Factors and processes involved in adjustment to multiple sclerosis

Abstract

Multiple sclerosis (MS) creates numerous ongoing challenges which, for some, result in negative outcomes such as depression, poor quality of life, and impaired functioning. This thesis aimed to investigate the nature of psychological adjustment to MS and elucidate factors that interventions could address in order to promote successful adjustment. A review of the theoretical literature on chronic illness and a systematic review of the empirical MS literature suggested that various theoretical approaches are useful for explaining aspects of adjustment to MS but no single existing theory offered a comprehensive framework. An integrative cognitive behavioural model of adjustment to MS was proposed and elements of this were examined in the empirical chapters.
In an initial qualitative study, people with MS (n=30) were interviewed about their experiences of living with the disease. Inductively-derived themes characterised the context and process of adjustment and the resources, actions, thoughts and feelings that have a bearing on it. Findings supported and elaborated on the model, and new insights were used to revise it. The quantitative studies were nested within a trial of interventions for adjustment to MS (n=94). A cross-sectional study using pre-therapy data found that cognitive and behavioural variables explained substantial variance in distress and functional impairment. Unhelpful beliefs and behaviours relating to MS itself (illness perceptions and responses to symptoms) appeared most relevant for explaining functional impairment. Beliefs about the self and about experiencing and sharing emotions were important correlates of distress. In an analysis of change within the treatment trial, reductions in unhelpful cognitions and behaviours mediated the improvements observed within interventions. Cognitive and behavioural variables also moderated the effects of the interventions on outcomes. A final qualitative study (n=30) explored participants‘ experiences of the adjustment interventions. The set of interlinked themes provided insights into the broad range of positive outcomes of interventions, perceived therapeutic processes and factors that appear to promote engagement in interventions in this patient group.
Overall, the suggested cognitive behavioural model appears to be a useful means of understanding adjustment. This thesis pinpointed a number of potential cognitions and behaviours which may be important targets for adjustment interventions. Continued research efforts to understand factors that determine a range of adjustment outcomes and to determine what people with MS find helpful and appropriate is necessary for a more complete understanding of successful adjustment to MS and how it can be promoted

More information

Identifiers

ORCID for Laura Dennison: orcid.org/0000-0003-0122-6610

Catalogue record

Export record