Bidirectional Linkages Research Articles

Transactional Linkages Between Parenting Behaviors and Child Executive Functions and Self-Regulation from Early Childhood to Adolescence.

Research on the development of executive functions (EFs) and self-regulation (SR) has focused heavily on the early childhood years, when these abilities first emerge. Less is known in comparison about how these abilities develop through adolescence, and how contextual factors, such as parenting, influence their development in later years. Using longitudinal data from the Study of Early Child Care and Youth Development (SECCYD), we used random intercept cross-lagged panel modeling (RI-CLPM) to examine the bidirectional linkages between three parenting behaviors (i.e., autonomy support, supportive presence, hostility), child EFs (i.e., working memory, inhibitory control) and child SR outcomes, from early childhood to adolescence. Parenting in early childhood was significantly associated with change in child EFs from early to middle childhood, but not from middle childhood to adolescence. Specifically, greater autonomy support in early childhood was associated with stronger child working memory and inhibitory control in middle childhood; greater supportive presence in early childhood was associated with stronger child working memory in middle childhood; and higher rates of hostility in early childhood were associated with weaker child inhibitory skills in middle childhood. Reciprocal effects of child EF and SR on parenting were also observed. Specifically, stronger child inhibitory control in early childhood was associated with less hostility in middle childhood, and stronger child self-regulation in middle childhood was associated with greater supportive presence in adolescence. Accounting for lagged and stability effects, there was significant residual covariance between parenting behaviors and child SR in adolescence, suggesting that parenting continues to be associated with the development of SR skills through adolescence. Understanding reciprocal linkages between parenting and child EF/SR through adolescence is critical in developing targeted parenting interventions beyond early childhood to improve children's outcomes.

The interrelationships between economic growth and innovation: international evidence

ABSTRACT Technological innovation towards the goal of sustainable development is one of the concerns of many countries. This research investigates the linkages between innovation and growth for 71 countries worldwide from 1996 to 2020 by employing a simultaneous equation model and the three-stage least squares method to examine the bidirectional linkages among the variables. Outcomes state a two-way relation between growth and technology innovation. Specifically, a positive influence of technology innovation on economic expansion emphasizes the importance of innovation in growth. Meanwhile, a negative relationship between growth and technology innovation shows that the pressure of growth hinders innovation. Furthermore, a bidirectional relationship still exists between them in the sample of high-upper-middle-income countries but only one way for low-lower-middle-income countries. Institutional quality positively affects growth, while institutional quality has a negative influence on innovation. A number of policies have proposed to help promote innovation and enhance economic growth.

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

BackgroundEthiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies.MethodsFrom November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies.ResultsStrategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery.ConclusionPragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment.

The interplay of depression symptoms and physical activity: Bidirectional insights from 25-years of the Americans' changing lives panel

BackgroundDepression symptomology (DSx) and insufficient Physical Activity (PA) are among the leading causes of illness, and major contributors to global public health burden. Reviews and meta-analyses indicate that DSx and PA cause each other, yet most studies conducted use data and analyses which cannot specify their bidirectional associations across the life course. MethodThe present study estimates dynamic panel models with fixed effects through structural equation models with full-information maximum likelihood estimation (ML-SEM) based on 5 waves (1986–2011) of the Americans' Changing Lives (ACL) panel. This is a nationally representative probability sample of 3499 non-institutionalized U.S. adults ages 25 and older in 1986. Respondents participated in an average of 3.29 waves, with 67.84% participating in at least 3 waves, and 27.26% participating in all 5 waves. Models adjust for age, partner status, social integration, activity limitations, and serious financial problems. Data are available from the ICPSR (4690). ResultsEstimates from ML-SEM reveal negative and significant bidirectional cross-sectional associations between DSx and PA. Models also indicate a negative and significant cross-lagged association from DSx to PA, but not from cross-lagged PA to DSx. On both sides, earlier levels are significantly associated with future levels of PA and DSx. ConclusionsThis study is the first to use a causal inference technique which adjusts for all time-invariant confounders while modelling the bidirectional linkages between depression symptoms and physical activity over 25-years of adulthood. It supports literature showing a consistent cross-sectional relationship, and advances understanding on how DSx earlier in the adult life course may influence PA as people age.

ASSESSING BIDIRECTIONAL LONGITUDINAL ASSOCIATIONS BETWEEN SOCIAL RESOURCES AND COGNITIVE DECLINE IN LATE LIFE

Abstract Objectives To better understand bidirectional longitudinal relationships between social networks and cognitive decline. Method: We examined nine waves of data from the National Health and Aging Trends Study (2011-2019). Our primary outcome was global cognition, consisting of a summation of scores on episodic memory, orientation, and executive function tests. Social network measures included measures of social participation, number and type of social ties, attributes of network alter, and neighborhood markers of social cohesion and disorder. We applied linear mixed models to study associations between time-invariant measures of social cohesion and disorder with cognitive decline over time. We employed dual-outcomes mixed models to examine the bidirectional linkages between time-varying measures of social network structures and cognitive decline. Result: Eligible participants (N = 7,325) were included at baseline and followed for an average of 4.86±3.22 years/waves. Having more friend-ties and a higher percentage of college graduates within a social network at baseline were associated with slower declines in global cognition and episodic memory. Additionally, higher global cognition at baseline was associated with smaller reductions in social network size. Less disorientation at baseline was associated with a slower decline in social participation. Social cohesion and environmental disorder were not associated with cognitive decline. Conclusion Social networks may improve cognitive health but are also vulnerable to declining orientation. Results suggest that bidirectional longitudinal relationships link social network structure with cognitive decline and inform our understanding of the framework of associations between diverse aspects of social resources and cognitive decline in a longitudinal setting.

Diversification Potential Among the N-10 Countries: An Empirical Investigation

Emerging nations like Indonesia, South Korea, Bangladesh, Egypt, Mexico, Nigeria, Pakistan, Turkey, the Philippines, Iran and Vietnam have developing stock markets which may offer ample opportunities to investors for their portfolio returns. The emerging next ten countries (N-10) in the present paper have been explored for diversification opportunities for investors. The study has incorporated eight years’ (2013-2020) time series data for N-10 countries’ stock market indices. Portfolio diversification strategies between Pakistan and other markets have been indicated as per the findings of Granger causality, Johansen Cointegration techniques, VECM and Wald test. The unidirectional and bidirectional linkages analysis has shown fewer possibilities between Bangladesh and Egypt stock markets with diversification benefits. Thus, investors may utilise the findings of the study in planning their portfolio among these stock markets.

Mismatches in the ecosystem services-wellbeing nexus: a case study for Chilean Patagonia

ABSTRACT The supply of ecosystem services (ES) is commonly assumed to be linked to human wellbeing within socio-ecological systems. However, these linkages are seldom assessed using quantitative approaches at large scales and low spatial resolution. Here, we investigated the complex bidirectional linkages between ES supply and material wellbeing (income) using data from 382,199 rural properties in 178 municipalities from Chilean Patagonia. We assessed two model groups using structural equation modeling (SEM), wherein the first group assumed an impact of ES supply on wellbeing and the second postulated the opposite impact, with wellbeing affecting ES supply. For each group we run a separate SEM per ES category (i.e. provisioning, regulating, and cultural), making a total of six SEM analyzed. We found that neither model group was significantly stronger than the other, as the linkage between ES supply and material wellbeing was not significant in any model. Each model differed notably in their significant path coefficients, with models for cultural and regulating ES showing a better fit than for provisioning ES. We therefore assert that previously assumed links between ES and material wellbeing do not necessarily hold at larger spatial scales and in contexts where rural economies are more diverse and less dependent on natural capital. Understanding ES supply-wellbeing dynamics and how they vary across spatial and temporal scales is important for fostering sustainable socio-ecological systems.

The Reciprocal Relationship of Self-Rated Health and Instrumental Help From Adult Children: Evidence From Germany.

Receiving support from adult children may promote or be harmful for older adults' health. Poor health, however, often precedes the need for intergenerational support. To date, few studies have addressed the relationship between instrumental help (i.e., help with household chores) and older adults' self-rated health (SRH) simultaneously, thereby accounting for potential reverse causality. Moreover, little research has accounted for omitted variable bias. Dynamic panel models with fixed effects provide an opportunity to address these methodological issues. Drawing on four waves of the German Ageing Survey, which provide a sample of 3,914 parents aged 40-95 years, I investigate the bidirectional linkages between instrumental help from adult children and SRH. Results suggest that prior receipt of instrumental help is not a significant predictor of future reported SRH. Similarly, previous SRH does not significantly predict the likelihood of receiving instrumental help at follow-up. Instead, earlier values of SRH and instrumental help are most important for predicting future SRH and instrumental help. The results shed new light on the interplay between SRH and instrumental help from adult children. The study suggests that older adults' health and support in later life are not interdependent. I discuss these findings in relation to future policies for healthy aging to focus on interventions that facilitate optimal health in the earlier stages of the life course and for adult children to provide continued support to their parents.

Energy resources, tourism development and growth-emission nexus in developing countries

The primary purpose of this research is to evaluate the interrelationship between economic growth, carbon dioxide emissions, fossil fuel resource consumption, renewable energy resource consumption, and the development of the tourism industry. To this end, the panel VAR (Vector Autoregressive) approach is employed to analyze the annual data over 2000–2021 for 40 developing Asian countries. The major findings confirmed the Environmental Kuznets Curve hypothesis only for economic growth in the industry and services sectors. In addition, there are bi-directional linkages between economic growth in all three sectors and tourism development, revealing the existence of both TLGH (the Tourism-led growth hypothesis) and ELTG (Economic Lead Tourism Growth) hypotheses. Regarding the value of the growth rate of CO2 (Carbon dioxide) emissions, the growth rates of all variables in the previous period positively impact it. In contrast, the growth rate of the green energy index negatively affects the value of the growth rate of carbon emissions in the examined Asian developing economies. Developing green financing markets and promoting green culture are two recommended practical policies by this research.

Participatory Stakeholder Assessment for Drivers of Mangrove Loss to Prioritize Evidence-Based Conservation and Restoration in Bhitarkanika and Mahanadi Delta, India

In recent times, environmental stewardship of mangroves has provided the impetus to protect and restore these ecosystems for their inherent ability to protect coastal regions from climate change, sequester carbon dioxide as rich blue carbon, and support human well-being through a multitude of ecosystem services. Participatory stakeholder assessment, as a part of the present study, integrated local stakeholder perspectives in assessing drivers of mangrove loss in Bhitarkanika and Mahanadi delta, Odisha, providing empirical evidence through a mixed-method approach. The use of a Likert scale provided the methodology to develop a single composite variable as the best measure of central tendency. In total, 27.5% of the respondents were locals and were living close to the study area for generations, whereas the other 72.5% represented researchers, academics, and forest department officials. Stakeholder responses at the ground level indicated that Bhitarkanika and Mahanadi delta were facing increased frequency of extreme climatic events followed, by aquaculture and other land-use changes, which can be considered potential drivers causing mangrove loss. Co-development of future scenarios by integrating concerns of all the stakeholders emerged as a potential solution to effectively address the trade-offs arising from local anthropogenic interferences, as well as large-scale developmental activities. This study highlights the need for convergence of multi-disciplinary knowledge from diverse stakeholder groups, including traditional and indigenous knowledge, for the purpose of developing accurate plausible alternative scenarios. Interactive governance and incentivization approaches, along with alternative livelihood opportunities, are proposed as the means to improve conservation and restoration in the region based on the present study. Understanding of the coupled socio-ecological system and its relevance is found to be critical to improve bi-directional linkages of ecosystem health and human well-being.

Racial discrimination predicts depressive symptoms throughout adolescence among Black youth.

Experiences of racial discrimination are common among Black youth and predict worse mental health cross-sectionally and over time. Additional research is needed to address lingering questions regarding the direction of effect(s) underlying these patterns, differences in the magnitude of effects across adolescence, and gender differences. To address these gaps, the current study tested bidirectional linkages between racial discrimination and depressive symptoms at the between- (interpersonal) and within- (intrapersonal) level using 4 waves of data from 889 Black youth (54% female) from Georgia and Iowa. Participants reported experiences of racial discrimination and depressive symptoms at ages 10.6 years (Wave 1), 12.5 years (Wave 2), 15.7 years (Wave 3), and 18.8 years (Wave 4). The cross-lagged panel model (CLPM) was used to examine between-person associations over time, and the random intercept cross-lagged panel model (RI-CLPM) was used to examine within-person associations over time. Results were consistent across models, revealing significant concurrent associations between racial discrimination and depressive symptoms, significant lagged effects from racial discrimination to depressive symptoms, and no significant lagged effects from depressive symptoms to racial discrimination. Effects did not differ across adolescence, and there were few gender differences in the degree of association between racial discrimination and depressive symptoms. Findings provide rigorous evidence that experiencing greater racial discrimination is associated with increases in depressive symptoms throughout adolescence and add to a growing body of work showing that racial discrimination can undermine mental health and well-being among Black youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disentangling the Relationship Between Social Protection and Social Cohesion: Introduction to the Special Issue

While there is substantial evidence of the effect of social protection on poverty and vulnerability, limited research has focused on societal outcomes. This paper serves as introduction to a special issue (SI) examining the relationship between social protection and social cohesion in low- and middle-income countries. Over the last years, social cohesion has emerged as a central goal of development policy. The introduction and the papers in the SI use a common definition of social cohesion as a multi-faceted phenomenon, comprising three attributes: cooperation, trust and inclusive identity. This introductory article provides a conceptual framework linking social protection to social cohesion, shows the current empirical evidence for the bi-directional linkages, and highlights how the papers in the SI contribute to filling existing research gaps. In addition to this introduction, the SI encompasses seven papers, covering different world regions and social protection schemes, and using different quantitative and qualitative methods.

Supporting adolescents living with HIV within boarding schools in Kenya.

Adolescents and youth living with HIV (AYLHIV) are a uniquely vulnerable population facing challenges around adherence, disclosure of HIV status and stigma. Providing school-based support for AYLHIV offers an opportunity to optimize their health and wellbeing. The purpose of this study was to evaluate the feasibility of school-based supportive interventions for AYLHIV in Kenya. From 2016-2019, with funding from ViiV Healthcare, the Elizabeth Glaser Pediatric AIDS Foundation implemented the innovative Red Carpet Program (RCP) for AYLHIV in participating public healthcare facilities and boarding schools in Homa Bay and Turkana Counties in Kenya. In this analysis, we report the implementation of the school-based interventions for AYLHIV in schools, which included: a) capacity building for overall in-school HIV, stigma and sexual and reproductive health education; b) HIV care and treatment support; c) bi-directional linkages with healthcare facilities; and d) psychosocial support (PSS). Overall, 561 school staff and 476 school adolescent health advocates received training to facilitate supportive environments for AYLHIV and school-wide education on HIV, stigma, and sexual and reproductive health. All 87 boarding schools inter-linked to 66 regional healthcare facilities to support care and treatment of AYLHIV. Across all RCP schools, 546 AYLHIV had their HIV status disclosed to school staff and received supportive care within schools, including treatment literacy and adherence counselling, confidential storage and access to HIV medications. School-based interventions to optimize care and treatment support for AYLHIV are feasible and contribute to advancing sexual and reproductive health within schools.

A K-6 computational thinking curricular framework: pedagogical implications for teaching practice

ABSTRACT In this paper we propose a universal curricular framework that is intended to aid K-6 schoolteachers holistically and humanistically developing their students’ computational thinking (CT) skills (e.g. algorithmic thinking, abstraction, decomposition, generalization, patterns recognition, evaluation, and logical thinking). This framework, which can be applied to any subject at the elementary school level, is grounded on specific principles that we have gleaned from both learning theories and considerations on child development. New media literacy skills (NML) and social-emotional skills are also targeted, as they are strongly connected with CT skills and display bidirectional linkages that can comprehensively benefit students in various ways (cognitively, imaginatively/creatively, materially, socially, and affectively/emotionally) without the need for digital technologies or coding. The universal nature of our curricular proposal rests on the following factors: it is based on a cross-disciplinary approach that can be applied in ways that mirror real life; CT is seen as a universal skill that should be learned by everyone, not just computer scientists, and is applicable to every aspect of daily life; one-sided intellectualism is avoided; and, lastly, the resulting classroom practices have an impact on and are influenced by children’s cognitive, social, and emotional development.

The Radically Embodied Conscious Cybernetic Bayesian Brain: From Free Energy to Free Will and Back Again.

Drawing from both enactivist and cognitivist perspectives on mind, I propose that explaining teleological phenomena may require reappraising both “Cartesian theaters” and mental homunculi in terms of embodied self-models (ESMs), understood as body maps with agentic properties, functioning as predictive-memory systems and cybernetic controllers. Quasi-homuncular ESMs are suggested to constitute a major organizing principle for neural architectures due to their initial and ongoing significance for solutions to inference problems in cognitive (and affective) development. Embodied experiences provide foundational lessons in learning curriculums in which agents explore increasingly challenging problem spaces, so answering an unresolved question in Bayesian cognitive science: what are biologically plausible mechanisms for equipping learners with sufficiently powerful inductive biases to adequately constrain inference spaces? Drawing on models from neurophysiology, psychology, and developmental robotics, I describe how embodiment provides fundamental sources of empirical priors (as reliably learnable posterior expectations). If ESMs play this kind of foundational role in cognitive development, then bidirectional linkages will be found between all sensory modalities and frontal-parietal control hierarchies, so infusing all senses with somatic-motoric properties, thereby structuring all perception by relevant affordances, so solving frame problems for embodied agents. Drawing upon the Free Energy Principle and Active Inference framework, I describe a particular mechanism for intentional action selection via consciously imagined (and explicitly represented) goal realization, where contrasts between desired and present states influence ongoing policy selection via predictive coding mechanisms and backward-chained imaginings (as self-realizing predictions). This embodied developmental legacy suggests a mechanism by which imaginings can be intentionally shaped by (internalized) partially-expressed motor acts, so providing means of agentic control for attention, working memory, imagination, and behavior. I further describe the nature(s) of mental causation and self-control, and also provide an account of readiness potentials in Libet paradigms wherein conscious intentions shape causal streams leading to enaction. Finally, I provide neurophenomenological handlings of prototypical qualia including pleasure, pain, and desire in terms of self-annihilating free energy gradients via quasi-synesthetic interoceptive active inference. In brief, this manuscript is intended to illustrate how radically embodied minds may create foundations for intelligence (as capacity for learning and inference), consciousness (as somatically-grounded self-world modeling), and will (as deployment of predictive models for enacting valued goals).

Mindful Parenting, Parenting Cognitions, and Parent-Youth Communication: Bidirectional Linkages and Mediational Processes

Mindful Parenting, Parenting Cognitions, and Parent-Youth Communication: Bidirectional Linkages and Mediational Processes

Insomnia symptoms and non-suicidal self-injury in adolescence: understanding temporal relations and mechanisms.

We propose a theoretical model of insomnia symptoms and non‐suicidal self‐injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; M age = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß 23 = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß 12 = 0.09, p = .01; ß 23 = 0.11, p < .001). In addition, depressive symptoms (ß ind = 0.01, p = .02), but not impulsivity (ß ind = 0.01, p = .09), mediated the path from insomnia to increased NSSI. Neither worry (ß ind = 0.00, p = .59) nor rumination (ß ind = 0.00, p = .96) mediated the link between NSSI and increased insomnia. We conclude that NSSI and insomnia maintain each other over time. Thus, screening adolescents for insomnia symptoms may help identify those at risk of NSSI. Although depression seems to explain why insomnia is a risk factor for NSSI, further studies should investigate why NSSI plays a role in the maintenance of insomnia. This understanding will lay the foundation for intervention.

Examining foreign direct investment and environmental pollution linkage in Asia.

This study investigated the causal linkage between environmental pollution by carbon dioxide (CO2) emissions and net foreign direct investment (FDI), along with some other variables, namely economic growth by real per capita income and trade openness, using balanced annual data of 17 countries from Asia for the period from 1980 to 2014. Panel cointegration tests confirm the long-run association among the variables. After checking the panel data for stationarity properties, the method panel fully modified ordinary least squares (FMOLS) is implemented. The FMOLS estimates on CO2 emission model reveal that inward FDI has a significantly positive impact on environmental pollution, supporting the pollution haven hypothesis (PHH). Likewise, FDI model results imply that CO2 emissions represent environmental pollution; economic growth and trade openness are the pivotal determinants of FDI. Panel causality results suggest bidirectional linkages between CO2 emissions and inward FDI. Empirical findings suggest that economic policy reforms are required to channelise foreign capital inflows to a more environmentally healthy direction. The governments of Asian countries should chalk out policies on FDI inflows and the environment in order to achieve sustainable economic growth and development.

A Granger causality analysis of groundwater patterns over a half-century

Groundwater depletion in many areas of the world has been broadly attributed to irrigation. However, more formal, data-driven, causal mechanisms of long-term groundwater patterns have not been assessed. Here, we conducted the first Granger causality analysis to identify the “causes” of groundwater patterns using the rice-producing parishes of Louisiana, USA, as an example. Trend analysis showed a decline of up to 6 m in groundwater level over 51 years. We found that no single cause explained groundwater patterns for all parishes. Causal linkages were noted between groundwater and area harvested, number of irrigation wells, summer precipitation totals, and drought. Bi-directional linkages were noted between groundwater and rice yield, suggesting feedback between both time series. Causal linkages were absent between groundwater and many drivers where significant correlations were noted, highlighting the importance of using robust causal relationships over illusive correlations to detect the cause. These results advance our understanding of groundwater dynamics and can reveal a key connection between food and groundwater.

Daily and bidirectional linkages between pain catastrophizing and spouse responses.

Pain catastrophizing has been shown to predict greater pain and less physical function in daily life for chronic pain sufferers, but its effects on close social partners have received much less attention. The overall purpose of this study was to examine the extent to which pain catastrophizing is an interpersonal coping strategy that is maladaptive for patients and their spouses. A total of 144 older knee osteoarthritis patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that, on days when patients reported greater catastrophizing in the morning, their spouses experienced more negative affect throughout the day. In addition, a higher level of punishing responses from the spouse predicted greater pain catastrophizing the next morning, independent of patient pain and negative affect. Multilevel mediation models showed that patients' morning pain catastrophizing indirectly impacted spouses' negative affect and punishing responses through patients' own greater negative affect throughout the day. There was no evidence that spouses' empathic or solicitous responses either followed or preceded patients' catastrophizing. These findings suggest that cognitive-behavioral interventions that reduce pain catastrophizing should be modified for partnered patients to address dyadic interactions and the spouse's role in pain catastrophizing.