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Coping with Cancer Interventions for the Family
Cancer & Family continuing education addiction counselor CEUs

Section 25
Men’s Adjustment to Their Partners’ Breast Cancer:
A Dyadic Coping Perspective

CEU Question 25 | CE Test | Table of Contents | Cancer
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

The American Cancer Society (2003) estimated that there would be 212,600 new breast cancer cases in the United States in 2003. In 2000,182,000 cases were diagnosed, which represents an increase of 30,000 new cases in just three years. With this increase in occurrence, growing numbers of men are likely to experience the impact of breast cancer on their relationships.

The psychosocial impact of breast cancer and its treatment generates a ripple effect from the patient to her partner and ultimately to the entire family system (Lewis, Ellison, & Woods, 1985). This ripple effect affects a family's basic identity by triggering multiple challenges (Sabo, 1990) that alter the routines of daily living as well as exposing the patient, her spouse, and other family members to significant psychological stress (Given & Given, 1992; Lewis et al., 1985; Northouse & Peters-Golden, 1993). In fact, Rolland (1994a) noted that a woman's serious illness can present the greatest overall risk to couples' and family functioning because historically women have served many of the practical and nurturant roles in families.

As the number of women facing breast cancer and national concern over medical costs continue to increase, managed care in health care provision has precipitated changes in patient caregiving. One way managed care companies have lowered their costs is by shifting the burden of patient care from hospitals to patients' partners and families. Consequently, more men have become primary caregivers to their wives and partners on top of coping with the stress and chaotic disturbances that accompany breast cancer. Male partners of breast cancer patients assume fundamental roles in patient and family care, yet their issues and the ripple effect of this disease on the family tend to be neglected or disregarded because health care professionals focus on patient concerns (Northouse & Peters-Golden, 1993).

Breast Cancer’s Impact on the Partner
In an early article about the psychosocial aspects of the cancer experience, Dyk and Sutherland (1956) suggested, "The spouse is often the key to the patient's success or failure in adapting…to the disability" (p. 138). Nevertheless, until the 1970s partners of breast cancer patients were viewed as passive observers rather than active participants in the cancer experience. In the 1970s and 1980s, descriptive studies documented that men often experienced psychosomatic symptoms and sexuality and intimacy distress (Wellisch, Jamison, & Pasnau, 1978), increased anxiety and depression (Maguire, 1981; Oberst & James, 1985), a general sense of helplessness (Vachon et al., 1977), fear of cancer and its treatment (Gotay, 1984), and concern about their own and their partner's ability to cope with the cancer (Grandstaff, 1975). Despite methodological problems, these studies provided important information about the process of adjusting to breast cancer.

For example, Wellisch and colleagues (1978) surveyed 31 men approximately two years after their wife's mastectomy and found that most men reported good overall adjustment but that close to half of them reported problems with their ability to work and sleep and about a quarter reported symptoms consistent with eating disorders. In addition, more than a third stated that the influence of breast cancer on their sexual relationship was "somewhat bad" or "bad." Not surprising, the higher the men's evaluation of their relationships, the less negative influence they attributed to the mastectomy. Overall, most of the men coped well or denied psychosocial stresses. However, a smaller subgroup was distressed, remained distressed, and reported a downward spiraling in their relationship quality.

In 1981 Maguire assessed husbands' adjustment to breast cancer over time. He included a comparison group of husbands of women with nonmalignant breast disease. Maguire's data revealed increased distress for cancer patients' husbands at three time points: before surgery and at three and 12 months following surgery. More than three quarters of Maguire's sample reported that the time period during the hospitalization and surgery was especially stressful. Although the results showed that anxiety levels of most husbands decreased with time, more than one-third of the husbands reported increased anxiety related to their wives' illness one year after surgery.

Since then, several studies have attempted to quantify the level and length of emotional distress experienced by husbands and to compare the stress levels of spouses by using standardized measurement scales (Baider & Kaplan De-Nour, 1984; Ell, Nishimoto, Mantell, & Hamovitch, 1988; Northouse, 1989; Northouse & Swain, 1987). Findings consistently report high correlations between partners' and patients' adjustment levels.

Sabo and colleagues (1986) examined the efficacy of support group experiences for husbands and found that men most feared that their wives might not survive, but also felt anxious about their own ability to provide their wives enough emotional support. They placed high priority on their wives' adjustment and hid their own feelings. Notably, most participants claimed that the loss of a breast did not matter to them and that their feelings of attraction toward their wives remained unchanged. In a later study, Sabo (1990) found that anxiety reactions, depression, and hypochondriacal preoccupations were common among husbands of breast cancer patients. Again, husbands felt inadequate in their ability to help their wives cope with the cancer diagnosis, and they used denial as the primary defense mechanism to minimize worries and cope with added duties. Similarly, Wilson and Morse (1991) found that many men reported feeling guilty during the treatment phase when they tried to meet basic needs, such as when cooking a meal and worrying that the odors would nauseate their wives. Some husbands believed concealing fears of death was best and used self-control to hide feelings of sadness and fear from their wives. 

Dyadic Coping and Chronic Illness                                                           
Kerson (1985) included breast cancer among those chronic illnesses considered to be most devastating and highest in prevalence. Its ambiguous outcome and unpredictable course pose substantial challenges for couples (Sidell, 1997). Compared with other chronic disorders, such as diabetes, a breast cancer diagnosis invokes images of "death, pain, and horror" (Lewis, Woods, Hough, & Bensley, 1989). Bourjolly and colleagues (1999) observed that the physical and emotional demands of breast cancer affect patients' social roles, social functioning, and functional status. Areas most likely to be affected are household tasks, sexual function, and marital problems (Harwood & O'Connor, 1994; Silberfarb, Maurer, & Crouthamel, 1980). Remission, the "process of adapting, not to terminal disease, but to uncertainty," is the only attainable goal of breast cancer treatment (Nathan, 1990). Men who are partners of breast cancer patients must also learn to live with this uncertainty.

Indeed, coping with chronic and severe illness has become a normative endeavor for many couples (Coyne & Fiske, 1992). Early coping research (see Lazarus, 1966; Lazarus & Folkman, 1984) focused on individual coping patterns and failed to consider the interpersonal and sociocultural domains in which coping takes place (Piening, 1998). However, given the significance of these contextual issues, research has since suggested that chronic illness stressors affect both partners. Dyadic coping constitutes a couple's efforts to cope conjointly with a common or shared stressor.

The limited amount of research conducted from the dyadic coping perspective has identified different types of dyadic coping and depicted situations in which dyadic coping strategies are applied (Kayser, Bodenmann, Piening, & Feldman, 2000). For example, Hannum and colleagues (1991) investigated whether the coping style of one spouse affected the effectiveness of the other spouse's coping. They found that distress reported by wives was linked to the coping of their husbands and that distress reported by husbands was linked to both their own and their wives' coping. There was a degree of symmetry in partners' coping strategies within the couples, such that when wives expressed more stress, husbands expressed increased optimism.

In their study of couples coping with Alzheimer's disease, DeLongis and O'Brien (1990) drew attention to the interpersonal processes of stress and coping and toward perceiving couples coping with chronic illness as "open systems." The researchers identified active engagement (involving both partners in discussions, asking how the partner feels, and other forms of constructive problem solving) and protective buffering (hiding concerns, denying worries, and yielding to partner to avoid arguments) as dyadic coping mechanisms considered instrumental in couples' relationships. The authors suggested that certain communications, such as criticizing, confronting, ignoring, and minimizing contact with others, disrupt social relationships.

In general, despite the current emphasis on breast cancer research and the abundance of accumulated knowledge about the woman's experiences, there remains a paucity of research on the man's experience as he is affected by his partner's disease (Ptacek, Ptacek, & Dodge, 1994). Although dyadic coping and chronic illness studies depict that both partners are affected by each other's coping styles, no research explores the factors that enable some male partners of breast cancer patients to adjust more successfully than others. One important question that remains unanswered is: How does dyadic coping affect men's psychosocial adjustment to their partners' illness? The research presented here addressed this question by exploring the men's experience with their partner's illness using standardized measurement instruments.

Theoretical and Conceptual Framework: The Dyadic Perspective
Traditional perspectives on coping with stress in individuals have been conceptually within the individualistic transactional model of stress, appraisal, and coping initially espoused by Lazarus (1966) and Lazarus and Folkman (1984). Dyadic coping extends the individualistic model of stress and coping by providing a systemic-transactional approach to perceiving and comprehending coping. Stress is dyadic if it affects both partners and takes into consideration both verbal and nonverbal "stress signals of one partner and the coping reactions of the other partner to these signals" (Bodenmann, 1997,p. 138). When unresolved, the stress of one partner affects the other and both partners have a strong interest in providing mutual support to achieve stability, satisfaction, and well-being in their relationship. Depending on the situation and individual and dyadic appraisals, couples can use various dyadic coping strategies, including positive coping strategies (dyadic stress communication, positive dyadic coping, and common dyadic coping) and negative strategies (hostile dyadic coping and avoidance of dyadic coping).

With breast cancer couples, conceptualizing stress as dyadic provides a more accurate understanding of how the stress process systemically affects the couple dyad, whereby the partner shares the stress burden of the patient and vice versa. Adaptation to stress must not be limited to individualized efforts to cope, but also must include the partner's social support (Revenson, 1994). Hence, coping is more appropriately viewed from a dyadic perspective. Thus far, research has not examined men's dyadic coping behaviors in response to their partners' breast cancer.

-Feldman, Barry N., Broussard, C. Anne; Men’s Adjustment to Their Partners’ Breast Cancer: A Dyadic Coping Perspective; Health and Social Work; May 2006; Vol. 31, Issue 2

Personal Reflection Exercise #11
The preceding section contained information regarding Dyadic coping and men’s adjustment to their partners’ breast cancer. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Friedlander, M. L., Escudero, V., Welmers-van de Poll, M. J., & Heatherington, L. (2018). Meta-analysis of the alliance–outcome relation in couple and family therapy. Psychotherapy, 55(4), 356–371.

Kuhn, R., Bradbury, T. N., Nussbeck, F. W., & Bodenmann, G. (2018). The power of listening: Lending an ear to the partner during dyadic coping conversations. Journal of Family Psychology, 32(6), 762–772.

Soriano, E. C., Otto, A. K., Siegel, S. D., & Laurenceau, J.-P. (2017). Partner social constraints and early-stage breast cancer: Longitudinal associations with psychosexual adjustment. Journal of Family Psychology, 31(5), 574–583.

Soriano, E. C., Pasipanodya, E. C., LoSavio, S. T., Otto, A. K., Perndorfer, C., Siegel, S. D., & Laurenceau, J.-P. (2018). Social constraints and fear of recurrence in couples coping with early stage breast cancer. Health Psychology, 37(9), 874–884.

Online Continuing Education QUESTION 25
What is Dyadic coping? Record the letter of the correct answer the CE Test.

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