Download PDF
Psychother Psychosom Med Psychol 2018; 68(05): 202-211
DOI: 10.1055/s-0044-102012
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Einfluss von Emotionsregulation und emotionaler Erregung auf Lebensqualität und Adhärenz bei Paaren nach Nierentransplantation

Impact of Emotion Regulation and Emotional Arousal on Quality of Life and Adherence of Couples after Kidney Transplantation
Luisa Peters
1   Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule, Hannover
,
Laura Franke
1   Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule, Hannover
,
Daria Tkachenko
1   Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule, Hannover
,
Mario Schiffer
2   Klinik für Nieren- und Hochdruckerkrankungen, Medizinische Hochschule Hannover
,
Tanja Zimmermann
1   Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule, Hannover
› Author Affiliations
Further Information

Publication History

eingereicht 28 September 2017

akzeptiert 14 January 2018

Publication Date:
03 May 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung Bei Patienten nach Nierentransplantationen ist die Nonadhärenz an die immunsuppressive Behandlung das größte Risiko für einen Transplantatverlust. Maladaptive Emotionsregulationsstrategien (ERS) stellen Risikofaktoren für Nonadhärenz dar, während bei Patienten in Partnerschaft Unterstützung des Partners protektiv wirkt. In Zusammenhang mit dem partnerschaftlichen Unterstützungsverhalten steht außerdem emotionale Erregung, objektiv messbar mithilfe der Sprachgrundfrequenz (f0 ).

Material & Methoden Bei N=50 Paaren nach Nierentransplantation wurde der Zusammenhang zwischen Erfahrungen und Überzeugungen hinsichtlich der imunsuppressiven Medikation (ISM), Lebensqualität (LQ), erlebten Emotionen, ERS und f0 während eines Paargesprächs untersucht.

Ergebnisse Mehr maladaptive ERS des Transplantierten hingen mit geringerer mentaler LQ des Partners, tendenziell höherem eigenen negativem Affekt und schlechteren eigenen Erfahrungen und Überzeugungen hinsichtlich der ISM zusammen. Maladaptive ERS des Partners wiesen negative Korrelationen mit der eigenen mentalen LQ auf. Bezüglich der f0 fanden sich Geschlechterunterschiede. Eine höhere f0 des männlichen Transplantierten hing mit mehr maladaptiven ERS der Partnerinnen zusammen. Tendenziell signifikante Zusammenhänge zeigten sich auch mit schlechteren eigenen Erfahrungen und Überzeugungen hinsichtlich der ISM. Eine erhöhte f0 der Partnerinnen männlicher Transplantierter wies Zusammenhänge mit geringerem eigenem positivem Affekt, mehr negativem Affekt des Transplantierten und schlechteren Erfahrungen und Überzeugungen hinsichtlich der ISM aus Sicht der Partnerin auf. Höhere f0 weiblicher Transplantierter stand in Zusammenhang mit geringeren eigenen maladaptiven ERS und denen des Partners.

Diskussion Die Ergebnisse geben Hinweise auf die Relevanz von frühzeitigen Interventionen nach einer Nierentransplantation, in denen auf die Identifizierung und Modifizierung maladaptiver ERS von Patient und Partner fokussiert werden sollte.

Abstract

Introduction Nonadherence to immunosuppressive medication increases the risk of graft failure. Maladaptive emotion regulation strategies (ERS) seem to be a risk factor for nonadherence, whereas for patients in relationships spousal support appears as a protective resource. Emotional arousal, objectively measured by the fundamental frequency (f0) during spousal supportive communication is associated with supportive behavior.

Materials & Methods This study examined the relationship between beliefs about immunosuppressive medication, quality of life, ERS, emotions and emotional arousal, assessed during social support interactions of both spouses of N=50 couples after kidney transplantation.

Results Maladaptive ERS of the transplant recipient were associated with lower mental quality of life of the partner, marginally higher own negative affect and lower beliefs about medication. Maladaptive ERS of the partner showed negative correlations with own mental quality of life. Regarding f0, gender differences were found. Higher f0 of the male transplant recipient were associated with more maladaptive ERS of the female partner. Marginally significate correlations were found with lower own beliefs about medication. Higher f0 of the wife of the male transplant recipient showed correlations with lower own positive affect, more negative affect of the male patient and lower beliefs about medication. Higher f0 of female transplant recipients were associated with lower own maladaptive ERS and lower maladaptive ERS of the husband.

Discussion The findings support the relevance of early interventions focusing on identifying and modifying maladaptive ERS for both the patient and partner.

Schlüsselwörter

Nierentransplantation - Partnerschaft - Emotionsregulation - emotionale Erregung - Adhärenz

Key words

kidney transplantation - couples - emotion regulation - emotional arousal - adherence
 

  • Literatur

  • 1 Liem YS, Bosch JL, Arends LR. et al. Quality of life assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health 2007; 10: 390-397
    CrossrefPubMedGoogle Scholar
  • 2 Fisher R, Gould D, Wainwright S. et al. Quality of life after renal transplantation. J Clin Nurs 1998; 7: 553-563
    CrossrefPubMedGoogle Scholar
  • 3 Wiederhold D. Lebensqualität und subjektives Erleben nach einer Nierentransplantation – Quantitative und qualitative Forschung. Dialyse aktuell 2008; 12: 82-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Dew MA, DiMartini AF, De Vito Dabbs A. et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83: 858-873
    CrossrefPubMedGoogle Scholar
  • 5 Erim Y, Beckmann M, Klein C. et al. Psychosomatische Aspekte der Transplantationsmedizin. Psychother Psych Med 2013; 63: 238-249
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Schäfer-Keller P, Steiger J, Bock A. et al. Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transplant 2008; 8: 616-626
    CrossrefPubMedGoogle Scholar
  • 7 Denhaerynck K, Dobbels F, Cleemput I. et al. Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review. Transpl Int 2005; 18: 1121-1133
    CrossrefPubMedGoogle Scholar
  • 8 Jindal RM, Jindel RM, Joseph JT. et al. Noncompliance after kidney transplantation: a systematic review. Transplant Proc 2003; 35: 2868-2872
    CrossrefPubMedGoogle Scholar
  • 9 Griva K, Davenport A, Harrison M. et al. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake. Ann Behav Med 2012; 44: 85-93
    CrossrefPubMedGoogle Scholar
  • 10 Bertram A, Pabst S, Zimmermann T. et al. How can you be adherent if you don't know how?. Transpl Int 2016; 29: 830-832
    CrossrefPubMedGoogle Scholar
  • 11 Prendergast MB, Gaston RS. Optimizing medication adherence: an ongoing opportunity to improve outcomes after kidney transplantation. Clin J Am Soc Nephrol 2010; 5: 1305-1311
    CrossrefPubMedGoogle Scholar
  • 12 Frazier PA, Davis-Ali SH, Dahl KE. Stressors, social support, and adjustment in kidney transplant patients and their spouses. Soc Work Health Care 1995; 21: 93-108
    CrossrefPubMedGoogle Scholar
  • 13 Laederach-Hofmann K, Bunzel B, Freundorfer E. et al. Veränderung der Paarbeziehung nach Organtransplantation: Vergleich von Herz-, Leber- und Nierentransplantation. Psychother Psych Med 2002; 52: 5-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Bernhardt M, Franke GH, Jagla M. et al. Unterschiede in der Krankheitsbewältigung zwischen allein und nicht allein lebenden nierentransplantierten Patienten. Fachhochschule Schmalkalden, Hrsg 2010; 11: 261-264
    PubMedGoogle Scholar
  • 15 Kellerman QD. Looking beyond social support: examining dimensions of relationship quality in kidney transplant recipients. Iowa: University of Iowa; 2012
    Google Scholar
  • 16 DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 2004; 23: 207-218
    CrossrefPubMedGoogle Scholar
  • 17 Manne SL, Ostroff JS, Norton TR. et al. Cancer-related relationship communication in couples coping with early stage breast cancer. Psycho-Oncology 2006; 15: 234-247
    CrossrefPubMedGoogle Scholar
  • 18 Juslin PN, Scherer KR. Vocal expression of affect. In: Harrigan J, Rosenthal R, Scherer K. (Hrsg.) The new handbook of methods in nonverbal behavior research. New York, NY: Oxford University Press; 2005: 65-135
    Google Scholar
  • 19 van den Broek EL. Emotional Prosody Measurement (EPM): a voice-based evaluation method for psychological therapy effectiveness. Stud Health Technol Inform 2004; 103: 118-125
    PubMedGoogle Scholar
  • 20 Busso C, Lee S, Narayanan S. Analysis of emotionally salient aspects of fundamental frequency for emotion detection. IEEE Trans Audio Speech Lang Process 2009; 17: 582-596
    CrossrefPubMedGoogle Scholar
  • 21 Weusthoff S, Baucom BR, Hahlweg K. The siren song of vocal fundamental frequency for romantic relationships. Front Psychol 2013; 4: 439
    PubMedGoogle Scholar
  • 22 Weusthoff S, Baucom BR, Hahlweg K. Fundamental frequency during couple conflict: an analysis of physiological, behavioral, and sex-linked information encoded in vocal expression. J Fam Psychol 2013; 27: 212-220
    CrossrefPubMedGoogle Scholar
  • 23 Juslin PN, Scherer KR. Vocal Expression of Affect. In: Harrigan J, Rosenthal R, Scherer KR. (Hrsg.) Handbook of Methods in nonverbal Behavior Research. Oxford: University Press; 2005: 65-135
    Google Scholar
  • 24 Weusthoff S, Baucom BR, Hahlweg K. Fundamental frequency during couple conflict: an analysis of physiological, behavioral, and sex-linked information encoded in vocal expression. J Fam Psychol 2013; 27: 212-220
    CrossrefPubMedGoogle Scholar
  • 25 Baucom BR, Atkins DC, Eldridge K. et al. The language of demand/withdraw: Verbal and vocal expression in dyadic interactions. J Fam Psychol 2011; 25: 570
    CrossrefPubMedGoogle Scholar
  • 26 Fischer MS, Baucom DH, Baucom BR. et al. Emotional arousal predicts observed social support in German and American couples talking about breast cancer. J Fam Psychol 2015; 29: 744-754
    CrossrefPubMedGoogle Scholar
  • 27 Zimmermann T, Krüger JH, Weusthoff S. Stimmlich enkodierte emotionale Erregung (Voice Stress) und Posttraumatische Reifung sowie Partnerschaftszufriedenheit bei Partnern von Brustkrebspatientinnen im Kontext der sozialen Unterstützung. Psychother Psychosom Med Psychol 2017; 67: 288-295
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Karademas EC, Tsalikou C, Tallarou MC. The impact of emotion regulation and illness-focused coping strategies on the relation of illness-related negative emotions to subjective health. J Health Psychol 2011; 16: 510-519
    CrossrefPubMedGoogle Scholar
  • 29 Peh CX, Kua EH, Mahendran R. Hope, emotion regulation, and psychosocial well-being in patients newly diagnosed with cancer. Support Care Cancer 2016; 24: 1955-1962
    CrossrefPubMedGoogle Scholar
  • 30 Gross JJ. Emotion regulation in adulthood: Timing is everything. Curr Dir Psychol Sci 2001; 10: 214-219
    CrossrefPubMedGoogle Scholar
  • 31 Roberton T, Daffern M, Bucks RS. Emotion regulation and aggression. Aggression and Violent Behavior 2012; 17: 72-82
    CrossrefPubMedGoogle Scholar
  • 32 Gross JJ, Levenson RW. Hiding feelings: the acute effects of inhibiting negative and positive emotion. J Abnorm Psychol 1997; 106: 95
    CrossrefPubMedGoogle Scholar
  • 33 Peh CX, Liu J, Bishop GD. et al. Emotion regulation and emotional distress: The mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients. Psychooncology 2017; 26: 1191-1197
    CrossrefPubMedGoogle Scholar
  • 34 Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 2003; 85: 348-362
    CrossrefPubMedGoogle Scholar
  • 35 Butler JA, Peveler RC, Roderick P. et al. Modifiable risk factors for non-adherence to immunosuppressants in renal transplant recipients: a cross-sectional study. Nephrology Dialysis Transplantation 2004; 19: 3144-3149
    CrossrefPubMedGoogle Scholar
  • 36 Goetzmann L, Klaghofer R, Spindler A. et al. Die „Medikamenten-Erfahrungs-Skala für Immunsuppressiva“ (MESI) – erste Ergebnisse zu einem neuen Screeninginstrument in der Transplantationsmedizin. Psychother Psych Med 2006; 56: 49-55
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Weusthoff S, Krüger J, Zimmermann T. MESI – Partnerversion in Vorbereitung
    PubMed
  • 38 Beierlein V, Morfeld M, Bergelt C. et al. Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8. Diagnostica 2012; 58: 145-153
    CrossrefPubMedGoogle Scholar
  • 39 Grob A, Horowitz D. FEEL-E. Fragebogen zur Erhebung der Emotionsregulation bei Erwachsenen. Bern: Huber; 2014
    Google Scholar
  • 40 Greuel J, Heinrichs N. Eltern-Kurzversion des Fragebogens zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen (FEEL-KJ). Unpublizierter Fragebogen. In. Braunschweig: Technische Universität Braunschweig; 2014
    PubMed
  • 41 Grob A, Smolenski C. FEEL-KJ Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen. Bern: Verlag Hans Huber; 2005
    Google Scholar
  • 42 Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988; 54: 1063-1070
    CrossrefPubMedGoogle Scholar
  • 43 Boersma P, Weenink D. Praat: doing phonetics by computer. Software
    PubMed
  • 44 Traunmuller H, Eriksson A. The perceptual evaluation of F0 excursions in speech as evidenced in liveliness estimations. J Acoust Soc Am 1995; 97: 1905-1915
    CrossrefPubMedGoogle Scholar
  • 45 Traunmüller H, Eriksson A. The frequency range of the voice fundamental in the speech of male and female adults. In. Stockholm, Sweden: Institutionen för lingvistik, Stockholms universitet; 1995: 11
    Google Scholar
  • 46 Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. Guilford: 2006
    Google Scholar
  • 47 Knowles SR, Castle DJ, Biscan SM. et al. Relationships between illness perceptions, coping and psychological morbidity in kidney transplants patients. Am J Med Sci 2016; 351: 233-238
    CrossrefPubMedGoogle Scholar
  • 48 Stilley CS, DiMartini AF, de Vera ME. et al Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation. Prog Transplant 2010; 20: 58-66
    CrossrefPubMedGoogle Scholar
  • 49 Kurz JM. Experiences of well spouses after lung transplantation. J Adv Nurs 2001; 34: 493-500
    CrossrefPubMedGoogle Scholar
  • 50 Frazier PA, Davis-Ali SH, Dahl KE. Correlates of noncompliance among renal transplant recipients. Clin Transplant 1994; 8: 550-557
    PubMedGoogle Scholar
  • 51 Calia R, Lai C, Aceto P. et al. Emotional self-efficacy and alexithymia may affect compliance, renal function and quality of life in kidney transplant recipients: results from a preliminary cross-sectional study. Physiol Behav 2015; 142: 152-154
    CrossrefPubMedGoogle Scholar
  • 52 Gillanders S, Wild M, Deighan C. et al. Emotion regulation, affect, psychosocial functioning, and well-being in hemodialysis patients. Am J Kidney Dis 2008; 51: 651-662
    CrossrefPubMedGoogle Scholar
  • 53 Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev 2010; 30: 217-237
    CrossrefPubMedGoogle Scholar
  • 54 Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: a transdiagnostic examination. Behav Res Ther 2010; 48: 974-983
    CrossrefPubMedGoogle Scholar
  • 55 Laupacis A, Muirhead N, Keown P. et al. A Disease-Specific Questionnaire for Assessing Quality of Life in Patients on Hemodialysis. Nephron 1992; 60: 302-306
    CrossrefPubMedGoogle Scholar
  • 56 Massey EK, Tielen M, Laging M. et al. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation 2015; 99: 375-380
    CrossrefPubMedGoogle Scholar
  • 57 Dobbels F, Berben L, De Geest S. et al. The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review. Transplantation 2010; 90: 205-219
    PubMedGoogle Scholar
  • 58 Reber S, Morawa E, Stößel L. et al. Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample. Z Psychosom Med Psychother 2016; 62: 270-283
    PubMedGoogle Scholar