For some couples just staying together is good enough. But others want the relationship to move forward and get better and are willing to put in the effort to get there.
For a new study, researchers at the University of Illinois reviewed more than 1,100 studies on relationships dating back to 1950. They found two primary motives behind a couple’s attempts at staying together: threat mitigation and relationship enhancement.
For the most part, improving a relationship includes both components and requires putting effort into the relationship for the pleasure of it.
“Threats to the relationship come from all kinds of different places,” said Dr. Brian Ogolsky.
“Generally, there are many threats early in relationships that can cause problems, but that is not to say that these disappear later. We know couples cheat in the long-term, people end up in new work places and in new situations where possible alternative partners show up, conflicts arise, or a lack of willingness to sacrifice time for your partner emerges.”
Some threat mitigation tactics can actually become enhancement strategies over time, Ogolsky said, but the reverse is not usually true.
“We get to a place where we are pouring energy into the relationship simply because we want to keep the relationship moving forward rather than just mitigating threats.”
In their integrative model of relationship maintenance, the researchers also illustrate individual versus interactive components of maintenance.
“This question of ‘is this an individual thing or is this a couple-level thing’ often goes unanswered. But as we were doing this review, we started noticing that there are ways to maintain the relationship that we can characterize as ‘more or less in our own heads.’ We are doing something to convince ourselves that this is a good relationship and therefore it’s good for our relationship,” Ogolsky said.
“Things like positive illusions, the idea that we can believe our relationship is better than it is or that our partner is better than he or she is. We can do that without our partner,” he said.
Mitigating conflict, however, is something that partners must do together. “Good conflict management or forgiving our partner for doing something wrong is an interactive process.
“When a threat comes in, we can do one of two things: We can ditch our partner or forgive them over time.”
The same is true of enhancement strategies: Partners can do things individually or interactively.
“Individually, even the act of thinking about our relationship can be enhancing. Whereas engaging in leisure activities together, talking about the state of our relationship, these are all interactive,” Ogolsky said.
While Ogolsky rarely offers direct interventions to couples, he said he tends to study the positive side of relationships because of what can be learned from people going through what is inherently a very turbulent thing.
“Relationships have ups and downs. I never go into my work saying people should stay together or they should break up.
“What we are talking about here are processes that exist across different kinds of couples, some of which work very well for some people, some of which may not work for some people. I am interested in understanding processes that keep relationships moving.”
The study appears in the Journal of Family Theory and Review.
Source: University of Illinois
Recovery from a traumatic brain injury (TBI) frequently includes overcoming physical and mental impairments. Unfortunately, working through emotional issues often becomes one of the largest challenges as options for care, and access to care, may be limited.
These limitations have fueled innovative approaches to care for emotional deficits after TBI. New options includes the use of various forms of health information technology to provide training in emotional regulation skills.
The study is presented in a special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America.
Many patients with TBI experience disruptions in emotional functioning, including problems in awareness, recognition, expression, and regulation of emotions.
“Of the vast array of consequences of TBI, emotional deficits are among the most prevalent, persistent, and difficult to treat,” according to Dawn Neuman, Ph.D., of Indiana University School of Medicine at Indianapolis.
Deficits in emotional regulation can affect patients’ lives in many ways, including a reduced ability to participate in and benefit from other rehabilitation treatments.
Yet emotional issues after TBI remain “grossly understudied,” especially in terms of treatment. The seven original research papers in the special issue evaluate innovative treatments for common emotional problems after TBI.
Theo Tsaousides, Ph.D., and colleagues of Icahn School of Medicine at Mount Sinai, New York, evaluated a web-based intervention to improve emotional regulation after TBI. The study included 91 adults with a history of TBI and current problems with emotional regulation, based on the “Difficulties in Emotional Regulation Scale” (DERS).
Average time since TBI was about 10 years. In nearly half of patients, the severity of TBI was rated mild.
Over 12 weeks, participants received 24 one-hour emotional regulation skills training sessions. The group sessions were delivered by videoconference, supervised by experienced rehabilitation neuropsychologists.
The program provided education on how TBI affects emotional functioning, followed by training, practice, and feedback on specific strategies for improving emotional regulation skills in everyday life.
At the end of the 12-week program, the participants showed meaningful improvements in emotional regulation, including “medium to large” effects on all aspects measured by the emotional regulation questionnaire. Follow-up assessment 12 weeks beyond the treatment period showed continued improvement.
Measures of positive emotions, satisfaction with life, and problem-solving skills also improved significantly. Participants felt they made substantial progress toward their personal goals. Nearly 90 percent reported moderate to large improvements in their capacity for emotional regulation skills.
The use of videoconferencing technology could help to overcome distance and travel barriers to treatment, while maintaining the benefits of group interventions.
The study recruited participants from 33 states and five countries. Said Tsaousides, “This technology allowed us to create an online educational environment that, in addition to providing skill training, enabled people who were hundreds and thousands of miles apart–many of whom had been isolated from support communities–to connect, share, and learn from one another.”
Other papers in the special issue report on treatments targeting emotional self-awareness, social-emotional perception, anger and aggression, and depression after TBI. While the studies are an important step forward, “The state of the science for studying and treating emotional deficits in people with TBI is sorely lagging behind the needs,” Neumann writes.
“A lot more evidence-based research is needed to support more confident treatment recommendations.”
Source: Wolters Kluwer Health/EurekAlert
A new U.K. study finds that strong coping skills may be key to keeping anxiety levels low during stressful situations.
The findings show that among women with poor coping skills, those living in a deprived area are twice as likely to suffer from anxiety compared to those living in more affluent communities. On the other hand, living in a deprived or affluent community makes very little difference to the levels of anxiety experienced by women with strong coping skills.
The study is the largest ever conducted on how coping skills might impact anxiety levels in women in adverse circumstances. The findings, recently presented at the European College of Neuropsychopharmacology (ECNP) Conference in Paris, suggest that teaching women coping strategies may be a way to help them overcome the anxiety stemming from adverse circumstances, such as living in deprivation.
“Individuals with this sense of coherence, with good coping skills, view life as comprehensible and meaningful,” said lead researcher Olivia Remes, doctoral student at the University of Cambridge in England.
“In other words, they feel they can manage their life, and that they are in control of their life, they believe challenges encountered in life are worthy of investment and effort; and they believe that life has meaning and purpose. These are skills which can be taught.”
The University of Cambridge researchers surveyed 10,000 women over the age of 40 who were participating in a major cancer study in Norfolk, U.K.. The women completed health and lifestyle questionnaires on their living conditions, history of physical health, and mental health problems. The researchers then linked this information to 1991 census data to determine if the women were living in a deprived community.
They also measured each person’s sense of coherence using a questionnaire developed from Aaron Antonovsky’s research on how people find meaning and purpose in life. They found that 261 (2.6 percent) of the 10,000 women had generalized anxiety disorder.
Among women without coping skills, those living in a deprived area were about two times (98 percent) more likely to have anxiety than those living in more affluent communities. On the other hand, living in a deprived or affluent community made very little difference to the levels of anxiety experienced by women if they had good coping skills.
“In general, people with good coping skills tend to have a higher quality of life and lower mortality rates than people without such coping skills,” said Remes.
“Good coping can be an important life resource for preserving health. For the first time, we show that good coping skills can buffer the negative impact of deprivation on mental health, such as having generalized anxiety disorder. And importantly, these skills, such as feeling like you’re in control of your life and finding purpose in life, can be taught.”
Many people live in deprivation, and a significant portion of these have generalized anxiety disorder. For the first time, the researchers have shown that coping skills can significantly impact levels of anxiety.
“Many people with anxiety are prescribed medication-and while it is useful in the short-term-it is less effective in the long run, is costly, and can come with side effects. Researchers are therefore now turning to coping mechanisms as a way to lower anxiety. This is particularly important for those people who do not experience any improvement in their anxiety symptoms following commonly-prescribed therapies,” said Remes.
New research has found that a major factor predicting how much an alcoholic will drink is immediate mood.
The new study also found that suffering from long-term mental health problems did not affect alcohol consumption, with one important exception: Men with a history of depression had a different drinking pattern than men without a history of depression. Surprisingly, the researchers found that those men were drinking less often than men who were not depressed.
“This work once again shows that alcoholism is not a one-size-fits-all condition,” said lead researcher Victor Karpyak of the Mayo Clinic. “So the answer to the question of why alcoholics drink is probably that there is no single answer. This will probably have implications for how we diagnose and treat alcoholism.”
The study, presented at the 2017 European College of Neuropsychopharmacology (ECNP) Congress, determined the alcohol consumption of 287 males and 156 females with alcohol dependence over the previous 90 days, using the accepted Time Line Follow Back method and standardized diagnostic assessment for life time presence of psychiatric disorders (PRISM).
The researchers were then able to associate this with whether the drinking coincided with a positive or negative emotional state (feeling “up” or “down”), and whether the individual had a history of anxiety, depression, or substance abuse.
The results showed that alcohol dependent men tended to drink more alcohol per day than alcohol dependent women.
As expected, alcohol consumption in both men and women was associated with feeling either up or down on a particular day, with no significant association with anxiety or substance use disorders.
However, men with a history of major depressive disorder had fewer drinking days and fewer heavy drinking days than men who never a major depressive disorder, according to the study’s findings.
“Research indicates that many people drink to enhance pleasant feelings, while other people drink to suppress negative moods, such as depression or anxiety,” Karpyak said.
“However, previous studies did not differentiate between state-dependent mood changes and the presence of clinically diagnosed anxiety or depressive disorders. The lack of such differentiation was likely among the reasons for controversial findings about the usefulness of antidepressants in treatment of alcoholics with comorbid depression.”
While the study will need to be replicated and confirmed, Karpyak said the reasons alcoholics drink depend on their background, as well as the immediate circumstances.
“There is no single reason,” he said. “And this means that there is probably no single treatment, so we will have to refine our diagnostic methods and tailor treatment to the individual.”
It also means that treatment approaches may differ depending on targeting different aspects of alcoholism, such as craving or consumption. Treatment also needs to take into account whether the alcoholic patient is a man or a woman and whether the patient has a history of depression or anxiety, he noted.
Postpartum depression is a relatively common occurrence among females. Now, a new study finds that an elevation or a decline in a father’s testosterone level after childbirth may play a significant role in emotional health and relationship satisfaction.
Researchers from the University of Southern California (USC) discovered fathers face a risk of experiencing depression if their testosterone levels drop nine months after their children are born.
Moreover, researchers also found that a father’s low testosterone may affect his partner, but in an unexpectedly positive way. Women whose partners had lower levels of testosterone postpartum reported fewer symptoms of depression themselves nine and 15 months after birth.
Paradoxically, fathers whose testosterone levels spiked faced a greater risk of experiencing stress due to parenting and experienced a greater risk of acting hostile. Characteristics of hostile behaviors include showing emotional, verbal, or physical aggression toward their partners.
The findings support prior studies that show men have biological responses to fatherhood, said Dr. Darby Saxbe, the study’s lead author and an assistant professor of psychology at USC.
“We often think of motherhood as biologically driven because many mothers have biological connections to their babies through breastfeeding and pregnancy,” Saxbe said.
“We don’t usually think of fatherhood in the same biological terms. We are still figuring out the biology of what makes dads tick.
“We know that fathers contribute a lot to child-rearing and that on the whole, kids do better if they are raised in households with a father present,” she added. “So, it is important to figure out how to support fathers and what factors explain why some fathers are very involved in raising their children while some are absent.”
Saxbe worked with a team of researchers from USC, University of California at Los Angeles, and Northwestern University.
For the study, which appears in the journal Hormones and Behavior, researchers examined data from 149 couples in the Community Child Health Research Network. The study by the National Institute for Child Health and Human Development involves sites across the country, but the data for this study came from Lake County, Illinois, north of Chicago.
Mothers in the study were 18 to 40 years old; African-American, white, or Latina; and low-income. They were recruited when they gave birth to their first, second, or third child. Mothers could invite the baby’s father to participate in the study as well. Of the fathers who participated and provided testosterone data, 95 percent were living with the mothers.
Interviewers visited couples three times in the first two years after birth: around two months after the child was born, about nine months after birth, and about 15 months after birth.
At the nine-month visit, researchers gave the fathers saliva sample kits. Dads took samples three times a day — morning, midday, and evening — to monitor their testosterone levels.
Participants responded to questions about depressive symptoms based on a widely-used measure, the Edinburgh Postnatal Depression. They also reported on their relationship satisfaction, parenting stress and whether they were experiencing any intimate partner aggression. Higher scores on those measures signaled greater depression, more stress, more dissatisfaction, and greater aggression.
Relatively few participants — fathers and mothers — were identified as clinically depressed, which is typical of a community sample that reflects the general population. Instead of using clinical diagnoses, the researchers looked at the number of depressive symptoms endorsed by each participant.
Men’s testosterone levels were linked with both their own and their partners’ depressive symptoms — but in opposing directions for men and for women.
For example, lower testosterone was associated with more symptoms in dads, but fewer symptoms in moms. The link between their partners’ testosterone levels and their own depression was mediated by relationship satisfaction. If they were paired with lower-testosterone partners, women reported greater satisfaction with their relationship, which in turn helped reduce their depressive symptoms.
“It may be that the fathers with lower testosterone were spending more time caring for the baby or that they had hormone profiles that were more synced up with mothers,” she said. “For mothers, we know that social support buffers the risk of postpartum depression.”
Fathers with higher testosterone levels reported more parenting stress, and their partners reported more relationship aggression.
To measure parenting stress, parents were asked how strongly they related to a set of 36 items from the Parenting Stress Index-Short Form. They responded to statements such as “I feel trapped by my responsibilities as a parent” and “My child makes more demands on me than most children.” A high number of “yes” responses signaled stress.
Relationship satisfaction questions were based on another widely-used tool, the Dyadic Adjustment Scale. Parents responded to 32 items inquiring about their relationship satisfaction, including areas of disagreement or their degree of closeness and affection. Higher scores signaled greater dissatisfaction.
Mothers also answered questions from another scientific questionnaire, the HITS (Hurts, Insults, and Threats Scale), reporting whether they had experienced any physical hurt, insult, threats, and screaming over the past year. They also were asked if their partners restricted activities such as spending money, visiting family or friends, or going places that they needed to go.
“Those are risk factors that can contribute to depression over the long term,” Saxbe said.
Although doctors may try to address postpartum depression in fathers by providing testosterone supplements, Saxbe said that the study’s findings indicate a boost could worsen the family’s stress.
“One takeaway from this study is that supplementing is not a good idea for treating fathers with postpartum depression,” she said. “Low testosterone during the postpartum period may be a normal and natural adaptation to parenthood.”
She said studies have shown that physical fitness and adequate sleep can improve both mood and help balance hormone levels.
In addition, both mothers and fathers should be aware of the signs of postpartum depression and be willing to seek support and care, Saxbe said. Talk therapy can help dads or moms gain insight into their emotions and find better strategies for managing their moods.
“We tend to think of postpartum depression as a mom thing,” Saxbe said. “It’s not. It’s a real condition that might be linked to hormones and biology.”
A new Dutch study finds that the maternal use of antidepressants during pregnancy appears to increase the risk of the child developing a mental health issue. Risk increased for conditions such as autism, depression, anxiety, and attention deficit hyperactivity disorder (ADHD).
However, investigators are uncertain as to the role of hereditary as part of the elevated risk. Moreover, untreated severe depression during pregnancy can lead to negative outcomes for both the mother and child.
Experts acknowledge that the use of antidepressants among pregnant women has been on the rise for many years. Currently, between two and eight percent of pregnant women are on antidepressants.
In the new study, researchers from the National Centre for Register-based Research at Aarhus BSS show that there is an increased risk involved in using antidepressants during pregnancy.
The researchers, headed by Xiaoqin Liu, have applied register-based research to the study of 905,383 children born between 1998 and 2012 with the aim of exploring the possible adverse effects of the mother’s use of antidepressants during her pregnancy.
They found that out of the 905,383 children in total, 32,400 developed a psychiatric disorder later in life. Some of these children were born to mothers who were on antidepressants during their pregnancy, while other children had not been exposed to medication.
“When we look at children born to mothers who discontinued and continued antidepressant treatment during pregnancy, we can see an increased risk of developing a psychiatric disorder if the mothers continued antidepressant treatment while pregnant,” says Xiaoqin Liu.
Liu is the lead author of the article, which appears in the BMJ-British Medical Journal.
Researchers divided the children into four groups depending on the mother’s use of antidepressants before and during pregnancy.
The children in group one had not been exposed to antidepressants in the womb. In group two, the mothers had been taking antidepressants up until the pregnancy, but not during. In group three, the mothers were using antidepressants both before and during the pregnancy. Group four consisted of children, whose mothers were new users of antidepressants and had started taking the medication during the pregnancy.
The result of the study showed an increased number of children with psychiatric disorders in the group in which the mothers had been using antidepressants during their pregnancy.
Approximately twice as many children were diagnosed with a psychiatric disorder in group four (14.5 percent) than in group one (eight percent). In groups two and three respectively, 11.5 percent and 13.6 percent were diagnosed with a psychiatric disorder at age 16 years.
Despite the apparent medication link, researchers are quick to note that psychiatric disorders are hereditary.
Therefore, the investigators took into account that heritability also plays a part in determining who will be diagnosed with a psychiatric disorder, and that it is not just a question of being exposed to antidepressants in the womb.
“We chose to conduct the study on the assumption that psychiatric disorders are highly heritable. For this reason, we wanted to show that is too narrow if you only look at autism, which is what many previous studies have done.
If heritability plays a part, other psychiatric disorders such as depression, anxiety, ADHD-like symptoms would also appear in the data,” says Trine Munk-Olsen, who is also one of the researchers behind the study.
Indeed, the study also shows that the increase covers not only autism but also other psychiatric disorders such as depression, anxiety, and ADHD.
Thus it becomes clear that the mother’s underlying psychiatric disorder matters in relation to the child’s mental health later in life. At the same time, it cannot be ruled out that the use of antidepressants further increases the risk of psychiatric diseases in the child.
“Our research shows that medication seems to increase the risk, but that heritability also plays a part,” says Trine Munk-Olsen, who also points out that it might be the mothers who suffer from the most severe forms of depression who need to take medication during their pregnancy.
The findings are murky. Indeed, the researchers hope the study can increase the focus on the fact that the research results are not just black and white.
This could help doctors advise women on the use of antidepressants both before and after their pregnancy. Some women might be able to discontinue treatment with the medication while pregnant.
However, the researchers also acknowledge that some women need medication and stress that the consequences of an untreated depression are severe and can lead to serious consequences to both mother and child.
The most important message is that we ensure and safeguard the mental well-being of the pregnant women, and for some women, this involves the use of antidepressants.
“These women should not feel guilty about taking antidepressants. Even though there is an increased risk of the child developing a psychiatric disorder later in life, our research shows that we cannot blame medication alone. Heritability also plays a part,” says Trine Munk-Olsen.
Source: Aarhus University
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A new study suggests some of the most effective medications for chronic pain are the same medications that are used for depression.
At doses lower than those needed to treat depression, antidepressants can relieve chronic pain in conditions ranging from diabetic neuropathy, migraine and tension headaches, to osteoarthritis and fibromyalgia.
Experts explain, however, that most medications have significant associated side-effects and the ability to tolerate these side effects varies between individuals.
Side effects may depend on other medications an individual is using, or could be influenced by other existing health issues. Therefore, predicting the ability to tolerate such side effects could be crucial for the success of an antidepressant in treating pain.
This scenario is discussed in a recent article by Dr. Carina Riediger and colleagues in Dr. Timo Siepmann’s group at the University Hospital Carl Gustav Carus, in Dresden, Germany. The paper appears in the online journal Frontiers in Neuroscience.
“Understanding adverse effects and their impact on patients’ quality of life is crucial in modern clinical medicine and poses a substantial challenge to clinicians who face a exponentially growing range of available medical therapies” said Siepmann, the principal investigator of this study.
To help physicians match a chronic pain sufferer to a suitable antidepressant, their group performed a systematic study and meta analysis of the reported adverse effects for a wide variety of commonly used antidepressant drugs, each with its own side effect profile.
These antidepressants fall into different categories based on their mechanism of action, such as tricyclic antidepressants amitriptyline (Elavil) and nortriptyline (Pamelor), and serotonin reuptake inhibitors venlafaxine (Effexor), duloxetine (Cymbalta) and milnacipram (Ixel), among others.
The study collected all reported adverse effects for these drugs in the clinical literature from the past two decades. These side effects ranged from dizziness, dry mouth, and drowsiness, to palpitations, weight gain, sexual and urinary dysfunction, and hypertension, to name a few. The researchers also took into account whether treatment was discontinued due to the severity of these side effects.
Researachers found that almost all antidepressants presented significant side effects, and no drug was clearly superior to others. However, clinical data also showed that some individuals might better tolerate certain side effects than others, and therefore, the authors recommend personalized medicine.
For instance, dizziness and drowsiness as side effects may not be acceptable for individuals who drive vehicles or operate heavy machinery. On the other hand, some sedation might be tolerated, and perhaps even be desirable, in a chronic pain patient with sleep disruptions or insomnia.
These results may help physicians improve treatment outcomes by better matching the health status of chronic pain patients to their antidepressant medication.
“Dr. Riediger’s work contributes to this understanding, but further research is needed to improve general treatment recommendations and enable personalized multimodal therapy which is tailored to the patient’s individual health situation and includes non-pharmacological strategies in addition to pharmacotherapy,” Siepmann said.