Marriage Education Improves the Health of Children

By Jennifer Brett, ND, LAc

Parents with good communication and conflict resolution skills tend to create stable relationships. A stable family structure can significantly reduce illness in all members of the family. A dysfunctional family with adults who do not have good communication skills is a significant risk factor for both mental and physical diseases in the children. Because prevention of long-term disease and mitigating stress or the effects of stress are of critical importance in naturopathic medicine, marriage education training can be used to enhance family wellness.

There is an abundance of research dating back to the 1970s showing that a stable, happy marriage is predictive of emotional stability and a protector against physical illness and premature death for all members of that family (Burman and Margolin, 1992; Dawson, 1991; Verbrugge, 1979). Chronic marital conflict harms the emotional and physical well-being of children (Emery, 1998; Gottman and Katz, 1989). That having parents who have good communication and conflict resolution skills would help reduce mental illness in their children may seem self-evident; however, understanding how profoundly such a stable family structure can reduce the incidence of physical disease is less well understood by many medical professionals.

Naturopathic physicians are general care clinicians who focus on healthy lifestyles and disease prevention using natural (drugless) therapeutics. “Naturopathic physicians are primary care and specialty doctors who address the underlying cause of disease through effective, individualized natural therapies that integrate the healing powers of body, mind and spirit” (AANP, 2006). Naturopathic training emphasizes the need to use evidence-based approaches to reduce physical and mental stresses on the body to best prevent long-term disease and disability.

Stress is a recognized underlying cause of many illnesses. As described by Rokutan and colleagues, “Stress is the coordinated physiological processes to maintain a dynamic equilibrium under stressful conditions. The equilibrium is threatened by certain physiological and psychological stressors. Stressors trigger physiological, behavioral, and metabolic responses that are aimed at reinstating homeostasis. The hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system play an essential role in the stress response. Excessive, prolonged, or inadequate response that is termed as ‘allostasis’ or ‘allostatic load’ leads to pathological outcomes. Dysregulation of the HPA axis activity is involved in the pathogenesis of stress-related disorders including major depression. The complex brain-immune-endocrine network regulates the HPA axis, and hereditary predisposition as well as environmental factors such as traumatic experiences in early life also modifies the capacity of an individual to cope” (Rokutan et al., 2005). In simpler language, when presented with something new, different, or a perceived threat, the body responds with changes in physiology and behavior.

Hans Selye was one of the first researchers to attempt to define and quantify the effect of stress on health. His view in 1956 was that stress is not inherently deleterious for the human body. Whether a stressor is beneficial or harmful depends on how each individual responds. The stress of exhilarating, creative, successful work is beneficial, while that of failure, humiliation, or infection is detrimental. Selye believed that the biochemical effects of stress would be experienced irrespective of whether the situation was positive or negative. Selye defined stress as a “nonspecific response of the body to a demand” (MindTools.com, 2006). Most people report daily stressors come from the following areas: family, relationships, and friends; work/employment or the lack thereof; personal or family economic concerns; personal lifestyle (appearance, health); and household and community environmental stressors such as housework, local politics, and neighborhood interactions. Researchers point out that some people have better coping strategies than others, often relating to the amount of control they feel over the stressor (Bertges Yost et al., 2005). Of these common daily stressors, personal relationships, particularly those within the family, are one of the most amenable to change through behavior modification.

There are many studies on how stress increases the likelihood someone will become ill. For instance, Kielcolt-Glasser and Glaser found that stress may alter lymphocyte responses and DNA repair mechanisms (1999). Another study found that “homeostasis of GH [growth hormone] in patients with RA [rheumatoid arthritis] is disturbed, and the increased serum GH levels in RA patients may be associated with their stress condition” (Ishigami et al., 2005). When attempting to reduce the chances of such life-altering diseases as arthritis and cancer, it appears that clinicians need to use effective means to mitigate common, persistent stressors so that the body’s stress response is reduced. Reducing the stress response to everyday events is a valuable strategy to preventing many chronic illnesses.

Stress also plays a critical role in mental health. Negative stressors can increase the risk of many mental diseases including depression. “Stressful events promote neurochemical changes that may be involved in the provocation of depressive disorder. In addition to neuroendocrine substrates (e.g., corticotropin releasing hormone, and corticoids) and central neurotransmitters (serotonin and GABA), alterations of neuronal plasticity or even neuronal survival may play a role in depression. Indeed, depression and chronic stressor exposure typically reduce levels of growth factors, including brain-derived neurotrophic factor and anti-apoptotic factors (e.g., bcl-2), as well as impair processes of neuronal branching and neurogenesis” (Hayley et al., 2005). Stress can be a causative factor in the onset of depressive episodes. Depression changes our ability to cope mentally and physically with daily stressors.

The interpersonal dynamics of a family can be either a major daily stressor or a stress buffer depending on the quality of the marriage. “Prospective studies link marriage to better cardiovascular health, but marital dissatisfaction and discord predict increased rates of hypertension, higher blood pressure (BP), greater reactivity to stress, and left ventricular mass…Relationship quality is a better predictor of daily BP, affect and stress than partner status. High RQ [relationship quality] is linked to lower ABP [ambulatory blood pressure] across race and gender. This reduced ABP may be due, in part, to the stress buffering effects of better RQ and/or the stress enhancing effects of poor RQ” (Grewen et al., 2005). The same can be said for the children who witness and respond to their parents’ relationship quality. “The health and well-being of children are inextricably linked to their parents’ physical, emotional and social health” (Schor, 2003). The type of marital relationship—healthy, neutral, or negative—is more strongly correlated with the physical response to arguments than how well an individual thinks he or she might handle anger or emotional volatility. Results from the multivariate regression analyses indicated that the nature of the couple’s relationship, rather than individual levels of anger dysregulation, predicted lower parasympathetic cardiac activity (indexed by high-frequency heart period variability) and shorter cardiac interbeat intervals. Anger dysregulation, rather than the dyadic relationship, was predictive of greater displays of angry behavior during the marital conflict interaction (Carrere et al., 2005). Children too can learn how to have healthier relationships within and outside of the family. There are significant health consequences when there is breakdown of the parent-child relationship (Napp-Peters, 2005). Children’s response to negative family interactions has a similar impact on their ability to maintain psychological and physical homeostasis. When marriage acts to buffer stress, all members of the family are more consistently healthy.

Marriage education training is a behavioral modification based set of skills that can be taught to couples in a relatively short time frame. Unlike psychoanalysis, marriage education groups seek to enhance relationships and avoid the breakdown of marriages and partnerships through changes in everyday behavior and improved communication skills. The basic premise is that learning relationship skills such as how to communicate effectively, how to handle stress and conflict, and learning how to express how much couples appreciate each other, can and will improve relationships without needing to unbury issues from childhood or beyond.

Education designed to change behaviors in relationships does decrease divorce and increase marital satisfaction, particularly in those who learn these relationship skills before marriage. “The results of 13 studies suggest that behaviorally oriented, skills-based marriage preparation programs can lead to behavioral changes that may help prevent the emergence of marital dysfunction” (Sayers et al., 1998). Marriage education has a great deal of research supporting its simplified behavior modification strategy. This research supports the idea that marriage education is a means to prevent those types of relationships that engender daily stress responses (Halford et al., 2001; Markman et al., 1988; Van Widenfelt et al., 1996). Marriage education is effective in promoting marital quality and stability. Well-researched marriage education programs have demonstrated that brief, skills-based educational programs for couples increase couple satisfaction, improve communication skills, and reduce negative conflict behaviors (Markman et al., 1993).

Stress has strong effects on the body’s immune response. Family-related stresses, particularly marital stress, strongly correlate with both physical and mental health of all family members. One major type of family stress—marital dissatisfaction—has an evidence-based proven method of mitigation. The behavioral modification intervention of marriage education is a therapy that supports the body’s natural healing process. The focus on evidence-based healing and prevention in both naturopathic medicine and marriage education makes the two interventions a natural fit. Marriage education skills can be one extremely effective tool naturopathic physicians can use to improve the health of the whole family, including the children.

References

American Association of Naturopathic Physicians (AANP): http://www.naturopathic.org/naturopathic_medicine/philosophy.aspx

Bertges Yost W et al: A national study of burnout among American transplant surgeons, Transplant Proc 37(2):1399-401, 2005.

Burman B, Margolin G: Analysis of the association between marital relationships and health problems: an interactional perspective, Psychol Bull 112:39-63, 1992.

Carrere S et al: The roles of marriage and anger dysregulation in biobehavioral stress responses, Biol Res Nurs 7(1):30-43, 2005.

Dawson DA: Family structure and children’s health and well-being: data from the 1988 National Health Interview Survey on Child Health, Journal of Marriage and the Family 53:573-84, 1991.

Emery RE: Marriage, Divorce, and Children’s Adjustment, Newbury Park, CA, 1998, Sage.

Gottman JM, Katz LF: Effects of marital discord on young children’s peer interruption and health, Dev Psychol 25:373-81, 1989.

Grewen KM et al: Relationship quality: effects on ambulatory blood pressure and negative affect in a biracial sample of men and women, Blood Press Monit 10(3):117-24, 2005.

Halford KW et al: Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program, J Fam Psychol15:750-68, 2001.

Hayley S et al: The pathogenesis of clinical depression: stressor- and cytokine-induced alterations of neuroplasticity, Neuroscience135(3):659-78, 2005.

Ishigami S et al: Effects of mirthful laughter on growth hormone, IGF-1 and substance P in patients with rheumatoid arthritis, Clin Exp Rheumatol 23(5):651-7, 2005.

Kielcolt-Glasser JK, Glaser R: Pscychoneuroimmunology and immunotoxicology: implications for carcinogenesis, Psychosom Med 61(3):271-2, 1999.

Markman HJ et al: Preventing marital distress through communication and conflict management training: a 4- and 5-year follow-up, J Consult Clin Psychol 61:70-77, 1993.

Markman HJ et al: Prevention of marital distress: a longitudinal investigation, J Consult Clin Psychol 56:210-17, 1988.

MindTools.com: http://www.mindtools.com/pages/article/newTCS_00.htm

Napp-Peters A: Multi-parent families as “normal” families—segregation and parent-child-alienation after separation and divorce, Prax Kinderpsychol Kinderpsychiatr 54(10):792-801, 2005.

Rokutan K et al: Gene expression profiling in peripheral blood leukocytes as a new approach for assessment of human stress response, J Med Invest 52(3-4):137-44, 2005.

Sayers SL et al: Prevention of marital dysfunction: behavioral approaches and beyond, Clin Psychol Rev 18(6):713-44, 1998.

Schor EL, American Academy of Pediatrics Task Force on the Family: Family pediatrics: report of the Task Force on the Family, Pediatrics 111(6 Pt 2):1541-71, 2003.

Van Widenfelt B et al: The prevention of relationship distress for couples at risk: a controlled evaluation with nine-month and two-year follow-ups, Family Relations 45:156-65, 1996.

Verbrugge LM: Marital status and health, Journal of Marriage and the Family 41:267-85, 1979.


 

Jennifer BrettDr. Jennifer Brett is a graduate of the National College of Naturopathic Medicine (1987) and the Tri-State Institute of Traditional Chinese Acupuncture (now Tri-State College). She is currently director of the Acupuncture Institute, and an adjunct faculty member for the College of Naturopathic Medicine at the University of Bridgeport in Bridgeport, Connecticut.

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