Thoughts after marital conflict and punch biopsy wounds: Age-graded pathways to healing
Introduction
Marital quality influences long-term health and longevity, similar to the effect sizes reported for regular exercise and healthy eating (Robles et al., 2014). Mechanistic studies have focused on cardiovascular, endocrine, and immune reactivity to hostility during marital disagreement (Robles et al., 2014). Similar to other stressors’ disruption of wound repair (Broadbent et al., 2003), behaving more negatively during conflict slowed married couples’ blister wound healing (Kiecolt-Glaser et al., 2005). Little is known about the health significance of thoughts and emotions following marital conflict, though improving couples’ conflict reappraisal can successfully curb marital quality decline (Finkel et al., 2013). The current study examined the roles of post-disagreement mood and thoughts in punch biopsy wound healing. Compared to superficial blisters, full-thickness punch biopsy wounds require more time to heal and serve as an important clinical endpoint, particularly for older adults who are more likely to develop chronic wounds and face more serious wound-related consequences (Gould et al., 2015).
Thoughts and appraisals can amplify reactivity to a stressful event, expedite recovery, and even trigger a stress response in the absence of an external event. Whether a thought is positive or negative, its valence partially determines how constructive it is (Watkins, 2008). More negative thoughts are typically considered unconstructive because they can perpetuate a stressor’s noxious effects (Kashdan and Roberts, 2007, Watkins, 2008). Indeed, a meta-analysis of 60 studies showed that rumination heightened cardiovascular and neuroendocrine reactivity in the lab and in daily life (Ottaviani et al., 2016). People prompted to ruminate after a stressful speech had elevated cortisol one hour later (Zoccola et al., 2014). Higher salivary cortisol accompanied people’s everyday worries about work (Slatcher et al., 2010); cardiovascular reactivity was sustained up to two hours after worry episodes (Pieper et al., 2010).
Conversely, positive thoughts may hasten physiological recovery and protect health. People with human immunodeficiency virus (HIV) who reframed the illness more positively had higher 5-year survival rates and slower HIV progression than less positive thinkers (Ickovics et al., 2006). Low socioeconomic status parents and children who shifted and persisted, i.e. found greater meaning and positively reframed stressors, had lower inflammation and less glucocorticoid insensitivity than those who reframed less (Chen et al., 2015).
Because rumination reactivity has only been examined one to two hours post-stressor (Ottaviani et al., 2016) and positive-thought studies have focused on general self-report measures, studies linking acute post-stressor thoughts to later outcomes will help to assess the viability of thoughts as an explanation for long-term stress-related health risks.
According to aging theories, changes in time perspective, motivation, and physiology across adulthood alter affect and stressor reactivity. Socioemotional Selectivity Theory (SST) posits that older adults increasingly value and invest in close relationships to optimize emotional well-being (Carstensen, 1995). According to the Strength and Vulnerability Integration (SAVI) model, through experience, older adults hone the ability to positively reframe challenges, and, thus, can maintain positive affect, minimize negative mood, and circumvent stressor-related health risks (Charles, 2010).
Consistent with SAVI, older adults reported ruminating less and using more positive appraisal compared to their younger counterparts (Scheibe et al., 2016). Furthermore, when older adults were instructed to ruminate, their blood pressure remained higher than younger adults’ and older adults’ in the control condition (Robinette and Charles, 2016). On the other hand, when asked to focus on the positive aspect of upsetting films, older adults did so more successfully and reacted less physiologically compared to a neutral condition (Lohani and Isaacowitz, 2014). Studies addressing age differences have relied largely on emotion-provoking lab tasks, such as showing emotional films, that may lack active engagement and personal relevance for older adults, a disconnect known to produce variable results (Stanley and Isaacowitz, 2015). Marital disagreement, a potent stressor, is an active, personal task that can inform our understanding of age differences in post-stressor processes.
Some evidence exists for age differences in conflict, but we know less about post-conflict thoughts, emotions, and their physiological sequelae. Consistent with theory, older couples express less hostility than middle-aged couples during disagreement (Carstensen et al., 1995), but it is unclear whether they reap health benefits from this relative positivity. In two studies, older couples exhibited lower heart rate reactivity to conflict, but not in other peripheral measures (Levenson et al., 1994, Smith et al., 2009). Older partners may enjoy a larger advantage in their post-conflict thoughts and mood, more controllable than the course of a marital discussion.
To assess the immune effects of post-stressor marital processes, we examined partners’ post-conflict self-reported mood and emotional content of thoughts as predictors of wound healing in an age-diverse sample of married couples who received a punch biopsy and discussed a marital problem. Cortisol disrupts healing by inhibiting inflammation at the wound site (Ebrecht et al., 2004); thus, we also tested effects on afternoon-evening cortisol, as an intermediate indicator of wound healing relevance. The parent study documented marital conflict’s disruptive effects on blister wound healing (Kiecolt-Glaser et al., 2005). The full-thickness punch biopsy wound was better suited to test the longer-term immune relevance of post-conflict thoughts and feelings, and to probe age differences.
Our first objective was to examine age differences in post-conflict self-reported mood and emotional content of thoughts. Consistent with theory and past empirical evidence (Scheibe et al., 2016), we hypothesized that older adults’ mood would be more positive and less negative; they would also express more positive and fewer negative emotion words post-conflict. The next objective was to examine the effects of post-conflict mood and thoughts on cortisol and wound healing, as well as age differences in these associations. We predicted that more positive and less negative mood and thoughts would relate to lower cortisol levels, as well as faster wound healing (Kiecolt-Glaser et al., 1998). Stronger effects were expected in older adults than younger adults (Lohani and Isaacowitz, 2014, Robinette and Charles, 2016).
Section snippets
Participants
Heterosexual married couples (N = 42; 84 individuals) were recruited for a larger study on marital stress and wound healing through newspaper and radio ads, notices posted on campus and in the community, and referrals from other participants. Couples married fewer than 2 years were ineligible. We excluded couples if either spouse took blood pressure medication, smoked, or used excessive alcohol or caffeine. We also excluded couples with health problems that involved immunological or
Results
Key study variables and their zero-order correlations are summarized in Table 1.
Discussion
Following the marital disagreement, partners who expressed more positive emotion in their privately recorded thoughts had lower cortisol than those who expressed less positive emotion. Only among older adults did more positive thoughts also relate to faster full-thickness wound healing. Thus, not only does negative behavior during marital conflict incite neuroendocrine and immune reactivity (Kiecolt-Glaser et al., 2005, Robles et al., 2014), but also the thoughts that linger after the
Author note
Many thanks to Ron Glaser for his invaluable contributions to the study. Support included NIH grants P01 AG16321, P50 DE13749, K05 CA172296, T32 DE014320, UL1RR025755 and a Pelotonia Postdoctoral Fellowship from Ohio State University’s Comprehensive Cancer Center.
Conflict of interest
The authors have no conflicts of interest to report.
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