{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T19:04:12Z","timestamp":1784055852670,"version":"3.55.0"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA201179"],"award-info":[{"award-number":["R01CA201179"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K08CA258947"],"award-info":[{"award-number":["K08CA258947"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA201179"],"award-info":[{"award-number":["R01CA201179"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["K08CA258947"],"award-info":[{"award-number":["K08CA258947"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cancer poses a threat to well-being that may activate the attachment system and influence interpersonal dynamics, such as communication. Research indicates that avoidant and anxious attachment, as well as communication, are independently associated with poorer psychosocial well-being, yet studies examining links between attachment, communication, and long-term physical well-being are lacking. We examined (a) associations between patient and partner attachment (measured with the adult attachment scale [AAS-Revised]) and observed communication (across affect [the Relational Affective Topography System (RATS) coding system] and behavior [the Asymmetric Behavior Coding System (ABCS) coding system]) and (b) the extent to which attachment and communication independently predicted long-term physical well-being (measured by the Functional Assessment of Cancer Therapy-General Population [FACT-GP]). Participants were 134 couples [mean age 53.9 (SD = 13.4), 86.2% Caucasian, 66% of patients, 36% of partners female]. Patient participants had either breast, colorectal, or lung cancer. Couples individually completed self-report measures of attachment (baseline) and physical well-being (baseline and 4, 8, and 12 months later). At baseline, couples engaged in a 15 min videorecorded cancer-related conversation coded for communication behavior and affective expression. Patients and partners with higher anxious and avoidant attachment exhibited more negative affect and negative approach behaviors. A greater avoidant attachment was associated with less positive affective expression. Attachment insecurity and affective expression were prospectively linked with physical well-being. Findings indicate that attachment is associated with overt communication behaviors and that insecure attachment and affective expression may be risk factors for poorer health outcomes.<\/jats:p>","DOI":"10.3390\/ijerph20075249","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T03:16:46Z","timestamp":1679627806000},"page":"5249","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Attachment in Couples Coping with Cancer: Associations with Observed Communication and Long-Term Health"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7584-3040","authenticated-orcid":false,"given":"Katherine","family":"Ramos","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA"},{"name":"Center for the Study of Human Aging and Development, Duke University, Durham, NC 27705, USA"},{"name":"Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karena","family":"Leo","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura S.","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan M.","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian R. W.","family":"Baucom","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Utah, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby L.","family":"Langer","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00520-015-2840-4","article-title":"Cancer and quality of life in spousal dyads: Spillover in couples with and without cancer-related health problems","volume":"24","author":"Litzelman","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_2","first-page":"232","article-title":"Couples dealing with cancer: Role and gender differences regarding psychological distress and quality of life","volume":"9","author":"Hagedoorn","year":"2000","journal-title":"Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s12160-008-9026-y","article-title":"Quality of Life of Couples Dealing with Cancer: Dyadic and Individual Adjustment among Breast and Prostate Cancer Survivors and Their Spousal Caregivers","volume":"35","author":"Kim","year":"2008","journal-title":"Ann. Behav. Med."},{"key":"ref_4","unstructured":"Bowlby, J. (1982). Attachment and Loss: Attachment, Basic Books."},{"key":"ref_5","unstructured":"Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development, Basic Books."},{"key":"ref_6","unstructured":"Mikulincer, M., and Shaver, P.R. (2016). Attachment in Adulthood: Structure, Dynamics, and Change, Guilford Press. [2nd ed.]."},{"key":"ref_7","unstructured":"Cassidy, J., and Shaver, P.R. (2016). Handbook of Attachment: Theory, Research, and Clinical Applications, Guilford Press. [3rd ed.]."},{"key":"ref_8","first-page":"1083","article-title":"The role of relationship attachment in psychological adjustment to cancer in patients and caregivers: A systematic review of the literature","volume":"23","author":"Nicholls","year":"2014","journal-title":"Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_9","first-page":"1017","article-title":"Correlates of self-rated attachment in patients with cancer and their caregivers: A systematic review and meta-analysis","volume":"25","author":"Nissen","year":"2016","journal-title":"Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_10","first-page":"1045","article-title":"The role of attachment dimensions and perceived social support in predicting adjustment to cancer","volume":"18","author":"Cicero","year":"2009","journal-title":"Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00520-010-0981-z","article-title":"Examination of couples\u2019 attachment security in relation to depression and hopelessness in maritally distressed patients facing end-stage cancer and their spouse caregivers: A buffer or facilitator of psychosocial distress?","volume":"19","author":"McLean","year":"2010","journal-title":"Support. Care Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.socscimed.2008.10.037","article-title":"Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients","volume":"68","author":"Rodin","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1111\/pere.12330","article-title":"Attachment style, partner communication, and physical well-being among couples coping with cancer","volume":"27","author":"Ramos","year":"2020","journal-title":"Pers. Relatsh."},{"key":"ref_14","first-page":"284","article-title":"Physical sequelae and self-perceived attachment in adult survivors of childhood cancer","volume":"10","author":"Joubert","year":"2001","journal-title":"Psycho-Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.copsyc.2014.12.001","article-title":"Attachment and health-related physiological stress processes","volume":"1","author":"Pietromonaco","year":"2015","journal-title":"Curr. Opin. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1037\/a0029349","article-title":"Close relationship processes and health: Implications of attachment theory for health and disease","volume":"32","author":"Pietromonaco","year":"2013","journal-title":"Health Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11764-007-0011-4","article-title":"Age and attachment style impact stress and depressive symptoms among caregivers: A prospective investigation","volume":"1","author":"Kim","year":"2007","journal-title":"J. Cancer Surviv."},{"key":"ref_18","first-page":"2459","article-title":"Attachment styles in patients with lung cancer and their spouses: Associations with patient and spouse adjustment","volume":"20","author":"Porter","year":"2012","journal-title":"Support. Care Cancer"},{"key":"ref_19","first-page":"935","article-title":"Caregiving styles and attachment orientations in couples facing advanced cancer","volume":"21","author":"Braun","year":"2011","journal-title":"Psycho Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1017\/S1478951507000466","article-title":"Marital therapy for couples facing advanced cancer: Case review","volume":"5","author":"McLean","year":"2007","journal-title":"Palliat. Support. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1159\/000455956","article-title":"The Role of Couples\u2019 Attachment Styles in Patients\u2019 Adjustment to Cancer","volume":"92","author":"Dorangricchia","year":"2017","journal-title":"Oncology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1007\/s10865-019-00096-3","article-title":"Dyadic coping mediates the effects of attachment on quality of life among couples facing ovarian cancer","volume":"43","author":"Crangle","year":"2019","journal-title":"J. Behav. Med."},{"key":"ref_23","first-page":"833","article-title":"The impact of attachment security on death preparation in advanced cancer: The role of couple communication","volume":"29","author":"Mah","year":"2020","journal-title":"Psycho Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_24","first-page":"927","article-title":"The association between individual attachment patterns, the perceived social support, and the psychological well-being of Turkish informal caregivers","volume":"18","author":"Kuscu","year":"2009","journal-title":"Psycho Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S144","DOI":"10.1037\/0278-6133.27.2(Suppl.).S144","article-title":"Adult attachment and psychological well-being in cancer caregivers: The mediational role of spouses\u2019 motives for caregiving","volume":"27","author":"Kim","year":"2008","journal-title":"Health Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1037\/a0031798","article-title":"Buffering attachment-related avoidance: Softening emotional and behavioral defenses during conflict discussions","volume":"104","author":"Overall","year":"2013","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102176","DOI":"10.1016\/j.cpr.2022.102176","article-title":"Beyond \u201cbeing open about it\u201d: A systematic review on cancer related communication within couples","volume":"96","author":"Goldzweig","year":"2022","journal-title":"Clin. Psychol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ogolsky, B.G., and Monk, J.K. (2019). Relationship Maintenance: Theory, Process, and Context, Cambridge University Press.","DOI":"10.1017\/9781108304320"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1037\/fam0000802","article-title":"A replication and extension of the interpersonal process model of demand\/withdraw behavior: Incorporating subjective emotional experience","volume":"35","author":"Leo","year":"2021","journal-title":"J. Fam. Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"769407","DOI":"10.3389\/fpsyg.2021.769407","article-title":"Couple Communication in Cancer: Protocol for a Multi-Method Examination","volume":"12","author":"Langer","year":"2022","journal-title":"Front. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1037\/0022-3514.58.4.644","article-title":"Adult attachment, working models, and relationship quality in dating couples","volume":"58","author":"Collins","year":"1990","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1037\/0022-3514.71.4.810","article-title":"Working models of attachment: Implications for explanation, emotion, and behavior","volume":"71","author":"Collins","year":"1996","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1200\/JCO.1993.11.3.570","article-title":"The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure","volume":"11","author":"Cella","year":"1993","journal-title":"J. Clin. Oncol."},{"key":"ref_34","unstructured":"StataCorp (2021). Stata Statistical Software: Release 17, StataCorp LLC."},{"key":"ref_35","first-page":"1605","article-title":"Couples coping with cancer: Exploration of theoretical frameworks from dyadic studies","volume":"24","author":"Regan","year":"2015","journal-title":"Psycho Oncol. J. Psychol. Soc. Behav. Dimens. Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1703","DOI":"10.1200\/JCO.2013.54.4825","article-title":"Psychological and Behavioral Approaches to Cancer Pain Management","volume":"32","author":"Syrjala","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1093\/bja\/aet207","article-title":"Psychological approaches to chronic pain management: Evidence and challenges","volume":"111","author":"Eccleston","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1037\/0022-3514.90.4.613","article-title":"Dating couples\u2019 attachment styles and patterns of cortisol reactivity and recovery in response to a relationship conflict","volume":"90","author":"Powers","year":"2006","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.copsyc.2018.04.004","article-title":"Adult attachment and physical health","volume":"25","author":"Pietromonaco","year":"2019","journal-title":"Curr. Opin. Psychol."},{"key":"ref_40","unstructured":"Cancer and Your Emotions (2023, January 01). MacMillan Cancer Support. Updated 28 February 2022. Available online: http:\/\/www.macmillan.org.uk\/information-and-support\/coping\/your-emotions\/dealing-with-your-emotions\/cancer-and-your-feelings.html."},{"key":"ref_41","unstructured":"Communication in Cancer Care (PDQ\u00ae)\u2014Health Professional Version (2023, January 14). National Cancer Institute, Available online: https:\/\/www.cancer.gov\/about-cancer\/coping\/adjusting-to-cancer\/communication-hp-pdq."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Nicolaisen, A., Hansen, D.G., Hagedoorn, M., Flyger, H.E., Rottmann, N., Nielsen, P., S\u00f8e, K., Pedersen, A.E., and Johansen, C. (2014). Attachment-oriented psychological intervention for couples facing breast cancer: Protocol of a randomised controlled trial. BMC Psychol., 2.","DOI":"10.1186\/2050-7283-2-19"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1111\/famp.12229","article-title":"A Review of the Research in Emotionally Focused Therapy for Couples","volume":"55","author":"Wiebe","year":"2016","journal-title":"Fam. Process."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1080\/23761407.2018.1563013","article-title":"Emotionally Focused Couples Therapy: A Systematic Review of Its Effectiveness over the past 19 Years","volume":"16","author":"Beasley","year":"2019","journal-title":"J. Evid. Based Soc. 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