Intimacy processes and psychological distress among couples coping with head and neck or lung cancers

Manne and Badr [1] recently studied crosssectional data from 109 patients undergoing active treatment for head and neck or lung cancers and their partners. They reported that, for both patients and partners, cancer-specific and global intimacy mediated associations between interpartner disclosures related to cancer and distress. Based on these findings, the authors concluded that disclosure of cancer-related concerns affects both cancer-specific and global intimacy and that improving shared disclosure between spouses about cancer is an important target for psychological intervention. As noted by the authors, however, there are important limitations that should be considered. Two important limitations suggest that the authors’ call for future research should preempt their suggestions regarding implications for psychological interventions. First, as noted by the authors, the study was cross-sectional. Given this study design, it is not at all implausible that distress may influence intimacy and disclosure in the context of cancer. Although Manne and Badr’s model assumes that the direction of the relationship goes from marital intimacy to distress, there are prominent theoretical models that emphasize the effect of depression or distress on marital satisfaction [2–4] or the bidirectionality of effects [5]. A recent study of patients with end-stage renal disease and their partners that used multilevel modeling with longitudinal data, for instance, found that time-varying depressive symptoms of patients and spouses affected marital satisfaction, but the reverse was not true [6]. Future work by Manne’s group and others on communication and intimacy processes over time will be important to better understand the directionality of the distress–intimacy relationship. Second, cancer-specific and global disclosure processes and intimacy were not well differentiated in the study. Although only cancer-specific communication was studied, it is important to determine the degree to which communication patterns are similar or different in the context of cancer compared with precancer patterns. Regarding intimacy, the correlations for both patients and partners of cancer-specific and global intimacy were very high (0.65 and 0.68), and approached what would be considered reasonable test–retest reliability for a single measure with a small number of items. Consistent with this, the relationships (1) between selfand partner disclosure and intimacy and (2) between intimacy and distress did not differ substantively whether cancer-specific or global intimacy variables were used. The authors did not present standardized regression coefficients, which would have facilitated a direct comparison of these relationships across models. However, a comparison of the t-values for these regression parameters in the cancer-specific and global models suggests that they were remarkably similar and that standardized parameters, if provided, would substantiate this. We read Manne and Badr’s study with great interest and look forward to more work from them on this important topic. Future work that clarifies longitudinal processes and the global versus cancer-specific nature of these processes will help to further clarify for clinicians the specific nature of their task. Namely, to what degree should clinicians focus on how couples communicate and relate, generally, versus how they communicate about cancer, specifically? Additionally, should the management of distress, intimacy and marital satisfaction, or both be the focus of interventions in couples coping with chronic illnesses?