class 18: social support and negative social support

Class 18:

Social Support and Negative Social Support

Prospective Studies on Social Support and Health

Which method is more reliable, prospective or retrospective. Why?

Prospective: 1. Not biased by recall.2. Causality more easily determined, because causes

"don't work backwards."

Our emotions, stress, and health diary study is: ____ Prospective ____ Retrospective

X

Prospective study: Research sample identified first, then outcomes measured.

SAMPLE: People lacking support - Outcome: Illness ratesRetrospective Study: Outcomes identified first, then characteristics of sample identified.

OUTCOME: Rates of Illness Interview sample, find out who got sick.

Community Based Studies, 1979-1984Alameda County: Men and women w/o support were 1.9 to 3.1 times more likely to die in 9 year follow up.

What was main cause of death?

___ Heart Disease ___ Stroke

___ Cancer___ Respiratory

___ Gastrointestinal

XXXXX

Problems with this study: Doesn't account for pre-study illness

N. Karelia, CA Study: Focuses only on CHD

Admits only patients with pre-existing CHD/CHD risks

Isolated men (not women) higher CHD mortality

12 Additional Studies Associate Social Isolation with Mortality

Emotional Isolation Pre-MI, Mortality Post Myocardial Infarction (MI)

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Died in HospitalDied 6 mos. later

Social Support and Biomedical Model of Health

Social support challenges the bio-med model. Why?

“Over the last 150 years of medical research from Pasteur, Koch onward, research has proceeded successfully along lines of identifying one cause of one disease with the theory of disease specificity being one of the major advances in our thinking over the last century.”

Biomed model predicts 1 cause for illness, specific to illness. Social support indicates multiple, general causes for specific illness.

Social Support Affects Multiple Biological Mechanisms

Immune system functioning

Neuroendocrine functioning

Cardiovascular functioning

Maladies Related to Social Isolation

1. Pregnancy complications

2. Herpes outbreaks

3. Arthritis pain

4. Cancer

5. Diabetes mismanagement

6. Cardiac illness and recovery

7. Suppressed recovery from other illnesses

Social Support as Non-Specific Resistance

Stress: Non-specific health threat. Why?

Effects cardiovascular, respiratory, digestive, emotional health.

Social Support: Non-specific resistance factor. Why?

Effects cardiovascular, respiratory, digestive, emotional health.

Social Support and Resistance to Cold VirusCohen, et al., 1997

Healthy volunteers report degree of social support

Vols. Get nasal drops that contain cold virus

Outcome: Who gets more colds?

___ Low Social Support

___ High Social Support

X

Lending a Hand Coan, Shaefer, & Davidson, 2006

What's happening in this photo? Why?

Lending a Hand Coan, Shaefer, & Davidson, 2006

Thesis: Social contact helps people regulate disturbing emotion.

Method:

16 married women expected to receive painful shocks

Women placed in fMRI scanner with shock electrodes on ankle.

Women receive signal indicating shock/no shock will be delivered.

Fear measured at signal onset. This is repeated for 3 blocks of 12 trials.

During these trial blocks, women hold: 1) husband's hand 2) Experimenter's hand 3) no hand.

Lending a HandCoan, Shaefer, & Davidson, 2006

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No Hand StrangersHand

Spouses Hand1

1.21.41.61.8

22.22.42.62.8

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No Hand StrangersHand

Spouses Hand

Unpleasantness of Expected Shock

Phys. Arousal Due to Expected Shock

Effect of spousal hand holding on neural threat response was moderated by relationship quality: Closer relationships led to lower threat response, but only when holding husband's hand.

Social Support: Better to Give Or to Receive?

Brown, Nesse, Vinokur, & Smith, 2003

Social Support: Better to Give than to Receive?

Brown, Nesse, Vinokur, & Smith, 2003

Design: Prospective study conducted over five years.

Subjects—older couples, where husband is 65 + years old

Time 1 measures: a. Receive social supportb. Supply social supportc. Dependencyd. Age, gender, physical health, mental health, SES, personality.

Time 2 measure: Mortality.

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Effects of Giving Vs. Receiving Support on Mortality

Note: Anyone seemed "hurt" here by support delivery/receipt?

What's that about?

Summary of Social Support Benefits

1. General health promoter—effects all physio-systems

2. Reduces rates of illness

3. Reduces death rates (e.g., post MI)

4. Quicker recovery from major illness

5. Sustains life for people with terminal illness

However, people’s helping efforts can also fail. How so? What are ways in which people made it worse by trying to make it better?

“Recipe” for Negative Social Support: Husbands of Dieting Women

91% of men support wives’ attempts to lose weight.

Study observes behavior of husbands and dieting wives at dinner.Finds that husband, compared to wives, are:

Four times more likely to offer food.Seven times more likely to discuss foodRatio of criticism to praise: 12:1

Solution: Tell husband to just be uninvolved = Actively involve husband in dieting training

Why Would Social Support from Close Others "Go Bad"?

Continues over time

Requires higher level of commitment

Draws on past history

Social Support as an InteractionAction Actor's Intent Partner's Interpretation

1. Husb. wants to carry object To be helpful, show ability Husband is at risk.

2. Wife says "don't carry" To protect husband Wife is overreacting

3. Husb: "don't be worrier" I can do this, it's OK Feels dismissed, insulted

4. Wife: it's right to worry Sit. is serious, I have stake in your health

Feels manipulated, insulted

5. Husb. “I have a right to make my own choices"

Don't treat me like a child Feels misunderstood, under-appreciated.

6. Wife leaves in a huff You need to understand me. What happened?

Few minutes later, husband feels slight chest pain. What does he say to his wife?

Phases of Negative Social SupportCoyne, et al. 1988

Initial phase: high morale

Flagging morale

Re-definition of situation

Overwhelmed phase

Stalemate

Support Statement at Initial Phase

“I gave him repeated pep talks and assured him we were going to lick this awful thing that had ruined our lives”.

What is good about this statement?

What may be a problem with this statement?

Phase II: Flagging Morale Helper

Helper

1. Reassurance and support statements become forced, not sincere

2. Signs of worry, concern become more common

Recipient

1. Increased pressure to inhibit and fake.

2. No-win of inhibitiona. Blamed for not disclosingb. Blamed for complaining

Problem persists —helpers and copers become emotionally exhausted

Inability to fix problem --> threatened sense of control

Helpers want to take direct action to regain personal control

a. Advice giving: "Try harder", "Do more"b. Monitoring

Effects of helper's actionsa. Close monitoring undermines performanceb. Undermines intrinsic motivation to cope

Redefinition of Problem

Statement of Over-involvement

“When I tell you to lift your leg and stop dragging it, I am only doing it for your own benefit, because if you concentrate hard enough on lifting that leg you are physically able to do it”.

Wife's comments to her stroke-disabled husband.

What’s going on here?

1. Nature of illness: How acquired, duration, limitations

2. Nature of symptoms: Objective vs. Subjective

3. Orientation to situation: Motives (affection vs. guilt)Choice to be in helping roleHelpee’s responsibility for illness

4. Tasks that helper takes on:Clearly defined vs. ambiguous

5. Social network: Backup supporters vs. isolated

6. Relationship factorsDegree of affection pre-illnessQuality of communication pre-illness

Causes of Negative Social Support

1. Realistic expectations

2. Coordinate perspective of helper and helpee

3. Provide specific tips on how to help

4. Prepare both parties for possible set-backs

5. Describe miscarried helping

6. Inform helpers how own anxiety over-involvement

7. Urge both helper and helpee to focus on own, personal needs

How to Maintain Good Social Support?