Steven R. H. Beach - US grants

The Principal Investigator is currently more than half way through the treatment phase of an outcome study comparing the effectiveness of individual cognitive therapy, conjoint behavioral marital therapy, and a wait-list control group in the alleviation of depressive symptomotology in maritally discordant couples. It is anticipated that over 30 couples will receive a trial of behavioral marital therapy. Preliminary results suggest that behavioral marital therapy can be effective in this population. We wish to study intensively the change process for couples receiving this new form of treatment for depression. Three interlocking sets of analyses are proposed: (1) a set of analyses which examine the impact of therapist and spouse behavior on in session patient behavior, (2) a set of analyses which examine the same therapist and spouse behaviors in terms of their impact on symptom remission during the course of therapy, and (3) a set of analyses which examine the relationship of these process variables to final outcome. By examining the process of therapy simultaneously at the micro, intermediate, and macro levels of analysis, we hope to provide a description of therapy process which is both detailed enough to guide clinical activity as well as clinically relevant enough to exert an impact on clinical practice. The current proposal is focussed on the component of therapy which is unique to the couple format, viz: the contribution of the spouse to the therapy process. It has only been very recently that couple format approaches have been introduced in the major treatment modalities for depression. Accordingly, the study of ways to maximize the potential positive impact of the spouse on the therapy process is particularly timely. It is also hoped that the three level approach advanced for the study of therapy process may prove hueristic for clinically relevant process work in other areas.

This program of research extends the PIs' Self-Evaluation Maintenance (SEM) model to intimate relationships. More specifically, it examines the way in which self-evaluation threat and self-evaluation benefit in close relationships lead to changes in cognition and cognitive processes that are associated with the destructive processes of envy in marital relationships as well as with such positive emotions as felt attachment and commitment. The PIs will investigate the role of SEM cognitive processes in: 1) precipitating defensive, negative judgments about the partner; 2) increasing the availability of positive and negative memories of the partner; 3) facilitating constructive or destructive interpretations of prior interactive behavior; and 4) influencing definitiion of the self and the emergence of complimentary 'selves' in intimate relationships. The automaticity of SEM processes will also be examined. Taken together, these studies will provide a foundation for understanding defensive reactions in dyadic relationships and their destructive interpersonal and intrapersonal consequences. Marriage is a fundamental building block of civilization. Well functioning marriages provide the basis for effective emotional support in times of difficulty, thereby preventing potentially serious declines in worker health and productivity, and they also are a foundation upon which successful child rearing can occur. Because parents who are able to nurture each other are also in the best position to enable their children to develop into competent and productive adults, successful marriages are the foundation of the nation's future productive capacity. Yet, fully half of first marriages are destined to end in divorce at great cost both to the individuals involved, their families, and to society as a whole. This program of research will elucidate cognitive processes in the service of self-evaluation maintenance that can contribute to marital discord. As such, it is highly relevant to the "Famili es" component of the Human Capital Research agenda. One of the perplexing problems in understanding marital discord is how to account for the shift that may occur from giving a partner the benefit of the doubt to assuming the worst when negative things happen. It is clear that automatic cognitive processes are involved and that these processes are often not amenable to conscious introspection. However, the exact nature of these automatic cognitive processes has been elusive. This program of research will illuminate some of these processes. Moreover, the project focuses on processes that are particularly relevant to the changing nature of American families. In particular, the theoretical model that guides the work is highly relevant to the "new" marital problems that may emerge as traditional gendered divisions of labor give way to more egalitarian marital relationships. As such, the knowledge generated by this program of research will be highly useful in developing improved methods for preventing and ameliorating marital difficulties.

DESCRIPTION (provided by applicant): The long-term objective of the proposed research is to better understand the effects of social support, particularly that offered by romantic partners and spouses. Social support appears to contribute in important ways to relationship satisfaction and stability, and may play a key role in maintaining marital stability and marital satisfaction. Because various aspects of marital relationships are amenable to efforts at intervention (Baucom, et al., 1998), considerable potential societal benefit may result from understanding the function and effects of social support in marriage. In addition, prevention efforts are particularly likely to be responsive to basic research findings (Bradbury et al., 2000), and marital therapy is currently undergoing profound changes (Gottman, 1999). These considerations lead to the conclusion that research on the provision of social support in marriage is particularly timely. The current application addresses several gaps in research on social comparison processes as they are related to social support and therefore renders this body of research more applicable to the applied context of support in romantic relationships and marriage. Each proposed study is strongly theory driven and jointly they are designed to provide a firmer theoretical foundation for the application of the social comparison literature to the close relationship context. In particular, we examine the way in which "defensiveness" may result from efforts to provide partners with support. We examine the way advice and directive support may lead to self-evaluation threat and problematic reactions to offers of support, including a more negative impact of advice, negative cognitions about advice that has been given, and failure to utilize the advice. We examine as well the potential for social comparison processes to influence expectations about partner support, and positive and negative evaluation of the partner. Finally, we contrast the response of persons in different ethnic groups to examine the generalization of predictions to an African-American population, a sub-cultural context that may place greater emphasis on collective identity. In the context of greater collective orientation, social comparison processes may unfold differently.

DESCRIPTION (provided by applicant): This application addresses the need for preventive interventions designed to protect two-parent, rural African American families with an early adolescent from the negative effects of economic distress. Economic hardship disproportionately affects African American families in the rural South. Economic constraints and oppressive social structures in rural communities combine to render steady employment a challenge for many African American parents, particularly fathers. Economic pressures cascade through the family system, undermining parents' emotional well- being, personal and co-parenting relationships, and use of competence-promoting parenting practices. As a result, many rural African American early adolescents are at risk for academic failure and school dropout, behavioral and emotional problems, substance use, and the early initiation of sexual activity. This application addresses the need for health promotion and prevention programs designed to bolster protective family processes for African Americans living in rural communities. We propose to evaluate the efficacy of the Program for Strong African American Families (ProSAAF) in a Phase II prevention trial. Based on 15 years of longitudinal and prevention research with rural African American families, ProSAAF consists of 6 structured, 1.5-hour sessions conducted in families' homes. A Phase I randomized pilot trial (n = 94) showed that (a) our recruitment and implementation protocols were effective; (b) ProSAAF significantly enhanced stress-buffering couple relationship processes and competence- promoting parenting practices; and (c) ProSAAF deterred early adolescent self-regulatory problems. We propose to recruit 444 rural African American families who have experienced recent economic distress and are rearing a youth age 10-14. Families will be randomly assigned to ProSAAF or a minimal-contact control condition. Baseline, 8, 16, and 24-month assessments will be obtained of adolescents' academic, social, and self-regulatory competence; internalizing and externalizing problems; onset of sexual activity; and substance use. The ProSAAF causative model incorporates protective processes in the couple subsystem that ameliorate the impact of stress generated by economic insecurity (e.g., knowledge of the impact of financial stressors on the family, problem-solving versus avoidant coping strategies, and access to community resources) and competence-promoting parenting practices (e.g., involved-vigilant parenting; parental involvement in adolescents' academic pursuits; and adaptive racial socialization).

? DESCRIPTION (provided by applicant): Strong evidence has accrued indicating that inflammation (INF) predicts the onset of chronic, age-related diseases. Although psychosocial stress is a major determinant of INF, we know little about the role of stress contagion from romantic partners, a prominent social context in early adulthood, or the role of childhood stressors in amplifying INF response to adult stress. Evidence has accumulated indicating that early stress experiences may shift propensity to respond with INF due to early calibration of Inflammation Related Transcriptional Response (IRTR). However, we have little information regarding the extent to which IRTR predicts amplified INF response to adult stressors or the extent which it accounts for the impact of early stressors on INF. In addition, we do not know the extent to which persistent, supportive relationships in young adulthood have the potential to ameliorate the impact of earlier stressors by modifying IRTR and so reducing INF in response to adult stressors. Finally, prior research has largely focused on White samples, thereby limiting our understanding of the causes of INF among African Americans, a group at elevated risk for age- related chronic illness. This application seeks funding to add assessment of romantic partners and to directly assess IRTR for both targets and partners who are participating in a recently funded application. In the parent application we assess INF and collect telephone interview data from targets regarding stress and health behaviors in a sample of roughly 700 African Americans (now 28 years of age). In the current application we add parallel interview assessments and assessment of INF for N = 320 romantic partners. In addition we add assessment of IRTR for both targets and romantic partners. This additional data collection will allow us to address the following specific aims: 1) Identify the effect of stress contagion on young adult INF among African Americans, controlling for own stressors and history of early exposure to stressors; 2) Test hypothesized amplification of effect on INF of own stress, stress contagion, and dyad-level effects due to exposure to early stressors, and examine the hypothesis that calibration of Inflammation Related Transcriptional Response (IRTR) is the mechanism by which early stress influences INF; and 3) Test the hypothesized role of persistent supportive romantic relationships (PSR) in recalibrating stress biology, i.e., examine the hypothesis that among those in persistent supportive relationships in young adulthood we will see reduced impact of early stress exposure on IRTR. The Institute of Medicine prescribes development of prevention based on longitudinal, epidemiological research with target populations. Currently, no prospective investigations identify the protective factors that interrup the impact of stress on INF for African Americans. The results of the proposed research will identify protective processes and serve as the basis for empirically- based, health disparities prevention programs as well as provide a basis for ongoing policy discussions, e.g. the Healthy Marriage Initiative.

PROJECT SUMMARY In this proposal, we seek to follow a well-characterized sample of 346 low-income, middle-age African American couples who recently concluded participation in a randomized prevention trial of the Protecting Strong African American Families (ProSAAF) program. All couples reside in impoverished small towns and communities in rural Georgia in which poverty rates are among the highest in the nation. Individuals in this catchment area are at elevated risk for multiple chronic diseases of aging (CDAs) including cardiovascular disease and diabetes as well as risk factors for CDAs such as inflammation and metabolic syndrome. Continuing to follow this sample with more thorough assessments of aging over the next five years will provide one of the first prospective studies of couple relationships and aging conducted within a randomized prevention trial designed for rural African American adults. As observational designs are prone to residual confounding and reverse directionality errors, the current proposal will provide a unique opportunity for testing casual hypotheses about the role of enhanced couple functioning in promoting and protecting the health of African American adults from the erosive effects of cumulative stress exposure. This proposal, therefore, is directly responsive to PA-15-042, which encourages innovative, hypothesis-driven R01 grant applications that can expand understanding of the role and impact of families and interpersonal relationships on health and well-being in midlife and older age. In this continuation then, we propose to collect two additional waves of multi-level data from couples who participated in the ProSAAF trial. This data collection will involve intravenous blood draws and other biometrics to determine whether ProSAAF participation and program-induced changes in couple functioning will carry forward to promote African Americans' healthy aging. Assessments of psychological well-being and behavioral coping strategies will be collected as well. We will test hypotheses concerning: (a) ProSAAF participation on the physical health and psychological well-being of rural African American adults; (b) mediating mechanisms through which ProSAAF- induced changes in couple relationship functioning and cumulative stress exposure influence rural African Americans' health; and (c) resilience mechanisms on healthy aging among rural African Americans. Hypotheses will be analyzed using individual- and couple-level models to examine actor, partner, and dyadic-level effects. Our proposed design provides both strong tests of theory and enhanced ability to guide practical application than typically is possible using observational research alone. Findings from this research will facilitate the development of health promotion strategies to enhance healthy aging and, ultimately, reduce health disparities among rural African Americans.