The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

• Published date: 01 December 2019
• Author: Danielle M. Weber,Cynthia M. Bulik,Jennifer S. Kirby,Cristin D. Runfola,Brian R. W. Baucom,Melanie S. Fischer,Camden E. Matherne,Donald H. Baucom
• DOI: http://doi.org/10.1111/famp.12391
• Date: 01 December 2019

The Association between Symptom Accommodation

and Emotional Coregulation in Couples with Binge

Eating Disorder

DANIELLE M. WEBER*

MELANIE S. FISCHER*

DONALD H. BAUCOM*

BRIAN R. W. BAUCOM

†

JENNIFER S. KIRBY

‡

CRISTIN D. RUNFOLA

‡,§

CAMDEN E. MATHERNE

‡

CYNTHIA M. BULIK

‡,¶,k

Intense negative emotions and maladaptive behavioral strategies to reduce emotional

distress occur not only in patients with various forms of psychopathology but also in their

committed partners. One common strategy to reduce distress is for partners to accommo-

date to the symptoms of the disorder, which reduces distress short term but maintains

symptoms long term. Accommodation is believed to be motivated by the partner reacting

behaviorally to the patient’s emotions, but the emotions of the partner in this context have

yet to be examined. This pilot study examined how partner accommodation related to speci-

fic patterns of emotional coregulation between patients with binge eating disorder (BED)

and their partners, before and after a couple-based intervention for BED. Vocally encoded

emotional arousal was measured during couples’ (n=11) conversations about BED. As

predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with

high accommodation before treatment. Thus, partners may use accommodation as a strat-

egy to reduce both the patients’ and their own distress. After treatment, partners’ arousal

was no longer associated with the patients’ emotional arousal; instead, partners showed

greater emotional stability over time, specifically when accommodation was low. Addition-

ally, patients were less emotionally aroused after treatment. Therefore, treatment may have

decreased overall emotionality of patients and altered the association bet ween accommoda-

tion and partners’ emotional reactivity. If replicated, this understanding of the emotional

*Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC.

†

Department of Psychology, University of Utah, University of Utah, Salt Lake City, UT.

‡

Department of Psychiatry, University of North Carolina at Chapel Hill.

§

Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.

¶

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC.

k

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Correspondence concerning this article should be addressed to Danielle M. Weber, University of North

Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270. E-mail: dmweber@

live.unc.edu.

Dr. Runfola was supported by the Global Foundation for Eating Disorders (PIs: Bulik & Baucom). This

investigation was also supported by a grant from the Hilda and Preston Davis Foundation. Dr. Bulik is a

consultant and grant recipient from Shire Pharmaceuticals and acknowledges funding from the Swedish

Research Council (VR Dnr: 538-2013-8864).

Dr. Runfola conducted this research while at the Department of Psychiatry at the University of North

Carolina at Chapel Hill. She is now at the Department of Psychiatry and Behavioral Sciences at Stanford

Univeristy.

920

Family Process, Vol. 58, No. 4, 2019 ©2018 Family Process Institute

doi: 10.1111/famp.12391

context associated with accommodation in BED can inform couple-based treatment by tar-

geting specific emotional precipitants of behaviors that maintain symptoms.

Keywords: Emotion Cor egulation; Couples; Accommodation; Binge Eating Disorder

Fam Proc 58:920–935, 2019

Emotion regulation is understood as a set of intra- and interpersonal processes that influ-

ence the occurrence, duration, and intensity of emotions (e.g., Butler & Randall, 2013).

The ability toregulate emotions effectively is critical to psychological andphysical well-being

(e.g., Eisenberg, Fabes, Guthrie, & Reiser, 2000; John & Gross, 2004). Furthermore, deficits

in emotion regulation, such as the frequent experience of intense negative emotions and the

reliance on maladaptive behavioral strategies to reduce negative emotions (e.g., binge eat-

ing, substance use, and self-injurious behaviors), are linked to various forms of psychopathol-

ogy (Werner & Gross, 2010). Given the multifaceted nature of emotion regulation and the

deleterious consequences of deficits in this area, extensive research has explored emotion

regulation at the individual level. However, emotions typically do not occur within a vac-

uum; the presence of close others can influence emotions and their regulation (e.g., Butler,

2011; Sbarra & Hazan, 2008). Ideally, close others facilitate regulation by promoting emo-

tional stability while reducing the burden on the individual to regulate individually (Coan &

Maresh, 2014). Under less ideal circumstances, close others can inhibit effective regulation

(Sbarra & Hazan, 2008), such as prolonging the duration or increasing the intensity of nega-

tive emotions. Given that the majority of adults are in committed romantic relationships

(U.S. Census Bureau, 2016), examining emotionregulation within a couple context is critical

to provide insight into the process of emotion regulation for both individuals.

Most research on interpersonal emotion regulation has focused on healthy couples. In

this context, calling on a partner to assist in emotion regulation may be an adaptive way to

regulate an acutely negative experience (e.g., Butler & Randall, 2013). However, interper-

sonal processes to regulate emotions appear to be more complex for individuals with psy-

chopathology. These individuals often have difficulties regulating emotions (Werner &

Gross, 2010), and they experience interpersonal difficulties (e.g., Baucom, Belus, Adelman,

Fischer, & Paprocki, 2014) which may make it difficult to work together as a couple to regu-

late emotions adaptively. When a partner witnesses the patient in distress, that is, experi-

encing and expressing intense negative emotions, the partner often searches for ways to

help (e.g., Fredman, Vorstenbosch, Wagner, Macdonald, & Monson, 2014). Not knowing

how to respond adaptively, partners may engage in strategies that alleviate distress in the

short term but are not helpful for the patient long term (Fischer, Baucom, & Cohen, 2016).

One way that partners respond to patients’ negative emotions is to engage in behaviors

that help the patient immediately avoid or escape intense emotional experiences. Whereas

behaviors such as providing reassurance in response to anxiety or completing tasks that

the individual would rather avoid could be considered social support under adaptive cir-

cumstances, if they serve to maintain the disorder, these partner behaviors are known as

symptom accommodation.

1

Despite the reduction or prevention of patients’ distress in the

short term, accommodation can reinforce maladaptive behaviors and emotion regulation

strategies in the long term (Salkovskis, 1996). Accommodation takes different forms

depending on the disorder, such as the partner participating in compulsive rituals (e.g.,

1

This understanding of accommodation should not be confused with Rusbult, Verette, Whitney, Slovik,

and Lipkus’s (1991) conceptualization of “accommodation” as a willingness to engage in constructive

rather than maladaptive behaviors in relationships.

Fam. Proc., Vol. 58, December, 2019

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