Intervention Research

The sizable body of evidence linking supportive aspects of relationships to physical health outcomes calls into question whether interventions to improve social support might benefit health. A review of 100 interventions of either group- or individual-level formats designed to modify perceptions of support availability and/or skills related to seeking and receiving social support documented that a majority of interventions were successful in improving psychosocial (e.g., psychological well-being, perceptions of support availability, or receipt) and behavioral outcomes (e.g., adherence to medical treatments, maintenance of adopted health behaviors; Hogan et al, 2002). However, a much smaller body of research has examined physical health impacts of social support interventions. Campbell (2003) noted that interventions for physical health conditions that involve family members, such as interventions which educate families about the target health condition and provide social support skills training, generally support the salutary benefits of family intervention for a number of health conditions (e.g., better glycemic control in diabetics, better asthma control, lower blood pressure in hypertensive patients; see also Martire et al, 2004).

Given the large body of evidence suggesting that low levels of social integration/social support are predictive of cardiovascular disease outcomes, the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial was designed to provide psychosocial treatment to individuals who had recently suffered an MI and also perceived low social support availability (Berkman et al, 2003). Over 2000 individuals with low levels of perceived social support, high levels of depressive symptoms, or both, were randomized to either usual care (with private physician) or psychosocial treatment, which consisted of both individual cognitive behavioral therapy and group therapy. A tailored therapy program was designed for each participant that addressed social skill deficits, cognitive factors contributing to dissatisfaction with social support in one's network, network development, support needs and preferences, and individual factors (e.g., anxiety) that might be contributing to deficiencies with support processes. For those with depressive symptomatology, cogni tive behavioral therapy also addressed depression. The intervention was successful in decreasing depressive symptoms and increasing perceptions of social support to a greater degree in intervention subjects, although both intervention and control groups actually experienced improvements in these parameters. The crushing blow, however, was a failure of greater improvements in these psychosocial outcomes in the intervention group to translate into better cardiovascular outcomes. Post hoc analyses did indicate that perceptions of low levels of perceived support at study entry predicted risk of recurrent MI or mortality, consistent with observational research linking low perceived support to greater risk of poor cardiovascular outcomes; however, change in social support in trial participants did not alter mortality outcome. Other post hoc analyses indicated greater treatment effects for social support in those without as compared to those with a partner, suggesting that such interventions might be particularly beneficial in those without an intimate support source (Burg et al, 2005), or alternatively that efforts to modify support transactions through therapy with support recipients may be at odds with the preferences of established support providers, or redundant with already available support. Another possibility is that the critical period for support intervention in terms of effecting change in cardiovascular disease outcomes may be earlier in the disease process; there may be less of an opportunity for improvements in social support to effect change at a physiological level late in the progression of the disease.

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