Re-thinking dyadic coping in the context of chronic illness

Re-thinking dyadic coping in the context of chronic illness

Accepted Manuscript Title: Re-thinking Dyadic Coping in the Context of Chronic Illness Author: Hoda Badr Linda K. Acitelli PII: DOI: Reference: S2352...

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Accepted Manuscript Title: Re-thinking Dyadic Coping in the Context of Chronic Illness Author: Hoda Badr Linda K. Acitelli PII: DOI: Reference:

S2352-250X(16)30003-3 http://dx.doi.org/doi:10.1016/j.copsyc.2016.03.001 COPSYC 256

To appear in: Received date: Accepted date:

14-3-2016 18-3-2016

Please cite this article as: H. Badr, L.K. Acitelli, Re-thinking Dyadic Coping in the Context of Chronic Illness, COPSYC (2016), http://dx.doi.org/10.1016/j.copsyc.2016.03.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

1 Highlights

 The importance of viewing chronic illness in the context of dyadic relationships is discussed.

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 Existing models involving psychosocial interventions to improve couples’ coping with and adjustment to chronic illness are briefly reviewed.

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 A new model is presented that emphasizes cognitive processes occurring before appraisal begins and throughout the coping process.

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 The interplay between individual and dyadic coping processes is a fruitful area for new research.

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 We recommend couple-based interventions to occur soon after diagnosis or very early in the treatment process.

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Re-thinking Dyadic Coping in the Context of Chronic Illness

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Hoda Badr1 and Linda K. Acitelli2

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Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, One Gustave L Levy Place, Box 1130, New York, NY 10029 2

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University of Houston, Department of Psychology, Houston, TX 77204-5022

Corresponding author: Linda K. Acitelli, [email protected]

Word Count: 2000

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Abstract In the past two decades scholars have increasingly recognized the importance of viewing

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chronic illness in a relationship context. However, questions remain regarding how couples make sense of illness, how they negotiate and coordinate coping, and the extent to which

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viewing the illness as a shared problem is beneficial for individual and relationship outcomes. This article seeks to clarify the role that couple relationships play in chronic illness adaptation by

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first describing major theoretical frameworks that have guided research in this area. Next, we propose a new model that emphasizes cognitive processes occurring before appraisal begins

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and throughout the coping process. We conclude by positing future research directions and

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implications for couple-based psychosocial interventions.

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Chronic illnesses such as heart disease, cancer, and diabetes are among the leading causes of death and disability in the United States [1]. The diagnosis of a chronic illness can be

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a life-altering experience that signals profound changes in an individual’s life. However, most people do not get sick in isolation or cope alone. For those who are married or in a committed

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relationship, their relationship with their partner (spouse or significant other) is their primary

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coping resource [2]. Partners often take an active role in medical decisions and provide emotional support [3,4]. As the primary setting for care has shifted from hospital to home, many

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have replaced skilled healthcare workers in the delivery of everyday care [5]. Partners often assume their caregiving role with little or no preparation or training [6]. They must also cope with feelings of loss and sadness associated with changes in life plans and watching their loved one

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suffer [7]. Although traditional approaches for addressing coping and adjustment to chronic illness have focused on the individual, both members of the couple and their relationship are

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profoundly affected [8-11]. Illness challenges couples’ established communication patterns, roles, and responsibilities [12,13]. Thus, it is not surprising that some report chronic illness

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brought them closer together and others report significant adjustment problems that fuel

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interpersonal conflict and result in divorce [14,15]. Over the last two decades, scholars have recognized the importance of viewing chronic illness in a relationship context and a burgeoning literature involving psychosocial interventions to improve couples’ coping and adjustment has emerged [16-21]. However, questions remain regarding how couples make sense of illness, how coping is negotiated between partners, and to what extent viewing the illness as a shared problem is beneficial. Here, we seek to advance our understanding of the role that couple relationships play in chronic illness adaptation by first describing major theoretical frameworks that have guided research in this area. Next, we

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5 propose a new model that we believe holds promise for future dyadic coping research. We conclude by positing future directions and clinical implications.

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Models of Dyadic Coping Various terms have been used to describe how couples cope with chronic illness

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including: relationship-focused coping [22], communal coping [23,24], collaborative coping [25], “we talk” [9,26], coping congruence [27], and dyadic coping [10,11]. Although these terms are

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often used interchangeably, we use the term dyadic coping to refer to the different ways that couples can interact (e.g., uninvolvement, support, collaboration, control, protective buffering,

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overprotection) as they manage illness-related stressors [10,11].

Berg and Upchurch [10] proposed a developmental-contextual model (DCM) of stress

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and coping in which couples’ appraisal of and coping with chronic illness are processes that occur over time and are bidirectional in influence. Appraisals are defined as subjective

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interpretations of an event as harmful or beneficial and include assessments of the coping strategies and resources needed to deal with the situation [28]. According to the DCM,

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contextual factors such as culture, age, gender, type or stage of illness, and marital quality can influence illness appraisals, appraisals inform coping, and coping informs outcomes. Although

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the DCM acknowledges that people can appraise a stressor as either an individual or shared problem, shared appraisals are the starting point for dyadic coping. Recent studies provide partial support for the DCM through their examination of dyadic appraisals of intrusive thoughts about prostate cancer [29], dyadic coping strategies of posttraumatic stress disorder victims and their spouses [30], and associations between contextual factors, dyadic appraisals, and dyadic coping in a mixed sample of couples coping with chronic illness [31]. Although these studies support the notion that couples can respond to stress as a unit, research has also shown that patients and partners have their own unique stressors in addition to their shared stressors as a couple [32,33]. Patients and spouses may also benefit differently from individual and dyadic

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6 coping strategies [32,34-36]. However, the DCM does not directly address the interplay between individual and dyadic coping. Bodenmann’s [11] Systemic Transactional Model (STM) of couples coping with stress

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requires that stress be experienced by at least one partner and emphasizes the transactional nature of the coping process. Dyadic coping is comprised of the stress signals of one partner,

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the verbal or nonverbal coping responses of the other partner, and the couple’s joint coping efforts. It can be problem- or emotion-focused and take on positive and negative forms.

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Examples include common dyadic coping (both partners engage in joint problem solving or the sharing of feelings), supportive dyadic coping (one partner provides support to assist the other

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with his/her coping efforts), and delegated dyadic coping (one partner explicitly asks the other to provide support).

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Bodenmann further describes a stress-cascade process whereby individual and dyadic coping efforts come into play and are applied in sequence [11]. Following the onset of stress,

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people start coping on their own; however, in cases of prolonged stress, individuals seek out social resources and engage in dyadic coping. Even if an individual is engaging in dyadic

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coping, he or she will continue to engage in individual coping efforts, suggesting that individual and dyadic coping occur simultaneously under conditions of prolonged stress. Research

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supporting Bodenmann’s model has shown that couples in stable relationships demonstrated more individual and more dyadic coping strategies over a 5 year period compared to distressed couples [37]. Likewise, dyadic coping has been shown to be a stronger predictor of relationship functioning than individual coping strategies [38]. Studies examining the link between dyadic coping and individual well-being suggest promising areas for new research. Interestingly, such studies have not found substantive, direct associations between these constructs [39]. Thus, it is possible that dyadic coping may be more closely related to relationship outcomes (e.g., relationship satisfaction) and individual coping may be more closely related to individual outcomes (e.g., psychological adjustment and

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7 behaviors). An alternate possibility is that dyadic coping is indirectly associated with individual outcomes. Supporting this idea, a cross-sectional study of couples in which one partner was diagnosed with type 2 diabetes found that dyadic coping was related to better patient dietary

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and exercise adherence via the mechanism of diabetes self-efficacy [40]. Extending this idea, researchers studying how couples cope with incontinence after prostate cancer found that

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individual planning was more important for the initial uptake of a new health behavior (i.e., pelvic floor exercises), but that dyadic planning played a role in the maintenance of that behavior [41].

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A New Model of Dyadic Coping

Although existing models focus on different aspects of dyadic coping, no comprehensive

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model exists to describe how couples make sense of and negotiate coping with chronic illness. We propose the Cognitive-Transactional Model (CTM) of couples’ adaptation to chronic illness

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(see Figure 1). While the CTM builds upon existing models of dyadic coping, it extends them in a number of important ways. First, it is specific to the illness context and acknowledges that

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illness-related contextual factors (e.g., health literacy, disease stage, functional disability, length of time since diagnosis) can influence each aspect of the model. Second, it synthesizes the

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DCM and STM by describing the circumstances under which relational partners may engage in individual or dyadic coping as well as the process by which couples negotiate coping. Third, it

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articulates processes that occur in the illness context before appraisal that deserve more research attention. Finally, it introduces the concepts of self-efficacy [40] and dyadic efficacy (i.e., confidence in the ability to work together as a team) [42], to explain how individual and dyadic coping affect psychological, behavioral, and relational outcomes. To illustrate the different components of the model, imagine a couple in which both members are relatively healthy, and after 10 years together, one partner is diagnosed with a chronic illness. At first, the partners may be in shock and not understand the implications of the diagnosis [43]. Never having experienced chronic illness before, they may expect it to be a temporary interruption [44,45]. Soon, but maybe not simultaneously, both partners observe that

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8 the ill partner has to adapt to accomplish everyday tasks. The well partner may offer to help or not know what to do. Each partner, perhaps at different times, comes to realize that “chronic” means the disease is something one may deal with every day and does not disappear [46]. The

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illness might be relapsing and remitting, introducing uncertainty into the couple’s daily routine. What may have been perceived as a temporary interruption is now the new normal. What

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seemed to be an individual stressor which necessitated an individual coping process is now a relationship stressor that will require dyadic coping.

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Such a scenario suggests that individual processing (i.e., illness representations, illness ownership) is required before dyadic appraisal can begin. Sometimes ill individuals do not hold

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adequate representations for their own illnesses. These misperceptions can have an important influence on how the person chooses to cope [46]. Individuals need to first understand what the

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illness is and what it means for their everyday lives [47] in order to develop schemas and assign ownership [48]. Even if the ill partner does identify her own illness, the well partner may still be

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uncertain about what the diagnosis means. For example, if one partner has fibromyalgia, and the other has no idea she is in pain, why would the healthy partner have to cope? Because the

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well partner does not have direct access to the ill partner’s physical symptoms or cognitions, dyadic appraisal requires communication between partners about the problem and the

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perception that the partner is responsive and supportive [2]. Such adaptive communication may help reduce uncertainty [13], facilitate the development of shared appraisals [49], and foster dyadic coping. When both partners own the illness and work to support each other and the relationship, it is anticipated that this will result in improvements in self-efficacy [40] and dyadic efficacy [42], which in turn, should be positively associated with individual and relationship outcomes. Future Research Directions and Clinical Implications We hope the CTM will propel the growing field of dyadic coping by stimulating both descriptive and intervention research. Although we agree that shared appraisals and communal

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9 coping are laudable goals for interventions, researchers need to step back to figure out how partners learn to adopt similar and shared appraisals of the relationship challenge. More studies are needed to understand the associations between illness representations, appraisals,

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communication, and coping, and how these factors vary with each other and over time. Future research may also benefit from understanding the interplay between individual and dyadic

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coping, the circumstances under which one type of coping may be more or less adaptive than the other, and the mechanisms by which dyadic coping may influence the uptake and/or

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maintenance of health behaviors.

Understanding how couples communicate and negotiate coping is an important research

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goal with direct implications for couple-based interventions. Researchers should explore how couples’ avoidance of specific illness-related topics influences individual and couple adjustment.

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For example, strategically deciding not to disclose or avoiding certain topics may be ways that individuals cope with illness-related stressors and partners are likely to differ from one another

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in their topic avoidance appraisals [50]. Finally, our review has highlighted the fact that the majority of the literature on dyadic coping focuses on chronic illnesses in contexts that entail

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physical disorders, not mental disorders; psychosocial outcomes, and not physical outcomes or health behaviors; and heterosexual couples. More work is needed to clarify the role that

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contextual factors play in couples’ illness representations, identification and ownership, appraisals, coping, and outcomes. The CTM also has several clinical implications. First, psychosocial interventions for couples coping with chronic illness should be offered soon after diagnosis or very early in the treatment process for maximal effect. Second, interventions should educate couples about the illness, its impact on daily life, and tasks involved in day-to-day illness management. Finally, because a mismatch between appraisal and coping strategies may be problematic for adjustment, interventions that provide communication skills training to teach couples how to

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10 solicit/provide support and coordinate care may directly improve relationship adaptation and

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indirectly improve individual health and lifestyle behaviors by improving self-efficacy.

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References [1] Centers for Disease Control and Prevention: Death and Mortality. NCHS FastStats

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Website. 2013. http://www.cdc.gov/nchs/fastats/deaths.htm. [2] Manne S, Badr H: Intimacy and relationship processes in couples' psychosocial

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adaptation to cancer. Cancer 2008, 112:2541-2555.

[3] Levesque JV, Lambert SD, Girgis A, Turner J, McElduff P, Kayser K: Do men with prostate

us

cancer and their partners receive the information they need for optimal illness self-management in the immediate post-diagnostic phase? Asia-Pacific Journal of

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Oncology Nursing 2015, 2:169.

[4] Rosland A-M, Heisler M, Piette JD: The impact of family behaviors and communication

Medicine 2011, 35:221-239.

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patterns on chronic illness outcomes: a systematic review. Journal of Behavioral

Control 2001, 8:36-45.

ed

[5] McCorkle R, Pasacreta JV: Enhancing caregiver outcomes in palliative care. Cancer

pt

[6] Blum K, Sherman DW: Understanding the experience of caregivers: a focus on

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transitions. In Seminars in Oncology Nursing: Elsevier: 2010:243-258. [7] Weingarten K: The “cruel radiance of what is”: Helping couples live with chronic illness. Family process 2013, 52:83-101. *[8] Karademas E: The psychological well-being of couples experiencing a chronic illness: A matter of personal and partner illness cognitions and the role of marital quality. Journal of health psychology 2014, 19:1347-1357. This study shows how individuals’ cognitions relate to their partners’ psychological symptoms via a flow of information between partners.

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12 [9] Acitelli LK, Badr H: My illness or our illness? Attending to the relationship when one partner is ill. In Couples coping with stress: Emerging Perspectives on Dyadic Coping. Edited by Revenson T, Kayser K, Bodenmann G: American Psychological Association;

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2005:121-136. [10] Berg CA, Upchurch R: A developmental-contextual model of couples coping with

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chronic illness across the adult life span. Psychological Bulletin 2007, 133:920-954. [11] Bodenmann G: Dyadic coping and its significance for marital functioning. In Couples

us

coping with stress: Emerging perspectives on dyadic coping. Edited by Revenson TA, Kayser K, Bodenmann G: American Psychological Association; 2005:33-50.

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[12] Manne S, Badr H: Social relationships and cancer. In Support Processes in Intimate Relationships. Edited by Davila J, Sullivan K: Oxford Press; 2010:240-264.

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[13] Goldsmith DJ: Uncertainty and Communication in Couples Coping with Serious Illness. In Uncertainty, information management, and disclosure decisions: Theories

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and applications. Edited by Afifi T, Afifi W: Routledge; 2009:203-225. *[14] Karraker A, Latham K: In sickness and in health? Physical illness as a risk factor for

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435.

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marital dissolution in later life. Journal of health and social behavior 2015, 56:420-

Findings suggest health as a determinant of marital dissolution in later life via both biological and gendered social pathways. *[15] Samios C, Pakenham KI, O’Brien J: A Dyadic and Longitudinal Investigation of Adjustment in Couples Coping with Multiple Sclerosis. Annals of Behavioral Medicine 2014, 49:74-83. Findings suggest health as a determinant of marital dissolution in later life via both biological and gendered social pathways.

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13 *[16] Badr H, Krebs P: A systematic review and meta-analysis of psychosocial interventions for couples coping with cancer. Psycho-Oncology 2013, 22:1688-1704. This is the first systematic review and meta-analysis published of randomized controlled

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trials of psychosocial interventions for couples coping with cancer. [17] Collins AL, Love AW, Bloch S, Street AF, Duchesne GM, Dunai J, Couper JW: Cognitive

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existential couple therapy for newly diagnosed prostate cancer patients and their

an

us

partners: a descriptive pilot study. Psycho‐Oncology 2013, 22:465-469.

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[18] Kayser K, Scott J: Helping couples cope with women's cancers: An evidence-based approach for practitioners. New York, NY: Springer Science + Business Media; US;

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2008.

[19] Heinrichs N, Zimmermann T, Huber B, Herschbach P: Long-term effects of a couple-

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based intervention for couples coping with cancer. International Journal of Psychology 2008, 43:42-42.

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*[20] Badr H, Smith CB, Goldstein NE, Gomez JE, Redd WH: Dyadic psychosocial intervention for advanced lung cancer patients and their family caregivers: results of a randomized pilot trial. Cancer 2015, 121:150-158. This study shifts the timing of dyadic psychosocial interventions in advanced lung cancer from hospice to shortly following diagnosis to coincide with recent practice guideline changes for cancer supportive care. [21] Robinson-Smith G, Harmer C, Sheeran R, Bellino Vallo E: Couples' Coping After Stroke—A Pilot Intervention Study. Rehabilitation Nursing 2015:n/a-n/a.

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14 [22] Coyne JC, Ellard JH, Smith DAF: Social support, interdependence, and the dilemmas of helping. In Social support: An interactional view. Edited by Sarason BR, Sarason IG, Pierce GR: John Wiley; 1990:129-149.

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[23] Afifi TD, Hutchinson S, Krouse S: Toward a theoretical model of communal coping in postdivorce families and other naturally occurring groups. Communication Theory

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2006, 16:378-409.

[24] Lyons R, Mickelson KD, Sullivan M, Coyne JC: Coping as a communal process. Journal

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of Social & Personal Relationships 1998, 15:579-605.

[25] Berg CA, Wiebe DJ, Butner J, Bloor L, Bradstreet C, Upchurch R, Hayes J, Stephenson R,

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Nail L, Patton G: Collaborative coping and daily mood in couples dealing with prostate cancer. Psychology and Aging 2008, 23:505-516.

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[26] Rohrbaugh M, Shoham V, Skoyen J, Jensen M, Mehl M: We-talk, communal coping, and cessation success in a couple-focused intervention for health-compromised

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smokers. Family Process 2012, 51:107-121. [27] Banthia R, Malcarne VL, Varni JW, Ko CM, Sadler GR, Greenbergs HL: The effects of

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dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. Journal of Behavioral Medicine 2003, 26:31-52.

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[28] Lazarus RS, Folkman S: Stress Appraisal And Coping. New York: Springer; 1984. [29] Fagundes CP, Berg CA, Wiebe DJ: Intrusion, avoidance, and daily negative affect among couples coping with prostate cancer: a dyadic investigation. Journal of Family Psychology 2012, 26:246. [30] Gilbar O, Weinberg M, Gil S: The effects of coping strategies on PTSD in victims of a terror attack and their spouses: Testing dyadic dynamics using an Actor-Partner Interdependence Model. Journal of Social and Personal Relationships 2012, 29:246261.

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15 *[31] Checton MG, Magsamen-Conrad K, Venetis MK, Greene K: A Dyadic Approach Applying a Developmental-Conceptual Model to Couples Coping With Chronic Illness. Health Education & Behavior 2015, 42:257-267.

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This one of the first studies to test multiple components of Berg and Upchurch’s (2007) developmental-contextual model simultaneously in couples coping with a variety of

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chronic illnesses.

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[32] Badr H, Carmack C, Kashy D, Cristofanilli M, Revenson T: Dyadic coping in metastatic breast cancer. Health Psychology 2010, 29:169-180.

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[33] Northouse L, Williams A-l, Given B, McCorkle R: Psychosocial care for family caregivers of patients with cancer. Journal of Clinical Oncology 2012, 30:1227-1234.

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*[34] Rottmann N, Hansen DG, Larsen PV, Nicolaisen A, Flyger H, Johansen C, Hagedoorn M: Dyadic coping within couples dealing with breast cancer: A longitudinal,

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population-based study. Health Psychology 2015, 34:486-495. This is one of the only existing studies that seeks to disentangle how individual and

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dyadic coping behaviors influence couples’ adjustment to cancer. [35] Heinrichs N, Zimmermann T, Huber B, Herschbach P, Russell DW, Baucom DH: Cancer

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distress reduction with a couple-based skills training: A randomized controlled trial. Annals of Behavioral Medicine 2012, 43:239-252. *[36] Dagan M, Sanderman R, Hoff C, Meijerink WJ, Baas PC, van Haastert M, Hagedoorn M: The interplay between partners’ responsiveness and patients’ need for emotional expression in couples coping with cancer. Journal of Behavioral Medicine 2014, 37:828-838. Findings highlight the importance of the relational context in improving adaptation to cancer taking into account individual differences.

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16 [37] Bodenmann G, Cina A: Stress and coping among stable-satisfied, stable-distressed and separated/divorced Swiss couples: A 5-year prospective longitudinal study. Journal of Divorce & Remarriage 2006, 44:71-89.

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[38] Papp LM, Witt NL: Romantic partners' individual coping strategies and dyadic coping: implications for relationship functioning. Journal of Family Psychology 2010, 24:551.

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[39] Bodenmann G, Meuwly N, Kayser K: Two conceptualizations of dyadic coping and their

comparison. European Psychologist 2011, 16:255.

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potential for predicting relationship quality and individual well-being: A

*[40] Johnson MD, Anderson JR, Walker A, Wilcox A, Lewis VL, Robbins DC: Common dyadic

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coping is indirectly related to dietary and exercise adherence via patient and partner diabetes efficacy. Journal of Family Psychology 2013, 27:722.

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This is the first study to demonstrate that dyadic coping is associated with specific dietary and exercise self-care behaviors patients perform to manage type 2 diabetes.

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*[41] Keller J, Burkert S, Wiedemann AU, Luszczynska A, Schrader M, Knoll N: Individual and dyadic planning predicting pelvic floor exercise among prostate cancer survivors.

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Rehabilitation psychology 2015, 60:222.

Results of this study suggest that dyadic coping may be less important for the uptake of

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new health behaviors and more important for the maintenance of health behaviors relative to individual coping. [42] Sterba K, de Vellis R, Lewis M, Baucom D, Jordan J, de Vellis B: Developing and testing a measure of dyadic efficacy for married women with rheumatoid arthritis and their spouses. Arthritis Care and Research 2007, 57:294-302. [43] MacInnes J: Relationships between illness representations, treatment beliefs and the performance of self-care in heart failure: a cross-sectional survey. European Journal of Cardiovascular Nursing 2013, 12:536-543.

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17 [44] Charmaz K: Good days, bad days: The self in chronic illness and time. New Brunswick, NJ: Rutgers University Press; 1991. [45] McCluskey S, Brooks J, King N, Burton K: Are the treatment expectations of'significant

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others' psychosocial obstacles to work participation for those with persistent low back pain? Work 2014, 48:391-398.

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[46] Radat F, Koleck M, Foucaud J, Lantéri-Minet M, Lucas C, Massiou H, Nachit-Ouinekh F, El Hasnaoui A: Illness perception of migraineurs from the general population.

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Psychology & health 2013, 28:384-398.

[47] Gilbert DT, McNulty SE, Giuliano TA, Benson JE: Blurry words and fuzzy deeds: The

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attribution of obscure behavior. Journal of Personality and Social Psychology 1992, 62:18.

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[48] Timmers L, Thong M, Dekker FW, Boeschoten EW, Heijmans M, Rijken M, Weinman J, Kaptein A: Illness perceptions in dialysis patients and their association with quality

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of life. Psychology and Health 2008, 23:679-690. [49] Figueiras MJ, Weinman J: Do similar patient and spouse perceptions of myocardial

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infarction predict recovery? Psychology & Health 2003, 18:201-216. [50] Venetis MK, Greene K, Checton MG, Magsamen-Conrad K: Decision making in cancer-

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related topic avoidance. Journal of Health Communication 2015, 20:306-313.

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Figure Caption Figure 1. Cognitive-Transactional Model of Couples’ Adaptation to

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Chronic Illness Note: Rectangles represent the main variables in the model, diamonds represent

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individual perceptions, and ellipses represent outcomes. Dashed lines represent the

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need to go back and reappraise cognitions about illness ownership or choice of coping

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strategy.

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ip t Individual Appraisals

(What is happening?)

(Who’s problem is it?)

coping strategy is effective

Individual Coping

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Illness Ownership

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Illness Representations

(How bad is this and what can I do about it?)

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my problem

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SelfEfficacy coping strategy is ineffective

partner is not responsive

Communicate the Problem to One’s Partner

partner is responsive

Dyadic/Shared Appraisals

our problem

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Individual Outcomes

(How bad is this and what can we do about it?)

coping strategy is effective

Dyadic Coping

coping strategy is ineffective

Self- and Dyadic Efficacy Individual and Relationship Outcomes

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