Anxiety Disorders and Intimate Relationships:
A Study of Daily Processes in Couples
Talia I. Zaider and Richard G. Heimberg
Kent State University
Although adults with anxiety disorders often report interpersonal distress, the degree to which anxiety is
linked to the quality of close relationships remains unclear. The authors examined the relational impact
of anxiety by sampling the daily mood and relationship quality of 33 couples in which the wife was
diagnosed with an anxiety disorder. Use of a daily process design improved on prior methodologies by
capturing relational processes closer to their actual occurrence and in the setting of the diagnosed
partner’s anxiety. Analyses revealed significant associations between wives’ daily anxiety and both partners’
perceptions of relationship quality. Associations were moderated by anxiety-specific support. Results also
indicated significant concordance between wives’ daily anxiety and husbands’ distress. Concordance was
stronger for husbands who reported frequent accommodation of wives’ anxiety symptoms. Findings are
discussed in the context of existing evidence on the social costs of anxiety disorders.
Keywords: anxiety disorders, couples, marriage, marital distress, relationship functioning
Intimate relationships are a primary context in which adults express
and manage personal distress. The study and treatment of depression
in particular have benefited from increased recognition of its inter-
personal consequences (Beach, Whisman, & O’Leary, 1994). In com-
parison, we have far more limited knowledge of how anxiety disor-
the significant other of living with a partner who suffers from persis-
tent and chronic anxiety. Given the degree of social and functional
impairment often accompanying these disorders (e.g., Bystritsky et
al., 2001), the current study sought to clarify how the presence of an
anxiety disorder impacts the relational life of a couple.
Are Anxiety Disorders Associated With Relationship
Population studies point to strong associations between an anx-
iety disorder in one partner and perceptions of poor marital quality
by both partners (e.g., McLeod, 1994). A longitudinal analysis of
4,796 married couples indicated that baseline marital quality was
a strong predictor of the onset of an anxiety disorder over a
subsequent 2-year period (Overbeek et al., 2006). Recent data from
the National Comorbidity Survey Replication have also demon-
strated that marital distress is significantly associated with in-
creased risk of having any concurrent anxiety disorder, particularly
social anxiety disorder (SAD), generalized anxiety disorder
(GAD), and posttraumatic stress disorder (PTSD; Whisman,
2007). The association between anxiety disorders and poor marital
functioning does not appear to be an artifact of general social
impairment (Whisman, Sheldon, & Goering, 2000) and is not
better accounted for by age, gender, or comorbidity with depres-
sion or with alcohol or drug dependence (McLeod, 1994; Whis-
man, 1999, 2007). Moreover, adults with anxiety disorders may
engage in interpersonal behaviors that elicit poor reactions from
others or jeopardize opportunities for support and intimacy (e.g.,
Darcy, Davila, & Beck, 2005).
Prior research in this area has taken a predominantly nomothetic
approach, in which associations between anxiety disorders and
marital quality were examined across a group of individuals. These
data tell us that, on average, adults with anxiety disorders are likely
to experience poor relationship quality. However, it remains un-
known whether a person affected by an anxiety disorder is more or
less likely to experience relational difficulties on those occasions
when he or she experiences elevated anxiety. Tennen, Affleck,
Armeli, and Carney (2000) cautioned against using cross-
sectional, between-person associations to draw inferences about
how two variables are related within the same person. It is possi-
ble, for instance, that adults with anxiety disorders experience
improved relationship quality during episodes of heightened anx-
iety because of increased support received from an intimate partner
at this time.
In developing theoretical models and designing interventions,
clinicians and researchers rely on idiographic formulations of how
these processes unfold for a given person. Over the last decade,
there have been significant advances in the procedural and analytic
tools available to study idiographic processes over time. In partic-
ular, the daily diary method has proven to be a useful way to
examine how two processes (e.g., marital quality and anxiety)
covary within the same person over time. In the present study,
Talia I. Zaider and Richard G. Heimberg, Department of Psychology,
Temple University; Masumi Iida, Department of Psychology, Kent State
We thank Patrick E. Shrout for statistical advice. This research was
funded by National Research Service Award 1F31MH068047-01 (National
Institute of Mental Health) to Talia I. Zaider. Portions of the article were
presented at the annual meeting of the Association for Advancement of
Behavior Therapy, Chicago, Illinois, November 2006.
Correspondence concerning this article should be addressed to Talia I.
Zaider, who is now at Memorial Sloan Kettering Cancer Center, 641
Lexington Avenue, 7th Floor, New York, NY 10022. E-mail: zaidert@
Journal of Abnormal Psychology
2010, Vol. 119, No. 1, 163–173
© 2010 American Psychological Association
daily diary reports were used to determine the within-person
association between anxiety and relationship quality among adults
with anxiety disorders and their partners.
One limitation of prior literature on anxiety disorders and rela-
tionship quality is the inconsistency across studies in how rela-
tionship quality is defined. Daiuto, Baucom, Epstein, and Dutton
(1998) argued that it is important to distinguish relationship sat-
isfaction (i.e., subjective appraisal of how happy one is in a
relationship) from relationship adjustment (i.e., the quality of
specific relational processes such as communication or problem-
solving). The utility of this distinction is supported by previous
studies showing that aspects of relationship adjustment (e.g.,
avoidance of communication) significantly predicted the outcome
of treatment for an anxiety disorder, even when global relationship
satisfaction was high (Craske, Burton, & Barlow, 1989; Marcau-
relle, Belanger, & Marchand, 2003). Exclusive reliance on global
evaluations of relationship satisfaction may therefore miss clini-
cally useful information about areas of relationships more or less
disrupted by anxiety. Even when couples describe their relation-
ships as high functioning across multiple domains, couples who
struggle to accommodate one partner’s anxiety symptoms (e.g.,
with effective support and communication) may experience more
pronounced relational impact in the context of these symptoms
(Craske et al., 1989). In observed interactions between agorapho-
bic women and their husbands, problem-solving difficulties were
greater when the topic of discussion was the wife’s anxiety
(Chambless, Bryan, Aiken, Steketee, & Hooley, 2001). In the
present study, we used a measure of anxiety-specific relationship
adjustment to provide a contextually sensitive assessment of rela-
tionship functioning. We hypothesized that anxiety-specific rela-
tionship adjustment would be more informative in predicting the
strength of the association between anxiety and daily relationship
quality than would a measure of global relationship functioning.
What Is the Experience of the Significant Other?
Research on the interpersonal consequences of depression high-
lights the adverse effects of one partner’s mood disturbance on
another (Joiner & Katz, 1999). The tendency to “catch” another
person’s distress is referred to as emotional contagion and has
been supported extensively in social psychology (e.g., Hatfield,
Cacioppo, & Rapson, 1994) as well as in the literature on depres-
sion (Katz et al., 1999). Spouses of depressed partners show higher
levels of depressed mood than do controls, with a substantial
portion carrying levels of distress that warrant clinical intervention
(Benazon & Coyne, 2000; Coyne et al., 1987). Yet data on the
concordance of anxiety in dyads is sparse. One study found that
displays of anxiety elicited high levels of distress, rejection, and
devaluation from others, with some evidence for affect-specific
mood induction (Gurtman, Martin, & Hintzman, 1990). However,
most studies in this area used nonclinical samples and did not
examine these phenomena in the context of intimate relationships.
Adults who meet diagnostic criteria for an anxiety disorder may be
more likely to show dyadic concordance in distress than nonclini-
cal groups, perhaps as a function of the severity, chronicity, and
perceived unmanageability of their anxiety (e.g., Joiner & Katz,
1999). A second focus of the current study was therefore to
examine the degree to which one partner’s anxiety is associated
with elevated distress in the partner.
We were further interested in specifying conditions that
strengthen this concordance in distress. Studies examining familial
responses to a relative with an anxiety disorder have identified
response styles that may contribute to shared distress (Calvocor-
essi et al., 1995). For example, Amir, Freshman, and Foa (2000)
found that the degree of distress felt by relatives of patients with
obsessive-compulsive disorder (OCD) was significantly related to
how frequently they accommodated the patient’s symptoms and
how critical or rejecting they felt toward the patient. Geffken et al.
(2006) similarly reported that high levels of family accommoda-
tion to OCD patients’ symptoms was strongly related to relatives’
disengagement and denial in the face of stressful situations. In the
present study, we examined whether adults with anxiety disorders
were more likely to transmit distress to their partners when their
partners featured certain habitual response styles, such as hostility
and rejection, or symptom accommodation.
The Current Study
We observed associations between anxiety and relationship
quality (RQ) among couples in which one partner (the wife) was
diagnosed with an anxiety disorder. We used a daily process
design to improve on prior studies that relied on cross-sectional,
between-person analyses. Specifically, we hypothesized that:
1.Wives’ daily anxiety would be associated with daily
perceptions of RQ for both partners.
2.The associations between wives’ anxiety and perceptions
of RQ would be moderated by wives’ anxiety-specific,
but not global, relationship adjustment. We hypothesized
that associations would be stronger for couples with
lower anxiety-specific relationship adjustment.
3.On days in which wives reported elevations in anxious
mood, husbands would be perceived as having at least
some involvement in their wives’ anxiety. Exploratory
analyses examined how often husbands were perceived
as contributing to the (a) reason for anxiety, (b) worsen-
ing of anxiety, or (c) alleviation of anxiety.
4.Wives’ daily anxiety would be associated with husbands’
level of distress (i.e., anxiety, anger, depression) on the
5.The association between wives’ anxiety and husbands’
levels of distress would be moderated by (a) husband-
reported hostility toward the wife and (b) husband’s
accommodation of wives’ anxiety symptoms. We hy-
pothesized that wives’ anxiety would be more strongly
associated with husbands’ distress for husbands who
report greater hostility and greater accommodation of
Our sample consisted of 33 married and/or cohabiting (?6
months) heterosexual couples in which the female partner met
ZAIDER, HEIMBERG, AND IIDA
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Received August 25, 2008
Revision received September 21, 2009
Accepted September 22, 2009 ?
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ANXIETY DISORDERS AND INTIMATE RELATIONSHIPS