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Provision and receipt of emotional spousal support: The impact of visibility on well-being.

Authors:
Provision and Receipt of Emotional Spousal Support:
The Impact of Visibility on Well-Being
Susanne N. Biehle and Kristin D. Mickelson
Kent State University
The present study systematically examined the impact of visibility of emotional support
provision and receipt in the daily lives of married couples. Hierarchical linear modeling
analyses indicated that reported support provision was related to less anxiety and
depression and more positive mood, whereas unacknowledged support provision was
related to more anxiety and depression. Moreover, reported support receipt was
beneficial for an individual’s well-being, such that it was related to more positive mood
and less anxiety and depression. On the other hand, invisible support receipt was only
found to be related to less anxiety. No gender differences were found for any of the
analyses. These results suggest the importance of examining support provision and
receipt in marital relationships.
Keywords: social support, marriage, gender, well-being
Research on marital relationships consis-
tently finds that husbands and wives differ not
only in their perceptions of the relationship, but
they also receive differential levels of benefits
from marriage. The issue of spousal support has
been a primary focus in this field of research
because of its importance in both the marital
relationship and marital satisfaction (e.g., Cut-
rona & Suhr, 1994; Pasch, Bradbury, & Sulli-
van, 1997; Sullivan et al., 2010). Yet, a clear
understanding of the dyadic interplay of spousal
support between partners is limited. Bolger and
colleagues (2000) introduced the concept of in-
visible support as a way to better understand
how provision and receipt perceptions work to-
gether to impact an individual. However, Bolg-
er’s research focuses exclusively on receipt of
invisible support in the context of an acute
stressor. The present study seeks to systemati-
cally examine the visibility of emotional spou-
sal support provision and receipt in the context
of the daily lives of newly married couples.
Emotional support is specifically examined in
the current study because it is an important
aspect of relationship satisfaction in the lives of
couples (e.g., Pasch, Bradbury, & Sullivan,
1997). Moreover, we examined newly married
couples because we felt that the early years of
marriage may be a time when support visibility
is more important as couples are establishing
their communication and support styles. Addi-
tionally, support visibility is a new area of re-
search in spousal support, and examining newly
married couples allows us to expand on the
prior literature and deepen our understanding of
the support relationship in couples. Thus, this
nuanced picture of emotional support processes
can lead to a better understanding of how sup-
port transactions within newly married couples
function to impact mental well-being.
Support from one’s spouse— especially emo-
tional support—is one of the most important
predictors of an individual’s well-being (e.g.,
Thoits, 1995). Emotional spousal support refers
to expressions of interest, caring and under-
standing, and receiving empathy from one’s
spouse. Coyne and DeLongis (1986) found,
among married individuals experiencing a
stressful event, support from other sources does
not completely compensate for lack of social
support from one’s spouse. Yet, numerous stud-
ies have also found that marriage is more ben-
eficial for husbands than wives (e.g., Kiecolt-
Glaser & Newton, 2001). One explanation for
This article was published Online First July 16, 2012.
Susanne N. Biehle and Kristin D. Mickelson, Department
of Psychology, Kent State University.
The current study was supported by a grant to the second
author from the Ohio Board of Regents.
Correspondence concerning this article should be ad-
dressed to Susanne N. Biehle, Department of Psychology,
Kent State University, P.O. Box 5190, Kent, OH 44242-
0001. E-mail: sbiehle@kent.edu
Couple and Family Psychology: Research and Practice © 2012 American Psychological Association
2012, Vol. 1, No. 3, 244–251 2160-4096/12/$12.00 DOI: 10.1037/a0028480
244
this gender gap may be that wives are providing
more and receiving less emotional support than
husbands (e.g., Vinokur & Vinokur-Kaplan,
1990). Wives have also been found to provide
more support on days when their husbands were
experiencing stress. Husbands, on the other
hand, provided both support and negative be-
haviors on days when their wives were experi-
encing stress. Consequently, wives reported
feeling less supported on stressful days than did
their husbands (Neff & Karney, 2005). What
remains unclear is how emotional spousal sup-
port plays out in the daily lives of married
couples and whether or not the visibility of this
support is important for the well-being of the
partners.
One potential way to expand our understand-
ing of spousal support and the gender gap in
marriage is through examination of the visibil-
ity of support in these exchanges. Research on
received support is typically assessed by asking
individuals whether certain acts of support have
occurred—in other words, visible or reported
support receipt. By contrast, Bolger and col-
leagues argue that invisible support receipt may
be a more positive type of support receipt.
Bolger, Zuckerman, and Kessler (2000) define
invisible support as occurring in two ways: (1)
specific supportive expressions that “occur out-
side of the recipient’s awareness” and (2) be-
haviors or expressions that the recipient is
aware of but does not register as support. Indi-
viduals reap the benefits of being provided with
support without the negative consequences re-
ported support receipt can have on an individ-
ual—that is, the supportive act helps the recip-
ient in dealing with a situation without harming
his or her self-esteem or feelings of self-efficacy
(Bolger et al., 2000; Bolger & Amarel, 2007).
Research conducted on invisible support in
couples has focused on a specific stressor oc-
curring to only one partner. Bolger et al. (2000)
investigated the impact of receiving reported
versus invisible emotional spousal support in
law students preparing to take the bar exam.
Invisible emotional support from one’s spouse
lessened depression but not anxiety, whereas
reported emotional support from one’s spouse
showed only a slight benefit over no support.
Although Bolger and colleagues have shown
that receiving invisible spousal support is ben-
eficial for individuals experiencing an acute
stressor, it is unclear whether invisible spousal
support is beneficial in nonstressful times. Re-
cently, Vangelisti (2009) suggested that invisi-
ble support may not be as beneficial in everyday
or positive situations as it is in negative or
stressful situations. Specifically, Vangelisti ar-
gues that support in more positive situations can
communicate interest in the other person,
encouragement, validation, and love. Hence, in-
visible support in this context means the indi-
vidual is unaware of these acts of love. There-
fore, to expand on Bolger and colleague’s prior
findings, the current study will examine the
impact of the visibility of emotional spousal
support receipt in the context of daily life, rather
than in a controlled setting or while experienc-
ing a specific stressor. Based on Vangelisti’s
argument, we predict that invisible support re-
ceipt will have little or no relation with daily
well-being. Moreover, given the daily context,
we predict that reported emotional support re-
ceipt will be related to better well-being as it is
less tied to feelings of competence and more to
feeling loved and valued by one’s partner.
One additional issue with regard to support
visibility is whether it is equally beneficial for
the provider and receiver. As stated above, re-
ceiving support may have detrimental effects
because needs are not always met when support
is received and the support receipt may imply
the recipient is not in control of the situation and
must depend on others (Helgeson, 1993; Shrout,
Herman, & Bolger, 2006). On the other hand,
several studies have shown that providing social
support is more beneficial than receiving social
support (e.g., Gleason, Iida, Bolger, & Strout,
2003). The explanations for these findings in-
clude the potential to increase self-esteem and
well-being, and buffer against distress (Va¨a¨n-
a¨nen et al., 2005), as well as allowing the indi-
vidual to feel valued and needed by others
(Knoll et al., 2007). Several gender differences
were also found in the aforementioned studies.
Va¨a¨na¨nen et al. (2005) found evidence that
women benefit more from support provision,
whereas men benefit more from support receipt.
Additionally, Knoll et al. (2007) found that
women benefit most from providing emotional
support—in this study support receipt was not
related to outcomes for either men or women.
However, these prior studies focus exclusively
on reported support receipt and provision. Will
the same pattern hold for invisible support re-
ceipt and unacknowledged support provision?
245PROVISION AND RECEIPT
Bolger and colleagues argue that receiving in-
visible support should be related to better men-
tal health outcomes. To our knowledge, the
impact of providing unacknowledged emotional
support on mental well-being has not been ex-
amined. When an individual provides support
but is not given credit for it, he or she may feel
upset or not validated and these feelings may
increase negative well-being. In married cou-
ples, provision of support without acknowledg-
ment may be interpreted as ungratefulness and
could even lead to arguments about what one
spouse has provided. Thus, we predict that un-
acknowledged emotional support provision will
be related to worse well-being whereas reported
emotional support provision will be related to
better well-being.
Finally, based on prior literature, we predict
that husbands will benefit most from receiving
emotional support, whereas wives will benefit
most from providing emotional support. Given
the lack of prior research on support visibility
and gender, we did not make specific predic-
tions about gender differences with regard to
invisible emotional support receipt and unac-
knowledged emotional support provision.
Method
Sample and Procedure
To test the current hypotheses, a 7-day diary
study was conducted to collect information
about emotional support provision and receipt
in married couples during the early years of
marriage (i.e., less than 7 years). The sample
was composed of 50 heterosexual couples (n
100 individuals) married for the first time. Cou-
ples were married on average for 4 years
(SD 2 years), were primarily White (90%),
had a mean household income of approximately
$58,000 (M$57,437; SD $29,581), and
44% had children. Age ranged from 19 to 46
years, with husbands slightly older (M31;
SD 6) than wives (M30; SD 6). Partic-
ipants were recruited from a Midwestern uni-
versity through emails and flyers to faculty,
staff, and students. Potential participants were
told the study was examining the daily lives of
newly married couples. Couples completing the
study were paid $25 and entered into a raffle for
$50. Couples initially came to the lab together
to complete informed-consent forms and learn
how to use the online daily diary survey. After-
ward, couples were separated to individually
complete a baseline survey. Couples were asked
to complete their daily questionnaires indepen-
dently of their spouse each day for 7 days. Each
member of the couple was given a user ID and
password to log onto the survey from home or
work which provided a time stamp of when the
daily survey was completed. Reminder emails
were sent out to couples periodically throughout
the daily diary portion to remind them to com-
plete the daily surveys. In case of technical
difficulties or inability to access the online diary
on a given day, participants were also provided
with a hard copy of the daily diary surveys to
complete and return if needed. In addition, the
survey for a given day was only available after
6 p.m. so that the participant had a better chance
of providing an accurate representation of the
support provided and received for that day.
Only seven individuals completed the entire
diary on paper versions. In these cases, phone
calls were made on Days 2, 4, 6, and 7 to
remind participants to fill out the survey. Par-
ticipants who filled out the survey online re-
ceived a reminder phone call only if they had
not filled out the survey on a particular day.
Measures
Well-being. Daily well-being was as-
sessed using an adapted version of the Profile of
Mood States (POMS), consisting of 25 items
(McNair, Lorr, & Droppleman, 1971). Partici-
pants in the current study were asked to report
each day to what extent they felt each of the
given moods on a scale from 1 to 5 (1 very
slightly or not at all to 5 extremely) each day.
For the purposes of the current analysis, a mean
score was calculated for three factors of the
POMS: positive mood (␣⫽.91), depression
(␣⫽.90), and anxiety (␣⫽.81).
Reported provision and receipt of support.
To examine reported provision and receipt of
emotional spousal support, participants were
asked how much emotional support they pro-
vided to and received from their spouse each
day. Provision of support consisted of six items
(e.g., “How much did you show your spouse
you cared about them today?”) rated on a scale
from1to5(1not at all to5a lot). The
items regarding receipt of emotional support
paralleled the six provision items but were
246 BIEHLE AND MICKELSON
asked in relation to how much support their
spouse gave them that day (e.g., “how much did
your spouse show you that they cared about you
today?”). Mean scores were calculated for re-
ported support provision (␣⫽.84) and reported
support receipt (␣⫽.86).
Unacknowledged support provision. To
calculate the amount of unacknowledged sup-
port provision, a difference score was created
between an individual’s report of how much
support they provided minus how much support
their spouse reported receiving from them. For
example, we calculated the difference between
how much a wife reported providing emotional
support to her husband on a given day (e.g.,
score of 4) minus how much the husband re-
ported receiving emotional support from his
wife on that day (e.g., score of 3.) Thus, the
unacknowledged support provision score for the
wife on that day would be a 1. Because we are
interested in unacknowledged support provision
(as opposed to overacknowledged support pro-
vision), we decided to collapse all instances
where the recipient reported receiving more
than the provider reported giving to zero—in
other words, a score of zero represents all levels
of reported support provision.
Invisible support receipt. The calcula-
tion of invisible support receipt parallels that
of unacknowledged support provision, but
this measure focuses on how much the indi-
vidual reports receiving compared with what
their spouse provided. In other words, a dif-
ference score was created between how much
support a spouse reported providing minus
how much support an individual reported re-
ceiving. For instance, we calculated the dif-
ference between how much a husband re-
ported providing support to his wife on a
given day (e.g., score of 5) minus how much
his wife reported receiving support from the
husband on that day (e.g., score of 3). Thus,
invisible emotional support receipt score for
the wife on that day would be 2. Again, we
decided to collapse all instances where the
recipient reported receiving more than the
provider reported giving to zero. To reiterate,
each individual had a daily score for how
much unacknowledged support they provided
to and invisible support they received from
their spouse.
Overview of Analyses
Hierarchical linear modeling (HLM) was
used to test the proposed hypotheses. According
to Kreft’s (1996) recommendations, the current
analyses with 100 individuals at seven time
points should have adequate statistical power.
Because the sample consists of couples, HLM
analyses were conducted using a two-intercept
model as recommended by Raudenbush, Bren-
nan, and Barnett (1995). The two-intercept
model was chosen because the dyads were dis-
tinguishable and because it allows us to test
whether the husband and wife variances are
equal and whether the covariance is signifi-
cantly different from zero (Kenny, Kashy, &
Cook, 2006). Specifically, in a two-intercept
model at Level-1, dummy variables are intro-
duced for both husbands and wives. Terms are
then created separately for husbands and wives
with reported provision (PROV) and unac-
knowledged provision (UNA) and reported re-
ceipt (REC) and invisible receipt (INV). Anal-
yses were conducted separately for provision
and receipt of support. We chose to conduct an
analysis on the difference scores between actor
and partner reports of emotional support as op-
posed to a moderation model where actor and
partner reports interacted. This decision was
made because our focus for this study is on
whether discordance versus concordance be-
tween the two reports of emotional support im-
pacts well-being. Before testing our hypotheses,
unconditional models were conducted at Lev-
el-1 for each outcome. These analyses deter-
mined that there was significant within-person
variance in each outcome, which then allowed
us to conduct conditional models. See Table 1
for bivariate correlations of the aggregated
study variables reported separately for husbands
and wives.
Results
Before the HLM analyses, gender differences
in provision and receipt of emotional support
were examined with aggregated data (across the
7-day diary) using ANCOVA analyses, control-
ling for years married, mean couple education,
household income, and parental status. No sig-
nificant gender differences were found in the
amount of reported emotional support receipt or
provision or for invisible emotional support re-
247PROVISION AND RECEIPT
ceipt or unacknowledged emotional support
provision. Wives (M1.46, SD .66) were
found to be marginally more depressed than
husbands (M1.28, SD .34), F(1,
99) 3.04, p.08.
For the conditional HLM analyses, we found,
as predicted, that reported emotional support
receipt was strongly related to well-being while
invisible support receipt showed limited links
with well-being. Specifically, reported emo-
tional support receipt was related to less depres-
sion and anxiety and greater positive mood for
both husbands and wives (see Table 2). Invisi-
ble emotional support receipt, on the other hand,
was only related to less anxiety for husbands,
with wives showing a similar but marginal re-
lation to anxiety (b⫽⫺.18, SE .09, p.06).
Our predictions were also supported for
support provision, such that unacknowledged
emotional support provision was related to
less well-being whereas reported emotional
support provision was related to better well-
being. Specifically, as shown in Table 2, for
both husbands and wives, reported emotional
Table 1
Correlations for Major Study Variables (n100)
1234567
Husbands
1. Provision reported support
2. Provision invisible support .27
ⴱⴱⴱ
3. Receipt reported support .82
ⴱⴱⴱ
.13
4. Receipt invisible support .36
ⴱⴱⴱ
.34
ⴱⴱⴱ
.50
ⴱⴱⴱ
5. Anxiety .36
ⴱⴱⴱ
.11
.39
ⴱⴱⴱ
.17
ⴱⴱ
6. Depression .21
ⴱⴱⴱ
.06 .30
ⴱⴱⴱ
.07 .46
ⴱⴱⴱ
7. Positive mood .50
ⴱⴱⴱ
.11 .51
ⴱⴱⴱ
.30
ⴱⴱⴱ
.45
ⴱⴱⴱ
.34
ⴱⴱⴱ
Wives
1. Provision reported support
2. Provision invisible support .36
ⴱⴱⴱ
3. Receipt reported support .83
ⴱⴱⴱ
.31
ⴱⴱⴱ
4. Receipt invisible support .41
ⴱⴱⴱ
.34
ⴱⴱⴱ
.54
ⴱⴱⴱ
5. Anxiety .37
ⴱⴱⴱ
.05 .31
ⴱⴱⴱ
.19
ⴱⴱⴱ
6. Depression .30
ⴱⴱⴱ
.02 .27
ⴱⴱⴱ
.15
ⴱⴱ
.63
ⴱⴱⴱ
7. Positive mood .56
ⴱⴱⴱ
.14
ⴱⴱ
.51
ⴱⴱⴱ
.23
ⴱⴱⴱ
.52
ⴱⴱⴱ
.45
ⴱⴱⴱ
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
Table 2
Relation of Visibility of Spousal Support to Well-Being
Positive mood Anxiety Depression
b(SE)b(SE)b(SE)
Husbands’ intercept 2.85
ⴱⴱⴱ
(.09) 1.48
ⴱⴱⴱ
(.06) 1.28
ⴱⴱⴱ
(.05)
Wives’ intercept 2.77
ⴱⴱⴱ
(.09) 1.59
ⴱⴱⴱ
(.08) 1.45
ⴱⴱⴱ
(.09)
Support provision model
Husbands’ reported .34
ⴱⴱⴱ
(.07) .36
ⴱⴱⴱ
(.07) .14
ⴱⴱ
(.05)
Husbands’ unacknowledged .14 (.09) .14
(.08) .10 (.07)
Wives’ reported .47
ⴱⴱⴱ
(.05) .41
ⴱⴱⴱ
(.06) .29
ⴱⴱⴱ
(.06)
Wives’ unacknowledged .11 (.07) .14
(.08) .17
(.08)
Support receipt model
Husbands’ reported .35
ⴱⴱⴱ
(.07) .40
ⴱⴱⴱ
(.07) .24
ⴱⴱ
(.07)
Husbands’ invisible .06 (.07) .22
(.09) .08 (.07)
Wives’ reported .43
ⴱⴱⴱ
(.06) .33
ⴱⴱⴱ
(.07) .17
(.08)
Wives’ invisible .09 (.09) .18
(.09) .11 (.13)
Note. The variables in the table above are group-mean centered.
p.10.
p.05.
ⴱⴱ
p.01.
ⴱⴱⴱ
p.001.
248 BIEHLE AND MICKELSON
support provision was related to greater pos-
itive mood and less depression and anxiety.
Unacknowledged emotional support provi-
sion, on the other hand, was related to more
depression for wives, but not for husbands; it
was also marginally related to more anxiety in
both husbands and wives (Husbands: b.14,
SE .08, p.06; Wives: b.14, SE .08,
p.09).
With respect to gender differences in our
HLM analyses, hypothesis testing of the slopes
revealed very few gender differences. Only two
marginal findings were observed: reported pro-
vision of emotional support showed a stronger
impact on wives’ depression (Wives: ␤⫽⫺.29;
Husbands: ␤⫽⫺.14;
2
(1, n100) 3.16,
p.07) and positive mood (Wives: ␤⫽.47;
Husbands: ␤⫽.34;
2
(1, n100) 2.37, p
.12) than husbands’ depression and positive
mood.
Discussion
Our study is the first, to date, to examine the
role of emotional support visibility on daily
well-being in newly married couples. We found
that whereas reported emotional support provi-
sion is related to better well-being, unacknowl-
edged emotional support provision is related to
worse well-being. Moreover, our results suggest
that reported emotional support receipt was
strongly related to better well-being, but invis-
ible emotional support receipt was only mini-
mally related to well-being. In other words, our
findings suggest three things: (1) emotional sup-
port receipt and provision are both important
predictors of well-being, (2) visibility of sup-
port does matter for well-being, and (3) emo-
tional spousal support appears to act similarly
for husbands and wives. Each of these findings
will be elaborated on in the following discus-
sion.
First, in accordance with prior research, re-
ported support provision was related to less
depression and anxiety and greater positive
mood for both husbands and wives. As the prior
literature suggests, providing support may be
beneficial for well-being because it increases
feelings of self-esteem and, in the context of
marriage, positive feelings about the partner and
the status of the relationship. Similarly, but
somewhat contradictory with prior research, re-
ported support receipt was related to less de-
pression and anxiety and greater positive mood
for both husbands and wives. Prior literature has
suggested that support receipt can lead to neg-
ative outcomes because of engendered feelings
of incompetence and lower self-esteem (Helge-
son, 1993). However, Vangelisti (2009) argues
that emotional support in positive situations is
connected with feelings of love and apprecia-
tion by one’s partner—not to issues of compe-
tence. Thus, our positive link between daily
reported emotional support receipt and well-
being is in line with Vangelisti’s argument.
Our second finding nuances the picture a bit
more by adding in the dimension of support
visibility. As predicted, unacknowledged sup-
port provision was related to more anxiety and
depression, whereas invisible support receipt
was not linked with well-being. Moreover,
taken as a whole, the results were strongest for
reported (i.e., visible) support as opposed to
invisible/unacknowledged support. This study
is the first to examine the issue of invisible
support with respect to provision, as well as in
a daily context. Contrary to Bolger and col-
leagues, we found few benefits for invisible
support receipt and several negative conse-
quences for unacknowledged (i.e., invisible)
support provision. One explanation for these
results can be found in the central issue of
importance in communal relationships—the
demonstration and acknowledgment of caring
and love between individuals (Clark & Mills,
1979). With unacknowledged emotional support
provision, a provider may feel unappreciated if
his or her efforts at emotional support go unno-
ticed by the spouse. Moreover, in our study, we
focused on couples in daily life (as opposed to
those experiencing a specific stressor). Thus,
couples may have concentrated more on day-to-
day positive support interactions with their
spouse and what these reflect about the quality
of their relationship. Future research is needed
to replicate these results and to more systemat-
ically examine the role of support visibility
within the context of receipt and provision, as
well as in various types of situations (e.g., pos-
itive and negative experiences, acute vs. chronic
stressors, and daily hassles) and relationships
(e.g., romantic, friendship, and familial).
Finally, we predicted there would be gender
differences in our results, such that husbands
would benefit most from receiving emotional
support, whereas wives would benefit most
249PROVISION AND RECEIPT
from providing emotional support. However,
our analyses revealed no significant gender dif-
ferences. The lack of gender differences may
suggest emotional spousal support processes
may be similar for husbands and wives—
especially in the early years of marriage as
communication and support styles are still de-
veloping. Before concluding that husbands and
wives are similar, these results need to be rep-
licated in a larger sample of married couples.
Future research should compare the emotional
spousal support process (i.e., receipt, provision,
and visibility) in the early years of marriage,
middle years of marriage, and later years of
marriage. Over time, couples may fall into a
rhythm or routine whereby invisible or unac-
knowledged support provision and receipt are
more common as certain acts or behaviors are
taken for granted; also, they may not require
awareness of supportive interactions as much to
reaffirm the strength of their relationship.
While the current study helps to expand the
literature by examining visibility of emotional
support provision and receipt on multiple well-
being outcomes in a daily diary design, there are
several limitations that should be addressed.
First, our sample size was limited; thus, future
studies need to replicate these findings in a
larger sample of married couples in various
stages of marriage. Second, we only examined
emotional support; future studies would benefit
from also examining instrumental spousal sup-
port. Visibility of instrumental spousal support
(as assessed by division of household labor)
may show very different results for receipt ver-
sus provision than those found for emotional
support. Third, as with all diary studies, issues
of sensitization and priming are a concern. In
other words, by asking participants to keep a
journal they may have been primed to notice
support they might have otherwise overlooked.
Finally, future studies should attempt to exam-
ine emotional support through more objective
methods, as opposed to relying solely on self
and spousal reports. Research may also want to
address different ways to operationalize visibil-
ity of support. Specifically, the current study
may have measured support that was intended
but did not occur; future research needs to as-
sess intention to provide support. Finally, our
study sought to expand the research on invisible
support by focusing on the role of unacknowl-
edged provision and invisible receipt on daily
well-being in newly married couples. As such,
we chose not to examine the issue of “overac-
knowledged” support provision and receipt in
the current study. However, we feel it is impor-
tant for support researchers to examine the idea
of overacknowledged support (i.e., when the
recipient reports more support being received
than the provider reports giving). To our knowl-
edge, this construct has not been examined in
the prior literature; yet, the implications of over-
acknowledged support are important in com-
pleting our understanding of the role of support
visibility on well-being.
Our study gives important insight into the
dyadic interplay between support provision and
receipt. Additionally, it expands on previous
work done by Bolger and colleagues on invisi-
ble support by addressing the issue of invisible
(i.e., unacknowledged) support provision. Even
so, many unanswered questions remain. For ex-
ample, invisible support has been defined as a
support exchange where providers report sup-
port has been made available but the recipient
does not encode the support transaction as hav-
ing taken place (Bolger, Zuckerman, & Kessler,
2000). In our study, with regard to measuring
provision of unacknowledged support, it was
unclear whether providers were truly aware
their support attempts were going unnoticed. In
some cases, support provision is intended to be
acknowledged. Yet, in other cases, a provider
may make a conscious decision to provide sup-
port in a way that is not encoded by the recip-
ient. Future research needs to examine both
types of unacknowledged support provision
(i.e., intended and not intended) to determine
whether both are negatively related to well-
being.
To conclude, our study provides prelimi-
nary evidence for the importance of examin-
ing both support receipt and provision in mar-
ital exchanges, as well as understanding the
impact of support visibility on both the pro-
vider and recipient. Findings from the current
study are important not only in terms of spou-
sal support research, but also for its potential
clinical implications in terms of understand-
ing how couples support and communicate
with one another. Marital therapy and mar-
riage interventions need to address the issue
of unacknowledged support provision on
well-being and give couples ways of letting
their partner know that they are providing
250 BIEHLE AND MICKELSON
support, and/or help them to understand why
their support provision is not being inter-
preted or encoded as support by their partner.
In marriage, as well as other relationships,
what both parties report and perceive in terms
of support is crucial to understanding the
complex dynamics of relationships.
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Received August 16, 2011
Revision received January 17, 2012
Accepted April 5, 2012
251PROVISION AND RECEIPT
... According to Bolger et al [32], support is invisible to recipients when the supportive acts occur outside of their awareness (ie, one partner takes care of unexpected housework without telling the other) or the recipient may be aware of the act but may not code it as support (ie, one partner purposefully gives advice in an indirect way so as not to draw attention to the recipient's distress or his/her inability to deal with the stressful situation). To date, the few studies that have investigated invisible support in prospective diary designs (eg, studies by Bolger et al [32], Shrout et al [35], Maisel and Gable [36], and Biehle and Mickelson [37]), observational studies (eg, studies by Howland and Simpson [38] and Girmeet al [39]), and experimental designs (eg, studies by Bolger and Amarel [40] and Kirsch and Lehman [41]) have yielded support for beneficial effects on well-being and encourage further research. ...
... In this approach, invisible support was coded when the target person reported no receipt of support, but the support provider reported provision of support. On the other hand, researchers calculated continuous invisible support by subtracting received support reported by the target person from provided support reported by partners (eg, studies by Biehle and Mickelson [37] and Lüscher et al [44,45]). Instances in which the recipient reported receiving more than the provider reported giving were collapsed to zero. ...
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... According to Bolger et al [32], support is invisible to recipients when the supportive acts occur outside of their awareness (ie, one partner takes care of unexpected housework without telling the other) or the recipient may be aware of the act but may not code it as support (ie, one partner purposefully gives advice in an indirect way so as not to draw attention to the recipient's distress or his/her inability to deal with the stressful situation). To date, the few studies that have investigated invisible support in prospective diary designs (eg, studies by Bolger et al [32], Shrout et al [35], Maisel and Gable [36], and Biehle and Mickelson [37]), observational studies (eg, studies by Howland and Simpson [38] and Girmeet al [39]), and experimental designs (eg, studies by Bolger and Amarel [40] and Kirsch and Lehman [41]) have yielded support for beneficial effects on well-being and encourage further research. ...
... In this approach, invisible support was coded when the target person reported no receipt of support, but the support provider reported provision of support. On the other hand, researchers calculated continuous invisible support by subtracting received support reported by the target person from provided support reported by partners (eg, studies by Biehle and Mickelson [37] and Lüscher et al [44,45]). Instances in which the recipient reported receiving more than the provider reported giving were collapsed to zero. ...
Preprint
BACKGROUND Type II diabetes mellitus (T2DM) is a common chronic disease. To manage blood glucose levels, patients need to follow medical recommendations for healthy eating, physical activity, and medication adherence in their everyday life. Illness management is mainly shared with partners and involves social support and common dyadic coping (CDC). Social support and CDC have been identified as having implications for people’s health behavior and well-being. Visible support, however, may also be negatively related to people’s well-being. Thus, the concept of invisible support was introduced. It is unknown which of these concepts (ie, visible support, invisible support, and CDC) displays the most beneficial associations with health behavior and well-being when considered together in the context of illness management in couple’s everyday life. Therefore, a novel ambulatory assessment application for the open-source behavioral intervention platform MobileCoach (AAMC) was developed. It uses objective sensor data in combination with self-reports in couple’s everyday life. OBJECTIVE The aim of this paper is to describe the design of the Dyadic Management of Diabetes (DyMand) study, funded by the Swiss National Science Foundation (CR12I1_166348/1). The study was approved by the cantonal ethics committee of the Canton of Zurich, Switzerland (Req-2017_00430). METHODS This study follows an intensive longitudinal design with 2 phases of data collection. The first phase is a naturalistic observation phase of couples’ conversations in combination with experience sampling in their daily lives, with plans to follow 180 T2DM patients and their partners using sensor data from smartwatches, mobile phones, and accelerometers for 7 consecutive days. The second phase is an observational study in the laboratory, where couples discuss topics related to their diabetes management. The second phase complements the first phase by focusing on the assessment of a full discussion about diabetes-related concerns. Participants are heterosexual couples with 1 partner having a diagnosis of T2DM. RESULTS The AAMC was designed and built until the end of 2018 and internally tested in March 2019. In May 2019, the enrollment of the pilot phase began. The data collection of the DyMand study will begin in September 2019, and analysis and presentation of results will be available in 2021. CONCLUSIONS For further research and practice, it is crucial to identify the impact of social support and CDC on couples’ dyadic management of T2DM and their well-being in daily life. Using AAMC will make a key contribution with regard to objective operationalizations of visible and invisible support, CDC, physical activity, and well-being. Findings will provide a sound basis for theory- and evidence-based development of dyadic interventions to change health behavior in the context of couple’s dyadic illness management. Challenges to this multimodal sensor approach and its feasibility aspects are discussed. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/13685
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