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Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis?

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Abstract

Background

Goal regulation strategies such as flexible goal adjustment and acceptance are believed to be protective factors in persons with chronic illness, but research on their relative contributions to quality of life in multiple sclerosis (MS) is lacking.

Purpose

We aimed to test the idea that acceptance and flexible goal adjustment (in contrast to tenacious goal pursuit) may help preserve the quality of life in persons with MS.

Method

A sample of 117 patients with MS was recruited. They completed questionnaires measuring quality of life (physical functioning, psychological distress), acceptance, flexible goal adjustment, and tenacious goal pursuit.

Results

Acceptance significantly accounted for variance in all three indexes of quality of life, beyond the effects of demographic and illness characteristics. The role of goal regulation style was less clear. Flexible goal adjustment significantly accounted for psychological well-being only. Surprisingly, tenacious goal pursuit predicted better psychological functioning and less psychological distress. No support was found for the hypothesis that acceptance and flexible goal adjustment would moderate the relation between illness severity and quality of life.

Conclusion

The findings suggest the potential importance of acceptance in understanding MS patients’ quality of life, although its hypothesized protective function could not be confirmed. Further conceptual work on acceptance and goal regulation style is needed, as well as prospective work investigating their causal status.

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References

  1. Mitchell AJ, Benito-Léon J, Morales Gonzalez J-M, Rivera-Navarro J. Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol. 2005;4:556–66.

    Article  PubMed  Google Scholar 

  2. Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372:1502–17.

    Article  CAS  PubMed  Google Scholar 

  3. Benito-Leon J, Morales J, Rivera-Navarros J, Mitchell AJ. A review about the impact of multiple sclerosis on health-related quality of life. Disabil Rehabil. 2003;25:1291–303.

    Article  PubMed  Google Scholar 

  4. De Judicibus MA, McCabe MP. The impact of the financial costs of multiple sclerosis on quality of life. Int J Behav Med. 2007;14:3–11.

    Article  PubMed  Google Scholar 

  5. Dennison L, Moss-Morris L, Silber E, Galea I, Chalder T. Cognitive and behavioral correlates of different domains of psychological adjustment in early-stage multiple sclerosis. J Psychosom Res. 2010;69:353–61.

    Article  PubMed  Google Scholar 

  6. Kehler MD, Hadjistavropoulos HD. Is health anxiety a significant problem for individuals with multiple sclerosis? J Behav Med. 2009;32:150–61.

    Article  PubMed  Google Scholar 

  7. Siegert R, Abernethy D. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005;76:469–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bol Y, Duits AA, Lousberg R, Hupperts RMM, Lacroix MHP, Verhey FRJ, et al. Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach. J Behav Med. 2010;33:355–63.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29:141–53.

    Article  PubMed  Google Scholar 

  10. Aikens JE, Fischer JS, Namey M, Rudick RA. A replicated prospective investigation of life stress, coping, and depressive symptoms in multiple sclerosis. J Behav Med. 1997;20:433–45.

    Article  CAS  PubMed  Google Scholar 

  11. Lester K, Stepleman L, Hughes M. The association of illness severity, self-reported cognitive impairment, and perceived illness management with depression and anxiety in a multiple sclerosis clinic population. J Behav Med. 2007;30:177–86.

    Article  PubMed  Google Scholar 

  12. Pakenham KI. Making sense of multiple sclerosis. Rehab Psychol. 2007;52:380–9.

    Article  Google Scholar 

  13. Pakenham KI. Making sense of caregiving for persons with multiple sclerosis (MS): the dimensional structure of sense making and relations with positive and negative adjustment. Int J Behav Med. 2008;15:241–52.

    Article  PubMed  Google Scholar 

  14. Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging. 1990;5:58–67.

    Article  PubMed  Google Scholar 

  15. Heckhausen J, Wrosch C, Schulz R. A motivational theory of life-span development. Psychol Rev. 2010;117:32–60.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Brandtstädter J, Rothermund K. The life-course dynamics of goal pursuit and goal adjustment: a two process framework. Dev Rev. 2002;22:117–50.

    Article  Google Scholar 

  17. Rothermund K. Hanging on and letting go in the pursuit of health goals: psychological mechanisms to cope with a regulatory dilemma. In: Ridder DD, Wit JD, editors. Self-regulation in health behaviour. Chichester: Wiley; 2006. p. 217–41.

    Chapter  Google Scholar 

  18. Frazier LD, Newman FL, Jaccard J. Psychosocial outcomes in later life: a multivariate model. Psychol Aging. 2007;22:676–89.

    Article  PubMed  Google Scholar 

  19. Rothermund K, Brandstadter J. Coping with deficits and losses in later life: from compensatory action to accommodation. Psychol Aging. 2003;18:896–905.

    Article  PubMed  Google Scholar 

  20. Wrosch C, Miller GE, Scheier MF, Brun de Pontet S. Giving up unattainable goals: benefits for health? Personal Soc Psychol Bull. 2007;33:251–65.

    Article  Google Scholar 

  21. Wrosch C, Scherier MF, Miller GE, Schulz R, Carver CS. Adaptive self-regulation of unattainable goals: goal disengagement, goal reengagement and subjective wellbeing. Personal Soc Psychol Bull. 2003;29:1494–508.

    Article  Google Scholar 

  22. Van Damme S, Crombez G, Goubert L, Eccleston C. Current issues and new directions in Psychology and Health: the costs and benefits of self-regulation—a call for experimental research. Psychol Health. 2009;24:367–71.

    Article  PubMed  Google Scholar 

  23. Eccleston C, Crombez G. Worry and chronic pain: a misdirected problem solving model. Pain. 2007;132:233–6.

    Article  PubMed  Google Scholar 

  24. Schmitz U, Saile H, Nigles P. Coping with chronic pain: flexible goal adjustment as an interactive buffer against pain-related distress. Pain. 1996;67:41–51.

    Article  CAS  PubMed  Google Scholar 

  25. Van Damme S, Crombez G, Eccleston C. Coping with pain: a motivational perspective. Pain. 2008;139:1–4.

    Article  PubMed  Google Scholar 

  26. Evers AW, Kraaimaat FW, Van Lankveld W, Jongen PJ, Jacobs JW, Bijlsma JW. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J Consult Clin Psychol. 2001;69:1026–36.

    Article  CAS  PubMed  Google Scholar 

  27. Lauwerier E, Caes L, Van Damme S, Goubert L, Rosseel Y, Crombez G. Acceptance: what’s in a name? A content analysis of acceptance instruments in individuals with chronic pain. J Pain. 2015;16:306–17.

    Article  PubMed  Google Scholar 

  28. McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105:197–204.

    Article  PubMed  Google Scholar 

  29. Viane I, Crombez G, Eccleston C, Poppe C, Van Houdenhove B, De Corte W. Acceptance of pain is an independent predictor of mental wellbeing in patients with chronic pain: empirical evidence and reappraisal. Pain. 2003;106:65–72.

    Article  PubMed  Google Scholar 

  30. Brooks SK, Rimes KA, Chalder T. The role of acceptance in chronic fatigue syndrome. J Psychosom Res. 2011;71:411–5.

    Article  PubMed  Google Scholar 

  31. Van Damme S, Crombez G, Van Houdenhove B, Mariman A, Michielsen W. Well-being in patients with chronic fatigue syndrome: the role of acceptance. J Psychosom Res. 2006;61:595–9.

    Article  PubMed  Google Scholar 

  32. Casier A, Goubert L, Huse D, Theunis M, Franckx H, Robbrecht E, et al. The role of acceptance in psychological functioning in adolescents with cystic fibrosis: a preliminary study. Psychol Health. 2008;23:629–38.

    Article  CAS  PubMed  Google Scholar 

  33. Pakenham KI. Investigation of the coping antecedents to positive outcomes and distress in multiple sclerosis (MS). Psychol Health. 2006;21:633–49.

    Article  Google Scholar 

  34. Harrison AM, McCracken LM, Bogosian A, Moss-Morris R. Towards a better understanding of MS pain: a systematic review of potentially modifiable psychosocial factors. J Psychosom Res. 2015;78:12–24.

    Article  PubMed  Google Scholar 

  35. Kikuchi H, Mifune N, Niino M, Kira J, Kohrriyama T, Ota K, et al. Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis. BMC Neurol. 2013;13:10. doi:10.1186/1471-2377-13-10.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pakenham KI, Fleming M. Relations between acceptance of multiple sclerosis and positive and negative adjustments. Psychol Health. 2011;26:1292–309.

    Article  PubMed  Google Scholar 

  37. Pakenham KI, Samios C. Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance. J Behav Med. 2013;36:389–400.

    Article  PubMed  Google Scholar 

  38. Kurtzke J. Rating neurological impairment in multiple sclerosis, an expanded disability status scale. Neurology. 1983;33:1444–52.

    Article  CAS  PubMed  Google Scholar 

  39. Zigmund AS. The hospital anxiety and depression scale. Acta Psychatr Scand. 1983;67:361–70.

    Article  Google Scholar 

  40. Spinhoven P, Ormel J, Sloekers P, Kempen GS, Van Hemert A. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27:363–70.

    Article  CAS  PubMed  Google Scholar 

  41. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale: an updates review. J Psychosom Res. 2002;52:69–77.

    Article  PubMed  Google Scholar 

  42. Honarmand K, Feinstein A. Validation of the hospital anxiety and depression scale for use with multiple sclerosis patients. Mult Scler. 2009;15:1581–624.

    Article  Google Scholar 

  43. Ware JS. The MOS 36 item short form health survey (SF36). Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  44. Lauwerier E, Crombez G, Van Damme S, Goubert L, Vogelaers D, Evers AWM. The construct validity of the illness cognition questionnaire: robustness of a three-factor structure across patients with chronic pain and chronic fatigue. Int J Behav Med. 2010;17:90–6.

    Article  PubMed  Google Scholar 

  45. Moss-Morris R, Dennison L, Landau S, Yardley L, Silber E, Chalder T. A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): Does CBT work and for whom does it work? J Consult Clin Psychol. 2013;81:251–62.

    Article  PubMed  Google Scholar 

  46. Nordin L, Rorsman I. Cognitive-behavioural therapy in multiple sclerosis: a randomized controlled pilot study of acceptance and commitment therapy. J Rehabil Med. 2012;44:87–90.

    Article  PubMed  Google Scholar 

  47. Little BR. Personal projects: a rationale and method for investigation. Environ Behav. 1983;15:273–309.

    Article  Google Scholar 

  48. Neter E, Litvak A, Miller A. Goal disengagement and goal reengagement among multiple sclerosis patients: relationship to well-being and illness representation. Psychol Health. 2009;24:175–86.

    Article  PubMed  Google Scholar 

  49. Rasmussen HN, Wrosch C, Scheier MF, Carver CS. Self-regulation processes and health: the importance of optimism and goal adjustment. J Pers. 2006;74:1721–46.

    Article  PubMed  Google Scholar 

  50. van Lankveld W, van Diemen T, van Nes I. Coping with spinal cord injury: tenacious goal pursuit and flexible goal adjustment. J Rehabil Med. 2011;43:923–9.

    PubMed  Google Scholar 

  51. Fournier M, de Ridder D, Bensing J. Optimism and adaptation to multiple sclerosis: what does optimism mean? J Behav Med. 1999;22:303–26.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Stefanie Lekime, Astrid Boeykens, and Kelly Messiaen for their help with collecting and processing the data.

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Authors and Affiliations

  1. Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium

    Stefaan Van Damme

  2. Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Annelies De Waegeneer & Jan Debruyne

Authors
  1. Stefaan Van Damme
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  2. Annelies De Waegeneer
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  3. Jan Debruyne
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Corresponding author

Correspondence to Stefaan Van Damme.

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Conflict of Interest

The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Van Damme, S., De Waegeneer, A. & Debruyne, J. Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis?. Int.J. Behav. Med. 23, 333–339 (2016). https://doi.org/10.1007/s12529-015-9519-6

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  • DOI: https://doi.org/10.1007/s12529-015-9519-6

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