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Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple-based intervention for BED. Vocally encoded emotional arousal was measured during couples' (n = 11) conversations about BED. As predicted, partners' emotional reactivity to patients' emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients' and their own distress. After treatment, partners' arousal was no longer associated with the patients' emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners' emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple-based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.La emociones negativas intensas y las estrategias conductuales desadaptativas para reducir el distrés emocional se producen no solo en pacientes con varias formas de psicopatología, sino también en sus parejas estables. Una estrategia común para disminuir el distrés es que las parejas se adapten a los síntomas del trastorno, lo cual reduce el distrés a corto plazo pero mantiene los síntomas a largo plazo. Se cree que la adaptación está motivada por la reacción conductual de la pareja a las emociones del paciente, pero las emociones de la pareja en este contexto aún no se han analizado. Este estudio piloto examinó cómo la adaptación de la pareja está relacionada con patrones específicos de corregulación emocional entre los pacientes con trastorno por atracón de alimentos y sus parejas, antes y después de una intervención en la pareja por trastorno por atracón de alimentos. Se midió la excitación emocional codificada en la voz durante conversaciones de las parejas (n = 11) acerca del trastorno por atracón de alimentos. Como se anticipó, la reacción emocional de las parejas a la excitación emocional de los pacientes estuvo asociada con una alta adaptación antes del tratamiento. Por lo tanto, las parejas pueden usar la adaptación como estrategia para reducir tanto el distrés de los pacientes como el propio. Después del tratamiento, la excitación de las parejas dejó de estar asociada con la excitación emocional de los pacientes. En cambio, las parejas demostraron una mayor estabilidad emocional con el tiempo, específicamente cuando la adaptación fue baja. Además, los pacientes estuvieron menos excitados emocionalmente después del tratamiento. En consecuencia, el tratamiento pudo haber disminuido la emocionalidad general de los pacientes y modificado la asociación entre la adaptación y la reacción emocional de las parejas. Si se reproduce, esta comprensión del contexto emocional asociada con la adaptación en los trastornos por atracón de alimentos puede fundamentar el tratamiento basado en la pareja abordando precipitantes emocionales específicos de conductas que mantienen los síntomas.强烈负面情绪和不良适应行为策略来降低情绪困扰不仅发生在各种精神病患者中间,而且发生在其稳定伴侣中间。一个常见减轻困扰的策略是伴侣适应紊乱症状,这会减轻短期困扰但长期症状维持不变。适应被认为是伴侣行为上对患者情绪反应所激发,然而在这一背景下伴侣的情绪还没有研究. 该试点研究考察了以伴侣为基础的针对过食症干预措施之前和之后伴侣适应如何与过食症患者和其伴侣情绪共同管理特定模式相关联。我们在伴侣双方(n = 11)关于过食症进行对话过程中测量了通过声音加码的情绪唤醒。和预期一样,配偶对于患者情绪唤醒和情绪反应和治疗前高度适应相关。因此,伴侣可能使用适应作为一种策略来降低患者以及自身困扰。治疗后,伴侣唤醒不再和患者情绪唤醒相关联。相反,伴侣表现出更强的长期情绪稳定性,特别是当适应较低时。此外,患者在治疗后情绪唤醒较少。因此,治疗可能会总体降低患者情绪化并改变适应和伴侣情绪反应之间的关联。如果通过复制,对于过食症适应情绪背景的这一理解可以通过针对特定维持症状行为情绪促使因素来影响伴侣为基础的治疗。.

Adult anorexia nervosa (AN) often is persistent, significantly erodes quality of life for both the patient and loved ones, and carries high medical and psychiatric comorbidity. Whereas individual psychotherapy for adult AN leads to improvement in some patients, recent findings indicate that the magnitude of improvement is limited: Only a small percentage of individuals fully recover and dropout rates are high. Thus, it is important to build upon current interventions to improve treatment response. We present results from an open trial of a couple-based intervention for adult anorexia nervosa as an adjunct treatment to standard multidisciplinary care. Twenty couples received treatment over approximately 26 weeks, including a couple-based intervention, individual CBT sessions, psychiatry visits for medication management, and nutritional counseling sessions. The results indicate that patients improved at posttest and 3-month follow-up on a variety of AN-related measures, anxiety and depression, and relationship adjustment. Partners also improved on anxiety, depression, and relationship adjustment. In an exploratory analysis, the multicomponent couple treatment intervention was benchmarked to well-conducted randomized controlled trials of individual therapy for AN; the couple intervention seems to compare favorably on AN-related measures and was associated with a lower dropout rate. In spite of methodological limitations, the findings suggest that including partners in the treatment of adult AN holds potential for bolstering treatment outcomes. (PsycINFO Database Record

Impaired emotion regulation and maladaptive strategies to manage distress are central to psychopathology, including obsessive-compulsive disorder (OCD) and anorexia nervosa (AN). Emotion regulation can be fostered or thwarted by romantic partners, and the tendency to rely on interpersonally oriented emotion regulation may vary by disorder. This study examined coregulation as a form of interpersonal emotion regulation in OCD and AN. We hypothesized that OCD is associated with exaggerated and AN with diminished coregulation, and that OCD patients have greater overall levels of emotional arousal than AN patients. Greater symptom severity was expected to exacerbate these opposing tendencies. Vocally encoded emotional arousal was measured during couple conversations in 34 AN patients, 18 OCD patients, and their partners. Two indicators of coregulation (covariation and coupling) were analyzed using cross-lagged actor-partner interdependence and coupled linear oscillator models. As hypothesized, OCD was associated with greater overall emotional arousal than AN. Symptom severity was not associated with emotional arousal or coregulation. Covariation differed in the opposite direction of the hypothesis; there was no difference in coupling. AN patients exhibited consistent coregulation, indicating high reactivity to partners' emotional arousal which may contribute to interpersonal avoidance. OCD couples showed limited predictability of patients' arousal over time, while partners were affected by the patients' emotional arousal; thus, symptom accommodation may in part be partners' attempts at managing their own distress along with the patients'. A better understanding of interpersonal emotion regulation in OCD and AN can inform treatment by targeting interaction patterns that may maintain symptoms. (PsycINFO Database Record

Objective To evaluate the feasibility, acceptability, and preliminary efficacy of a couple-based intervention for binge-eating disorder (BED), called UNiting couples In the Treatment of Eating disorders-BED edition (UNITE-BED). Method In an open pilot trial, 11 couples in which one or both adult partners had a diagnosis of DSM-5 threshold or sub-threshold BED participated in 22 weekly sessions of UNITE-BED. Patients also received individual treatment, outside of the context of the trial. Couples completed measures on treatment satisfaction, eating disorder symptom severity, depression, anxiety, emotion regulation, and relational functioning at post-treatment and 3-month follow-up. Statistical analyses were conducted to identify change over the course of treatment. Results UNITE was feasible and acceptable to the majority of couples (9% dropout; high satisfaction ratings). Objective binge abstinence was 81.8% and subjective binge abstinence was 45.5% by post-treatment. Patient binge-eating symptomatology reduced over the course of treatment with results maintained at follow up. Patients' depression symptoms decreased and patients' emotion regulation improved at both time points. Discussion Including partners in treatment for BED may be beneficial. Results support further evaluation of the efficacy of couple-based interventions for BED in larger randomized-controlled trials.

Women who are diagnosed with breast cancer can experience an array of psychosocial difficulties; however, social support, particularly from a spouse, has been shown to have a protective function during this time. This study examined the ways in which a woman's daily mood, pain, and fatigue, and her spouse's marital satisfaction predict the woman's report of partner support in the context of breast cancer. Pretest data from a larger intervention study and multilevel modeling were used to examine the effects of women's daily mood, pain, and fatigue and average levels of mood, pain, and fatigue on women's report of social support received from her partner, as well as how the effects of mood interacted with partners' marital satisfaction. Results show that on days in which women reported higher levels of negative or positive mood, as well as on days they reported more pain and fatigue, they reported receiving more support. Women who, on average, reported higher levels of positive mood tended to report receiving more support than those who, on average, reported lower positive mood. However, average levels of negative mood were not associated with support. Higher average levels of fatigue but not pain were associated with higher support. Finally, women whose husbands reported higher levels of marital satisfaction reported receiving more partner support, but husbands' marital satisfaction did not moderate the effect of women's mood on support. Implications of these findings are discussed relative to assisting couples during this difficult time in their lives.

The interpersonal context of anorexia nervosa (AN) is critical in adolescents, both in terms of the maintenance and treatment of the disorder.1–3 However, for AN patients who are adults, their romantic partners may be their primary interpersonal relationship.4–6 Importantly, recent research suggests that involving partners in treatment of AN can be quite valuable.7 Thus, it is important to better understand partners’ experience of and behavioral responses to AN to inform treatment. Romantic relationships often experience significant strain related to AN,8–10 and family members report high levels of caregiver distress.11 However, it is unclear what predicts the partners’ distress. In addition to symptom severity,12 other features of AN such as patients’ low motivation to change appear to impact partners.13 Patients’ experience of negative consequences due to AN is considered an important predictor of readiness for change,14 and patients who recognize few negative consequences may be reluctant to engage partners in recovery. Partners may be troubled if patients do not recognize the adverse effects of AN and may feel frustrated or hopeless that the patient will improve.15,16 In addition, this dynamic may interfere with adaptive dyadic coping,17 and a less favorable interpersonal environment for AN may be the result. In addition, partners react to AN in ways that may inadvertently facilitate or detract from their own and the patients’ ability to cope. For example, partners may engage in behaviors that aim at promoting changes in AN-related behavior and fundamental beliefs in the patients toward recovery, e.g., monitoring the patient’s eating or trying to convince the patient she is thin. Also, partners may try to show acceptance and understanding as patients struggle with AN, for example, by expressing empathy for how challenging recovery is. These two behavioral strategies are defined as Change Promotion and Acceptance/Validation in the current study. Use of these constructs does not imply that partners employ them effectively or communicate their intentions constructively, only that they are salient goals that the partners actively pursue. The goal of the current study was to explore how patients’ perceived negative consequences of AN and partners’ behavioral strategies are related to the partners’ distress across three domains – relationship satisfaction, caregiver distress, and negative affect, after controlling for AN severity. Patients’ lower perceived negative AN consequences was expected to be associated with greater partner distress. In addition, an interaction effect was expected between the patients’ perceived negative consequences and partners’ change promotion. More specifically, partners with high change promotion would experience more distress if patients’ reported negative consequences were low because this directly interferes with the partners’ goal of change toward recovery; conversely, partners with low change promotion would experience less of an impact from patients’ low reported negative consequences. Further, it was expected that a higher level of acceptance/validation behaviors of the partners would be associated with less partner distress. Engagement in these behaviors may be rewarding for partners irrespective of patients’ perception of negative consequences of AN, because the partners’ efforts are directed at showing understanding, rather than at change. An interaction effect was included for exploratory purposes.

The current paper discusses general principles, therapeutic strategies, common factors, and domains commonly addressed in the treatment of couples who have a partner with a medical condition. Couple-based interventions for medical problems are contrasted with couple therapy and relationship education in that the emphasis is on assisting the patient in addressing the medical disorder, along with being attentive to the patient's partner and their relationship. Guidelines are provided showing how knowledge and understanding of medical disorders and couple functioning are integrated in order to conduct such interventions. Five common domains addressed during intervention are elaborated upon: (a) psychoeducation about the disorder, (b) sharing thoughts and feeling regarding the disorder, (c) making decisions focal to the medical disorder, (d) implementing relationship changes that are nonmedical but that result from the disorder, and (e) addressing relationship functioning unrelated to the disorder. The importance of empirically demonstrating the utility of each domain in future investigations is noted.

Objective: This study examined whether the relationship between daily spousal support and dailypsychological and physical outcomes varied as a function of level of breast cancer related concern (stressbuffering model). Design: Ninety-five women with early stage breast cancer completed daily reports ofemotional and physical experiences and satisfaction with spousal support for 30 days. Women also ratedproblems dealing with three types of cancer specific concerns: emotional, physical, and social. Mainoutcome measures: Women’s positive and negative affect and cancer related pain and fatigue. Results:Multilevel analyses supported a stress buffering effect for social concerns and a reverse stress bufferingeffectforemotionalandphysicalconcerns. Conclusion: Dailyspousalsupportappearstobeanimportantcontributor to the daily emotional and physical wellbeing of women with breast cancer. Contrary to thetenets of the stress buffering model, these data suggest that the buffering effect of spousal support isattenuated when breast cancer related emotional and physical concerns reach high levels.Keywords: spousal support, early stage breast cancer, couples, oncology, reverse stress buffering

Anorexia nervosa (AN) is a serious psychiatric disorder that often follows a protracted course, and continues to confound those who attempt treatment once the patient has reached adulthood. Several randomized clinical trials for adults with AN have tested well-known therapies such as cognitive behavior therapy, supportive psychotherapies, or focal psychodynamic therapy, all of which have delivered frustratingly few helpful treatment strategies. Perhaps a different path could be pursued where we do not aim to cure all patients with 1 or 2 of these well-trodden therapies. Instead, a more targeted alternative, testing several novel approaches, could collectively reach a larger cohort of patients suffering from AN, the most lethal of all psychiatric disorders. (PsycINFO Database Record

Objective: Despite mounting evidence supporting the use of psychosocial interventions to promote adaptation to cancer, enrolling participants into these interventions is challenging. This is particularly salient for couple-based interventions, and newer, more targeted recruitment strategies to increase enrollment are needed. However, there have been few published empirical studies focused specifically on recruitment-related variables associated with enrollment into these types of interventions. To better understand how to encourage participation in couple-based psychosocial interventions for cancer, we examined facilitating and impeding factors to enrollment into a couple-based intervention for women with early-stage breast cancer. Method: In this sample of 99 women diagnosed with early-stage breast cancer, patient demographic variables and method of approaching eligible patients were examined as predictors of enrollment into a randomized controlled trial comparing couple-based relationship enhancement with treatment as usual. Results: Results indicated that women were more likely to enroll if they were contacted at home or at a follow-up medical appointment rather than when first diagnosed at a busy multidisciplinary clinic; they were also more likely to enroll the closer they lived to the research facility. Conclusions: In addition to decreasing participant burden, timing and setting of recruitment efforts may have important implications for enhancing participation rates in couple-based intervention studies for cancer. Copyright © 2008 John Wiley & Sons, Ltd.

Adult anorexia nervosa (AN) is a serious and often fatal illness that significantly erodes quality of life for both the patient and loved ones. Treatment of adults with AN has focused largely on individual therapy, with recent findings suggesting that improvement is limited and dropout rates are high. In an effort to improve treatment response, we developed a couple-based intervention, Uniting Couples in the treatment of Anorexia Nervosa (UCAN) as an adjunct treatment to standard multidisciplinary care. UCAN leverages the support of a partner and the relationship in treatment by decreasing avoidance around AN, teaching the couple how to effectively address the eating disorder, and helping to foster a more satisfying relationship. This paper presents a case study of a couple who completed UCAN, "Laura and Steve," including their experiences in treatment and outcome measures at pretest, posttest, and 3-month follow-up. Laura showed clinically significant change on the Restraint subscale of the Eating Disorders Examination at follow-up, and both partners showed clinically significant improvements in relationship satisfaction, as well as on self-reported and observed communication. Both partners reported very high satisfaction with the treatment. A discussion of therapists' experiences in delivering UCAN is provided, including common challenges for therapists with primarily a couple therapy or an individual CBT for eating disorders background, as well as important factors for therapists to consider in order to optimally leverage the benefits of including partners in treatment for AN. (PsycINFO Database Record

Given the reciprocal influences of emotion dysregulation and relationship functioning, it is important to target such emotional difficulties within an interpersonal context. Treating emotion dysregulation within intimate relationships can offer valuable opportunities for both emotional and relationship difficulties to be addressed. This paper reports the development and implementation of one such intervention, which helped couples to address both emotion dysregulation and relationship dynamics. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this 16-week group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. This paper provides a clinical description of this treatment, along with a case study and empirical data for this case.

This article reports the development of a couple-based intervention in which at least one partner had experienced chronic difficulties in emotion regulation, operationalized as having participated in a yearlong dialectical behavior therapy (DBT) skills training group. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. The effects of treatment were evaluated in terms of relationship satisfaction and individual well-being. Sizeable treatment effects were found in several domains, including a reduction in DBT graduates' depressive symptoms and emotion dysregulation, and an increase in their partners' relationship satisfaction and confidence in their graduate spouses' ability to regulate emotions.

A significant number of adults with eating disorders fail to achieve relief from the disorder, with many dropping out of treatment or relapsing. The standard treatment remains individual therapy despite partners being negatively affected and typically wanting to help in an effective and loving way. We propose that couple-based interventions, which leverage the support of a partner and the relationship in treatment, may improve outcome and recovery rates for adults with eating disorders. In this article, we survey the empirical literature supporting the treatment of adults in a couple context and describe our existing and emerging couple-based interventions for eating disorders.

The current paper reviews the literature regarding psychosocial issues confronting young women with breast cancer. The findings indicate that younger women with breast cancer experience a lower quality of life after cancer compared to older women. In part, this lower quality of life results from the effects of medical treatment. The effects of surgery and removal of the breast result in more negative feelings regarding body image, particularly for young women. With systemic treatment, many younger women experience the sudden onset of menopause, with the attendant symptoms of hot flashes, decreased sexual desire, and vaginal dryness. These physical effects along with a variety of relationship issues contribute to a high level of sexual concerns for young women. From a psychosocial perspective, breast cancer affects both females and their male partners. Both partners experience psychological distress including depression and anxiety. Within the relationship, emotional support from the partner is important in women's adjustment. In terms of psychosocial interventions for breast cancer, findings suggest that the most frequently employed interventions, which treat the woman without her partner, are not optimal. Initial findings provide encouraging evidence that couple-based psychosocial interventions for women and their partners might be of particular assistance to both partners.

Whereas most couples enter into marriage or similar committed, romantic relationships with the full expectation that they will live their lives together in a happy and rewarding manner, the divorce rate in the United States and many Western countries continues to be alarmingly high—in the United States hovering around 50%. As a result, mental health practitioners have focused energy on ways to alleviate relationship distress. Many approaches for assisting distressed couples have been developed, yet few have been evaluated to demonstrate that they actually help couples. The current chapter provides an overview of the major models of couple therapy that have been evaluated in well-controlled research studies and have demonstrated that they benefit couples. The models included are: behavioral couple therapy, cognitive-behavioral couple therapy, integrative behavioral couple therapy, emotionally focused couple therapy, and insight-oriented couple therapy. For each model, the theoretical approach, overall interventions, and effectiveness are discussed.

Previous research indicates that men are affected when their female partners have breast cancer. However, little is known about what predicts men’s psychological well-being in this context. The current investigation involved couples in which the woman had early stage breast cancer and explored the degree to which men’s positive and negative well-being was related to women’s well-being, women’s physical symptoms, relationship functioning, and relationship duration. The findings indicate that all of these factors play a role and interact in predicting men’s well-being. In particular, when women have a high level of physical symptoms, the typical associations between men’s well-being with women’s well-being and relationship adjustment no longer persist. Implications for working with couples addressing health problems are provided.

Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment—especially in adults—is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her or his partner in the treatment process. This article describes the theoretical rationale behind the development ofUniting Couples (in the treatment of) Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.

OBJECTIVE: Although women's breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple-based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time. METHOD: In this pilot study, 14 couples in which the wife had early stage breast cancer were randomly assigned to one of the two treatment conditions: Couple-based relationship enhancement (RE) or treatment-as-usual (TAU). RESULTS: The results from this study suggest that compared with couples receiving treatment-as-usual, both women and men in the RE condition experienced improved functioning on individual psychological variables as well as relationship functioning at posttest and 1-year follow-up. In addition, women in RE show fewer medical symptoms at both time periods. CONCLUSIONS: In this pilot study, the couple-based intervention, RE, has shown promise in improving individual, medical, and relationship functioning for couples in which the woman is facing breast cancer, and therefore merits further investigation on a larger scale.