The effects of social support and social control on cardiovascular reactivity during problem disclosure.
In many different contexts social support has repeatedly benefited individuals, both physically and mentally. More specifically, social support has been linked to positive affect, improved emotional adjustment (Chou, 1999; Curtis, Groarke, Coughlan, & Gsel, 2004), decreased levels of psychological distress, decreased cardiovascular reactivity (CVR) in the face of stressors (Fritz, Nagurney, & Helgeson, 2003; Uchino, Uno, & Holt-Lunstad, 1999), and enhanced adjustment to coronary heart disease (Helgeson, 1993). Considering that heightened CVR is a risk factor for heart disease (Kamarck, Manuck, & Jennings, 1990; Smith, Limon, Gallo, & Ngu, 1996) and that social support attenuates heightened cardiovascular reactivity, social support may ultimately decrease one's risk of heart disease.
There are three main types of social support: emotional, instrumental, and informational. Emotional support involves the communication of understanding and concern, instrumental support involves the offer of tangible and concrete aid, and informational support involves the provision of guidance or advice (Helgeson & Cohen, 1996). Regarding emotional support, higher levels are associated with increased life satisfaction, decreased psychological distress, greater positive affect, lesser negative affect, and fewer depressive symptoms (Chou, 1999; Goehl, Nunes, Quitkin, & Hilton, 1993; Nelson, 1990). Furthermore, increases in perceived stress paired with decreases in social support are associated with poor emotional adjustment (Curtis et al., 2004). Regarding informational support, perceived informational support decreases distress and is related to increased positive affect, while received informational support is associated with increased distress (Neely, Lakey, Cohen, Barry, Orehek, et al., 2006; Helgeson, 1993). This pattern indicates that the actual provision of support may be harmful in some circumstances (e.g. if the support is not wanted), but simply perceiving that others are there if needed may have a calming effect.
Research suggests that females provide more emotional support than males (Antonucci & Akiyama, 1987; Mickelson, Helgeson, & Weiner, 1995). This discrepancy may be due to women's increased number of intimate and confiding relationships, and men's relatively high generalized mistrust of others (Shumaker & Hill, 1991; Vaux 1985).
Furthermore, research shows that receiving social support seems to lower blood pressure in women but not men (Linden, Chambers, Maurice, & Lenz 1993) and that social support received from females results in less CVR, for both males and females, than non-support from women; however no such difference has surfaced for support provided by males (Glynn, Christenfeld, & Gerin, 1999). One explanation for the positive effects of social support received from females may be that they are more skilled at providing the support. In fact, women do perceive greater self-efficacy in the area of emotional support than men (MacGeorge, Clark, & Gillihan, 2002). This notion is supported by the fact that individuals often tend to fill traditional gender roles; emotional support is considered feminine versus masculine (Kunkel & Burleson, 1999), and females tend to exhibit emotion-focused behavior (e.g., females are more expressive), while men tend to be more problem-focused (Burleson & Gilstrap, 2002).
Research using biological sex and support receipt to predict CVR has demonstrated that emotional support is associated with decreased levels of cardiovascular reactivity for females, but increased reactivity for males (Fritz, Nagurney, & Helgeson, 2003). Fritz and colleagues (2003) had participants who were pairs of friends interact with each other. One disclosed a relationship problem while the other provided whatever support he/she saw fit for the situation. The results showed that females' SBP and DBP reactivity were both negatively correlated with emotional support. On the other hand, males' SBP reactivity was significantly positively correlated with emotional support, but DBP reactivity and emotional support were uncorrelated. This pattern of results suggests that the interaction between type of support and gender is an important factor to examine when dealing with reactivity.
In summary, numerous studies have demonstrated that women provide more emotional support than men and that high levels of emotional support are associated with decreased cardiovascular reactivity (an important marker of physical health) and decreased distress (an important marker of mental health). With these results in mind, attention will now be given to the second major issue involved with this study, that of social control.
Social control is defined as interactions involving influence and regulation, especially in the area of health behaviors (Lewis & Rook, 1999). Examples of social control include throwing away another person's cigarettes or encouraging a spouse to start dieting. Social control contributes to well-being through discouraging unhealthy behaviors in favor of healthier ones, yet not through reducing stress (as with social support). As this is a newer research area compared to social support, the empirical findings for social control are much more limited than those for social support.
Research supports the fact that, in addition to social support, females also provide more social control than males (Umberson, 1992). It has been found that 80% of males identified their wives as the person who imposed the most social control upon them while only 59% of females reported that their husbands filled this same role (Umberson, 1987). In addition, the mere presence of a spouse or child has been enough to exert social control over participants, which indicates social control is pervasive enough that the mere presence of others can activate its effects (Umberson, 1987).
When examining the effect of social control on health behaviors, Lewis and Rook (1999) conducted a longitudinal study demonstrating that higher levels of social control were associated with more behavioral change, but also with higher levels of distress at follow-up. It should be noted that this pattern of results only held when the control was coming from a single network member, suggesting that reactance processes may have been at work when faced with social control from the larger social network (Brehm & Brehm, 1981). However, contrary research indicates that receiving social control is associated with lower levels of psychological distress and not strongly associated with health practices (Rook, Thuras, & Lewis, 1990). These differences could be due to differences in the population sampled (e.g., middle-aged participants versus elderly participants).
Regarding social control and CVR, research demonstrates that exerting social dominance (which may be construed as a form of social control) can potentially increase one's risk for Coronary Heart Disease (CHD; Smith et al., 1996). However, research regarding gender differences within CVR and social control is mixed. Some research has shown that men and women are differentially reactive to stressors that highlight gender-related characteristics (Smith, Gallo, Goble, Ngu, & Stark, 1998). For example, men have shown to be most reactive to tasks or stressors that are traditionally associated with male roles, such as achievement and competition, while other stressors have produced increased responses from women, such as those involving communal concerns (e.g., argument with husband; Smith et al., 1998; Smith et al., 1996). Thus, it is possible that men should be more reactive to social control than women. It is also possible that interaction partners should be more reactive when attempting to control a male than a female. Alternatively, other research does not indicate these effects (e.g., Davis & Matthews, 1996). Further research is thus warranted in this area.
Other research has shown that a socially dominant interactional style (which is more typical among men) is an independent predictor of subsequent CHD (Houston, Chesney, Black, Cates, & Hecker, 1992). Animal models support this finding. For instance, dominant male monkeys have developed more severe coronary artery disease than subordinate male animals when housed with unfamiliar monkeys (an interpersonal stressor). However, female subordinate monkeys were significantly more prone to coronary artery disease when compared to the dominant animals (Kaplan, Manuck, Williams, & Strawn, 1993). Human studies involving personality styles such as the Type A behavior pattern have been supportive of the results from this animal research (Carver & Glass, 1978;Lovallo & Pishkin, 1993).
In summary, the findings for social control are mixed. It has been found that women provide more social control than men. Results are ambiguous regarding how social control relates to the issues of health behavior and psychological distress, but there is some evidence that, under certain circumstances (e.g., among the middle-aged, among the ill) its effects are opposite those of emotional support. One of the main purposes of this study is to try to unravel these uncertain results.
Study Overview & Hypotheses
The format for the current study is modeled after that of Fritz et al. (2003). Participants disclosed a problem to a same or opposite-sex confederate. The confederate provided either very supportive feedback or very controlling feedback, which yields a 2 (participant sex) x 2 (confederate sex) x 2 (condition) design. Participants' cardiovascular reactivity and recovery were measured before, during, and after this interaction as indicators of how support or control affected their physical states.
A three-way interaction was predicted between condition (support or control), confederate sex, and participant sex. The pattern of the predicted interaction is as follows: Females who received support rather than control would evidence less reactivity and greater recovery than males, particularly when this support was received from other females. Males who received control rather than support would evidence less reactivity and faster recovery than females, particularly when this control was received from other males. These results should occur based upon the phenomenon that individuals will be more reactive to a situation that is not within traditional sex roles (Smith et al., 1996, 1998), in addition to the notion that social support received from women results in less reactivity for both SBP and DBP, in either a male or female (Glynn et al., 1999).
Participants were 150 students, 69 males and 81 females, recruited from the student bodies of two large universities located in the Southwest. These institutions are characterized by populations of mostly Caucasian with a large minority of Hispanic students. Participants were randomly assigned to interact with either a male or a female confederate and to receive either supportive or controlling feedback. Cell sizes as well as participant information are included in Table 1.
The study utilized an Industrial and Biomedical Sensors Corporation (Model SD-700A) automated blood pressure monitor with a standard inflatable blood pressure cuff placed on the participant's non-dominant arm. The monitor assesses blood pressure using the auscultatory method and is equipped to detect errors caused by movement and/or poor cuff placement.
Participants arrived at the lab and were seated on a comfortable couch. At this time, they met the confederate, whom participants believed to be another participant in the study. After this initial introduction, the participant gave informed consent. The participants were told that they were completing a study examining the effects of speaking and listening on the body and that they would therefore be interacting with each other during the course of the study session. The participant and confederate then completed a background questionnaire assessing demographics (age, height, and weight--all self-reported) that could potentially impact cardiovascular reactivity and recovery
After completing this questionnaire, the experimenter conducted a "rigged" drawing to determine who would be the "discloser" and who would be the "listener" for the ensuing interaction. This drawing was set up so that the confederate was always the listener. The experimenter held out two pieces of folded paper, both of which had the word "discloser" written on them. The participant first selected one of the pieces followed by the confederate choosing the other. After unfolding the papers, the experimenter asked the confederate what his/her paper said. The confederate always responded that his/her paper said "listener," while the participant's paper always noted "discloser." None of the participants questioned this procedure. The confederate was then asked to wait in the area outside of the experimental room while the participant's pre-discussion blood pressure and heart rate were recorded. The participant had the option to listen to a relaxing background sound that he/she chose from a noise machine or to remain in a silent room. As the confederate and experimenter waited in the next room for the baseline readings to be taken, the random assignment of a support or control condition was conducted by the confederate flipping a coin. The participant sat alone quietly in the room for approximately ten minutes, while five blood pressure readings were taken at two-minute intervals. The blood pressure data were collect after one, three, five, seven, and nine minutes.
After the pre-discussion period was complete, the experimenter reentered the room and explained to the participant that he/she should think of a current relationship problem that could be discussed with the confederate. This problem could be with a friend, roommate, parent, etc. The experimenter emphasized that the problem could not be fictitious and that it should be at least fairly distressing to the participant. When the participant indicated that he/she was prepared, the experimenter confirmed that the problem was valid by asking for a one or two sentence overview of the issue. The experimenter then brought the confederate back into the room.
At this point the experimenter explained that the participant would disclose a relationship problem for four minutes. During this time, the confederate was to remain quiet. When the four minutes had passed, the experimenter knocked on the door to inform the participant that it was time to switch roles. At this time, the confederate had two minutes to respond to the disclosure, while the participant remained quiet. Again, the experimenter informed the participant when this period was complete. The participant was given another two minutes to talk while the confederate listened silently. Finally, the experimenter knocked a third time to indicate that the confederate had another two minutes to respond to the disclosure while the participant again listened quietly. Blood pressure data were again collected twice during the initial problem disclosure and once during each succeeding time period at minutes one, three, five, seven, and nine of the interaction. While data related to the specific types of relationship problems disclosed was not recorded, common examples included roommate problems and problems stemming from romantic relationship dissolution. It should be noted that the phone number of the school's counseling center was available at all times in the event that the participant became overly distressed by the interaction, however it was never necessary to use it. Participants were also given this number and the number of the first author to take home in the event that they became distressed following the study's completion.
The manipulation of support versus control took place during the interactions that were just described. In the support condition, the confederates were trained to be attentive, sympathetic, and understanding during their turns to respond to the participant's disclosure. They were also trained to lean forward toward the participant in an effort to appear interested and to smile and nod often in order to assure the participant that they were paying attention to the disclosure. In contrast, the confederates in the social control condition were instructed to tell the participant what to do in a very assertive manner. The confederates were trained to avoid any type of expression of sympathy or understanding in the social control condition. They also maintained a closed body position and provided very little eye contact. Before the participant began his/her disclosure, the confederates stated that they would provide the participant with a few ways to solve his/her problem.
The confederates were given several opportunities to practice these techniques before the beginning of data collection. Pilot participants were recruited from the first author's courses in exchange for extra credit. The pilot participants provided the researchers with verbal feedback concerning whether the confederates' behavior had elicited the desired impressions during the interactions. All pilot participants were able to accurately identify whether they had been assigned to the social support or social control condition following the interactions. Because the nature of the problem disclosures varied from one participant to the next, there was not a script in place for what confederates were required to say during each experimental session, although their mannerisms were standardized across all participants.
After this interaction was completed, the experimenter once again asked the confederate to wait in the next room while the participant again sat alone quietly in silence or with a chosen calming noise for a ten minute recovery period. Data collection during this time was identical to the pre-discussion period. Participants were debriefed, probed for suspicion by asking if they had figured out the true purpose of the study (none admitted to this), and given course credit for their participation.
The data were examined for errors before conducting the main analyses. To evaluate pre-discussion physiological measures, baseline readings were averaged for systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). To examine physiological reactivity during the interaction, the readings taken during the interactions were averaged. The average baseline scores were then subtracted from average interaction scores. This change score was used as the dependent measure for the reactivity analyses. Similarly, to evaluate recovery from the interaction, post-interaction measures were averaged. The average interaction scores were then subtracted from these post-interaction scores to obtain recovery values.
Two Analysis of Variance (ANOVA) tests were performed using participant sex, confederate sex, and condition as the independent variables and age and BMI as the dependent variables. These tests were carried out in an effort to see whether age and BMI should be included as covariates in subsequent analyses. The ANOVA for age revealed a significant Participant sex by Confederate sex interaction, F(1,152) = 171.96, p < .001, the pattern for which was that same-sex dyads were younger than opposite-sex dyads. The ANOVA for BMI revealed a significant sex effect, F(1,153) = 11.83, p < .001, such that males had a higher BMI than females. Age and BMI were thus both included as covariates in all subsequent analyses.
Raw values for the averaged physiological measures are displayed in Table 2. To test the main study hypotheses concerning physiological reactions, a between-person multivariate analysis of covariance (MANCOVA) was computed with participant sex, confederate sex, and condition (support versus control) as the independent variables, body mass index and age as covariates, and the six physiological indices (reactivity-baseline and recovery-reactivity for SBP, DBP, and HR) as the dependent measures. The MANCOVA revealed a significant effect for the condition by participant sex interaction, F(6,135) = 2.79, p < .02, and a marginally significant effect for the condition by confederate sex interaction, F(6,135) = 2.79, p < .07.
Participant Sex X Condition Interactions
Univariate analyses revealed that the sources of the significant multivariate participant sex by condition interaction were HR reactivity, F(1,140) = 4.00, p < .05, SBP recovery, F(1,140) = 5.40, p < .03, and HR recovery, F(1,140) = 11.47, p < .001. When examining HR reactivity, simple effects tests revealed that males and females did not differ in the support condition, F(1,71) = 1.35, p > .25, however males were more reactive to the receipt of control than were females, F(1,73) = 4.34, p < .05. When examining SBP recovery, there was again no sex difference for support, F(1,70) = 1.57, p > .20, however males who were controlled recovered to a significantly greater extent than females who were controlled, F(1,74) = 4.64, p < .04. Finally, when examining HR recovery, there was a tendency for females who were supported to recover to a greater extent than males who were supported F(1,70) = 3.37, p < .08, however males who were controlled recovered to a significantly greater extent than females who were controlled, F(1,74) = 13.82, p < .001.
Confederate Sex X Condition Interactions
Univariate analyses revealed that the sources of the significant multivariate confederate sex by condition interaction were SBP reactivity, F(1,140) = 9.44, p < .01, DBP reactivity, F(1,140) = 6.69, p < .02, SBP recovery, F(1,140) = 5.57, p < .02, and DBP recovery, F(1,140) = 4.22, p < .05. When examining SBP reactivity, simple effects tests reveal that those participants who interacted with males versus females did not differ in the support condition, F(1,71) = .28, p > .55, however those who were controlled by males were more reactive than those were controlled by females, F(1,73) = 4.97, p < .03. An identical pattern of results emerged for DBP reactivity, support: F(1,71) = .40, p > .50; control: F(1,73) = 8.24, p < .01. When examining SBP recovery, simple effects tests reveal that those participants who interacted with males versus females did not differ in the support condition, F(1,70) = 1.57, p > .20, however those who were controlled by males recovered to a greater than those who were controlled by females, F(1,74) = 4064, p < .04. An identical pattern of results emerged for DBP recovery, support: F(1,70) = .30, p > .55; control: F(1,74) = 17.47, p < .001.
This study was conducted as a first attempt to directly compare the physiological consequences of receiving social support vs. social control from a same sex vs. an opposite-sex interaction partner. Participants disclosed a relationship problem to a confederate whom they believed to be another participant. The confederate provided either supportive or controlling feedback in response to the problem disclosure. Participants had their blood pressure and heart rate monitored before, during, and after the interaction.
It was predicted that, compared to social control, social support would lead to lower levels of physiological reactivity for female participants, especially for those who interacted with another female. It was also predicted that, compared to social support, social control would be associated with lower reactivity and better recovery for males, especially when received from another male.
Some evidence supported these hypotheses. In general, social support did not differentiate participants during either the reactivity or the recovery periods, regardless of the dyad's sex composition. This is in contrast to past research indicating that social support received from a female is associated with attenuated cardiovascular measures (Glynn et al, 1999) and that females benefit more than males from the receipt of social support (Fritz at al, 2003; Linden at al, 1993). On the other hand, the sex composition of the dyads within the social control condition seemed to play a large role in predicting cardiovascular outcomes. There was a number of significant condition by participant sex interactions. In terms of reactivity, male participants showed larger increases in HR than females when they were controlled. In terms of recovery, males who were controlled recovered to a greater extent than females who were controlled in terms of both SBP and HR. This pattern of results indicates that males may be more reactive initially to the receipt of social control, but that the longer-term outcome of control is more beneficial for males than females. Past research has demonstrated that control has been associated with both increased levels of psychological distress (Lewis & Rook, 1999) and decreased levels of psychological distress (Rook et al., 1990). The current study has expanded this research into the area of physiological differences. It has also opened up the door to examining sex differences, an area not previously explored and one that could potentially explain the divergent findings of past research regarding psychological distress.
There was a number of significant condition by confederate sex interactions. In terms of reactivity, within the social control condition, those participants who interacted with a male confederate showed larger increases in SBP and DBP relative to those participants who interacted with a female confederate. In terms of recovery, being controlled by males was associated with better recovery than being controlled by females. This pattern of findings supports that reported by Smith et al. (1996) who found that males tend to report the most reactivity when they engage in traditionally male-oriented tasks (such as social control). No such difference emerged within the support condition.
One possible explanation for this pattern of results could be that males were more reactive when the type of support they received matched the kind of support they wanted or expected to receive. In the case where participants did not receive the type of feedback they hoped to receive, they might have detached themselves from the problem discussion and talked about its trivial, unimportant aspects. Such trivial discussion would lead their reactivity levels to be attenuated. When examining recovery, it is quite possible that participants who were more involved in the situation might have displayed a form of catharsis or even found some new ways of coping with their problem situation. It is possible that support was universally beneficial; hence no sex differences appeared in this condition.
No previous examinations of the effects of social control on cardiovascular reactivity could be located. It is therefore believed that this study is the first one to examine this issue. Because of the lack of research in this area, it was not completely clear how participants would respond to the receipt of social control. It was found that males who received control, as well as those who received control from a male, were both more reactive than females in the same situations. This pattern of results highlights the fact that the sex composition of a dyad should be considered as a major factor when considering reactions to the receipt of social control.
Limitations and Future Directions
No reports of actual behaviors were included in these analyses. In other words, we have no record of whether or not participants actually felt supported or controlled. Confederates were trained in such a way that they should have been able to confer a feeling of support vs. a feeling of control; however future research would benefit from comparing these results to analyses using ratings of feedback made by either the participants themselves or independent raters.
Another limitation is that the participants in this study were college students who were generally physically healthy and emotionally stable. Future research should examine other groups (disabled individuals, depressed groups) to see whether these results also generalize to these populations.
There are a number of potential confounds that were unaddressed in the current study. Behaviors such as smoking and exercising prior to the study, as well as factors related to overall health and time of data collection were not systematically assessed and could therefore have exerted an unintended effect on the outcomes of interest. Personality variables such as extraversion were also not assessed. It is believed that random assignment to condition probably attenuated most of these effects, but without specific measurements of these areas it is impossible to know whether random assignment was effective in doing so. It should also be noted that BMI, one of the covariates in the study, has some inherent limitations as a measure of fitness. It was, however, the most efficient way available to the researchers to assess body composition.
Finally, what was called a baseline period in the current study was not a true baseline. As they experienced the baseline period, the participants knew that they would be interacting with another person later in the study. This might have influenced their baseline readings. Related to this issue, the recovery period in the current study was only ten minutes. Future research should seek to lengthen this time, perhaps looking to see how long it takes the participants to return to their actual baseline levels.
The results of the current study indicated that interactions involving control and males, whether the males were providing or receiving control, were more beneficial than interactions involving control and females. No such effect emerged for social support. This pattern may be explained by sex role expectations being met or unmet and participants subsequently detaching themselves from their problem disclosures and instead discussing trivial matters surrounding their problems.
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Author info: Correspondence should be sent to: Dr. Alexander Nagurney, Department of Psychology, Texas State University--San Marcos, 601 University Dr., San Marcos, TX 78666. E-mail: firstname.lastname@example.org
North American Journal of Psychology, 2009, Vol. 11, No. 3, 583-598. [c] NAJP
Alexander J. Nagurney
Texas State University--San Marcos
University of Colorado at Denver
University of Texas at Austin
TABLE 1 Demographic Information by Group Confederate sex n Age BMI Condition Participant sex Support Male Male 20 19.15 25.45 Support Male Female 16 22.38 25.88 Support Female Male 18 22.78 25.33 Support Female Female 25 18.92 21.64 Control Male Male 26 18.96 24.33 Control Male Female 14 22.64 25.24 Control Female Male 16 21.60 21.79 Control Female Female 26 19.08 21.67 Note: BMI = Body Mass Index TABLE 2 Mean SBP, DBP, and HR by Group Period SBP DBP HR Condition Participantsex/ Confederate sex Support Male/male baseline 123.43 73.85 72.59 reactivity 135.87 80.98 79.56 recovery 124.67 78.07 77.70 Support Male/female baseline 125.76 71.60 69.09 reactivity 138.98 82.80 73.43 recovery 127.97 73.00 69.12 Support Female/male baseline 114.53 70.22 76.10 reactivity 124.05 77.18 81.49 recovery 114.13 70.98 74.75 Support Female/female baseline 111.33 71.26 74.44 reactivity 125.59 80.67 83.96 recovery 111.25 76.06 77.83 Control Male/male baseline 121.94 70.08 72.26 reactivity 137.20 81.86 82.76 recovery 123.14 73.96 71.79
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|Author:||Nagurney, Alexander J.; Bagwell, Brandi; Forrest, Katherine|
|Publication:||North American Journal of Psychology|
|Date:||Dec 1, 2009|
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