Caring hearts, weighted shoulders: The moderating role of attachment in the relationship between received support and caregiver burden in cardiac illness

Caregiving for cardiac patients is often accompanied by significant emotional and physical strain. While prior research has emphasized the contribution of support to mitigate caregivers’ burden, limited attention has been paid to the support they may receive from the patients themselves. Attachment theory provides a crucial lens for understanding individual differences in how this specific kind of partner’s support is perceived and utilized. Drawing on dyadic coping models and attachment theory, this study examines how support dynamics within the couple influence caregivers’ burden, and whether these effects depend on caregivers’ attachment orientations. Specifically, the study investigates whether caregivers’ attachment anxiety and avoidance moderate the associations between (a) patient-reported support provided to the caregiver (b) caregiver perceived received support from the patient, and (c) levels of caregiver burden during cardiac rehabilitation. Eighty-eight heterosexual couples, in which the male partner had experienced a recent cardiac event, were assessed at the beginning and end of a three-month rehabilitation program. Measures included self-reported support (provided and received), attachment orientations, and multidimensional caregivers’ burden. Overall support was not directly associated with reduced general burden. Caregivers high in avoidant attachment reported lower emotional burden when they perceived receiving greater support from their ill partner. No such effect was found among caregivers low in avoidance or those high in anxious attachment. These findings highlight the importance of considering both interpersonal and intrapersonal factors in understanding caregiver burden. Recognizing and addressing attachment-related patterns in caregiving dyads could inform targeted interventions aimed at reducing emotional distress and enhancing resilience in couples coping with cardiac illness.