic, borderline, or neurotic) and the characteristic secondary attachment strategies (dismissing/deactivating or preoccupied/hyperactivating) used by the patient as an adult but originally developed out of caregiving experiences from childhood.
ACKNOWLEDGEMENT The author gratefully acknowledges the assistance of Valeda Dent in reproducing Figure 1 in Microsoft PowerPoint.
REFERENCES Ainsworth, M. D. S., Bell, S. M., & Stayton, D. J. (1974). Infant-Mother attachment and social development: “Socialization” as a product of reciprocal responsiveness to signals. In M. P. M. Richards (Ed.), The integration of a child into a social world (pp. 99-135). Cambridge, England: Cambridge University Press. Altman, N., Briggs, R., Frankel, J., Gensler, D., & Pantone, P. (2002). Relational child psychotherapy. New York: Other Press. Amini, F., Lewis, T., Lannon, R., Louie, A., Baumbacher, G., McGuinness, T., & Schiff, E. Z. (1996). Affect, attachment and memory: Contributions toward psychobiologic integration. Psychiatry, 59, 213-239. Aron, L. (2006). Analytic impasse and the third: Clinical implications of intersubjectivity theory. International Journal of Psycho-Analysis, 87, 349-368. Benjamin, J. (1987). The decline of the oedipus complex. In J. M. Broughton (Ed.), Critical theories of psychological development (pp. 211-244). New York: Plenum Press. Benjamin, J. (2002). The rhythm of recognition: Comments on the work of Louis Sander. Psychoanalytic Dialogues, 12, 43-53. Benjamin, J. (2004). Beyond doer and done to: An intersubjective view of thirdness. Psychoanalytic Quarterly, 73, 5-46. Bion, W. R. (1962). Learning from experience. London: Heinemann. Bion, W. R. (1967). Second thoughts. London: Heinemann. Bordin, E. S. (1994). Theory and research on the therapeutic working alliance: New directions. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 13-37). New York: Wiley. Bowlby, J. (1958a). The nature of the child’s tie to his mother. International Journal of Psycho-Analysis, 39, 350-373. Bowlby, J. (1973). Attachment and loss: Vol.2. Separation: Anxiety and anger. New York: Basic Books. Bowlby, J. (1977a). The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. British Journal of Psychiatry, 130, 201-210.
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Bowlby, J. (1977b). The making and breaking of affectional bonds: II. Some principles of psychotherapy. British Journal of Psychiatry, 130, 421-431. Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss, sadness and depression. New York: Basic Books. Bradley, R., Heim, A. K., & Westen, D. (2005). Transference patterns in the psychotherapy of personality disorders: Empirical investigation. British Journal of Psychiatry, 186, 342349. Burns, P., Sander, L. W., Stechler, G., & Julia, H. (1972). Distress in feeding: Short-Term effects of caretaker environment of the first 10 days. Journal of the American Academy of Child Psychiatry, 11, 427-439. Cooper, G., Hoffman, K., Powell, B., & Marvin, R. (2005). The Circle of Security intervention: Differential diagnosis and differential treatment. In L. J. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments: Theory, research, intervention, and policy (pp. 127-151). New York: Guilford. Diamond, D., Clarkin, J., Levine, H., Levy, K., Foelsch, P., & Yeomans, F. (1999). Borderline conditions and attachment: A preliminary report. Psychoanalytic Inquiry, 19, 831-884. Diamond, D., Clarkin, J. F., Stovall-McClough, K. C., Levy, K. N., Foelsch, P. A., Levine, H., & Yeomans, F. E. (2003). Patient-therapist attachment: Impact on the therapeutic process and outcome. In M. Cortina & M. Marrone (Eds.), Attachment theory and the psychoanalytic process. London: Whurr. Dozier, M., Stovall, K. C., Albus, K. E., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 1467-1477. Eagle, M. N. (2006). Attachment, psychotherapy, and assessment: A commentary. Journal of Consulting and Clinical Psychology, 74, 1086-1097. Eagle, M., & Wolitzky, D. L. (2006, November). The perspectives of attachment theory and psychoanalysis: Adult psychotherapy. In M. Eagle & D. L. Wolitzky (Chairs), The perspectives of attachment theory and psychoanalysis: Adult psychotherapy. Symposium conducted by Adelphi University and the New York Attachment Consortium, Garden City, NY. Farber, B. A., & Geller, J. (1994). Gender and representation in psychotherapy. Psychotherapy, 31, 318-326. Farber, B. A., Lippert, R. A., & Nevas, D. B. (1995). The therapist as attachment figure. Psychotherapy, 32, 204-212. Ferber, R. (1990). Sleep schedule-dependent causes of insomnia and sleepiness in middle childhood and adolescence. Pediatrician, 17, 13-20. Ferber, R. (2006). Solve your child’s sleep problems (rev. ed.). New York: Fireside. Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press. Freud, A. (1946). The psycho-analytical treatment of children. London: Imago. Freud, S. (1910). Five lectures on psycho-analysis. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 11, pp. 156). London: Hogarth, 1961. Freud, S. (1912a). The dynamics of transference. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 97108). London: Hogarth, 1961.
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Freud, S. (1912b). Recommendations to physicians practising psycho-analysis. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 109-120). London: Hogarth, 1961. Freud, S. (1915). Observations on transference-love (Further recommendations on the technique of psycho-analysis III). In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12, pp. 157-171). London: Hogarth, 1961. George, C., Kaplan, N., & Main, M. (1996). Adult Attachment Interview (3rd ed.). Unpublished manuscript, University of California, Berkeley. Goodman, G. (2006, November). [Discussant, The perspectives of attachment theory and psychoanalysis: Adult psychotherapy]. In M. Eagle & D. L. Wolitzky (Chairs), The perspectives of attachment theory and psychoanalysis: Adult psychotherapy. Symposium conducted by Adelphi University and the New York Attachment Consortium, Garden City, NY. Greenberg, J. (2001). The analyst’s participation: A new look. Journal of the American Psychoanalytic Association, 49, 359-381. Greenson, R. R. (1965). The working alliance and the transference neurosis. Psychoanalytic Quarterly, 34, 155-181. Grossmann, K. E., Grossmann, K., & Waters, E. (Eds.). (2005). Attachment from infancy to adulthood: The major longitudinal studies. New York: Guilford. Hamilton, C. E. (2000). Continuity and discontinuity of attachment from infancy through adolescence. Child Development, 71, 690-694. Henry, W. P., & Strupp, H. (1994). The therapeutic alliance as interpersonal process. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 51-85). New York: Wiley. Holmes, J. (1996). Psychotherapy and memory: An attachment perspective. British Journal of Psychotherapy, 13, 204-218. Holmes, J. (1998). The changing aims of psychoanalytic psychotherapy: An integrative perspective. International Journal of Psycho-Analysis, 79, 227-240. Horvath, A., & Greenberg, L. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223-233. Horvath, A., & Symonds, B. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38, 139-149. Kernberg, O. (1986). Borderline personality organization. In M. Stone (Ed.), Essential papers on borderline disorders: One hundred years at the border (pp. 279-319). New York: New York University Press. Kernberg, O. F. (1992). Aggression in personality disorders and perversions. New Haven, CT: Yale University Press. Kernberg, O. F. (1996). A psychoanalytic theory of personality disorders. In J. F. Clarkin & M. F. Lenzenweger (Eds.), Major theories of personality disorder (pp. 106-140). New York: Guilford. Klein, M. (1927). Symposium on child analysis. International Journal of Psycho-Analysis, 7, 339-370. Kohut, H. (1971). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. New York: International Universities Press.
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Lacan, J. (1977). Écrits: A selection (A. Sheridan, Trans.). New York: Norton. Luborsky, L. (1994). Therapeutic alliances as predictors of psychotherapy outcomes: Factors explaining the predictive success. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research, and practice (pp. 38-50). New York: Wiley. Lyons, L. S., & Sperling, M. (1996). Clinical applications of attachment theory: Empirical and theoretical perspectives. In J. M. Masling & R. F. Bornstein (Eds.), Psychoanalytic perspectives on developmental psychology (pp. 221-256). Washington, DC: American Psychological Association. Lyons-Ruth, K. (1999). The two-person unconscious: Intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization. Psychoanalytic Inquiry, 19, 576-617. Mackie, A. J. (1981). Attachment theory: Its relevance to the therapeutic alliance. British Journal of Medical Psychology, 54, 203-212. Mahler, M. S., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis and individuation. New York: Basic Books. Main, M., & Goldwyn, R. (1994). Adult attachment scoring and classification systems (6th ed.). Unpublished manuscript, University College, London. Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. In I. Bretherton & E. Waters (Eds.), Growing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50(1-2, Serial No. 209), 66-104. Mallinckrodt, B. (2000). Attachment, social competencies, social support, and interpersonal process in psychotherapy. Psychotherapy Research, 10, 239-266. Mallinckrodt, B., Gantt, D. L., & Coble, H. M. (1995). Attachment patterns in the psychotherapy relationship: Development of the Client Attachment to Therapist Scale. Journal of Counseling Psychology, 42, 307-317. Mallinckrodt, B., King, J. L., & Coble, H. M. (1998). Family dysfunction, alexithymia, and client attachment to therapist. Journal of Counseling Psychology, 45, 497-504. Mallinckrodt, B., Porter, M. J., & Kivlighan, D. M., Jr. (2005). Client attachment to therapist, depth of in-session exploration, and object relations in brief psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 42, 85-100. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450. McLaughlin, J. (1991). Clinical and theoretical aspects of enactment. Journal of the American Psychoanalytic Association, 39, 595-614. McWilliams, N. (1999). Psychoanalytic case formulation. New York: Guilford. Mitchell, S. (1999). Attachment theory and the psychoanalytic tradition: Reflections on human relationality. Psychoanalytic Dialogues, 9, 85-107. Rogers, C. R. (1977). Carl Rogers on personal power. Oxford: England: Delacorte. Safran, J. D., & Moran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press. Sandler, J. (1960). The background of safety. International Journal of Psycho-Analysis, 41, 352-356. Schafer, R. (1983). The analytic attitude. New York: Basic Books. Schore, A. N. (2003). Affect regulation and the repair of the self. New York: Norton.
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Stern, D. N. (1977). The first relationship: Mother and infant. Cambridge, MA: Harvard University Press. Stern, D. N. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books. Stern, D. N. (1995). The motherhood constellation. New York: Basic Books. van IJzendoorn, M. H. (1995). Adult attachment representations, parental responsiveness, and infant attachment: A meta-analysis on the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117, 387-403. Vitz, P. C. (1977). Psychology as religion: The cult of self-worship. Grand Rapids, MI: William B. Eerdmans. Waters, E., Merrick, S., Treboux, D., Crowell, J., & Albersheim, L. (2000). Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Development, 71, 684-689. Weiss, J., & Sampson, H. (1986). The psychoanalytic process: Theory, clinical observation, and empirical research. New York: Guilford Press. Westen, D., & Gabbard, G. O. (2002). Developments in cognitive neuroscience: II. Implications for theories of transference. Journal of the American Psychoanalytic Association, 50, 99-134. Westen, D., Nakash, O., Thomas, C., & Bradley, R. (2006). Clinical assessment of attachment patterns and personality disorder in adolescents and adults. Journal of Consulting and Clinical Psychology, 74, 1065-1085. Winnicott, D. W. (1960). The theory of the parent-infant relationship. International Journal of Psycho-Analysis, 41, 585-595. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. New York: International Universities Press. Woodhouse, S. S., Schlosser, L. Z., Crook, R. E., Ligiero, D. P., & Gelso, C. J. (2003). Client attachment to therapist: Relations to transference and client recollections of parental caregiving. Journal of Counseling Psychology, 50, 395-408.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 29
A STUDY OF THE RELATIONSHIP BETWEEN SELF-CONSCIOUS AFFECTS, COPING STYLES, AND DEPRESSIVE REACTION AFTER A NEGATIVE LIFE EVENT Masayo Uji*, Toshinori Kitamura Department of Clinical Behavioural Sciences, Kumamoto University Graduate School of Medical Sciences, Japan
Toshiaki Nagata Kyushu University of Nursing and Social Welfare, Japan
ABSTRACT This study aimed to explore how the affects that result from conflictive social interpersonal relationships influence mental health, as well as to investigate how specific coping styles mediate between these affects and mental health. The Test of Self-Conscious Affect-3 (TOSCA-3, Tangney, Dearing, Wagner, & Gramzow, 2000) assesses six self-conscious affects, namely guilt-proneness, shameproneness, externalization, detachment, alpha pride, and beta pride. In this study, we selected for analysis the four affects that originated from negative evaluations of the presented scenarios (guilt-proneness, shame-proneness, externalization, and detachment). We used the Coping Inventory for Stressful Situations (CISS, Endler, and Parker, 1990) for estimating coping style, specifically task-oriented coping, emotion-oriented coping, and avoidance-oriented coping. A structural equation model that makes it possible to explore the causal relationship between self-conscious affects, coping styles, and mental health, was chosen as a statistical technique. Among the 394 Japanese university students who agreed to participate in this study, 298 experienced moderate to severe stressful negative life events *
E-mail
[email protected]; Telephone +81-(0)96-373-5183; Fax + 81-(0)96-373-5181. Address: Department of Clinical Behavioural Sciences, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, Japan 860-8556.
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Masayo Uji, Toshinori Kitamura and Toshiaki Nagata during the four-month study. Of those 298 respondents, 268 completed every item of the TOSCA-3, the CISS, and the Self-rating Depressive Scale (SDS, Zung, 1965). These 268 were subjected to a structural equation model. Among the four affect categories which occur under stressful situations, only shameproneness directly contributed to a depressive reaction, whereas the other three (guiltproneness, externalization, and detachment) did not. Individuals with shame-proneness tended towards an emotional-oriented coping style, but this inhibited task-oriented coping. Guilt-proneness induced task-oriented coping and avoidance-oriented coping. Externalization induced task-oriented coping and emotion-oriented coping. Detachment gave rise only to avoidance-oriented coping. Interestingly, among the three coping styles, only task-oriented coping induced a depressive reaction, whereas emotion-oriented coping and avoidance-oriented coping did not. We discuss these results primarily from the psychological perspective but also look briefly at how they might be applied to a clinical setting within psychiatry.
Keywords: guilt-proneness, shame-proneness, externalization, detachment, coping style, depressive reaction
INTRODUCTION People live within a complex web of interpersonal relationships. These relationships stimulate various affects, some of which are not experienced at a conscious level. Even when one is aware of them, it is often difficult to put them into words. One of the aims of psychotherapy is to use an empathetic relationship with patients to help them become more aware of their affects and to put those affects in order. We sometimes see patients recognize affects that had previously been imperceptible to them. Shame and guilt are two primary examples in this regard. From a clinical perspective is crucial to have a deeper understanding of these two affects, namely whether they have beneficial properties in maintaining mental health, or conversely, whether they have negative properties which lead to psychological maladjustment. Okada (2006), making reference to Ausubel (1955), mentioned that both guilt and shame are moral affects that contribute to the maintenance of any given social order. For several reasons, defining guilt and shame is an extremely difficult task. Guilt and shame differ from other affects such as anger, fear, pleasure, and sadness because they are not clearly exhibited, they include diverse moods (Sakuta, 1967, Inoue, 1977), and their definitions may vary across cultures. Some researchers discuss these two affects from a cultural perspective, while others explain them as tendencies of a particular person, in which case they are related to the individual’s psychopathology. Benedict is a sociologist who compared Western culture and Japanese culture. In “The Chrysanthemum and the Sword” (Benedict, 1967), she described Western culture as a “culture of guilt” and Japanese culture as a “culture of shame.” She defined guilt as an internal sanction, and shame as an external sanction. In other words, guilt is an autonomous reaction that derives from an internalized conscience, whereas shame occurs when the individual is criticized or ridiculed by those around them. In some epidemiological studies, researchers have compared the two cultures: that of guilt and that of shame. Inoue (1977) pointed out that this had become a somewhat popular trend in the realm of anthropology. He
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criticized anthropologists for having compared these two cultures and having connoted that a culture of guilt is superior to a culture of shame. However, many scholars have disputed Benedict’s argument. Sakuta (1967), while honoring Benedict for having profiled one aspect of the ethnic group, criticized her for focusing exclusively on the negative aspects of shame. Sakuta (1967) further stated that guilt is experienced as a recognition of “being bad,” whereas shame is experienced as a recognition of “being inferior.” He added that people feel shame not only when they are rejected but also when they are praised in public, which he states is a point that Benedict missed. Sakuta (1967) also contradicted Benedict’s simple differentiation between guilt as internal sanction and shame as an external sanction. He wrote that a sense of guilt can be acquired as the result of external sanction, while shame can control one’s behavior in the absence of external judgment. Freud (1923) also mentioned that after external sanction is internalized as the superego, guilt eventually functions as an internal sanction. Inoue (1977) further developed Sakuta’s (1966) ideas of “private shame” and “public shame.” He theorized that when people feel private shame, they see themselves as other people might see them and judge themselves based on the values of the referential group (Inoue, 1977). They then recognize themselves as being inferior to their ego-ideal (Piers, & Singer, 1971). Inoue (1977) mentioned that this private shame is very close to guilt, and therefore shame and guilt are not separate affects but instead exist along a continuum. Lebra (1983) also refuted Benedict’s description of Japan as embodying a shame culture. She asserted that, guilt involves far more awareness of others in the Japanese tradition as compared with the Judeo-Christian theistic tradition. For many Japanese people a sense of guilt is often accompanied by a deep consideration for the victim, a feeling that they have caused the other person to suffer as a result of their action. Although Lebra acknowledges that both shame and guilt are pervasive in the Japanese culture, she argues that guilt comes to the fore in the Japanese psychic structure. She explains the relative primacy of guilt using the Japanese moral value of self-denial. Withholding self-expression is regarded as a virtue in Japan. Both guilt and shame are allocentric, but shame includes an egocentric concern with one’s self-image. Japanese people may therefore show some ambivalence towards shame. Guilt sensitivity is always seen as acceptable though shame sensitivity is not. Through the different theories of guilt and shame in the realms of sociology and cultural anthropology, we begin to recognize the difficulty in defining and distinguishing between these two affects. In the psychiatric and psychological realms, we usually target excessive guilt and shame under the assumption that they may induce mental disorders or maladjustment. We also discuss these affects as individual tendencies. Some mental disorders, such as depression and obsessive-compulsive disorder, are believed to be more closely related to guilt, while others, such as social phobia and avoidant personality disorder, have been linked more strongly to shame. Specifically, “taijinkyohusyo” (anthropophobia) is thought to be related to shame (Lebra, 1983, Inoue, 1977), though Lebra (1983) suggests at the end of her paper that “taijinkyohusyo” is guilt-related rather than shame-related in terms of patients’ fear of the discomfort they may arouse in others, not in themselves. Kimura (1972) suggests that “taijinkyohusyo” is unique to Japanese culture and that no corresponding term exists in Western languages. It is not a single disease unit and the subject may fear several different conditions -- i.e., blushing, staring at another, emitting odor, facial expression, looking ugly -with the underlying concern being the fear of causing discomfort in others. Kasahara (1968)
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points out that among various symptoms of“taijinkyohusyo”, fear of staring at another is quite unique to Japanese. When these patients make eye contact with another, they become stiff and tense. Another discipline that may help deepen our understanding of guilt and shame is psychoanalysis. Freud discussed guilt and its relation with the superego and Oedipus complex (Freud, 1923), and also its role as a psychological process in melancholia (Freud, 1917) and obsessive-compulsive neurosis (Freud, 1909). Klein (1957) has distinguished two types of guilt: guilt in the paranoid-schizoid position, and guilt in the depressive position. Grinberg (1964) later called these two types of guilt “persecutory guilt” and “depressive guilt.” The latter type of guilt is more mature, reparative to the harmed object, and sympathetic. Freud did not discuss shame to a great extent, but Piers and Singer (1971) later reinterpreted Freud’s theory and explained that guilt derives from a conflict between the superego and ego, while shame stems from a conflict between the ego-ideal and ego. In the area of self-psychology, Kohut explained shame from the viewpoint of the relationship between self and object (usually the mother). In his paper (Kohut, 1972), he argued that without the mother’s approval and admiration, a crude and intensely narcissistic cathexis of the grandiose self cannot be transformed and cannot be integrated with the remainder of the psychic organization. It is either split off or repressed. When these defense mechanisms do not function because of archaic claims made by one’s exhibitionistic self, the ego is flooded by this self and becomes paralyzed, consequently feeling intense shame and rage. Kohut (1966) also discusses the possibility of the ego inviting an object to participate in alleviating the narcissistic tension. When the object rejects these attempts, the ego experiences painful feelings of shame. Since Lewis (1971) published “Shame and Guilt in Neurosis,” many researchers have undertaken empirical studies to explore the role of shame and guilt in the development of psychological maladjustment (Tangney, 1996). This led to the development of inventories that assess guilt and shame. Tangney has reviewed these inventories and assessed their strengths and weaknesses (Tangney, 1996). Feiring and her colleagues demonstrated how “shame feeling” and “abuse-specific internal attribution” worsen subsequent psychological maladjustment among those who experience sexual abuse (Feiring, Taska, & Lewis, 1998, Feiring, Coates, & Taska, 2001, Feiring, Taska, & Chen, 2002a, Feiring, Taska, & Lewis, 2002b, Feiring, & Taska, 2005). To conduct their research, they invented a questionnaire that assesses shame. It included four items: (1) “People can tell from looking at me what happened,” (2) “I want to go away by myself and hide,” (3) “I am the only one in my school who this happened to,” and (4) “What happened to me makes me feel dirty.” These items seem to cover exposure sensitivity, a negative evaluation of the entire self, and the impetus to hide oneself. Using the same questionnaire, Uji, Shono, Shikai, and Kitamura (2007) conducted research on sexual victimization among Japanese university women, and demonstrated how the feeling of shame contributed to developing post-traumatic stress disorder (PTSD). This shame-focused questionnaire is regarded as a tool to assess shame as an emotional state, which alludes to the emotions an individual feels temporarily and in a particular situation. Among empirical studies that have assessed both guilt-proneness and shame-proneness as individual dispositions, the Self-Conscious Affect and Attribution Inventory (SCAAI, Tangney, 1990) and the Test of Self-Conscious Affect (TOSCA, Tangney, Wagner, Fletcher, & Gramzow, 1992b) are scenario-based inventories developed by Tangney and her
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colleagues. The development of TOSCA is based on Lewis’s (1971) definition of the two affects. Lewis (1971) noted that in the case of shame, the central object of negative evaluation is the entire self, whereas in the case of guilt, it is the thing done or undone. Therefore, we can see that shame is a more painful affect because the entire self is scrutinized and negatively evaluated, and moreover it paralyses an individual, driving them to hide themselves (Tangney, 1996). Furthermore, she (Tangney, 1996) referred to the ameliorative characteristics of guilt. She wrote, “.… guilt doesn’t affect one’s core identity or self-concept. In guilt, there’s a sense of tension, remorse and regret over the ‘bad thing done.’ And this sense of tension and regret often motivates reparative action-confessing, apologizing, or somehow repairing the damaged one”. TOSCA is a refined version of SCAAI. SCAAI is applicable only to college students, whereas TOSCA is applicable to adults of all ages. In addition, scenario items in the SCAAI were experimenter-generated whereas those in TOSCA were subject-generated for the purpose of enhancing ecological validity. TOSCA was revised twice to solve a few flaws, and was superseded by TOSCA-3 (TOSCA-3, Tangney, Dearing, Wagner, & Gramzow, 2000). TOSCA-3 is composed of 11 negative scenarios and five positive scenarios, which assesses guilt-proneness, shame-proneness, externalization, detachment, alpha pride, and beta pride. Tangney and her colleagues verified Lewis’ (1971) idea about the negative property of shame. They demonstrated that shame-proneness rather than guilt-proneness prompts psychopathology such as depression, anxiety, obsessive-compulsive disorder, psychoticism, interpersonal sensitivity, and anger (Tangney, Dearing, Wagner, & Gramzow, 1992a, Tangney, et al., 1992b). Furthermore, Tangney (1991) showed that guilt was positively correlated with empathic responses, in contrast to the negative correlation of shame to this variable. Based on this previous research, we hypothesized that shame-proneness has more psychopathology-inducing characteristics than guilt-proneness. As an indicator, we adopted a depressive reaction which is assessed by the Self-rating Depression Scale (Zung, 1965). Another interesting aspect of TOSCA-3 is that it does not only take into account the two more controversial affects, guilt and shame, but also assesses externalization and detachment. While shame and guilt involve a sense of responsibility (Eisenberg, 2000) and play a role in maintaining social order, externalization and detachment do not seem to be related to selfresponsibility. They do not motivate moral behaviors. It is interesting to examine these affects from the perspective of mental health rather than tools for maintaining social order or morality. One of the purposes of this study is to examine how these affects (shame, guilt, externalization, and detachment) correlate with each other and how they might influence a depressive reaction in those who have experienced a negative life event (NLE). Furthermore, we wanted to look at which particular coping styles are likely to be adopted by people who are prone to feeling particular affects in specific conflictive situations. For the purpose of assessing coping styles, we chose the Coping Inventory for Stressful Situations (CISS, Endler, & Parker, 1990). The CISS is a self-report measure to assess an individual’s typical pattern of coping. There are 48 items with a 5-point scale (1 = not at all, 5 = very much). These include three orthogonal subscale dimensions: task-oriented coping, emotion-oriented coping, and avoidance-oriented coping. Task-oriented coping is defined as a strategy in which an individual attempts to solve or re-conceptualize the problem through some action. Emotional-
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oriented coping is defined as an emotional response, and it includes a preoccupation with worrying, blaming oneself, tension or other related emotions. Avoidance-oriented coping refers to strategies where an individual tries to either avoid the difficult situations they are confronted with or ignore the problems they face by seeking out others or engaging in a substitute task. Shikai, Uji, Chen, Hiramura, Tanaka, Shono, and Kitamura (2007) showed significant correlations between any two of the three coping styles. All three styles assist the individual in maintaining a sense of balance, even though some of them do not offer a resolution to the problem. For instance, previous studies have shown that task-oriented coping is more closely linked to adaptive health variables (Endler, & Parker, 1990, Endler, Parker, & Butcher, 1993, Miller, Brody, & Summerton, 1988, Parkes, 1990), whereas the other two coping styles tend toward maladaptive health variables. With regard to an emotion-oriented coping style, previous research has suggested that it is linked to negative health variables such as depression (Shikai et al., 2007), anxiety (Shikai et al., 2007), insufficient ability to recover from bodily illnesses (Billings, Cronkite, & Moos, 1983, Endler & Parker, 1990, Endler et al., 1993, McWilliams, Cox, & Enns, 2003, Vollrath, Alnaes, & Torgersen, 1994), and other maladaptive health variables (Cronkite, Moos, Twohey, Cohen, & Swindle, 1998, Endler, & Parker, 1990, Holahan & Moos, 1987, Krantz & Moos, 1988, McCrae & Costa, 1986), though Park and Adler (2003) reported no such link. Avoidance-oriented coping has also been shown to predict negative health variables (Cronkite, et al., 1998, Endler & Parker, 1990, Holahan & Moos, 1987, McCrae & Costa, 1986). This study aims to explore how each coping style mediates between self-conscious affects and the depressive reaction caused by NLEs. In other words, our goal is to determine which self-conscious affects cause an individual to adopt a particular coping style, and whether a depressive reaction is provoked by the adoption of a given coping styles. We hypothesized that an individual with guilt-proneness is more apt to apply a coping strategy that relies heavily on problem-solving, namely task-oriented coping. We also premised that an individual with shame-proneness is apt to apply one of both of the remaining two coping styles, emotion-oriented coping and avoidance-oriented coping. This is because a person who exhibits shame-proneness has low self-esteem and may attribute the cause of a problematic situation to themselves, being unable to deal with the situation efficiently. Furthermore, we predicted that task-oriented coping has an inhibiting effect on a depressive reaction, whereas the other two coping styles, emotion-oriented coping and avoidanceoriented coping precipitate a depressive reaction. To summarize, the purpose of our study is to determine 1) whether specific selfconscious affects have an effect on an individual’s depressive reaction, 2) whether these selfconscious affects prompt an individual to adopt specific coping styles, and 3) as a result, whether or not these coping styles worsen a depressive reaction caused by a NLE. The research hypothesis is shown in Figure 1.
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Task-oriented Coping W2
W3 eT
eSDS
W1 Δ SDS
Self-conscious Affect eE
W5
W4
Emotion-oriented Coping W7 W6
eA
Avoidance-oriented Coping Figure 1. The hypothesis about the relationship between self-conscious affect, coping styles, and depressive reaction.
METHOD Procedure and Participants As a longitudinal follow-up study on depressive mood and suicidality in a Japanese university student population, a 9-wave four-month prospective study was performed on students of two universities in Kumamoto. The anonymity and voluntary participation were guaranteed. The research protocol was approved by the Ethical Committee of Kumamoto University. (Institutional Review Board). The number of eligible students was 642, but because not all students attended class on each occasion and 2% to 3% of the students declined participation in the study. The TOSCA-3 was included in the questionnaire given to students on the 6th occasion, and the CISS was included in the first occasion. The SDS was included in the questionnaire on all 9 occasions. However, only the scores from the first occasion and the final occasion were used in the analysis. Therefore, the 394 respondents who agreed to participate in the 1st, 6th, and 9th occasions formed the target population of this study. The population included 68 men and 326 women, with a mean age of 18.8 years (SD 1.28).
Measurements Test of Self-Conscious Affect-3 (TOSCA-3, Tangney, et al., 2000) TOSCA-3 is a self-report measure of six self-conscious affects: shame-proneness, guiltproneness, externalization, detachment, alpha pride, and beta pride. The TOSCA-3 consists of
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a series of 11 negative and five positive scenarios with four or five responses reflecting one of the six affects. Each response is rated on a 5-point scale from “not likely” to “very likely.” We allocated between 1 and 5 points for each item. A bilingual graduate student translated the TOSCA-3 into Japanese. A second bilingual graduate student familiar with the literature on shame and guilt back translated the measure and compared it to the original English. In this study, among the six affect categories, the four affects which originate from negative evaluations of the presented scenarios (guilt-proneness, shame-proneness, externalization, and detachment) were used in the analysis.
Coping Inventory for Stressful Situations (CISS, Endler, and Parker, 1991) The CISS is a self-report measure of coping styles. It consists of 48 items rated on a 5point scale (1=not at all, 5=very much). There are three categories: task-oriented coping, emotion-oriented coping, and avoidance-oriented coping. Its factor structure was confirmed (Rafnsson, Smari, Windle, Mears, & Endler, 2006). The English version of the CISS was translated into Japanese by Furukawa and its validity and reliability are well established (Furukawa, Suzuki, Saito, & Hamanaka, 1993). Self-rating Depressive Scale (SDS, Zung, 1965) The SDS was included in the questionnaire on all occasions. The SDS is a self-report measure of depressive symptoms which consists of items on a 4-point scale from “never” (scored 1) to “almost always” (scored 4). Using a Japanese university student population, Kitamura, Hirano, Chen, and Hirata (2004) have reported a three-factor structure for the scale. They identified the three factors as affective, cognitive, and somatic. We drew our seven SDS items from the affective category. Among the total scores of the SDS assessed on nine different occasions, we used the scores from the first and last occasions because their difference (ΔSDS: the final SDS score – the first SDS score) represents the change in the mood of the participants during the study period. Negative Life Event (NLE) In the questionnaire given to students at the 9th occasion (the final occasion of this study), participants were asked to recall their most stressful negative experience during the fourmonth period of the study. This was assessed by an ad hoc item: “Consider an event you experienced in this four-month study period which was undesirable, upsetting, depressing, or that made you sad, and score its impact from 0 (not stressful at all) to 100 (extremely stressful).” In addition to providing a numeric value, each of the respondents was required to describe the contents of their NLE in words.
Statistical Methods Correlations between Subscale Scores of TOSCA-3 and between Subscales of CISS Responses from 394 students who agreed to participate on all three occasions were used in the analyses.
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Partial Correlations between Each Subscale of TOSCA-3 and ΔSDS The NLE score was significantly correlated with ΔSDS [r=.12, (p<.05) ], as well as three of four self-conscious affects [r=.17 with guilt-proneness, (p<.01), r=.15 (p<.01) with shameproneness, r=-.17 (p<.01) with detachment], though it did not correlate significantly with externalization (r=-.03). Therefore, to remove the influence of the NLE on correlations between each of the four affects and ΔSDS, partial correlations were estimated by setting the NLE as a control variable. The Relationship between Each Self-conscious Affect, Coping Styles, and the Depressive Reaction Partially Caused by a NLE To investigate this relationship, we used a structural equation model, which made it possible to verify whether specific coping styles mediate each self-conscious affect and the depressive reaction. The goodness of fit of the model to the data was expressed by the goodness of fit index (GFI), adjusted goodness of fit index (AGFI), and root mean square error of approximation (RMSEA) (Arbuckle, & Wothke). We premised the hypothesis schematized in Figure 1. The depressive reaction was calculated by subtracting the 1st SDS score from the 9th SDS score. Analysis subjects included the 271 respondents who experienced a moderate to severe NLE (NLE score ≧ 50) and also completed TOSCA-3, CISS, and SDS. All the statistical analyses were conducted using the Statistical Package for Social Science (SPSS) version 12.0 and Amos 5.0.
RESULTS Correlations between Subscale Scores of TOSCA-3 Guilt-proneness was significantly correlated only with shame-proneness (r=.59, p<.01) (Table 1). Guilt-proneness did not have a significant correlation with the other two affects, externalization and detachment. Shame-proneness was significantly correlated with externalization (r=.21, p<.01) but not with detachment (r=-.08). The correlation between externalization and detachment was significant (r=.53, p<.01). Table 1. Correlations between subscales of TOSCA-3 Mean (SD)
shameproneness
63.9 (8.02)
guiltproneness -
externalization
guiltproneness shameproneness externalization
52.1 (8.88)
.59**
-
35.4 (7.94)
-.08
.21**
-
detachment
29.0 (6.62)
-.09
-.08
.53**
** p<.01
detachment
-
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task emotion avoidance
Mean (SD) 43.3 (11.9) 37.2 (11.1) 42.9 (10.3)
task 0.18** 0.36**
emotion
avoidance
0.28**
-
** p<.01
Table 3. Partial correlations between each subscale of TOSCA-3 and ΔSDS (control variable: NLE score)
guilt proneness shame proneness externalization detachment
Partial correlation coefficient with ΔSDS .01 .12* .04 .01
* p<.05
Correlations between Subscale Scores of CISS ALL pairs of the three Subscale Scores were Significantly Correlated (Table 2).
Partial correlations between Each Subscale of TOSCA-3 and ΔSDS Only shame-proneness had a significant partial correlation with ΔSDS (r=.12, p<.05) (Table 3).
The Description of the most Stressful NLE Among 374 participants, 180 described their most stressful NLE, but the remaining 214 did not. A total of 298 participants experienced a moderate to severe NLE (the NLE score was 50 or more). Of these, 145 described the content of their NLE. Whether they described their NLE varied by subgroup in terms of the NLE intensity [Chi-squared (1) = 4.14, p=.04]. Respondents who experienced a moderate to severe NLE were more likely to describe their experiences. The contents of the NLEs were roughly grouped into six categories: distress within a family, distress concerning a relationship with friends, difficulties regarding a romantic relationship, hardship due to the participant’s own physical disease or injury, distress about schoolwork, and other stressful situations. NLEs within a family were as follows: a family member’s disease (e.g. mother’s cancer, grandmother’s subarachnoid hemorrhage, etc.), the loss of a family member, the disappearance of a family member, or a family member’s attempt at suicide. Some reported a
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negative relationship with other family members. One student wrote, “there was a big fight in my family and glasses were broken; I am afraid that may happen again.” NLEs involving relationships with their friends were as follows: having been betrayed, having been told something hurtful, a friend’s cold attitude, having been irritated because of a friend’s selfish behavior, anxiety over a friend’s reaction to an unintentional mistake (e.g. having broken or lost a friend’s belongings). One reported that her friend was murdered. Some had a negative experience with a romantic relationship, such as a “broken heart,” the breakup of a relationship, or a conflict with their partner. One reported that she was exhausted because her boyfriend was involved in a traffic accident and was admitted to a hospital. Some suffered from their own physical disease or injury. One wrote, “I was about to die because of chicken pox.” Another wrote, “I suffered from acute bronchitis and was admitted to a hospital for one week. I worried about my schoolwork because I could not attend classes during this period.” A few students reported having had a traffic accident. Some worried about succeeding in their studies and graduating from university as planned, because they were not confident about submitting many reports or passing all of their tests. One wrote that a teacher reprimanded her because she missed the deadline for submitting a report. Some stated that they failed the entrance examination for their firstchoice university and had difficulty motivating themselves to continue their studies at their current university.
Task-oriented Coping .20***
eT
Guilt-proneness
.13* eSDS
Δ SDS eE
.19**
Emotion-oriented Coping .15* -.12 eA
Avoidance-oriented Coping Numerical values in the figure are standardized regression weights between the respective observed variables. * p<.05, ** p<.01. *** p<.001. Figure 2. The relationship between guilt-proneness, coping styles, and depressive reaction.
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Other responses included the loss of a pet, economic distress, a contentious relationship with seniors, and difficulty in managing their schedule. One student was suspected of stealing money from work. Some defined their distress as an inability to come to terms with their own existence or their own self-image. One female student wrote, “I am always anxious about whether I am worthy of being loved by other people. I have confided in my friend that I am always scared, but I do not think that she will ever understand me. As a result, I feel more lonely.” Another female student wrote, “I am not confident with myself, I hate myself. I always hang out with two of my friends, they chat very happily, but I cannot join in their conversation and feel anxious. I do not have anywhere else to go other than this group.” One wrote “I cannot remember a specific trigger, but I do not want to have contact with other people. I have been depressed for several months. I am afraid that I am suffering from depression.” One female student wrote, “I do not want to write about it.” She scored her NLE at 100.
Structural Equation Model The Relationship between Guilt-Proneness, Coping Styles, and a Depressive Reaction The model that showed the best fit (GFI: 1.00, AGFI: .99, RMSEA: 0.00) assumed the following causal coefficients to be zero: from guilt-proneness to ΔSDS, and from emotionoriented coping to ΔSDS. The estimates of standardized regression weights are shown in Figure 2. Individuals with guilt-proneness had a tendency to make use of any of the three coping styles included in the CISS. The standardized regression weights from guilt-proneness to each coping style were as follows: .20 to task-oriented coping (p<.001), .19 to emotionoriented coping (p<.01), and .15 to avoidance-oriented coping (p<.05). The causal relationship between task-oriented coping and ΔSDS was significant (p<.05). Emotionoriented coping did not influence the ΔSDS. The causal relationship between avoidanceoriented coping and ΔSDS was not significant (p>.05). The Relationship between Shame-Proneness, Coping Styles, and Depressive Reaction The model that showed the best fit (GFI: 1.00, AGFI: 1.00, RMSEA: 0.00) assumed three of the causal coefficients to be zero: from shame-proneness to task-oriented coping, from shame-proneness to avoidance-oriented coping, and from emotion-oriented coping to ΔSDS. The estimates of standardized regression weights are shown in Figure 3. Shame-proneness prompted an individual to adopt emotion-oriented coping only (the standardized regression weight from shame-proneness to emotion oriented coping was .42 (p<.001). The causal relationship between task-oriented coping and ΔSDS was significant (p<.05), whereas emotion-oriented coping did not influence the ΔSDS. The causal relationship between avoidance-oriented coping and ΔSDS was not significant (p>.05).
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Task-oriented Coping .12* eSDS
eT .12*
Δ SDS
Shame-proneness eE .42***
Emotion-oriented Coping -.12 eA
Avoidance-oriented Coping Numerical values in the figure are standardized regression weights between the respective observed variables. * p<.05, *** p<.001. Figure 3. The relationship between shame-proneness, coping styles, and depressive reaction.
The Relationship between Externalization, Coping Styles, and Depressive Reaction The model that showed the best fit (GFI: 1.00, AGFI: .99, RMSEA: 0.00) assumed two causal coefficients to be zero: from externalization to ΔSDS, and from emotion-oriented coping to ΔSDS. The estimates of standardized regression weights are shown in Figure 4. Similar to guilt-proneness, externalization also prompted an individual to adopt all three of the coping styles in the CISS. The standardized regression weights from externalization to each coping style were as follows: .15 to task-oriented coping (p<.05), .21 to emotionoriented coping (p<.001), and .13 to avoidance-oriented coping (p<.05). The causal relationship between task-oriented coping and ΔSDS was significant (p<.05), whereas emotion-oriented coping did not influence the ΔSDS. The causal relationship between avoidance-oriented coping and ΔSDS was not significant (p>.05). The Relationship between Detachment, Coping Styles, and Depressive Reaction The model that showed the best fit (GFI: 1.00, AGFI, .099, RMSEA: 0.00) assumed three of the causal coefficients to be zero: from detachment to ΔSDS, from detachment to emotionoriented coping, and from emotion-oriented coping to ΔSDS. The estimates of standardized regression weights are shown in Figure 5. The standardized regression weights from detachment to each coping style were as follows: .17 to task-oriented coping (p<.01) and .21 to avoidance-oriented coping (p<.001). The causal relationship between task-oriented coping and ΔSDS was significant (p<.05), whereas emotion-oriented coping did not influence the ΔSDS. The causal relationship between avoidance-oriented coping and ΔSDS was not significant (p>.05).
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Task-oriented Coping .13* .15*
eSDS
eT
Δ SDS
Externalization eE .21***
Emotion-oriented Coping -.12
.13*
eA
Avoidance-oriented Coping Numerical values in the figure are standardized regression weights between the respective observed variables. * p<.05, *** p<.001. Figure 4. The relationship between externalization, coping styles, and depressive reaction.
Task-oriented Coping .13* .17**
eT
eSDS
Δ SDS
Detachment eE
Emotion-oriented Coping .21*** eA
-.12
Avoidance-oriented Coping Numerical values in the figure are standardized regression weights between the respective observed variables. * p<.05, ** p<.01, *** p<.001. Figure 5. The relationship between detachment, coping styles, and depressive reaction.
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The Relationship between Guilt-proneness, Shame-Proneness, Externalization, Detachment, Coping Styles, and a Depressive Reaction As shown in Table 1, significant correlations were observed between guilt-proneness and shame-proneness, between shame-proneness and externalization, and between externalization and detachment. To refine our statistical analysis, we put these four affects in the same model (Figure 6). This made it possible to assess how coping styles and depressive reaction are affected by the residual portion of guilt-proneness which is not influenced by shameproneness, by shame-proneness which is not influenced by guilt-proneness and externalization, by externalization which is not influenced by shame-proneness and detachment, and lastly by detachment which is not influenced by externalization. In this model, we added covariances between guilt-proneness and shame-proneness, between shameproneness and externalization, and between externalization and detachment (C1, C2, C3 in Figure 6). We inferred from preliminary analyses (Figure 2 – Figure 5) that emotion-oriented coping did not influence ΔSDS, and therefore the path from emotion-oriented coping to ΔSDS was dismissed. In addition, the model which eliminated the following causal coefficients showed the best fit: from guilt-proneness to ΔSDS, from externalization to ΔSDS, from detachment to ΔSDS, from guilt-proneness to emotion-oriented coping, from shame-proneness to avoidanceoriented coping, from externalization to avoidance-oriented coping, from detachment to emotion-oriented coping, and from emotion-oriented coping to ΔSDS (GFI=.99, AGFI=.97, RMSEA=0.00) (Figure 7).
Guilt-proneness
Task-oriented coping
eT C1 Δ SDS Shame-proneness
Emotion-oriented coping
eE
C2 Externalization
eA C3 Avoidance-oriented coping Detachment
Figure 6. The relationship between four conscious affects, coping styles, and depressive reaction.
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Task-oriented coping Guilt-proneness
eT
Δ SDS Shame-proneness
Emotion-oriented coping
eE
Externalization
eA Avoidance-oriented coping
Detachment
Detail estimates were shown in Table 4. Key: thick lines: causal coefficients and covariances were significant; narrow lines: causal coefficients were not significant; solid lines: causal coefficients showed positive values; dotted lines: causal coefficients showed negative values. Figure 7. The best-fit model of the relationship between four conscious affects, coping styles, and depressive reaction.
Table 4. Covariences and Regression weights of Figure 7
Covariances Guilt-proneness ↔ Shame-proneness Shame-proneness ↔ Externalization Externalization ↔ Detachment Regression weights Guilt-proneness → Task-oriented coping Guilt-proneness → Avoidance-oriented coping Shame-proneness → Task-oriented coping Shame-proneness → Emotion-oriented coping Externalization → Task-oriented coping Externalization → Emotion-oriented coping Detachment →Task-oriented coping Detachment →Avoidance-oriented coping Shame-proneness → SDS Task-oriented coping → SDS Avoidance-oriented coping → SDS *p<.05, **p<.01. ***p<.001
Standardized
Non-standardized
.58 .29 .60
42.74*** 21.70*** 33.45***
.33 .18 -.18 .41 .15 .11 .10 .23 .13 .12 -.12
0.47*** 0.22** -0.23* 0.51*** 0.22* 0.15* 0.17 0.34*** 0.06* 0.05* -0.05
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Standardized covariances and regression weights as well as non-standardized covariances and regression weights are shown in Table 4. As predicted, the standardized covariances between the combination of two affects were significant. The standardized covariance between guilt-proneness and shame-proneness (C1 in Figure 6) was .58 (p<.001), the standardized covariance between shame-proneness and externalization (C2 in Figure 6) was .29 (p<.001), and the standardized covariance between externalization and detachment (C3 in Figure 3) was .60 (p<.001). As observed in Figure 3, shame-proneness still induced a direct positive effect on ΔSDS (the standardized causal coefficient from shame-proneness to ΔSDS was .13, p<.05), although guilt-proneness, externalization and detachment did not. Interestingly, shame-proneness inhibited task-oriented coping (the standardized causal coefficient from shame-proneness to task-oriented coping was -.18, p<.05). Guilt-proneness had no effect on emotion-oriented coping, but it gave rise to one or both of a choice of the other two coping styles: task-oriented coping (the standardized causal coefficient from guilt-proneness to task-oriented coping was .33, p<.001) and avoidance-oriented coping (the standardized causal coefficient from guiltproneness to avoidance-oriented coping was .18, p<.01). Externalization tended towards both task-oriented coping (the standardized causal coefficient from externalization to task-oriented coping was .15, p<.05) and emotion-oriented coping (the standardized causal coefficient from externalization to emotion-oriented coping was .11, p<.05), but it did not influence avoidance-oriented coping. Detachment promoted avoidance-oriented coping (the standardized causal coefficient from detachment to avoidance-oriented coping was .23, p<.01) whereas it had no effect on emotion-oriented coping. The causal coefficient from detachment to task-oriented coping was not significant (the standardized causal coefficient from detachment to task-oriented coping was .10, p=.17). As shown in Figures 2-5, task-oriented coping reinforced the direction towards ΔSDS (the standardized causal coefficient was .12, p<.05), and the causal coefficient from avoidance-oriented coping to ΔSDS was not significant (the standardized causal coefficient was -.12, p=.06).
DISCUSSION Correlations between Subscale Scores of TOSCA-3 The definitions of shame and guilt have been debated for many years. The similarity between these two affects was supported by a strong positive correlation between them in our analysis (Tables 1 and 4, Figure 7). As mentioned briefly in the Introduction section, both affects share similar characteristics. Each includes uncomfortable or dysphoric moods that are derived from an internal attribution. Two other self-conscious affects, externalization and detachment, do not encompass these characteristics. Both guilt and shame are moral affects, and are therefore ubiquitous among civilized cultures and play a role in maintaining social order. As noted in the Introduction, distinguishing between these two affects is extremely difficult, and it might be appropriate to consider the two not as distinct affects but rather as existing along a single continuum. Furthermore, they may be experienced simultaneously.
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Our results replicate those of several past studies in terms of the overlap between shame and guilt (Tangney, 1990, Tangney et al., 1992a, Tangney, et al., 1992b). Guilt-proneness did not correlate significantly with the other two affects, externalization and detachment. As noted previously, guilt-proneness and shame-proneness are different from externalization and detachment. Those who are ashamed blame themselves and those who feel guilt place the blame on their own actions. However, in the case the other two affects, individuals do not look introspectively or reflect on their actions. This might be the reason why guilt-proneness did not correlate with the remaining two affects. As opposed to guilt-proneness, however, shame-proneness correlated significantly and positively with externalization (Table 1 and 4, Figure 7). Tangney et al. (1992b) also concluded that in contrast with guilt-proneness, shame-proneness was consistently correlated with anger-arousal, resentment, and a tendency to blame others. This might be because shame includes persecutory feelings. In the Japanese language, there is a common expression, “I was humiliated in public.” This might be related to a public shame that Sakuta (1967) referred to. In the psychoanalytic realm, Kohut (1972) mentioned that shame is related to the experience of being rejected by the mother. From this, we can infer that shame is related to persecutory feelings and this in turn may be transformed into externalization, since an individual who exhibits shame-proneness is not able to fully keep their persecutory feelings in themselves. Externalization and detachment also had a significant positive correlation (Table 1 and 4, Figure 7). Both of these affects have a role in freeing the individual from responsibility. In that respect, these affects are markedly different from guilt-proneness and shame-proneness.
Correlations between Subscale Scores of CISS All three coping styles correlated significantly with positive values. As mentioned briefly in the Introduction, these coping styles may share in common strategies to both prevent a situation from becoming worse and to maintain mental balance. People who are likely to employ one particular coping style tend also to employ the other two coping styles to varying degrees. The coping styles people use may be interchangeable.
NLE The intensity of an NLE and ΔSDS correlated significantly (r=.12, p<.05). This might be interpreted in two ways. First, more stressful NLEs may cause severe depressive reactions. However, in this study, the intensity of the NLE was assessed subjectively by the individual at the end of the study. Therefore a second interpretation is possible, namely that a severely depressed individual assess the NLE as being more stressful. Interestingly, an individual with higher guilt-proneness and shame-proneness rated the intensity of the NLE more highly [r=.17 (p< .01) with guilt-proneness, r=.15 (p<.01) with shame-proneness]. Conversely, an individual with a higher detachment score was more likely to give a lower rating to the intensity of an NLE [r=-.17 (p<.01) with detachment]. The NLE score did not correlate significantly with externalization. It goes without saying that the traumatic effects of an actual NLE are important, but an individual’s perception of the NLE may also play a role in the aftermath. As noted briefly in the Introduction, externalization and
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detachment are not moral affects, but our results showed that detachment may help an individual perceive a negative event less seriously. The opposite is true with the two moral affects, shame-proneness and guilt-proneness, as people experiencing these affects tend to recognize the NLE as being more serious. Painful perceptions of NLEs are unavoidable consequences of these moral affects. An individual who has experienced an NLE which brought about strong distress was apt to describe their experiences. Whether anonymous or not, the desire to share the experience seems to be higher among those who have a traumatic experience. One respondent did not want to describe her NLE and scored it as 100, suggesting that for some people, it is difficult to talk about their experiences to others because, in this confiding process, they have to retrace their experience and inevitably recall it vividly. They also may feel fear or shame in disclosing their experience. This student’s attitude may be related to avoidance or shame.
Partial Correlations between Each Subscale of TOSCA-3 and ΔSDS By calculating the partial correlations between each subscale of TOSCA-3 and ΔSDS, we were able to see the relationships between them which were not influenced by the intensity of the NLE. Similar to Tangney et al. (1992a), only shame-proneness had a significant correlation with ΔSDS, suggesting its role in developing psychopathology.
Structural Equation Model Relationship of the Self-conscious Affects to Coping Styles We first examined the relationship between each affect, coping styles, and depressive reactions after an NLE (Figures2-5). Significant correlations were identified between guiltproneness and shame-proneness, between shame-proneness and externalization, and between externalization and detachment (Table.1). Therefore, we next constructed a structural equation model that took into account these significant correlations and examined each affect’s relationship to coping styles and to depressive reactions (Figure 6). Figure 7 shows guilt-proneness not influencing emotion-oriented coping, whereas Figure 2 does. We infer that guilt-proneness in Figure 2 shared common features with shameproneness and thus exerted a positive effect on emotion-oriented coping. Shame-proneness that is free from guilt-proneness and externalization inhibited taskoriented coping (Figure 7). When we examined only shame-proneness, coping styles, and depressive reactions (Figure 3), we did not observe this inhibition. Shame-proneness in Figure 3 may include the domains where there is overlap with guilt-proneness and externalization. It is plausible that these domains cancel the inhibiting impact of shameproneness on task-oriented coping (Figure 3). Similarly, externalization that is free from shame-proneness and detachment did not have any effect on avoidance-oriented coping (Figure 7), whereas it had a significant positive effect on avoidance-oriented coping when the correlations between the four affects had not been into taken account (Figure 4). In Figure 4, externalization may include the part that
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overlaps with detachment and therefore influences the causal relationship between externalization and avoidance-oriented coping. In Figure 5, detachment had a positive effect on task-oriented coping (the causal coefficient from detachment to task-oriented coping was .17 (p<.01). However, in Figure 7 the causal coefficient from detachment to task-oriented coping was .10 (p=.17). We assume that in Figure 7, the effect of externalization on detachment was removed. This implies that detachment in Figure 7 is more refined than that of Figure 5. The main findings in Figure 7 were as follows: individuals with guilt-proneness tended employ task-oriented coping and avoidance-oriented coping, while those with shameproneness were more likely to use emotion-oriented coping and less likely to rely on taskoriented coping and avoidance-oriented coping. These results were by and large concordant with our hypothesis. Externalization tended towards task-oriented coping and emotionoriented coping, and detachment tended towards avoidance-oriented coping. These results should be discussed in great deal. Both guilt-proneness and externalization prompted an individual to use task-oriented coping. However, the quality of task-oriented coping induced by guilt-proneness might be different from that motivated by externalization. It is likely that task-oriented coping that is stimulated by guilt-proneness is more focused on problem solving, is more accommodating of surroundings, and is more reasoned than that the same type of coping prompted by externalization. Shame-proneness tended only towards emotion-oriented coping, and it inhibited taskoriented coping. People who feel shame are overwhelmed with the emotion; thus, it might be hard to adopt either of the other two coping strategies, even though these individuals might prefer to adopt avoidance-oriented coping. One common aspect of externalization and detachment is that people who feel these affects do not attribute negative events to themselves or to their own actions. Awareness of negative emotions however, especially anger, may differ. People who externalize the cause of their situation can recognize their feelings, but those who detach themselves from the cause of their situation try to avoid feeling anything, and once they fail to avert their attention from their emotions, the person loses some control of them. Therefore, it is easy to imagine that people who are prone to detach themselves from the cause of a problematic situation tend to avoid the situation in order not to arouse disquiet in their mind. On the other hand, people who are prone to externalize the cause of a dilemma deal with the problem using emotionoriented coping, in particular, anger, or task-oriented coping. For them, anger may have a great healing effect and relieve them from introspection. Task-oriented coping adopted by these individuals may be characterized by a accusative nature.
Relations of Coping Styles to the Depressive Reaction We found two phenomena in common in all structural equation models (Figures 2-5, Figure 7). First, emotion-oriented coping did not affect the depressive reaction. Emotionoriented coping in CISS includes several categories of emotion, such as anger, anxiety, worry, regret, self-blame, tension, and confusion. If the range of emotion-oriented coping in CISS were limited to self-blame, emotion-oriented coping could precipitate or worsen a depressive reaction. However, in this study, the range of emotion-oriented coping was broad, therefore this did not occur. However, previous research that adopted CISS still showed the maladaptive aspect of an emotion-oriented coping style (Endler &, Parker, 1990, Endler et al., 1993, Shikai et al., 2007). Our result suggests that emotion-oriented coping could be a way of
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maintaining psychological balance, although it is not a problem-solving strategy. As noted in the Introduction, all the coping styles are thought of as being beneficial in terms of maintaining mental balance. Similar to emotion-oriented coping, avoidance-oriented coping had no effect on depressive reactions. This suggests that this particular coping style enables an individual to avoid a depressive reaction. The second common phenomenon is that task-oriented coping prompted a depressive reaction. This was contrary to what we had hypothesized. Of the three coping styles, taskoriented coping has been regarded as the most effective strategy in resolving problems, being both adaptive and mature. It has also been known to minimize the detrimental effects of stress on mental health. The results of our current study seem to contradict previous research. However, an individual who is prone to adopt this coping style is better able to face problematic situations. Furthermore, becoming depressed as a result of facing a difficult problem is quite a natural phenomenon. If a person becomes hypomanic after adopting this coping style, this reaction might be seen as psychotic.
Relations of the Self-conscious Affects and the Depressive Reaction In the current study, shame-proneness directly reinforced the pathway to a depressive reaction, but guilt-proneness did not. This result supported the study of Tangney et al. (1992a), which showed a strong relationship between shame-proneness and several mental disorders, including depression. Furthermore, detachment and externalization did not directly lead to a depressive reaction. These affects are generally recognized as being undesirable because they discourage an individual from taking responsibility. However, they may also temporarily prevent an individual from undergoing a severe depressive reaction. One intriguing question relates to which factors determine shame-proneness. Some researchers attempt to derive an answer from a comparative cultural point of view, while others argue from the perspective of psychodynamic theory. Among the latter, Kohut (1966, 1972) argues that shame is related to the object’s rejection, in the process of transforming the narcissistic cathexis of the grandiose self and alleviating the narcissistic exhibitionistic tension. It could be surmised that patients with shame-proneness have experienced this type of rejection repeatedly, not only as regards their relationship with their mother, but also in relationships with other important figures. Therefore, for these patients, it is crucial to be admired and approved by a significant person, such as a parent or a partner. In a therapeutic relationship, therapists should be sensitive to the patients’ shame and its manifestation within this relationship, and deal with it warm-heartedly. This might help raise the patients’ selfesteem, improve their pathological state, and hopefully, enable them to reconstruct past painful experiences.
LIMITATIONS The limitations of this study should be noted. The coping styles assessed by the CISS are not necessarily those employed by any given subject when dealing with an NLE during the four-month study. In other words, the coping styles actually adopted might be different from those scored in the CISS. Similarly, there might be a discrepancy between the affects subjects
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actually felt in experiencing a NLE and the affects they supposed they might feel when participating in a given scenario.
CONCLUSION AND APPLICATION IN A CLINICAL SETTING 1. Patients who externalize the cause of a problematic situation sometimes adopt emotion-oriented coping, in particular anger, or task-oriented coping. In this case, task-oriented coping may not demonstrate problem solving, may not be reasoned, may sometimes be accusatory, and can therefore be seen as immature. However, anger can have a healing effect on patients even though it is temporary. Medical professionals have to be patient when listening to these patients and also consider their resources from multiple dimensions, such as socio-economic support or individual resilience. We should also be aware that we may be a patient resource and thus help patients solve their problem in a more efficient way. 2. Patients who are apt to detach themselves from the cause of a NLE tend to employ avoidance-oriented coping. These individuals might not be able to face their problems for several reasons, such as the traumatic nature of the NLE, severe pathology, the lack of current social support, and the lack of support from parentfigures during childhood. We have to understand the reasons for these attribution and coping styles. 3. Task-oriented coping enhances a depressive reaction. Patients who employ taskoriented coping try to confront the problem. We have to empathize with and support them through their difficulties. A depressive reaction due to a stressful situation is a very natural phenomenon, but if the reaction is too severe, we must consider pharmacotherapy, making use of family support, or admission. 4. Patients with shame-proneness are more likely to become overwhelmed with their emotions, and cannot deal with their stressful situation with task-oriented coping and avoidance-oriented coping. Medical professionals should help patients put their feelings in order, free from criticism or judgment.
REFERENCES Arbuckle, J. L., & Wothke, W. (1995). Amos 4.0 User’s Guide. Small Waters Cooperation. Ausubel, D. P. (1955). Relationship between shame and guilt in the socializing process. Psychological Review, 62, 378-390. Benedict, R. (1967). The chrysanthemum and sword. Boston: Hoyghton Mifflin. Billings, A. G., Cronkite, R. C., & Moos, R. H. (1983). Social-environmental factors in unipolar depression: Comparisons of depressed patients and nondepressed controls. Journal of Abnormal Psychology, 92, 119-133. Cronkite, R., Moos, R., Twohey, J., Cohen, C., & Swindle, R. (1998). Life circumstances and personal resources as predictors of the ten-year course of depression. American Journal of Community Psychology, 26, 255-280.
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Eisenberg, N. (2000). Emotion, regulation, and moral development. Annual Review of Psychology, 51, 665-697. Endler, N. S., & Parker, J. D. A. (1990). Coping Inventory for Stressful Situations (CISS): Manual. Multi-Health Systems, Inc, Toronto. Endler, N. S., Parker, J. D. A., & Butcher, J. N. (1993). A factor analytic study of coping styles and the MMPI-2 Content Scales. Journal of Clinical Psychology, 49, 523-527. Feiring, C., Taska, L., & Lewis, M. (1998) The role of shame and attributional style in children’s and adolescents’ adaptation to sexual abuse. Child Maltreatment 3, 129-142. Feiring, C., Coates, D. & Taska, L. (2001) Ethnic status, stigmatization, support and symptom development following sexual abuse. Journal of Interpersonal Violence, 16, 1307-1329. Feiring, C., Taska, L., & Chen, K. (2002a) Trying to understand why horrible things happen: attribution, shame, and symptom development following sexual abuse. Child Maltreatment 7, 25-39. Feiring, C., Taska, L., & Lewis, M. (2002b) Adjustment following sexual abuse discovery: the role of shame and attributional style. Developmental Psychology, 38, 79-92. Feiring, C., & Taska, L. (2005) The persistence of shame following sexual abuse: a longitudinal study. Child Maltreatment, 10, 337-349. Freud, S. (1909). Bemerkungen über enien Fall von Zwangstneurose. [Notes upon a Case of Obsessional Neurosis]. Freud, S. (1917). Tauer and Melancholie [Mourning and Melancholia]. Freud, S. (1923). Das Ich und Es. [The Ego and the Id]. Internationaler psychoanalytischer Verlag. Furukawa, T., Suzuki, A., Saito, Y., & Hamanaka, T. (1993). CISS nihongo-ban no shinraisei to datousei: taishokoudou no hikakubunkateki kenkyu eno ichi kiyo. [Reliability and validity of the Japanese version of the Coping Inventory for Stressful Situations (CISS): A contribution to the cross-cultural studies of coping]. Psychiatrica et Neurologica Japonica, 95, 602-621. (in Japanese). Grinberg, L. (1964). Two kinds of guilt: their relations with normal and psychological aspects of mourning. International Journal of Psychoanalysis, 45, 366-371. Holahan, C. J., & Moos, R. H. (1987). Personal and contextual determinants of coping strategies. Journal of Personality Social Psychology, 52, 946-955. Inoue, T. (1977). “Haji” no syakaishinnri [Social psychology of “Haji (shame)”]. In: Inoue, T. (ed.) “Sekentei” no kozo: shakai shinnrishi e no kokoromi [Anatomy of respectability: challenging the socio-psycho-history]. Nippon hoso shuppan kyokai [Japan Broadcast Publishing Company], Tokyo, 105-142 (in Japanese). Kasahara, Y. (1968). Seishi (Shisen) kyofu ni tuiteno rinshoteki kosatsu [Clinical considerations Phobia “staring at another”.]. Seisinbunseki kenkyu [Japanese Journal of Psychoanalysis]. 14, 5-5. (in Japanese). Kimura, B. (1972). Hito to hito tono aida: seishin byorigakuteki nipponron [Between two persons: discussing Japan from a psychopathological perspective]. Kobundo. Tokyo. (in Japanese). Kitamura, T., Hirano, H., Chen, Z., & Hirata, M. (2004). Factor structure of the Zung Selfrating Depression Scale in first year university students in Japan. Psychiatry Research, 128, 281-287. Klein (1957). Envy and gratitude. Tavistok, London.
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Kohut, H. (1966). Forms and transformations of narcissism. Journal of the Psychoanalytic Association, 14, 243-272. Kohut, H. (1972). Thoughts on narcissism and narcissistic rage. Psychoanalytic Study of the Child, 27, 360-400. Krantz, S. E., & Moos, R. H. (1988). Risk factors at intake predict nonremission among depressed patients. Journal of Consulting and Clinical Psychology, 56, 863-869. Lebra T. S. (1983). Shame and guilt. Ethos, 11, 192-209. Lewis, H. B. (1971). Shame and Guilt in Neurosis. New York: Intentional University Press. McCrae, R. R., & Costa, P. T. Jr. (1986). Personality, coping and coping effectiveness in an adult sample. Journal of Personality, 54, 385-405. McWilliams, L. A., Cox B. J., & Enns, M. W. (2003). Use of the Coping Inventory for Stressful Situations in a clinically depressed sample: Factor structure, personality correlates, and prediction of distress. Journal of Clinical Psychology, 59, 423-437. Miller, S., M., Brody, D., S., & Summerton, S. (1988). Styles of coping with threat: Implications for health. Journal of Personality and Social Psychology, 54, 142-148. Okada, A. (2006). Jikoishikitekikanjyo syakudo seinenban (TOSCA-A): nihongoban no sakusei [Developing a Japanese version of the Test of Self Conscious Affect-Adult version (TOSCA-A)]. Sapporo Kokusai Daigaku sinnri sodan kenkyusyo syohou [Journal of psychological consultation and Research center in Sapporo International University], 5, 1-17. (in Japanese). Park, C. L., & Adler, N. E. (2003). Coping style as a predictor of health and well-being across the first year of medical school. Health Psychology, 22, 627-631. Parkes, K. R. (1990). Coping, negative affectivity, and the work environment: Additive and interactive predictions of mental health. Journal of applied Psychology, 75, 399-409. Piers, G., & Singer, M. B. (1971). Shame and Guilt. New York: Norton. Rafnsson, F. D., Smari, J., Windle, M., Mears, S. A., & Endler, N. S. (2006). Factor structure and psychometric characteristics of the Icelandic version of the Coping Inventory for Stressful Situations (CISS). Personality and Individual Differences, 40, 1247-1258. Sakuta, K. (1967). Haji to Kodoku [Shame and solitude]. In: Sakuta, K. (ed.) Haji no bunkateki saiko [Cultural reconsideration of shame]. Chikuma shobo, Tokyo, 7-72 (in Japanese). Shikai, N., Uji, M., Chen, Z., Hiramura, H., Tanaka, N., Shono, M, & Kitamura, T. (2007). The role of coping styles and self-efficacy in the development of dysphoric mood among nursing students. Journal of Psychopathology and Behavioral Assessment, 29, 291-248. Tangney, J. P. (1990). Assessing individual differences in proneness to shame and guilt: development of the Self-Conscious Affects and Attribution Inventory. Journal of Personality and Social Psychology, 59, 102-111. Tangney, J. P. (1991). Moral affects: The good, the bad, and the ugly. Journal of Personal Social Psychological Bulletin, 18, 199-206. Tangney, J. P., Dearing, R., Wagner, P., & Gramzow, R. (1992a). Proneness to shame, proneness to guilt, and psychopathology. Journal of Abnormal Psychology, 101, 469-478. Tangney, J. P., Wagner, P., Fletcher, C., & Gramzow, R. (1992b). Shame into anger? The relation of shame and guilt to anger and self-reported aggression. Journal of Personality and Social Psychology, 62, 669-675. Tangney, J. P. (1996). Conceptual and methodological issues in the assessment of shame and guilt. Behavioral Research Therapy, 34, 741-754.
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Tangney, J. P., Dearing, R., Wagner, P., & Gramzow, R. (2000). The Test of Self - Conscious Affect (TOSCA–3). Fairfax, VA: George Mason University. Uji, M., Shono, M., Shikai, N., & Kitamura, T. (2007). Contribution of shame and attribution style in developing PTSD among Japanese university women with negative sexual experiences. Archives of Women’s Mental Health, 10, 111-120. Vollrath, M., Alnaes, R., & Torgersen, S. (1994). Coping and MCMI-2 Symptom Scales. Journal of Clinical Psychology, 50, 727-736. Zung, W. W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63-70.
In: Psychology of Relationships Editors: Emma Cuyler and Michael Ackhart
ISBN 978-1-60692-265-1 © 2009 Nova Science Publishers, Inc.
Chapter 30
THE NEUROPSYCHOLOGY OF PASSIONATE LOVE Elaine Hatfield and Richard L. Rapson University of Hawaii
ABSTRACT Throughout history, artists, poets, and writers have been interested in the nature of passionate love, sexual desire, and sexual behavior. In the 1960s, social psychologists and sexologists began the systematic investigation of these complex phenomena (see Berscheid & Hatfield, 1969; Hatfield & Rapson, 1993; Hatfield & Rapson, 2005, for a review of this research). Yet, only recently have neuroscientists and biochemists begun to explore these complex phenomena. In this entry, we will review what these distinguished theorists and researchers have learned about these processes.
DEFINING PASSIONATE LOVE Passionate love is a powerful emotional state. It has been defined as: A state of intense longing for union with another. Passionate love is a complex functional whole including appraisals or appreciations, subjective feelings, expressions, patterned physiological processes, action tendencies, and instrumental behaviors. Reciprocated love (union with the other) is associated with fulfillment and ecstasy. Unrequited love (separation) is associated with feelings of emptiness, anxiety, and despair (Hatfield & Rapson, 1993, p. 5). People in all cultures recognize the power of passionate love. In South Indian Tamil families, for example, a person who falls head-over-heels in love with another is said to be suffering from mayakkam—dizziness, confusion, intoxication, and delusion. The wild hopes and despairs of love are thought to “mix you up” (Trawick, 1990). The Passionate Love Scale (PLS) was designed to tap into the cognitive, emotional, and behavioral indicants of such longings (Hatfield & Sprecher, 1986). The PLS has been found to be a useful measure of passionate love for men and women of all ages, in a variety of cultures, and to correlate well with certain well-defined patterns of neural activation (see
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Bartels & Zeki, 2000, 2004; Doherty, Hatfield, Thompson, & Choo, 1994; Fisher, 2003; Landis & O’Shea, 2000). Sexual desire (the desire to merge sexually) is assumed to be a closely related construct. A facsimile of the PLS appears below.
THE PASSIONATE LOVE SCALE We would like to know how you feel (or once felt) about the person you love, or have loved, most passionately. Some common terms for passionate love are romantic love, infatuation, love sickness, or obsessive love. Please think of the person whom you love most passionately right now. If you are not in love, please think of the last person you loved. If you have never been in love, think of the person you came closest to caring for in that way. Try to describe the way you felt when your feelings were most intense. Answers range from (1) Not at all true to (9) Definitely true. Whom are you thinking of? • Someone I love right now. • Someone I once loved. • I have never been in love. Possible answers range from: 1 Not at all true
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5 Moderately true
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I would feel deep despair if _____ left me. Sometimes I feel I can’t control my thoughts; they are obsessively on _____. I feel happy when I am doing something to make _____ happy. I would rather be with _____ than anyone else. I’d get jealous if I thought _____ were falling in love with someone else. I yearn to know all about _____. I want _____ physically, emotionally, mentally. I have an endless appetite for affection from _____. For me, _____ is the perfect romantic partner. I sense my body responding when _____ touches me. _____ always seems to be on my mind. I want _____ to know me—my thoughts, my fears, and my hopes. I eagerly look for signs indicating _____’s desire for me. I possess a powerful attraction for _____. I get extremely depressed when things don't go right in my relationship with _____.
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9 Definitely true Not Definitely true true 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 Total: _______
On this scale, the higher the score, the more wildly in love a person is said to be.
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THE NEUROPSYCHOLOGY OF PASSIONATE LOVE The Ancients Since antiquity, court physicians and social observers have searched for methods to detect “lovesickness.” In the 2nd century A. D. Appian of Alexandria (1899) recounted this “case history.” During the last years of his life, King Seleucus, appointed his son Antiochus King of upper Asia in place of himself. Appian notes: If this seems noble and kingly on his part, even nobler and wiser was his behavior in reference to his son's falling in love and his self-restraint in suffering; for Antiochus was in love with Stratonice, the wife of Seleucus, his own step-mother, who had already borne a child to Seleucus. Recognizing the wickedness of this passion, Antiochus did nothing wrong, nor did he show his feelings, but he fell sick, took to his bed, and longed for death. Nor could the celebrated physician, Erasistratus, who was serving Seleucus at a very high salary, form any diagnosis of his malady. At length, observing his body was free from all the symptoms of disease, he conjectured that this was some condition of the mind, through which the body is often strengthened or weakened by sympathy. Grief, anger, and other passions disclose themselves; love only is concealed by the modest. As Antiochus would confess nothing when the physician asked him in confidence, he took a seat by his side and watched the changes of his body to see how he was affected by each person who entered his room. He found that when others came the patient was all the time weakening and wasting away at a uniform pace, but when Stratonice came to visit him his mind was greatly agitated by the struggles of modesty and conscience, and he remained silent. But his body in spite of himself became more vigorous and lively, and when she went away he became weaker again (pp. 317-318).
Antiochus and Stratonice. In this painting, Jacques-Louis David (1748-1825) depicts the moment in which Erasistratos diagnosed Antiochus’ love for his stepmother. École des Beaux-Arts at Paris.
Plutarch (1st century, A.D./1920), more medically oriented, detailed Antiochus' symptoms:
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Elaine Hatfield and Richard L. Rapson Accordingly, when any one else came in, Antiochus showed no change; but whenever Stratonice came to see him, as she often did, either alone, or with Seleucus, lo, those tell-talesigns of which Sappho sings were all there in him—stammering speech, fiery flashes, darkened vision, sudden sweats, irregular palpitations of the heart, and finally, as his soul was taken by storm, helplessness, stupor, and pallor (pp. 93 and 95).
Appian of Alexandria (1899) continued: So the physician told Seleucus that his son had an incurable disease. The king was overwhelmed with grief and cried aloud. Then the physician added, “His disease is love, love for a woman, but a hopeless love.” (pp. 317-318).
King Seleucus, however, was not one to be stopped by obstacles. Appian of Alexandria (1899) notes: Selecus was overjoyed, but it was a difficult matter to persuade his son and not less so to persuade his wife; but he succeeded finally. Then he assembled his army, which was perhaps expecting something of the kind, and told them of his exploits and the extent of his empire, showing that it surpassed that of any of the other successors of Alexander, and saying that as he was now growing old it was hard for him to govern it on account of its size. “I wish,” he said, “to divide it and so at the same time to provide for your safety in the future and give a part of it now to those who are dearest to me. It is fitting that all of you, who had advanced to such greatness of dominion and power under me since the time of Alexander, should cooperate with me in everything. The dearest to me, and well worthy to reign, are my grownup son and my wife. As they are young, I pray they may soon have children to be an ample guarantee to you of the permanency of the dynasty. I will join them in marriage in your presence and will send them to be sovereigns of the upper provinces now. And I charge you that none of the customs of the Persians and other nations is more worthy of observance than this one law, which is common of them, “That what the king ordains is always right.” When he had thus spoken the army shouted that he was the greatest king of all the successors of Alexander and the best father. Seleucus laid the same injunctions on Stratonice and his son, then joined them in marriage, and sent them to their kingdom, showing himself even stronger in this famous act than in his deeds of arms (pp. 319-320).
For a review of the speculations of ancient Greek physicians such as Avicenna, Erasistratos, and Galen, see M.-Marsel Mesulam and J. Perry (1972). In ancient China, classical scholars possessed a great deal of scientific information about sexual response. For example, the 4th century classic, Secret Instructions Concerning the Jade Chamber, provided information concerning the selection of sexual partners, foreplay, and positions for intercourse. The text taught men and women how to identify the stage their partner had reached in the sexual response cycle (Ruan, 1991). Recently, neuropsychologists have assembled information from neuroanatomical and neurophysiological investigations, ablation experiments, pharmacologic explorations, clinical investigations and behavioral research as to the social psychophysiology of passion. These scientists document that the observations of the ancients are, in part, correct. Passionate love does produce the autonomic nervous system and skeletal-muscular reactions Plutarch and his fellow physicians described (Hatfield & Rapson, 1987; Kaplan, 1979; Liebowitz, 1983.) The early Chinese physicians appear to have been careful observers, too. Their descriptions of the
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stages of sexual response sound much like those described by Alfred Kinsey and his associates (1948 and 1953) and by William Masters and Virginia Johnson (1966). The ancients provide a beginning. In spite of the valuable insights that their observations provide, folklore is often wrong-headed or incomplete. Today’s neuropsychological research into passionate love and sexual desire makes it clear that men and women’s cognitions, emotions, and behaviors interact in ways only dreamed of by early court physicians and scientists.
Modern Day Neuropsychological Explorations into Passionate Love The Pioneering EEG Research of Niels Birbaumer and his Tübingen colleagues The first modern-day neuroscientists to study passionate love were Niels Birbaumer and his Tübingen colleagues (1993). These authors argued that cortical processes in imagery do not differ from “actual” processing, storage, and retrieval of information. As part of a larger research project, they interviewed 10 men and women. Participants were asked to complete six different tasks, which ranged from imaging tasks (imagining a time in their past in which they had been joyously in love [without sexual imagery] and imagining the same scene [with sexual imagery]) to sensory tasks (such as determining which of two pieces of sandpaper was the smoothest). The authors observed: Subjects in love carry their emotional “burden” like a snail’s house into the laboratory of the physiologist. The vividness and readiness of their emotional imagery is particularly intense and easy to create under laboratory conditions (p. 133).
While participants performed these tasks, EEG (electroencephalogram) recordings were obtained from 15 different brain locations. The authors discovered (on the basis of their EEG assessments) that the frontal and posterior groupings showed similar dimensions on the romantic imagery tasks, whereas smaller dimensions were found in the frontal as compared to the posterior electrode sites on the four sensory tasks. The authors concluded that passionate imagery involves a significantly higher brain complexity than does sensory stimulation at all brain sites, but particularly at frontal regions. In a second experiment, Birbaumer and his group (1993) focused primarily on erotic images—comparing 10 people who were passionately in love (as assessed by the Passionate Love Scale described earlier) with a matched group of 10 people who were not emotionally involved with anyone. Participants were asked to imagine a joyous scene with a beloved partner, a scene of intense jealousy, and a neutral scene (an empty living room). During these visualizations, the scientists recorded EEG responses from the midline (Fz, Cz, Pz) and its fractal dimensions were estimated (using the method described by Graf & Elbert, 1988). On the bases of these analyses, the authors concluded that passionate love is “mental chaos.” Passionate imagery employed anatomically more complex and more widespread (less localized) brain processes than did sensory tasks. Frontal lobe mechanisms, in particular, seemed to add to imagery-related chaos compared to tactile or visual stimulation. Images, they note, may be “more than just pictures in the head”( p. 134).
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The authors concluded this preliminary study by calling for more research. It was a full decade before anyone responded to their plea.
2. Recent fMRI Research: Andreas Bartels and Semir Zeki In 2000, two London neuroscientists, Andreas Bartels and Semir Zeki, attempted to identify the brain regions associated with passionate love and sexual desire. The scientists put up posters around London, advertising for men and women who were “truly, deeply, and madly in love.” They also recruited participants via the internet. Seventy young men and women from 11 countries and several ethnic groups responded. Respondents were asked to write about their feelings of love and to complete the Passionate Love Scale (PLS). Seventeen men and women, ranging in age from 21-37, were selected for the study. Participants were then placed in an fMRI (functional magnetic imagery) scanner. This high-tech scanner constructs an image of the brain in which changes in blood flow (induced by brain activity) are represented as color-coded pixels. Bartels and Zeki (2000) gave each participant a color photograph of their beloved to gaze at, alternating the beloved’s picture with pictures of a trio of casual friends. They then digitally compared the scans taken while the participants viewed their beloved’s picture with those taken while they viewed a friend’s picture, creating images that represented the brain regions that became more (or less) active in both conditions. These images, the researchers argued, revealed the brain regions involved when a person experiences passionate love and/or sexual desire. Bartels and Zeki discovered that passion sparked increased activity in the brain areas associated with euphoria and reward, and decreased activity in the areas associated with sadness, anxiety, and fear. Activity seemed to be restricted to foci in the medial insula and the anterior cingulated cortex and, subcortically, in the caudate nucleus, and the putamen, all bilaterally. Most of the regions that were activated during the experience of romantic love were those that are active when people are under the influence of euphoria-inducing drugs such as opiates or cocaine. Apparently, both passionate love and those drugs activate a “blissed-out” circuit in the brain. The anterior cingulated cortex has also been shown to be active when people view sexually arousing material. This makes sense since passionate love and sexual desire are generally assumed to be tightly linked constructs. Among the regions where activity decreased during the experience of love were zones previously implicated in the areas of the brain controlling critical thought (i.e., the sort of mental activity involved when people are asked to make social judgments or to “mentalize”— that is, to assess other people’s intentions and emotions.) Such brain areas are also activated when people experience painful emotions such as sadness, anger and fear. The authors argue that once we fall in love with someone, we feel less need to assess critically their character and personality. (In that sense, love may indeed be “blind.”) Deactivations were also observed in the posterior cingulated gyrus and in the amygdala and were right-lateralized in the prefrontal, parietal, and middle temporal cortices. Once again, the authors found passionate love and sexual arousal to be tightly linked. Not surprisingly, the Bartels and Zeki (2000, 20004) research sparked a cascade of fMRI research. 3. Helen Fisher, Arthur Aron, and Lucy Brown In Why We Love, Helen Fisher (2004) argued that people possess a trio of primary brain systems designed to deal with close, intimate relationships. These are: attraction (passionate
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love), lust (sexual desire), and attachment (companionate love).1 Presumably, this trio of systems evolved during humankind’s long evolutionary history; each is designed to play a critical role in courtship, mating, and parenting. In theory, attraction evolved to persuade our ancestors to focus attention on a single favored courtship partner. Sexual desire evolved to motivate young people to seek a wide range of sexual partners. Attachment evolved to insure that devoted parents would remain together during the first crucial four years of a child’s life. According to Fisher (2004) attraction (passionate love) is characterized by a yearning to win a preferred mating partner. She speculated that three chemicals—dopamine, norepinephrine, and serotonin—play a crucial role in romantic passion. Sexual desire (lust), on the other hand, is typified by a general craving for sexual gratification and may be directed toward many potential partners. In men and women, she observed, the androgens, particularly testosterone, are central to sparking sexual desire. Attachment (companionate love) is comprised of feelings of calm, social comfort, emotional union, and the security felt in the presence of a long-term mate. It sparks affiliative behaviors, the maintenance of close proximity, separation anxiety when closeness disappears, and a willingness to participate in shared parental chores. Animal studies suggest that this brain system is primarily associated with oxytocin and vasopressin in the nucleus accumbens and ventral pallidum.
The Joys of Love In focusing in on passionate love, Fisher (January 19, 2000) observed: I speculated that the feelings of euphoria, sleeplessness and loss of appetite as well as the lover’s intense energy, focused attention and increased passion in the face of adversity might all be caused in part by heightened levels of dopamine or norepinephrine in the brain. Similarly, I believed that the lover’s obsessive thinking about the beloved might be due to decreased brain activity of some type of serotonin. I also knew these three compounds were much more prevalent in some brain regions than in others. If I could establish which regions of the brain become active while one is feeling romantic rapture, that might confirm which primary chemicals are involved (p. 77).
To test these notions, Fisher (2004) and her colleagues Arthur Aron and Lucy Brown (along with graduate students Deborah Mashek and Greg Strong) conducted a series of fMRI studies. “Have you just fallen madly in love?” asked the announcement posted on a bulletin board on the SUNY Stony Brook campus. She received a flood of replies. On the basis of interviews, Fisher selected 17 young lovers. All of these men and women scored high on the Passionate Love Scale. To test her notions, Fisher followed the prototype described by Bartels and Zeki (2000). She asked lovesick men and women to view pictures of their beloved and “a boring acquaintance,” while an fMRI imager recorded the activity (blood flow) in the their brains. Fisher (January 19, 2004) found that when lovesick men and women gazed at their beloved, activity was sparked in many brain areas. (This should come as no surprise since as Acevedo, et al., 2008; and Carlson & Hatfield, 1992, noted, passionate love is associated with 1 You will notice that while most social psychologists (see Hatfield & Rapson, 2005) and neuroscientists such as Birbaumer and his colleagues (1993) and Bartels and Zeki (2004) assume that the emotion of passionate love and sexual desire are closely linked, Fisher (2004) assumes that passionate love and sexual desire are fueled by very different brain systems. We will discuss this theoretical difference in greater length in a later section.
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a wider array of related feelings and emotions [guilt, sadness, anger, jealousy, sexual desire, etc.] than is any other basic emotion.) Two areas, were found to be critically important: the caudate nucleus (a large, C-shaped region deep in the center of the brain) and the ventral tegmental area (VTA), a group of neurons at the very center of the brain. “I was astonished,” Fisher said. The caudate is “a key part of the brain’s ‘reward system,’ the mind’s network for general arousal, sensations of pleasure and the motivation to acquire rewards” (p. 79). The VTA is a central part of the reward circuitry of the brain. Fisher (January 19, 2004) observed: I had hypothesized that romantic love is associated with elevated levels of dopamine or norepinephrine. The VTA is a mother lode for dopamine-making cells. With their tentacle-like axons, these nerve cells distribute dopamine to many brain regions, including the caudate nucleus. And as this sprinkler system sends dopamine to various parts of the brain, it produces focused attention as well as fierce energy, concentrated motivation to attain a reward, and feelings of elation—even mania—the core feelings of romantic love. No wonder lovers talk all night or walk till dawn, write extravagant poetry and self-revealing e-mails, cross continents or oceans to hug for just a weekend, change jobs or lifestyles, even die for one another. Drenched in chemicals that bestow focus, stamina and vigor, and driven by the motivating engine of the brain, lovers succumb to a Herculean courting urge (p. 79).
Lucy Brown added: “That’s the area that’s also active when a cocaine addict gets an IV injection of cocaine. It’s not a craving. It’s a high” (Quoted in Blink, 2007, p. 3.) Blink (2007) observes: You see someone, you click, and you’re euphoric. And in response, your ventral tegmental area uses chemical messengers such as dopamine, serotonin, and oxytocin to send signals racing to a part of the brain called the nucleus accumbens with the good news, telling it to start craving. [Certain regions] are deactivated—areas as within the amygdala, associated with fear (p. 3).
(For more detailed descriptions of this research, see Aron, et al, 2005; and Fisher, et al, 2005). Fisher (2004) concluded by observing that the chemistry of romantic attraction generally elevates sexual motivation. Alas, other neuroscientists (such as Bartels & Zeki, 2000, who studied the fMRI responses of joyous lovers), have secured slightly different results than those described by Fisher and her colleagues (2002). (Bartels & Zeki considered (1) passion to be an emotion and (2) found a close connection between passionate love and sexual desire). Fisher speculates that such differences may be due to the fact that while she and her colleagues studied young people who are in the first throes of love of love, her critics have focused on men and women who fell in love some time ago. (Fisher’s participants had been in love for an average of seven months; Bartels and Zeki’s participants for 2.3 years.) In addition, Fisher studied a homogeneous group of SUNY students, while Bartels and Zeki studied people from different cultural backgrounds and of a variety of ages. Whether or not these differences adequately account for these differing results is as yet unknown.
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fMRI pictures of “The Brain in Love.”
The Dark Side of Love: Anger, Sadness, and Misery Joyous passionate love is only one-half of the equation, of course. Love is often unrequited. What kind of brain activity occurs when passionate lovers are rejected? In a second study, Fisher and her colleagues (2004) studied 15 men and women who had just been jilted by their beloved. First, they hung a flyer on the SUNY at Stony Brook bulletin board. “Have you just been rejected in love. But can’t let go?” Rejected sweethearts were quick to respond. In initial interviews, Fisher found that heartbroken men and women were caught up in a swirl of conflicting emotions—they were still wildly in love, yet feeling abandoned, depressed, angry, and in despair. But what was going on in their brains? To find out, Fisher and her colleagues (2004) followed the same protocol they’d utilized in testing happily-in-love men and women—i.e.,
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they asked participants to alternately view a photograph of their one-time beloved and a photograph of a familiar, but emotionally neutral individual. The authors found that when contemplating their beloved, rejected lovers displayed greater activity in the right nucleus accumbens/ventral putamen/pallidum, lateral orbitofrontal cortex and anterior insular/operculum cortex than they did when contemplating neutral images. In short, jilted lovers’ brains “lit up” in the areas associated with anxiety, pain, and attempts at controlling anger as well as addiction, risk taking, and obsessive/compulsive behaviors. Jilted lovers did, indeed, appear to experience a storm of passion—passionate love, sexual desire, plus anguish, rejection, rage, emptiness, and despair. Other neuroscientists who have studied the fMRI responses of lovers who are actively grieving over a recent romantic breakup, have secured slightly different results than those secured by Fisher and her colleagues (see Najib, et al., 2004). Fisher (2004) speculates that her critics may have focused on men and women who broke up some time ago and have presumably adapted to their losses. Instead of at the grief stage, they may have been at a subsequent stage in the grieving process—experiencing resignation and despair. In conclusion: Psychologists’ opinions may differ on whether romantic and passionate love are emotions (Shaver, Morgan, & Wu, 1996) or are not emotions (Reis & Aron, 2008) and whether passionate love, sexual desire, and sexual motivation are closely related constructs (psychologically, neurobiologically, and physiologically) (Fehr & Russell, 1991; Hatfield & Rapson, 1987; Hendrick & Hendrick, 1987a; Regan, 1998, 2004) or very different in their nature (Diamond, 2004; Reis & Aron, 2008). In addition, scientists have sharply criticized the widespread use of fMRI techniques to study the nature of love, claiming that currently the fMRI studies track only superficial changes and lack reliability and validity (Cacioppo, et al., 2003; Movshon, 2006; Panksepp, 2007; Wade, cited in Wargo, 2005). One critic observed: “It’s like the Wild West out there. Scientists are working in uncharted territory; there hasn’t been time for the development of adequate critical standards; and fMRI research has such status, that everything gets published!” (We might also note that although in TV shows like House, the administration of fMRIs is an eerily silent procedure, in fact a real fMRI is a ear-splitting and bone shattering process. Participants staggering out the an experimental room often report: “I thought I was going crazy! In spite of my earplugs, the noise was unbelievable. I tried to think of love, but in fact I kept thinking ‘Get me out of here!’” This technological problem may make the interpretation of fMRI studies somewhat problematic.) Nonetheless, this path-breaking research (as it grows ever more sophisticated) has the potential to answer age-old questions as to the nature of culture, love, and human sexuality.
Adrenalin makes the heart grow fonder —Elaine Hatfield & Ellen Berscheid Dopamine. God’s little neurotransmitter. Better known by its street name, romantic love. Also norepinephrine. Street name, infatuation. —Neely Tucker
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THE BIO-CHEMISTRY OF LOVE Researchers are beginning to learn more about the chemistry of passionate love and a potpourri of related emotions. They are also learning more about the way that various emotions, positive and negative, interact.
The Ancients A number of researchers have focused on the chemistry of love—searching for (in effect) the elusive “Love potion #9.” In 18th century, London physicians crafted love nostrums and aphrodisiacs from a variety of substances, combining: . . . crushed toads, salt of vipers, ground garden snails “bruised to a perfect paste,” pulvis humani cranum (powered human skull), “volatile salt of millipedes,” sal vitrioli (hydrochloric acid), and copious amount of alcohol (Madeira was favored), rhubarb, and that luckily easily available substance acqua pluvialis (rain water) (Hunt, 2000-2001, p. 46.)
Pioneering Research: Michael Liebowitz and Helen Singer Kaplan Psychiatrist Michael Liebowitz (1983) was one of the first to speculate about the chemistry of love. He argued that passionate love brings on a giddy feeling, comparable to an amphetamine high. He contended that it was phenylethylamine (PEA), an amphetaminerelated compound, that produces the mood-lifting and energizing effects of romantic love. He observed that “love addicts" and drug addicts have a great deal in common: the craving for romance is merely the craving for a particular kind of high. The fact that most romances lose some of their intensity with time, may well be due to normal biological processes. The crash that follows a breakup is much like amphetamine withdrawal. Liebowitz speculates that there may be a chemical counteractant to lovesickness: MAO (monoamine oxidase) inhibitors may inhibit the breakdown of PEA, thereby “stabilizing" the lovesick. Liebowitz also offered some speculations about the chemistry of the emotions which criss-cross lovers' consciousness as they plunge from the highs to the lows of love. The “highs" include euphoria, excitement, relaxation, spiritual feelings, and relief. The “lows" include anxiety, terrifying panic attacks, the pain of separation, and the fear of punishment. His speculations were based on the assumption that non-drug and drug highs and lows operate via similar changes in brain chemistry. In excitement, Liebowitz proposed that naturally occurring brain chemicals, similar to the stimulants (such as amphetamine and cocaine), produce the “rush" lovers feel. In relaxation, chemicals related to the narcotics (such as heroin, opium and morphine), tranquilizers (such as Librium and Valium), sedatives (such as barbiturates, Quaaludes and other “downers"), or alcohol, which acts chemically much like the sedatives, and marijuana and other cannabis derivatives, produce a mellow state and wipe out anxiety, loneliness, panic attacks, and depression. In spiritual peak experiences, chemicals similar to the psychedelics (such as LSD, mescaline and psilocybin) produce a sense of beauty, meaningfulness, and timelessness.
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In the same era, Helen Singer Kaplan (1979) provided some information as to the chemistry of sexual desire. In both men and women, testosterone (and perhaps LH-RF, luteinizing hormone-releasing factor) are the libido hormones. The neurotransmitter dopamine may act as a stimulant, serotonin or 5-HT (5-hydroxtryptamine) as inhibitors, to the sexual centers of the brain. Kaplan (1979) observed: When we are in love, libido is high. Every contact is sensuous, thoughts turn to Eros, and the sexual reflexes work rapidly and well. The presence of the beloved is an aphrodisiac; the smell, sight, sound, and touch of the lover—especially when he/she is excited—are powerful stimuli to sexual desire. In physiologic terms, this may exert a direct physical effect on the neurophysiologic system in the brain which regulates sexual desire. . . . But again, there is no sexual stimulant so powerful, even love, that it cannot be inhibited by fear and pain. (p. l4).
Kaplan ended by observing that a wide array of cognitive and physiological factors shape desire. Although passionate love and the related emotions we have described may be associated with specific chemical neurotransmitters (or with chemicals which increase/decrease the receptors' sensitivity), most emotions have more similarities than differences. Chemically, intense emotions do have much in common. Kaplan reminds us that chemically, love, joy, sexual desire, and excitement, as well as anger, fear, jealousy, and hate, are all intensely arousing. They all produce an ANS sympathetic response. This is evidenced by the symptoms associated with all these emotions—a flushed face, sweaty palms, weak knees, butterflies in the stomach, dizziness, a pounding heart, trembling hands, and accelerated breathing. For a survey of modern research on the biological substrates of human sexuality, see Hatfield & Berscheid (1971); Hyde (2005); Kauth (2007); and Regan (1999).
Falling in love is a bit like going crazy. —Donatella Marazziti
Modern Day Neurobiological Research: Donatella Marazziti Italian psychiatrist Donatella Marazziti (an editor of this collection) has done some of the most intriguing work on the nature of passionate love. In the popular press, one of Marazziti’s observations—“Love is insanity”—has sparked intense scientific and journalistic interest. In the late 1990s, Donatella Marazziti and her colleagues (1999) speculated that passionate lovers and patients suffering from obsessive-compulsive disorders (OCD) might have something in common: both may be lacking in a neurotransmitter (serotonin) that has a soothing effect on the brain. Too little serotonin has been linked to anxiety, depression, and aggression. Drugs in the Prozac family fight these conditions by boosting the chemicals presence in the brain. To test this notion, the authors selected 20 men and women who were passionately in love, 20 unmedicated OCD patients, and 20 normal controls. Tracking chemicals inside the brain is difficult (to say the least!), so the authors settled on a simple technique: they calculated the amount of serotonin in platelets—tiny cells that are easily retrieved from an
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ordinary blood sample. The 5-HT transporter was evaluated with the specific binding of 3HPparoxetine (3H-Par) to platelet membranes. The results supported Marazziti and her colleagues’ notion. The density of 3H-Par bonding sites was indeed significantly lower in lovers and those suffering from OCD disorders than in normal controls (people who were either single or in monogamous, long term relationships) (see also Marazziti & Canale, 2004). Marazziti and her colleagues (2003) have also investigated the dark side of love— passionate jealousy. The authors selected 21 Italian university students consumed by jealous thoughts, 14 OCD patients (whose main obsession was jealousy), and 21 control subjects, not plagued by jealous concerns. They discovered that men and women who were excessively jealous suffered from a number of psychopathological traits (as well) and produced reduced density of 3H-Par binding compared with their healthy peers. It was these findings that led the Marazziti group to conclude that love is a kind of insanity. For additional information, see Marazziti (2005) and chapter 30 in this text.
Odi et amo (I hate and I love) —Catullus
The Cross-Magnification Process Scientists have long contended that men and women are most susceptible to passionate love and sexual desire when their lives are turbulent. It is assumed that although each basic emotion has its basic chemical signature that an additional supply of adrenalin and noradrenalin may help fuel the intensity of emotional reactions (Kaplan, 1979; Schachter & Singer, 1962). Social psychologists have called this phenomenon “the cross-magnification process” (Carlson & Hatfield, 1992) or the “excitation transfer process” (Zillmann, 1984). An array of theorists (Freud, 1953; Reik, 1972), for example, have proposed that it is precisely when people are not at their best—when their self-esteem has been shattered, when they are anxious and afraid, when their lives are turbulent and stressful—that they will be especially vulnerable to falling head-over-heels in love. This makes some sense. After all, infants' early attachments (which motivate them to cling tightly to their mother's side in panic when danger threatens and to go their own way when it all is safe) are thought to be the initial prototype of passionate love (Hatfield, Brinton, & Cornelius, 1989; Hatfield, Schmitz, Cornelius, & Rapson, 1988; Hazen & Shaver, 1987). Several researchers have demonstrated that children and adults are especially prone to seek romantic and sexual ties when they are anxious and/or under stress. In a duo of studies, Hatfield and her Hawaii colleagues (Hatfield, Brinton, & Cornelius, 1989; Hatfield, Schmitz, Cornelius, & Rapson, 1988), for example, found that children and teen-agers who were either momentarily or habitually anxious were especially vulnerable to passionate love. Young people who varied in age from l2 to 16 years of age, and who were of Chinese-, European-, Japanese-, Korean-American, or mixed ancestry, were asked to complete the Child Anxiety Scale (Gillis, 1980) or the State-Trait Anxiety Inventory for Children (Spielberger, Gorsuch, & Lushene, 1970). These scales were designed to measures both state anxiety (how anxious young people happen to feel at the moment) and trait anxiety (how anxious they generally
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are). The authors found that children and adolescents who were high on either trait or state anxiety received the highest scores on the Passionate Love Scale. Donald Dutton and Arthur Aron (1974) also tested the notion that anxiety and fear can deepen desire in a series of ingenious experiments. In one experiment, they compared reactions of men who crossed one of two bridges in North Vancouver. The first bridge (the Capilano Canyon Suspension Bridge) is a five-foot wide, 450-foot-long bridge, composed of wood slats and wire cable, which is suspended 230 feel above dangerous rocks and shallow rapids. As people walked over it, the bridge swayed, wobbled, and tilted in a frightening manner. The second bridge was a solid, safe cement structure. As each young man crossed one of the bridges, a good-looking college woman approached him. She explained that she was doing a class project and asked if he would fill out a questionnaire concerning his attitudes toward conservation. When the man had finished, she offered to explain her project in greater detail. She scribbled her telephone number on a scrap of paper, so he could call her if he wanted more information. Which men called? Nine of the 33 men on the suspension bridge called her; only two of the men on the solid bridge called! In subsequent years, researchers have collected a great deal of experimental and correlational evidence for the intriguing contention that, under the right conditions, a variety of awkward and painful experiences can deepen passion. These include anxiety and fear (Brehm et al., 1978; Dienstbier, 1978; Hatfield & Rapson, 1996; Hoon et al., 1977; Meston & Frohlich, 2003; Riordan & Tedeschi, 1983), embarrassment (Byrne, Przybyla, & Infantino, 1981), the discomfort of seeing others involved in conflict (Dutton, 1979), jealousy (Clanton & Smith, 1987), loneliness (Peplau & Perlman, 1982), anger (Barclay, 1969 and 1971; Driscoll, Davis, & Lipetz, 1972), horror (White et al., 1981), or even grief.
The End of the Affair Fisher (2004) closes her analysis of the brain systems sparking attraction, lust, and attachment by observing that passionate attachments are by their nature time-bound. She contends that in the course of evolution our ancestors came to be genetically programmed to meet, mate, and move on—a strategy designed to create optimal genetic variety in the young. When she examined the data from 58 human societies selected from the Demographic Yearbook of the United Nations, she discovered that in the majority of societies, couples tended to separate and divorce around the fourth year of marriage. Fisher notes that: (1) many socially monogamous species form pair-bonds that last only long enough to rear the young through infancy; and (2) in hunting/gathering societies, it generally takes four years to rear a child. (Children in such societies join in multi-age play groups soon after being weaned, becoming the responsibility of relatives and older siblings.) (3) Thus she hypothesizes that it may be “natural” for young couples to meet, court, marry, reproduce, and remain together only long enough to raise a child. After that period, the chemistry of attraction (the stew of increased dopamine, decreased serotonin, and increased norepinephrine) swings into action and men and women begin to feel ancient tugs of attraction, sexual desire, and finally attachment yet again.
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MAJOR ISSUES In reviewing this literature, two questions stand out: (1) Is love an emotion? (2) How tightly linked are passionate love and sexual desire? We will close with a final question: (3) How useful are cyber-matching sites based on neuroscience models—like Chemistry.com and ScientificMatch.com?
Is Passionate Love an Emotion? Most social psychologists would probably agree that passionate love is an emotion. In a seminal article, Kurt W. Fischer and his colleagues (1990) characterized emotions this way: Emotions are complex functional wholes including appraisals or appreciations, patterned physiological processes, action tendencies, subjective feelings, expressions, and instrumental behaviours (p. 85).
Scholars have interviewed men and women from a variety of cultures and of different ages. They have conducted surveys and experiments, utilized prototype analyses, and taken a social categorical approach to order to determine whether or not love should be classified as a basic emotion, and if so, what people mean by the terms “in love” and “love.” When Shaver and his colleagues (1996 and 1991) reviewed all the evidence, pro and con, they concluded that love is indeed a basic emotion. In cross-cultural research—in languages as different as English, Italian, Basque, and Indonesian—ordinary people are able to identify five distinct emotions: love, joy, anger, sadness, and fear—as prototypic emotions. Generally, passionate love is associated with the terms “arousal,” “desire,” “lust,” “passion,” and “infatuation. Companionate love is associated with “love,” “affection,” “liking,” “attraction,” and “caring” (see Shaver et al., 1987; Shaver, et al., 2001). After discussing the criteria that various theorists have used to classify emotions, they concluded that given these criteria, love (which includes passionate and companionate love) must be classified as an emotion. They observe: . . . a number of controversies over the status of love can be resolved by distinguishing between the momentary surge form of love, a basic emotion having properties similar to joy, sadness, fear, etc., and relational love, a bond that develops between people, associated with states that include not only surge love, but many other emotions such as distress and anxiety (p. 81)
In another set of studies, Beverly Fehr and James Russell (1991) used the techniques of prototype analysis to find out how ordinary people classified emotions. They found that throughout the world, men and women generally assume that happiness, love, anger, fear, sadness, and hate are basic emotions. They also discovered that people tend to draw a sharp distinction between passionate love (i.e., “being in love”) and companionate love (i.e., “loving.) Similar results were secured by Berscheid & Meyers (1996), Fehr (1994), Hatfield
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& Rapson (1993), Regan, 1998; Regan & Berscheid (1999); Regan et al. (1999), among a host of others. Social psychologists, then, generally assume that love (passionate or companionate) is indeed a basic emotion. Yet, some scholars have argued that “being in love” and “loving” are not emotional experiences. They prefer to call love “a plot” or “script” (as in a story you tell yourself), “a sentiment,” “a feeling,” “a disposition,” a “syndrome,” or “a motivational state.” (For a review of these positions, see Shaver, et al., 1996.) Neuroscientists themselves are sharply divided as to whether or not love is an emotion (see Bartels & Zeki, 2000; Birbaumer, et al., 1996; Hatfield & Rapson, 2008) or is not an emotion (see Diamond, 2003 and 2004; Gonzaga, et al., 2006; Reis & Aron, 2008). Only subsequent research can answer this question. In part it seems like a semantic question. If forced to hazard a guess, however, we would argue that in the future, love in all its varieties will be classified as an emotion. When so many scientists and ordinary people classify love as an emotion, insist they feel the “emotion” of love, and behave emotionally when in love, it may be impossible for scientists to produce a paradigm shift.
What is love? . . . [I end by] confessing that, in the case of romantic love, I don’t really know. If forced against a brick wall to face a firing squad who would shoot if not given the correct answr, I would whisper “It’s about 90% sexual desire as yet not sated. —Ellen Berscheid
How Tightly Linked Are Passionate Love and Sexual Desire? Are “passionate love” and “sexual desire” the same thing? Forty years ago, when Ellen Berscheid and I began our research into the nature of love, we weren't certain. Some social commentators insisted that the two were one. In the 18th century French erotic novel Histoire de Dom Bougre, for example, a cynical nun disclosed the true meaning of the expression: “to be in love.” It meant, she said, to be “in lust”: When one says, the Gentleman . . . is in love with the Lady . . . it is the same thing as saying, the Gentleman . . . saw the Lady . . . the sight of her excited his desire, and he is dying to put his Prick into her Cunt. That's truly what it means (as quoted in Ellrich, 1985, p. 222).
Others insisted that the two were very different. In the 18th century, the Marquis de Sade (1797/1968) violently opposed the equation of love and pleasure: I do not want a woman to imagine that I owe her anything because I soil myself on top of her . . . . I have never believed that from the junction of two bodies could arise the junction of two hearts: I can see great reasons for scorn and disgust in this physical junction, but not a single reason for love (p. 148).
In the Victorian era, romantic love was considered to be a delicate, spiritual feeling—the antithesis of crude, animal lust. Freudians, of course, mocked such pretensions. They irritated
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romantics by insisting that chaste love was simply a sublimated form of carnal love, which lay bubbling just below the surface. What about today? In the West, most college students make a sharp distinction between “being in love” (which embodies sexual feelings) and “loving” someone (which is not necessarily associated with sexual desire). Ellen Berscheid and her colleagues (Meyers & Berscheid, 1995) found that most students assumed that although you could “love” someone platonically, you could only be “in love” with someone you were sexually attracted to and desired sexually. They concluded: “Thus, our findings suggest that although sexuality may not be a central feature of love, it is most definitely a central feature of the state of being in love” (p. 24). In a national survey, Andrew Greeley (1991) interviewed newly married couples who said they were still in the “falling in love” stage of marriage. He found that passionate love is a highly sexual state. He described the falling in love stage of marriage this way: When one is in love, one is absorbed, preoccupied, tense and intense, and filled with a sexual longing which permeates the rest of existence, making it both glorious and exhausting . . . Those who are falling in love seem truly to be by love possessed (pp. 122-124).
In the end, Ellen Berscheid and I concluded that passionate love and sexual desire were “kissing cousins.” Passionate love was defined as “a longing for union” while sexual desire was defined as “a longing for sexual union” (Hatfield & Rapson, 1987). Today, this debate seems settled. As Susan and Clyde Hendrick (1987b) noted: It is apparent to us that trying to separate love from sexuality is like trying to separate fraternal twins: they are certainly not identical, but, nevertheless, they are strongly bonded. . . . Love and sexuality are strongly linked to each other and to both the physical and spiritual aspects of the human condition. For romantic personal relationships, sexual love and loving sexuality may well represent intimacy at its best (pp. 282 and 293).
There is abundant social psychological evidence in support of the contention that in most people’s minds, love and sex are tightly related—in fact, most people find it hard to imagine passionate love absent sexual desire (Hatfield & Rapson, 2005; Regan et al., 1999, 2004; Regan & Berscheid, 1999; Ridge & Berscheid, 1989). (Naturally, men and women can easily imagine the converse—sexual desire without passionate love.) As Pamela Regan (2004) observes: Theoretical discourse from a number of disciplines suggest that sexual desire is a distinguishing feature of the passionate love experience . . . Empirical research substantiates this hypothesis. People believe that sexual desire is part and parcel of the state of being in love, assume that couples who desire each other sexually are also passionately in love, and report a similar association when reflecting on their own dating relationships (p. 115).
Of course, culture surely has a powerful impact on how likely young couples are to link passionate love, sexual desire, and sexual expression (Hatfield & Rapson, 2005). Many men, for example, are taught to separate sex and love, while many women are taught to connect the two. The different meanings attributed to sexual activity have been known to cause lovers much distress (Hatfield & Rapson, 2006).
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Neuroscientists and evolutionary psychologists, however, are still in sharp disagreement as to whether love and lust are very different systems (Diamond, 2003 and 2004; Gonzaga, et al., 2006) or are tightly linked (Bartels & Zeki, 2000). These neuroscients do agree, however, that all of the brain systems for passionate love, sexual desire, and attachment do in fact communicate and coordinate with one another. When the dust settles, we suspect neuropsychologists will come to acknowledge that although love and lust may possess a few distinct features, they are tightly linked. It is hard to imagine that two phenomena so linked in the public mind could be such disparate entities. Thus, the contention that love and sexual desire are “kissing cousins” seems to be an appropriate one.
The Commercialization of Love and Sex Research: The BusinessofLove.com. Any time a new form of communication is invented—the penny newspaper, Morse code and the telegraph, the ham-radio, TV, or computers—men and women find ways to use that technology to find love. In the 1950s, for example, almost as soon as computers appeared, commercial matchmaking services sprang up (CBC Archives, 1957). Recognized as the first widespread computer matching service was Operation Match, which was created in the mid 1960s by Harvard students after a discussion of the evils of blind dates and mixers. They distributed thousands of questionnaires to college students at several universities and asked them to rate themselves on looks, intelligence, and other dimensions and also to indicate what they would desire in a partner on these same dimensions. In return for the completed questionnaire and a fee of three dollars, they were promised a list of compatible matches. Data were entered on punch cards and analyzed with an Avco #1790 computer (which was probably the size of a small room). According to media reports, it took the computer six weeks to generate the lists. Not surprisingly, the business failed miserably (for a description of this experiment, see Leonhardt, 2006). Today, while some sites, such as Match.com, are designed for the general population of singles, other sites target special niches of the population. There are those designed to appeal to various age groups (HookUp.com, SilverSingles.com), political groups (ConservativeMatch.com, LiberalHearts.com), religious groups (CatholicSingles.com, ChristianCafe.com, HappyBuddhist.com, Jdate.com), and sexual orientation (GayWired.com, superEva.com). Dating sites also exist for people who possess mental and physical disabilities, unusual sexual preferences, and so forth. Even people who wish to find dates for themselves and their favorite pets can sign on to a site (DateMyPet.com). At the time this chapter was written, there had sprung up almost 1,000 dating websites servicing the U.S. (e.g., Thompson, Zimbardo, & Hutchinson, 2005), and the technology available to create another one in an afternoon. Recently, neuroscientists and biochemists have joined the gold rush. They have set up sites like ScientificMatch.com (people are matched on the basis of DNA) or Chemistry.com, where scientists use indicators (such as finger length) to classify and match up people, among a host of others. What scientific principles are being used to match people on the major relationship websites, such as eHarmony.com and Perfectmatch.com? Or on the “scientific” websites? Do
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people sign up for these services just for fun or do they truly believe that scientists can match them with their ideal Prince Charming or Sleeping Beauty? Almost all of the sites make fantastic claims. ScientificMatch.com, for example, promises:
DNA Matching and the Magic of Chemistry When you share chemistry with someone, you significantly increase your chances of realizing these amazing benefits: 1. You’ll love their natural body fragrance—they’ll smell “sexier” than other people. 2. You’ll have a more satisfying sex life. 3. If you’re a woman, you’ll have a higher rate of orgasms. 4. There will be less cheating in your exclusive relationship. 5. As a couple, you’ll be more fertile. 6. Your children will be healthier. In support of these contentions, the authors cite a slew of articles published in prestigious social psychological, neuroscience, evolutionary psychology, and neurobiochemistry journals. The more popular Chemistry.com asks men and women to answer 56 questions—things like: “Which image most closely matches your right hand?” The assumption is that people possess different levels of dopamine, serotonin, estrogen, and testosterone. The scholars assume that these differences in brain chemistry have a powerful effect on people’s personalities—determining which of four categories they fit: the explorer, the builder, the negotiator, and the director. (The site attempts to tell people what type (or combination of types) they are, based on physical characteristics (i.e., finger length, etc.) For common folk, computer matching sites have the imprimatur of Science (with a capital S). In the scientific community there are mixed reactions to claims such as those made by Science.com. Some argue that no one takes the claims of these sites seriously. People access the sites in fun. Besides, such sites give people that are shy or live in geographical locations or work at jobs that make it difficult to find partners (particularly those who share their values and interests) can access the web to meet dates and mates that might never come their way. They also point out that commercial matching services are still in their infancy. Since social psychologists, neuroscientists, and neurobiologists are working for these sites, in time—given the money that is being lavished on these commercial enterprises—it is reasonable to hope that in the future, the BusinessofLove.com sites will craft more complex versions of relationship science to inform their questionnaire construction, website construction, and matching algorithms. Thus, in time these matching sites will provide increased opportunities for men and women to find dating and marital relationships that are fulfilling. Other scientists cringe, arguing that these sites can’t possibly fulfill their promises of the perfect match. Currently, these matching sites—arguing that they are businesses not scientific enterprises—are reluctant to explain in any detail how they match people and how successful such matches are. Critics point out that only charlatans, crooks, and con men sell “elixirs” that cure nothing. People who join these sites looking for love are being cheated. Worse yet, false claims make
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people who get burned skeptical about the scientific enterprise itself. When people are disappointed—and they are bound to be—they will blame science for their disappointment (see Sprecher, et al, 2008, for a longer discussion of these issues.) Our personal opinion is that an appreciation of science and its methods is a fragile blossom, easily trampled underfoot, and that scientists participating in these commercial enterprises should tread with care. They can potentially inflict serious damage to the whole neuroscientific enterprise when they promise what they cannot deliver. Love may be wonderful or painful because it is no simple matter.
REFERENCES Acevedo, B., Aron A., Xu, X., & Gross, J. (2008) Romantic love: basic emotion or motivation? Unpublished manuscript. Stony Brook: State University of New York at Stony Brook. Appian of Alexandria. (1899). The Syrian wars. The Roman history, Vol. 2. Horace White (Trans.). (pp. 317-320). New York: Macmillan: Loeb Classical Library. Aron, A., Fisher, H. E., Mashek, D. J., Strong, G., Li, H-F, Brown, L. L. (2005). Reward, motivation, and emotion systems associated with early-stage intense romantic love. Journal Neurophysiology, 94, 327-337. Barclay, A. M. (1969). The effect of hostility on physiological and fantasy responses. Journal of Personality, 37, 651-667. Barclay, A. M. (1971). Linking sexual and aggressive motives: Contributions of “irrelevant” arousals. Journal of Personality, 39, 481-492. Bartels, A. & Zeki, S. (November 27, 2000). The neural basis of romantic love. Neuroreport, 11, 3829-3834. Bartels, A. & Zeki, S. (2004). The neural correlates of maternal and romantic love. Neuroimage, 21, 1155-1166. Berscheid, E. & Hatfield, E. (1969). Interpersonal attraction. New York: Addison-Wesley. Berscheid, E., & Meyers, S. A. (1996). A social categorical approach to a question about love. Personal Relationships, 3, 19-43. Birbaumer, N., Lutzenberger, W., Elbert, T., Flor, H., & Rockstroh, B. (1993) Imagery and brain processes. In Niels Birbaumer and Arne Öhman (Eds.) The structure of emotion (pp. 132-134). Göttingen, Germany: Hogrefe & Huber Publishers. Blink, S. (July 30, 2007). This is your brain on love. Los Angeles Times latimes.com. http://www.latimes.com/features/health/la-heattraction30jul30.1.68965446.story?coll=la-headlines-health&ctrack=1&cset. Brehm, J. W., Gatz, M., Goethals, G., McCrimmon, J., & Ward, L. (1978). Psychological arousal and interpersonal attraction. JSAS Catalogue of Selected Documents in Psychology, 8, 63 (ms. #1724). Byrne, D., Przybyla, D. P. J., & Infantino, A. (1981, April). The influence of social threat on subsequent romantic attraction. Paper presented at the meetings of the Eastern Psychological Association, New York.
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Cacioppo, J. T., Berntson, G. G., Lorig, T. S., Norris, C. J., & Nusbaum, H. (2003). Just because you’re imaging the brain doesn’t mean you can stop using your head: A primer and set of first principles. Journal of personality and Social Psychology, 85, 650-661. Carlson, J. G. & Hatfield, E. (1992). Psychology of emotion. New York: Harcourt, Brace, Jovanovich. Carter, C. S., Lederhendler, I. & Kirkpatrick, B. (1999). (Eds.) The integrative neurobiology of affiliation. Cambridge, MA: The MIT Press. CBC Archives. (July 17, 1957). Clip: Computer matchmaker. http://archives.cbc.ca/400i.asp? IDCat=75&IDDos=710&IDCli=4199&IDLan=1&NoCli=3&type=clip. Clanton, G., & Smith, L. G. (Eds.) (1986). Jealousy. Lanham, MA: University Press of America. de Sade, Marquis. (1797/1963). Histoire de Juliette, in Oeuvres complètes du marquis de Sade (Vol. 9). Paris, France: Cercle du Livre Précieux. Diamond, L. M. (2003). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 73-192. Diamond, L. M. (2004). Emerging perspectives on distinctions between romantic love and sexual desire. Current Directions in Psychological Science, 13, 116-119. Dienstbier, R. A. (1978). Emotion-attribution theory: Establishing roots and exploring future perspectives. In H. E. Howe & R. A. Dienstbier (Eds.). Nebraska Symposium on Motivation, Vol. 26, pp. 237-306). Lincoln: University of Nebraska Press. Doherty, R. W., Hatfield, E., Thompson, K., & Choo, P. (1994). Cultural and ethnic influences on love and attachment. Personal Relationships, 1, 391-398. Driscoll, R., Davis, K. E., & Lipetz, M. E. (1972). Parental interference and romantic love: The Romeo & Juliet effect. Journal of Personality and Social Psychology, 24, 1-10. Dutton, D. (1979) The arousal-attraction link in the absence of negative reinforcement. Meetings of the Canadian Psychological Association, Toronto, Canada. Dutton, D., & Aron, A. (1974). Some evidence for heightened sexual attraction under conditions of high anxiety. Journal of Personality and Social Psychology, 30, 510-517. Ellrich, R. J. (1985, May). Modes of discourse and the language of sexual reference in eighteenth-century French fiction. In R. P. Maccubin (Ed.), Unauthorized sexual behavior during the Enlightenment, a special issue of Eighteenth-Century Life, 9, p. 222. Fehr, B. (2001). The status of theory and research on love and commitment. In G. Fletcher & M. Clark (Eds.) Blackwell handbook of social psychology: Interpersonal processes. (pp. 331-356). New York: Wiley. Fehr, B. (1994). Prototype-based assessment of laypeople’s views of love. Personal Relationships, 1, 309-331. Fehr, B., & Russell, J. A. (1991). Concept of love viewed from a prototype perspective. Journal of Personality and Social Psychology, 60, 425-438. Fischer, K. W., Shaver, P. R., & Carnochan, P. (1990). How emotions develop and how they organize development. Cognition and Emotion, 4, 81-127. Fischer, K. W., Wang, L., Kennedy, B., & Cheng, C. (1998). Culture and biology in emotional development. In D. Sharma & K. W. Fischer (Eds.), Socioemotional development across cultures. New Directions for Child Development, 81, 21-43. San Francisco: Jossey-Bass.
540
Elaine Hatfield and Richard L. Rapson
Fisher, H. E. (July 16, 2003.) The brain chemistry of romantic attraction and its positive effect on sexual motivation. Paper presented at the 29th annual meeting of the International Academy of Sex Research. Bloomington, IN. Fisher, H. E. (2004). Why we love: The nature and chemistry of romantic love. New York: Henry Holt. Fisher, H. E. (January 19, 2004). Your brain in love. Time Magazine, p. 77. Fisher, H., Aron, A., & Brown, L. L. (2005). Romantic love: an fMRI study of a neural mechanism for mate choice. The Journal of Comparative Neurology, 493, 58-62. Fisher, H. E., Aron, A., Mashek, D., & Brown, L. L. (2002). Defining the brain systems of lust, romantic attraction, and attachment. Archives of Sexual Behavior, 31, 413-419. Freud, S. (1910/1953). Contributions to the psychology of love: A special type of choice of objects made by men. In E. Jones (Ed.), Sigmund Freud: Collected papers (Vol. 4, pp. 192-202). (Trans. Joan Riviere). New York: Basic Books. Gillis, J. S. (1980). Child anxiety scale. Champaign, IL: Institute for Personality and Ability Testing. Gonzaga, G. C., Turner, R. A., Keltner, D., Campos, B., & Altemus, M. (2006). Romantic love and sexual desire in close relationships, Emotion, 6, 163-179. Graf, K. E., & Elbert, T. (1989) Dimensional analysis of the waking EEG. In E. Basar & T. H. Bullock (Eds.) Brain dynamics, (Vol. 2). (pp. 174-191). Berlin/Heidelberg: SpringerVerlag. Greeley, A. (1991). Faithful attraction: Discovering intimacy, love, and fidelity in American Marriage. New York: St. Martin’s Press. Hatfield, E., & Berscheid, E. (1971). Adrenaline makes the heart grow fonder. Psychology Today, 6, 46-50 and p. 62. Hatfield, E., Brinton, C., & Cornelius, J. (1989). Passionate love and anxiety in young adolescents. Motivation and Emotion, 13, 27l-289. Hatfield, E., & Rapson, R. L. (1987b). Passionate love: New directions in research. Advances in Personal Relationships, 1, 109-139. Hatfield, E., & Rapson, R. L. (1993). Love, sex, and intimacy: Their psychology, biology, and history. New York: HarperCollins. Hatfield, E., & Rapson, R. L. (1996). Stress and passionate love. In C. D. Spielberger & I. G. Sarason (Eds.), Stress and Emotion: Anxiety, Anger, and Curiosity, 16, 29-50. Hatfield, E., & Rapson, R. (2005). Love and sex: Cross-cultural perspectives. Needham Heights, Lanham, MD: University Press of America. Hatfield, E. & Rapson, R. L. (2006). Love and passion. In Irwin Goldstein, C. M. Meston, S. R. Davis, & A. M. Traish (Eds.) Women’s sexual function and dysfunction: Study, diagnosis and treatment, (pp. 93-97). London: Taylor and Francis, UK. Hatfield, E. & Rapson, R. L. (2008). Passionate love and sexual desire: Multidisciplinary perspectives. In J. P. Forgas (Ed.). Personal Relationships: Cognitive, Affective, and Motivational Processes. The Sydney Symposium of Social Psychology (pp. 21-38). New York: Psychology Press. Hatfield, E., Schmitz, E., Cornelius, J., & Rapson, R. L. (1988). Passionate love: How early does it begin? Journal of Psychology and Human Sexuality, 1, 35-52. Hatfield, E., & Sprecher, S. (1986). Measuring passionate love in intimate relations. Journal of Adolescence, 9, 383-410.
The Neuropsychology of Passionate Love
541
Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. Hendrick, S. S., & Hendrick, C. (1987a). Love and sex attitudes: A close relationship. In W. H. Jones & D. Perlman (Eds.), Advances in personal relationships, 1, (pp. 141-169). Greenwich, CT: JAI. Hendrick, S. S., & Hendrick, C. (1987b). Love and sexual attitudes, self-disclosure, and sensation-seeking. Journal of Social and Personal Relationships, 4, 281-297. Hoon, P. W., Wincze, J. P., & Hoon, E. F. (1977). A test of reciprocal inhibition: Are anxiety and sexual arousal in women mutually inhibitory? Journal of Abnormal Psychology, 86, 65-74. Hunt, C. (2000-2001). Concoctions, potions, poisons . . . San Francisco Opera Performing Arts Magazine, pp. 17-46. Hyde, J. S. (Ed.) (2005). Biological substrates of human sexuality. Washington, D. C.: American Psychological Association. Kaplan, H. S. (1979). Disorders of sexual desire. New York: Simon & Schuster. Kauth, M. R.. (Ed.) (2007). Handbook of the evolution of human sexuality. Binghampton, NY: The Hayworth Press. Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia: Saunders. Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, P. H. (1953). Sexual behavior in the human female. Philadelphia: Saunders. Landis, D. & O’Shea, W. A. O. III, (2000). Cross-cultural aspects of passionate love; An individual difference analysis. Journal of Cross-Cultural Psychology, 31, 754-779. Leonhardt, D. (March 28, 2006). The famous founder of operation match. The New York Times. Retrieved December 22, 2007 from www.nytimes.com/2006/03/28/business /29leonside.html Liebowitz, M. R. (1983). The chemistry of love. Boston: Little, Brown, and Co. Marazziti, D. (2005). The neurobiology of love. Current Psychiatry Reviews, 1, 331-335. Marazziti, D., Akiskal, H. S., Rossi, A., & Cassano, G. B. (1999). Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine, 29 (3), 741-745. Marazziti, D. & Canale, D. (2004). Hormonal changes when falling in love. Psychoneuroendrocrinology, 29 (7) 931-936. Marazziti, D., Di Nasso, E., Masala, I., Baroni, S., Abelli, M. Mengali, F., Mungal, F., & Rucci, P. (2003). Normal and obsessional jealousy: a study of a population of young adults. European Psychology, 18, 106-111. Masters, W. H., & Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown. Meston, C. M. & Frohlich, P. F. (2003). Love at first fright: Partner salience moderates rollercoaster-iduced excitation transfer. Archives of Sexual Behavior, 32, 537-544. Mesulam, M.-M., & Perry, J. (1972). The diagnosis of love-sickness: Experimental psychophysiology without the polygraph. Psychophysiology, 9, 546-551. Meyers, S., & Berscheid, E. (1997). The language of love: What a difference a preposition makes. Personality and Social Psychology Bulletin, 23, 347-362. Movshon, J. A. (February 5, 2006). Searching for the person in the brain. The New York Times. Week in Review. P. 1-4.
542
Elaine Hatfield and Richard L. Rapson
Najib, A., Loberbaum, J. P., Kose, S., Bohning, D. E., & George, M. S. Regional brain activity in women grieving a romantic relationship breakup. American Journal of Psychiatry, 161, 2245-2256. Panksepp, J. (2007). Neurologizing the psychology of affects: How appraisal-based constructivism and basic emotion theory can coexist. Perspectives on Psychological Science, 2, 281-312. Peplau, L. A., & Perlman, D. (1982). Loneliness. New York: Wiley-Interscience. Plutarch. Demetrius. (1920). In Plutarch’s Lives, B. Perrin (Trans.). (pp. 93-97). Cambridge, MA: The Loeb Classical Library. Vol. 9. cap. Xxxviii. Regan, P. C. (1998). Of lust and love: Beliefs about the role of sexual desire in romantic relationships. Personal Relationships, 5, 139-157. Regan, P. C. (1999). Hormonal correlates and cases of sexual desire: A review. The Canadian Journa of Human Sexuality, 8, 1-16. Regan, P. C. (2004). Sex and the attraction process: Lessons from science (and Shakespeare) on lust, love, chastity, and fidelity. In J. H. Harvey, A. Wenzel, & S. Sprecher (Eds.) The handbook of sexuality in close relationships. (pp. 115-133). Mahwah, NJ: Lawrence Erlbaum. Regan, P. C. & Berscheid, E. (1999). Lust: what we know about human sexual desire. London: Sage. Regan, P. C., Kocan, E. R. & Whitlock, T. (1999). Ain’t love grand! A prototype analysis of the concept of romantic love. Journal of Social and Personal Relationships, 15, 411-420. Reik, T. (1972). A psychologist looks at love. New York: Holt, Rinehart & Winston. Reis, H. T. & Aron, A. (2008). Love: What is it, why does it matter, and how does it operate? Psychological Science, 3, 79-86. Ridge, R. D. & Berscheid, E. (May, 1989). On loving and being in love: A necessary distinction. Paper presented at the annual convention of the Midwestern Psychological Association, Chicago, IL. Riordan, C. A., & Tedeschi, J. T. (1983) Attraction in aversive environments: Some evidence for classical conditioning and negative reinforcement. Journal of Personality and Social Psychology, 44, 683-692. Ruan, F. F. (1991). Sex in China: Studies in sexology in Chinese culture. New York: Plenum. Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological determinants of emotional state. Psychological Review, 69, 379-399. Shaver, P. R., Morgan, H. J., & Wu, S. (1996). Is love a “basic” emotion? Personal Relationships, 3, 81-96. Shaver, P. R., Murdaya, U., & Fraley, R. C. (2001). Structure of the Indonesian emotion lexicon. Journal of Social Psychology, 4, 201-224. Shaver, P., Schwartz, J., Kirson, D., & O’Connor, C. (1987). Emotion knowledge: Further exploration of a prototype approach. Journal of Personality and Social Psychology, 52, 1061-1087. Shaver, P. R., Wu, S., & Schwartz, J. C. (1991). Cross-cultural similarities and differences in emotion and its representation: A prototype approach. In M. S. Clark (Ed.), Review of Personality and Social Psychology, (Vol.13) (pp. 175-212). Newbury Park, CA: Sage. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). STAI manual for the State-Trait Inventory. Palo Alto, CA: Consulting Psychologist Press.
The Neuropsychology of Passionate Love
543
Sprecher, S., Schwartz, P., Harvey, J., & Hatfield, E. (2008). The businessoflove.com: Relationship initiation at Internet matchmaking services. In S. Sprecher, A. Wenzel, & J. Harvey (Eds.), The Handbook of Relationship Initiation pp. 249-265). New York: Erlbaum. Thompson, M., Zimbardo, P., & Hutchinson, G. (April 29, 2005). Consumers are having second thoughts about online dating. Unpublished report from weAttract.com, Inc. Trawick, M. (1990). Notes on love in a Tamil family. Berkeley, CA: University of California Press. Tucker, N. (February 13, 2007). An affair of the head. The Washington Post. (p. C1.) Wargo, E. (2005). With the brain, is seeing believing? American Psychological Society, 18, p. 33. White, G. L., Fishbein, S., & Rutstein, J. (1981). Passionate love and the misattribution of arousal. Journal of Personality and Social Psychology, 41, 56-62. Zillman, D. (1984). Connections between sex and aggression. Hillsdale, NJ: Lawrence Erlbaum Associates.
INDEX A aberrant, 327 abnormalities, 118, 120, 121, 127 abstinence, 128, 444 academic, 9, 21, 97, 144, 341, 346, 349, 350, 351, 353, 355, 358, 360, 466 academic difficulties, 350, 355 academic performance, 9 Academic Search Premier, 440 academic settings, 97 academic success, 351, 353, 355, 358 access, 9, 39, 331, 347, 476, 537 accessibility, 55, 58, 62, 94, 95, 106, 108 accidental, 334 accidental injury, 334 accidents, 323, 332 accommodation, 16, 17, 23, 28, 29, 31 accounting, xv, 163, 245, 250 acculturation, 276 accuracy, xiii, 11, 14, 19, 32, 35, 41, 46, 47, 48, 49, 50, 51, 52, 53, 54, 60, 61, 62, 64, 191, 195, 196, 202, 204, 205, 206, 299 acetate, 227 acetylation, 112 achievement, 25, 97, 355 acid, 112, 216 Acquired Immune Deficiency Syndrome, 438 ACTH, 113 activation, xxii, 9, 10, 56, 60, 94, 116, 118, 119, 120, 218, 222, 227, 322, 373, 374, 379, 406, 412, 451, 519 acupuncture, 90 acute, 81, 106, 113, 118, 120, 216, 218, 341, 350, 406, 416, 458, 503 acute leukemia, 458 acute stress, 81, 113, 406, 416 Adams, 132, 133, 134, 142, 145, 146, 458
adaptability, 356 adaptation, xxii, 120, 300, 340, 341, 342, 344, 353, 355, 357, 359, 360, 451, 484, 515 adaptive functioning, 335, 342 addiction, xvii, 128, 319, 320, 348, 378, 528 adenosine, 221 adipocytes, 114 adjustment, ix, x, xii, xiii, xvi, xix, 23, 32, 39, 45, 59, 60, 77, 78, 144, 145, 148, 149, 150, 169, 170, 173, 174, 175, 176, 187, 202, 203, 206, 245, 255, 281, 282, 299, 304, 305, 307, 310, 311, 312, 315, 316, 327, 335, 336, 344, 353, 357, 358, 359, 360, 361, 362, 381, 384, 415, 453, 455 administration, 113, 115, 116, 117, 119, 120, 123, 124, 128, 373, 376, 482, 528 administrators, 20, 351 adolescence, xvi, xvii, xxii, 33, 132, 133, 141, 142, 143, 144, 145, 146, 147, 208, 210, 211, 255, 281, 282, 283, 284, 287, 288, 297, 298, 299, 300, 301, 313, 324, 326, 359, 385, 395, 434, 438, 451, 488, 489 adolescent behavior, 440 adolescent boys, 368, 419 adolescent patients, xxii, 451, 453 adrenocorticotropic hormone, 113, 122 adult, ix, xii, xvi, xix, 8, 59, 60, 61, 63, 72, 92, 96, 97, 102, 106, 107, 108, 115, 116, 121, 124, 131, 133, 141, 142, 143, 144, 146, 169, 186, 194, 196, 199, 204, 207, 222, 227, 256, 267, 268, 281, 283, 300, 308, 326, 336, 337, 338, 355, 369, 370, 372, 374, 375, 376, 377, 378, 379, 403, 414, 418, 454, 455, 456, 457, 458, 473, 481, 487, 516 adult population, 355 adulthood, xii, xiii, xvi, 40, 46, 61, 62, 63, 64, 105, 106, 107, 108, 115, 131, 132, 133, 141, 142, 143, 144, 146, 169, 186, 191, 193, 207, 210, 281, 287, 288, 289, 290, 294, 297, 359, 371, 372, 455, 489, 490, 491
546
Index
adults, xii, xiii, xix, 37, 42, 76, 95, 102, 115, 119, 131, 133, 134, 135, 141, 142, 143, 144, 146, 191, 260, 327, 333, 369, 372, 383, 386, 406, 434, 442, 446, 454, 455, 456, 476, 491, 497, 531 advertising, 197, 524 advocacy, 351, 353, 356, 358, 452 aerobic, 223 AFC, 158, 160, 164, 181 affective dimension, 269 affective disorder, 332, 334, 335, 336, 377 affective experience, 479 affective reactions, 8 affective states, 13, 14 affiliates, 253 African American, 167, 184, 255, 307, 340, 345, 347, 349, 354, 355, 356, 362, 363 African Americans, 340, 349, 354, 356, 363 African-American, 476 afternoon, 268, 269, 288, 290, 536 Ag, 79 AGFI, 501, 504, 505, 507 aggregation, 289 aggression, xiv, 73, 83, 117, 168, 185, 192, 208, 213, 215, 217, 255, 282, 299, 303, 325, 327, 386, 516, 530 aggressive behavior, 78, 109, 215, 346 aggressiveness, 370 aging, 33, 40, 128, 372, 407, 414 agonist, 216 agoraphobia, xi, 65, 77, 78, 79, 80, 82, 84, 239, 241 agrarian, 261 agreeableness, 192 agricultural, 262 agriculture, 89, 261, 264 aid, 400 AIDS, xxi, 420, 435, 437, 438, 439, 440, 442, 443, 444, 445, 446, 447, 448, 450 air, 220, 225, 227, 386 alcohol, x, 2, 70, 120, 150, 249, 429, 433, 442, 473, 529 alcohol abuse, 150 alcohol consumption, x, 2 alcohol dependence, 70 alcohol use, 249, 433 alcoholics, 120, 128, 208, 236, 244 alcoholism, 230, 235, 238, 243, 338 alexithymia, 490 alienation, xvi, 69, 281, 287, 290, 294, 295, 296, 298 ALL, 502 Allah, 421 alpha, xxiii, 198, 289, 493, 497, 499 alternative, 20, 254, 298, 306, 385, 464 alternatives, 57, 352
alters, 305, 376 altruism, 11, 13, 21, 387 altruistic behavior, 20, 383 Alzheimer, 414 ambiguity, 101, 116 ambivalence, xx, 98, 400, 404, 406, 407, 408, 410, 411, 412, 414, 495 ambivalent, xx, 92, 102, 151, 175, 400, 404, 405, 406, 407, 408, 409, 410, 411, 412, 414 American Indian, 261 American Psychiatric Association, 77, 126, 169, 186, 234 American Psychological Association, 29, 30, 31, 32, 34, 211, 280, 315, 355, 490, 541 amino, 112, 122, 216, 371 amino acid, 112, 122, 216, 371 amnesia, 373, 379 amnion, 113 amphetamine, 529 amygdala, 114, 116, 119, 124, 126, 215, 221, 222, 226, 374, 378, 524, 526 analgesic, 348, 349 analog, 31, 125 analysis of variance, 139, 232, 392 analytic techniques, xv, 245, 247 analytical techniques, 342 androgen, 222 androgens, 114, 121, 525 anemia, 340, 360, 361 anger, 58, 104, 162, 267, 272, 303, 304, 314, 343, 344, 349, 452, 487, 494, 497, 510, 512, 514, 516, 521, 524, 526, 528, 530, 532, 533 angiotensin, 120, 128 angiotensin converting enzyme, 128 animal models, xii, 111, 114, 129 animal studies, 374 animal welfare, 96, 103 animals, ix, xiv, xviii, 88, 89, 90, 91, 92, 93, 94, 95, 96, 99, 100, 101, 102, 103, 105, 107, 108, 109, 114, 115, 119, 121, 219, 220, 223, 224, 369, 370, 387, 394 anorexia, 120, 127, 128 anorexia nervosa, 127, 128 ANOVA, 232 ANS, 530 antagonism, 127 antagonists, xii, 111, 114, 115, 116, 216, 373 anterior cingulate cortex, 9, 374 anthropology, 283, 494, 495 anticoagulant, 240 antidepressants, 82, 377 antisocial, 205, 256, 299, 484, 368 antisocial behavior, 205, 256, 299
547
Index antisocial personality, 484 antisocial personality disorder, 484 antithesis, 534 anxiety disorder, ix, xi, 65, 66, 70, 71, 72, 74, 75, 77, 78, 79, 80, 81, 82, 83, 84, 102, 119, 125, 239, 325, 333 anxiolytic, 118, 119, 127 APA, 168, 185, 232 appetite, 118, 520 application, 14, 93, 222, 223, 225, 247, 249, 332, 473 appraisals, 304, 342, 519, 533 aquatic, 221 arginine, 125 argument, 133, 141, 142, 143, 155, 192, 306, 322, 329, 495 arithmetic, 100 arousal, 10, 17, 18, 23, 117, 120, 225, 306, 322, 374, 510, 524, 526, 533, 538, 539, 541, 543 artery, 218 arthritis, 362 artificial, 103 aspartate, 377 assertiveness, 13, 263, 271, 273 assessment, xii, xiii, 146, 148, 149, 150, 152, 154, 158, 161, 166, 167, 168, 170, 171, 173, 174, 175, 176, 177, 183, 184, 185, 187, 188, 189, 243, 244, 254, 255, 276, 308, 316, 322, 329, 335, 336, 357, 407, 410, 453, 488, 491, 516, 539 assessment techniques, 276 assessment tools, 176, 357 assignment, 9, 393, 462 associations, xiii, xxi, 12, 19, 37, 43, 44, 70, 129, 134, 138, 142, 143, 144, 146, 155, 157, 161, 162, 163, 180, 182, 191, 255, 297, 324, 375, 402, 409, 410, 421, 438, 441, 445, 446, 486 assumptions, 12, 13, 101, 251, 357, 476, 479 asthma, xviii, 322, 335, 336, 337, 339 atherosclerosis, 218 atmosphere, 269, 423, 454, 472 attachment theory, xi, xxii, 42, 59, 87, 92, 93, 97, 102, 103, 104, 370, 471, 472, 481, 483, 487, 488, 489, 490 attention, xii, xiii, xvii, xix, 5, 12, 28, 36, 51, 54, 69, 101, 148, 149, 150, 154, 166, 173, 174, 175, 177, 183, 192, 217, 220, 223, 230, 238, 246, 261, 266, 268, 273, 292, 298, 313, 320, 325, 327, 331, 339, 344, 349, 350, 351, 352, 370, 372, 373, 383, 425, 453, 466, 467, 477, 512, 525, 526 attentional bias, 69 attitudes, xxi, xxiii, 17, 21, 55, 78, 83, 193, 194, 195, 206, 211, 246, 265, 272, 332, 334, 345, 350, 413,
421, 423, 434, 435, 437, 439, 442, 444, 445, 446, 447, 453, 456, 472, 532, 540 attractiveness, 21, 167, 184, 222, 224, 225, 227, 346, 393 attribution, 19, 496, 509, 514, 515, 517, 539 attribution theory, 539 atypical, 322, 340 audio, 155, 157, 180 authoritarianism, 472 authority, 262, 272, 476 autism, 120, 121, 129, 217 autonomic, 104, 113, 116, 119, 122, 222, 225, 323, 522 autonomic nervous system, 222, 225, 323, 522 autonomous, 11, 260, 261, 263, 272, 290, 343, 467, 494 autonomy, xvi, 11, 12, 263, 271, 272, 273, 275, 281, 287, 290, 294, 295, 296, 298, 328, 341, 466 autoradiography, 379 autosomal recessive, 340 availability, 28, 42, 218, 343, 386, 402, 473, 474, 475, 477, 481 averaging, 157 aversion, 327, 406, 410 avoidance, xi, xxiii, xxiv, 33, 63, 69, 75, 87, 93, 94, 97, 98, 99, 117, 119, 230, 231, 309, 371, 400, 405, 493, 494, 497, 498, 500, 502, 504, 505, 507, 509, 511, 512, 513, 514 avoidance behavior, 119, 231 avoidant, 44, 92, 93, 95, 96, 97, 98, 99, 102, 161, 162, 165, 182, 192, 198, 199, 482, 495 awareness, 11, 14, 69, 224, 261, 353, 362, 383, 453, 454, 477, 495 axons, 112, 113, 221, 526
B babies, 103, 269 bacteria, 223 bacterial, 465 bad day, 153, 178 bananas, 262 banking, 261 barbiturates, 529 barrier, xxii, 347, 432, 451 barriers, 329, 331, 347, 349, 357, 358, 409, 421, 427, 433, 454, 456 basal ganglia, 113, 126 basic research, 151, 176 battery, xv, 167, 184, 237, 239 BDNF, 372, 374, 377, 378 beef, 262 behavior modification, 171, 189
548
Index
behavior therapy, xi, 65, 78 behavioral aspects, 370 behavioral change, 222, 251, 252, 254, 434 behavioral difficulties, 452, 454 behavioral dysregulation, 309, 311 behavioral modification, 117, 371 behavioral problems, xvii, 319, 320, 325, 328, 331 behaviours, xii, 111, 114, 115, 121, 223, 267, 337, 533 belief systems, 260, 278, 279, 350 beliefs, xv, 17, 33, 41, 42, 43, 45, 60, 134, 143, 195, 211, 259, 260, 261, 262, 263, 265, 271, 272, 273, 274, 275, 276, 277, 278, 279, 284, 342, 348, 350, 357, 401, 421, 423, 424, 427, 435, 439, 443, 445, 446 belongingness, 88 benchmark, 47, 50 beneficial effect, xx, 115, 399, 404 benefits, xx, 62, 88, 100, 101, 102, 103, 105, 106, 192, 305, 307, 312, 386, 399, 400, 401, 402, 403, 404, 406, 412, 414, 537 benevolence, 200, 201, 202, 203, 474 benign, 13 benzodiazepines, 67, 232 bereavement, 95, 105, 107, 109 best practice, vii, 339 beta, xxiii, 113, 128, 493, 497, 499 bias, 35, 46, 47, 48, 49, 50, 51, 52, 53, 54, 60, 61, 69, 78, 82, 135, 169, 186, 233, 332, 405, 433 bilateral, 374 bilingual, 265, 500 binding, xv, 113, 215, 216, 220, 221, 237, 238, 239, 240, 241, 243, 379, 531 biochemical, 114 biogenesis, 122 biological, 119, 192, 206, 242, 269, 370, 387, 444, 481, 529, 530 biological processes, 529 biological rhythms, 269 biologically, 89, 112, 220, 224, 226, 382 biology, 124, 231, 238, 387, 539, 540 biomedical, 341, 359 bipolar, 222, 223, 239, 243, 334 bipolar disorder, 70, 239 birth, xviii, 82, 114, 115, 123, 221, 270, 322, 324, 329, 369, 370, 371, 372, 377, 425, 426, 428, 432, 473, 481, 490 birth control, 425, 426, 428, 432 birth weight, 324 births, 333 blame, 3, 4, 8, 178, 310, 311, 312, 510, 512, 537 blaming, 403, 498 bleeding, 347
blind spot, 463 blood, xiii, 100, 102, 112, 114, 115, 121, 213, 214, 216, 240, 241, 262, 340, 406, 407, 410, 411, 414, 415, 455, 524, 525, 531 blood flow, 340, 524, 525 blood group, 455 blood pressure, 100, 102, 406, 407, 410, 411, 414, 415 blood vessels, 340 body image, 433 bonding, ix, xii, xvii, xviii, 93, 111, 114, 116, 121, 123, 129, 238, 319, 320, 321, 324, 330, 346, 365, 369, 373, 375, 377, 378, 531 bonds, 81, 92, 94, 95, 102, 103, 104, 112, 114, 115, 116, 117, 205, 262, 370, 373, 386, 487, 488, 532 bone, 347, 360, 528 bone marrow, 347, 360 bone marrow transplant, 347, 360 borderline, 473, 475, 483, 484, 487, 489 borderline personality disorder, 473, 475, 483, 484 boys, xvi, xxi, 133, 208, 264, 281, 282, 283, 284, 287, 288, 291, 292, 297, 324, 346, 366, 388, 391, 417, 418, 419, 421, 422, 423, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 443, 444, 476 bradykinin, 120 brain, xiv, 9, 10, 113, 115, 116, 119, 120, 122, 123, 124, 213, 214, 215, 216, 217, 218, 222, 223, 226, 227, 231, 238, 322, 333, 340, 370, 371, 372, 373, 374, 375, 377, 378, 523, 524, 525, 526, 527, 529, 530, 532, 536, 537, 538, 539, 540, 541, 543 brain activity, 10, 322, 524, 525, 527, 541 brain chemistry, 529, 537, 539 brain damage, 340 brain development, 372, 375 brain growth, 115 brain stem, 113 brain structure, 215 brainstem, 215 BrdU, 374, 378 breakdown, 307, 314, 529 breast, 33, 113, 115, 123, 371 breast cancer, 33 breast feeding, 123 breastfeeding, 262, 263, 268, 269, 272, 277, 324 breathing, 530 breeding, 116 brick, 534 bronchitis, 503 Bronfenbrenner, 353, 359, 440, 446 brothers, 428, 430, 431 buffer, 61, 99, 100, 240, 331, 343, 401, 414 building blocks, 484 buildings, 223
Index bulimia, 120, 128 bulimia nervosa, 120 bullies, 366, 367, 368 bullying, xviii, 106, 207, 365, 366, 367, 368 business, 536, 541
C Ca2+, 113 campaigns, 262, 418 cancer, x, xviii, xxii, 2, 3, 4, 8, 9, 10, 12, 13, 14, 20, 21, 23, 25, 26, 28, 29, 31, 32, 33, 339, 360, 361, 403, 412, 413, 451, 452, 454, 455, 456, 457, 458, 459, 502 candidates, 115, 420 cannabis, 529 capacity, 5, 14, 16, 132, 137, 141, 145, 240, 366, 385, 386, 395, 444 capital, 264, 422, 537 cardiac activity, 105 cardiac arrhythmia, 106 cardiac risk, 403 cardiac risk factors, 403 cardiovascular, 100, 125, 336, 403, 406, 407, 408, 410, 412, 414, 416 cardiovascular function, 406, 407, 408, 410, 412, 414 cardiovascular risk, 412 cardiovascular system, 408 caregiver, xii, xxii, 32, 92, 94, 95, 111, 114, 121, 343, 358, 370, 471, 472, 473, 474, 475, 477, 478, 479, 480, 481, 483, 484, 485, 486, 488 caregivers, xxii, 40, 92, 96, 97, 265, 342, 343, 353, 354, 360, 361, 371, 414, 457, 461, 462, 464, 466, 474, 478, 481, 482, 483, 485, 486 caregiving, xi, xxiii, 87, 92, 95, 96, 100, 105, 107, 260, 266, 268, 269, 272, 472, 481, 482, 484, 485, 486, 487 caretaker, 488 cartilage, 221 case study, 214, 463 cash crops, 262 casting, 483 catalyst, 348 catalysts, 101 categorization, 425 category a, 136, 288 category d, 92 catheter, 465 cathexis, 496, 513 Catholic, 191, 195, 197, 199, 261, 262, 264 Catholic Church, 197, 262 cats, 88, 89, 90, 91, 93, 98, 99, 100
549
cattle, 89 Caucasian, 121, 129, 156, 167, 180, 184, 280, 307, 353 causal relationship, xiv, xxiii, 213, 216, 493, 504, 505, 512 causality, 57, 261 cbc, 539 CBS, 435 CBT, xi, 65, 67, 68, 74, 75, 76, 356, 357, 359 cell, xviii, 113, 221, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 358, 360, 361, 362, 371, 372 census, 156, 171, 189 Census Bureau, 171, 189 Centers for Disease Control, 356, 359 central nervous system, 221, 372 cerebellum, 215 cerebral blood flow, 223 cerebrospinal fluid, 118, 122, 127, 129, 216 cerebrovascular, 340 cerebrovascular accident, 340 certainty, 231, 234, 238, 386, 439 certificate, 419 CFA, 37 CFI, 83 c-fos, 373 channels, 432, 478 chaos, 523 cheating, 537 check-ups, 350 chemical, xiv, 219, 220, 221, 227, 526, 529, 530, 531 chemicals, 224, 525, 526, 529, 530 chemistry, 526, 529, 530, 532, 537, 539, 541 chemotherapy, 12, 13, 21, 28, 453 Chi square, 391 chicken, 503 chicken pox, 503 chicks, 371, 426, 427 Child Behavior Checklist (CBCL), 309, 314 child development, 261, 265, 315, 316, 334, 371 child rearing, 345, 475 childbirth, 126, 265, 321 childcare, xvi, 153, 178, 260, 262, 265, 269, 271, 272, 321, 330, 366 childhood, xviii, 32, 62, 66, 77, 99, 171, 188, 255, 263, 282, 284, 299, 300, 324, 327, 335, 336, 340, 359, 360, 365, 367, 383, 384, 385, 388, 395, 396, 455, 456, 457, 458, 459, 475, 476, 478, 482, 483, 486, 487, 488, 490, 514 childrearing, xv, 238, 259, 260, 261, 262, 263, 265, 271, 272, 273, 275 Chinese, 121, 129, 522, 531, 542 Chi-square, 502
550
Index
Christianity, 418 chronic, xviii, 56, 58, 66, 97, 120, 126, 322, 323, 330, 336, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 351, 352, 353, 355, 356, 357, 358, 359, 362, 462 chronic disease, 347, 355, 357, 359, 462 chronic illness, xviii, 336, 339, 341, 342, 343, 344, 345, 346, 347, 349, 351, 352, 353, 355, 356, 357, 358, 359 chronic pain, 347, 348 chronic stress, 322 chronically ill, 341, 343, 360, 361, 463 chrysanthemum, 514 CIA, 261, 262, 277 cigarettes, 3, 426 cingulated, 524 circadian, 240 circulation, 340 citalopram, 377 classes, 22, 91, 135, 349, 503 classical, 41, 42, 472, 482, 522, 542 classical conditioning, 542 classification, 114, 146, 155, 179, 220, 261, 273, 292, 298, 407, 411, 482, 490 classified, 67, 139, 142, 248, 249, 297, 329, 390, 391, 392, 408, 409, 478, 533, 534 classroom, 7, 23, 253, 325, 326, 345, 346, 388, 393 classroom environment, 7 cleavage, 112 cleavages, 119 clinical, xiii, xvi, xxii, xxiv, 57, 59, 67, 76, 82, 102, 123, 128, 149, 152, 153, 163, 166, 173, 174, 175, 176, 177, 182, 183, 239, 242, 260, 315, 321, 325, 331, 337, 354, 379, 397, 403, 448, 451, 459, 471, 474, 476, 480, 486, 491, 494, 522 clinical depression, 331 clinical disorders, 325 clinical judgment, 239 clinical psychology, 57, 153, 177 clinical trial, 76, 448 clinically significant, 239, 242, 345 clinicians, 151, 152, 163, 176, 177, 182, 230, 238, 275, 321, 331, 344 close relationships, xv, xx, 35, 42, 58, 59, 61, 62, 63, 64, 87, 103, 105, 106, 107, 108, 150, 152, 153, 155, 168, 176, 177, 185, 192, 193, 245, 250, 255, 256, 272, 279, 399, 403, 415, 540, 542 closure, 97, 108, 251 clothing, 269 clouds, 292 clusters, 79 CNS, 126, 379 cocaine, 120, 128, 379, 524, 526, 529
codes, 156, 157, 160, 164 coding, 149, 152, 158, 163, 165, 171, 174, 176, 188, 266, 276, 290, 434, 486 coffee, 262, 291 cognition, xii, 30, 55, 62, 89, 94, 111, 121, 129, 279, 324, 447 cognitive behavioral therapy, 78, 356 cognitive capacities, 313 cognitive deficit, 320, 322, 324, 373, 393, 455 cognitive deficits, 320, 322, 324, 373, 455 cognitive development, 313, 324, 332, 334, 336, 384, 394 cognitive dissonance, 151, 153, 154, 176, 178, 179 cognitive dysfunction, 120 cognitive function, xix, xxii, 118, 324, 370, 451 cognitive impairment, 118, 324 cognitive performance, 279, 324, 396 cognitive perspective, 7, 41, 170, 187 cognitive process, 220, 315, 335, 386, 411 cognitive reaction, 307, 308 cognitive therapy, 63, 74, 75, 77, 79 coherence, 208, 283, 284, 286, 287, 290, 292, 297, 298 cohesion, 7, 73 cohort, 82, 334, 336, 458 coke, 2, 18, 20, 30 collaboration, 387, 450, 482, 486 collectivism, 260, 271, 274, 278, 279, 280 college students, 39, 107, 137, 146, 448, 497, 535, 536 colors, 217, 324, 380 combat, 12, 13, 19, 20, 25, 78, 79, 124 combined effect, 314 commerce, 261 commercial, 257, 421, 536, 537 commodities, 476 communication competence, 22, 33 communication skills, 31, 34, 308, 312, 314, 396, 454 communication strategies, 2, 151, 175 communities, 109, 156, 180, 260, 261, 263, 272, 274, 314, 356 community, 82, 108, 168, 186, 192, 235, 244, 261, 285, 289, 307, 315, 333, 335, 336, 338, 353, 356, 400, 409, 412, 430 community psychology, 412 community-based, 108, 356 comorbidity, 84 companionate love, 525, 533 comparative research, 266 compassion, 16, 345 compensation, 307
Index competence, x, xv, 1, 22, 23, 34, 43, 109, 153, 179, 259, 261, 263, 264, 271, 272, 275, 282, 299, 333, 344, 345, 346, 360, 361, 383, 385 competency, 30, 345 competition, xix, 381, 384, 387, 388, 393, 394, 395, 397 competitiveness, 476 compilation, 155 complementarity, 61 complementary, 92, 222, 255, 384, 472, 483 complex interactions, 353, 466 complexity, 5, 33, 61, 154, 178, 248, 353, 383, 484, 485, 523 compliance, 303, 328, 350, 354 complications, 286, 340, 341, 347, 349, 455 components, xi, 2, 7, 9, 14, 15, 16, 17, 18, 35, 36, 41, 44, 45, 46, 53, 55, 67, 68, 105, 112, 158, 223, 285, 304, 307, 309, 313, 347, 446, 472, 474, 482 composite, 17, 37, 46 composition, 107, 288 compositions, 288, 290, 296 compounds, xiv, 219, 220, 223, 225, 525 comprehension, 324 compulsive behavior, 126, 528 computer, xv, 240, 243, 245, 251, 536, 537 computer simulations, xv, 245, 251 computing, 40, 195, 200, 201 concentrates, 462 concentration, 208, 222, 372 conceptualization, 14, 36, 37, 42, 44, 45, 46, 54, 58, 133, 141, 154, 178, 194, 404, 410, 411, 479 conceptualizations, 41, 402, 410, 479 conditioned response, 119 conditioning, 373 condom, xxi, 417, 418, 420, 421, 424, 425, 427, 428, 429, 430, 431, 432, 433, 434, 435, 443, 444, 445, 446, 447, 448, 449, 450 condoms, xxi, 417, 418, 421, 424, 426, 427, 428, 429, 430, 432, 433, 438, 443, 444, 445, 449 conduct disorder, 257, 325 conductance, 227 confidence, 43, 91, 92, 102, 153, 178, 310, 343, 346, 365, 386, 428, 432, 444, 452, 521 confidence interval, 310 confidence intervals, 310 confirmatory factor analysis, 37 conflict, xii, xiii, xvii, xx, xxii, xxiii, 10, 21, 23, 25, 26, 39, 40, 44, 52, 68, 77, 80, 149, 150, 151, 152, 153, 154, 155, 158, 162, 165, 167, 170, 173, 174, 175, 176, 177, 178, 181, 185, 188, 209, 255, 303, 304, 305, 306, 307, 308, 309, 310, 311, 312, 313, 314, 315, 316, 317, 328, 343, 350, 362, 383, 394,
551
396, 400, 403, 412, 415, 461, 467, 472, 496, 503, 532 conflict resolution, 25, 26, 153, 155, 178, 209, 308 confounding variables, 320 confrontation, 394 confusion, 150, 306, 512, 519 congenital heart disease, 343 congruence, 19, 194, 207, 209, 210 consciousness, 214, 394, 474, 529 consensus, xi, xvii, 53, 65, 76, 319, 320, 345, 389 consent, 232, 239 conservation, 532 consolidation, 57, 117, 119, 127, 371, 374 constraints, 248, 250, 385 construct validity, 165, 207 construction, xvi, 62, 145, 281, 283, 284, 285, 287, 298, 299, 349, 382, 385, 386, 394, 397, 450, 475, 476, 537 constructive communication, 192, 208, 304 constructive conflict, 366 constructivist, 283, 383 contamination, 119 contempt, 164, 165 content analysis, 98, 276, 288 contingency, 261 continuing, 465 continuity, 205, 283, 284, 285, 287, 289, 298 contraceptives, 442 contractions, 117 control condition, 313 control group, xvii, 76, 224, 303, 310, 325, 326, 355, 374 controlled, xiii, 18, 19, 40, 48, 77, 82, 101, 114, 168, 186, 191, 224, 311, 317, 323, 338, 346, 366, 410, 435 convergence, 29, 48, 235 conviction, 50, 62, 238 coordination, 300, 384, 467 coping, vii, xxiii, 339, 341, 342, 344, 414, 415, 493, 497, 500, 501, 504, 505, 507, 511, 512, 515, 516, 517 coping model, 353, 360, 362 coping strategies, 306, 355, 405, 413, 512, 515 coping strategy, 498 coronary artery disease, 413 coronary heart disease, 415 corpus luteum, 113 correlation, ix, 18, 22, 72, 118, 125, 139, 158, 162, 182, 195, 200, 248, 497, 501, 502, 511 correlation coefficient, 502 correlational analysis, 255 correlations, xii, 18, 37, 138, 139, 145, 149, 156, 157, 158, 160, 161, 162, 165, 174, 180, 181, 198,
552
Index
200, 201, 202, 203, 248, 270, 401, 498, 501, 502, 507, 511 cortex, 114, 115, 116, 215, 223, 372, 373, 524, 528 cortical, 223, 226, 371, 401, 523 corticosterone, 117 corticotropin, 122, 125, 376 cortisol, 321, 322, 333, 337, 413 co-sleeping, 272 cost-effective, 167, 185 costs, 14, 20, 21, 66, 82, 106, 109, 421 counseling, 19, 109, 435, 436, 442, 452 counseling psychology, 19 couples, ix, xi, xiii, 49, 51, 52, 59, 60, 64, 65, 68, 69, 70, 71, 73, 74, 75, 76, 79, 81, 83, 84, 94, 98, 106, 109, 149, 150, 152, 153, 154, 156, 160, 163, 166, 167, 168, 171, 174, 176, 177, 178, 179, 180, 183, 184, 185, 186, 188, 191, 192, 193, 197, 199, 202, 203, 204, 207, 208, 209, 255, 257, 304, 307, 308, 315, 388, 389, 390, 391, 392, 393, 394, 532, 535 coupling, 116, 119 courts, 90 covariate, 22, 67, 252, 253, 310 coverage, 20, 476 covering, 355, 473 craving, 525, 526, 529 creativity, 263 credibility, 434, 463 credit, 135 CRH, 113 criminality, 208 criticism, 73, 74, 76, 79, 80, 85, 403, 514 cross-cultural, xv, 259, 260, 265, 276, 277, 278, 279, 280, 334, 347, 515, 533 cross-cultural psychology, 278 cross-sectional, 154, 163, 174, 178, 182, 206, 402 crosstalk, 217 crying, 92, 370, 374, 383, 478 CSF, 118, 119, 120, 121 CSI, 309 cues, xix, xxiii, 6, 11, 22, 23, 69, 82, 89, 115, 346, 369, 471, 485 cultivation, 8 cultural, xv, xviii, xxi, 168, 185, 195, 203, 209, 210, 231, 234, 259, 260, 261, 262, 263, 264, 265, 266, 267, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 284, 285, 291, 298, 340, 341, 343, 345, 353, 354, 355, 356, 357, 358, 359, 383, 417, 421, 423, 453, 494, 495, 513, 526, 540, 541, 542 cultural beliefs, 265, 271, 277 cultural differences, 270 cultural factors, 231, 354 cultural heritage, 345 cultural influence, 280
cultural norms, 263, 275 cultural perspective, 234, 494, 540 cultural psychology, 280 cultural values, 195, 261, 262, 271, 272, 273, 275, 423 culture, 13, 28, 89, 171, 189, 193, 194, 196, 206, 207, 210, 230, 263, 266, 268, 274, 275, 276, 278, 279, 280, 285, 288, 298, 341, 347, 411, 419, 421, 423, 476, 494, 495, 528, 535, 542 curing, 457 curiosity, 97, 108, 455 curriculum, 432 curve-fitting, 240 cycles, xx, 222, 382, 394 cystic fibrosis, xviii, 339
D daily living, 341 danger, 97, 119, 386, 473, 531 data analysis, 209, 256, 270, 279, 425 data collection, 249, 250, 276 data set, 79, 463 dating, xiii, 44, 48, 49, 50, 51, 59, 61, 73, 81, 98, 145, 149, 156, 157, 158, 160, 162, 163, 166, 173, 174, 179, 180, 181, 182, 183, 193, 209, 535, 536, 537 DBP, 407 death, xviii, 6, 90, 95, 339, 361, 403, 406, 414, 430, 438, 453, 454, 521 death sentence, 430 deception, 91 decision making, 32, 73, 453 decisions, 133, 134, 141, 143, 144, 154, 155, 179, 250, 329, 344, 464, 466, 467, 475 decoding, 89 defects, 455 defense, xxii, 55, 370, 412, 451, 496 defense mechanisms, xxii, 370, 451, 496 defensiveness, 224, 226 deficit, 325, 340 deficits, xvii, 120, 275, 319, 322, 328, 350, 352 definition, x, 1, 15, 230, 231, 245, 285, 297, 298, 384, 386, 474, 482, 497 degradation, 215 degree, xiv, 3, 4, 5, 10, 14, 15, 19, 22, 46, 49, 53, 69, 94, 101, 192, 194, 195, 197, 200, 229, 231, 234, 238, 250, 254, 322, 324, 389, 401, 402, 404, 439, 453, 454 dehydration, 113, 340, 351 delays, xvii, 319, 320, 340 delinquency, 208, 252, 253, 303 delinquent behavior, 253
Index delivery, 348, 349, 371, 372 delusion, 230, 519 demand, 29, 170, 188, 262, 268, 429, 452 demographic, 101, 137, 139, 198, 261, 264, 265, 287, 360, 406 demographic factors, 261 dendrites, 113 denial, 80, 484, 495 density, xv, 114, 118, 214, 216, 237, 242, 372, 531 dentate gyrus, 372, 377 dependent variable, 170, 188, 270, 390 depressed, xvii, 69, 72, 73, 75, 78, 79, 80, 81, 83, 101, 118, 151, 176, 215, 290, 319, 320, 322, 323, 324, 325, 326, 327, 330, 331, 332, 333, 335, 336, 337, 338, 342, 367, 377, 504, 510, 513, 514, 516, 520, 527 depression, xi, xvii, 45, 58, 61, 65, 67, 69, 70, 73, 74, 75, 77, 79, 80, 81, 82, 83, 84, 101, 104, 118, 125, 145, 150, 153, 171, 179, 188, 215, 216, 217, 218, 303, 319, 320, 321, 322, 323, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 336, 337, 338, 342, 345, 367, 372, 377, 378, 413, 414, 452, 488, 495, 497, 498, 504, 513, 514, 517, 529, 530 depressive disorder, 82 depressive symptomatology, 328 depressive symptoms, 72, 75, 81, 83, 101, 321, 324, 326, 330, 332, 334, 335, 336, 337, 413, 500 deprivation, 115, 377 derivatives, 529 desensitization, 215 desire, xxiv, 9, 11, 20, 21, 23, 25, 26, 28, 91, 96, 97, 117, 297, 327, 343, 351, 452, 479, 511, 519, 520, 523, 524, 525, 526, 528, 530, 531, 532, 533, 534, 535, 536, 539, 540, 541, 542 desires, 20, 350, 393, 418 detachment, xxiii, 95, 161, 162, 165, 182, 493, 494, 497, 499, 501, 502, 505, 506, 507, 509, 510, 511, 512, 513 detection, 221, 238 devaluation, 73, 81, 476, 484 developed nations, 347 developing brain, 115 developmental change, 342, 478 developmental delay, 324, 343 developmental factors, 354 developmental milestones, 353 developmental process, 132, 246, 341, 407 developmental psychology, xxii, 382, 446, 471, 490, 491 deviation, 390, 423 diabetes, xviii, 339, 360 diabetes mellitus, 360 diagnostic, 66, 70, 321, 454, 475
553
Diagnostic and Statistical Manual of Mental Disorders, 234 diagnostic criteria, 66, 321 Diagnostic Statistical Manual, 152, 176 Diamond, 473, 482, 488, 528, 534, 535, 539 diet, 101, 400, 403 differential approach, 141, 151, 175 differential treatment, 488 differentiation, 2, 40, 59, 79, 285, 372, 478, 479, 480, 495 disability, 11, 12, 13, 28, 32, 33, 336, 345, 353, 362 disabled, x, xxii, 10, 11, 13, 23, 461, 462, 463 disappointment, 8, 465, 537 disaster, 464 discipline, 209, 328, 474, 496 disclosure, 23, 25, 33, 69, 97, 407, 540 discomfort, xvi, 12, 69, 107, 281, 287, 288, 289, 290, 294, 297, 351, 455, 485, 495, 532 discontinuity, 489 discounting, 405 discourse, 463, 535, 539 discrimination, 33, 343, 356 disease activity, 323, 335, 337 diseases, x, 421, 426 disinhibition, 215 disorder, xi, 65, 66, 67, 70, 79, 83, 119, 120, 121, 126, 127, 129, 232, 235, 243, 244, 325, 326, 337, 358, 360, 361, 481, 484, 489 disposition, xiii, 7, 191, 192, 193, 204, 207, 534 disputes, 79, 83 dissatisfaction, xi, 65, 70, 84, 150 dissociation, 58, 240 distal, 261, 273, 275 distress, x, 1, 3, 4, 5, 9, 10, 17, 18, 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 66, 70, 71, 72, 75, 83, 91, 95, 96, 129, 150, 151, 152, 154, 156, 163, 167, 169, 171, 174, 175, 177, 179, 182, 184, 186, 188, 189, 231, 316, 326, 335, 345, 414, 454, 456, 473, 485, 502, 504, 511, 516, 533, 535 distribution, 113, 116, 122, 124, 235, 243, 373, 374, 376, 378, 386, 391, 414 divergence, 11 diversity, 221, 279, 366, 400, 418 division, 14, 23, 153, 179, 419, 462, 463 divorce, 52, 54, 70, 72, 73, 150, 167, 169, 171, 184, 186, 188, 304, 305, 307, 315, 316, 317, 532 divorce rates, 167, 184 dizziness, 519, 530 DNA, 536, 537 doctor, xxii, 101, 102, 323, 451, 454, 466, 467, 474 doctors, 67, 323, 329, 400 dogs, 88, 89, 90, 93, 98, 99, 100, 104, 106 DOI, 458, 468
554
Index
domestic violence, 80 domestication, 89, 105, 106 dominance, xiv, 117, 164, 165, 217, 219, 221 donor, 225, 227, 454 donors, 414 dopamine, 113, 120, 128, 215, 238, 370, 374, 375, 525, 526, 530, 532, 537 dopaminergic, 118, 120, 215, 373 dreaming, 284 drinking, 249, 288, 291, 351, 433 drowning, 464 drug addict, 348, 529 drug addiction, 348 drug treatment, 82, 329 drugs, 120, 232, 291, 524 DSM, 66, 81, 84, 152, 169, 176, 186, 232, 235 DSM-II, 66, 81, 84 DSM-III, 66, 81, 84 DSM-IV, 66, 152, 232, 235 dualism, 383 duration, 137, 156, 163, 166, 180, 183, 197, 214, 232, 249, 250, 254, 263, 266, 270, 271, 272, 321, 330, 374, 455 dust, 536 duties, 12, 260 Dyads, xiii, 191, 202, 248 dysfunctional, 71, 83, 215, 217, 330 dysphoria, 84 dysregulated, 309, 479, 480 dysregulation, 118, 309, 311, 322, 484, 486
E eating, 102, 119, 128, 221, 288, 291 eating behavior, 221 eating disorders, 119, 128 ecological, xxi, 353, 383, 437, 497 ecology, 265, 276, 359, 446 economic, xxi, 262, 264, 321, 330, 345, 347, 349, 387, 394, 427, 437, 438, 504, 514 economic boom, 262 economic growth, 264 economic status, 321, 427 economies, 262 economy, 261, 264 ecstasy, 519 education, 26, 29, 30, 32, 104, 156, 180, 262, 264, 269, 270, 272, 277, 287, 300, 304, 305, 307, 313, 315, 321, 325, 328, 348, 350, 351, 353, 354, 355, 356, 363, 386, 396, 418, 420, 422, 423, 424, 431, 432, 434, 435, 436, 452, 455, 457, 476 educational attainment, 264, 324, 333 educational programs, 312
educational system, 262 educators, 354, 356, 431, 433 EEG, 322, 333, 523, 540 efficacy, xvi, 68, 74, 75, 76, 77, 78, 82, 105, 167, 184, 282, 287, 298, 310, 313, 355, 356, 357, 386, 395, 424, 428, 434, 444 egalitarianism, 472 ego, 39, 40, 53, 144, 146, 147, 209, 252, 253, 454, 481, 484, 495, 496 ego strength, 146 egocentrism, 14, 50, 62 egoism, 31 ejaculation, 117 elaboration, 4, 27 elderly, 34, 101, 102, 105, 106, 108, 109, 412, 414 elderly population, 102 electrical, 227, 333 electroencephalogram, 523 electrophysiological, 122, 226 electrophysiological study, 122 elementary school, 197, 307, 396 embryo, 223 emotion, xiv, xxiii, xxiv, 3, 7, 15, 29, 30, 73, 78, 79, 80, 84, 88, 92, 94, 193, 217, 218, 229, 230, 238, 279, 314, 316, 344, 379, 493, 494, 497, 498, 500, 502, 504, 505, 507, 509, 511, 512, 514, 525, 526, 531, 533, 534, 538, 541, 542 emotion regulation, 92, 217 emotional disorder, 82, 84 emotional distress, 21, 23, 24, 25, 81, 314, 370 emotional experience, 375, 472, 478, 534 emotional health, 151, 175 emotional intelligence, 170, 187 emotional processes, 79, 129 emotional reactions, 304, 305, 306, 531 emotional responses, 303 emotional stability, 39, 192, 273 emotional state, 4, 8, 11, 13, 23, 238, 341, 374, 383, 496, 519, 542 emotional well-being, 334, 346, 412 emotionality, 18, 72, 315 emotions, xvii, xviii, xix, xxii, 2, 3, 4, 8, 11, 12, 13, 14, 16, 17, 19, 23, 24, 26, 29, 30, 34, 153, 178, 273, 282, 284, 286, 303, 304, 305, 306, 308, 312, 316, 322, 327, 339, 369, 375, 451, 452, 453, 468, 496, 498, 512, 514, 523, 524, 526, 527, 528, 529, 530, 533, 539 empathy, ix, x, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 192, 194, 211, 458, 485 employers, 464, 466 employment, 264, 278, 287, 343, 360
555
Index employment status, 264, 287 empowerment, 354, 360, 361 encoding, 215, 265 endocrine, xviii, 113, 220, 369, 371, 375, 379, 412 endocrinology, ix, xiv, 122, 123, 219 endogenous, 114, 251, 252, 253 energy, 330, 464, 525, 526 engagement, 29, 69, 279, 325, 425 enhancement, 154, 177, 304 enterprise, 537, 538 entertainment, 269 enuresis, 340 envelope, 288 environment, xiv, 7, 8, 19, 23, 79, 97, 219, 220, 263, 264, 269, 272, 277, 280, 325, 330, 334, 342, 352, 357, 440, 442, 452, 453, 472, 488, 491 environmental, xix, 97, 98, 330, 367, 369, 372, 440, 514 environmental factors, 330, 514 environmental influences, 367 environmental stimuli, 372 enzymatic, 128, 215 enzyme, 119 enzymes, 128 epidemic, 321 epidemiological, 66, 150, 403, 494 epidemiology, 81, 235, 412, 434 episodic, xvi, 207, 281 episodic memory, xvi, 281 epistemology, 462, 467 epithelia, 221 epithelial cell, 125 epithelial cells, 125 epithelium, 221 equality, 386 equilibrium, 9, 453 equipment, 94, 465 equity, 205, 383 EST, 223, 304, 306 estimating, xxiii, 32, 69, 247, 493 estrogen, 114, 118, 121, 127, 128, 537 estrogen, 123, 376 estrogens, 223 ethanol, 120, 128 ethical, xxii, 287, 388, 434, 461, 475, 486 ethics, 462 ethnic groups, 424, 524 ethnic minority, xxi, 156, 180, 417, 421 ethnicity, 435 etiology, 8, 316, 327, 413 euphoria, 524, 525, 529
European, 126, 146, 210, 217, 235, 243, 257, 260, 261, 279, 300, 334, 337, 396, 421, 435, 456, 531, 541 Europeans, 261 euthanasia, 105 evening, 268, 288, 290, 297 evolution, xxii, 33, 88, 89, 108, 109, 122, 226, 257, 258, 370, 451, 452, 532, 541 evolutionary, 7, 89, 112, 223, 231, 234, 238, 452, 525, 535, 537 evolutionary process, 231 ewe, 114 excitability, 113, 122 excitation, 531, 541 excitement, 220, 529, 530 exclusion, 109 excretion, 337 execution, 389 executive function, 352, 385 exercise, 101, 118, 262, 340, 395, 403 exocytosis, 112 exogenous, 246, 251, 252 expenditures, 90 experimental design, 441 expert, iv, 239, 468 expertise, 466, 468 experts, 456 exposure, 33, 67, 74, 75, 76, 79, 82, 83, 118, 119, 121, 151, 222, 223, 225, 226, 304, 321, 325, 326, 327, 333, 366, 374, 482, 496 externalization, xxiii, 493, 494, 497, 499, 501, 502, 505, 506, 507, 509, 510, 511, 512, 513 externalizing, 257, 303, 309, 323, 327, 342, 344, 361 externalizing behavior, 257, 323, 327, 342, 344 externalizing disorders, 303 externalizing problems, 327, 361 extracellular, 221 extraction, 198, 265 extrinsic, 306, 386 extrinsic motivation, 386 extrovert, 267 eye, 82, 273, 419, 496 eye contact, 273, 496 eye movement, 82 eyes, 49, 268, 352
F face-to-face interaction, xvi, 259, 261, 266, 275, 348 facial expression, 82, 495 factor analysis, 198 factorial, 199, 202 failure, 7, 94, 97, 316, 323, 347, 402, 454
556
Index
failure to thrive, 323 fairness, 14 faith, 62 false, 537 familial, xviii, 37, 73, 115, 194, 207, 339, 341, 358, 407, 411 family conflict, 304, 313, 316, 342 family environment, 300, 454 family factors, 314, 335, 353, 354 family functioning, ix, xi, xviii, 65, 68, 71, 72, 76, 339, 341, 343, 344, 345, 357, 358, 359, 361, 362, 462 family history, 218, 234, 239 family interactions, 74, 80 family life, 194 family members, 12, 28, 47, 71, 73, 88, 99, 246, 247, 257, 262, 269, 272, 309, 313, 321, 325, 345, 353, 354, 355, 357, 358, 409, 411, 424, 428, 431, 455, 466, 503 family physician, 337 family relationships, xvii, 210, 269, 303, 304, 308, 314, 316, 354, 368, 419 family structure, 262, 277 family studies, 153, 177 family support, 342, 514 family system, 208, 305, 312, 313, 344 family therapy, 76, 79 farming, 264 fatalistic, 421 fatigue, 66, 286, 465, 477 fatty acids, 227 faults, 91 fear, xi, 7, 34, 87, 88, 91, 97, 114, 116, 118, 119, 233, 303, 304, 325, 331, 346, 386, 420, 421, 427, 428, 453, 455, 477, 484, 494, 495, 511, 524, 526, 529, 530, 532, 533 fear response, 119 fears, 91, 97, 214, 453, 482, 520 fee, 475, 476, 536 feedback, 48, 103, 167, 184, 253 feeding, 115, 119, 268, 269, 274, 371, 488 feet, 292 females, xii, xiii, 66, 116, 117, 118, 131, 132, 133, 134, 135, 139, 140, 141, 142, 143, 191, 194, 205, 220, 222, 227, 239, 252, 253, 344, 346, 370, 371, 442, 443, 444, 445 femininity, 476 fertility, 222, 455 fetal, 121 fetus, 333 fever, 113, 340, 347 fidelity, 146, 230, 231, 232, 239, 242, 540, 542 film, 18, 33, 292, 389
films, 290, 291 first principles, 538 first-time, 278, 332 fitness, 226, 227, 452 flexibility, 254, 356, 385, 393, 395, 454 flood, 525 flow, 423 fluctuations, 6, 15, 19, 224 fluid, 120, 125, 143 fluid balance, 120 fluoxetine, 235, 240 fMRI, 374, 379, 395, 480, 524, 525, 526, 527, 528, 539 focus group, xxi, 353, 362, 417, 418, 422, 423, 425, 430, 432, 433, 434, 435, 444, 463 focus groups, xxi, 353, 362, 417, 418, 422, 423, 432, 433, 435, 463 focusing, xvii, 10, 101, 192, 195, 275, 305, 319, 320, 321, 322, 327, 328, 330, 375, 495, 525 folklore, 523 follicular, 222 food, xiv, 89, 115, 127, 217, 219, 220 food intake, 127 football, 5, 291 Ford, 37, 59, 101, 108 forebrain, 123, 378, 379 forgetting, 482 forgiveness, ix, xiii, 106, 191, 192, 193, 194, 195, 196, 198, 199, 200, 202, 203, 204, 205, 206, 207, 208, 209, 210, 211, 285 formal education, 197 foster mothers, 481 Fox, 334, 366, 368 fractal dimension, 523 fragmentation, 40, 454 fraternal twins, 535 free choice, 285, 289 freedom, 231, 234, 239, 429, 464 freedom of choice, 464 frequency distribution, 409 Freud, 193, 209, 230, 382, 472, 473, 474, 478, 480, 481, 483, 488, 489, 495, 496, 515, 531, 540 Friedmann, 225 friendship, xvi, 37, 91, 132, 136, 137, 139, 146, 153, 166, 178, 184, 246, 247, 249, 250, 251, 253, 254, 255, 276, 281, 282, 286, 297, 298, 299, 300, 301, 374, 411 frontal cortex, 385 frustration, 343, 349, 452 fulfillment, 39, 61, 96, 418, 519 functional aspects, 400
557
Index G G protein, 113, 221 GABA, 370, 372, 377 games, 288, 289, 291, 308 gauge, 348, 358 GDP, 262 gel, 428 gender, ix, xii, xxi, 28, 70, 107, 117, 131, 134, 135, 138, 139, 141, 142, 144, 145, 146, 194, 195, 199, 200, 202, 203, 206, 211, 222, 231, 232, 233, 238, 240, 241, 253, 270, 287, 289, 290, 292, 297, 324, 346, 370, 378, 388, 391, 411, 431, 435, 437, 441, 442, 443, 444, 445, 452, 454, 475, 476 gender differences, xii, 131, 134, 135, 139, 141, 142, 144, 146, 287, 290, 292, 411 gender role, xxi, 437, 441, 444, 445 gene, xiv, 42, 45, 113, 121, 129, 213, 215, 217, 372, 373, 375, 378, 379 gene expression, 113, 372, 378 gene transfer, 378 general education, 422 general practitioner, 465 generalizability, 156, 166, 179, 183, 204, 206 generalization, 144 generalizations, 42, 45 generalized anxiety disorder, ix, 65, 66, 67, 78, 79, 80, 81, 82, 83, 84, 85 generation, 83, 84, 113, 200, 277, 298, 431 genes, 81, 129, 221, 222, 330, 340, 375, 387 genetic, xviii, 72, 120, 121, 192, 206, 216, 222, 327, 328, 330, 340, 345, 361, 365, 370, 375, 387, 394, 454, 532 genetic disease, 454 genetic endowment, xviii, 365 genetic factors, 192, 330 genetic linkage, 330 genetic load, 120, 375 genetic screening, 361 genetics, 209, 217, 330 gestation, 113, 371 gestures, 11 GFI, 501, 504, 505, 507 gift, 135, 240, 418 girls, xvi, 264, 281, 282, 283, 284, 287, 288, 292, 297, 344, 388, 391, 413, 419, 421, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 442, 443, 444 gland, 112 glasses, 503 globus, 114, 374 glucocorticoids, 114, 118 glutamate, 372, 377 glutamatergic, 373
glycerol, 113 glycoprotein, 112 glycosylation, 112 goals, xvi, 9, 11, 36, 41, 46, 97, 101, 193, 259, 260, 263, 265, 269, 271, 272, 274, 275, 277, 278, 279, 280, 286, 304, 314, 331, 482, 486 God, 88, 107, 261, 419, 528 gold, 536 goodness of fit, 387, 501 Gore, 42, 59 goslings, 103 gossip, 455 government, iv G-protein, 221 graduate students, 525 grain, 89 granules, 122 Greenhouse, 202 greening, 255 grief, 95, 108, 109, 468, 522, 528, 532 group identity, 25, 29 group involvement, 311 group membership, 10, 17, 311 group size, 422 group work, 360 groups, xvii, xix, 21, 25, 29, 33, 143, 196, 232, 233, 234, 240, 241, 242, 249, 250, 254, 256, 263, 264, 270, 271, 272, 273, 276, 279, 303, 308, 310, 311, 312, 313, 314, 316, 319, 326, 342, 345, 346, 347, 356, 357, 375, 381, 384, 388, 418, 421, 422, 423, 424, 425, 426, 427, 429, 430, 432, 433, 456, 468, 532, 536 growth, 7, 120, 147, 323, 336, 337, 340, 346, 378, 397, 452, 455 guardian, 90 guidance, 328, 352, 452, 473 guidelines, 347, 353, 354, 355, 359, 447, 472 guilt, xxiii, 32, 104, 328, 338, 343, 344, 476, 493, 494, 495, 496, 497, 498, 499, 501, 502, 503, 504, 505, 507, 509, 510, 511, 512, 513, 514, 515, 516, 526 guilty, 328 gyrus, 222, 524
H handicapped, 23, 34 handling, 343 hands, 153, 178, 266, 425, 465, 530 hanging, 400 haplotypes, 121 happiness, xx, 51, 77, 150, 151, 174, 272, 329, 399, 533
558
Index
hardships, 345 harm, 260, 279, 401 harmful, 426 harmony, 260, 279 hate, 504, 530, 531, 533 head, 292, 327, 519, 523, 531, 538, 542 Head Start, 335 healing, xxii, 349, 451, 512, 514 health care, 33, 83, 167, 185, 265, 345, 346, 347, 348, 349, 350, 353, 354, 355, 356, 357, 358, 435, 439, 454, 463, 464, 466, 467, 468 health care professionals, 346, 357, 454, 463, 464, 466, 467, 468 health care system, 347 health education, xxi, 417, 418, 434 health effects, 367, 411 health problems, 355 health psychology, 434 health status, 402, 452 healthcare, xxii, 66, 461, 462, 463 heart, 19, 100, 101, 113, 114, 322, 336, 347, 349, 403, 406, 408, 413, 503, 522, 528, 530, 540 heart disease, 403, 406 heart rate, 19, 100, 322, 336, 406, 408, 413 heavy smoking, 4 hedonic, 77 height, 323, 348 helping behavior, 13, 20, 25, 27 helplessness, 92, 453, 522 hemoglobin (Hb), 340 hemorrhage, 113 heroin, 529 heterogeneity, 272, 278 heterogeneous, 154, 178, 234, 238, 388 heterosexuals, 418, 420, 435 heterozygosity, 227 heuristic, 50, 63, 93, 260 high risk, xxii, 150, 174, 356, 432, 451, 452, 454 high school, xvi, 167, 184, 197, 281, 287, 296, 321, 324, 342, 431, 435, 447 high school degree, 197 higher education, 262 high-risk, x, 167, 184, 333, 335, 418, 432, 433 high-risk populations, 167, 184 high-tech, 524 hip, 14, 26, 70, 88, 383, 413, 503 hippocampal, 372, 377 hippocampus, 113, 215, 372, 377 hips, xx, 399, 404, 407, 409 Hispanic, 156, 171, 180, 189, 262, 272, 280, 446, 448 HIV infection, xxi, 437, 438, 448, 450
HIV/AIDS, vii, x, xx, xxi, 30, 363, 402, 403, 412, 415, 417, 418, 420, 421, 426, 427, 428, 431, 432, 433, 434, 437, 438, 439, 440, 441, 442, 443, 444, 445, 446, 447, 448, 449, 450 homeostasis, 112, 472 homes, 288, 292, 303 homogeneity, 256, 270, 404 homogeneous, 388, 526 homogenized, 240 homosexuality, 419, 423, 430 homosexuals, 418, 421, 430 honesty, 272, 347, 454 Hops, 73, 78, 80 horizon, 298 hormone, 112, 114, 115, 120, 221 hormones, xiv, 113, 114, 120, 126, 128, 219, 222, 227, 370, 530 hospice, 105 hospital, 20, 349, 356, 357, 361, 403, 466, 503 hospital care, 361 hospitalization, 347, 348, 453, 454 hospitalizations, 347 hospitalized, 102, 107, 463, 466 hospitals, 323, 454, 466 host, 534, 536 hostility, 45, 69, 73, 74, 76, 165, 182, 325, 538 household, 197, 342, 345, 476 household income, 197 households, 90, 262 housing, 265 HPA, 118, 371 HPA axis, 118 human actions, 284 human behavior, 21, 33, 89, 224, 257, 439 human brain, 114, 129, 226, 374, 379 human cognition, 88 human condition, 286, 535 human development, 104, 277, 278, 279, 280, 359, 446 human experience, xi, 87, 88, 479 human motivation, 255, 284 human nature, 387 human psychology, ix, xi, 87, 88, 90 human rights, 349 humans, ix, xiv, xviii, 88, 89, 90, 91, 93, 94, 95, 96, 98, 100, 101, 102, 103, 113, 114, 115, 116, 117, 124, 219, 220, 221, 222, 224, 225, 226, 227, 369, 371, 374 humiliation, 104 hunting, 89, 532 husband, 69, 75, 80, 162, 180, 208 hydrochloric acid, 529 hyperactivity, 120, 128, 325, 326
Index hypersensitivity, 91 hypertension, 414, 415, 416 hypnosis, 107 hypogonadism, 121 hypothalamic, 113, 118, 129, 371, 401 hypothalamic-pituitary-adrenal axis, 118 hypothalamus, xi, 111, 112, 113, 115, 121, 123, 125, 215, 221, 222, 371, 374, 376 hypothesis, xii, xiii, xix, 8, 22, 36, 42, 107, 111, 116, 119, 126, 131, 141, 171, 189, 194, 196, 199, 203, 205, 206, 213, 214, 287, 297, 315, 373, 381, 383, 384, 388, 392, 401, 402, 405, 408, 412, 413, 415, 498, 499, 501, 512, 535 hypothesis test, 199
I IBM, 243 ice, 291, 423 id, 209 idealization, 53, 333 identification, 10, 27, 195, 242, 329, 411, 476, 483 identity, ix, xii, xiii, xxii, 3, 4, 5, 7, 9, 10, 26, 28, 31, 32, 131, 132, 133, 134, 136, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 191, 194, 207, 208, 273, 283, 284, 285, 287, 298, 307, 341, 400, 402, 415, 419, 438, 452, 454, 461, 462, 463, 464, 465, 466, 467, 468, 497 identity achievement, 133, 143 idiographic approach, 195 idiosyncratic, 476 illiteracy, 262 illusion, 62 illusions, 45, 57, 59, 60, 62, 170, 187 imagery, 67, 523, 524 images, 49, 50, 480, 523, 524, 528 imaging, 222, 370, 523, 538 immigrant mothers, 279 immigrants, 422, 434, 435 immobilization, 118 immune function, 412 immune system, 412 immunity, 421 immunochemistry, 379 immunocompetence, 222, 226 immunological, 222 immunomarkers, 222 immunoreactivity, 120, 129 implementation, xxi, 149, 174, 306, 354, 438 impotence, 453 imprinting, 103, 371, 376 impulsive, xiv, 213, 215, 285, 486 impulsivity, 215, 225
559
in situ, 366, 379, 483 in vivo, 79 incentive, 288, 388 incidence, 119, 273, 326, 403, 415, 455 inclusion, xxi, 76, 307, 355, 437, 440 income, 156, 180 increased access, 56 incubation, 240 incurable, 522 independence, 43, 153, 179, 246, 254, 256, 260, 261, 263, 271, 272, 275 independent variable, 390 Indian, 214, 340, 519 indication, 10, 22, 432 indicators, xvi, 37, 39, 47, 155, 157, 163, 179, 263, 281, 285, 286, 287, 292, 297, 389, 455, 536 indices, 19, 158, 181, 321, 322 indirect measure, 19 individual development, 254, 382 individual differences, 5, 6, 30, 40, 43, 52, 53, 59, 160, 161, 162, 165, 182, 208, 406, 411, 516 individualism, 260, 261, 263, 271, 272, 273, 274, 279, 280 individuality, 205 Individuals with Disabilities Education Act (IDEA), 352 induction, 119, 376 industrial, 260, 262, 264 industrialized societies, xv, 259 industry, 90, 104, 261 ineffectiveness, 383 infancy, xvii, 62, 105, 260, 262, 319, 320, 322, 324, 333, 335, 370, 383, 418, 476, 489, 490, 491, 532, 537 infant care, 279 infant mortality rate, 262 infants, xv, xvii, 92, 94, 95, 97, 114, 115, 116, 118, 259, 260, 261, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 275, 276, 279, 314, 319, 320, 321, 322, 323, 326, 327, 331, 332, 333, 336, 337, 370, 476, 478, 481, 488, 531 infection, xx, 340, 347, 417, 420, 432 infections, 427, 432, 433, 438 infectious, 412 infectious diseases, 412 infertility, 452 inflammation, 412 inflammatory, 412, 415 inflammatory disease, 415 information processing, 55, 56, 69, 108, 359 informed consent, 265, 287, 388 inheritance, 387 inherited, 194, 340, 343
560
Index
inhibition, 114, 117, 127, 225, 306, 322, 511, 541 inhibitor, 374 inhibitors, xiii, 67, 213, 230, 529, 530 inhibitory, 113, 215, 385, 395, 541 initiation, 91, 114, 153, 178, 208, 246, 249, 250, 254, 371, 542 injection, 114, 115, 117, 119, 371, 372, 526 injuries, 323, 336 injury, iv, 323, 331, 336, 477, 486, 502, 503 inmates, 108 inositol, 113, 221 insects, xiv, 219, 220 insecurity, 40, 476 insight, xxi, xxii, 13, 142, 234, 238, 265, 421, 437, 451, 479 insomnia, 488 inspiration, 103 instability, 194, 207, 330 institutions, 262, 464, 466 instruction, 389 instruments, xv, xxiii, 237, 239, 240, 243, 244, 286, 288, 388, 472 insulin, 128, 360 insurance, 90, 464, 465 insurance companies, 90 intangible, 88 integration, 3, 4, 36, 93, 103, 133, 384, 401, 402, 412, 435, 458, 484, 485, 486, 487 integrity, 286, 287 intellectual development, 337 intellectual functioning, 362 intelligence, 18, 383, 396, 397, 536 intensity, 15, 117, 136, 139, 140, 230, 238, 348, 374, 472, 502, 510, 511, 529, 531 intentions, xxi, 9, 13, 192, 206, 230, 284, 384, 437, 439, 442, 445, 446, 447, 448, 449, 480, 524 interaction, vi, vii, 158, 160, 161, 181, 208, 259, 300, 381 interaction effect, 202, 250, 254 interactivity, 7 interdependence, xv, xvi, 9, 30, 42, 43, 44, 58, 90, 103, 107, 146, 153, 178, 193, 245, 246, 247, 250, 254, 255, 256, 257, 259, 260, 261, 271, 273, 275, 477 interdependence theory, 103 interdependent self-construal, 59 interference, xiv, 97, 219, 222, 231, 234, 240, 405, 408, 452, 456, 539 intergenerational, 193, 194, 205, 206, 211 intermediaries, 261 internal consistency, xii, 149, 174, 310 internal working models, 36, 42, 44, 63, 477, 482, 484, 487
internalised, 284 internalization, 193, 194, 196, 205, 206, 209 internalizing, 309, 323, 325, 335, 342, 344, 361 international, 25, 26, 277, 458 internet, 409, 431, 452, 457, 524, 542 interparental conflict, 305, 307, 308, 309, 313, 314, 315 interpersonal communication, x, 1, 33 interpersonal conflict, 25 interpersonal interactions, 8, 10, 17, 18, 19, 68, 74 interpersonal relations, ix, x, xi, xxiii, 1, 14, 15, 26, 29, 35, 54, 88, 90, 93, 103, 104, 107, 224, 227, 260, 273, 411, 493, 494 interpersonal relationships, ix, x, xi, xxiii, 1, 15, 29, 35, 54, 88, 90, 93, 103, 104, 224, 227, 260, 273, 411, 493, 494 interpersonal skills, 75, 263 interpretation, 24, 31, 99, 247, 298, 313, 357, 419, 425, 462, 463, 468, 478, 479, 486, 510, 528 interrelatedness, xv, 259 interrelations, xxiii, 472 intervention, xiii, xviii, xx, 57, 75, 76, 101, 154, 167, 169, 173, 177, 184, 186, 304, 308, 313, 316, 331, 332, 340, 341, 353, 354, 355, 356, 358, 360, 362, 382, 410, 413, 440, 448, 450, 475, 486, 488 intervention strategies, 353, 356 interview, xii, xiii, 149, 152, 154, 155, 158, 161, 163, 166, 167, 169, 170, 173, 174, 176, 177, 179, 180, 182, 183, 184, 186, 187, 188, 234, 239, 243, 265, 423, 463 interviews, xii, 149, 150, 152, 153, 155, 156, 157, 174, 175, 176, 177, 180, 265, 286, 321, 423, 454, 455, 463, 525, 527 intimacy, ix, xii, xiii, 77, 92, 131, 132, 133, 134, 136, 137, 138, 139, 140, 141, 142, 143, 145, 146, 147, 149, 150, 152, 153, 154, 155, 165, 170, 173, 174, 175, 176, 177, 178, 187, 192, 194, 246, 282, 297, 301, 407, 409, 452, 535, 540 intoxication, 249, 519 intrinsic, 96, 122, 272, 386, 387, 468, 478 intrinsic motivation, 272, 386 intrinsic value, 468 introspection, 512 invasive, 114 inventories, 151, 496 investment, 3, 146, 483 investment bank, 3 investment model, 146 irritability, xvii, 66, 272, 319, 320 Islam, 418, 419, 425, 430, 431, 433, 434 Islamic, 418, 419, 420, 423, 434 island, 89 isolation, 116, 372, 377, 402, 440, 454
Index Italian population, 274 Italy, xv, xvi, 111, 191, 197, 219, 229, 237, 244, 259, 261, 262, 264, 272, 276, 277, 279, 280, 281, 287, 369, 381, 395, 396, 397, 451 item response theory, 106, 169, 186
J jobs, 526, 537 joints, 297 judge, 47, 64, 495 judgment, xxii, 60, 297, 329, 451, 495, 514 justification, xx, 149, 174, 400
K Kaiser Family Foundation, 457 kidney, 112, 114 kindergarten, 269, 351, 383 kinetics, 218 King, 154, 169, 177, 186, 473, 490, 521, 522 knees, 5, 530 knockout, 373
L labeling, 308 labor, 115, 263, 268 labor force, 263 laboratory studies, 224, 379 labour, xi, 111, 112 lactating, 118, 122 lactation, xi, 111, 112, 114, 115, 118, 125, 370, 376 language, xix, 89, 265, 324, 325, 354, 369, 422, 478, 479, 480, 483, 510, 539, 541 language acquisition, 479 language development, 324 large-scale, 262 Latin America, 260, 262, 438 Latin American countries, 438 Latino, 171, 189, 272, 277, 278, 448, 450 law, 287, 299, 388, 419, 522 laws, 403 lead, x, xxii, 1, 14, 21, 23, 25, 56, 57, 96, 112, 114, 116, 117, 132, 134, 143, 154, 166, 178, 183, 214, 220, 230, 242, 251, 284, 294, 305, 306, 324, 340, 366, 372, 382, 384, 386, 405, 418, 419, 426, 461, 462, 494, 513 leadership, 344 learning, xiv, 7, 89, 100, 117, 120, 123, 219, 220, 306, 313, 327, 350, 352, 370, 371, 376, 384, 386, 481, 529
561
learning disabilities, 350 leisure, xvi, 166, 184, 281, 286, 287, 288, 292, 296, 297, 298 leisure time, 166, 184, 287, 288, 292, 296, 297, 298 lending, 165 lesions, 115, 122, 371, 376 leukemia, 8, 452, 454, 456 lexical decision, 95 libido, 480, 530 life course, 208, 283, 300 life expectancy, 340 life experiences, 2, 4, 5, 7 life span, 282 life stressors, 337 lifespan, 341, 347, 440 lifestyle, 350 lifestyles, 526 life-threatening, 13 lifetime, 66, 242, 243, 326, 335, 443 ligands, 221 likelihood, 26, 52, 70, 72, 74, 117, 206, 342, 366, 392, 414, 423, 443, 486 Likert scale, 136, 137, 231, 239, 289 limitation, xxi, 37, 39, 134, 233, 242, 313, 320, 437, 440 limitations, xvi, 9, 101, 150, 154, 176, 178, 273, 282, 297, 298, 313, 314, 329, 330, 346, 394, 513 Lincoln, 123, 378, 463, 468, 539 linear, xix, 199, 202, 250, 252, 310, 311, 314, 381 linear model, 199, 202, 250, 310, 311, 314 linear modeling, 250, 310 linguistic, 29, 324, 325, 463, 479, 486 linguistically, 17, 29 linkage, 221 links, 39, 45, 57, 144, 253, 375, 403, 412, 416, 442 lipid, 227 listening, 9, 29, 153, 178, 288, 291, 374, 425, 454, 456, 462, 468, 473, 485, 514 literacy, 262 literature, xiii, xx, 31, 36, 41, 44, 57, 72, 73, 76, 99, 100, 103, 133, 146, 152, 153, 154, 155, 177, 178, 192, 194, 196, 204, 213, 214, 238, 246, 250, 277, 320, 321, 324, 325, 327, 329, 330, 331, 336, 341, 343, 344, 345, 357, 359, 393, 399, 400, 404, 420, 423, 428, 434, 439, 440, 442, 444, 446, 454, 463, 474, 480, 500, 533 living arrangements, 91 living environment, 476 localization, 122 location, 89, 227, 262 locomotion, 370 locus, 214, 216, 217, 343, 357, 358, 376 locus coeruleus, 376
562
Index
loneliness, 91, 101, 104, 105, 106, 132, 453, 529, 532 long distance, 351 long period, 366 longevity, 109, 414, 416 longitudinal studies, 57, 208, 323, 326, 489 longitudinal study, 11, 52, 101, 107, 108, 170, 187, 208, 210, 235, 243, 278, 395, 396, 491, 515 long-term, 13, 21, 77, 99, 104, 133, 141, 322, 342, 343, 344, 371, 372, 385, 412, 452, 454, 456, 458, 525 loss of appetite, 525 loss of control, 66, 433 losses, 528 love, ix, xiii, xxiv, 5, 48, 51, 56, 58, 60, 62, 63, 90, 96, 100, 104, 106, 114, 123, 126, 146, 153, 178, 213, 214, 215, 216, 217, 235, 238, 242, 243, 267, 374, 375, 379, 380, 396, 403, 419, 425, 426, 428, 431, 454, 472, 473, 489, 519, 520, 521, 522, 523, 524, 525, 526, 527, 528, 529, 530, 531, 533, 534, 535, 536, 537, 538, 539, 540, 541, 542, 543 lover, 525, 530 low risk, 427 low-income, 355, 448 loyalty, 272 LSD, 529 lung, 3, 4, 8, 101 lung cancer, 3, 4, 8 lungs, 426 luteinizing hormone, 227, 530 lying, 283
M magnetic, 9, 116, 359, 480, 524 magnetic resonance, 9, 116, 359, 480 magnetic resonance imaging, 9, 359, 480 mainstream, 275, 423 maintenance, xx, 45, 82, 90, 94, 95, 114, 115, 119, 143, 146, 205, 209, 282, 347, 350, 400, 409, 410, 413, 475, 494, 525 maintenance, 409 major depression, xi, 65, 81, 84, 118, 125, 126, 242, 243, 335, 337, 376 major depressive disorder, 72, 81, 326, 332 major histocompatibility complex, 222 maladaptive, 40, 57, 355, 357, 385, 479, 498, 512 males, xii, xiii, 66, 116, 117, 131, 132, 133, 134, 135, 139, 141, 142, 191, 194, 205, 220, 222, 226, 239, 252, 253, 346, 370, 418, 442, 443, 444 malignancy, 454 malnutrition, 120 mammal, 370
mammalian, 225 mammals, xi, xiv, 89, 111, 112, 114, 123, 125, 219, 221, 370, 371, 372, 378 management, x, xii, xiii, 2, 11, 14, 15, 16, 17, 32, 67, 149, 150, 151, 152, 153, 158, 162, 165, 167, 173, 174, 175, 176, 178, 181, 185, 333, 344, 348, 354, 356, 359, 468 mania, xiv, 70, 213, 215, 526 manic, 216 manipulation, 372 manners, 269, 272, 331 MANOVA, 139, 390, 391, 392 MAO, 529 mapping, 93 marijuana, 529 marital conflict, xvii, 169, 186, 194, 303, 304, 305, 306, 307, 308, 310, 311, 312, 313, 314, 315, 316, 317 marital discord, xvii, 77, 83, 305, 306, 307, 312, 314, 319, 320, 330 marital distress, 69, 70, 71, 72, 75, 80, 155, 316 marital quality, 60, 81, 82, 169, 170, 171, 186, 187, 188, 192, 210 marital status, 264, 321, 330, 400 market, 268 marketing, 90 Markov, 251, 254 Markov chain, 251 Markov process, 254 marriage, 45, 54, 60, 61, 63, 68, 70, 76, 80, 84, 151, 156, 161, 165, 166, 167, 168, 169, 170, 171, 176, 180, 183, 184, 185, 186, 187, 189, 194, 197, 207, 208, 209, 214, 262, 400, 411, 415, 416, 419, 420, 421, 429, 430, 431, 455, 522, 532, 535 marriages, 51, 60, 169, 186, 317, 403 married couples, xiii, 48, 156, 163, 173, 179, 180, 193, 209, 254, 304, 308, 535 married women, 75, 84 marrow, 347 Marx, 106 masculinity, 444 mass media, 432 mastery, 284, 386 maternal, xvi, xvii, xix, 114, 115, 117, 118, 119, 123, 195, 206, 211, 259, 263, 264, 265, 266, 267, 270, 271, 273, 274, 278, 319, 320, 321, 322, 323, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 336, 337, 362, 369, 370, 371, 373, 375, 376, 377, 476, 483, 538 maternal care, 114, 118, 123, 370, 371 maternal mood, 324 maternal support, 211 mathematical, 169, 186
Index mathematicians, 387 mathematics, 169, 186 matrix, 168, 185 maturation, 2, 5, 7, 23, 223 MCA, 421, 434, 435 meanings, 284, 285, 286, 299, 397, 424, 475, 535 measurement, 17, 18, 19, 20, 31, 137, 154, 169, 170, 171, 178, 186, 188, 241, 246, 250, 251, 255, 322, 377, 413 measures, xiii, 7, 17, 18, 19, 30, 48, 55, 67, 93, 106, 121, 136, 137, 139, 140, 149, 150, 151, 154, 156, 158, 161, 162, 163, 165, 169, 170, 174, 175, 176, 178, 179, 180, 181, 182, 186, 187, 188, 198, 199, 200, 202, 246, 247, 250, 308, 310, 311, 313, 322, 324, 326, 328, 330, 351, 367, 401, 402, 403, 409, 412, 455, 531 media, x, 1, 18, 19, 28, 308, 426, 429, 449, 536 medial prefrontal cortex, 10 median, 113, 122, 136, 287, 340 mediation, 30 mediators, 305, 372, 446 medical care, 323, 347 medical school, 516 medical student, 238 medication, 214, 323, 348 medications, xi, 65, 67 medicine, xxii, 123, 124, 360, 435, 451, 457 meditation, 218 Medline, xix, 369, 440 membranes, 240, 531 memory, xix, xxii, 99, 117, 119, 124, 127, 151, 176, 225, 284, 369, 370, 371, 373, 376, 451, 477, 487, 489 memory biases, 151, 176 memory retrieval, 119 men, 66, 70, 72, 75, 80, 96, 117, 124, 156, 163, 166, 179, 182, 183, 197, 199, 200, 201, 202, 203, 204, 205, 211, 217, 222, 223, 224, 225, 226, 227, 231, 232, 238, 406, 409, 410, 411, 415, 418, 419, 421, 447, 499, 519, 522, 523, 524, 525, 526, 527, 528, 530, 531, 532, 533, 535, 536, 537, 540 menstrual, 222, 223, 225, 227 menstrual cycle, 222, 223, 225, 227 mental activity, 524 mental arithmetic, 100 mental disorder, ix, xii, 77, 82, 111, 335, 455, 495, 513 mental health, ix, x, xxiii, 59, 64, 67, 82, 207, 277, 326, 329, 331, 333, 334, 335, 357, 367, 401, 416, 493, 494, 497, 513, 516 mental illness, 326, 331, 332, 338 mental model, 59 mental processes, 224
563
mental representation, 35, 41, 56, 58, 62, 108, 473, 474, 476 mental retardation, 121 mental state, 116, 375, 383 mental states, 383 messages, 13, 15, 23, 24, 25, 30, 31, 32, 411, 415 messenger ribonucleic acid, 122 messengers, 526 meta analysis, 75 meta-analysis, 67, 80, 420, 435, 446, 447, 448, 489, 491 metabolism, 123 metabolites, 216 metacognitive, 286, 293, 297 metaphor, xxii, 471, 472, 474, 478, 480, 486 metaphors, xxii, 463, 471, 472 metropolitan area, 262 Mexican, vii, x, xxi, 280, 437, 438, 439, 440, 441, 442, 445, 447, 448 Mexico, xxi, 437, 438, 439, 440, 444, 445, 446, 447, 448, 449, 450 MHC, 222, 226, 227 mice, 118, 120, 128, 373, 378, 379 microdialysis, 376 microinjection, 126 microsystem, xxi, 437, 440, 442 midbrain, 122, 214 middle class, 167, 184, 363 middle-aged, 415 middle-class families, 261, 271 midlife, 416 migrant, 277, 418, 435 migrants, 435 migration, 262, 372 military, 456 milk, 103, 112, 123, 268, 475 mining, 261 minorities, 418, 423 minority, xviii, 275, 279, 339, 341, 357 minority groups, xviii, 275, 339, 341, 357 mirror, ix, 278 misconceptions, 350, 356, 420, 421, 426 misunderstanding, 466 mitral, 371 mixing, 394 modalities, xi, xvi, 65, 76, 281, 347, 387 model specification, 247 modeling, 39, 105, 169, 170, 186, 187, 207, 247, 248, 250, 251, 252, 253, 254, 257, 325, 327, 344 models, xiii, xv, xxiii, 35, 36, 37, 39, 40, 42, 43, 44, 45, 55, 58, 59, 60, 61, 62, 63, 77, 99, 105, 145, 191, 194, 195, 196, 203, 204, 206, 207, 245, 246, 247, 250, 251, 253, 254, 255, 257, 258, 260, 261,
564
Index
278, 280, 282, 310, 311, 353, 371, 372, 401, 402, 412, 413, 414, 439, 446, 447, 471, 482, 533 moderates, 541 moderators, 104, 105, 206, 253, 254, 279, 446 modern society, 231, 256 modulation, 117, 121, 222, 327, 372, 376, 379, 480 modules, 253 modus operandi, 390 molecular weight, 221 molecules, 214, 220 money, 90, 153, 155, 179, 290, 344, 400, 428, 475, 504, 537 monkeys, 122, 370, 374, 375 monoamine, 529 monoamine oxidase, 529 mood, ix, xiv, 82, 116, 151, 168, 176, 185, 218, 219, 220, 222, 223, 224, 225, 226, 227, 232, 238, 239, 241, 242, 243, 286, 323, 327, 337, 360, 377, 499, 500, 516, 529 mood change, 225 mood disorder, 82, 232, 238, 239, 377 moral behavior, 497 moral development, 515 morality, 462, 497 morals, 272 moratorium, 136, 139, 140, 141, 142 morbidity, xx, 81, 337, 399, 403, 404, 407, 410 morning, 268, 426, 481 Morocco, 418, 419, 421, 427, 431, 432, 434, 435 morphine, 120, 122, 529 morphology, 372 morphometric, 120 mortality, xx, 323, 336, 399, 402, 403, 404, 407, 410, 412, 413, 414 mortality rate, 402, 403 mortality risk, 402, 403 motherhood, 329, 333, 491 mothers, xiii, xv, xvii, 103, 119, 191, 195, 197, 198, 199, 200, 202, 205, 206, 210, 255, 259, 262, 263, 264, 265, 266, 267, 268, 269, 270, 271, 272, 273, 275, 276, 277, 278, 279, 305, 307, 309, 315, 319, 320, 321, 322, 323, 324, 325, 326, 327, 328, 329, 330, 331, 332, 333, 334, 335, 336, 338, 366, 368, 374, 379, 442, 478, 481 moths, 220 motion, 486 motivation, xix, 11, 20, 21, 24, 25, 26, 27, 30, 49, 97, 115, 279, 370, 378, 526, 538 motives, x, 1, 55, 97, 224, 348, 386, 538 motor skills, 262 motor stimulation, xvi, 259, 263, 266, 273, 275 motorcycles, 289, 291, 297 mouse, 127, 373, 379
mouth, 428 mRNA, 118, 372 MSI, 151, 158, 160, 163, 164, 165, 175, 181 multicultural, 275, 278, 429 multidimensional, x, xiii, 2, 4, 17, 20, 28, 30, 150, 151, 152, 173, 175, 176, 185, 410 multidisciplinary, 155, 349, 353, 354, 358, 439, 450 multiple factors, 322, 328 multiple regression analysis, 125 multiple sclerosis, 468 multivariate, 139, 270, 280, 310, 392 multivariate distribution, 270 multivariate statistics, 280 murder, 230 muscle, 66 music, 288, 291, 292, 297 Muslim, 419, 420, 428, 429, 435 mutual respect, 347 mutuality, 155 myocardial infarction, 106, 403, 412
N NaCl, 240 naming, 324 narcissism, 60, 516 narcissistic, 53, 484, 486, 489, 496, 513, 516 narcissistic personality disorder, 484, 489 narcotic, 348 narcotics, 348, 529 narratives, xxii, 276, 283, 284, 286, 290, 292, 298, 458, 461, 462, 463, 464, 466, 467 National Academy of Sciences, 123, 235, 243 National Institutes of Health, 361, 457 national origin, 272 nationality, 455 natural, 11, 88, 116, 323, 389, 407, 414, 423, 429, 456, 463, 513, 514, 532, 537 natural environment, 407, 414 NBC, 88 NCS, 66 negative affectivity, 516 negative attitudes, 73, 430, 444 negative consequences, 40, 314, 330, 366 negative emotions, 29, 153, 155, 178, 322, 512 negative life events, xxiii, 408, 493 negative mood, 342 negative outcomes, 305, 322, 331 negative reinforcement, 539, 542 negative relation, xx, 56, 399, 404, 407, 409, 503 negativity, xx, 400, 403, 404, 405, 406, 407, 410, 411 neglect, 14, 17, 137, 328
565
Index negotiating, 284, 395 negotiation, xxii, 284, 385, 393, 461, 462 neocortex, 215 neonatal, 377 neonate, 334, 335 neostriatum, 371, 376 nerve, 112, 220, 379, 526 nerve cells, 220, 526 nerve growth factor, 379 nervous system, 122 Netherlands, x, xx, 93, 213, 218, 245, 257, 417, 418, 419, 420, 422, 427, 429, 432, 435, 461, 464, 465 network, xv, 79, 152, 176, 245, 250, 251, 252, 253, 254, 256, 257, 258, 289, 400, 401, 402, 403, 404, 405, 406, 407, 408, 410, 414, 526 network members, 79, 406, 407 neural mechanisms, 31, 376 neural systems, 117, 370 neuroanatomy, 126 neurobiological, ix, xix, 114, 115, 116, 124, 231, 238, 369, 375 neurobiology, xix, 127, 129, 214, 217, 369, 379, 538, 541 neuroendocrine, xix, 220, 369, 373, 377, 401 neuroendocrine system, 401 neurogenesis, 372, 374, 376, 377, 379 neuroimaging, 116, 216, 217, 480 neuroimaging techniques, 480 neuroleptics, 120, 232 neurological disease, 462 neurological disorder, 231 neurologist, 464 neuronal plasticity, 372 neurons, 112, 113, 115, 117, 118, 121, 122, 125, 129, 221, 372, 526 neuropeptide, xii, 111, 112, 129 neuropeptides, xix, 117, 120, 122, 124, 126, 128, 235, 369, 373 neuropharmacology, 126 neuroplasticity, 375 neuropsychiatric disorders, xii, xix, 111, 118, 121, 370, 372 neuroscience, 491, 533, 537 neuroscientists, xxiv, 519, 523, 524, 525, 526, 528, 536, 537 neurosecretory, 112 neurotensin, 120 neurotic, 44, 230, 484, 487 neuroticism, 72, 171, 188, 209 neurotransmission, 118, 371 neurotransmitter, 528, 530 neurotransmitters, ix, xv, 118, 120, 224, 231, 237, 238, 321, 370, 377, 530
neurotrophic, 377 New York Times, 541 New Zealand, 83, 235, 244, 336 Newton, 123 Nicaragua, xv, 259, 261, 264, 272, 277, 278, 280 nicotine, 3 nitric oxide, 112, 122, 377 nitric oxide (NO), 112 NLEs, 498, 502, 503, 510, 511 noise, 3, 4, 6, 481, 528 nomothetic approach, 195 non-human, 88, 89, 95, 123 non-human primates, 123 nonlinear, 169, 186 nonparametric, 270 nonverbal, x, 1, 23, 24, 25, 32, 89, 472, 478, 485 nonverbal cues, 23 nonverbal signals, 485 norepinephrine, 67, 238, 376, 525, 526, 528, 532 normal, ix, xiv, 8, 47, 67, 69, 70, 115, 117, 119, 121, 129, 156, 180, 216, 229, 230, 231, 232, 233, 234, 238, 242, 337, 358, 373, 377, 389, 408, 429, 430, 455, 456, 457, 484, 515, 529, 530 normal conditions, 238 normal distribution, 47, 156, 180 norms, xvi, xxi, 260, 342, 357, 400, 417, 423, 424, 432, 435, 437, 439, 442, 443, 444, 445 North America, 81, 372, 456, 458 novel stimuli, 98 novelty, 117 nuclear, 262, 263, 273 nuclear family, 262, 273 nuclei, xi, 111, 112, 113, 215 nucleus, 112, 113, 115, 116, 118, 121, 122, 126, 371, 373, 374, 378, 524, 525, 526, 528 nucleus accumbens, 115, 116, 373, 378, 525, 526, 528 nulliparous, 114, 371 nurse, 268, 351, 465 nurses, 349, 456, 466, 467 nursing, 31, 268, 373, 434, 435, 450, 463, 465, 466, 467, 516 nursing home, 463, 465, 466 nurturance, 403 nutrition, 269, 272, 370, 452
O obedience, 262, 271, 275 objective criteria, 47 obligation, 96, 409, 410, 411 obligations, 260 observable behavior, 322
566
Index
observations, xiii, xvii, 80, 118, 149, 158, 161, 165, 174, 180, 181, 246, 265, 266, 276, 319, 320, 372, 373, 374, 389, 454, 522, 523, 530 observed behavior, 266 obsessive-compulsive, ix, xiii, xiv, 78, 82, 119, 126, 127, 213, 214, 215, 217, 218, 229, 230, 234, 235, 238, 239, 241, 242, 243, 244, 495, 496, 497, 530 obsessive-compulsive disorder (OCD), ix, xiii, xiv, 82, 126, 127, 213, 214, 215, 217, 218, 229, 230, 232, 233, 234, 235, 238, 239, 242, 495, 497, 530, 531 occupational, ix, xi, 65, 76 odds ratio, 70 odorants, 224, 227 odors, 224, 225, 227 Oedipus, 230, 475, 496 Oedipus complex, 475, 496 offenders, 208 older adults, 108, 414, 416 older people, 108, 109 olfaction, 227 olfactory, 113, 221, 223, 224, 225, 227, 371, 372, 373, 376, 377 olfactory bulb, 114, 221, 371, 372, 373, 376, 377 olfactory epithelium, 221, 227 olfactory receptor, 225 omission, 167, 184 omnibus, 151, 175 oncology, 22, 451, 454, 457 one dimension, 150, 176, 410 one sample t-test, 200 online, 34, 98, 277, 542 online dating, 542 ontogenesis, 300 openness, 263, 273 opiates, 120, 524 opioid, 127, 238, 362 opioids, 114, 370 opium, 529 oppression, 356 optimal health, 347, 349, 350 optimism, 11, 44, 48, 51, 272 oral, 227, 426, 431, 432, 445, 449 orbitofrontal cortex, 528 organ, 66, 221, 222, 226, 227, 340, 347, 455 organic, 9, 10, 11, 29, 230, 238 organization, xi, 35, 37, 61, 256, 268, 292, 343, 477, 478, 481, 484, 485, 486, 487, 489, 490, 496 organizations, 278, 452, 477, 481, 484 orgasm, 117 orientation, xvi, 69, 97, 146, 259, 260, 261, 271, 290 oscillations, 483 outliers, 270
outpatients, xiv, 78, 229, 232 ovarian, 115 ovariectomized, 115, 371 ovariectomized rat, 115 overproduction, 115 ovulation, 113, 223, 227 ownership, 101, 102, 105, 106, 108, 109 oxygen, 340, 465 oxytocin, ix, xi, xix, 111, 112, 122, 123, 124, 125, 126, 127, 128, 129, 231, 238, 369, 370, 371, 372, 374, 375, 376, 377, 378, 379, 525, 526
P packets, 308 pain, xviii, 9, 10, 12, 21, 31, 58, 95, 113, 118, 171, 188, 339, 340, 341, 343, 346, 347, 348, 349, 350, 351, 352, 356, 359, 360, 361, 362, 452, 528, 529, 530 pain management, 348, 349, 356, 361, 362 paints, 67 pairing, 98, 99, 257 pallor, 522 palpitations, 522 pancreas, 114 pandemic, 438 panic attack, 82, 453, 454, 529 panic disorder, xi, 65, 78, 82, 118, 119, 125, 239, 242 paradigm shift, 534 paradox, 484 paradoxical, 208 parameter, 222, 252, 253 paranoia, 230, 238 parasites, 226 parasympathetic, 113, 322, 408, 412 paraventricular, xi, 111, 112, 122, 123, 125, 129 paraventricular nucleus, 122, 125, 129 parental care, 115, 375, 491 parental influence, xviii, 365 parental relationships, 475 parent-child, xv, xvii, 93, 194, 195, 203, 204, 206, 207, 209, 246, 259, 266, 268, 276, 277, 303, 305, 308, 310, 311, 312, 313, 314, 343, 344, 446 parenthood, 166, 184 parenting, xv, xviii, 80, 206, 209, 257, 259, 261, 262, 263, 265, 273, 274, 275, 276, 277, 278, 308, 316, 323, 327, 328, 330, 332, 335, 339, 341, 342, 343, 357, 358, 365, 366, 368, 525 parenting behaviours, 80 parenting styles, 327, 328, 341, 342 Parkinson, 378 parole, 301
Index paroxetine, xv, 237, 238, 243 partition, xv, 245 partnership, 26, 347 parvicellular, 113 passive, 69, 73, 119, 328, 419 paternal, xix, 206, 331, 369, 483 paternity, 231, 238 pathogenic, 80, 401, 412 pathology, xiv, 76, 229, 235, 238, 242, 243, 325, 326, 330, 331, 514 pathophysiology, ix, 118, 119, 120, 121, 125, 127, 336, 347, 349, 372 pathways, xvi, xxiii, 120, 122, 125, 133, 134, 145, 257, 260, 276, 277, 280, 335, 371, 375, 376, 411, 412, 415, 472, 480 patient care, 434 patient-centered, 454 patients, x, xi, xiii, xiv, xv, xxii, 8, 12, 20, 21, 32, 65, 66, 67, 68, 69, 72, 74, 75, 76, 78, 79, 80, 85, 118, 119, 120, 121, 125, 126, 127, 128, 129, 213, 214, 216, 229, 232, 233, 234, 238, 242, 243, 335, 336, 340, 344, 345, 347, 348, 349, 350, 353, 356, 357, 362, 377, 403, 413, 451, 452, 453, 454, 455, 457, 461, 462, 463, 466, 467, 468, 472, 473, 475, 476, 481, 483, 486, 494, 495, 513, 514, 516, 530, 531 patterning, 274 PBC, 441 peak experience, 529 pediatric, 321, 334, 337, 349, 353, 355, 356, 357, 359, 361, 362, 454, 456 pediatrician, 454 peer, xvi, xviii, xxi, 5, 7, 21, 31, 63, 73, 132, 144, 247, 249, 253, 255, 257, 277, 281, 282, 286, 289, 296, 298, 300, 301, 341, 345, 346, 351, 358, 361, 365, 366, 368, 382, 383, 386, 393, 396, 417, 430, 435, 437, 441, 463 peer group, 132, 247, 300, 301 peer influence, xxi, 253, 437 peer relationship, xvi, 249, 277, 281, 282, 286, 296, 341, 345, 346, 358, 382, 383, 386, 393, 396 peer review, 441 peers, xvii, xviii, 7, 22, 39, 40, 48, 63, 68, 94, 95, 245, 257, 282, 283, 291, 297, 301, 314, 327, 339, 345, 346, 351, 358, 361, 366, 367, 382, 383, 384, 385, 386, 397, 432, 433, 442, 456, 531 penis, 427 PEP, 119, 406 peptide, 112, 115, 129 peptides, xix, 124, 221, 238, 369, 370, 373, 375 perception, xvi, xxii, 36, 47, 60, 61, 64, 69, 79, 80, 152, 176, 194, 195, 205, 206, 218, 224, 226, 230, 281, 282, 287, 289, 294, 295, 296, 297, 305, 386,
567
401, 408, 424, 442, 444, 451, 453, 455, 476, 486, 510 perceptions, xi, 25, 31, 32, 35, 36, 41, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 60, 61, 63, 96, 98, 105, 136, 137, 143, 145, 151, 152, 158, 171, 175, 176, 181, 189, 196, 198, 203, 255, 257, 289, 310, 311, 335, 341, 342, 343, 346, 353, 356, 360, 362, 368, 401, 410, 427, 432, 445, 455, 466, 476, 511 perfectionism, 194, 211 performance, 7, 48, 58, 218, 386 perfusion, 376 perinatal, 321, 322, 330 periodic, 341 permit, 239 perseverance, 285 personal, x, xiii, xxii, 1, 4, 5, 8, 10, 11, 13, 14, 17, 18, 19, 20, 21, 22, 25, 26, 27, 32, 34, 39, 46, 48, 55, 59, 101, 106, 107, 108, 114, 124, 132, 137, 151, 155, 175, 191, 192, 207, 239, 260, 272, 283, 284, 285, 288, 291, 297, 298, 304, 306, 343, 349, 350, 354, 382, 383, 384, 385, 386, 408, 409, 419, 422, 423, 451, 452, 454, 456, 458, 474, 490, 514, 535, 537, 540 personal communication, 458 personal control, 4, 48 personal goals, 11, 382, 383 personal identity, 5, 13, 132, 283 personal life, 343 personal relations, 8, 106, 107, 108, 137, 535, 540 personal relationship, 8, 106, 107, 108, 137, 535, 540 personal responsibility, 385 personality, 5, 22, 32, 50, 55, 57, 58, 59, 60, 61, 63, 64, 72, 84, 105, 145, 161, 162, 171, 188, 192, 208, 209, 210, 234, 256, 267, 411, 477, 482, 484, 485, 486, 487, 488, 489, 491, 495, 516, 524, 538 personality characteristics, 50, 61, 209 personality differences, 5 personality dimensions, 192 personality disorder, 171, 188, 484, 488, 489, 491, 495 personality factors, 32 personality traits, 161, 162 person-centeredness, 23, 32 PET, 214, 216, 218, 223, 480 PET scan, 480 pets, 88, 90, 91, 93, 95, 96, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 536 pH, 240 pharmacological, 80, 113, 215, 370 pharmacological treatment, 80 pharmacology, 217 pharmacotherapy, 67, 514
568
Index
phenotypic, 72 pheromone, ix, xiv, 219, 220, 221, 223, 224, 225, 226, 227, 228 philanthropic, 12 philosophy, 292 phobia, 72, 80 phone, 265, 303, 348 phospholipase C, 113 phosphorylation, 112 photographs, 223, 425 physical abuse, 169, 186 physical activity, 102 physical aggression, 72, 83, 152, 153, 155, 177, 178, 208, 255 physical education, 351, 352 physical exercise, 452 physical health, ix, xx, 88, 101, 107, 150, 192, 263, 268, 316, 323, 399, 400, 401, 403, 416 physical well-being, 282, 343 physicians, xxii, 66, 329, 349, 451, 453, 455, 456, 457, 489, 521, 522, 523, 529 physiological, xi, xiv, 7, 19, 67, 100, 102, 111, 113, 114, 117, 119, 219, 220, 222, 223, 304, 321, 322, 370, 401, 406, 408, 410, 411, 412, 416, 519, 530, 533, 538, 542 physiological arousal, 304 physiological factors, 530 physiology, 94, 224, 234, 243, 415 Piagetian, 383 pig, 372, 377 pigs, 89, 223 pilot study, 179, 389, 448 ping-pong, 291 pituitary, 112, 113, 118, 122, 125, 127, 222, 371, 379, 401 pituitary gland, 118, 122, 222 placebo, 67, 224 placenta, 113 plague, 347 planning, 171, 188, 306, 384, 434, 439, 453, 457 plasma, 113, 117, 118, 121, 122, 125, 128, 240, 374, 379 plasma levels, 117, 118 plasma membrane, 125 plasticity, 372, 377 platelets, xv, 214, 217, 218, 235, 237, 238, 240, 242, 243, 530, 531, 541 play, ix, xiv, xv, xvi, xviii, xix, 5, 36, 40, 41, 44, 52, 73, 102, 108, 113, 114, 215, 219, 220, 221, 222, 224, 237, 238, 247, 259, 261, 262, 263, 265, 266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 288, 289, 292, 306, 323, 339, 341, 350, 354, 356, 365,
369, 375, 381, 387, 388, 389, 390, 392, 393, 394, 397, 452, 455, 478, 497, 509, 510, 525, 532 play activity, 266 pleasure, 288, 291, 418, 421, 426, 427, 433, 444, 445, 494, 526, 534 PLS, 519, 524 poisoning, xiv, 219, 220 poisons, 541 polarity, 220 policy makers, 331 policy-makers, 329 politeness, 272 political, xxi, 211, 262, 356, 437, 438, 536 politics, 291 polygraph, 541 polymorphism, 121, 215, 225, 375 polymorphisms, 121, 215, 217 poor, xi, 65, 69, 73, 91, 103, 155, 167, 185, 324, 325, 326, 327, 330, 340, 343, 356, 359 poor relationships, 356 population, xiv, 29, 47, 66, 76, 81, 101, 113, 121, 206, 229, 233, 234, 235, 242, 243, 261, 262, 310, 328, 329, 331, 345, 348, 349, 353, 355, 356, 357, 412, 418, 421, 439, 442, 455, 457, 499, 500, 536, 541 population group, 310 positive attitudes, x, xxi, 2, 419, 438, 444, 445 positive behaviors, 20, 21 positive correlation, 18, 374, 509, 510 positive emotions, 29 positive feedback, 56, 122 positive regard, 153, 179 positive relation, xviii, 18, 26, 45, 340, 352, 383, 385, 393, 404, 407 positive relationship, xviii, 18, 26, 45, 340, 352, 383, 385, 393, 404, 407 positron, 214, 223, 480 positron emission tomography, 214, 223, 480 Post Traumatic Stress Disorder (PTSD), 71, 72, 74, 79, 81, 83, 84, 119, 124, 496, 517 posterior cingulated, 524 postmortem, 118 postpartum, xvii, 118, 119, 126, 319, 320, 321, 329, 330, 332, 333, 334, 335, 337 postpartum depression, xvii, 319, 320, 321, 329, 330, 332, 335, 337 postpartum period, 119, 321, 330, 332 postsynaptic, 371 post-translational, 112 post-traumatic stress, xxii , 79, 81, 83, 119, 124, 128, 376, 452, 453, 455, 457, 458, 496 posture, 286 potassium, 377
Index poverty, 475 power, xii, xiii, 39, 45, 61, 93, 103, 149, 163, 173, 174, 178, 183, 285, 310, 313, 344, 366, 367, 368, 402, 490, 519, 522 preclinical, 218 prediction, 39, 44, 51, 52, 54, 58, 170, 187, 208, 414, 516 predictive validity, 39, 163, 187, 491 predictor variables, 139 predictors, 39, 44, 51, 64, 70, 74, 77, 85, 175, 195, 251, 254, 278, 311, 333, 357, 391, 392, 414, 428, 445, 446, 490, 514 pre-existing, 6, 355, 423, 477 preference, xix, 97, 116, 117, 124, 251, 265, 369, 373, 376, 378, 442, 473, 481 prefrontal cortex, xiv, 213, 215, 223, 372 pregnancy, 29, 119, 125, 126, 265, 321, 333, 334, 337, 371, 376, 428, 431 pregnant, 428, 431 prejudice, 33, 34, 195, 211 preschool, 332, 335, 338, 343, 476 preschool children, 335, 338 preschoolers, 7, 30, 368 pressure, xviii, 289, 365, 407, 411, 412, 419, 430, 433 presynaptic, 214, 215, 371 prevention, xiii, xxi, 30, 149, 166, 167, 168, 174, 183, 184, 185, 231, 304, 305, 307, 312, 313, 315, 316, 317, 335, 354, 417, 418, 420, 424, 426, 427, 432, 434, 435, 437, 438, 439, 440, 441, 442, 443, 444, 445, 446, 447, 448, 450 preventive, 167, 184, 317, 447 primacy, 97, 486, 495 primary care, 66, 83, 97, 99, 334, 361, 468, 473, 475, 476 primary caregivers, 97, 361 primate, 225, 370 primates, 115, 122, 123, 221, 371, 373 priming, 56, 57, 62 prisoners, 79, 83 prisoners of war, 79, 83 private, 105, 262, 288, 292, 297, 430, 431, 433, 495 proactive, 328, 351 probability, 51, 357, 387, 442, 443, 477 probe, 155, 179 problem behavior, 300, 338 problem-solving, 82, 151, 158, 161, 163, 165, 175, 181, 282, 305, 306, 325, 354, 454, 498, 512, 513, 514 problem-solving skills, 305, 306 procedural knowledge, 478, 479, 482, 486 procedures, 20, 136, 247, 253, 254, 265, 356, 454 production, 223, 371
569
productivity, 3, 67 profession, 419, 464 professions, 472, 476 progesterone, 114 prognostic value, 415 program, xvii, 85, 167, 184, 303, 304, 305, 307, 308, 310, 311, 312, 313, 314, 315, 316, 317, 332, 335, 349, 392, 439, 447 programming, 7, 8 progressive, 94, 134, 384, 462, 465 prolactin, 113, 216, 370, 371 proliferation, 372, 374 prolyl endopeptidase, 119, 128 promote, xv, xviii, 57, 118, 259, 260, 263, 269, 273, 289, 305, 308, 313, 340, 341, 345, 346, 356, 358, 382, 384, 385, 386, 412, 457 property, iv, 93, 116, 497 proposition, 39, 40, 54 prosocial behavior, 3, 19, 28, 30, 32, 33 protection, 93, 115, 272, 370, 401, 472, 473, 476 protective factors, 153, 167, 184 protein, 89, 113, 214, 220, 221, 240, 241, 244, 372 protein synthesis, 113 proteins, 112, 221, 238, 240, 242 Protestants, 261 protocol, xv, 166, 169, 183, 186, 237, 406, 499, 527 protocols, 152, 176, 455, 467 prototype, 51, 483, 525, 531, 533, 539, 542 proximal, 44, 261, 273, 275 Prozac, 530 PRP, 240 pseudo, 18, 20 psyche, 2, 24 psychiatric disorder, xii, 70, 71, 81, 82, 84, 111, 129, 230, 238, 239, 242, 332, 336 psychiatric disorders, xii, 70, 81, 82, 84, 111, 129, 230, 238, 239, 242, 336 psychiatric morbidity, 82 psychiatric patients, 102 psychiatrist, 530 psychiatry, xxiv, 108, 146, 397, 494 psychoanalysis, 9, 62, 84, 193, 210, 478, 486, 488, 489, 491, 496, 515 psychoeducational intervention, 355 psychoeducational program, 315 psychological development, 331, 487 psychological distress, 322, 333, 342, 414, 454 psychological functions, 383 psychological health, 101, 103 psychological problems, 102, 337 psychological processes, 55 psychological resources, 386 psychological stress, 102
570
Index
psychological variables, 328, 439 psychological well-being, 40, 209, 263, 272, 273, 415 psychologist, 465, 467, 468, 472, 542 psychologists, xxii, xxiv, 47, 57, 92, 94, 103, 401, 451, 454, 456, 475, 519, 525, 531, 533, 534, 535, 537 psychology, x, xvi, xxiii, 33, 34, 57, 77, 79, 84, 87, 88, 93, 103, 104, 107, 108, 146, 155, 156, 179, 180, 210, 218, 234, 243, 256, 260, 280, 283, 301, 397, 471, 496, 515, 537, 540, 541 psychometric properties, 158, 166, 181, 183, 211, 239 psychopathic, 483, 484 psychopathology, xv, xvii, 77, 112, 119, 235, 237, 239, 242, 315, 319, 320, 325, 326, 333, 334, 335, 337, 484, 487, 494, 497, 511, 516 psychopharmacology, 218 psychophysiological, 94, 105 psychophysiology, 332, 336, 522, 541 psychoses, 120 psychosocial, x, xviii, xxi, xxii, 145, 146, 245, 282, 286, 333, 335, 339, 341, 344, 349, 353, 357, 358, 359, 360, 361, 362, 437, 438, 441, 445, 446, 451, 453, 455, 458 psychosocial development, 358 psychosocial factors, 357, 360 psychosocial functioning, x psychosocial variables, 360, 445 psychosomatic, 171, 188, 335, 337, 412, 413, 414, 415 psychostimulants, 373, 374 psychotherapy, xxii, 19, 29, 30, 31, 32, 34, 75, 471, 477, 478, 480, 481, 482, 487, 488, 489, 490, 494 psychotic, 484, 487, 513 psychoticism, 497 PsycInfo, 440 puberty, 223, 340 public, x, xxi, 288, 291, 297, 331, 435, 437, 438, 449, 450, 495, 510, 536 public health, x, xxi, 435, 437, 438 PubMed, 440 puerperium, 126 Puerto Rican, 277, 278 pulse, 100 punishment, 477, 529 punitive, 171, 188 PVN, 112, 113, 118, 121
Q Qualia, xvi, 282, 286, 289, 293, 295 qualitative differences, 141, 333
qualitative research, 424, 434, 463 quality of life, xviii, xxii, 13, 66, 84, 101, 107, 330, 339, 340, 343, 348, 357, 358, 362, 451, 452, 455 Quality of life, 82 quantitative research, 433 query, 277 questioning, 143, 443 questionnaire, xiv, xv, 96, 107, 138, 162, 163, 168, 169, 170, 181, 185, 186, 188, 229, 231, 233, 234, 237, 238, 239, 265, 286, 288, 422, 496, 499, 500, 532, 536, 537 questionnaires, xii, xiv, 138, 149, 150, 151, 152, 158, 160, 162, 163, 164, 165, 170, 174, 175, 176, 180, 181, 182, 187, 197, 199, 202, 203, 229, 232, 239, 241, 276, 421, 434, 455, 536 quizzes, 358
R race, 346, 475, 476 racism, 476 radial glia, 372 radiation, 458 radical, 89, 430 radio, 536 rain, 529 random, xi, 35, 36, 46, 52, 53, 70, 98, 155, 169, 186, 393, 408, 434 random assignment, 408 random errors, xi, 35, 36, 46, 52, 53 range, xviii, xix, 2, 44, 67, 121, 155, 156, 162, 179, 180, 182, 194, 200, 220, 230, 232, 234, 265, 267, 286, 309, 310, 322, 324, 325, 330, 339, 341, 370, 401, 433, 484, 485, 486, 512, 520, 525 raphe, 215 rat, 115, 122, 123, 124, 125, 371, 376, 377 ratings, xii, xiii, 30, 40, 44, 47, 48, 49, 51, 52, 61, 64, 149, 152, 154, 155, 156, 157, 163, 165, 169, 173, 174, 179, 180, 186, 223, 227, 321, 325, 337, 361, 407, 408, 483 rats, xix, 113, 114, 117, 118, 122, 123, 124, 127, 128, 369, 372, 373, 376, 377 reactivity, 18, 100, 102, 115, 118, 276, 309, 406, 408, 416 reading, 64, 89, 102, 324, 407, 424, 425, 431 reality, xvi, 2, 8, 9, 13, 41, 46, 49, 54, 98, 281, 284, 285, 384, 385, 452, 455, 456, 475 reasoning, 477 recall, 500, 511 reception, 220, 485 receptors, xiv, 112, 113, 114, 115, 116, 118, 119, 121, 123, 125, 213, 215, 221, 371, 373, 374, 376, 378, 530
Index reciprocity, 193, 194, 204, 205, 207, 208, 251, 252, 253, 256, 282, 299 recognition, xiv, xvii, xix, 9, 11, 117, 125, 219, 220, 222, 225, 319, 320, 370, 373, 376, 487, 495 recollection, xvi, 281 reconcile, 23, 26, 43 reconciliation, 25, 32, 33, 207, 367 reconstruction, 285 recovery, 29, 102 recruiting, 135, 167, 184 recurrence, 8, 403 red blood cells, 340 reduction, 24, 25, 28, 107, 116, 118, 119, 121, 196, 208, 327, 363, 372, 448 refining, 68 reflection, 297, 298, 427, 431 reflexes, 530 reflexivity, 286, 287, 290, 292, 297 refuge, 92 regional, 223, 373 regression, xix, 144, 163, 246, 250, 381, 390, 392, 503, 504, 505, 506, 509 regression weights, 503, 504, 505, 506, 509 regressions, 391, 392 regular, 347, 350, 351, 433, 445, 481 regulation, xi, 111, 113, 115, 120, 122, 224, 282, 304, 306, 308, 314, 315, 316, 322, 326, 328, 372, 376, 378, 379, 473, 474, 477, 479, 480, 483, 486, 488, 490, 515 rehabilitation, 463, 465, 467 Rehabilitation Act, 352 reinforcement, 128, 373 rejection, xi, 69, 87, 88, 90, 106, 216, 344, 347, 402, 403, 513, 528 relapse, 80 relationship maintenance, 44, 91, 146, 170, 187, 409, 410 relationship quality, ix, xii, xiii, 52, 59, 61, 148, 149, 150, 151, 152, 153, 154, 155, 156, 158, 161, 163, 165, 166, 168, 173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 207, 305, 408, 414 relationship satisfaction, xii, xiii, 44, 50, 52, 54, 148, 149, 150, 152, 153, 160, 161, 163, 164, 165, 173, 174, 175, 177, 179, 182, 207, 209, 247 relatives, 70, 74, 76, 89, 262, 268, 532 relaxation, 67, 120, 222, 408, 529 relevance, 73, 75, 98, 125, 224, 382, 423, 490 reliability, xii, xiii, 136, 137, 149, 152, 155, 156, 157, 165, 166, 170, 173, 174, 176, 179, 180, 183, 184, 187, 201, 235, 241, 243, 309, 389, 463, 500, 528 religion, 261, 262, 288, 419, 491 religions, 193
571
religiosity, 343 religious, 107, 136, 203, 264, 291, 314, 400, 418, 420, 431, 536 religious belief, 136 religious beliefs, 136 religious groups, 536 religiousness, 197 remission, 28, 66 repair, 490 reparation, 328 repetitive behavior, 120 replication, 257, 346, 356 representative samples, 273 reproduction, xviii, 369, 419 reproductive organs, 117 reputation, 277, 345, 346, 426, 444 research design, 37, 57, 357, 358 researchers, x, xvii, xxiii, xxiv, 1, 3, 8, 9, 10, 17, 18, 19, 21, 22, 23, 25, 36, 37, 40, 41, 43, 45, 48, 49, 52, 53, 54, 55, 56, 57, 66, 74, 88, 93, 94, 97, 102, 103, 134, 137, 141, 151, 152, 154, 176, 177, 178, 230, 238, 246, 247, 250, 253, 254, 274, 288, 313, 319, 320, 321, 322, 323, 324, 325, 326, 329, 330, 331, 342, 344, 356, 388, 410, 445, 472, 480, 494, 496, 513, 519, 524, 529, 531, 532 resentment, 210, 475, 480, 510 residuals, 249 residues, 112 resilience, 345, 514 resistance, 30, 231 resolution, 13, 25, 26, 32, 315, 366, 475, 498 resource allocation, 14, 21 resources, 20, 23, 46, 98, 153, 178, 283, 285, 286, 287, 290, 292, 297, 298, 325, 326, 343, 344, 349, 350, 352, 355, 358, 386, 401, 402, 453, 454, 514 responsibilities, 40, 153, 342, 462, 463 responsiveness, 3, 42, 118, 123, 170, 188, 376, 377, 477, 487, 491 restaurants, 291 restoration, 120 Restorative Justice, 367 restructuring, 67 retardation, 455 retention, 307, 314, 356 returns, 99, 216 Revised Conflict Tactics Scale, 171, 188 reward pathways, 374 rewards, 20, 386, 526 Reynolds, 171, 188, 308, 309, 316 Rho, 138 rhythm, 487 rhythms, 240, 268, 300 rigidity, 472
572
Index
rings, 5 risk, xvii, xviii, xx, xxi, 30, 70, 72, 81, 91, 119, 121, 153, 156, 163, 167, 179, 182, 184, 194, 208, 255, 282, 285, 286, 299, 319, 320, 321, 323, 326, 332, 333, 334, 335, 336, 341, 343, 344, 349, 357, 361, 363, 365, 366, 387, 399, 403, 406, 413, 414, 417, 418, 427, 432, 433, 434, 435, 437, 440, 445, 448, 457, 528 risk behaviors, 434, 445 risk factors, 167, 184, 321, 333, 336, 361, 403, 440 risks, xvii, 13, 101, 316, 319, 320, 332, 333, 347, 424, 427, 428, 429, 432 risk-taking, 418, 434 RMSEA, 501, 504, 505, 507 roadblocks, 341 robustness, 40 rodent, 378 rodents, 116, 124, 371, 372, 373, 378 romantic relationship, ix, xii, xiii, 37, 40, 46, 48, 51, 53, 57, 58, 60, 62, 90, 91, 92, 93, 99, 100, 105, 107, 109, 131, 132, 133, 134, 135, 137, 138, 139, 141, 142, 143, 144, 145, 146, 156, 168, 180, 185, 191, 192, 193, 205, 209, 257, 288, 291, 341, 346, 374, 502, 503, 541, 542 routines, 265, 268, 272, 325 rumination, 211, 411 rural, xv, 82, 259, 260, 262, 263, 264, 272 rural areas, xv, 259, 260, 272
S sacrifice, 20, 434 SAD, 71 sadness, 330, 488, 494, 524, 526, 533 safety, 97, 312, 472, 490, 522 salary, 521 salt, 529 sample, xii, xiii, xix, 39, 54, 70, 72, 74, 75, 76, 80, 81, 98, 121, 131, 135, 144, 154, 155, 157, 158, 160, 161, 162, 163, 166, 178, 180, 181, 182, 183, 191, 195, 199, 200, 201, 204, 206, 231, 233, 238, 240, 242, 263, 264, 265, 267, 273, 287, 297, 307, 313, 335, 338, 342, 345, 346, 357, 382, 406, 414, 433, 434, 516, 531 sample mean, 200 sampling, 122, 266, 308 sanctions, 472 satisfaction, ix, xii, xiii, 39, 40, 44, 45, 51, 52, 54, 61, 62, 64, 77, 149, 150, 151, 153, 155, 161, 163, 165, 167, 168, 169, 170, 171, 173, 174, 175, 176, 178, 182, 183, 184, 185, 186, 187, 189, 211, 247, 452, 453, 464 saturation, 240, 463
savings, 106 SBP, 407, 408 SCD, 359 scheduling, 153, 179, 268, 269 schema, 35, 36, 41, 42, 44, 62, 97, 411 schemas, 42, 44, 45, 58, 63, 97, 99, 104, 284 Schiff, 487 schizophrenia, 120, 129, 215, 326, 333 schizophrenic patients, 120 school, xviii, 32, 169, 186, 207, 253, 262, 269, 282, 288, 289, 291, 297, 299, 307, 325, 326, 327, 328, 332, 335, 341, 346, 350, 351, 352, 354, 358, 360, 362, 365, 366, 367, 368, 386, 388, 389, 395, 422, 423, 426, 431, 432, 434, 441, 444, 447, 449, 450, 455, 496 schooling, 263 science, 19, 114, 123, 135, 217, 255, 288, 314, 435, 537, 542 scientific, 103, 283, 291, 456, 522, 530, 536, 537 scientific community, 537 scientists, 413, 457, 522, 523, 524, 528, 534, 536, 537 scores, xiv, 67, 121, 138, 140, 142, 143, 150, 155, 156, 161, 179, 180, 182, 195, 200, 206, 208, 229, 232, 233, 234, 238, 239, 241, 246, 309, 389, 499, 500, 532 SCP, 435 SDS, xxiii, 494, 499, 500, 501, 508 search, 97, 409, 431, 440, 464 searching, 124, 529 second generation, 422, 435 secondary students, 368 secret, 431, 432 secrete, 112 secretion, 113, 221, 227 security, xvii, 5, 20, 40, 51, 61, 62, 83, 87, 95, 98, 99, 247, 257, 303, 304, 305, 308, 309, 311, 312, 315, 316, 365, 386, 454, 476, 479, 491, 525 sedative, 348 sedatives, 529 sedentary, 413 sedentary behavior, 413 selecting, 76, 91, 394 selective serotonin reuptake inhibitor, 214 self, vii, xvi, xxiii, 9, 41, 42, 43, 44, 47, 48, 49, 50, 59, 60, 61, 62, 63, 64, 79, 107, 137, 158, 160, 180, 181, 277, 279, 281, 282, 284, 285, 286, 287, 289, 290, 292, 293, 294, 295, 296, 297, 298, 299, 300, 305, 306, 309, 322, 333, 358, 368, 386, 395, 424, 428, 434, 493, 494, 496, 497, 499, 500, 501, 511, 513, 515, 516, 517 self representation, xi, 35, 40, 41, 42, 43, 44, 45, 48, 56
Index self worth, 300 self-awareness, 453 self-care, 343 self-concept, 40, 48, 58, 59, 63, 132, 463, 466, 484, 497 self-conception, 463 self-confidence, 271, 272, 282, 342, 386 self-consciousness, 31, 105 self-determination theory, 61 self-efficacy, xvi, xxi, 48, 97, 273, 281, 287, 288, 289, 290, 294, 295, 296, 297, 341, 343, 386, 417, 423, 428, 444, 445, 516 self-enhancement, 45, 48, 60, 61 self-esteem, 39, 40, 42, 44, 45, 48, 55, 56, 60, 81, 83, 132, 272, 323, 342, 344, 353, 453, 498, 513, 531 self-evaluations, 48, 53, 56, 59 self-expression, 263, 495 self-image, 55, 345, 468, 495, 504 self-monitoring, 31 self-perceptions, 47, 48, 49 self-presentation, 55 self-recognition, 278 self-regulation, 193, 305, 306, 316 self-report, xii, xiv, xv, 7, 19, 30, 46, 48, 51, 55, 106, 108, 116, 149, 151, 152, 153, 154, 156, 158, 162, 163, 165, 168, 169, 174, 175, 176, 178, 179, 180, 181, 182, 185, 186, 224, 229, 231, 237, 239, 243, 249, 276, 286, 288, 311, 321, 343, 497, 499, 500, 516 self-study, xvii, 303, 308, 310, 311, 312 self-verification, 60, 61 self-view, 53 self-worth, 43 semantic, 151, 175, 477, 534 semantic memory, 477 semi-structured interviews, 152 sensation, 540 sensations, 12, 374, 526 sensitivity, 14, 15, 18, 115, 261, 325, 336, 348, 478, 495, 496, 497, 530 sensitization, 120, 128 sentences, 97 separate identities, 25 separateness, 261, 275 separation, 45, 73, 92, 94, 95, 96, 115, 124, 129, 150, 238, 370, 372, 377, 473, 477, 485, 519, 525, 529 septum, 112, 116, 122, 221, 373 sequelae, 354, 455, 456 series, 71, 89, 94, 126, 137, 154, 179, 233, 262, 290, 353, 372, 476, 500, 525, 532 serotonergic, xiv, xv, 213, 214, 215, 216, 217, 218, 235, 237
573
serotonin, ix, xiii, xv, 67, 213, 214, 215, 216, 217, 218, 224, 225, 230, 231, 235, 237, 238, 243, 370, 375, 525, 526, 530, 532, 537, 541 serum, 119, 128, 216, 377 services, iv, 90, 108, 109, 265, 329, 331, 351, 352, 452, 475, 536, 537, 542 SES, 323, 355 severe stress, xxiii, 493 severity, 11, 26, 44, 74, 80, 119, 169, 186, 218, 232, 234, 323, 335, 337, 350, 403, 421, 452 sex, xix, xxi, 32, 116, 136, 137, 144, 146, 154, 166, 170, 171, 178, 184, 187, 189, 220, 221, 224, 225, 227, 248, 252, 253, 289, 291, 297, 323, 374, 379, 382, 388, 417, 418, 419, 420, 421, 424, 425, 426, 427, 428, 429, 430, 431, 432, 433, 434, 435, 437, 438, 442, 443, 444, 445, 446, 447, 448, 535, 537, 540 sex differences, 146, 154, 178 sexual abuse, 496, 515 sexual activities, xxi, 418, 429, 437 sexual activity, 125, 132, 153, 178, 231, 419, 420, 425, 429, 433, 442, 443, 444, 535 sexual behavior, xx, xxi, xxiv, 117, 119, 123, 145, 220, 224, 238, 370, 378, 379, 417, 418, 419, 420, 421, 423, 424, 427, 435, 438, 439, 440, 442, 443, 444, 445, 449, 450, 519, 539 sexual behaviour, 117, 123, 224 sexual contact, 117 sexual experiences, 442, 448, 517 sexual health, xxi, 418, 433, 437, 438, 441, 442, 443, 444, 445, 449 sexual identity, 454 sexual intercourse, 224, 233, 234, 418, 421, 425, 427, 438, 443 sexual motivation, 526, 528, 539 sexual orientation, 536, 539 sexuality, xxi, 94, 125, 153, 417, 418, 419, 420, 421, 423, 424, 425, 430, 431, 432, 433, 434, 435, 438, 442, 452, 528, 530, 535, 541, 542 sexually transmitted diseases (STD), xxi, 417, 418, 420, 426, 427, 434, 435, 443 shame, xxiii, 10, 207, 343, 367, 493, 494, 495, 496, 497, 498, 499, 501, 502, 504, 505, 507, 509, 510, 511, 512, 513, 514, 515, 516, 517 shape, xvi, 57, 105, 200, 242, 281, 283, 287, 476, 530 shaping, xvi, xviii, 48, 260, 339, 341 shares, 3, 24, 70, 263, 482, 484 sharing, xiv, xvii, 3, 4, 7, 14, 16, 17, 25, 26, 108, 219, 260, 272, 282, 287, 291, 297, 319, 320, 384, 397, 414, 423 sheep, 114, 371, 377 shelter, 89, 91
574
Index
shoot, 534 short period, 5 short-term, 13, 67, 250, 371, 372 shy, 58, 352, 537 sibling, 344, 345, 483 siblings, xviii, 23, 32, 266, 327, 339, 341, 343, 344, 345, 359, 361, 362, 366, 396, 454, 483, 532 sickle cell, x, xvii, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359, 360, 361, 362, 363 sickle cell anemia, 340, 359, 360, 362 side effects, 453, 455 sign, 242, 536 signalling, 221 signals, xii, xiv, 111, 119, 121, 219, 221, 224, 227, 261, 285, 377, 477, 487, 526 signs, 26, 520, 522 silkworm, 220 similarity, xv, 15, 17, 19, 42, 50, 51, 53, 54, 61, 64, 193, 194, 195, 196, 200, 201, 202, 203, 204, 205, 206, 207, 208, 209, 245, 246, 247, 248, 249, 250, 252, 253, 254, 419, 509 simulation, 255 singular, 40 SIS, 309 sites, 9, 113, 273, 286, 379, 431, 452, 523, 531, 533, 536, 537 skills, xvii, xviii, xx, 7, 22, 91, 109, 150, 167, 170, 175, 185, 188, 193, 207, 267, 289, 303, 304, 305, 307, 308, 312, 349, 352, 356, 360, 365, 366, 382, 383, 394, 447, 454, 482 skills training, 360, 482 skin, 100, 223 skin conductance, 100, 223 sleep, 263, 269, 272, 348, 427, 475, 488 smiles, 266 smoking, x, 2, 3, 297, 403, 413 smooth muscle, 117 snakes, 100 SNAP, 160, 161, 162, 182 sociability, xvii, 267, 272, 319, 320, 384 social acceptance, xviii, 339, 345, 346 social activities, 462 social adjustment, 132, 138, 383 social anxiety, 119, 239, 241, 346, 362 social attitudes, 226 social behavior, xiv, xix, 114, 117, 124, 129, 210, 219, 221, 280, 369, 372, 373, 378, 384, 387, 446 social behaviour, 114, 225, 378 social categorization, 301 social change, xxi, 284, 396, 437 social class, 476
social cognition, 56, 57, 59, 60, 106, 116, 124, 223, 226, 383 social comparison, 29, 42, 47, 60, 283, 383, 384, 386 social comparison theory, 42 social competence, 263, 282, 370, 382, 383, 384, 395, 397 social construct, 278 social context, xviii, 116, 280, 282, 286, 330, 340, 341, 383 social control, 432 social desirability, 151, 153, 154, 169, 170, 176, 178, 179, 186, 187, 195, 276 social development, xvi, 132, 256, 281, 299, 382, 384, 386, 394, 397, 487 social dilemma, 29 social environment, 7, 374, 446 social events, 298 social exchange, 383 social exclusion, 90, 104, 106, 109 social factors, 386 social group, 10, 20, 23, 28, 29, 97 social identity, 14, 25, 28, 29, 33, 343 social identity theory, 25, 29, 33 social impairment, 66, 326 social influence, 247, 250, 252, 253, 254 social integration, 402, 433 social isolation, 14, 124, 341, 374, 402, 415 social learning, 117, 170, 187, 194 social life, xvii, 255, 282, 297, 386, 400, 455, 465, 467 social network, x, xv, 192, 245, 246, 250, 251, 252, 253, 255, 256, 257, 265, 282, 340, 342, 345, 346, 358, 382, 400, 402, 403, 404, 405, 409, 412, 416 social norms, 421, 423, 424, 445 social order, 208, 286, 289, 494, 497, 509 social organization, 116, 124, 235, 243, 378 social perception, 56 social phobia, 72, 74, 76, 79, 495 social policy, 280 social psychology, 34, 108, 256, 397, 447, 539 social relations, ix, xviii, xx, 14, 28, 70, 84, 118, 145, 193, 255, 256, 257, 260, 273, 339, 341, 357, 370, 375, 382, 383, 399, 400, 401, 402, 403, 404, 405, 406, 408, 410, 411, 412, 413, 414 social relationships, ix, xviii, xx, 14, 28, 70, 84, 118, 145, 193, 260, 273, 339, 341, 357, 370, 375, 382, 383, 399, 400, 401, 402, 403, 404, 405, 406, 408, 410, 411, 412, 414 social roles, 59, 283, 402 social rules, 385 social sciences, x, 1, 253 social services, 263 social situations, 91, 346
Index social skills, 91, 120, 346, 366, 368, 393 social standing, 21 social status, 247, 255 social stress, 379 social structure, 400 social support, xviii, xx, 30, 34, 68, 95, 100, 101, 102, 105, 106, 109, 162, 168, 170, 171, 185, 186, 188, 189, 246, 321, 330, 342, 360, 365, 367, 368, 399, 400, 401, 402, 403, 404, 408, 410, 412, 413, 415, 416, 455, 490, 514 social withdrawal, 118, 402 social work, 95, 109, 349 social workers, 349 socialisation, 207, 287 socialization, xvi, xviii, 193, 196, 204, 205, 206, 207, 209, 210, 256, 259, 261, 262, 263, 271, 274, 275, 278, 279, 280, 339, 382, 415, 476 socially, 50, 91, 116, 203, 206, 207, 230, 313, 346, 379, 403, 404, 406, 413, 532 society, xv, 7, 21, 66, 84, 121, 195, 199, 210, 230, 259, 262, 263, 277, 329, 357, 397, 456, 465, 476 sociocultural, 260, 261, 263, 264, 271, 272, 342, 355 socioeconomic, xvii, 279, 319, 320, 321, 343, 345, 347, 353, 355, 358, 443 socioeconomic background, 279 socioeconomic status, xvii, 319, 320, 321, 345, 355, 443 socio-emotional, 32, 263, 271, 272 sociologist, 494 sociology, 153, 177, 283, 435, 495 sociosexual, 224, 225, 226, 378 software, 250, 253, 255 soil, 534 solitude, 516 solubility, 220 solutions, 113, 306, 328, 385, 386, 387 somatic complaints, 344 sounds, 309 spasticity, 465 spatial, 289, 475, 486 specialists, xxii, 451 species, xiv, 89, 91, 114, 116, 117, 219, 220, 222, 372, 373, 374, 378, 532 specific knowledge, 12 specificity, xvii, 12, 81, 276, 282, 372, 373, 410 spectrum, 3, 129, 239, 241, 242, 243, 244, 452 speech, 17, 522 speed, 240 sperm, 426, 428 spheres, 296 spinal cord, 113, 122 spiritual, 529, 534, 535 sporadic, 44
575
sports, 288, 289, 366, 368 spousal support, 154 spouse, 57, 61, 70, 72, 74, 83, 95, 103, 154, 157, 168, 185, 331, 400, 409, 429 SPSS, 235, 240, 501 stability, xv, 52, 56, 57, 60, 81, 82, 99, 105, 109, 137, 153, 170, 171, 177, 187, 188, 192, 239, 245, 247, 248, 249, 262, 269, 285, 287, 393 stages, xiv, xviii, 10, 14, 28, 40, 57, 94, 95, 166, 179, 184, 213, 215, 217, 249, 286, 328, 339, 372, 523 STAI, 542 standard deviation, 40, 293, 390, 391 standard error, 246 standardization, 152, 177 standards, 41, 49, 193, 264, 347, 419, 467, 528 State-Trait Anxiety Inventory for Children, 328, 531 statistical analysis, 255, 256, 507 statistics, 67, 203, 247, 307, 434, 441 stem cell transplantation, 457 stereotype, xiii, 13, 191, 195, 196, 200, 201, 202, 203, 204, 205, 206, 208 stereotypes, 13, 21, 55, 60, 200, 345 stereotypical, 205, 207 sterile, 472 steroid, 225, 227, 379 steroids, xix, 114, 369, 371, 372 stigma, 21, 329, 331, 361 stigmatization, 515 stimulant, 3, 530 stimulus, 18, 20, 374 stomach, 530 storage, 89, 122, 523 strain, 25 strategies, xvi, 2, 25, 29, 96, 105, 153, 155, 162, 178, 193, 234, 246, 254, 259, 261, 268, 297, 322, 355, 356, 367, 382, 384, 385, 386, 387, 393, 394, 410, 411, 450, 474, 475, 486, 487, 498, 510 streams, 220 strength, 20, 137, 167, 184, 193, 196, 394, 419, 476 stress, xiv, 3, 61, 66, 73, 79, 80, 83, 84, 95, 102, 103, 104, 113, 115, 117, 118, 119, 125, 127, 151, 168, 175, 185, 207, 219, 220, 276, 287, 299, 304, 322, 325, 334, 340, 353, 354, 358, 360, 362, 366, 371, 372, 375, 376, 377, 379, 386, 401, 402, 405, 407, 408, 413, 414, 452, 454, 458, 477, 513, 531 stressful events, 168, 185, 371, 401, 402 stressful life events, 73 stressors, 73, 321, 330, 342, 343, 344, 347 stress-related, 61, 118, 372, 375, 377, 401 striatum, 215, 374 strikes, 10 stroke, 340 structural characteristics, 250, 407
576
Index
structural equation model, xxiii, 249, 250, 493, 501, 511, 512 structural equation modeling, 249, 250 structuring, xvi, 260, 268, 383 students, xiv, 7, 32, 107, 155, 179, 229, 231, 233, 285, 296, 342, 352, 355, 404, 434, 435, 441, 445, 449, 450, 499, 500, 503, 516, 526, 535, 536 stupor, 522 subarachnoid hemorrhage, 502 subjective, xvi, xxi, 19, 102, 170, 188, 227, 265, 282, 284, 286, 292, 297, 321, 379, 435, 437, 439, 442, 443, 444, 445, 519, 533 subjective experience, 265, 284 subjective well-being, 102 subjectivity, 287, 289 subsistence, 260, 265 substance abuse, 231, 238, 325 substance use, 257 substances, xi, xiv, 111, 112, 120, 219, 220, 222, 223, 226, 529 substantia nigra, 114, 374 substrates, 116, 124, 126, 378, 413, 530, 541 suburban, 156, 180 suffering, xxii, 18, 70, 76, 125, 239, 328, 349, 360, 361, 452, 454, 468, 504, 519, 521, 530, 531 sugar, 85, 262 suicidal, 367 suicidal ideation, 367 suicide, 502 summer, 289 superego, 495, 496 superiority, 51, 63, 64 supervisor, 93, 404 supply, 531 support staff, 351 suppression, 106, 117, 411 Surgeon General, 329, 336 surgery, 13, 107 surgical, 223 surrogates, 106, 107 survival, xviii, 101, 106, 114, 339, 369, 370, 372, 378, 387, 412, 413, 415, 455 survival rate, xviii, 101, 339, 455 survivors, 81, 455, 456, 457, 458, 459 susceptibility, 16, 121 sweat, xiv, 170, 187, 219, 220, 223 symbiotic, 279, 478 symbolic, 89, 193, 298, 397, 478, 479, 480, 486 symbolic systems, 480 symbols, 106, 208 symmetry, 73, 153, 178, 227, 282 sympathetic, 113, 322, 401, 406, 412, 474, 496, 530 sympathetic nervous system, 401
sympathy, 2, 521 symptom, 32, 79, 80, 84, 218, 230, 238, 242, 351, 515 symptomology, 345 symptoms, xvii, 11, 26, 66, 67, 72, 74, 75, 76, 80, 81, 83, 118, 119, 120, 126, 167, 184, 214, 215, 232, 242, 243, 306, 309, 319, 320, 321, 323, 325, 327, 330, 334, 335, 342, 343, 349, 350, 351, 352, 356, 357, 375, 403, 420, 438, 474, 486, 496, 521, 530 synapses, 214, 221 synaptic plasticity, 372 syndrome, 79, 119, 121, 124, 127, 129, 534 synthesis, xxi, 113, 118, 215, 437, 439, 440, 442, 445, 446 synthetic, 117, 223, 224, 225 Syphilis, 356 systematic, xi, xxiv, 35, 36, 44, 46, 47, 53, 55, 56, 246, 265, 458, 489, 519 systems, 80, 92, 94, 97, 115, 149, 152, 171, 176, 188, 215, 217, 221, 274, 277, 284, 298, 314, 370, 371, 375, 376, 401, 412, 440, 480, 485, 490, 524, 525, 532, 535, 538, 540
T tactics, 80, 315 tangible, 153, 155, 178, 400 target organs, 112 target population, 156, 441, 499 targets, 76, 205, 304, 366 task performance, 406 taste, 228 teachers, 325, 346, 351, 352, 367, 386, 388, 442 teaching, 30, 269, 274, 304, 305, 307, 309, 312 team members, 352 team sports, 290 technological, 528 technology, 357, 536 teenagers, 367, 418, 420, 425, 431, 432, 433, 447 teens, 144, 207 telephone, 5, 532 television, 7, 8, 34, 107, 288, 291, 348, 409, 431 television viewing, 8 temperament, 84, 125, 162, 165, 182, 323, 333 temporal, 223, 287, 289, 388, 455, 475, 486, 524 tension, 66, 222, 279, 496, 497, 498, 512, 513 terminals, 112, 221 territorial, xiv, 113, 219, 221 territory, 116, 528 test statistic, 246 testis, 113 testosterone, 223, 525, 530, 537
Index test-retest reliability, 137, 239, 309 thalamus, 113, 214 thalassemia, 340 theoretical, xv, xx, 16, 34, 36, 57, 75, 99, 102, 103, 105, 106, 107, 141, 145, 193, 196, 238, 245, 253, 279, 283, 288, 298, 383, 386, 397, 400, 401, 439, 446, 462, 467, 472, 480, 482, 490, 525 theoretical assumptions, 279 theory, xvi, xxi, 16, 23, 28, 31, 36, 39, 40, 41, 42, 52, 59, 60, 63, 81, 82, 87, 88, 90, 92, 93, 95, 98, 100, 102, 103, 105, 106, 107, 116, 143, 144, 145, 146, 147, 170, 187, 207, 208, 225, 260, 279, 280, 285, 304, 305, 307, 316, 317, 353, 377, 397, 405, 415, 434, 437, 439, 440, 442, 445, 446, 447, 448, 450, 462, 468, 473, 483, 487, 488, 489, 490, 491, 496, 513, 525, 539, 541 Theory of Planned Behavior, xxi, 437, 439, 447 therapeutic, xxii, 101, 215, 216, 347, 348, 350, 356, 357, 362, 454, 455, 471, 472, 473, 474, 475, 476, 478, 479, 486, 487, 488, 489, 490, 513 therapeutic change, xxiii, 471, 478, 479, 486 therapeutic goal, 101 therapeutic process, 488 therapeutic relationship, xxiii, 348, 350, 471, 473, 475, 476, 513 therapists, xxiii, 76, 152, 170, 176, 187, 211, 472, 473, 475, 476, 481, 483, 513 therapy, xi, 65, 67, 68, 69, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 95, 101, 104, 105, 107, 108, 150, 152, 166, 169, 170, 171, 176, 177, 183, 186, 187, 189, 225, 329, 358, 361, 448, 452, 454, 472, 473, 475, 477, 482 thinking, 52, 97, 193, 214, 269, 349, 383, 385, 386, 394, 405, 421, 479, 480, 520, 525, 528 threat, xviii, 28, 56, 69, 82, 94, 95, 97, 230, 238, 304, 306, 310, 312, 314, 316, 339, 344, 401, 420, 486, 516, 538 threatened, 3, 50, 97, 230, 304, 455 threatening, 60, 69, 82, 91, 94, 98, 117, 312, 367, 368 threats, 42, 115, 320, 472, 473 threshold, 232, 240, 241 thymus, 114 thyrotropin, 112, 120 tic disorder, 126 time frame, 254 time periods, 326 timing, xiv, 219, 220, 222, 324, 332 tissue, 373 title, 288, 440 tobacco, 262 toddlers, 279, 323, 327, 328 tolerance, 120, 128, 340, 345, 419
577
tourism, 261 toxic, 230, 238 toys, 266, 269, 273 trading, 264 tradition, 78, 199, 463, 490, 495 traffic, 503 training, 7, 33, 67, 75, 91, 100, 132, 312, 313, 314, 348, 351, 353, 356, 358, 457 trait anxiety, 531 traits, 61, 64, 82, 128, 161, 182, 215, 327, 531 trajectory, xviii, 143, 339 tranquilizers, 529 transactional stress, 353, 360 transactions, 150, 152, 175, 176, 193, 205 transcripts, 266, 423, 424, 425 transduction, 115, 221 transfer, 60, 94, 95, 105, 220, 480, 482, 531, 541 transference, xxiii, 472, 474, 480, 481, 482, 483, 484, 485, 486, 488, 489, 491 transformation, 476 transformations, 452, 516 transgression, 198, 209, 282 transition, 132, 166, 171, 184, 188, 194, 207, 251, 359 transition to adulthood, 207 transitions, 208 translation, 265, 283, 284, 286, 486 transmembrane, 221 transmission, xiv, 101, 125, 193, 205, 206, 207, 209, 210, 211, 213, 215, 217, 224, 272, 279, 335, 337, 373, 420, 426, 427, 438 transplant, 101, 107, 347 transplant recipients, 101, 107 transport, 218 transportation, 357, 452 trauma, 71, 81, 119, 127 travel, 97, 423 trees, 58 trend, 76, 494 TRF, 314 trial, 68, 76, 77, 82, 106, 317 trust, ix, xii, xiii, 25, 26, 33, 44, 92, 97, 116, 124, 149, 169, 173, 174, 186, 251, 258, 347, 356, 427, 464, 474 trusts, 90, 466 tryptophan, 216, 217, 218, 225 T-test, 201 tumor, 13 turbulent, 531 two-dimensional, 89, 93 two-dimensional space, 93 typology, 51, 93, 389, 390, 391, 392 tyrosine, 112, 123
578
Index
tyrosine hydroxylase, 112, 123
U ubiquitous, 29, 90, 509 ultrastructure, 222 uncertainty, 13, 14, 28, 50, 97, 234, 238, 343, 386, 454, 458, 468 undergraduate, 135, 223, 409 underlying mechanisms, 416 underreported, 321, 329 ungulates, 114, 370 UNICEF, 438, 450 uniform, 2, 521 unilateral, xi, 87, 90, 246, 249, 250, 253, 254, 475 unions, 262 United Nations, 438, 450, 532 United States, xvii, 81, 87, 121, 123, 171, 188, 234, 260, 273, 279, 339, 340, 341, 347, 438, 439, 450 United States Agency for International Development (USAID), 438, 450 units of analysis, xiii, 191 univariate, 270, 392 universities, 499, 536 university students, xiv, xxiii, 229, 231, 233, 242, 436, 493, 515, 531 unpredictability, 91, 92, 97 urban, xv, 259, 262, 264, 342, 359, 434, 438, 444 urban areas, 438 urine, xiv, 216, 219 US Department of Health and Human Services, 457 users, 224, 354 uterus, 113
V vacation, 473, 485 vacuum, 240 vagina, 223 vaginal, 117, 227, 445, 449 vagus, 113 valence, 124 validation, 30, 144, 146, 168, 185, 406, 415, 489 validity, xii, xiii, 17, 18, 19, 37, 108, 137, 149, 152, 156, 158, 161, 162, 163, 165, 166, 168, 170, 171, 173, 174, 179, 181, 183, 184, 187, 188, 209, 235, 239, 244, 497, 500, 515, 528 values, xxii, 9, 28, 50, 193, 194, 209, 216, 231, 240, 241, 252, 260, 261, 262, 263, 272, 294, 386, 390, 419, 421, 449, 451, 468, 495, 503, 505, 506, 508, 510, 537 variability, 40, 43, 53, 113, 129, 200, 272, 274, 324
variable, 6, 8, 20, 23, 40, 139, 140, 161, 163, 181, 195, 211, 247, 310, 311, 324, 325, 330, 355, 390, 497, 501, 502 variables, xii, xiii, xvii, 5, 32, 37, 39, 52, 76, 83, 101, 139, 142, 148, 149, 150, 161, 173, 174, 181, 195, 197, 206, 207, 247, 250, 264, 270, 311, 319, 320, 321, 322, 324, 325, 326, 327, 330, 331, 355, 358, 360, 367, 375, 390, 402, 406, 421, 442, 447, 449, 485, 486, 490, 498, 503, 505, 506 variance, xv, 154, 178, 181, 198, 233, 245, 247, 248, 270, 330, 445 variation, xv, 4, 40, 53, 61, 201, 247, 259, 260, 271 vascular, 113, 340 vascular system, 113 vasopressin, xix, 112, 122, 123, 124, 125, 127, 128, 129, 369, 370, 371, 372, 374, 375, 376, 378, 379, 525 vasopressin level, 371 vein, 98, 419 ventricles, 115 ventricular, 122 vertebrates, xi, 111, 112, 225 veterans, 71, 78, 81, 83, 124 victimisation, 368 victimization, 368, 496 victims, 193, 367, 368 video, 291, 348, 389, 431 video games, 348 Vietnam, 78, 81, 124 violence, 72, 83, 211, 217, 230, 420, 429, 430, 432 violent, 208 visible, 11, 352 vision, 522 visual, 22, 371, 374, 523 visual attention, 374 visual stimulus, 371 vocabulary, 478 vocalizations, 266 vocational, xvi, 211, 281, 287, 422 vocational education, 422 vocational interests, 211 voice, 145, 425 volatility, 220 voles, xix, 116, 117, 123, 124, 125, 235, 243, 369, 370, 372, 374, 378 vomeronasal, 221, 226, 227 vulnerability, 72, 121, 242, 340, 372, 421, 427, 433, 464, 467, 484
W waking, 540 war, 430
579
Index warrants, 143, 351 Washington, 29, 30, 31, 32, 34, 77, 78, 169, 186, 234, 255, 280, 315, 316, 361, 490, 541, 542 watches, 266 water, 112, 220, 352, 529 Watson, 42, 44, 46, 47, 48, 49, 50, 63, 64, 72, 82, 84, 158, 329, 337 weakness, 167, 184 wealth, 175, 331 wear, 224, 352 web, 494, 537 websites, 357, 536 weight loss, 21 welfare, 3, 464 wellbeing, 45, 374 well-being, xiii, xvi, 39, 55, 59, 61, 64, 88, 100, 101, 150, 169, 186, 191, 192, 208, 281, 282, 286, 287, 289, 290, 294, 297, 300, 304, 305, 306, 312, 321, 342, 344, 345, 346, 347, 349, 350, 359, 368, 414, 516 western countries, 420, 421 Western culture, 260, 277, 423, 494 Western societies, 263 wheelchair, 465, 466 wholesale, 476 Wikipedia, x, 1, 34 wisdom, 476 withdrawal, 113, 120, 122, 153, 178, 529 witness, 305, 348
witnesses, 348 wives, 69, 75, 156, 157, 158, 162, 163, 165, 180, 181, 182, 183 work environment, 516 workers, 165, 182, 409, 421, 448 working hours, 465 working memory, 284 workload, 351 workplace, 28, 30, 268 World Health Organization (WHO), 321, 338, 438, 450 worldview, 271, 273 worry, 66, 67, 68, 69, 74, 79, 83, 329, 343, 425, 512
Y yield, 154, 175, 310 young adults, xiii, 39, 58, 60, 104, 105, 191, 204, 210, 235, 243, 320, 362, 434, 452, 456, 541 young men, 224, 236, 524 young women, 223, 226 younger children, 7, 309, 311, 312, 313
Z zoonotic, 101
