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ICRAE2015 Conference-Paper Proceedings, ISSN: 2308-0825
The 3nd International Conference on Research and Educatıon – “Challenges Toward the Future” (ICRAE2015), October 23-24, 2015,
University of Shkodra “Luigj Gurakuqi”, Shkodra, Alba nia
CONFLICT RESOLUTION STYLES AND HEALTH OUTCOMES IN
MARRIED COUPLES: A SYSTEMATIC LITERATURE REVIEW
Greta Hysi
1 Department of Psychology and Education. University of Tirana. Albania
E mail: gretahysi@hotmail.com
Abstract
This review focuses on the impact and importance of conflict resolution styles used by marital
partners to their physical health outcomes. The main aim of this study is to analyze the
relationship between marital conflict resolution style and physical health? A literature review
of 40 research studies in the marriage and health area from JStore, Francis and Taylor, Sage
Journals and EBSCO Host, has been used to synthesize the impact of marital conflict resolution
style to physical health. Studies suggest that higher levels of negative spousal behaviors
contribute to physical health, predicting more physical symptoms, chronic health problems,
physical disability and poorer perceived health. Conflict is a natural part of our interactions
with others. According to Thomas–Kilmann Conflict Mode framework, people tend to use five
different conflict resolution styles: collaboration, avoiding, compromising, accommodating
and competing. Studies suggest that partners living in unsatisfied marriages use avoidant style
in managing conflict, while satisfied partners use collaboration style. As a conclusion, conflict
resolution styles represent an important factor for developing physical symptoms and health
outcomes. Conflict resolution styles and health outcomes should be an important exploring
area for both couple and family therapists.
Keywords: marriage, health, conflict resolution styles
Introduction
This systematic literature review is based on the last two decades of empirical research studies
and approaches of conflict in health outcome in married couples. The overall goal of this review
is to explore how marital interaction and marital conflict affect mental and physical health. The
article will answer this question by synthetizing systematically the main research studies in this
field. There are three published reviews that have explored the advances made in observing
marital interaction, the first one is an annual review from Fincham and Beach (1999), the
second one is a decade review from Gottman & Nottarius (2000) and the third one is the review
of Kiecolt-Glaser & Newton (2001).
The first review (Fincham and Beach, 1999) focuses on the impact of marital conflict
on mental, physical, and family health and what is known about the nature of conflict in
marriage. After highlighting some recent theoretically grounded advances, the researchers
illustrate how conceptualizing marital conflict behavior as goal directed provides an integrative
theoretical framework for treatment, prevention, and marital conflict research.
The second review (Gottman & Nottarius, 2000), focuses on health outcomes and the
bidirectional effect of marriages not only in each partner, but also in their children. The
researchers mention also that there has been an expansion of the study of marital interaction to
common comorbid psychopathologies (Gottman & Nottarius, 2000).
ICRAE2015 Conference-Paper Proceedings, ISSN: 2308-0825
The 3nd International Conference on Research and Educatıon – “Challenges Toward the Future” (ICRAE2015), October 23-24, 2015,
University of Shkodra “Luigj Gurakuqi”, Shkodra, Alba nia
The third review (Kiecolt-Glaser & Newton, 2001), focuses on the pathways leading
from the marital relationship to physical health and suggests that marital functioning is
consequential for health; negative dimensions of marital functioning have indirect influences
on health outcomes through depression and health habits, and direct influences on
cardiovascular, endocrine, immune and other physiological mechanisms.
These three published reviews have contributed enormously in understanding the
marriage-health connection by bringing together the most important research studies conducted
in this field. However, this systematic review focuses mainly on research that uses the most
sophisticated statistical methods for determining whether marriage does indeed affect mental
and physical health outcomes.
Conflict Resolution Styles in Married Couples
In everyday life, people engage in different interactions, each of which is based on give and
take. This give-and-take relationship keeps people connected with each-other and encourages
them to exchange thoughts, feelings and attitudes. The impact of give and take is more powerful
especially in the marriage setting. Conflict in marriage relationship happens everywhere and it
is inevitable in forms of disagreements, tensions, dislikes, and arguments.
Although it is difficult to define conflict in a precise way; there are many authors that
have defined it from different angles. Thomas (1976) has described conflict as the process that
begins when one party perceives that the other one has frustrated some concerns of his or hers;
Johnson (1990) suggested that an interpersonal conflict exists whenever an action by one
person prevents or interferes with the actions of another person; Himes (1980) described
conflict as a struggle over status, and authority in which the endeavors of the conflicting
partners are not only to gain the ideal and best values, but also to destroy their competitors.
Despite romantic ideals, conflict in marriage relationships is pervasive (Buss, 1989;
Muelenhard & Linton, 1987). Both partners perform actions that upset and anger each other,
and conflict emerges. Argyle and Furnham (1983) found that relational closeness and conflict
were positively associated and that most conflict occurred in closest relationships. Conflict is
a predictable part of human relationships and by itself is not a negative phenomenon. However,
the way we manage conflict can shape psychological outcomes. Conflict management is one
of the most important determinants of the well-being of the relationships (Bacciocchi, 1997;
Crohan, 1992).
Partners can handle the conflict within the relationship either in a destructive or in a
constructive way. Destructive conflict management is characterized by increasing
manipulation, threat and coercion (overt expression of the conflict), avoidance spirals (covert
expression of the conflict), revenge, inflexibility and rigidity, a competitive pattern of
dominance and subordination, and degrading verbal and nonverbal communication (Hocker &
Wilmot, 1995). Constructive conflict, conversely, is characterized by flexibility, interaction
with the intent to learn instead of intent to protect, enhancement of self-esteem, a relationship
focus instead of an individual focus, and cooperation (Hocker & Wilmot, 1995).
Couples differ not only in their ability to use conflict constructively or destructively,
but also in the manner in which they argue, react to, and act upon conflict (Burman, Margolin,
& John, 1993; Gottman & Krokoff, 1989; Kilmann & Thomas, 1977). In an intimate
relationship, partners tend to use different styles for dealing with conflict which are almost
learned in childhood (Johnson, 1990). These different styles are viewed as (a) characteristics
of the person; (b) types of conflict behavior or categories of behavior, and (c) communicative
orientations that people adopt toward conflict. Conflict management styles may be affected by
certain situations or stances (Hocker & Wilmot, 1995) and may vary according to the nature of
ICRAE2015 Conference-Paper Proceedings, ISSN: 2308-0825
The 3nd International Conference on Research and Educatıon – “Challenges Toward the Future” (ICRAE2015), October 23-24, 2015,
University of Shkodra “Luigj Gurakuqi”, Shkodra, Alba nia
the conflict, previous success with the style in similar situations, or the suitability of the style
for the specific situation (Putnam & Wilson, 1982).
According to Thomas & Kilmann (1978), there are five different conflict management
styles that people use to handle conflicts in their relationships. They present two independent
dimensions of behavior in conflict situations: assertiveness (the attempt to satisfy one’s own
concerns) and cooperativeness (the attempt to satisfy the concerns of others). On the basis of
these two dimensions, five different conflict management styles were identified: Competing
behavior is both assertive and uncooperative. It is associated with forcing behavior and win-
lose arguing; collaborating behavior is assertive and cooperative. It has been identified with
confronting disagreements and problem solving to find solutions; compromising is
intermediate in both assertiveness and cooperativeness. It is identified with the proposal of a
middle ground; avoiding behavior is unassertive and uncooperative and is associated with
withdrawal and failure to take a position in a conflict situation; accommodating behavior is
unassertive and cooperative; it is seen as an attempt to soothe the other person and seek
harmony (Kilmann & Thomas, 1975; Thomas & Kilmann, 1978). The collaborating conflict
resolution style, the healthiest way of handling conflict, correlate positively with marital
satisfaction (Schaap et al., 1988). On the other hand, all other conflict management styles
correlate negatively with marital satisfaction (Schaap et al., 1988).
Conflict Resolution Styles and Mental Health in Married Couples
Conflict and health are closely related. There is limited, but consistent evidence that
physiological responses between members of an interacting dyad can show considerable
relatedness or linkage. Studies that examine both the supportive and the problematic aspects of
marriage relationships often show that negative relationships have stronger impacts than
positive relationships on well-being and distress (Fiore, Becker, and Coppel 1983; Rook 1984;
Abbey, Abramis, and Caplan 1985; Abbey, Andrews, and Halman 1995; Pagel, Erdly, and
Becker 1987; Finch et al. 1989; Revenson et al. 1991; Turner 1994; Umberson et al. 1996).
Most of the empirical results provide evidences that the direction of the influence is from
marriage to health, not from health to marriage (e.g., Umberson et al. 2006).
Unresolved marriage conflicts can impact negatively on the mental health of partners
(Bacciocchi, 1997; Markman, Renick, Floyd, Stanley, & Clements, 1993). Table 1 represents
the most cited research studies which have explored the relationship between marital conflict
and mental health outcomes. Research studies that has focused in this area, have explored and
come in conclusion that destructive marital interactions is especially connected with depression
symptoms at both partners.
Table 1: Marital interaction and/or conflict studies with mental health outcomes data
Study
Participants and
marital adjustment
Design and variables
Relevant findings
Mongrain &
Vetesse,
2003
94 women and
their male
romantic partners
Experimental: conflict
over emotional
expression, depressive
experiences, negative
affect suppression
Ambivalent women silence
themselves, which could help
explain the prevalence
of their depressive symptoms
Merchand &
Hock, 2000
40 married couples
Correlational:
depression, marital
satisfaction, conflict
resolution behavior
Maladaptive avoidance and
attacking conflict-resolution
strategies may be a function of
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The 3nd International Conference on Research and Educatıon – “Challenges Toward the Future” (ICRAE2015), October 23-24, 2015,
University of Shkodra “Luigj Gurakuqi”, Shkodra, Alba nia
the presence of depressive
symptoms in one or both spouses
Horwitz,
McLaughlin
& White,
1998
458 subjects who
got married and
remained married
during the study
Survey: depression,
problematic
relationship,
supportive
relationship, relational
balance
Both positive and negative
aspects of marital relationships
affect mental health. Both sides
of spousal relations are
associated with depression, the
problematic side of relationships
has a greater impact on mental
health than the supportive side
Willitts,
Benzeval &
Stansfeld,
2004
2127 men and
2303 women aged
under 65 who
provided full
interviews at every
survey wave
Longitudinal:
psychological distress,
depression, anxiety,
partnership change
Enduring first partnerships were
associated with good mental
health. Partnership splits were
associated with poorer mental
health, although the reformation
of partnerships partially reversed
this. The more recently a
partnership split had occurred the
greater the negative outcome for
mental health.
Based on results of empirical researches studying how negative and positive aspects of
partner relationship affect the mental health of married people, was found bigger effect size in
supportive and problematic marriage relationships than in absolute level of either aspects.
Neither support nor marital problems in themselves predict depression after control- ling for
the balance of these two aspects of marital quality (Horowitz et al., 1998). People with
supportive spouses are more likely to get depressed when problems occur in their marriages;
at the same time, problems with spouses are especially related to depression when people get
relatively little support from spouses. When people simultaneously have supportive and
problematic partner relationships, the supportive side can buffer the negative impact of
problematic relationships on depression. Conversely, problematic relationships mitigate the
beneficial contributions of supportive relationships with spouses.
Conflict Resolution Styles and Physical Health in Married Couples
Another category of research, have explored marital interactions in correlation with physical
health outcome, especially chronic illnesses and physical symptoms including somatization.
Romano et al., (1991) developed a methodology for behavioral observations of chronic pain
patients and their spouses. They discovered that positive attention from spouses of pain
patients, were associated with reports of more intense pain and greater disability; but negative
spouse responding to pain was associated with increased affective distress.
Brown & Smith (1992) studied 45 married couples and found that husbands attempting
to persuade their wives showed increased levels in systolic blood pressure before and during
the discussion. In males, physiological effects were accompanied by increased anger and
hostile behavior. In wives there was neither elevated systolic blood pressure nor anger, even
though they showed the same behavior as their husband in their interaction (Brown & Smith,
1992). In another study with 90 newlywed couples, hostile behaviors during the conflict
interactions were strongly correlated with decreased levels of prolactin and increases in
epinephrine, norepinephrine, ACTH, growth hormone, but not cortisone (Malarkey et al.,
ICRAE2015 Conference-Paper Proceedings, ISSN: 2308-0825
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1994). Table 2 represents most cited f research studies which have explored the relationship
between marital conflict and physical health outcomes. This findings, suggest that marital
interactions and conflict resolution styles affect directly physiological responses.
Table 2: Marital interaction and/or conflict studies with physical health outcomes data
Study
Participants and
marital adjustment
Design and variables
Relevant findings
Bookwala,
2005
729 individuals in
their first
marriage, aged
50+
Correlational: marital
quality, physical
symptomatology; chronic
health problems; physical
disability; percieved health
Negative spousal behaviors
contribute significantly to
physical health including
physical disability, chronic
illnesses, physical symptoms,
and self-rated health
Gottman,
Levenson
& Woodin,
2001
79 married couples
Experimental: emotional
expression, cardiac interbeat
interval, skin conductance
level, general somatic
activity, pulse transmission,
finger pulse amplitude
Facial expressions were related
in interpretable ways with the
couple’s perception of the
relationship, with significant
marital and health outcomes,
with concurrent physiological
responses, with the number of
interacts, and with the couple’s
behavior during Oral History
Interview
Gottman &
Levenson,
1983
30 married couples
Experimental: marital
satisfaction, affective
patterns, heart rate, skin
conductance, pulse
transmission time, and
somatic
activity
60% of the variance in marital
satisfaction was accounted for
using measures of
physiological linkage alone.
Additional non redundant
variance was accounted for by
the other physiological and
affective measures
Thoburn,
Hoffman,
Shelly &
Sayre, 2009
A case example
Case study: collaborative
treatment, somatization,
psychosomatic family,
systems approach
Couple communication,
intimacy, somatization, as well
as the part medical
intervention, play an important
role in maintaining
symptomatology and the
overall strength of couple
homeostasis
Sandberg,
Miller,
Harper,
Robila &
Davey,
2009
536 intact couples
aged 55 to 75
Survey: marital quality,
health problems, health care
utilization
Marital distress is associated
with cardiovascular disease,
with atherosclerosis and with
arthritis symptoms
Wolfsdorf,
Kaiser &
Hahlweg,
1999
80 couples
Experiment:
psychoneuroendocrinology,
cortisol, blood pressure,
couples interaction, negative
interaction behavior
Marital interaction directly
affects physiological responses
to a conflict depending on
interaction quality
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Yorgason,
Booth &
Johnson,
2008
2034 married
individuals
interviewed by
telephone in
1980, 1983, 1988,
1992, 1997, and
2000
Longitudinal: health, marital
quality, disability, aging
Health decrements were
associated with greater changes
in marital quality among the
young and middle aged than
among an older cohort.
Most of research studies that have focused on the link between marital quality and
health outcomes come from two main areas: lab-based studies in clinical populations and
community-based surveys (Umberson et al., 2006). The lab-based studies have observed
marital conflict and collected biomedical data on cardiovascular reactivity and hormonal
responses. These studies are based on stress models where marital conflict is viewed as the
stressful stimulus. Stress stimulates the production of stress hormones (cortisol, epinephrine,
and norepinephrine) and evokes a cardiovascular response (e.g., increased heart rate and blood
pressure). These results provide consistent evidence that physiological changes occur during
marital conflict, that marital distress triggers immune response, and that marital conflict
increases cardiovascular reactivity (see a review in Burman and Margolin 1992).
Gallo and his colleagues, found that healthy women in highly satisfying relationships
developed fewer symptoms of cardiovascular disease over an 11-year period, compared to
women in moderate and low-satisfaction relationships (Gallo et al, 2003). In the same line with
these findings, Grewen et al., (2003) and Light et al., (2005) discovered that under stressful
experimental conditions, the physical contact with a spouse tends to low blood pressure and
heart rate, and increases the hormone oxytocin, which prevents the body’s stress responses
from negatively influencing the cardiovascular and endocrine systems.
In clinical experiments, when a couple in a healthy, high quality marriage were told to
argue about a real problem that they disagreed about, their supportive and constructive
behaviors during the argument seemed to lower both partners’ stress hormone levels. This
effect was stronger in female partners. The couples who showed the least negativity response
when having a marital argument had the best immune system responses (Kielcolt-Glaser et al,
1997; Robles & Kielcolt-Glaser, 2003).
The community-based surveys are conducted in nonclinical population and provide an
important approach for marital quality and global health status (Umberson, et al., 2006). Two
large community-based studies of middle-aged and older married adults, found that those who
reported higher levels of negative spousal behaviors, such as experiencing criticism, arguments
and demands, had poorer health over time by reporting a lot of physical symptoms and show
specific chronic health problems (Bookwala, 2005; Umberson et al, 2006).
Wickrama and his colleagues (1997) analyzed empirical data from a rural community
and found a significant link between marital quality and physical illness over a three-year
period. They concluded that “improving marital quality over time is associated with decreasing
physical illness” (Wickrama et al. 1997). In a later longitudinal study, Wickrama et al. (2001)
found that marital stress significantly increased the risk of hypertension onset for both men and
women.
However, it is important to distinguish the casual relationship of marital interaction
and conflict on physical health. Some of the researchers believe that marriage itself has a
positive effect and those who marry will physically benefit and be protected from illness
(Staton, 2008). The other researchers believe that healthier people are selected as marriage
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partners (Staton, 2008). The research consensus is that the health benefits of marriage are a
combination of selection and protection effects. In fact, studies on the health status of young
adults prior to their first marriage demonstrate that selection effects explains only some of their
lifelong health benefits and highlight the consideration of protective effects in understanding
their better physical health status (Goldman, 2001; Wood et al, 2007).
According to these research findings, marriage seems to be a cause and a consequence
of physical and mental health outcomes. Based on published empirical research it is very
difficult to distinguish the direction of the influence of marriage to health and of health to
marriage. To address these issues requires careful analysis and advanced statistical methods
that are not always used in studies examining the link between marriage and health.
Conclusions
A healthy marriage has been found to be the best protection for health and well-being for both
partners (Wood et al., 2007) and for their children (Lerman 2002; Ross et al. 1990; Waite and
Gallagher 2000; Wilson and Oswald 2005). But, these findings are consistent only with the
empirical data conducted in partners who report high quality of marriage and who use healthy
marital interactions. Other researches show that marriage can have both negative and positive
effects, depending on the quality of marital relationship (Staton, 2008).
According to this systematic literature review, it is clear that negative spousal behaviors
and unresolved conflicts contribute significantly to mental and physical health of both partners.
Mental health is closely related to the presence of depressive symptoms. Depression in one of
the most common forms of psychological distress and can be highly debilitating (Wood et al.,
2007). Enormous research shows that it is also highly correlated with physical health. Marriage
may also affect physical health through its influence on mental health. In this synthesis of
research studies, it is summarized the effect of negative spousal behaviors and unresolved
conflict on particular physical health outcomes such as cardiovascular disease, atherosclerosis,
arthritis symptoms, physical disability, chronic illnesses and physical symptoms. In conclusion,
it is not the marriage itself that contribute to mental and physical health outcomes, but the
quality of marriage, the marital interaction and the way the spouses resolve their conflicts that
determine the health outcomes.
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ICRAE2015 Conference-Paper Proceedings, ISSN: 2308-0825
The 3nd International Conference on Research and Educatıon – “Challenges Toward the Future” (ICRAE2015), October 23-24, 2015,
University of Shkodra “Luigj Gurakuqi”, Shkodra, Alba nia
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