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UC Berkeley Electronic Theses and Dissertations (2015)

Abstract

Emotional Behavior in Couples with bvFTD:

Implications for Caregiver Relationship Satisfaction and Psychological Well-being

by

Anna Sapozhnikova

Doctor of Philosophy in Psychology

University of California, Berkeley

Professor Robert W. Levenson, Chair

Emotions are an important part of marital life. Prior research indicates that patients with behavioral variant frontotemporal dementia (bvFTD) experience significant impairments in socioemotional functioning, including emotional blunting, inappropriate behavior and decreased empathy (Neary et al., 1998). These changes in patients often strain marriages and can lead to a decline in marital satisfaction and increase the risk of depression in the healthy spouse (Ascher et al., 2010, Braun et al., 2010). However, few studies have explored the emotional dynamics of couples living with bvFTD in a systematic way (Braun et al., 2009). The aim of this study was to extend our understanding of the emotional dynamics of couples where one spouse has bvFTD as well as to understand the association between emotional behavior during the marital interaction and the caregiving spouse’s relationship satisfaction and psychological well-being, looking specifically at depression.

This study examined emotional behavior and emotional reciprocity of couples where one spouse is diagnosed with either bvFTD (N=30) or Alzheimer’s disease (N=30) in the context of a 10-minute naturalistic marital interaction in comparison to healthy controls (N=29). Emotional behavior was coded using the Specific Affect Coding System (SPAFF), which consists of five positive emotional behavior codes, ten negative emotional behavior codes, and a neutral code. Emotional reciprocity between spouses was established using the Allison and Liker (1982) statistic. The study also examined the relationship between positive and negative emotional behavior as well as escalating and de-escalating patterns of emotional reciprocity and the caregiving spouse’s self-reported marital satisfaction and levels of depression.

The current findings reveal a loss of humor and reciprocity of positive emotion and an exacerbation in negative emotion (e.g., criticism, sadness) and conflict escalation in couples with bvFTD during a marital interaction. Furthermore, low positive emotion, high negative emotion and conflict escalation are associated with low marital satisfaction and high negative emotion is related to increased levels of depression in the spousal caregiver.

    Cover page: Emotional Behavior in Couples with bvFTD: Implications for Caregiver Relationship Satisfaction and Psychological Well-being
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2021)
    Many caregivers of patients with neurodegenerative disease experience physical and psychological strain, which is associated with negative health outcomes. Caregiver strain may be partly attributable to negative emotional responses (e.g.of resentment) to the behavioral, cognitive, and physical changes associated with patients' disease. The philosopher Peter Strawson observed that in dealing with people who have neurological impairments, we often choose to suspend such emotional responses, adopting what he labeled the "objective attitude," though this may come at the expense of our relationships with them. In this study, we assessed the mediating effect of caregivers' adoption of the objective attitude on caregiver strain and relationship closeness in the setting of disease progression. Caregivers of patients with neurodegenerative disorders (n = 215) completed the Clinical Dementia Rating, Relationship-Closeness scale, Caregiver Strain Index, and a novel questionnaire assessing the adoption of the objective attitude. A structural equation model assessing associations among these variables demonstrated good fit (χ2 (88)=164.621, p < 0.001; CFI = 0.929, RMSEA = 0.064.) and showed that adoption of the objective attitude mediated the association between disease progression and relationship closeness (total β= -0.233, 95% CI: -0.351, -0.113; indirect β= -0.483, 95% CI: -0.602, -0.364; direct β = 0.250, 95% CI: 0.117, 0.384), but did not mediate the association between disease progression and caregiver strain (total β = 0.323, 95% CI: 0.234, 0.412; indirect β = 0.089, 95% CI: -0.027, 0.206; direct β = 0.153, 95% CI: -0.043, 0.349). For future work, we propose longitudinal measurements of these constructs to test the directionality of associations and consideration of how models for caregiver support can draw upon interdisciplinary insights.
      • Article
      • Peer Reviewed
      ICTS Publications (2015)
        Cover page: A Multiancestral Genome-Wide Exome Array Study of Alzheimer Disease, Frontotemporal Dementia, and Progressive Supranuclear PalsyCreative Commons 'BY' version 4.0 license
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