Observed Social Support Behaviors and Cancer-Related Cognitive Processing in Couples Coping with Head and Neck Cancer (HNC)

Given the disfiguring and debilitating nature of HNC and its treatment, patients and their spouses are at risk of experiencing trauma symptoms including cognitive intrusion and avoidance which may exacerbate psychological distress. Even though the Social Cognitive Processing Model (SCPM) posits that social support facilitates adaptive cognitive processing, recent literature has pointed to harmful effects of received support. Most studies use self-report measures of perceived as opposed to actual received support focusing on the patient as the recipient of support. In reality, the support process is reciprocal and interdependent involving both receiving and providing support in both patients and spouses. Further, self-reports of cognitive processing are susceptible to self-presentation and defensive biases. The purpose of this research was to examine the association between actual observed support behaviors and cognitive intrusion and avoidance in 60 newly diagnosed HNC patients (87% male) and their spouses using a multi-method approach. As part of an ongoing longitudinal study, couples completed baseline questionnaires including an explicit measure of cognitive intrusion and avoidance (IES), completed a problem-solving discussion task in the laboratory immediately followed by an implicit assessment of cognitive intrusion (cancer Stroop task (CST)). We used the Social Support Interaction Coding System (SSICS) to code the video-recorded discussions. Dyadic analyses using multi-level modeling revealed that when patients and spouses received more (compared to less) positive support behaviors, they demonstrated slower reaction times (RT) on the CST (p < .01) indicating greater cognitive intrusion. The results were similar using the self-report method (IES; p < .05). No role differences (patients vs. spouses) were found. The current findings map on to recent literature suggesting that receiving support may be initially distressing in the acute phase of the traumatic event as it may elicit negative emotional responses, which are yet necessary to facilitate successful long-term adjustment. Thus, our next step in this ongoing longitudinal study is to examine long-term consequences of these findings as they will reveal clinical implications.