Prediction of Marital Burnout Based on Automatic Negative Thoughts and Alexithymia among Couples

Document Type : Original Research Article

Authors

1 Graduate, MSc in clinical psychology, Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran

2 Assistant Professor, Department of clinical psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran

Abstract

Background & aim: Lack of objective expression of emotions leads to the experience of unpleasant thoughts and evocations, followed by the non-recognition of one’s emotions and feelings. This is identified as one of the most important factors accounting for marital conflicts. The purpose of this study was to predict marital burnout based on negative automatic thoughts and alexithymia among couples in Shiraz, Iran.
Methods: This correlational study was conducted on 150 couples referring to four counseling centers located in districts 1 and 2 of Shiraz in 2018-2019. The study population was selected using a multistage cluster sampling method. The data were collected using the burnout measure developed by Pines, automatic negative thoughts questionnaire, and twenty-item Toronto alexithymia scale on a self-report basis. Data analysis was performed in SPSS software (version 21) using regression analysis and Pearson correlation coefficient at a significance level of ≤ 0.05.
Results: The results showed that the dimensions of an automatic negative thoughts could predict marital burnout positively and significantly (P≤0.05). The coefficient was obtained as 0.27, meaning that automatic negative thoughts, alexithymia, age, and education could predict marital burnout at 27%.
Conclusion: Alexithymia and automatic negative thoughts could eventually lead to the elevation of dissatisfaction with marriage due to exerting a negative effect on maintaining a strong emotional relationship between partners.

Keywords

Full Text

Introduction


  Marriage is one of the fundamental relationships between men and women. Individuals get married for a variety of reasons, including being happy, having children, maintaining an intimate relationship, fulfilling sexual desires, and meeting social expectations (1). A happy marriage provides couples with mental, social, and physical intimacy (2). Marriage research shows that couples who connect have better marital relations, whereas couples who lack a coherent approach have greater conflicts and animosity inside marriage (3). The implications of marital quality during midlife, however, remain virtually unexplored until now. Given the vital importance of the well-being and functioning of couples for life (4-5), it is important to shed light on the wider consequences of marital relationships.

     According to Ellis, passion often slowly wears off among married couples (6). When the magic of fantastic love gets lost over time, couples miss the significance their sweetheart supposedly gave them. As a result, they are left alone with extreme anger and burnout feelings (7-8). Several factors lead to the incidence of marital burnout among couples. Some of these factors include social relation problems, more loneliness feeling, less life satisfaction, and inability to enjoy the relationship. In addition, when couples have an incessant sense of physical fatigue and believe that problems will remain unresolved forever, they will experience marital burnout. Finally, intense family disputes lead to the instability of couples' relationships and reduce marital satisfaction (9).

     Burnout is a highly ruinous state that affects all areas of an individual's life by generating the feelings of constant pressure, hopelessness, and disappointment (7). Some of the psychological exhaustion symptoms accompanied by burnout include low self-esteem, a negative view of one's partner, dissatisfaction with one's parents, and frustration with and despise one's self. Moreover, such agents can lead to irrational ideas, unreal expectations, and hardness in marital life (10).

Accordingly, burnout is an important issue associated with countless negative variables, such as depression (11), tension (12), frustration with life (13), and unhappiness (14-15). Automatic negative thoughts are among the factors that can trigger burnout in couples. According to Beck, only one stressful incident suffices for couples to place negative marks on their partners when they lack their passion and affection. In this situation, the lack of understanding by a husband makes him unemotional in the eyes of his wife. Accordingly, if the wife does not accept the husband's point of view, then the husband thinks the wife is unhappy (6).

     According to the cognitive model, thinking habits influence all cognitive functions, thereby affecting manners and psychological states. Dysfunctional or distorted thinking leads to dysfunctional behavior and, conversely, to logical and rational thinking which works well (16). Negative automatic thoughts of individuals about themselves and the world, which rely on their mediocre and core beliefs, establish a self-amplifying cycle that prepares people for emotional deregulation and abnormal behavior (16). Thoughts that are more negative are typically considered unconstructive because they can perpetuate the noxious effects of a stressor (17). Indeed, negative automatic thoughts heighten depression severity (18). People prompt negative automatic thoughts after a stressful situation (19). As proposed in several types of research, depression is correlated with enhanced levels of automatic negative thoughts (20). Furthermore, automatic negative thoughts are linked with fear, avoidance, and the severity of symptoms (21-22).

     Marital satisfaction is related to several factors, such as physical health, mental health, and overall life satisfaction (23). Alexithymia is one of the psychological factors involved in disappointment among couples. Alexithymia literally means "without emotional words" (24). This condition has recently been described as a deficit in the control of emotional states, and research efforts are attempting to situate alexithymia with respect to other emotional constructs (25).  Alexithymia is a concept that describes the inability to think about, discern, and verbally communicate affections, as well as difficulty in understanding feelings, body sensations, and finiteness of fantasy life (26).  Exhibition of emotions and affections not only dramatically influences marital satisfaction but also increases the feeling of being assisted in individuals (27). The relationship of alexithymia and its components with marital satisfaction is reported to be significantly negative (28). Karukivi et al. confirmed that alexithymia is not directly related to marital satisfaction. Nonetheless, alexithymia has a significant effect on the anxiety and avoidance associated with relationships (29).

     People who have a high level of negative automatic thoughts feel disturbed to be close to others and rely on them; accordingly, they prefer to retain emotional distance and feel incompetent. In addition, individuals with alexithymia show deactivating strategies for regulating emotions in response to others (e.g., wife or husband). These people are not pleasant to be close to and dependent on others and are not responsive to their partners. As a result, they are incapable of doing anything without receiving compassion and support from their families. Over time, this condition creates an unhappy marital relationship that leads to a marital burnout (29).

     Despite the importance of the issue, little work has explored how the interplay between negative automatic thoughts and alexithymia could form marital burnout. This critical feature of the nature of dyadic relationships is likely to be a significant predictor of the outcomes of marriage. Regarding this, the present research was conducted to examine how a combination of negative automatic thoughts and alexithymia in couples might predict their marital burnout. Our first objective was to examine marital burnout with regard to negative automatic thoughts and alexithymia. Based on theory and past empirical evidence (25-29), the components of emotional vulnerability significantly predict low marital satisfaction (28). It seems that the difficulty of recognizing thoughts, expressing emotions, and possessing objective thinking significantly affects marital satisfaction and increases marital burnout. Therefore, the purpose of this study was to predict marital burnout based on negative automatic thoughts and alexithymia among couples in Shiraz, Iran.

Materials and Methods

The present correlational study was conducted on the couples referring to the counseling centers located in districts 1 and 2 of Shiraz within 2018-2019 to predict marital burnout based on negative automatic thoughts. Given that the variables under research consisted of five components (i.e., marital burnout, negative automatic thoughts, and alexithymia with three dimensions), a total of 150 cases were selected to have 30 individuals per variable. The study population was chosen using the multi-stage cluster sampling method. To this end, two areas were selected from different regions of Shiraz. Subsequently, four counseling centers were randomly chosen from the given areas, and individuals were selected from every counseling center.

According to James Stevens, in multiple regression analyses with the conventional least-squares method, 15 samples must be considered for every predictor variable. However, if the researcher can use approximately 30 participants per predictor variable, he/she will have a better ability to represent a small effect size (30). In regression studies, a minimum sample size of 8k+50, where k is the number of predictor variables, is considered. Therefore, in the current study, it was required to have a minimum sample size of 106 cases for our five predictor variables. However, in order to increase generalizability, 150 people were selected (30).

   The inclusion criteria of the study were: 1) age of > 20 years, 2) non-use of psychotropic drugs, 3) no divorce experience, and 4) willingness to participate in the study. After sampling, the participants responded to the questionnaires. At a meeting, the subjects were informed about the purpose of the study and ensured about the confidentiality of their data. In addition, they were asked to submit questionnaires without writing the name and surname in order to maintain anonymity. In order to eliminate the problems of interviewing, the data were collected by means of questionnaires. Once the data were obtained, the statistical analysis was carried out.

The data were analyzed in SPSS software (version 21) using descriptive and inferential statistics. Such indicators as mean, standard deviation, minimum, and maximum scores were calculated at the descriptive level. Furthermore, regression analysis and Pearson correlation coefficient were used at the inferential level. A p-value of ≤ 0.05 was considered statistically significant.

Information about the participants’ age, gender, and educational level was collected using a demographic form.

The Marriage Burnout Scale-Short Form developed byPines (7) consists of 21 items. However, Pines et al. (31) used a brief form of this scale composed of 10 items in order to establish an easier-to-use evaluation tool with fewer items to meet scholars' demands. This instrument is rated on a seven-point Likert scale (never=1 to always=7) in form of a self-report. Based on the exploratory factor analysis, the loads of item factors in this research tool were found to vary between 0.49 and 0.83.

While the Cronbach’s alpha coefficient was measured at 0.91, the item-total correlations were found to differ between 0.41 and 0.76. Furthermore, the test-retest correlation coefficient was estimated at 0.90 (P<0.01) (1). Additionally, Navidi (32) obtained a Cronbach’s alpha coefficient of 0.86 for 120 nurses and 120 teachers in Iran (32). In the present study, the Cronbach’s alpha coefficient of the scale was obtained as 0.83.  

The negative automatic thoughts questionnaire (ATQ)is a self-report entailing 30 items rated on a 5-point Likert scale to assess the frequency of negative automatic thoughts. For each item, respondents are asked to show how often each thought has occurred in the past week (not at all=1 to all the time=5). The ATQ focuses primarily on the traditional negative cognitions of depression, such as the sense of loss, disappointment, and self-depreciation (33) and consists of statements representing different aspects of depression, such as demoralization, self-criticism, brooding rage, and interpersonal dissatisfaction (34).

This instrument has extraordinary psychometric properties and distinguishes between depressed and undepressed groups (35).  The Turkish version of the ATQ, which has good reliability and validity (α=0.93), was used in the present study (36).  The Persian version of ATQ had an outstanding internal consistency (α=0.96), test-retest reliability (r=0.84), and correlation with the Beck Depression Inventory (r=0.77) (37). In the present study, the Cronbach’s alpha coefficient of the scale was obtained as 0.75.  

The Toronto Alexithymia Scale is a 20-item self-report questionnaire developed by Bagby et al. (38). In this instrument, each item is rated on a 5-points Likert scale (strongly disagree=1 to strongly agree=50). Five items (i.e., items 4, 5, 10, 18, 19) in this scale are scored reversely. It consists of three subscales, namely difficulty identifying feelings, difficulty describing feelings, and externally oriented thought, providing a complete alexithymia ranking. Difficulty identifying feelings measures the extent to which people report difficulties in identifying their own inner emotional states. Difficulty describing feelings measures how difficult it is for people to describe feelings to others. Externally oriented thinking measures the extent to which people report a difficulty in describing feelings to others. It also measures the extent to which people report a tendency to focus on the details of external events rather than on their own feelings, fantasies, and other aspects of inner experience.

An example of the items related to difficulty identifying emotions is "I don't know what's going on inside me." Furthermore, "It's hard for me to find the right words for my emotions" is an example of difficulty describing feelings. One of the items addressing externally oriented thought is "I prefer to talk to people about their everyday activities rather than their thoughts." Several studies have reviewed and approved the psychometric properties of the Toronto Alexithymia Scale. Cronbach's alpha (0.89) of this scale has been reported as acceptable in international research (38). The reliability of the Persian version of this instrument has been also reported as 0.84, which is reasonable (39). In the present study, the Cronbach’s alpha coefficient of the scale was estimated at 0.87.    

Results

     In this section, first, the demographic data of the participants are reported. According to Table 1, 50% (n=75) of the samples are male. In addition, the age range of 35-40 years had the highest frequency (52%, n=8) (Table 1).

     Table 2 presents the descriptive statistics of the data in terms of central indices (i.e., mean and standard deviation), kurtosis, and skewness (Table 2).

     As the results indicated, the difficulty identifying feelings had the highest mean among the alexithymia components. This section seeks to answer the main research hypothesis stating that "automatic negative thoughts, alexithymia, age, and education predict marital burnout in couples" using regression analysis. One of the assumptions of regression analysis is univariate normality. To verify univariate normality, a general criterion is recommended that if the skewness and kurtosis are not within the interval of (-2, +2), the data do not have a normal distribution. Based on the data presented in Table 2, it can be seen that the skewness and kurtosis indices of any of the variables are not outside the range of (-2, +2) and can, therefore, be considered normal or normal approximations. Since regression analysis is based on the linear correlation between variables, in this section, the linear correlation matrix between research variables is reported (Table 3).

According to the correlation analysis, marital burnout showed a significantly positive correlation with negative automatic thoughts and alexithymia (P≤0.05). Another assumption of regression is the lack of collinearity between independent variables.

Tolerance and variance inflation factor indices test this assumption. In the present study, all values indicated no strong collinearity between the predictor variables. Another regression assumption is the independence of errors, which must be rejected as assuming a correlation between errors.  The Durbin-Watson statistic can be used to check this assumption. To confirm this assumption, the value of this statistic must be within the range of 1.5-2.5. In this study, the statistic was equal to 1.90, indicating the fulfillment of this assumption. The first test is the general model test. If at least one of the predictor variables has a significant effect on the criterion variable, the researcher model is confirmed (Table 4).

As can be seen in the table, the significance value is less than 0.05, indicating the significance of the regression model, meaning that at least one of the predictor variables has a significant effect on the criterion variable.

    R2:This index indicates that some percentages of the criterion variable are explained by predictive variables. In this study, R2 was 0.29, which means that automatic negative thoughts, alexithymia, age, and education were 29% able to predict marital burnout.

    R2adj: This index examines the ability to predict the dependent variable by the predictor

variables in the population, extending the sample to the whole population by slight adjustment. The coefficient was 0.27 in the study; in other words, automatic negative thoughts, alexithymia, age, and education were 27% able to predict marital burnout.

Given the significance of the whole model, it was necessary to consider the coefficients that were not zero to identify the variables exerting a significant effect on the model. The t-test was used for this purpose (Table 5).

 As the results revealed, the factors of negative automatic thought, difficulty identifying feelings, difficulty describing feelings, and age had a significant relationship with marital burnout (P<0.05). The positive coefficients indicate that with an increase in these factors, marital burnout is also increased.

Discussion

     This study was targeted toward examining the relationship between negative thoughts and burnout. The results indicated that all three dimensions of negative thoughts were positively correlated with burnout. In other words, negative automatic thoughts and alexithymia factors were able to predict marital burnout. Our results are in line with those of some studies, such as the ones conducted by Scimeca et al. (26), Pines et al. (31), and Chang et al. (40).  In a study performed by Miri et al. (28),

Intimacy, loneliness, and alexithymia were reported to play a role in predicting marital satisfaction. However, the relationship of alexithymia dimensions with marital satisfaction was not significant.  Panahi et al. demonstrated that since feeling alone is an unpleasant condition caused by the emotional state and lack of social relations, alexithymia could increase isolation by restricting the communication network and expressing emotions, thereby exerting an indirect negative effect on marital burnout (41). Some results are inconsistent with this finding. Karukivi et al. showed that alexithymia had no direct relationship with marital satisfaction (29). The presence of automatic negative thoughts in couples consequently causes a gap in the emotional relationships and isolation of the couple, followed by marital burnout.

     As our findings indicated, age and education had a significant relationship with marital burnout. In a study carried out by Darjazinil and Moradkhani (2017), the educational level of spouses had a significant impact on marital satisfaction. In this regard, higher education provides an increased level of marital satisfaction. The couples pursuing the same level of education are more likely to experience a higher level of marital satisfaction, which means that a higher level of education results in a lower level of marital burnout (27).

As stated previously, automatic negative thinking is accompanied by feeling incompetent. Ellis believes that dysfunctional mental representation and negative cognitive structures occur when a negative event triggers dysfunctional schemes. Negative schemes remain exploited for misguided reasons. According to Beck's theory, dysfunctional attitudes not only are inflexible but also are based on perfectionist criteria that are used by individuals to judge themselves and others. Since these attitudes are inflexible, extreme, and resistant to change, they are incompetent or infertile (42).

     Currently, psychotherapists have focused on the effect of values and thinking on developing a number of psychological problems. A mindfulness-based cognitive group therapy course stresses the need for replacing negative unconscious thinking with logical beliefs. The strategies in this course help the couples identify negative thought patterns that cause the feeling of failure and substitute them with rational functional thought patterns. In addition, they facilitate the generation of empathy, encourage couples to examine how others address automatic negative thoughts, and eventually reduce automatic negative thoughts in couples (43). In addition, marital burnout can be predicted by automatic negative thoughts. Explanatory ambiguity may be a constructive and useful way to predict marital burnout. The findings of this study are consistent with the results of the studies addressing integrity (24-26). 

     Based on the evidence, individuals with alexithymia have trouble in properly identifying others’ emotions (43). Accurate recognition of emotions is an integral part of an interpersonal relationship. Establishment of intimate relationships with others requires the ability to understand the feelings of one's own and those of others. Non-recognition of emotions leads to the development of interpersonal problems. Individuals with emotional distress also have limited capacity to sympathize with other people (44). The limitations of a person and inability to empathize with others affect and interfere with interpersonal relationships, especially in human and intimate relationships (45).

      Therefore, it can be argued that alexithymia is associated with deficits and lack of empathy, as well as the inability to recognize emotions (46). According to the theory of simulation, people simulate the feelings they experience in others to anticipate and understand people's feelings in their environment. Therefore, an inability to interpret and describe one's own internal affective states will accurately lead to difficulties in empathizing with the feelings of others (47). Emotional unconsciousness is related to problems in self-regulation or inability to process emotional information and emotional regulation cognitively (48). In cognitive processing, when emotional information cannot be perceived or evaluated, one becomes emotionally and cognitively distressed. This disorder interferes with the organization of one's emotions and cognitions, thereby affecting relationships between partners and contributing to a marital burnout (49).

     Some of the drawbacks of this research that we hope will be addressed in future research are the use of questionnaires to quantify variables, adoption of a cluster sampling approach that raises the risk of sampling errors, utilization of self-report instruments, and possibility of bias in completing the questionnaire. Given the importance of family, it is recommended that research in this area be performed to compare the results of different studies and obtain a more accurate explanation. Future studies are suggested to separately examine the relationship between variables in men and women. In other words, variables such as gender, education, and economic status should be controlled. 

Conclusion

     Burnout is a significant issue for couples because it can be detrimental to psychosocial development and well-being. Our results revealed that both negative automatic thoughts and alexithymia influenced marital burnout in couples.

Acknowledgements

     This article was extracted from a master thesis on clinical psychology in the Azad University of Shiraz, Shiraz, Iran, with an ethics   code   of IR.AUS.REC.1397.10192003.   Hereby, we extend our gratitude to the people who participated in our study.

Conflicts of interest

Authors declared no conflicts of interest.

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Journal of Midwifery and Reproductive Health
Volume 8, Issue 2
April 2020
Pages 2211-2219

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