Abstract
•Spouse observations of patient pain behavior predict spouse critical/hostile responses.•Spouse “internal” attributions predict spouse critical/hostile responses.•Internal attributions mediate observed pain behaviors and spouse responses links.
Spouse attributions regarding displays of pain behaviors by their partners with chronic pain may account for subsequent increases in spouse critical/hostile responses toward their partners. People with chronic low back pain (n = 105) and their pain-free spouses (n = 105) completed electronic diary measures 5 times per day for 14 consecutive days. Key items assessed spouse observations of patient pain behavior, attributions regarding these behaviors, and spouse critical/hostile responses toward patients. Results were 1) spouse observations of patient pain behavior at time 1 predicted high levels of spouse critical/hostile responses toward the patient at time 2. 2) “Internal” attributions (eg, the patient was attempting to influence spouse's feelings) at time 1 predicted high levels of spouse critical/hostile responses toward the patient at time 2. 3) Internal attributions mediated links between spouse-observed pain behaviors at time 1 and levels of spouse critical/hostile responses at time 2. Spouse observations of patient pain behavior was also related to an “external” attribution (ie, patient pain behavior was due to pain condition), but this attribution was not a significant mediator. A vital factor linking spouse scrutiny to spouse critical/hostile responses may be the spouse's ascribed reasons for the patient's grimacing, bracing, complaining, and so forth.
Perspective: Results indicate that spouse internal and negative attributions for pain behaviors of their partners with chronic pain may influence subsequent spouse critical/hostile reactions to them. Findings suggest that replacing spouse internal and negative attributions with external, compassionate, and accepting explanations may be useful therapeutic targets for couples coping with chronic pain.