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Licensed Unlicensed Requires Authentication Published by De Gruyter January 1, 2015

I see you’re in pain – The effects of partner validation on emotions in people with chronic pain

Sara M. Edlund, Maria L. Carlsson, Steven J. Linton, Alan E. Fruzzetti and Maria Tillfors

Abstract

Background and aims

Chronic pain not only affects the person in pain, but can also have a negative impact on relationships with loved ones. Research shows that chronic pain is associated with difficulties in marital relationships, which in turn is related to a variety of negative outcomes such as psychological distress and conflict within the family. This suggests that couples where chronic physical pain is present also struggle with emotional pain and relationship problems, and thus targeting relationship skills and interpersonal functioning might be helpful for these couples. Although studies in this area are promising, their numbers are few. In the present study, validation as a way of communicating is suggested for handling emotional expression in interpersonal interactions. Validation communicates understanding and acceptance of the other person’s experience, and it has been shown to have a down-regulating effect on negative emotions. It has previously been demonstrated to be important for these couples. However, the feasibility and effects of increasing partner validation in these couples are unknown. Therefore, the aim of the present study was to investigate if a brief training session in validation for spouses would result in more validating and fewer invalidating responses towards their partners with pain, and to investigate if changes in these behavioural responses were associated with changes in emotion and pain level in the partner with pain.

Methods

Participants were 20 couples where at least one partner reported chronic pain. The study employed a within-groups design in which spouses of people with pain received validation training (without their partner’s knowledge), and their validating and invalidating responses were rated pre- and post-intervention using a reliable observational scale. Also, positive and negative affect and subjective pain level in the persons with pain were rated pre- and post-intervention.

Results

Results showed that the validation training was associated with increased validating and decreased invalidating responses in the partners. Their spouses with chronic pain reported a decrease in negative affect from pre- to post-training.

Conclusions

Our results indicate that the partner or closest family member, after brief validation training, increased validating responses and decreased invalidating responses towards the person with pain, which had an immediate positive impact on emotions in the other person.

Implications

This study suggests that using validation in interpersonal interactions is a promising tool for couples where chronic pain is present.


DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2014.09.005.



JPS: Psychology, Örebro University, 701 82 Örebro, Sweden. Tel.: +46 19 301266; fax: +46 19 303484.

  1. Conflict of interest None declared.

References

[1] Cano A, Johansen AB, Leonard MT, DeGroot-Hanawalt J. What are the marital problems of patients with chronic pain? Curr Pain Headache Rep 2005;9:96–100.10.1007/s11916-005-0045-0Search in Google Scholar

[2] Flor H, Turk DC, Scholz OB. Impact of chronic pain on the spouse: marital, emotional and physical consequences. J Psychosom Res 1987;31:63–71.10.1016/0022-3999(87)90099-7Search in Google Scholar

[3] Cano A, Gillis M, Heinz W, Geisser M, Foran H. Marital functioning, chronic pain, and psychological distress. Pain 2004;107:99–106.10.1016/j.pain.2003.10.003Search in Google Scholar

[4] Kerns RD, Haythornthwaite J, Southwick S, Giller EL. The role of marital interaction in chronic pain and depressive symptom severity. J Psychosom Res 1990;34:401–8.10.1016/0022-3999(90)90063-ASearch in Google Scholar

[5] Romano JM, Turner JA, Jensen MP. The family environment in chronic pain patients: comparison to controls and relationship to patient functioning. J Clin Psychol Med Settings 1997;4:383–95.10.1023/A:1026253418543Search in Google Scholar

[6] Monga TN, Tan G, Ostermann HJ, Monga U, Grabois M. Sexuality and sexual adjustment of patients with chronic pain. Disabil Rehabil 1998;20:317–29.10.3109/09638289809166089Search in Google Scholar

[7] Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis: Mosby; 1976.Search in Google Scholar

[8] Flor H, Kerns RD, Turk DC. The role of spouse reinforcement, perceived pain, and activity levels of chronic pain patients. J Psychosom Res 1987;31:251–9.10.1016/0022-3999(87)90082-1Search in Google Scholar

[9] Turk DC, Kerns RD, Rosenberg R. Effects of marital interaction on chronic pain and disability: examining the down side of social support. Rehabil Psychol 1992;37:259–74.10.1037/h0079108Search in Google Scholar

[10] Romano JM, Turner JA, Friedman LS, Bulcroft RA, Jensen MP, Hops H, Wright SF. Sequential analysis of chronic pain behaviors and spouse responses. J Consult Clin Psychol 1992;60:777–82.10.1037/0022-006X.60.5.777Search in Google Scholar

[11] Romano JM, Turner JA, Jensen MP, Friedman LS, Bulcroft RA, Hops H, Wright SF. Chronic pain patient-spouse behavioral interactions predict patient disability. Pain 1995;63:353–60.10.1016/0304-3959(95)00062-3Search in Google Scholar

[12] Schwartz L, Slater MA, Birchler GR. Interpersonal stress and pain behaviors in patients with chronic pain. J Consult Clin Psychol 1994;62:861–4.10.1037/0022-006X.62.4.861Search in Google Scholar

[13] Keefe FJ, Blumenthal J, Baucom D, Affleck G, Waugh R, Caldwell DS, Beaupre P, Kashikar-Zuck S, Wright K, Egert J, Lefebvre J. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomised controlled study. Pain 2004;110:539–49.10.1016/j.pain.2004.03.022Search in Google Scholar

[14] Keefe FJ, Caldwell DS, Baucom D, Salley A, Robinson E, Timmons K, Beaupre P, Weisberg J, Helms M. Spouse-assisted coping skills training inthe management of osteoarthritic knee pain. Arthritis Care Res 1996;9:279–91.10.1002/1529-0131(199608)9:4<279::AID-ANR1790090413>3.0.CO;2-6Search in Google Scholar

[15] Fruzzetti AE, Worrall JM. Accurate expression and validating responses: a transactional model for understanding individual and relationship distress. In: Sullivan K, Davila J, editors. Support processes in intimate relationships. New York: Oxford University Press; 2010. p. 121–50.10.1093/acprof:oso/9780195380170.003.0005Search in Google Scholar

[16] Linehan MM. Validation and psychotherapy. In: Bohart AC, Greenberg LS, editors. Empathy reconsidered: new directions in psychotherapy. Washington: American Psychological Association; 1997. p. 353–92.10.1037/10226-016Search in Google Scholar

[17] Fruzzetti AE, Shenk CE, Hoffman PD. Family interaction and the development of borderline personality disorder: a transactional model. Dev Psychopathol 2005;17:1007–30.10.1017/S0954579405050479Search in Google Scholar

[18] Shenk CE, Fruzzetti AE. The impact ofvalidating and invalidating responses on emotional reactivity. J Soc Clin Psychol 2011;30:163–83.10.1521/jscp.2011.30.2.163Search in Google Scholar

[19] Fruzzetti AE, Iverson KM. Intervening with couples and families to treat emotion dysregulation and psychopathology. In: Snyder DK, Simpson JA, Hughes JN, editors. Emotion regulation in couples and families: pathways to dysfunction and health. Washington: American Psychological Association; 2006. p. 249–67.10.1037/11468-012Search in Google Scholar

[20] Fruzzetti AE. The high conflict couple - a dialectical behavior therapy guide to finding peace, intimacy, and validation. Oakland: New Harbinger Publications; 2006.Search in Google Scholar

[21] Cano A, Barterian JA, Heller JB. Empathic and nonempathic interaction in chronic pain couples. Clin J Pain 2008;24:678–84.10.1097/AJP.0b013e31816753d8Search in Google Scholar

[22] Issner JB, Cano A, Leonard MT, Williams AM. How do I empathize with you? Let me count the ways: relations between facets of pain-related empathy. J Pain 2012;13:167–75.10.1016/j.jpain.2011.10.009Search in Google Scholar

[23] Leong LEM, Cano A, Johansen AB. Sequential and base rate analysis of emotional validation and invalidation in chronic pain couples: patient gender matters. J Pain 2011;12:1140–8.10.1016/j.jpain.2011.04.004Search in Google Scholar PubMed

[24] Cano A, Leonard MT. Integrative behavioral couple therapy for chronic pain: promoting behavior change and emotional acceptance. J Clin Psychol 2006;62:1409–18.10.1002/jclp.20320Search in Google Scholar PubMed

[25] World Medication Association. Declaration of Helsinki. J Am Med Assoc 1997;277:925–6.Search in Google Scholar

[26] Ahlborg T, Lilleengen A, Lönnfjord V, Petersen C. Quality of dyadic relationship in swedish men and women living in long-term relationships and in couples in family counselling - introduction of a new self-report measure, QDR36. Nordic Psychol 2009;61:23–46.10.1027/1901-2276.61.3.23Search in Google Scholar

[27] Fruzzetti AE. Validating and invalidating behavior coding scale. Reno: University of Nevada; 2001.Search in Google Scholar

[28] Lowry K, Mosco E, Shenk C, Fruzzetti AE. Validating and invalidating behaviors coding scale (VIBCS): Reliability and validity. In: Paper presented at the 36th Annual Convention of the Association for the Advancement of Behavior Therapy. 2002.Search in Google Scholar

[29] Shrout PE, Spitzer RL, Fleiss JL. Quantification of agreement in psychiatric diagnosis revisited. Arch Gen Psychol 1987;44:172–7.10.1001/archpsyc.1987.01800140084013Search in Google Scholar PubMed

[30] Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988;54:1063–70.10.1037/0022-3514.54.6.1063Search in Google Scholar

[31] Watson D, Clark LA. The PANAS-X. Manual for the positive and negative affect schedule: expanded form. Iowa City: University of Iowa; 1994.10.17077/48vt-m4t2Search in Google Scholar

[32] Fruzzetti AE. Causes and consequenses: individual distress in the context of couple interactions. J Consult Clin Psychol 1996;64:1192–201.10.1037/0022-006X.64.6.1192Search in Google Scholar

[33] Fruzzetti AE, Jacobson NS. Toward a behavioral conceptualization of adult intimacy: implications for marital therapy. In: Blechman E, editor. Emotions and the family: for better or for worse. Hillsdale, NJ: Lawrence Erlbaum Associates; 1990. p. 117–36.Search in Google Scholar

Received: 2014-05-06
Revised: 2014-07-14
Accepted: 2014-07-20
Published Online: 2015-01-01
Published in Print: 2015-01-01

© 2014 Scandinavian Association for the Study of Pain