Specific Aim 1:

To examine the associations between emotional disclosure, social constraints/support and patient/spouse cognitive processing in Head and Neck Cancer (HNC) using self-report and observational methods.

Hypothesis 1A (self-report)

• When patients/spouses report fewer social constraints/more support from their partners, they will report more disclosure/less holding back and, in turn, fewer intrusive and avoidant thoughts.
• When patients/spouses report more social constraints/less support from their partners, they will report less disclosure/more holding back and, in turn, more intrusive and avoidant thoughts.

Hypothesis 1B (observation)

• When spouses respond positively to patient disclosures, patients and spouses will have better cognitive processing (a smaller absolute difference in reaction times to cancer-related words on a cancer Stroop task).
• When spouses respond negatively (criticize, stonewall), patients and spouses will have less adaptive cognitive processing (a larger absolute difference in reaction times to cancer-related words on a cancer Stroop task).

Specific Aim 2:

To examine the associations between emotional disclosure and social constraints/support at the initiation of radiation treatment (XRT) for HNC (baseline) and patient/spouse adjustment 4 and 12 months after XRT using self-report and observational methods.

Hypothesis 2A (self-report)

• When patients/spouses report fewer baseline social constraints/more support from their partners, they will report more disclosure/less holding back and, in turn, better psychological functioning, relationship quality, and QOL 4 and 12 months after XRT.
• When patients/spouses report more baseline social constraints/less social support from their partners, they will report less disclosure/more holding back and, in turn, worse psychological functioning, relationship quality, and QOL 4 and 12 months after XRT.

Hypothesis 2B (observation)

• When spouses respond positively to patients' baseline disclosures, patients/spouses will report better psychological functioning, relationship quality, and QOL 4 and 12 months after XRT.
• When spouses respond negatively to patients' baseline disclosures, patients/spouses will report worse psychological functioning, relationship quality, and QOL 4 and 12 months after XRT.

Specific Aim 3:

To examine the associations between patient/spouse reported emotional disclosure at baseline on patient distress and patient physical symptom reports/spouse caregiver burden 4 and 12 months after XRT.

Hypothesis 3A (patients)

-When patients hold back less/disclose more at baseline, they will report better psychological functioning, which, in turn, will be associated with less severe physical symptom reports 4 and 12 months after XRT.

Hypothesis 3B (spouses)

-When spouses disclose more to HNC patients at baseline, patients will report better psychological functioning, which, in turn, will be associated with spouses reporting less caregiver burden 4 and 12 months after XRT.