Week 12 - Love and Repair

Social support

Psychological construct used to measure the quality (not just quantity) of one’s social network

• “Information leading the subject to believe that s/he is cared for and loved, esteemed, and a member of a network of mutual obligation”

• Experience and perception of interconnectedness

• Can be emotional, informational, or instrumental

• Community = a sense of familiarity, safety, and comfort

Love and intimacy are viewed as a source of healing for both emotional and physical ailments (ex: disease and premature death from virtually all causes)

• Enhanced immune function

• Strengthened resistance to disease

Johns Hopkins Study

• 1,100 male medical students in the 1940s were given the “closeness to parents” scale that assessed the quality of students’ relationships with their parents

• Purpose of the study was to examine if the quality of human relationships might be a factor in the development of cancer

• 50-year follow-up:

  • The best predictor of who would get cancer was the closeness of the father-son relationships earlier in life

  • Better predictor than smoking, drinking, or radiation exposure

Harvard Mastery of Stress Study

• 126 healthy men at Harvard (classes 1952 and 1954) were given questionnaires to measure how they felt about their parents

• 35-year follow-up:

  • 95% of subjects who used few positive words in describing their parents and who rated their parents low in parental caring had diseases diagnosed in midlife (high cholesterol, high blood pressure, diabetes, obesity, heart disease, etc.)

  • 29% of subjects who used many positive words in describing their parents and who rated their parents high in parental caring had diseases diagnosed in midlife

Impact of Loving Relationships on the Development of Heart Disease

• 10,000 men participated

• Followed prospectively for the development of heart disease

• Men who answered “yes” to the question were half as likely to develop angina (chest pain) over the next 5 years

• 1,400 male and female participants who underwent cardiac catheterization and were found to have coronary artery disease (CAD)

• Followed prospectively

• After 5 years:

  • 15% mortality rate for those who were married or who reported having a close confidant

  • 50% mortality rate for those who were unmarried and reported having no close confidant

Impact of Loving Relationships on Ulcers

• 8,500 men participated; no prior history of ulcers or symptoms of ulcers

• Followed prospectively

• After 5 years, 254 developed ulcers

• Participants who answered “my wife does not love me” had 3 times as many ulcers as those who said their wives showed love and support

• This factor was most strongly associated with developing ulcers than smoking, age, blood pressure, BMI, and job stress

Impact of Loving Relationships on the Common Cold

• 276 healthy volunteers were exposed to nasal drops containing rhinovirus until the participants shed virus

• Participants were asked about 12 types of loving relationships: romantic partners, parents, children, friends, social groups, etc.

• Scored on the number of connections they had

• Participants with fewer social connections developed cold symptoms at a rate 4 times greater than those with many social connections

Social Capital

• “A community-level resource reflected in social relationships involving networks, norms, and levels of trust” (Putnam 2000).

  • “Connections among individuals – social networks and the norms of reciprocity and trustworthiness that arise from them” (Putnam 2000).

• Accrues to individuals as a protective factor as a result of membership in groups (Bourdieu, 1986)

• Positive influence on health are derived from enhanced self-esteem, sense of support, access to group and organizational resources, and its buffering qualities in stressful situations

• One of the most powerful determinants of an individual’s health (Putnam 2000)

• Persons who are socially disconnected are between two to five times more likely to die from all causes when compared to individuals with close ties to family, friends, and community

• Significance of social capital was first established in the Roseto study begun in the 1950s

The Adverse Childhood Experiences Study (ACES)

• Original study was conducted by Dr. Vince Felitti at Kaiser Permanente and Dr. Bob Anda at the Centers for Disease Control and Prevention from 1995-1997

• 17,000+ adults were asked about their history of exposure to what they called “adverse childhood experiences,” or “ACEs”

ACES Findings

ACEs are incredibly common, more than recognized or acknowledged

• 67% of the population had at least 1 ACE

• 12.6% had an ACEs score of 4 or more

• 22% of participants were sexually abused as children

• 66% of the women experienced abuse, violence or family strife in childhood

There’s a dose-response relationship between ACEs and health outcomes (the higher your ACE score, the worse your health outcomes)

• ACE score of 4 or higher: relative risk of chronic obstructive pulmonary disease was 2½ times that of someone with an ACE score of 0

• For hepatitis: it was also 2½ times higher

• For depression: it was 4½ times higher

• For suicidality: it was 12 times higher

• A person with an ACE score of 7 or higher:

  • 3 times the lifetime risk of lung cancer

  • 3½ times the risk of ischemic heart disease

• ACEs have a powerful relation to adult health and behaviors

Durkheim Study

• Applied basic sociological principles to study suicide

• Such principles helped explain suicide patterns by identifying factors external to the individual

• Major factor affecting rates of suicide was the degree of social integration of groups

• The extent to which an individual is integrated into group life determined whether he would be likely to commit suicide

• Found that unmarried men and women were more likely to commit suicide than those who were married

Love, therapeutic alliance, and the power of psychotherapy

Studies consistently show therapeutic alliance to be the single most important predictor of treatment response in psychotherapy, regardless of the treatment target

“What forms the basis of therapeutic alliance?”

• Trust, connection, compassion, commitment, intimacy, and love

Love and neuroplasticity

• Our individual neurons alter their structure and strengthen the synaptic connections between them

• Relational experiences can alter neuronal transcription which can change a neuron’s anatomical shape and increase the number of synaptic connections they have to other neurons

• The brain is a social organ of adaptation built through interactions with others

• Love as a nutrient: interpersonal experiences drive brain growth

• There are no single human brains – brains only exist within networks of other brains

• The bidirectional flow between neural structure and social experience requires a continual shift in focus from the brain to social behavior and back again to the brain

• Love as a nutrient for brain development and neuronal pathway formation and integration, even into adulthood

Love and neuroplasticity in “the brain that changes itself”

• Mr. L - main in his late 50s

  • Can’t stay faithful to his wife, feels that he isn’t that close to his kids

  • Had a profound loss in his own family when he was very young

• The argument: in therapy, our memories can be re-transcribed and changed

  • “Turning ghosts into ancestors”

• Mounting evidence that hippocampal growth is associated with recovery from mental health disorders

  • May be the “true” underlying mechanism of SSRIs

Maintaining and enhancing relationships

Relationship maintenance mechanisms = strategic actions people take to sustain partnerships

• The investment model of commitment suggests that several behavior follow from commitment

• Communication scholars have noted other things that distinguish happier from unhappier partners

Cognitive Maintenance Mechanisms (thinking differently in a committed relationship)

• Cognitive interdependence – “we/us/ours” not “I/me/mine”

• Positive illusions – some idealization, perceiving relationship in the best possible light

  • Bad behavior considered unintentional or temporary

  • As long as they are not too unrealistic, some rose-colored perceptions can be good

• Perceived superiority – thinking that their relationship is better than most, exceptional, special in some way

• Inattention to alternatives

• Derogation of tempting alternatives

Behavioral maintenance mechanisms (acting differently in a committed relationship)

• Willingness to sacrifice – do things they would prefer not to do, or NOT do things they would like to do for the sake of the relationship

• Prayer – people who pray for the success and wellbeing of partners (not self)

• Become more satisfied with sacrifices they make and more forgiving

• Michelangelo phenomenon: encouraging partner to become the person they want to be

  • Like Michelangelo creates art from ordinary blocks of tone 

• Accomodation – take minor mistreatment without biting back

  • But don’t want to be a martyr and ignore major issue

• Self-control – related to accommodation, but larger in scope

• Play – pursue novel, challenging, exciting, pleasant activities together

• Rituals – comfortable and pleasing habits

• Forgiveness – offering this after betrayals

Findings on staying content - 3 important for marriage

1. Positivity

2. Assurances

3. Sharing tasks

Can’t be sporadic, have to continue to do these behaviors

Repairing relationships: DIY strategies

TV shows, self-help books, websites, and podcasts are out there that are full of suggestions to improve and maintain relationships

• Caution, however: not all sources are credible

• Third-party/more objective observers also tend to be helpful

Repairing relationships: preventative maintenance strategies

• Premarital counseling is common and available in various forms (ex: Pre-Cana)

• Prevention and Relationship Enhancement Program (PREP) is a commonly used relationship skills course. It teaches…

  • The power of commitment to change partners’ outlooks and behaviors

  • The importance of having fun together

  • The value of open communication about sex

  • The consequences of inappropriate expectations

  • The speaker-listener technique 

• Such programs have been found to be effective over at least a 3-year period, though longer term outcomes are still unknown

  • But we do know that couples that do premarital counseling are more likely to seek regular counseling if needed later on, too

Therapies for repairing relationships

• Traditional Behavioral Couple Therapy (TBCT)

• Cognitive-Behavioral Couple Therapy (CBCT)

• Integrative Behavioral Couple Therapy (ICBT)

• Emotionally Focused Couple Therapy (EFCT)

• Insight Oriented Couple Therapy (IOCT)

Traditional behavioral couple therapy (TBCT)

TBCT focuses on changing a couple’s behaviors and making interactions more positive

• Techniques taught include:

  • Positive communication skills

  • “Love days”

  • Quid pro quo contracts

  • Good faith contracts (which may address downsides of quid pro quo contracts)

Cognitive-Behavioral Couple Therapy (CBCT)

CBCT is a descendant of TBCT and includes behavioral techniques plus addition of cognitive techniques

• Cognitions addressed include:

  • Selective attention

  • Expectations 

  • Attributions

  • Relationship beliefs

Integrative Behavioral Couple Therapy (ICBT)

Another descendant of TCBT

• Still includes bmod and communication skills but also assumes that when two partners behave well, some frustrating incompatibilities will still remain

  • Therefore, a goal is to teach adaptive emotion reactions to difficulties they will inevitably face

  • Acceptance of one’s own and one’s partner’s imperfections is promoted

• Techniques used include:

  • Empathic joining

  • Unified detachment

  • Tolerance building

Emotionally Focused Couple Therapy (EFCT)

• EFCT is derived from attachment theory

  • Strives to improve relationships by increasing attachment security

• Focus is on identifying maladaptive cycles of emotional communication and replacing them with restructured interactions that allow partners to feel safe, loved, and securely connected to one another

Insight Oriented Couple Therapy (IOCT)

Insight-oriented therapies are derived from psychodynamic traditions are not all focused on couples

• IOCT specifically tries to help people understand how habits and assumptions developed in other relationships may be creating difficulties with their present partners

  • More of a past focus compared to other therapies discussed, which are present-focused

  • Tools used in IOCT include affective reconstruction

Marital therapies

All of these therapies have been shown to be helpful to couples

• Probably more similar in some ways than it may seem from initially reading about them

• If seeking treatment, pick the one that appeals most to you

  • They all have common features and are reasonable

  • But your positive outlook on a treatment will help you believe that change is possible, so if you like one theoretical approach better, go in that direction

• Also it’s important that a couple respects and trusts their therapist