Serious medical conditions typically are not experienced by individuals alone, but rather occur in a relational context. Intimate partners are likely to play vital roles in each other’s well-being (Revenson, 2003
; Revenson, Kayser, & Bodenmann, 2005
). In a meta-analysis of couples who experienced cancer (Hagedoorn et al., 2008
), patients’ and partners’ distress was related significantly (r
=.29); women reported more distress than men regardless of their role as patient or partner. Consistent with the recommendation of Hagedoorn et al. (2008)
to investigate factors that mediate the impact of cancer on couples, the primary goal of this study was to identify women’s and their husbands’ coping strategies as contributors to women’s adjustment after breast cancer treatment.
In theories of coping with stressors, coping processes can be differentiated on the basis of whether the individual attempts to engage with or avoid the stressor (e.g., Suls & Fletcher, 1985
). Approach-oriented coping includes attempts to problem-solve, to understand or express stressor-related emotions (i.e., coping through emotional approach), and other strategies. Avoidance-oriented coping involves cognitive and behavioral attempts to minimize the threat. Consistent with research on other medical threats (e.g., Duangdao & Roesch, 2008
; Moskowitz et al., 2009
), use of specific approach-oriented coping processes often predicts decreases in distress in cancer patients (e.g., Stanton, Danoff-Burg et al., 2000
), whereas coping through avoidance predicts increased distress (e.g., Hack & Degner, 2004
; Stanton, Danoff-Burg, & Huggins, 2002).
Although intensive attention has been devoted to the effects of individuals’ coping on adjustment to illness, fewer studies have examined the contribution of partners’ coping to patients’ adjustment. depicts three models of coping as predictors of adjustment (Berghuis & Stanton, 2002
). An individual model holds that one’s adjustment is shaped primarily by one’s own coping. Even the individual model might be influenced by the relational context, however, in that partners’ unsupportive behaviors can prompt women’s coping with cancer through avoidance, which in turn can contribute to women’s distress (Manne, Ostroff, Winkel, Grana, & Fox, 2005
). A partner main effects model suggests that individuals are influenced by their partner’s coping, either alone or along with their own coping. Theoretically, partners’ coping strategies that promote engagement with the stressor should reassure the ill person of the partner’s concern, promote intimacy, and decrease the burden on the affected person as the partner shares in the management of the illness (e.g., Manne & Badr, 2008
; Rohrbaugh et al., 2008
). For example, women evidence an improvement in distress and an increase in finding benefit in the stressor when their partners use more approach-oriented coping (e.g., problem solving, emotional approach; Berghuis & Stanton, 2002
; Manne et al., 2004
) and little avoidance coping (e.g., Peterson et al., 2009
). In addition, the spouse engaging in “we” talk regarding coping with the patient’s medical problem (Rohrbaugh et al., 2008
) predicts improvement in disease-related symptoms and general health in individuals with chronic disease.
Models of coping as predictors of partners’ adjustment. (Solid lines depict the model’s essential relationships. Dashed lines represent additional potential relationships.)
Few studies have examined the partner interaction model, which posits that the relation of one partner’s coping to adjustment varies as a function of the other partner’s coping, stemming in part from transactional stress and coping theory (e.g. Lazarus & Folkman, 1984
; for a review of dyadic coping literature, see Berg & Upchurch, 2007
). Some evidence suggests that congruent coping predicts superior adjustment (Revenson, 2003
); for example, spouses who are similar in active engagement experience greater marital satisfaction (Badr, 2004
; also see Ben-Zur, Gilbar, & 2001
). The adaptive value of partners’ similarity on other psychological constructs, such as personality attributes and emotional experience, has also been demonstrated (e.g., Anderson, Keltner, & John, 2003
; Gonzaga, Campos, & Bradbury, 2007
Superior adjustment also might occur when couples are dissimilar in their use of the same strategies, with one partner’s adaptive coping efficiently addressing the problem or compensating for the other’s low use. Complementary use of protective buffering or avoidance coping predicts greater marital satisfaction (Badr, 2004
). In infertile couples who had received a negative pregnancy result, husbands’ high use of emotional approach coping compensated for wives’ low use to help ward off depressive symptoms in wives (Berghuis & Stanton, 2002
). Theorizing that a dissimilar approach to coping is a more efficient use of couple reserves, Pakenham (1998)
found that dissimilar levels of problem-focused coping among couples managing multiple sclerosis was related to better adjustment. Which coping model (i.e., individual, partner main effects, partner interaction) best characterizes predictors of adjustment warrants study.
This study was designed to examine both partners’ coping strategies as predictors of change in women’s adjustment after completion of breast cancer treatment. We investigated whether patients’ and partners’ coping strategies predict patients’ sense of vitality, depressive symptoms, marital satisfaction, cancer-specific distress, and perceived cancer-related benefits. As suggested by stress and coping models (e.g., Revenson, 2003
) and past research (e.g., Stanton, Danoff-Burg et al., 2000
), we stipulated that patients’ and partners’ approach-oriented coping would independently benefit patients’ adjustment by helping patients deal with long-term threats and bolster their reserves such that recovery of vitality and finding benefit in the experience can occur. Use of avoidant coping by patients and partners was postulated to negatively predict women’s adjustment (e.g., Hack & Degner, 2004
), as couples likely are devoting less effort to prevent long-term problems.
We also tested whether partners’ coping processes interact to predict patients’ adjustment, examining the distinct possibilities that women have superior adjustment when spouses engage in either uniformly high levels of approach-oriented forms of coping (i.e., similarity in problem-focused or emotional approach coping) or when they are dissimilar in approach-oriented coping, such that a partner’s high use of emotional approach and problem-focused coping compensate for a spouse’s low use. In addition, we examined the utility of similarity versus dissimilarity in avoidant coping (i.e., composite of coping through behavioral disengagement, mental disengagement, denial) to determine whether it is more important for couples to be uniform in their levels of this generally less-adaptive form of coping, or whether one partner’s low use of such coping may compensate for their partner’s high avoidance.
The present research is a companion study to the Moving Beyond Cancer (MBC) intervention trial to promote women’s transition to breast cancer survivorship (Ganz et al., 2004
; Stanton et al., 2005
). Women’s and partners’ coping processes during the re-entry phase (i.e., the period following completion of primary medical treatments) can set the stage for positive adjustment over the longer term and serve as targets for psychosocial interventions. We assessed cancer-specific coping strategies in women and their partners at 10 months after diagnosis (Time 1), on average (equivalent to four months after medical treatment completion). Dependent variables, which were identical to the MBC trial outcomes with the addition of marital satisfaction, were assessed at Time 1 and at 20 months after diagnosis (Time 2; analyses of dependent variables completed at 14 months post-diagnosis produced similar findings [data not shown]). Examination of predictors of adjustment over time was a key strength of the study and much called for in this research area (e.g., Berg & Upchurch, 2007
). Effects of the randomized MBC intervention arms, as well as the significant interaction obtained in the parent trial between the intervention and women’s perceived preparedness for re-entry (Stanton et al., 2005
), were controlled statistically.