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Cited by 125Musculoskeletal pain and rehabilitationAttachment and Relationship DynamicsEmpathy and Medical Education

Empathic and nonempathic interaction in chronic pain couples.

Open access
Cano, Annmarie, Barterian, Justin A., Heller, Jaclyn B.·2008·The Clinical Journal of Pain
DOI 10.1097/ajp.0b013e31816753d8PMC PMC2562912
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Abstract

OBJECTIVES: Empathy and empathic response are receiving greater attention in pain research as investigators acknowledge that other forms of interaction may impact the pain process. The purpose of this study was to examine validation and invalidation as forms of empathic and nonempathic responses in chronic pain couples. METHODS: Participants were 92 couples in which at least one spouse reported chronic musculoskeletal pain. Each couple participated in 2 videotaped interactions about the ways in which the pain has impacted their lives together. Trained raters then coded interactions for each partner's use of validation and invalidation. Couples also completed surveys on spouse responses to pain, marital satisfaction, and perceived spousal support. RESULTS: Correlations demonstrated validation by spouses of persons with pain was associated with punishing, solicitous, and distracting spouse responses to pain, marital satisfaction, and perceived spousal support. In contrast, spouses' invalidation scores were correlated with punishing spouse responses. Exploratory factor analyses were then conducted to determine the extent to which spouses' responses to pain and spouse validation and invalidation loaded on similar factors. Validation and invalidation are more closely related to punishing spouse responses than to solicitous or distracting spouse responses. DISCUSSION: This work suggests that empathic and nonempathic communication are distinct from solicitous spouse responses. The findings have implications for theoretical and clinical work on social factors in pain.

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Registry

Crossref · 10.1097/ajp.0b013e31816753d8

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 34 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Re-running with principal components, the 3-factor solution resulted in two factors with only 2 variables each.

    “The analysis was re-run with principal components extraction; however, the 3-factor solution resulted in two of the three factors with only 2 variables each.”
    Quote in the paperSubstantial claim
  • Findingown data

    Self-report variables assessing the same target's behaviors were significantly correlated.

    “Similarly, self-report variables assessing the same target’s behaviors were significantly correlated (reports of punishing spouse responses r = .47, p < .001; reports of spouse solicitousness r = .50, p < .001; reports of distracting spouse responses r = .46, p < .001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Validation and invalidation by persons with pain were not significantly related.

    “Validation and invalidation by spouses were significantly negatively correlated (r = -.38, p < .001) whereas validation and invalidation by persons with pain were not significantly related.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Validation expressed by the spouse was consistently related to spouse responses to pain by both partners' reports.

    “We found that validation expressed by the spouse was consistently related to spouse responses to pain by both partners’ reports.”
    Quote in the paperSubstantial claim
  • Findingown data

    The principal factors solution with two factors was stable across extraction methods.

    “Therefore, we present the principal factors solution with two factors, which was stable across extraction methods.”
    Quote in the paperSubstantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 25

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    Findingown data

    The Nonempathic Responding factor contained items assessed with different methods and also one item with a different valence (validation).

    “Interestingly, the Nonempathic Responding factor contained items assessed with different methods (i.e., observation and self-report) and also one item with a different valence (i.e., validation).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eigenvalues of 1 or greater indicated 2 factors accounting for 57% of variance, while the scree plot suggested 3 factors accounting for 69% of variance.

    “Eigenvalues of 1 or greater indicated that there were 2 factors that accounted for 57% of the variance whereas visual inspection of the scree plot suggested 3 factors that accounted for 69% of the variance in the variables.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Validation and invalidation were most consistently correlated with punishing spouse responses to pain, with invalidation and punishing sharing approximately 9% of variance.

    “Validation and invalidation were most consistently correlated with punishing spouse responses to pain, with invalidation and punishing spouse responses sharing approximately 9% of shared variance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both factors were significantly correlated with marital satisfaction and perceived spousal support, except spouses' perceived spousal support.

    “As shown in Table 3, both factors were significantly correlated with these indicators of marital quality with the exception of spouses’ perceived spousal support.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Validation scores of both spouses were significantly correlated, and invalidation scores of both spouses were significantly correlated.

    “Validation scores of both spouses were significantly correlated as were both spouses’ invalidation scores (r = .46, p < .001 and r = .55, p < .001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Validation by both partners was correlated positively with marital satisfaction in both partners and perceived spousal support in persons with pain.

    “Furthermore, validation by both partners was correlated positively with marital satisfaction in both partners and perceived spousal support in persons with pain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Correlations between negative and solicitous spouse responses and between negative and distracting responses as reported by persons with pain were significant.

    “With respect to self-reports of spouse responses, the correlations between negative and solicitous spouse responses and between negative and distracting responses as reported by persons with pain were also significant (r = -.30, p < .01 and r = -.20, p < .05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Validation, invalidation, and spouse response variables were consistently and significantly correlated with marital satisfaction in both partners, perceived spousal support in persons with pain, and to a lesser extent, perceived spousal support as reported by spouses.

    “Validation, invalidation, and the spouse response variables were consistently and significantly correlated with marital satisfaction in both partners, perceived spousal support in persons with pain, and to a lesser extent, perceived spousal support as reported by spouses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Solicitous and distracting spouse responses loaded on the same dimension, whereas punishing spouse responses, spouse validation, and spouse invalidation loaded on the other dimension.

    “As shown in Table 2, solicitous and distracting spouse responses loaded on the same dimension whereas punishing spouse responses, spouse validation, and spouse invalidation loaded on the other dimension.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The two factors were allowed to correlate but shared little variance.

    “The two factors were allowed to correlate but in fact, shared little variance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Contempt is negatively associated with marital and psychological adjustment in healthy couples.

    “Researchers have found a negative association between an intense form of invalidation (i.e., contempt) and marital and psychological adjustment in healthy couples 4, 15.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • May combine two claims.

    Interpretationown data

    Given the loading patterns, Factor 1 might be labeled Solicitous Responding and Factor 2 Nonempathic Responding.

    “Given the loading patterns, one might label Factor 1 as Solicitous Responding and Factor 2 as Nonempathic Responding.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Knowing the thoughts and feelings of someone in pain impacts an observer's affective and behavioral reactions.

    “Goubert et al. 16 proposed that knowing the thoughts and feelings of someone in pain impacts an observer’s affective and behavioral reactions (i.e., expressions of empathy) to the observed person with pain.”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    One-tailed tests of significance were used because negative and positive aspects of relationships were expected to be inversely associated and similar-valence aspects positively correlated.

    “One-tailed tests of significance were used because it was expected that negative and positive aspects of relationships would be inversely associated whereas relationship aspects sharing similar valence would be positively correlated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    Solicitousness may be interpreted as pain-specific support whereas validation may be conceptualized as an empathic response that generally builds intimacy.

    “Solicitousness may be interpreted as pain-specific support 3 whereas validation may be conceptualized as an empathic response that generally builds intimacy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Validation and Invalidation Behavior Coding System was developed from an emotion regulation perspective of couples' interactions.

    “The VIBCS was developed from an emotion regulation perspective of couples’ interactions 13.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    According to emotion regulation theory in couples, both partners may engage in behaviors that affect emotion regulation of the self and the other.

    “According to emotion regulation theory in couples, both partners may engage in behaviors that affect the emotion regulation of the self and the other 13.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Solicitous spouse responses measured by the Multidimensional Pain Inventory are positively related to pain severity and pain behaviors.

    “Solicitous spouse responses as assessed by the Multidimensional Pain Inventory are also positively related to pain severity and pain behaviors 8.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Classified as probably not a substantial claim.

    Premisecitation

    Operant models cannot explain that negative or punishing spouse responses are associated with increased pain behaviors and pain severity.

    “Newton-John 29 noted that operant models cannot explain the fact that negative or punishing spouse responses are associated with increased pain behaviors and pain severity 3, 22.”
    Quote in the paperSubstantial claim0 of 3 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Results were similar with untransformed and transformed variables, so untransformed variables were presented.

    “Because the results were similar with untransformed and transformed variables, we present analyses with untransformed variables for ease of interpretation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Operant theory offers a useful framework for understanding how marriage contributes to pain.

    “Operant theory 11 has provided a useful framework for understanding the role of marriage in the pain experience.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11]

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Multidimensional Pain Inventory has good construct and discriminant validity, internal consistency, and test-retest reliability.

    “The MPI has been shown to have good construct and discriminant validity, internal consistency, and test-retest reliability (8, 21).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Agreement was poor for 8 codes across 7 individuals, so their mean scores were deleted from further analyses.

    “Agreement was poor for 8 codes across 7 individuals (rwg(2) < .60). Therefore, mean scores for these individuals were deleted and not used in further analyses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Global methods of coding marital interaction allow simultaneous observation and coding of different dimensions of interaction.

    “Margolin et al. 26 noted that an advantage of global methods of coding marital interaction such as the method used in the current study is that such systems allow for the simultaneous observation and coding of different dimensions of interaction (e.g., quantity and quality, non-verbal and verbal).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26]

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  • May combine two claims.

    Interpretationown data

    Taken together, results provide preliminary evidence that spouse validation and invalidation are distinct from solicitous and distracting spouse responses and that validation and invalidation share the most variance with punishing spouse responses.

    “Taken together, these results provide preliminary evidence suggesting that spouse validation and invalidation are distinct from solicitous and distracting spouse responses and that validation and invalidation share the most variance with punishing spouse responses.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Interpreting factors with only two variables each is risky.

    “As indicated by Tabachnick and Fidell [34], interpreting such factors is risky.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] source

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    Premisecitation

    Global rating scales have been used to show that marital interaction is related to satisfaction and other outcomes.

    “Several teams have used global rating scales to demonstrate the extent to which marital interaction is related to satisfaction and other outcomes 19, 30, 36.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Coders were not blind to the identity of the person with pain but were blind to the couples' survey responses.

    “Coders were not blind to the identity of the person with pain because the topic of discussion was the impact of pain but coders were blind to the couples’ survey responses.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Observed solicitous spouse responses to pain behavior often increase pain behavior.

    “Romano and colleagues 31, 32 have demonstrated that observed solicitous spouse responses to pain behavior often result in increases in pain behavior.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [31] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Spouses had more opportunities to respond to the emotional expressions of the person with pain because the discussion was about the pain of the person with pain.

    “This makes sense since spouses had more opportunities to respond to the emotional expressions of the person with pain because the discussion was about the pain of the person with pain.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Spouse responses may not always serve a reinforcement function.

    “Recent research suggests that spouse responses may not always serve a reinforcement function 28.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28]

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    Study design and conductcitation

    Within-group inter-rater agreement was assessed with the rwg(j) statistic.

    “Within group inter-rater agreement was assessed with the rwg(j) statistic, which is calculated from observed and expected variances across coders and items 18.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Perceptions of spouses' tendency to respond empathically mediated the relationship of perceived support to marital satisfaction and depressive symptoms.

    “Fekete et al. 7 found that perceptions of the spouses’ tendency to respond empathically mediated the relationship of perceived support to marital satisfaction and depressive symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Different interaction coding schemes may produce different results, but the choice of a coding scheme depends on the researchers' questions.

    “Different interaction coding schemes may produce different results 9 but the choice of a coding scheme depends on the researchers’ questions 26.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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    Study design and conductreasoning

    In this study, the chosen coding system fit the research questions because the authors were interested in the empathic climate, not reinforcement contingencies.

    “In this study, we were interested in the empathic climate, not on reinforcement contingencies, so the chosen coding system fit our research questions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The interaction coding system was not developed specifically for couples with pain.

    “One possible limitation is that the interaction coding system was not developed specifically for couples with pain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    Validation likely requires mindfulness, tolerance, and acceptance of one's own emotions as well as the emotions of the partner.

    “Finally, it is likely that validation requires mindfulness, tolerance, and acceptance of one’s own emotions as well as the emotions of the partner 13.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] source

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37 of 37

  • The paper relies on this without support.

    The validation and invalidation observed during the two 10-minute laboratory discussions reflect the couples' typical interaction patterns.

    “Couples were encouraged to act as natural as possible and that both partners should be engaged in the discussions.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Observers reliably coded both validating and invalidating behaviors.

    “First, observers were able to reliably code both validating behaviors and invalidating behaviors.”

    From Validating pain communication: current state of the science (2015) · cites this paper as [1]

  • These behaviors were distinct from other spousal responses, including partner solicitousness.

    “Second, these behaviors were found to be distinct from other spousal responses such as partner solicitousness.”

    From Validating pain communication: current state of the science (2015) · cites this paper as [1]

  • Several studies have coded validation in chronic pain patient-partner interactions using the Validation and Invalidation Behavioral Coding System (VIBCS).

    “A number of studies have used the Validation and Invalidation Behavioral Coding System (VIBCS[7]) to code validation occurring in interactions between patients with chronic pain and their partners.[1–3]”

    From Validating pain communication: current state of the science (2015) · cites this paper as [1]

  • When partners gave more validation, patients disclosed more and reported less support entitlement.

    “Third, in couples where the partner provided higher levels of validation, patients were much more likely to engage in disclosure and much less likely to report a sense of support entitlement.”

    From Validating pain communication: current state of the science (2015) · cites this paper as [1]

  • More validation was unrelated to patients' pain reports or their anxiety or depression symptoms.

    “Finally, higher levels of validation were not related to patient reports of pain or symptoms of anxiety or depression.”

    From Validating pain communication: current state of the science (2015) · cites this paper as [1]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(88) = 8.96reported p < .0001 · recomputed p < .001

    “t (88) = 8.96, p < .0001”

  • Consistentt(87) = 2.18reported p < .05 · recomputed p = .032

    “t (87) = 2.18, p < .05”

  • Consistentz = 2.59reported p < .01 · recomputed p = .010

    “(z = 2.59, p < .01”

  • Consistentz = 2.58reported p < .01 · recomputed p = .010

    “(z = 2.58, p < .01”

4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Spouse race counts exceed the number of spouses

    Minor

    The listed spouse race categories and missing-race count total 94, rather than the 92 spouses implied by 92 couples.

    Reported 92 · recomputed 94

  • Female count does not match the reported percentage

    Minor

    With 92 persons with pain, 56 women would represent about 60.9%, not 52.7%.

    Reported 52.7 · recomputed 60.869565

2 of 2

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Authors
Cano, A., Barterian, J. A., & Heller, J. B.
Affiliations
Michigan State University (US)
ORCID
Barterian, Justin A.
Venue
The Clinical Journal of Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2008-10
Volume
24
Issue
8
Pages
678-684
ISSN
0749-8047 (ISSN-L)
DOI
10.1097/ajp.0b013e31816753d8
PMC
PMC2562912
OpenAlex
W2113653767
Cited by
125
References
42
Citations by year
2026: 1 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 1 · 2020: 7 · 2019: 7 · 2018: 11 · 2017: 12 · 2016: 8 · 2015: 14 · 2014: 10 · 2013: 16 · 2012: 11
FWCI
2.80
Type
journal article
Language
en
Open access
Locations
  • Clinical Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Human Biology (submittedVersion)
Funders
National Institute of Mental Health (K01MH066975, K01 MH66975)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
Keywords
chronic pain, couples, empathy, validation, invalidation, marital satisfaction, perceived spousal support, musculoskeletal pain, social factors in pain, marital interaction
MeSH terms
Adaptation, Psychological, Adult, Aged, Chronic Disease, Disability Evaluation, Empathy, Factor Analysis, Statistical, Family Characteristics, Female, Humans, Interpersonal Relations, Longitudinal Studies, Male, Middle Aged, Pain, Pain Measurement, Personal Satisfaction, Personality Inventory, Reproducibility of Results

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Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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