Close Relationship Processes and Health: Implications of Attachment Theory for Health and Disease

Supportive relationships are health protective (e.g., Berkman, Glass, Brissette, & Seeman, 2000; Cohen, 2004; Uchino, 2009). People who lack social ties or social integration experience higher mortality rates especially from cardiovascular disease but also from other diseases such as cancer (see Holt-Lunstad, Smith, & Layton, 2010). Although the connections between relationships and health are well-established, less is known about the interpersonal processes through which relationships influence health outcomes, despite a call for this type of research more than 20 years ago (e.g., House, Landis, & Umberson, 1988). Progress has been made on the biological mediators (e.g. Miller, Chen, & Cole, 2009), but cutting edge research in relationship science typically has not been integrated into health psychology. In this article, we draw on recent theory and research from the study of adult attachment theory in relationship science to develop an integrative framework for investigating how relationship constructs and processes influence health-related outcomes. The field of relationship science has expanded considerably in the past three decades, and it has yielded a number of rich theories of close relationships that have generated multiple innovative lines of research (for reviews, see Clark & Lemay, 2010 and Reis, in press). During approximately the same time period, health psychology also emerged as a distinct and rapidly expanding and developing subfield of psychology. Although many theories and empirical findings from relationship science are relevant for understanding a range of health-related issues, relationship science and health psychology have often progressed in parallel or independently with a few exceptions (e.g., Belcher et al., 2011; Kim, Carver, Deci, & Kasser, 2008; Manne et al., 2004a). Many specific ideas drawn from the social and personality literature on close relationships appear in the health literature, but overall, health psychology generally has not incorporated relationship science theories to generate hypotheses or integrated relationship science paradigms into research design and methodology. The goals of this article are threefold: To present one example of a theoretical model that integrates key relationship constructs and processes with biopsychosocial processes and health outcomes, to illustrate how the model can be applied to several specific health areas, and to offer recommendations to guide future relationship research designed to understand and promote health and well-being. Three major theoretical frameworks have guided most contemporary social and personality research on close personal relationships: attachment theory, interdependence theory, and theories based in evolutionary approaches (Reis, in press). In addition, relationships research has been informed by a variety of more specific theories such as the communal-exchange framework (Clark & Mills, 1979) and the intimacy process model (Reis & Shaver, 1988), and more recent approaches include the self-expansion model (Aron & Aron, 2001), the risk regulation model (Murray, Holmes, & Collins, 2006), and relationship goal approaches (Canevello & Crocker, 2011; Gable & Impett, in press). In this article, we selectively focus on one major theoretical perspective, adult attachment theory, because it is has driven a disproportionately large segment of research on relationship processes and outcomes over the past 25 years, has been shown to have wide explanatory power, and has clear relevance for health-related behavior and outcomes (see Mikulincer & Shaver, 2007). In the following sections, we first provide a brief overview of adult attachment theory. Second, we present a theoretical model incorporating components of attachment theory to specify how key relationship variables may predict health behavior and outcomes and highlight how this attachment-based model can generate novel lines of research to understand and promote health and well-being. Third, we discuss specific applications of the model to investigate connections between relationship processes and health (e.g., health behavior, coping with pain) in adults. Fourth, we offer examples of how the model might inform interventions. Finally, we provide a roadmap for future research. We focus on connections between close relationships and health and, because of space constraints as well as the centrality of close connections to our lives, we do not discuss other types of potentially relevant relationships such as broader social networks, buddy systems, or social connectivity (e.g., see Kawachi & Subramanian, 2008 and Smith & Christakis, 2008, all worthy of relationship science and health psychology integration as well.