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Perception of fatigue and couple communication in people with multiple sclerosis and their spouses: relationship… Whittall, Jane Susan 1996

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PERCEPTION OF FATIGUE AND COUPLE COMMUNICATION IN PEOPLE WITH MULTIPLE SCLEROSIS AND THEIR SPOUSES; RELATIONSHIP TO COPING EFFICACY By JANE SUSAN WHITTALL B.A., Mount A l l i s o n U n i v e r s i t y ,  1984  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department  of Counselling  Psychology)  We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA March 1996 © Jane Susan W h i t t a l l ,  1996  In presenting this  thesis in partial  fulfilment  of the requirements  for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further copying  agree that permission for extensive  of this thesis for scholarly purposes may be granted  department  or  by his or  her  representatives.  It  is  by the head of my  understood  that  copying or  publication of this thesis for financial gain .shall not be allowed without my written permission.  Department The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  Maitk  IH J\\>  1 1  Abstract The purpose o f t h i s e x p l o r a t o r y s t u d y was t o d e t e r m i n e t h e e x t e n t t o which congruence i n t h e p e r c e p t i o n o f f a t i g u e impact between people w i t h m u l t i p l e s c l e r o s i s  (MS) and t h e i r  spouses i s r e l a t e d t o t h e c o p i n g e f f i c a c y o f t h e i n d i v i d u a l s w i t h MS. A l t h o u g h  f a t i g u e i s a w e l l known symptom i n MS, t h e  n a t u r e o f i t s impact on t h e i n d i v i d u a l w i t h t h e d i s e a s e as w e l l as on t h e i r spouse i s p o o r l y understood. Lazarus  Working from  and Folkman's (1984) model o f s t r e s s and c o p i n g , I  q u e s t i o n e d whether i n d i v i d u a l s w i t h MS a p p r a i s e t h e impact o f t h e i r f a t i g u e d i f f e r e n t l y than do t h e i r spouses, and whether t h e degree o f incongruence  i s r e l a t e d to the coping  e f f i c a c y o f t h e p e r s o n w i t h MS. C r i t e r i a f o r i n c l u s i o n i n c l u d e d m a r r i e d c o u p l e s i n which one p e r s o n : diagnosed  (a) had been  w i t h MS f o r a t l e a s t one y e a r , and (b) i d e n t i f i e d  f a t i g u e as a symptom. The ENRICH Couple Communication S c a l e (Olson, 1985) and The F a t i g u e Impact S c a l e  (Fisk,  P o n t e f r a c t , R i t v o , A r c h i b a l d , & Murray, 1994) were a d m i n i s t e r e d t o 60 c o u p l e s i n which one p e r s o n had MS. I n d i v i d u a l s w i t h MS then r a t e d t h e i r p e r c e p t i o n o f c o p i n g e f f i c a c y u s i n g a m o d i f i e d v e r s i o n o f t h e Coping S t r a t e g y Indicator  (Amirkhan, 1990). E f f i c a c y o f avoidance,  problem-  I l l  s o l v i n g , and s e e k i n g s o c i a l support c o p i n g s t r a t e g i e s examined u s i n g the 3 s u b s c a l e s o f t h i s i n s t r u m e n t . a d d i t i o n , The ENRICH Couple Communication S c a l e 1985)  In  (Olson,  a s s e s s e d congruence about communication w i t h i n  c o u p l e s . The e x t e n t t o which congruence c o n c e r n i n g impact  and communication was  the i n d i v i d u a l s who simultaneous  have MS was  fatigue  examined u s i n g t h r e e  multiple regression analyses.  o f avoidance  married  r e l a t e d to coping e f f i c a c y of  congruence c o n c e r n i n g communication was predictor  was  Although  a significant  c o p i n g e f f i c a c y , congruence o f  f a t i g u e impact d i d not appear t o be a s i g n i f i c a n t p r e d i c t o r o f c o p i n g e f f i c a c y on any o f the s u b s c a l e s . I m p l i c a t i o n s f o r t h e o r y and r e s e a r c h were d i s c u s s e d , among them b e i n g increased understanding  o f (a) c o p i n g e f f i c a c y ,  o p e r a t i o n a l i z a t i o n o f congruence, and  an  (b) the  (c) the p e r c e p t i o n o f  an i n v i s i b l e symptom such as f a t i g u e i n p e o p l e who as w e l l as t h e i r spouses' p e r c e p t i o n s o f the  are  fatigue.  ill,  iv Table of Contents Page Abstract Table of Contents  i i iv  L i s t of Tables  v i i  Acknowledgments  viii  Introduction  1  L i t e r a t u r e Review Theory o f S t r e s s and Coping Gender and Coping S t r e s s o r s A s s o c i a t e d w i t h MS F a t i g u e as a S t r e s s o r o f MS The Impact o f C h r o n i c I l l n e s s on the Marital Relationship Couple Communication Shared P e r c e p t i o n s w i t h i n the M a r i t a l R e l a t i o n s h i p (Congruence) D e f i n i t i o n s o f Coping E f f i c a c y Problems i n O p e r a t i o n a l i z i n g Coping E f f i c a c y Studies that R e f l e c t D i f f i c u l t y i n O p e r a t i o n a l i z i n g Coping E f f i c a c y Summary  8 9 13 15 16  37 40  Research Questions Operational D e f i n i t i o n s of V a r i a b l e s  42 42  Method Criteria for Inclusion Participants Procedure Measures The F a t i g u e Impact S c a l e The Couple Communication S c a l e The Coping S t r a t e g y I n d i c a t o r Data A n a l y s i s  44 44 44 45 47 47 49 51 54  21 23 27 33 37  V  Results Research Questions...., F a t i g u e Impact Congruence o f Couple Communication Coping E f f i c a c y Gender D i f f e r e n c e s Post-hoc A n a l y s i s Congruence Couple Communication Coping Use and H e l p f u l n e s s  58 64 64 66 68 73 73 75 77 78  Discussion Congruence o f F a t i g u e Impact Congruence o f F a t i g u e Impact (post-hoc Analysis) Congruence o f Couple Communication Congruence o f Couple Communication (posthoc A n a l y s i s Coping E f f i c a c y Coping Use and H e l p f u l n e s s (post-hoc Analysis Gender D i f f e r e n c e s Summary Limitations Future Research Implications f o r Counsellors  82 82  96 99 101 104 107 108  References  111  87 89 92 93  Appendix A  Couple Communication S c a l e  120  Appendix B  P a r t i c i p a n t Consent Form  121  Appendix C  F a t i g u e Impact S c a l e  123  Appendix D  F a t i g u e Impact S c a l e f o r Spouses  124  Appendix E  Coping S t r a t e g y I n d i c a t o r  125  Appendix F  Demographic I n f o r m a t i o n Sheet  Appendix G  C o r r e l a t i o n s of V a r i a b l e s C a l c u l a t e d i n Post-hoc A n a l y s i s  . ... 127 128  vi  Appendix H  Page M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of Avoidance Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence 129  Appendix I  M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of S e e k i n g S o c i a l Support Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence . . . 130  Appendix J  M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of P r o b l e m - S o l v i n g Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence 131  Appendix K  M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of Avoidance Coping Use 132  Appendix L  M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of S e e k i n g S o c i a l Support Coping Use .... 133  Appendix M  M u l t i p l e Regression Analysis of P r e d i c t o r s of P r o b l e m - S o l v i n g Coping Use 134  Appendix N  L i s t o f Coping S t r a t e g i e s Used.  135  Appendix 0  Frequency D i s t r i b u t i o n o f S a l i e n t Demographic C h a r a c t e r i s t i c s o f Participants  136  Frequency D i s t r i b u t i o n o f Scores on the F a t i g u e Impact S c a l e  137  Frequency D i s t r i b u t i o n o f Scores on the Couple Communication S c a l e  138  Appendix P  Appendix Q  Appendix R Frequency D i s t r i b u t i o n o f Scores on the Coping S t r a t e g y I n d i c a t o r  139  vii L i s t of Tables  Page  T a b l e 1 Demographic C h a r a c t e r i s t i c s o f P a r t i c i p a n t s  59  T a b l e 2 Means and S t a n d a r d D e v i a t i o n s Criterion Variables  62  o f P r e d i c t o r and  T a b l e 3 C o r r e l a t i o n s o f P r e d i c t o r and C r i t e r i o n Variables  63  Table 4 M u l t i p l e R e g r e s s i o n A n a l y s i s o f P r e d i c t o r s o f Avoidance Coping E f f i c a c y  70  Table 5 M u l t i p l e Regression A n a l y s i s o f P r e d i c t o r s of S e e k i n g S o c i a l Support Coping E f f i c a c y  71  Table 6 M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of P r o b l e m - S o l v i n g Coping E f f i c a c y  72  T a b l e 7 Means and S t a n d a r d D e v i a t i o n s o f P r e d i c t o r and C r i t e r i o n V a r i a b l e s f o r Males and Females w i t h MS. . .  74  V I 1 1  Acknowledgments T h i s t h e s i s was a c c o m p l i s h e d w i t h t h e a s s i s t a n c e o f many p e o p l e , and now I have t h e p l e a s u r e o f t h a n k i n g them. First  and foremost, I thank my s u p e r v i s o r , Dr. Bonnie  Long, who has been an a b s o l u t e d e l i g h t and i n s p i r a t i o n t o me for  t h e p a s t 18 months. Her a s t u t e n e s s , academic e x p e r t i s e ,  reliability,  l o v e l y sense o f humour, knowledge o f APA s t y l e ,  p a t i e n c e , and encouragement have made t h i s p r o c e s s more r e w a r d i n g than I had ever hoped i t would be. I would a l s o l i k e t o thank my committee members. F i r s t , Dr. A r l e i g h R e i c h l f o r h i s g e n t l e y e t e f f i c i e n t his  way, and f o r  a b i l i t y t o share h i s knowledge o f s t a t i s t i c s . Next, Dr.  Ann H i l t o n f o r h e r i n - d e p t h knowledge o f L a z a r u s and Folkman's t h e o r y , and f o r h e r v e r y c a p a b l e  editorial  abilities. I extend a s p e c i a l thank you t o P e r r y L e s l i e who b e l i e v e d i n me (and h e l p e d me t o b e l i e v e i n m y s e l f ) even b e f o r e I e n t e r e d Graduate S c h o o l . I would l i k e t o thank Steve Jones, my f i a n c e , who has been a source o f d a i l y encouragement, p a t i e n c e , and h e l p . I would a l s o l i k e t o thank K a r i n S t e i c h e l e , my f e l l o w s t u d e n t  ix and  t r u s t e d f r i e n d who  our v e r y f i r s t To my  has been w i t h me  on t h i s j o u r n e y from  step.  o l d e s t f r i e n d , Sue M u l o i n ,  f o r her encouragement from a c r o s s  I am always g r a t e f u l  the P a c i f i c Ocean, and  for  her reminders t h a t " I f I can do i t , you can do i t " . Thank you  Sue. To Shannon Magnuson, who  art  has k i n d l y h e l p e d me w i t h  of l a s e r p r i n t i n g and p e r f e c t i n g the f i n a l document, I  e x t e n d my warmest and most s i n c e r e t h a n k s . Thank you my  the  f r i e n d , Heather, f o r her p a t i e n c e  and t a b l e  a l s o to  formatting  skills. F i n a l l y , I am v e r y g r a t e f u l t o the MS Canada, B.C.  Society  of  D i v i s i o n , and t o the Vancouver I s l a n d  MS  S o c i e t y . A l s o , I would l i k e t o acknowledge a l l the i n d i v i d u a l s who  p a r t i c i p a t e d i n t h i s s t u d y , who a l l  c o n t r i b u t e d a g r e a t d e a l t o my  learning.  1  Introduction Multiple sclerosis  (MS) i s a c h r o n i c d i s e a s e o f the  c e n t r a l nervous system t h a t a f f e c t s about 1/1,000 p e o p l e i n Canada today, or 0.1% o f the n a t i o n a l p o p u l a t i o n  (Eisen,  1993). Worldwide i n c i d e n c e o f t h i s d i s e a s e i s 57.9 p e r 100,000 p e o p l e o r 0.00058% ( O ' B r i e n , 1983). These s t a t i s t i c s p o i n t t o MS as b e i n g a p a r t i c u l a r l y Canadian d i s e a s e . More women than men 3:2  are i n c l u d e d i n t h i s number, by a r a t i o o f  (MS S o c i e t y o f Canada,- 1 992). MS i s caused by a  breakdown o f the m y e l i n s h e a t h t h a t s u r r o u n d s and p r o t e c t s nerve f i b e r s o f the c e n t r a l nervous system ( S a r a f i n o , Wolf, 1984)  1994;  i n much the same way as i n s u l a t i o n p r o t e c t s  e l e c t r i c a l w i r e s . The i n t e r r u p t e d nerve c o n d u c t i o n (caused by d e m y e l i n i z a t i o n ) produces the s p e c i f i c symptoms o f p a r a l y s i s , numbness, and f a t i g u e  (Wolf, 1984). Because  tends t o o c c u r i n young a d u l t h o o d , i t s i n i t i a l  impact o c c u r s  d u r i n g peak y e a r s o f e d u c a t i o n , c a r e e r development,  and  f a m i l y l i f e when i n d i v i d u a l s are assuming many s o c i a l economic r e s p o n s i b i l i t i e s  (O'Brien, 1993). The  MS  and  unrelenting  demands o f m e d i c a l t r e a t m e n t . a n d a d a p t a t i o n t o s p e c i a l needs  2 and  c o n s t a n t change t a k e t h e i r t o l l on the p e r s o n who  arid on t h e i r f a m i l y The  (Revenson & Maj e r o v i t z , 1991) .  impact of MS  on f a m i l i e s and  the i s s u e of s t r e s s and  f r i e n d s i s such t h a t  coping i s of great  (Buelow, 1991). Recent s t u d i e s have p o i n t e d aspects of chronic v u l n e r a b i l i t y and Dodd, 1993;  is i l l  relevance to s p e c i f i c  i l l n e s s as s t r e s s o r s , namely, an u n c e r t a i n i l l n e s s t r a j e c t o r y (Weiner &  Wineman, Durand, & S t e i n e r , 1994). "Thus, i t i s  assumed t h a t p e o p l e w i t h MS  experience s t r e s s ,  and  t h e r e f o r e , must employ c o p i n g methods t o handle s t r e s s " (Buelow, 1991, challenges (usual)  p.247). Other s t u d i e s emphasize p h y s i c a l  a s s o c i a t e d w i t h MS,  family l i f e  and  (Buelow, 1991;  t h e i r impact on normal O ' B r i e n , 1993). These  s t u d i e s i d e n t i f y f a t i g u e as a t r o u b l i n g symptom. More s p e c i f i c a l l y , f a t i g u e o f t e n becomes a s o c i a l , e m o t i o n a l , interpersonal  and  stressor.  A l t h o u g h f a t i g u e i s documented i n the l i t e r a t u r e as symptom f o r 76% of i n d i v i d u a l s w i t h MS  ( F i s k et a l . ,  a  1994;  Schwartz, J a n d o r f , & Krupp, 1993), i t i s a p a r t i c u l a r l y d i f f i c u l t symptom f o r c l i n i c i a n s t o u n d e r s t a n d due l a c k of r e l a t i o n s h i p between p e r c e i v e d  to  the  impact of f a t i g u e  and  n e u r o l o g i c a l assessment of f a t i g u e s e v e r i t y (Krupp, A l v a r e z ,  3 LaRocca,  & S c h e i n b e r g , 1988; Krupp, LaRocca, Muir-Nash,  &  S t e i n b e r g , 1989). Furthermore, the n a t u r e o f f a t i g u e ' s impact on the i n d i v i d u a l w i t h the d i s e a s e as w e l l as on t h e i r spouse i s . p o o r l y u n d e r s t o o d . Due  t o the f a c t t h a t  f a t i g u e i s an i n v i s i b l e symptom, i t may be d i f f i c u l t f o r spouses t o a p p r e c i a t e t h a t f a t i g u e i s a s t r e s s o r f o r the  ill  partner. The e x t e n t t o which m a r r i e d p a r t n e r s have a s h a r e d understanding of i l l n e s s - r e l a t e d issues i s l i k e l y r e l a t e d to how much they share t h e i r thoughts and f e e l i n g s w i t h one another  ( C o r b i n & S t r a u s s , 1984). However, i t i s not  n e c e s s a r i l y true that interpersonal f a m i l i a r i t y with a spouse i n c r e a s e s congruence  o f p e r s p e c t i v e s on ambiguous  i s s u e s . O f t e n , m a r r i e d c o u p l e s o v e r e s t i m a t e the degree t o which they u n d e r s t a n d one another  ( S i l l a r s & Scott,  1983).  Consequently, m i s c o n c e p t i o n s between m a r r i e d p a r t n e r s can o c c u r when c o u p l e s do not communicate e f f e c t i v e l y i l l n e s s - r e l a t e d changes.  about  I t f o l l o w s , then, t h a t  m i s u n d e r s t a n d i n g s c o u l d be compounded when the changes are u n p r e d i c t a b l e and i n v i s i b l e , as w i t h MS f a t i g u e . T h e r e f o r e , I expect t h a t s i m i l a r p e r c e p t i o n s o f b o t h the impact o f f a t i g u e and congruent p e r c e p t i o n s o f p o s i t i v e c o u p l e  4 communication may  h e l p the i l l  v a l i d a t e d , which i n t u r n may  spouse t o f e e l u n d e r s t o o d  and  c o n t r i b u t e t o more e f f i c a c i o u s  c o p i n g w i t h the f a t i g u e . In k e e p i n g w i t h my  f o c u s on i n d i v i d u a l s w i t h MS  and  t h e i r e x p e r i e n c e o f c o p i n g w i t h f a t i g u e i n the c o n t e x t o f the m a r i t a l r e l a t i o n s h i p , I chose t o examine t h e s e i s s u e s u s i n g L a z a r u s and Folkman's (1984, 1991)  theoretical  framework o f s t r e s s and c o p i n g . The r e l a t i o n a l as w e l l  as  the p r o c e s s - o r i e n t e d a s p e c t s o f t h i s t h e o r y have i m p o r t a n t i m p l i c a t i o n s r e g a r d i n g the p r e s e n t s t u d y . The  former i s  r e f l e c t e d i n the r e l a t i o n s h i p and communication between the i n d i v i d u a l who  is i l l  and t h e i r spouse. The  latter i s  r e f l e c t e d i n the n e c e s s a r y a d a p t a t i o n s t o i l l n e s s t h a t b o t h p a r t n e r s i n a marriage must make. Because the m a r i t a l dyad c o n s t i t u t e s "the most i m p o r t a n t s o c i a l c o n t e x t w i t h i n which the p s y c h o l o g i c a l a s p e c t s o f c h r o n i c i l l n e s s are managed" (Rodgers 1990,  p.25),  I f o c u s e d on how b o t h p a r t n e r s i n a m a r r i a g e  (when one p e r s o n has MS) daily l i f e  & Calder,  ( i . e . , how  p e r c e i v e the impact o f f a t i g u e i n  congruent  the c o u p l e i s c o n c e r n i n g  f a t i g u e i m p a c t ) . T h i s source o f support  (a spouse who  is  congruent w i t h the i n d i v i d u a l ' s a p p r a i s a l o f f a t i g u e ) would  5 be c a l l e d a resource  a c c o r d i n g t o L a z a r u s and Folkman's  t h e o r y o f s t r e s s and c o p i n g . Congruence i n communicating about h e a l t h - r e l a t e d i s s u e s between m a r r i e d c o u p l e s has been shown t o f o s t e r a sense o f f e e l i n g u n d e r s t o o d  ( H i l t o n , 1994;  Wineman, O'Brien, Nealon, & K a s k a l , 1993). W i t h i n L a z a r u s and Folkman's t h e o r e t i c a l framework, f e e l i n g u n d e r s t o o d r e p r e s e n t s an a v a i l a b l e resource  (support). Using resources  such as support i s r e l a t e d t o c o p i n g e f f i c a c y  (Billings &  Moos, 1981). The more congruent a c o u p l e i s c o n c e r n i n g t h e impact o f f a t i g u e and communication  p a t t e r n s , t h e more  s u p p o r t e d t h e i n d i v i d u a l w i t h MS i s l i k e l y t o f e e l . T h i s i n c r e a s e d sense o f s u p p o r t may l e a d t o t h e use o f more c o p i n g s t r a t e g i e s , and a f e e l i n g t h a t t h e use o f t h e s e s t r a t e g i e s i s more e f f i c a c i o u s . In o r d e r t o i l l u s t r a t e t h i s problem,  I describe a  h y p o t h e t i c a l s i t u a t i o n c o n c e r n i n g a woman w i t h MS and h e r husband. (I have chosen a woman w i t h MS because o f t h e h i g h e r i n c i d e n c e o f t h e d i s e a s e i n women.) Judy c o n s i d e r s her f a t i g u e as more o f a problem than does h e r husband, J i m . T h i s r e p r e s e n t s a l a c k o f congruence  i n how b o t h  spouses  view t h e impact o f f a t i g u e . I f Judy c l a i m s t h a t she i s t o o t i r e d t o make d i n n e r (even though she had gone t o a movie  6 w i t h t h e i r son e a r l i e r ) , J i m might assume t h a t she i s exaggerating  because he p e r c e i v e s  t h e impact o f h e r f a t i g u e  as l e s s o f a problem than she does. An e f f i c a c i o u s c o p i n g s t r a t e g y f o r Judy.might be t o o r d e r a p i z z a , however, she may not be a b l e t o use t h i s s t r a t e g y i f J i m i n s i s t s t h a t she get on w i t h making d i n n e r d e s p i t e h e r f a t i g u e . Or, t h e coping  s t r a t e g y o f o r d e r i n g a p i z z a might be e f f i c a c i o u s i n  c o p i n g w i t h h e r f a t i g u e , b u t not e f f i c a c i o u s i n h e r r e l a t i o n s h i p w i t h h e r husband because he g e t s angry and c a l l s h e r l a z y . I n t h i s h y p o t h e t i c a l case, Judy's p e r c e i v e d c o p i n g e f f i c a c y i s reduced as a r e s u l t o f t h e l a c k o f congruence between t h e c o u p l e .  I f , on t h e o t h e r hand, t h e y  had b o t h p e r c e i v e d t h e degree o f Judy's f a t i g u e as e q u a l l y h i g h , o r had been a b l e t o communicate about i t , J i m might a n t i c i p a t e t h a t Judy may be t o o t i r e d t o make d i n n e r , and might e i t h e r suggest o r d e r i n g a p i z z a o r accept h e r statement t h a t she i s t o o t i r e d t o cook. I n e i t h e r case, Judy would l i k e l y p e r c e i v e t h e c o p i n g s t r a t e g y  (ordering a  p i z z a ) as e f f i c a c i o u s . Even though s t r e s s , c o p i n g , recognized  as f u n d a m e n t a l l y  i l l n e s s i s present  and c o p i n g e f f i c a c y a r e  important  i s s u e s when p h y s i c a l  (Buelow, 1991), " a c t u a l l y a n a l y z i n g i t s  7 (coping) p a r t s and o b t a i n i n g a measure o f how  effectively i t  i s operating i s extremely d i f f i c u l t "  ( M c H a f f i e , 1992,  A l t h o u g h many s t u d i e s have attempted  to q u a n t i f y i l l n e s s -  related stressors  p.67).  and c o p i n g mechanisms u s i n g a v a r i e t y  i n s t r u m e n t s and methodologies  (O'Brien, 1993;  of  Somerfield &  Curbow, 1992), t h e r e has been v e r y l i t t l e r e s e a r c h on c o p i n g efficacy 1987;  (Bar-Tal & Spitzer,  1994;  Bennett,  1993;  McNett,  Menaghan, 1982). T h i s s t u d y extends c u r r e n t r e s e a r c h  on c o p i n g e f f i c a c y by m o d i f y i n g a measure o f c o p i n g e f f i c a c y f o r use w i t h i n d i v i d u a l s who  are c o p i n g w i t h MS  The purpose o f t h i s s t u d y was which shared p e r c e p t i o n o f f a t i g u e  fatigue.  t o examine the e x t e n t t o impact and  positive  communication between people w i t h MS and t h e i r spouses were r e l a t e d t o the p e r c e i v e d c o p i n g e f f i c a c y o f i n d i v i d u a l s w i t h MS.  Congruence i n p e r c e p t i o n o f f a t i g u e ,  as w e l l as  shared  f e e l i n g s about p o s i t i v e c o u p l e communication were e x p e c t e d to be r e l a t e d t o c o p i n g e f f i c a c y . S p e c i f i c a l l y , I examined: (a) the r e l a t i o n s h i p between p e r c e i v e d impact o f f a t i g u e i n the d a i l y l i v e s o f i n d i v i d u a l s w i t h MS and t h e i r spouses (congruence),  (b) c o u p l e consensus c o n c e r n i n g p o s i t i v e  communication, and individuals with  (c) c o p i n g e f f i c a c y w i t h t h i s f a t i g u e i n MS.  8 Literature MS a f f e c t s  0.1%  Review  o f the p o p u l a t i o n i n Canada  1993), 76% o f whom e x p e r i e n c e symptomatic f a t i g u e al.,  1994;  Krupp e t a l . , 1988;  et a l . , 1993). Many i n d i v i d u a l s  (Eisen, (Fisk et  Krupp et a l . , 1989; f e e l misunderstood  Schwartz as t o the  impact o f t h e i r f a t i g u e on t h e i r d a i l y l i v e s , due m o s t l y t o i t s i n v i s i b l e and u n p r e d i c t a b l e nature--making important area of study  (Burnfield,  1993;  i t an  Hubsky,  A l t h o u g h f o u r t y p e s o f f a t i g u e are t y p i c a l i n MS  1992). (Hubsky,  1992), i t f r e q u e n t l y i s d i f f i c u l t f o r c l i n i c i a n s or the individual's  s i g n i f i c a n t o t h e r t o d i f f e r e n t i a t e among them.  T h e r e f o r e , any type o f f a t i g u e e x p e r i e n c e d by the w i t h MS,  and i t s s u b j e c t i v e e x p e r i e n c e , was  individual  of i n t e r e s t i n  t h i s study. In t h i s s t u d y , the terms m a r r i e d p e o p l e , o t h e r , spouse, and  significant  (common-law) c o u p l e s were used  i n t e r c h a n g e a b l y t o denote two people who  share t h e i r  daily  l i v e s t o g e t h e r , whether o r not they are l e g a l l y m a r r i e d t o one  another. I f the m a r i t a l dyad i s the most i m p o r t a n t  social  c o n t e x t w i t h i n which the p s y c h o l o g i c a l a s p e c t s o f c h r o n i c i l l n e s s are managed (Rodgers  & C a l d e r , 1990), and i f c o u p l e  9  congruence i n communication h e l p s t h e i n d i v i d u a l w i t h t h e i l l n e s s t o f e e l more supported.and Wineman e t a l , 1 9 9 3 ) ,  1994;  able t o adjust  (Hilton,  then i t would be i m p o r t a n t t o  i n v e s t i g a t e t h e degree t o which m a r r i e d c o u p l e s a r e congruent ( i . e . , share t h e same p e r c e p t i o n ) about t h e i r communication p a t t e r n s as w e l l as t h e impact  o f MS f a t i g u e  on t h e d a i l y l i f e o f t h e i n d i v i d u a l w i t h MS. These c o u p l e c o n g r u e n c i e s .were examined i n an attempt  t o understand  their  r e l a t i o n s h i p t o t h e c o p i n g e f f i c a c y o f t h e spouse w i t h MS. I n t h i s l i t e r a t u r e r e v i e w , I p r o v i d e an o v e r v i e w o f L a z a r u s and Folkman's ( 1 9 8 4 )  t h e o r y o f s t r e s s and c o p i n g . I  e x p l o r e t h e s t r e s s o r s a s s o c i a t e d w i t h h a v i n g MS, p a r t i c u l a r l y f a t i g u e , and I examine i s s u e s r e l a t e d t o c o u p l e s ' communication and c h r o n i c i l l n e s s . S p e c i f i c a l l y , I f o c u s on congruence (shared p e r c e p t i o n s ) between m a r r i e d p a r t n e r s . F i n a l l y , I e x p l o r e t h e concept a c c o r d i n g t o L a z a r u s and Folkman ( 1 9 8 8 ) related  of coping  efficacy  and more r e c e n t  literature.  Theory o f S t r e s s and Coping The t h e o r e t i c a l framework on which t h i s s t u d y i s based i s t h e s t r e s s and c o p i n g t h e o r y o f L a z a r u s and Folkman (1991,  1984).  T h e i r work has had a major impact on s t r e s s  10 and c o p i n g r e s e a r c h . T h i s c o g n i t i v e t h e o r y o f s t r e s s c o p i n g i s r e l a t i o n a l and p r o c e s s o r i e n t e d . The  and  relational  c h a r a c t e r i s t i c i s e v i d e n t i n the d e f i n i t i o n o f s t r e s s as "a r e l a t i o n s h i p between the p e r s o n and the environment  that i s  a p p r a i s e d by the p e r s o n as t a x i n g or e x c e e d i n g h i s or her r e s o u r c e s and as endangering h i s or her w e l l - b e i n g " (Folkman, 1984, p.840). I n t h i s t h e o r e t i c a l c o n t e x t , s t r e s s i s not a s t i m u l u s o r a r e s p o n s e . R a t h e r , i t i s i n h e r e n t i n the r e l a t i o n s h i p between the p e r s o n and the environment. This cognitive theory i s also process-oriented i n that i t d e l i n e a t e s a dynamic (changing) r e l a t i o n s h i p between the p e r s o n and the environment, a r e l a t i o n s h i p t h a t i s i n t e r a c t i v e and b i - d i r e c t i o n a l . W i t h i n t h i s t h e o r e t i c a l framework o f s t r e s s  and  c o p i n g , the s t r e s s f u l n e s s o f an event i s d e t e r m i n e d t h r o u g h c o g n i t i v e a p p r a i s a l o f the event. There are two major t y p e s o f a p p r a i s a l - - p r i m a r y and secondary. P r i m a r y a p p r a i s a l i n v o l v e s an assessment  o f whether or not the event i s  p o t e n t i a l l y h a r m f u l t o the i n d i v i d u a l . Secondary  appraisal  i n v o l v e s the e v a l u a t i o n o f c o p i n g r e s o u r c e s and o p t i o n s . I n secondary a p p r a i s a l , p h y s i c a l , s o c i a l , p s y c h o l o g i c a l ,  and  11  m a t e r i a l a s s e t s a r e e v a l u a t e d w i t h r e s p e c t t o t h e demands o f the s i t u a t i o n  (Folkman, 1984).  In t h i s t h e o r y , c o p i n g i s d e f i n e d as "a c o n s t a n t l y c h a n g i n g b e h a v i o r a l and c o g n i t i v e e f f o r t t o manage s p e c i f i c e x t e r n a l and/or i n t e r n a l demands t h a t a r e a p p r a i s e d as t a x i n g o r e x c e e d i n g t h e r e s o u r c e s o f t h e p e r s o n " (Lazarus & Folkman,  1984,  p.141). Coping r e f e r s t o c o g n i t i v e and  b e h a v i o u r a l e f f o r t s t o master, reduce, o r t o l e r a t e t h e i n t e r n a l and/or e x t e r n a l demands t h a t a r e c r e a t e d by t h e s t r e s s f u l event (Folkman & L a z a r u s , 1980; S a r a f i n o , A c c o r d i n g t o L a z a r u s and Folkman,  1994).  t h e concept o f c o p i n g  needs t o be d i s t i n g u i s h e d from t h e l a y p e r s o n ' s use o f t h e term (Newman & Revenson,  1993). I n everyday language, t h e  term " c o p i n g " i s used t o convey t h e i d e a t h a t an i n d i v i d u a l i s h a n d l i n g a s t r e s s f u l l i f e event w i t h o u t s i g n i f i c a n t d i s t r e s s . The terms " c o p i n g " and "outcome" a r e , t h e r e f o r e , almost synonymous. However, a c c o r d i n g t o L a z a r u s and Folkman's  (1984) t h e o r y , t h e term " c o p i n g " r e f e r s t o c o p i n g  s t r a t e g i e s , r e g a r d l e s s o f t h e i r outcome. L a z a r u s and Folkman (1991, 1984) emphasize t h e i n d i v i d u a l ' s a p p r a i s a l o f c o p i n g s t r a t e g i e s as e f f i c a c i o u s , r a t h e r than someone e l s e ' s judgement about t h e e f f i c a c y o f c o p i n g .  12 The t h e o r e t i c a l s e p a r a t i o n o f c o p i n g e f f o r t s from  their  outcomes i s n e c e s s a r y i f t h e c o p i n g c o n s t r u c t i s t o be used t o p r e d i c t outcome because when c o p i n g i s confounded w i t h outcome, any use o f c o p i n g as a p r e d i c t o r i s r e p e t i t i o u s (Folkman,  1984; L a z a r u s & Folkman,  1991).  L a z a r u s s p e c i f i e s two approaches t o c o p i n g - - c o p i n g s t y l e and c o p i n g s t r a t e g i e s  (1993). A c o p i n g s t y l e  reflects  a p e r s o n a l i t y t r a i t o r a g e n e r a l way o f h a n d l i n g s t r e s s , whereas t h e c o p i n g s t r a t e g i e s used a t any g i v e n time change over time and depend on t h e i n d i v i d u a l ' s a p p r a i s a l o f t h e situation. Coping s t r a t e g i e s have two f u n c t i o n s : t o r e g u l a t e emotions (emotion-focused  c o p i n g ) , and t o manage t h e problem  that i s causing the d i s t r e s s Examples o f emotion-focused  (problem-focused  coping).  c o p i n g i n c l u d e avoidance and  s e e k i n g s o c i a l s u p p o r t . Examples o f p r o b l e m - f o c u s e d i n c l u d e making p l a n s t o s o l v e t h e problem issue d i r e c t l y  coping  o r c o n f r o n t an  (Folkman & L a z a r u s , 1986). A c c o r d i n g t o  Folkman and L a z a r u s  (1980), b o t h t y p e s o f c o p i n g s t r a t e g i e s  are used i n most s t r e s s f u l s i t u a t i o n s , and t h e p r o p o r t i o n s v a r y from s i t u a t i o n t o s i t u a t i o n . Problem-focused tends t o predominate when an i n d i v i d u a l f e e l s t h a t  coping something  13 can be done about the s i t u a t i o n , whereas e m o t i o n - f o c u s e d c o p i n g tends t o predominate when p e o p l e f e e l t h a t s t r e s s o r i s something t h a t must be endured  the  (Folkman &.  L a z a r u s , 1980). W i t h i n t h i s t h e o r e t i c a l framework, c o p i n g and e f f i c a c y are s u b j e c t i v e c o n s t r u c t s .  coping  Coping s t r a t e g i e s  c o n s i d e r e d t o be e f f i c a c i o u s ( s u b j e c t i v e l y ) by an i n d i v i d u a l w i t h MS  may  or may  not  actually (objectively)  be  e f f i c a c i o u s . For example, h a v i n g temper tantrums t o cope w i t h f r u s t r a t i o n about h a v i n g f a t i g u e may i n d i v i d u a l w i t h MS  t o f e e l b e t t e r , but  f a m i l y . Because Folkman and  help  i t may  the alienate  L a z a r u s (1980) p l a c e an emphasis  on the s u b j e c t i v e a p p r a i s a l of s t r e s s , i t f o l l o w s a t t e n t i o n to s u b j e c t i v e  t h a t "the p e r c e i v i n g  t o be the l i t m u s t e s t f o r the q u a l i t y of l i f e " 1988,  p.  Gender and  10  that  i n d i c a t o r s of coping e f f i c a c y  w a r r a n t f u r t h e r s t u d y , and  Baltes,  the  s e l f ought {Baltes  (as c i t e d i n F i l i p p & K l a u e r ,  c o p i n g . The  q u e s t i o n of whether men  &  1990)]. and  women cope w i t h s t r e s s i n d i f f e r e n t ways i s a d i f f i c u l t t o answer, due  m o s t l y t o a l a c k of c o n s i s t e n t  research findings  patterns  one in  (Ptacek, Smith, & Zanas, 1992). B i l l i n g s  and Moos (1981) r e p o r t e d  t h a t men  used l e s s  behavioural,  avoidance, and emotion-focused  c o p i n g than women, b u t s t a t e  t h a t these gender d i f f e r e n c e s were r e l a t i v e l y s m a l l . E n d l e r and P a r k e r  (1990) found no gender d i f f e r e n c e s i n t a s k  c o p i n g . However, women s c o r e d s i g n i f i c a n t l y h i g h e r on avoidance and emotion-focused  c o p i n g . E n d l e r and P a r k e r  r e p o r t e d t h a t t h i s was n o t a s u r p r i s i n g f i n d i n g  because  women t e n d t o seek more s o c i a l support and e x p r e s s more emotions when f a c e d w i t h s t r e s s f u l s i t u a t i o n s  (1990).  However, t h e s e f i n d i n g s may r e f l e c t d i f f e r e n c e s i n t h e characteristics  o f t h e s t r e s s o r s r a t h e r than a c t u a l  d i f f e r e n c e s i n c o p i n g s t r a t e g i e s employed. Fewer gender d i f f e r e n c e s i n c o p i n g s t r a t e g i e s used have been r e p o r t e d when c o n t r o l l i n g  f o r the s t r e s s o r  (Long,  1989).  Amirkhan's r e s e a r c h u s i n g t h e Coping S t r a t e g y I n d i c a t o r e v e a l e d a s i g n i f i c a n t gender d i f f e r e n c e on t h e s e e k i n g s o c i a l support s u b s c a l e o n l y , even when t h e type o f s t r e s s o r s were c o n t r o l l e d  (1990,  1994). No s i g n i f i c a n t  d i f f e r e n c e s i n avoidance o r p r o b l e m - s o l v i n g c o p i n g were found. I t i s p o s s i b l e t h a t p e o p l e may respond t o c o p i n g q u e s t i o n n a i r e s a c c o r d i n g t o s o c i a l d e s i r a b i l i t y o r gender r o l e s t e r e o t y p e s , thus masking a t r u e r e f l e c t i o n o f c o p i n g s t r a t e g i e s used (Ptacek e t a l . , 1990).  15 S t r e s s o r s A s s o c i a t e d w i t h MS I l l n e s s imposes d i f f e r e n t demands than do o t h e r t y p e s o f s t r e s s o r s , and s p e c i f i c i l l n e s s e s may  vary i n t h i s regard  (Ray, Weir, S t e w a r t , M i l l e r , & Hyde, 1993). The  literature  d e s c r i b e s b o t h p h y s i c a l and e m o t i o n a l s t r e s s o r s a s s o c i a t e d w i t h a d i a g n o s i s o f MS,  whether they are a c t u a l o r  anticipated. Specific physical d i f f i c u l t i e s include d e c r e a s e d m o b i l i t y and, c o n s e q u e n t l y , d i f f i c u l t y w i t h a c t i v i t i e s o f d a i l y l i v i n g , double v i s i o n , poor b a l a n c e , weakness, p a i n , and l o s s o f b l a d d e r or bowel c o n t r o l  (MS  S o c i e t y o f Canada, 1992; R e a g l e s , 1982; Wolf & F e l l o w s , 1 984) . E m o t i o n a l problems i d e n t i f i e d i n the l i t e r a t u r e i n c l u d e decreased s o c i a l contact, a l a c k of p e r s o n a l w e l l - b e i n g (Buelow,  1991), and a f e a r o f d i s a b i l i t y  (Thornton & Lea,  1992). A n t i c i p a t o r y g r i e f r e a c t i o n s t o the impending l o s s e s (Reagles, 1982;  S a n f o r d & P e t a j a n , 1989)  such as f e a r o f  becoming dependent on o t h e r s ( G u l i c k , 1994), and u n c e r t a i n t y o f what t o expect  ( M i l l e r & Hens, 1993)  have a l s o been  noted. The a m b i g u i t y o f MS c o u p l e d w i t h i t s u n p r e d i c t a b l e c o u r s e i s one o f the most f r u s t r a t i n g f a c t o r s o f the d i s e a s e f o r i n d i v i d u a l s and f a m i l y members (Thornton & Lea,  1992;  16 Wedi, 1 984) . I n a d d i t i o n , many o f t h e symptoms, such as t r e m o r s , speech d i f f i c u l t i e s , and b l a d d e r o r bowel  problems,  are p o t e n t i a l l y e m b a r r a s s i n g (Crawford & M c l v o r , 1987), and may, t h e r e f o r e , be a source o f p s y c h o s o c i a l s t r e s s . Some i n d i v i d u a l s a r e p l a g u e d w i t h t h e q u e s t i o n s , "Why me?" and "What s h o u l d I t e l l p e o p l e about MS?" (MS S o c i e t y o f Canada, 1992; R e a g l e s , 1982), which r e f l e c t s p i r i t u a l and s o c i a l stress  (Finder,  1990).  I n d i v i d u a l s who e x p e r i e n c e i n v i s i b l e symptoms may have more d i f f i c u l t y coming t o terms w i t h t h e i r c o n d i t i o n  because  "they a r e unable t o f i n d c i t i z e n s h i p e i t h e r i n t h e w o r l d o f the h e a l t h y o r i n t h e w o r l d o f t h e s i c k "  (Thornton & L e a ,  1992, p. 3 2 3 ) . Furthermore, some p e o p l e w i t h MS may f e e l e i t h e r g u i l t y o r judged f o r h a v i n g s e e m i n g l y i l l e g i t i m a t e symptoms such as f a t i g u e  ( B u r n f i e l d , 1993; Hubsky & S e a r s ,  1 992). F a t i g u e as a S t r e s s o r i n MS. found f a t i g u e t o be a predominant p e o p l e w i t h MS ( F i s k e t a l . ,  S e v e r a l s t u d i e s have symptom and s t r e s s o r i n  1994; Krupp e t a l . ,  e t a l . , 1 989; Schwartz e t a l . ,  1988; Krupp  1 993) . A l t h o u g h t h e cause o f  f a t i g u e i s not c o m p l e t e l y u n d e r s t o o d , i t i s b e l i e v e d t h a t the d e m y e l i n i z a t i o n i s a c o n t r i b u t i n g f a c t o r .  Because  17 demyelinization  slows c o n d u c t i o n i n p e r i p h e r a l nerve f i b e r s ,  even m i n i m a l p h y s i c a l a c t i v i t y may  result in a  d i s p r o p o r t i o n a l l o s s o f energy or f a t i g u e 1992). Hubsky and s c l e r o s i s as  Sears d e s c r i b e  (Hubsky & S e a r s ,  fatigue i n multiple  follows:  F a t i g u e i s a d i s t i n c t symptom complex,  reporting  d i s t i n g u i s h i n g c h a r a c t e r i s t i c s that d i f f e r e n t i a t e i t . from normal f a t i g u e , a f f e c t i v e d i s t u r b a n c e , neurological f a t i g u e i n MS  impairment  and  Unique c h a r a c t e r i s t i c s o f  i n c l u d e the f o l l o w i n g :  (a) i t o c c u r s more  q u i c k l y than normal; (b) i t i s more f r e q u e n t and than normal; (c) i t i s c h r o n i c ; o t h e r MS  symptoms; and  r e l a t e d to neurologic  (d) i t e x a c e r b a t e s  (e) i t s s e v e r i t y i s not  p.  1989,  fatigue,  be  (Hubsky & S e a r s , 1992;  1988). They a r e :  (a) normal f a t i g u e ,  (c) muscular f a t i g u e , and  (d) MS  experienced Krupp et (b)  o f t e n i n i n d i v i d u a l s w i t h MS.  o c c u r more q u i c k l y and Episodic  episodic  f a t i g u e . Normal  f a t i g u e o c c u r s i n everyone as a r e s u l t of work and d a i l y a c t i v i t i e s , yet i t may  MS  176-777).  There are f o u r t y p e s of f a t i g u e t h a t may  al.,  always  s t a t u s or s e v e r i t y of o t h e r  symptoms (Hubsky & S e a r s , 1992,  by an i n d i v i d u a l w i t h MS  severe  other more  f a t i g u e produces, a  18  f e e l i n g o f b e i n g worn out and r e s u l t s i n c o n s i d e r a b l e energyl o s s and i n a b i l i t y t o c a r r y out r e g u l a r a c t i v i t i e s .  Muscular  f a t i g u e , r e l a t e d t o muscle weakness or nerve f i b e r f a t i g u e , o c c u r s suddenly and i n t e r r u p t s a c t i v i t i e s such as w a l k i n g o r w r i t i n g . I n c r e a s e d e f f o r t needed t o p e r f o r m t a s k s r e l a t e d t o a c t i v i t i e s o f d a i l y l i v i n g may  cause t h i s extreme type o f  f a t i g u e . F i n a l l y , MS f a t i g u e i s unique t o MS and i s s e v e r e , f t may  o c c u r w i t h o u t w a r n i n g , at any time o f day, c a u s i n g  the p e r s o n t o f a l l a s l e e p i n the m i d d l e o f an  activity.  I n an i m p o r t a n t s t u d y by F i s k e t a l . ( 1 9 9 4 ) ,  the  r e s e a r c h e r s addressed the need f o r f u r t h e r u n d e r s t a n d i n g o f the impact o f f a t i g u e caused by a m e d i c a l problem on the i n d i v i d u a l ' s d a i l y l i f e . P r e v i o u s s t u d i e s had  investigated  f a t i g u e s e v e r i t y and f a t i g u e f r e q u e n c y (Krupp e t al.. , 1 9 8 9 ; Schwartz et a l . , 1 9 9 3 ) , but not the impact o f f a t i g u e  on  individuals' daily lives. The F a t i g u e Impact S c a l e (FIS) was  a d m i n i s t e r e d t o 85  p e o p l e w i t h MS and 20 p e o p l e w i t h h y p e r t e n s i o n . P e o p l e w i t h MS had s i g n i f i c a n t l y h i g h e r FIS s c o r e s (M=66.8,  SD=36.0)  than those i n the c o n t r o l group (M=29.2, .£D=29.6). A l t h o u g h the mean d i f f e r e n c e was c o n v i n c i n g , the l a r g e s t a n d a r d d e v i a t i o n s w a r r a n t f u r t h e r i n v e s t i g a t i o n . Of the 85  1 p a r t i c i p a n t s i n t h e group, 14 were male and 71 were female. T h i s was n o t addressed i n any way, and d i f f e r e n c e s i n reported  f a t i g u e i n men and women were n o t e x p l o r e d ,  p r o b a b l y due t o t h e uneven r a t i o o f men t o women i n t h e study. An i m p o r t a n t f i n d i n g was t h e l a c k o f r e l a t i o n s h i p between c l i n i c a l symptoms o f MS o r d u r a t i o n  o f bouts o f  f a t i g u e and a h i g h s c o r e on t h e F I S (r=.07 and r=-.06, r e s p e c t i v e l y ) . T h i s may have i m p l i c a t i o n s f o r c l i n i c i a n s because i t i s n o t p o s s i b l e t o p r e d i c t t h e degree t o w h i c h f a t i g u e a f f e c t s t h e l i v e s o f p e o p l e w i t h MS by d o i n g a r o u t i n e c l i n i c a l assessment. I n a d d i t i o n , p e o p l e who had b e n i g n MS (M=6) r e p o r t e d  s i g n i f i c a n t f a t i g u e on t h e FIS,  which u n d e r s c o r e s t h e p r e v a l e n c e o f t h e symptom i n t h e absence o f n e u r o l o g i c a l d y s f u n c t i o n .  Due t o t h e s m a l l  sampl  s i z e o f i n d i v i d u a l s w i t h t h i s type o f MS, f u r t h e r s t u d y i s w a r r a n t e d . T h i s measure may be u s e f u l i n o p e r a t i o n a l i z i n g fatigue. Sears and Hubsky (1993) conducted a s t u d y on t h e e f f i c a c y o f 17 s p e c i f i c s t r a t e g i e s used t o cope w i t h MS f a t i g u e . They found t h a t a l l p a r t i c i p a n t s delegating  tasks,^taking  (n=30) r a t e d  naps, r e s t i n g , and a v o i d i n g  stress  20 as the most e f f i c a c i o u s c o p i n g s t r a t e g i e s . The number o f years since diagnosis a f f e c t e d  individuals  7  perception of  e f f i c a c y . People who had been l i v i n g w i t h MS f o r more t h a n t h r e e y e a r s r a t e d p a c i n g a c t i v i t i e s , managing s t r e s s , and t a k i n g naps as more e f f i c a c i o u s than d i d p e o p l e who had been l i v i n g w i t h the d i s e a s e f o r l e s s t h a n t h r e e y e a r s (Sears & Hubsky, 1993, p. 5 ) . The r e s e a r c h e r s c o n c l u d e d t h a t newly d i a g n o s e d i n d i v i d u a l s may not have l e a r n e d how t o cope w i t h fatigue. In summary, f a t i g u e  i s a p r e v a l e n t symptom i n  i n d i v i d u a l s who have MS and may have a s i g n i f i c a n t impact on the c o u p l e ' s d a i l y l i v e s . . F a t i g u e i s a p a r t i c u l a r l y d i f f i c u l t symptom f o r c l i n i c i a n s t o u n d e r s t a n d due t o the l a c k o f r e l a t i o n s h i p w i t h r e p o r t e d impact and assessment o f f a t i g u e f i n d that  fatigue  invisible  and, o f t e n ,  neurological,  s e v e r i t y . Furthermore, spouses may  i s d i f f i c u l t t o u n d e r s t a n d due t o i t s , u n p r e d i c t a b l e n a t u r e . Because-  i n d i v i d u a l s w i t h MS a r e u s u a l l y young and appear h e a l t h y , t h e i r symptoms may be d i s c o u n t e d o r m i n i m i z e d by t h e i r f a m i l y . People w i t h MS may be accused o f t r y i n g t o get out of housework, s e e k i n g a t t e n t i o n , in significant relationships  o r not b e i n g as  as they once were  interested  (Burnfield,  21 1993). Consequently,  the s u b j e c t i v e nature of f a t i g u e lends  i t s e l f t o m i s i n t e r p r e t a t i o n by t h e person's other  significant,  (Hubsky & Sears, 1992). T h e r e f o r e , f a t i g u e i s an  i m p o r t a n t symptom t o c o n s i d e r i n t h e c o n t e x t o f s t r e s s and c o p i n g w i t h MS because i t can cause many p r o b l e m s - - p h y s i c a l , e m o t i o n a l , f a m i l i a l , and s o c i a l . Furthermore,  the extent to  which t h e i n d i v i d u a l w i t h f a t i g u e f e e l s u n d e r s t o o d i s expected t o be r e l a t e d t o c o p i n g The  efficacy.  Impact o f C h r o n i c I l l n e s s on t h e M a r i t a l R e l a t i o n s h i p A c c o r d i n g t o deLoach and Greer  sources o f s t r e s s f o r c h r o n i c a l l y i l l environmental  (1981), t h e t h r e e major people are s o c i a l or  f r u s t r a t i o n , pressure concerning  expectations  o f t h e s e l f o r o t h e r s , and c o n f l i c t . When one p a r t n e r i s chronically i l l ,  the s t r e s s o r s are i n c r e a s e d . I t i s not the  p h y s i c a l l i m i t a t i o n s , p e r se, which cause s t r e s s , b u t r a t h e r the need t o cope w i t h l i m i t a t i o n s w i t h i n t h e c o n f i n e s o f a c l o s e r e l a t i o n s h i p . deLoach and Greer found t h a t i n d i v i d u a l d i f f e r e n c e s such as pace o f l i f e ,  s o c i a l a c t i v i t i e s , and  a l l o c a t i o n o f r e s p o n s i b i l i t y a t home a r e a c c e n t u a t e d . P a r t n e r s go from f e e l i n g a l t r u i s t i c t o f e e l i n g overburdened and used, and t h e p e r s o n who i s s i c k f e e l s g u i l t y f o r t a k i n g  22 the spouse's time, and i s a f r a i d o f h a v i n g  t o r e l y on the.  spouse. In an e x p l o r a t o r y study d e s i g n e d t o i d e n t i f y s t r e s s o r s and c o p i n g b e h a v i o u r s o f s p o u s a l c a r e g i v e r s o f i n d i v i d u a l s w i t h MS, O'Brien (1993) found t h a t c a r e g i v i n g spouses experience  s t r e s s because o f t h e d a i l y and c h r o n i c impact o f  many symptoms o f t h e d i s e a s e . Among t h e s t r e s s o r s r e p o r t e d were c u r t a i l m e n t o f u s u a l a c t i v i t i e s , c h a n g i n g r o l e s , and i n c r e a s e d r e s p o n s i b i l i t y f o r managing h o u s e h o l d t a s k s . O ' B r i e n (1993) c o n c l u d e d t h a t these f a c t o r s , a l l r e l a t e d t o an i n c r e a s e d dependency on t h e w e l l spouse, "maximize s o c i a l and p s y c h o l o g i c a l problems t h a t e v o l v e and c o n t i n u e over an extended p e r i o d o f time"  t o grow  (p.124).  O ' B r i e n (1993) found t h a t t h e r e was a p o s i t i v e c o r r e l a t i o n between s t r e s s and t h e use o f p r o b l e m - f o c u s e d and e m o t i o n - f o c u s e d c o p i n g s t r a t e g i e s , s u g g e s t i n g  t h a t "as  s t r e s s i n c r e a s e d , so d i d t h e use o f t h e i r c o p i n g s t r a t e g i e s " (p. 131). I n a d d i t i o n , c a r e g i v e r s used more e m o t i o n - f o c u s e d c o p i n g s t r a t e g i e s as s t r e s s r e l a t e d t o t h e spouse's i l l n e s s i n c r e a s e d . A l t h o u g h t h i s study a s s e s s e d experienced  t h e degree o f s t r e s s  and c o p i n g s t r a t e g i e s used, i t . i s not c l e a r t h a t  the c a r e g i v e r ' s p e r c e p t i o n o f t h e c o p i n g was h e l p f u l . The  23;" \. q u e s t i o n o f whether these c o p i n g s t r a t e g i e s were h e l p f u l t o the spouse o r t o t h e c o u p l e remains.unanswered, and represents a l a r g e l y ignored area o f study i n the l i t e r a t u r e on s t r e s s and c o p i n g . Couple  Communication  When an i n d i v i d u a l i s diagnosed w i t h a c h r o n i c i l l n e s s , i t i s not o n l y t h a t i n d i v i d u a l who i s a f f e c t e d , b u t t h e entire family unit Fry,  ( D a n i e l s o n , H a m e l - B i s s e l l , & Winstead-  1 993) . Consequently,  effects of i l l n e s s  r e c e n t s t u d i e s have f o c u s e d on t h e  on t h e m a r i t a l r e l a t i o n s h i p  Edelmann, 1988). I n communication  (Woollett &  theory, f a m i l i e s , rather  .than i n d i v i d u a l s , have come t o be seen as t h e s i g n i f i c a n t u n i t o f s t u d y . Because t h e (communication)  system must be  u n d e r s t o o d o n l y i n i t s e n t i r e t y , a f o c u s on t h e i n d i v i d u a l i s apt t o be m i s l e a d i n g (Raush, G r e i f , & Nugent, The i s s u e o f c o u p l e communication  1979).  becomes i m p o r t a n t i n  a s t u d y c o n c e r n i n g c h r o n i c i l l n e s s . A l t h o u g h MS i t s e l f does not make o r break m a r r i a g e s , i t does p u t a s t r a i n on any marriage  (Wolf, 1984; W o o l l e t t & Edelmann,  1988).  In s i t u a t i o n s c o n c e r n i n g s u b j e c t i v e i s s u e s ,  individuals  may o v e r e s t i m a t e how much t h e y know about t h e i r spouse as w e l l as how much t h e i r spouse knows about them ( S i l l a r s &  24 Scott, 1 9 8 3 ) .  I n t h e p r e s e n t study, t h e s u b j e c t i v e i s s u e a t  hand i s t h e impact o f f a t i g u e on t h e i n d i v i d u a l w i t h  MS.  Therefore,, i t i s p o s s i b l e t h a t t h e w e l l spouse may assume t h a t what they p e r c e i v e  about t h e i l l  partner's  fatigue i s  congruent w i t h t h e i r p a r t n e r ' s p e r c e p t i o n . When a l a c k o f congruence i n p e r c e p t i o n the c o p i n g  of i l l n e s s - r e l a t e d issues  o f t h e i n d i v i d u a l who i s i l l  occurs,  may be n e g a t i v e l y  a f f e c t e d because t h e r e may be a n o n - v e r b a l d i s c o r d w i t h t h e spouse. T h i s , i n t u r n , c o u l d l e a d t o a d e c r e a s e d sense o f coping  e f f i c a c y w i t h t h e i l l n e s s - - i n t h i s c a s e , MS f a t i g u e .  P i k e and S i l l a r s  (1985) discuss a s o c i a l  skills  approach t o c o u p l e communication t h a t s u g g e s t s t h a t m a r i t a l d i s s a t i s f a c t i o n i s t h e r e s u l t o f i n e f f e c t i v e communication. The r e s u l t s o f t h e i r s t u d y were m o s t l y c o m p a t i b l e w i t h i n t e r p r e t a t i o n . However, they found t h a t  this  "non-verbal  p a t t e r n s were more c o n s i s t e n t w i t h p r e v a i l i n g assumptions about e f f e c t i v e communication than v e r b a l c o n f l i c t  patterns"  (p. 3 1 8 ) . T h i s f i n d i n g has i m p o r t a n t i m p l i c a t i o n s i n t h e p r e s e n t s t u d y because p e r c e i v e d  f a t i g u e i s s u b j e c t i v e , and  thus l e n d s i t s e l f t o m i s i n t e r p r e t a t i o n i f not d i s c u s s e d openly.  25 I n a study o f f a m i l y communication p a t t e r n s and c o p i n g w i t h b r e a s t cancer,  H i l t o n (1994) e x p l o r e d  communication  w i t h i n t h e m a r i t a l r e l a t i o n s h i p . Q u a l i t a t i v e and q u a n t i t a t i v e d a t a were c o l l e c t e d from f a m i l i e s  concerning  t y p e s o f d i s c u s s i o n p a t t e r n s about f e e l i n g s r e l a t e d t o a d i a g n o s i s of breast cancer.  In a d d i t i o n to the i n t e r v i e w s ,  f a m i l y members completed The ENRICH Couple Communication Scale  (CCS) as w e l l as t h e S t a t e - T r a i t A n x i e t y  ( S p i e l b e r g e r , 1983). The CCS focuses  Inventory  on t h e l e v e l o f c o m f o r t  f e l t by t h e p a r t n e r i n s h a r i n g and r e c e i v i n g e m o t i o n a l cognitive  and  information.  R e s u l t s o f t h i s study i n d i c a t e d t h a t " s h a r i n g meaning was a c e n t r a l s t r a t e g y f o r f a m i l i e s . . . B y s h a r i n g meaning, t h i s a l l o w e d members t o be i n sync w i t h one a n o t h e r , t o show t h e i r c o n c e r n and s u p p o r t ,  t o make and c a r r y out d e c i s i o n s ,  and t o enhance f a m i l y adjustment and s a t i s f a c t i o n " 1994,  (Hilton,  p. 369). Couples who agreed t h a t communicating about  t h e i r f e e l i n g s o r not communicating about t h e i r f e e l i n g s were more s a t i s f i e d w i t h t h e i r p a t t e r n s o f s h a r i n g meaning t h a n were those c o u p l e s who h e l d d i s c r e p a n t views about t h e importance o f t a l k i n g about f e e l i n g s .  26 F i v e major t y p e s o f c o u p l e d i s c u s s i o n p a t t e r n s were i d e n t i f i e d . They were; " t a l k e r s "  ( r e a s o n a b l e t a l k i n g and  a t t e n t i v e l i s t e n i n g by b o t h members), "medium t a l k e r s "  (both  l i s t e n and t a l k t o some degree, o r one t a l k s and t h e o t h e r listens),  " n o n t a l k e r s " (both p a r t n e r s view not t a l k i n g as an  important f a c i l i t a t i n g s t r a t e g y ) , "minorly d i s c r e p a n t " ( p a r t n e r s have d i v e r g e n t views on t h e importance o f t a l k i n g ) , and " m a j o r l y d i s c r e p a n t " ( g e n e r a l l y a r g u m e n t a t i v e and i n s e n s i t i v e communication) ( H i l t o n ,  1994). The more  s i m i l a r l y t h e c o u p l e s viewed t h e importance  of verbal  communication, t h e more s a t i s f i e d they were w i t h t h e r e l a t i o n s h i p , t h e more s u p p o r t e d they f e l t ,  and t h e b e t t e r  t h e i r adjustment t o t h e i r d i a g n o s i s and t h e t r e a t m e n t " (Hilton,  1994,  p.382).  C o r b i n and S t r a u s s  (1984) found t h a t i t was  through  t a l k i n g t h a t spouses were a b l e t o know how t h e i r p a r t n e r s f e l t about t h e i r responses  t o t h e i r needs. Communication  between i n t i m a t e p a r t n e r s can have t h e g o a l o f " i n c r e a s i n g openness and r e d u c i n g t h e number o f p r i v a t e m i s c o n c e p t i o n s " ( S i l l a r s & S c o t t , 1983, p.165). T h e r e f o r e , t h e e x t e n t t o which c o u p l e s ' p e r c e p t i o n s o f t h e i r communication i s congruent i s i n c l u d e d i n t h i s study because i t i s e x p e c t e d  27 t h a t i t w i l l be p o s i t i v e l y r e l a t e d t o congruence o f p e r c e p t i o n o f f a t i g u e and c o p i n g e f f i c a c y w i t h f a t i g u e . The more congruent t h e c o u p l e i s c o n c e r n i n g communication, t h e more congruent they a r e expected  t o be c o n c e r n i n g f a t i g u e  impact, and t h e more c o p i n g e f f i c a c y t h e i n d i v i d u a l w i t h MS i s expected  to experience.  Fowers and O l s o n  (1989) found t h a t t h e r e were no  s i g n i f i c a n t gender d i f f e r e n c e s i n s a t i s f a c t i o n w i t h c o u p l e communication. Other r e s e a r c h e r s have found t h a t e f f e c t i v e communication l e a d s t o more a c c u r a t e i n t e r p e r s o n a l p e r c e p t i o n ( F o u r n i e r , O l s o n , & Druckman, 1983; H i l t o n , 1994). I n o t h e r words, i f a c o u p l e agrees on an i s s u e , t h e r e would be g r e a t e r u n d e r s t a n d i n g  (White, 1985). T h i s  concept  may be c a l l e d c o u p l e consensus, congruence, o r agreement. Shared P e r c e p t i o n s w i t h i n t h e M a r i t a l R e l a t i o n s h i p (Congruence) The Webster's E n c y c l o p e d i c Unabridged D i c t i o n a r y o f t h e E n g l i s h Language (1989) d e f i n e s congruence as " t h e q u a l i t y or s t a t e o f a g r e e i n g o r c o r r e s p o n d i n g " al.  (p. 310). Wineman e t  (1993) d e f i n e d congruence i n i l l n e s s u n c e r t a i n t y as " t h e  degree o f harmony between t h e husband's and w i f e ' s p e r c e p t i o n s about i l l n e s s u n c e r t a i n t y " (p. 356). I n t h e  28 p r e s e n t s t u d y , congruence i n p e r c e p t i o n o f f a t i g u e i s d e f i n e d as the degree o f agreement between the husband's and w i f e ' s p e r c e p t i o n s o f f a t i g u e impact. Schutz and Roy  (1973) used the term " a b s o l u t e e r r o r " t o  denote a mean s c o r e d i f f e r e n c e w i t h i n i n d i v i d u a l s on t a s k performance. In the p r e s e n t s t u d y , congruence  was  o p e r a t i o n a l i z e d i n a s i m i l a r manner, t h a t i s , the mean s c o r e d i f f e r e n c e between m a r r i e d p a r t n e r s f o r p e r c e i v e d f a t i g u e impact was  calculated.  T e s t i n g f o r congruence e f f e c t s s h o u l d be most s e n s i t i v e i f i t i s done w i t h i n a r e l a t i o n s h i p t h a t i s s t r o n g and c o n t i n u i n g . The m a r i t a l r e l a t i o n s h i p p r o v i d e s such a c o n t e x t f o r s t u d y i n g congruence e f f e c t s  ( R e i c h , Z a u t r a , & Manne,  1 993). Rodgers and C a l d e r  (1990) have found a p o s i t i v e  r e l a t i o n s h i p between m a r i t a l adjustment and adjustment i n people w i t h MS.  emotional  Moreover, C o r b i n and  Strauss  (1984) s t a t e t h a t problems i n managing d a i l y t a s k s  may  develop when c o u p l e s u n d e r s t a n d  illness  and p e r c e i v e t h e i r  d i f f e r e n t l y . Thus, " f o r c o u p l e s , d i f f e r i n g p e r c e p t i o n s o f i l l n e s s u n c e r t a i n t y may (Wineman e t a l . ,  1993,  l e a d t o t e n s i o n i n the  marriage"  p. 357). The p r e s e n t s t u d y i n t r o d u c e s  29 the i l l  person's e x p e r i e n c e  of f a t i g u e , the s i m i l a r i t y  d i f f e r e n c e i n t h e i r spouse's u n d e r s t a n d i n g r e l a t i o n s h i p o f congruence t o c o p i n g  of i t ,  and  or the  efficacy.  However, i t i s not n e c e s s a r i l y t r u e t h a t j u s t because two p e o p l e are c o u p l e d ,  they share s i m i l a r p e r s p e c t i v e s  s u b j e c t i v e i s s u e s . When one  spouse has  on  a highly  u n p r e d i c t a b l e c h r o n i c i l l n e s s such as MS,  i t is likely  that  each p a r t n e r ' s p e r c e p t i o n o f the i l l n e s s s i t u a t i o n w i l l different  be  (Wineman et a l . , 1993). Wineman et a l . have,  suggested t h a t when i l l n e s s - r e l a t e d p e r c e p t i o n s between husband and w i f e , t h e i r b e h a v i o u r s , management s t r a t e g i e s , and synchronized.  f u t u r e dreams may  Thus, they may  differ  goals, not  be  f a i l t o make the r o l e  adjustments n e c e s s a r y f o r what t h e y deem t o be e f f i c a c i o u s c o p i n g . Furthermore, i n a study o f f a m i l i e s ' a d a p t a t i o n medical  crises, Fife  to  (1985) found t h a t "congruence i n  expectations w i t h i n family r e l a t i o n s h i p s i s necessary i f i n t e g r a t i o n i s t o e x i s t and c o n f l i c t i s t o be m i n i m i z e d "  (p.  1 09) . Wineman et a l . (1993) s t u d i e d the impact of d i f f e r i n g perceptions  of i l l n e s s u n c e r t a i n t y between p e o p l e w i t h  and t h e i r spouses on e m o t i o n a l  w e l l - b e i n g . The  Mishel  MS  30 Illness Uncertainty et a l . 1993)] was the p e r c e p t i o n  Scale  [ M i s h e l , 1990  administered  Congruence i n  c a l c u l a t e d by  d i f f e r e n c e between the spouses'  on u n c e r t a i n t y s c a l e i t e m s .  scores  Congruence i n p e r c e i v e d  t r e a t e d as a c o n t i n u o u s v a r i a b l e ,  r a t i o l e v e l data. Therefore, with  t o 61 c o u p l e s .  of i l l n e s s u n c e r t a i n t y was  summing the a b s o l u t e  u n c e r t a i n t y was  (as c i t e d i n Wineman  results  s h o u l d be  yielding  interpreted  caution. The  a s s o c i a t i o n between the spouses' p e r c e p t i o n s  uncertainty  (congruence) was  significant  (r_=.38, p.<.01). I n p e o p l e w i t h MS,  perception  moderate and  of i l l n e s s u n c e r t a i n t y was  of  statistically a gap  in  not r e l a t e d t o mood or  f a m i l y s a t i s f a c t i o n . However, f o r the w e l l spouses, the same l a c k of congruence n e g a t i v e l y a f f e c t e d f a m i l y F i n a l l y , the r e s e a r c h e r s  went on t o a n a l y z e  p r e d i c t i v e n a t u r e of i l l n e s s u n c e r t a i n t y and mood and  satisfaction.  perception  The  satisfaction. the  i t s impact  on  s t u d y found t h a t "congruence i n  accounted f o r a s i g n i f i c a n t amount of v a r i a n c e  spouses' sense of f a m i l y s a t i s f a c t i o n " words, spouses o f i n d i v i d u a l s w i t h MS  (p. 359).  In  in  other  f e e l a g r e a t e r sense •  of f a m i l y s a t i s f a c t i o n when they agreed w i t h the i l l  partner  on i s s u e s r e l a t e d t o the u n c e r t a i n t y of the i l l n e s s .  In  31 L a z a r u s ' s (1984) t h e o r y ,  t h i s would mean t h a t spouses  e x p e r i e n c e more f a m i l y s a t i s f a c t i o n when they a p p r a i s e the. s t r e s s o r o f i l l n e s s u n c e r t a i n t y i n a s i m i l a r manner t o t h a t o f t h e o t h e r p e r s o n i n t h e dyad. The  g r e a t e s t c o n t r i b u t i o n o f Wineman e t a l . ' s (1993)  work t o t h e p r e s e n t r e s e a r c h p r o j e c t i s t h e o p e r a t i o n a l i z a t i o n o f t h e congruence phenomenon w i t h i n t h e m a r i t a l r e l a t i o n s h i p . A l t h o u g h a gap i n congruence c o n c e r n i n g i l l n e s s u n c e r t a i n t y d i d not n e g a t i v e l y a f f e c t f a m i l y s a t i s f a c t i o n o f t h e i n d i v i d u a l s w i t h MS, i t d i d so . f o r t h e w e l l spouses. T h i s f i n d i n g may r e f l e c t t h e f a c t t h a t i l l n e s s u n c e r t a i n t y can p u t more p r e s s u r e  on t h e w e l l spouse  because they w i l l have t o assume more and more r e s p o n s i b i l i t y as t h e i l l n e s s p r o g r e s s e s .  Therefore, i t  f o l l o w s t h a t a l a c k o f congruence about t h i s i s s u e would impact more on t h e w e l l spouse's sense o f f a m i l y s a t i s f a c t i o n , than on t h a t o f t h e i n d i v i d u a l w i t h MS. However, i n t h e case o f congruence c o n c e r n i n g p e r c e p t i o n o f f a t i g u e impact, t h e f a t i g u e may be more o f a s t r e s s o r f o r the i n d i v i d u a l w i t h MS. Not o n l y must t h e p e r s o n d e a l  with  i t s p h y s i c a l e f f e c t s , but they must a l s o i n t e r a c t w i t h t h e w e l l spouse and d e a l w i t h t h e i r r e a c t i o n s t o t h i s f a t i g u e .  32  Because c o u p l e congruence i s a r e l a t i v e l y  unresearched  construct, further i n v e s t i g a t i o n of i t s o p e r a t i o n a l i z a t i o n i s an i m p o r t a n t a r e a o f s t u d y . There i s a common assumption s a t i s f a c t i o n and adjustment  that a couple's  marital  a r e d i r e c t l y r e l a t e d t o each  spouse's a c c u r a t e p e r c e p t i o n o f t h e i r p a r t n e r (White,  1985).  However, i t i s i m p o r t a n t t o d i s t i n g u i s h between p e r c e i v e d s i m i l a r i t y and u n d e r s t a n d i n g . P e r c e i v e d s i m i l a r i t y r e p r e s e n t s t h e e x t e n t t o which one spouse b e l i e v e s t h e i r mate agrees w i t h them on i m p o r t a n t i s s u e s .  Understanding  r e p r e s e n t s whether one spouse can a c c u r a t e l y p r e d i c t t h e response o f t h e o t h e r . Both o f these a s p e c t s o f c o u p l e congruence a r e i m p o r t a n t i n t h e c u r r e n t s t u d y - - e x a m i n i n g t o what e x t e n t b o t h p a r t n e r s i n a m a r r i a g e p e r c e i v e t h e impact o f MS f a t i g u e on t h e i n d i v i d u a l w i t h t h e d i s e a s e . S t r e s s o r s e x p e r i e n c e d i n c o u p l e s when one i n d i v i d u a l has•a c h r o n i c i l l n e s s have been shown t o be r e l a t e d t o such f a c t o r s a s : (a) e x p e c t a t i o n s o f t h e s e l f o r e x p e c t a t i o n s o f the o t h e r p e r s o n  (deLoach & Greer, 1 9 8 1 ) ,  (b) i n c r e a s e d  dependency on t h e w e l l spouse, and (c) degree o f congruence about i l l n e s s - r e l a t e d i s s u e s w i t h i n t h e m a r i t a l dyad ( H i l t o n , 1 9 9 4 ; Wineman e t a l . , 1 9 9 3 ) . Because f a t i g u e i s a  33 p r e v a l e n t symptom i n MS, w e l l spouses may  and because the e x p e c t a t i o n s t h a t  have o f t h e i r p a r t n e r s can cause  friction  when an i l l n e s s o r d i s a b i l i t y i s p r e s e n t , agreement w i t h i n the m a r i t a l dyad c o n c e r n i n g the impact o f f a t i g u e i s i m p o r t a n t t o c o n s i d e r . T h e r e f o r e , the f o c u s o f t h i s  study  w i l l be t o examine the e x t e n t t o which c o u p l e s ' congruence i n p e r c e p t i o n of f a t i g u e  (when one p e r s o n has MS)  i s related  t o the c o p i n g e f f i c a c y w i t h f a t i g u e o f the i n d i v i d u a l who  is  ill. D e f i n i t i o n s o f Coping E f f i c a c y At f i r s t g l a n c e , the d e f i n i t i o n o f c o p i n g e f f i c a c y appears t o be r e a s o n a b l y s i m p l e . However, t h e r e i s some c o n f u s i o n o f terms i n the c o p i n g l i t e r a t u r e . "When e f f i c a c y , i s i m p l i e d by c o p i n g and i n e f f i c a c y by defense, t h e r e i s an i n e v i t a b l e c o n f o u n d i n g between the p r o c e s s o f c o p i n g and outcome o f c o p i n g " (Lazarus & Folkman, 1 9 9 1 , p. 2 0 0 ) .  the  The  terms " c o p i n g e f f e c t i v e n e s s " and " c o p i n g e f f i c a c y " are  often  used i n t e r c h a n g e a b l y and/or i n a c c u r a t e l y . For purposes  of  c l a r i f i c a t i o n , I o p e r a t i o n a l i z e these terms as d e f i n e d by F i l i p p and K l a u e r ( 1 9 9 0 ) .  Coping e f f e c t i v e n e s s i s d e f i n e d as  "the e m p i r i c a l l y d e t e c t e d a s s o c i a t i o n between c o p i n g b e h a v i o u r s and adjustment  i n d i c a t o r s . . . . o b j e c t i v e l y measured  34 x  f r o m t h e o u t s i d e ' " (p.217). Coping e f f i c a c y , on t h e o t h e r  hand, i s d e f i n e d as " p e r c e i v e d u t i l i t y o f c o p i n g  responses  i n a t t a i n i n g one's s u b j e c t i v e g o a l s " (p.217). A l t h o u g h t h e d i s t i n g u i s h i n g f e a t u r e s o f these d e f i n i t i o n s may appear t o be m i n i m a l , they a r e i m p o r t a n t i n t h i s s t u d y .  Coping  e f f i c a c y i s t h e term t h a t most a c c u r a t e l y r e f l e c t s  Lazarus  and Folkman's t h e o r y , whereas c o p i n g e f f e c t i v e n e s s r e f l e c t s the l a y p e r s o n ' s use o f t h e term  "coping".  Despite t h i s c l a r i f i c a t i o n , coping e f f i c a c y i s a h i g h l y s u b j e c t i v e c o n s t r u c t , and i s , t h e r e f o r e , d i f f i c u l t t o quantify  ( M c H a f f i e , 1992; Stone, Greenberg, Kennedy-Moore, &  Newman, 1991). Based on L a z a r u s ' s t h e o r y , A l d w i n  (1994)  s t a t e s t h a t "one must c o n t r o l f o r . . . t h e l e v e l o f c o p i n g e f f o r t , o r one must use i n t e r a c t i o n terms w i t h c o p i n g e f f i c a c y f o r a more a c c u r a t e p i c t u r e o f t h e e f f e c t o f any g i v e n c o p i n g s t r a t e g y " (p.273). When measuring  coping  e f f i c a c y , and what p e o p l e do t o cope e f f i c a c i o u s l y , t h e q u e s t i o n o f v a l u e s i s an i n e v i t a b l e a s p e c t o f t h e c o n s t r u c t . T h i s i s t o say, " e f f i c a c i o u s " i s a r e l a t i v e term. Someone who e x p e r i e n c e s f a t i g u e may f e e l t h a t r e s t i n g more o f t e n i s an e f f i c a c i o u s c o p i n g s t r a t e g y , whereas t h a t person's  spouse  35 may  see i t as i n e f f i c a c i o u s , because the  accomplishes  individual  l e s s i n a day due t o f r e q u e n t r e s t p e r i o d s .  F i l i p p and K l a u e r (1990) a l s o s t a t e t h a t c o p i n g i s "by no means t o be equated w i t h t r a i t - l i k e  dispositions  to handle s t r e s s f u l s i t u a t i o n s . R a t h e r , the dynamics t h a t are i n h e r e n t i n the c o p i n g p r o c e s s i t s e l f have t o be u n d e r l i n e d , and c o p i n g has t o be c o n c e i v e d o f as a changing phenomenon. T h i s i m p l i e s t h a t s u c c e s s i n c o p i n g w i t h l i f e events cannot be e x p l a i n e d a p r i o r i  by  p e r s o n a l i t y f a c t o r s and/or s o c i a l r e s o u r c e s , but has t o be r e l a t e d t o what people do i n the f a c e o f c r i t i c a l l i f e events"  ( F i l i p p & K l a u e r , 1990,  A s t r o n g r a t i o n a l e f o r measuring  p.215).  coping e f f i c a c y ,  not  merely use o f c o p i n g s t r a t e g i e s , i s p r e s e n t e d by Folkman and Lazarus  (1980) and by A l d w i n  (1994). A l d w i n s t a t e s t h a t " I t  i s e q u a l l y a p p r o p r i a t e t o have i n d i v i d u a l s e v a l u a t e t h e i r c o p i n g b e h a v i o u r s as " h e l p f u l " or " s u c c e s s f u l " . . . as has been proposed by i n t r o d u c i n g the concept o f c o p i n g e f f i c a c y by d i s t i n g u i s h i n g i t from c o p i n g e f f e c t i v e n e s s "  and  (p.217).  T h i s n o t i o n i s s u p p o r t e d by a s t u d y by B a r - T a l and Spitzer  (1994) who  h i g h l i g h t the importance  of  c o n c e p t u a l i z i n g what they c a l l c o p i n g e f f e c t i v e n e s s as a  36 p r o d u c t o f use and p e r c e i v e d h e l p f u l n e s s o f c o p i n g s t r a t e g i e s . A c c o r d i n g t o my p r e v i o u s l y c i t e d o p e r a t i o n a l d e f i n i t i o n s , t h i s construct i s a c t u a l l y coping e f f i c a c y . They argue t h a t measuring  c o p i n g use and e f f e c t i v e n e s s  s e p a r a t e l y i s i n s u f f i c i e n t . Measuring  t h e e x t e n t t o which  c e r t a i n coping s t r a t e g i e s  a r e used r e s u l t s i n a d e s c r i p t i o n  o f t h e type o f s t r a t e g i e s  t h a t i n d i v i d u a l s use i n d i f f e r e n t  s i t u a t i o n s . Measuring h e l p f u l n e s s r e f l e c t s i n d i v i d u a l s ' ' o p i n i o n s o f what can h e l p them i n v a r i o u s s i t u a t i o n s . Each o f t h e above types o f assessment r e p r e s e n t s o n l y one dimension o f t h e c o p i n g concept. A composite  o f t h e two  dimensions, however, more a c c u r a t e l y r e f l e c t s t h e i n d i v i d u a l ' s perception of t h e i r coping e f f i c a c y . In summary, c o p i n g e f f i c a c y i s an e x t r e m e l y complex c o n s t r u c t t h a t comprises  s u b j e c t i v e judgment o f what i s  h e l p f u l i n r e l a t i o n t o each unique s t r e s s o r .  Moreover,  c o p i n g e f f i c a c y depends on an i n d i v i d u a l ' s p e r s o n a l meaning of t h e s i t u a t i o n , and h i n g e s on t h e e x t e n t t o which i t b a l a n c e s t h e e m o t i o n a l s t r e s s i n t h e i n d i v i d u a l ' s own p e r c e p t i o n and i n t h e i r t o t a l c o n t e x t  (McHaffie, 1 9 9 2 ) .  37 Problems i n O p e r a t i o n a l i z i n g Coping E f f i c a c y Despite  the c h a l l e n g e o f o p e r a t i o n a l i z i n g the  o f c o p i n g e f f i c a c y , some r e c e n t l i t e r a t u r e has  construct  appeared on  the s u b j e c t . A l t h o u g h L a z a r u s and Folkman's t h e o r y o f i s the framework on which t h i s study i s based, I  coping  review  r e s e a r c h on c o p i n g e f f i c a c y t h a t does not f o l l o w t h e i r t h e o r y as a r a t i o n a l e f o r the r e s e a r c h q u e s t i o n s present  i n the  study.  Studies that r e f l e c t d i f f i c u l t y i n o p e r a t i o n a l i z i n g c o p i n g e f f i c a c y . Buelow (1991) used The Scale  (JCS)  [ J a l o w i e c & Powers, 1981  1991)] t o assess  Jalowiec  Coping  (as c i t e d i n Buelow,  c o p i n g s t y l e s i n p e o p l e w i t h MS.  The  JCS  l i s t s 60 c o p i n g s t r a t e g i e s t h a t are r a t e d on a 4 - p o i n t L i k e r t s c a l e i n d i c a t i n g f r e q u e n c y of use. d i v i d e d i n t o eight conceptual  Coping items are  themes: c o n f r o n t i v e ,  evasive,  f a t a l i s t i c , s u p p o r t i v e , s e l f - r e l i a n t , o p t i m i s t i c , emotive, and p a l l i a t i v e , and are q u i t e d i f f e r e n t from L a z a r u s ' s e i g h t c o p i n g s t r a t e g i e s (Lazarus,  1993). Buelow i n d i c a t e d t h a t  e f f e c t i v e n e s s r a t i n g s c a l e was analyzed.  a l s o i n c l u d e d but  T h i s e f f e c t i v e n e s s r a t i n g s c a l e may  extremely important  an  not  have added an  d i m e n s i o n t o the a r e a of s t r e s s  c o p i n g w i t h c h r o n i c i l l n e s s , and i t i s u n f o r t u n a t e  and that i t  38 was  not i n c l u d e d i n the s t u d y . These r e s u l t s may  d i f f i c u l t y i n o p e r a t i o n a l i z i n g coping  reflect  efficacy.  Bennett (1993) used the Coping E f f e c t i v e n e s s Questionnaire  (CEQ;  McNett, 1985)  coping with myocardial  i n a s t u d y of i n d i v i d u a l s  i n f a r c t i o n . The  q u e s t i o n n a i r e w i t h a 5-point  CEQ  i s a 9-item  response s c a l e . Respondents are  asked t o r a t e t o what degree they f e e l s a t i s f i e d w i t h day,  f e e l a sense of w e l l - b e i n g , e t c . Bennett  suggests t h a t " p a t i e n t s ' e m o t i o n a l may  their  (1993)  responses (to i l l n e s s )  be most i n f l u e n c e d by t h e i r p e r c e p t i o n of a s i t u a t i o n  r a t h e r than by how  they cope. Emotions, r a t h e r t h a n w h i c h  c o p i n g s t r a t e g y i s used, may  p l a y the g r e a t e s t r o l e i n the  p a t i e n t ' s p e r c e i v e d c o p i n g e f f e c t i v e n e s s " (p.137).  In other  words, s p e c i f i c c o p i n g s t r a t e g i e s do not appear t o have as much of an e f f e c t on an i l l  p e r s o n ' s a p p r a i s a l of the  i l l n e s s - r e l a t e d s t r e s s o r s as do h i s or her p e r c e p t i o n s t h e i r p e r s o n a l u s e f u l n e s s . However, t h i s CEQ  instrument  of does  not have s a t i s f a c t o r y f a c e v a l i d i t y , and i t seems t o equate w e l l - b e i n g with coping  efficacy.  B a r - T a l and S p i t z e r (1994) s t a t e t h a t "most o f the r e s e a r c h i n the f i e l d  (of s t r e s s and coping) has  involved  s e l f - r e p o r t measures i n which p a r t i c i p a n t s were r e q u e s t e d  to  39 r e p o r t on the e x t e n t t o which they used each o f the behaviours.  coping  Coping s t r a t e g i e s , t h e r e f o r e , have been s t u d i e d  as n e u t r a l e n t i t i e s detached from t h e i r meaning t o the person" new  (p.91). For t h i s reason,  t h e i r s t u d y f o c u s e d on a  method o f measuring c o p i n g e f f i c a c y . In o r d e r t o  assess  t h i s c o n s t r u c t , the r e s e a r c h e r s used an adapted v e r s i o n o f the Coping S t r a t e g y S c a l e F i n e y , 1986  [Moos, C r o n k i t e , B i l l i n g s ,  (as c i t e d i n B a r - T a l & S p i t z e r , 1994)].  s t r a t e g i e s were d i v i d e d i n t o f o u r t y p e s : problem p o s i t i v e a p p r a i s a l , emotion f o c u s e d ,  & Coping  focused,  and.emotional  d i s c h a r g e . P a r t i c i p a n t s were asked t o r a t e c o p i n g use  and  p e r c e i v e d p e r s o n a l u s e f u l n e s s o f each i t e m on the f o l l o w i n g scale: a l o t / very u s e f u l , a l i t t l e  / somewhat u s e f u l ,  or  not at a l l / v e r y c o u n t e r p r o d u c t i v e . T h i s method i s a p p e a l i n g and has f a c e v a l i d i t y as an attempt t o g a i n more i n s i g h t i n t o t h i s n o t i o n of coping  efficacy.  In summary, r e s e a r c h c o n c e r n i n g . s t r e s s and c o p i n g w i t h MS o f t e n d e s c r i b e s the degree o f s t r e s s e x p e r i e n c e d  and  c o p i n g s t r a t e g i e s used, y e t one does not get a sense o f the c o p i n g e f f i c a c y o f these s t r a t e g i e s . Buelow (1991) i n t r o d u c e d a c o p i n g e f f e c t i v e n e s s s c a l e , but d i d not use i t . Moreover, the CEQ  i s c i t e d i n the l i t e r a t u r e  (McNett,  1985,  40 1987), y e t t h i s i s an i s o l a t e d c i t a t i o n and t h e r e i s no p u b l i s h e d manual, making i t an u n r e l i a b l e c h o i c e f o r t h i s p r o j e c t . Measuring  e i t h e r the type o f s t r a t e g i e s t h a t  i n d i v i d u a l s use i n d i f f e r e n t s i t u a t i o n s , o r t h e i r p e r c e i v e d h e l p f u l n e s s t o t h a t i n d i v i d u a l i n i s o l a t i o n from one  another  r e p r e s e n t s o n l y one dimension o f the c o p i n g concept.  A  composite, measurement a l l o w s r e s e a r c h e r s t o g a i n an increased understanding of coping e f f i c a c y . Summary G i v e n the p r e v a l e n c e o f MS  f a t i g u e , l i m i t e d r e s e a r c h on  congruence, and the d i f f i c u l t i e s i n q u a n t i f y i n g c o p i n g e f f i c a c y , the purpose o f t h i s s t u d y was:  (a) t o examine the  degree o f congruence between spouses c o n c e r n i n g MS  fatigue;  (b) t o examine the degree o f congruence c o n c e r n i n g c o u p l e communication p a t t e r n s ; and  (c) t o examine the r e l a t i o n s h i p s  between b o t h . a s p e c t s o f congruence and c o p i n g e f f i c a c y i n i n d i v i d u a l s w i t h MS  f a t i g u e . Gender d i f f e r e n c e s i n  congruence and c o p i n g e f f i c a c y were a l s o e x p l o r e d . Because o f the e x p l o r a t o r y n a t u r e o f t h i s s t u d y , s p e c i f i c hypotheses  no  were made r e g a r d i n g the r e l a t i o n s h i p  between congruence i n f a t i g u e impact, c o u p l e communication, and c o p i n g e f f i c a c y . However, i t seemed l o g i c a l t o expect  41 t h a t t h e e x t e n t t o which c o u p l e s were congruent c o n c e r n i n g communication would be p o s i t i v e l y r e l a t e d t o congruence i n p e r c e p t i o n o f f a t i g u e and c o p i n g e f f i c a c y . S p e c i f i c a l l y , one might expect t h a t t h e more congruent t h e c o u p l e was c o n c e r n i n g communication, t h e more congruent they were c o n c e r n i n g f a t i g u e impact, and t h e more c o p i n g e f f i c a c y t h e i n d i v i d u a l w i t h MS was e x p e c t e d t o r e p o r t .  Research Q u e s t i o n s I n m a r r i e d o r common law c o u p l e s when one spouse has MS: (1)  What i s t h e p e r c e p t i o n o f t h e degree o f f a t i g u e impact i n t h e p e r s o n w i t h MS?  (2)  What i s t h e p a r t n e r ' s p e r c e p t i o n o f t h e degree o f f a t i g u e impact on t h e spouse w i t h MS?  (3)  What i s t h e s i m i l a r i t y o f t h e p e r c e p t i o n o f f a t i g u e impact between t h e p e r s o n w i t h MS and t h e i r  (4)  partner?  What i s t h e s i m i l a r i t y o f t h e p e r c e p t i o n o f communication w i t h i n t h e m a r i t a l r e l a t i o n s h i p between the p e r s o n w i t h MS and t h e i r  (5)  partner?  What i s t h e r e l a t i o n s h i p between s i m i l a r i t y o f p e r c e i v e d f a t i g u e impact, s i m i l a r i t y o f communication and c o p i n g e f f i c a c y , c o n s i d e r i n g t h e number o f y e a r s s i n c e d i a g n o s i s and t h e l e v e l o f MS f a t i g u e ?  (6)  A r e t h e r e gender d i f f e r e n c e s i n congruence o f f a t i g u e impact, couple communication, and c o p i n g efficacy?  Operational D e f i n i t i o n s of Variables P e r c e p t i o n o f MS f a t i g u e by i n d i v i d u a l s w i t h MS and t h e i r spouses was d e f i n e d u s i n g t h e F I S . Congruence was c a l c u l a t e d by summing t h e a b s o l u t e d i f f e r e n c e o f b o t h spouses' s c o r e s on each i t e m . Congruence c o n c e r n i n g  couple  43 p e r c e p t i o n s o f t h e i r communication was d e f i n e d u s i n g the positive  c o u p l e agreement s c o r e on the CCS  Coping e f f i c a c y f o r the c o p i n g s u b s c a l e s support, problem-solving,  (see Appendix A ) .  (seeking s o c i a l  and avoidance) was measured i n t h e  spouses who have MS u s i n g the Coping S t r a t e g y I n d i c a t o r and s c o r i n g i t u s i n g t h e method c i t e d by B a r - T a l and S p i t z e r (1 994) .  44 Method C r i t e r i a for Inclusion I n d i v i d u a l s w i t h MS were i n c l u d e d i n t h i s s t u d y p r o v i d i n g t h a t they were 19-65 spouse who  was  have had MS recognized  y e a r s of age,  and had  a  a l s o w i l l i n g t o p a r t i c i p a t e . They must a l s o  f o r 1-30 fatigue  years.  One  or b o t h p e o p l e i n the dyad  (any of the f o u r t y p e s c i t e d i n the  l i t e r a t u r e review) as a problem so t h a t t h e i r p a r t i c i p a t i o n i n the s t u d y would be p e r s o n a l l y r e l e v a n t and  valid.  Participants . The  p a r t i c i p a n t s f o r t h i s s t u d y was  i n d i v i d u a l s who  have had MS  comprised o f  f o r a p e r i o d of 1-30  60  years,  and  t h e i r spouses (N =120). P a r t i c i p a n t s were r e c r u i t e d t h r o u g h the MS  S o c i e t y , B.C.  S o c i e t y . The newsletter  MS  D i v i s i o n , and The  Vancouver I s l a n d  MS  S o c i e t y announced the s t u d y i n t h e i r  and The  Vancouver I s l a n d MS  S o c i e t y sent a l e t t e r  t o i t s membership i n v i t i n g p a r t i c i p a t i o n . Both announcements r e q u e s t e d t h a t anyone who t e l e p h o n e f o r more The  average age  was  i n t e r e s t e d contact  me  by  information. o f the p e r s o n w i t h MS was  (range=24-65, S_D_=8.8), and  46  years  f o r the w e l l spouse, a l s o  46  y e a r s (range=25-64, SD=8.9). Couples were m a r r i e d an average  45 of 16 y e a r s  (range=1-42, SD=11.6). There were 17 men  and 43 women (71.7%) w i t h MS. Caucasian, Although  w h i l e 93.3%  (28.3%)  A l l i n d i v i d u a l s w i t h MS  of the spouses were  were  Caucasian.  40% o f the sample had t o t a l h o u s e h o l d incomes o f  $55,000 or more, 33% had h o u s e h o l d incomes o f $35,000$54,999, and 27%,  of l e s s than $34,999.  Spouses w i t h MS had been d i a g n o s e d an average o f years  (range=1-33, £D=7.3). Of the f o u r types of MS,  27%  r e l a p s e - r e m i t t i n g , 40% had c h r o n i c - p r o g r e s s i v e , 26% r e l a p s e - p r o g r e s s i v e , and 7% had b e n i g n MS. types of f a t i g u e , 13.3% experienced 21.7%  experienced  e p i s o d i c f a t i g u e , 8.3%  had MS  Of the  had  had four  normal f a t i g u e ,  11.7%  had muscular f a t i g u e , and  f a t i g u e . Many i n d i v i d u a l s w i t h MS  r e p o r t e d e x p e r i e n c i n g more than one  10  (40%)  type of f a t i g u e .  The m a j o r i t y of the i n d i v i d u a l s w i t h MS were on  long-  term d i s a b i l i t y p e n s i o n s (46.7%), whereas 8.5%  were w o r k i n g  f u l l - t i m e , 18.3%  r e f e r r e d to  had p a r t - t i m e work, and 23.3%  themselves as homemakers, r e t i r e d , s t u d e n t s , or v o l u n t e e r s . The  remaining  3.4%  were on s h o r t - t e r m  l e a v e from work.  Procedure A l l c o u p l e s w i s h i n g t o p a r t i c i p a t e i n the s t u d y were asked 'to telephone  the S t r e s s Lab at The U n i v e r s i t y of  46 B r i t i s h Columbia,  and a l l respondents were s c r e e n e d as p e r  the c r i t e r i a . The o n l y p a r t i c i p a n t s who were s c r e e n e d out o f the s t u d y were those people who were not m a r r i e d and had o v e r l o o k e d t h i s c r i t e r i o n on t h e i n v i t a t i o n t o p a r t i c i p a t e (n=20), o r i n d i v i d u a l s who wanted t o p a r t i c i p a t e b u t whose spouse d i d not (n=4). A l l c o u p l e s were seen i n t h e i r homes o r a t a c e n t r a l meeting p l a c e , except f o r f i v e c o u p l e s , t o whom q u e s t i o n n a i r e p a c k e t s were m a i l e d . T h i s was done o n l y w i t h c o u p l e s who wanted t o p a r t i c i p a t e b u t who l i v e d i n areas t o o remote f o r me t o a c c e s s . A l l participants  s i g n e d an i n f o r m e d consent p r i o r t o  f i l l i n g out t h e q u e s t i o n n a i r e s (see Appendix o f t h e dyad completed CCS.  t h e F I S (see Appendix  B ) . Each member C and D) and t h e  Then, t h e spouse who had MS was asked t o complete t h e  Coping S t r a t e g y I n d i c a t o r  (CSI) (see Appendix E ) .  Demographic d a t a t h a t were p e r t i n e n t t o t h i s s t u d y were c o l l e c t e d on a demographic d a t a sheet a t t h e end o f t h e q u e s t i o n n a i r e packet asked t o complete  (see Appendix  F ) . A l l c o u p l e s were  the questionnaires without c o n f e r r i n g w i t h  one another, thus e n s u r i n g u n b i a s e d  responses.  47 Measures The F a t i g u e Impact S c a l e . The FIS was used t o e v a l u a t e perception  o f f a t i g u e by the i n d i v i d u a l w i t h MS and the w e l l  spouse. The i n s t r u m e n t i s a 40-item s c a l e d e s i g n e d t o measure the p e r c e i v e d  impact o f f a t i g u e on the i n d i v i d u a l ' s  c o g n i t i v e , p h y s i c a l , and p s y c h o s o c i a l al.,  functioning  (Fisk et  1994). I n d i v i d u a l s are asked t o r a t e the degree t o  which f a t i g u e has caused problems f o r them on a 4 - p o i n t L i k e r t scale  (ranging  from 0 = no problem t o 4 = extreme  p r o b l e m ) . The minimum s c o r e i s 0 - - i n d i c a t i n g t h a t f a t i g u e • causes no problem i n a l l 40 items on the s c a l e , and maximum score i s 160--indicating  t h a t f a t i g u e i s an extreme  i n a l l 40 items on the s c a l e . Thus, the g r e a t e r the F I S , the more f a t i g u e the respondent i s  problem  the s c o r e on  experiencing.  P a r t i c i p a n t s were then asked t o r a t e the degree t o which the impact o f f a t i g u e was u n d e r s t o o d . For i n d i v i d u a l s w i t h MS,  an a d d i t i o n a l q u e s t i o n (item 41) was added t o the  FIS and r e a d "How  w e l l do you f e e l your spouse u n d e r s t a n d s  your f a t i g u e ? " For spouses, the q u e s t i o n r e a d "How  w e l l do  you f e e l you u n d e r s t a n d your spouse's f a t i g u e ? " The same 4point Likert scale  (ranging  from 0 = e x t r e m e l y w e l l t o 4 =  48 e x t r e m e l y p o o r l y ) was  used. Thus, the s m a l l e r the s c o r e  t h i s i t e m , the more u n d e r s t a n d i n g  on  there i s .  Having r e c e n t l y been developed,  the  psychometric  p r o p e r t i e s o f the FIS have not y e t been p u b l i s h e d i n a manual. F i s k et a l . (1994) c i t e d h i g h i n t e r n a l c o n s i s t e n c y w i t h a Cronbach's a l p h a g r e a t e r than o f the i n s t r u m e n t  suggests  .93  (p. 11). A  review  t h a t i t appears t o have good f a c e  v a l i d i t y . F i s k e t a l . a l s o a d m i n i s t e r e d o t h e r measures, demonstrating  s t r o n g c o n s t r u c t v a l i d i t y . They were:  Expanded D i s a b i l i t y S t a t u s S c a l e Health Inventory Profile  as c i t e d i n F i s k e t a l . ,  The  (Monroe, 1982), and  The  ( R u s s e l l , P e p l a u , & Gutrona, 1994}.  P e r s o n a l communication w i t h the t e s t d e v e l o p e r s r e g a r d s t o i t s use w i t h spouses suggested psychometric  Mental  S i c k n e s s Impact  (Bergner, B o b b i t t , C a r t e r & G i l s o n , 1981),  R e v i s e d UCLA L o n e l i n e s s S c a l e 1980)  ( K u r t s k e , 1983), The  (Weit & Ware, 1983), The  S o c i a l Readjustment R a t i n g S c a l e  The  that  with  "the  p r o p e r t i e s o f such a m o d i f i e d s c a l e remains an  e m p i r i c a l q u e s t i o n . I t i s c e r t a i n l y an i n t e r e s t i n g q u e s t i o n , however, and one t h a t i s w o r t h e x p l o r i n g " (J.D.  Fisk,  p e r s o n a l communication, October 26, 1994). Couple congruence on the FIS was  c a l c u l a t e d by summing the a b s o l u t e d i f f e r e n c e  49 between t h e spouses'  s c o r e s on f a t i g u e impact  scale items.  Schutz and Roy (1973) used t h e term " a b s o l u t e e r r o r " t o denote a mean s c o r e d i f f e r e n c e w i t h i n i n d i v i d u a l s on t a s k performance, and t h e same method was employed i n t h e p r e s e n t study. Cronbach's a l p h a i n t h i s study was c a l c u l a t e d f o r i n d i v i d u a l s w i t h MS and t h e i r spouses on t h e FIS and were .96 and .97, r e s p e c t i v e l y . Given t e s t d e v e l o p e r s ' Cronbach's alpha l e v e l s s t u d y suggest  (>.93), t h e v a l u e s o b t a i n e d i n t h e p r e s e n t t h a t t h e s c a l e has s a t i s f a c t o r y  internal  c o n s i s t e n c y f o r b o t h i n d i v i d u a l s w i t h MS and t h e i r  spouses.  The ENRICH Couple Communication S c a l e (CCS). The CCS i s a 10-item s c a l e t h a t i s one o f 14 s u b s c a l e s o f t h e ENRICH M a r i t a l Inventory  (ENRICH--Evaluating  & Nurturing  R e l a t i o n s h i p I s s u e s , Communication, Happiness)  (Olson,  1985). T h i s m u l t i d i m e n s i o n a l i n s t r u m e n t was d e s i g n e d  through  t h e o r e t i c a l and e m p i r i c a l a n a l y s e s f o r m a r i t a l t h e r a p i s t s and r e s e a r c h e r s . The Couple Communication S c a l e (CCS) a s s e s s e s t h e l e v e l o f comfort  f e l t by t h e p a r t n e r i n s h a r i n g  and r e c e i v i n g e m o t i o n a l and c o g n i t i v e i n f o r m a t i o n . A l l items are answered on a 5 p o i n t L i k e r t s c a l e : (2) moderately  agree;  (1) s t r o n g l y agree;  (3) n e i t h e r agree nor d i s a g r e e ; (4)  50 m o d e r a t e l y d i s a g r e e ; and (5) s t r o n g l y d i s a g r e e . The P o s i t i v e Couple Agreement s c o r e i s t h e p e r c e n t a g e o f t h e 10 items on which t h e c o u p l e has p o s i t i v e agreement, and i s a measure o f c o u p l e consensus  (Fowers & O l s o n , 1989). Scores o f 60% and  h i g h e r g e n e r a l l y mean t h a t p a r t n e r s a r e u n d e r s t o o d and e a s i l y share t h e i r f e e l i n g s . Scores o f 30% o r l e s s mean t h e y are concerned about t h e i r communication share t h e i r  and f e e l unable t o  feelings.  U n i v a r i a t e comparison  o f ENRICH s c a l e s showed t h a t  c o u p l e agreement s c o r e s were h i g h e r among s a t i s f i e d on e v e r y s c a l e  couples  (Fowers & O l s o n , 1989), d e m o n s t r a t i n g good  d i s c r i m i n a n t v a l i d i t y . The i n s t r u m e n t was developed t o h e l p c o u p l e s t o r e f l e c t on t h e i r r e l a t i o n s h i p , and t h e r e f o r e , needs h i g h f a c e v a l i d i t y  ( F o u r n i e r e t a l . , 1983). C o n s t r u c t  v a l i d i t y o f t h e i n s t r u m e n t was ensured by c o n d u c t i n g c o r r e l a t i o n a l a n a l y s e s on i t and over 100 p r e v i o u s l y e s t a b l i s h e d s c a l e s a s s e s s i n g m a r i t a l and i n d i v i d u a l ( F o u r n i e r e t a l . , 1983). F i n a l l y , t e s t - r e t e s t  topics  reliability  ranged from .64 t o .93 over a 4-week p e r i o d . Test d e v e l o p e r s cautioned that, although t h i s i s s u f f i c i e n t f o r research purposes,  "reliabilities  a r e not h i g h enough t o determine  whether c o u p l e s s h o u l d be d e n i e d m a r r i a g e o r r e q u i r e d t o  51 seek c o u n s e l l i n g w i t h o u t o t h e r s o u r c e s o f i n f o r m a t i o n " ( F o u r n i e r e t a l . , 1983,  p.237).  The Coping S t r a t e g y I n d i c a t o r . The CSI i s a  33-item  q u e s t i o n n a i r e d e s i g n e d t o measure the use o f t h r e e t y p e s o f coping s t r a t e g i e s : problem-solving, seeking s o c i a l and avoidance  (11 items each, Amirkhan, 1990).  are asked t o f o c u s on a s p e c i f i c problem  and 1 =  Individuals  and t o i n d i c a t e t o  what e x t e n t they used the c o p i n g s t r a t e g i e s a little,  support,  (3 = a l o t , 2 =  not at a l l ) . Scores f o r each o f the t h r e e  types o f c o p i n g s t r a t e g i e s measured by t h i s i n s t r u m e n t c a l c u l a t e d w i t h a range o f s c o r e s b e i n g 11  are  (the i n d i v i d u a l  1  does not use the c o p i n g s t r a t e g y at a l l ) t o 33  (the  i n d i v i d u a l uses the c o p i n g s t r a t e g y a l o t ) . T h i s s c a l e has shown i t s e l f t o be p s y c h o m e t r i c a l l y sound (Amirkhan, Amirkhan, 1990; was  1 994;  P t a c e k , Smith, Espe, & R a f f e t y , 1994)  and  chosen over any o f the o t h e r numerous c o p i n g measures  because o f i t s s t r o n g p s y c h o m e t r i c p r o p e r t i e s . Among these, i s i n t e r n a l c o n s i s t e n c y , which was seeking support,  .89 f o r problem  a v o i d a n c e . Furthermore, retest r e l i a b i l i t y  r e p o r t e d at .93 f o r  s o l v i n g , and  .84 f o r  there i s evidence of high t e s t -  (Amirkhan,  1990,  c o n c u r r e n t and d i v e r g e n t v a l i d i t y  1993)  as w e l l as  (Amirkhan,  1993;  Ptacek et  52 al.,  1994). T e s t - r e t e s t r e l i a b i l i t y was r e p o r t e d f o r b o t h a  c o l l e g e and a heterogeneous community sample  (respectively)  over a 4 t o 8 week p e r i o d f o r each o f t h e t h r e e s u b s c a l e s . They were: .83 and .77 f o r p r o b l e m - s o l v i n g , .80 and .86 f o r s e e k i n g s o c i a l s u p p o r t , and .82 and .79 f o r avoidance (Amirkhan,  1990). The c o r r e l a t i o n between p r o b l e m - s o l v i n g  c o p i n g methods a s s e s s e d by t h e CSI and The D e f i n i t i o n a l Coping I n v e n t o r y (Ptacek e t a l . , 1992) were m o d e r a t e l y (52% shared v a r i a n c e ) . The Support moderately h i g h l y c o r r e l a t e d  Seeking s u b s c a l e was a l s o  ( s h a r i n g 55% o f t h e v a r i a n c e ) ,  d e m o n s t r a t i n g r e a s o n a b l e convergent  validity.  Divergent  v a l i d i t y was demonstrated  w i t h low c o r r e l a t i o n s  between n o n - c o r r e s p o n d i n g  c o p i n g methods on b o t h  (Ptacek e t a l . ,  high  (r_< .20) instruments  1994).  P a r t i c i p a n t s were asked t o r a t e b o t h f r e q u e n c y o f use and p e r c e i v e d h e l p f u l n e s s o f each o f t h e 33 items on t h e q u e s t i o n n a i r e . Respondents a s s i g n e d a p e r s o n a l c o p i n g s c o r e of  1 t o 3 f o r u s i n g each o f these 33 c o p i n g s t r a t e g i e s not  at a l l t o  a l o t , r e s p e c t i v e l y . Respondents then s c o r e d t h e  same i t e m on a s c a l e o f 1 t o 3 f o r t h e p e r c e i v e d h e l p f u l n e s s of each o f these c o p i n g s t r a t e g i e s t h a t they did use. I f they d i d not use a s t r a t e g y , they were i n s t r u c t e d not t o  53  answer  the  question  responses were 3 = very scores 33.  rated  helpful.  on each o f  and h e l p f u l n e s s  Scores  the  differently usual")  generated  .64,  Therefore,  by  of  the  10,  and  potential increase  the  less  s u b s c a l e were its  be  calculations  Results  of  than  The  coping  ("sleeping  strategy. slightly  more  than  strategy  for  an a v o i d a n c e from  coping  the  and i t e m s  were  avoidance,  problem-solving,  and  s u b s c a l e s were  by  calculated,  An i t e m  items  indicated  deleting  analysis  from the  any o f  CSI  that the  scores are  to use  for  coping efficacy  section.  11  Cronbach's alpha  deleting  improved  score.  the  to  helpfulness  11.  respectively.  of  helpful  calculated  subscale,  internal, consistency)  not  items  rather  by  all  These  The C S I was  i t e m was o m i t t e d  than  was.  score u s i n g measures of  efficacious  avoidance  support  impact  c o p i n g use and  a coping efficacy  this  on the  .60,  at  be a n e c e s s a r y c o p i n g  rather  social  .72,  would  the  avoidance  coping efficacy seeking  a composite  w i t h MS f a t i g u e ,  calculation  of  subscales of  three  was deemed t o  strategy.  1 = not  the  b e c a u s e one o f  individuals  divided  on a s c a l e o f  strategy  of  score,  on the  the  The r a n g e  C a l c u l a t i o n of  greater  o n how h e l p f u l  and of  (in  the  were, the  order  to  alpha  items.  Details  reported  in  54 Data A n a l y s i s D e s c r i p t i v e i n f o r m a t i o n and demographic d a t a were c o l l e c t e d , i n c l u d i n g : type o f MS,  number o f y e a r s s i n c e  d i a g n o s i s , number o f y e a r s m a r r i e d , socioeconomic gender, and h i g h e s t l e v e l o f e d u c a t i o n SPSS f o r Windows ( v e r s i o n 6.0)  was  status,  completed. used t o a n a l y z e the  d a t a . Means, s t a n d a r d d e v i a t i o n s , and ranges were c a l c u l a t e d f o r each v a r i a b l e . P r e l i m i n a r y d a t a a n a l y s i s a l s o i n c l u d e d c a l c u l a t i o n o f d e s c r i p t i v e s t a t i s t i c s such as age, number o f y e a r s m a r r i e d , type o f MS,  gender,  and number o f y e a r s  s i n c e d i a g n o s i s . Congruence i n p e r c e p t i o n o f f a t i g u e (the second p r e d i c t o r v a r i a b l e ) was  impact  o b t a i n e d by summing the  a b s o l u t e d i f f e r e n c e between the spouses' s c o r e s on  fatigue  impact s c a l e i t e m s . Congruence i n p e r c e p t i o n o f communication ( p r e d i c t o r v a r i a b l e ) was  o b t a i n e d by  c a l c u l a t i n g the p o s i t i v e c o u p l e agreement s c o r e on the  CCS.  Coping e f f i c a c y s c o r e s ( c r i t e r i o n v a r i a b l e s ) were c a l c u l a t e d f o r a l l t h r e e s u b s c a l e s o f the C S I - - p r o b l e m - s o l v i n g ,  seeking  s o c i a l s u p p o r t , and avoidance. S p e c i f i c a l l y , c o p i n g e f f i c a c y s c o r e s were c a l c u l a t e d u s i n g the f o l l o w i n g method by B a r - T a l & S p i t z e r  [specified  (1994)}:  F i r s t , the z - s c o r e s o f use and h e l p f u l n e s s f o r each  55 i t e m o f t h e s c a l e was c a l c u l a t e d . Second, t h e a b s o l u t e d i f f e r e n c e s c o r e between t h e z - s c o r e o f t h e use and h e l p f u l n e s s o f each i t e m was c a l c u l a t e d . F i n a l l y , t h e c o p i n g e f f e c t i v e n e s s i n d e x o f each c o p i n g s t r a t e g y was c o n s t r u c t e d by a v e r a g i n g a l l items b e l o n g i n g t o t h e s u b s c a l e s . I n t h i s way, l a r g e r f i g u r e s r e p r e s e n t l e s s s u c c e s s f u l consequences o f c o p i n g 1994,  (Bar-Tal & S p i t z e r ,  p.94).  Next, a Pearson product-moment c o r r e l a t i o n m a t r i x was c a l c u l a t e d on demographic as w e l l as p r e d i c t o r v a r i a b l e s t o be sure t h a t they were d i v e r g e n t . M i s s i n g d a t a were handled by s u b s t i t u t i n g t h e sample mean on demographic v a r i a b l e s , and t h e p a r t i c i p a n t ' s mean f o r t h e F I S and t h e CCS. The p a r t i c i p a n t ' s mean f o r each o f the s u b s c a l e s o f t h e CSI were used i n cases where  responses  were o m i t t e d . M i s s i n g d a t a were s p o r a d i c , comprised  less  than 10% o f a l l d a t a , and were not s p e c i f i c t o any items o r variables. Three s i m u l t a n e o u s m u l t i p l e r e g r e s s i o n a n a l y s e s were performed  t o determine  t o what e x t e n t congruence i n  p e r c e i v e d communication as w e l l as f a t i g u e impact p r e d i c t e d c o p i n g e f f i c a c y f o r t h e t h r e e c o p i n g s u b s c a l e s . Sample s i z e  56 was deemed t o be l a r g e enough t o examine t h e d a t a regression  a n a l y s i s . Tabachnick and F i d d e l l  using  (1989) s t a t e  t h a t "a b a r e minimum r e q u i r e m e n t i s t o have a t l e a s t 5 t i m e s more cases than I V s - - a t /  l e a s t 25 c a s e s " . Furthermore, Green  (1991) s t a t e s t h a t a t y p i c a l n f o r a medium e f f e c t s i z e i s 53, making t h i s a b a r e minimum f o r m u l t i p l e a n a l y s i s . Due t o t h e e x p l o r a t o r y  regression  n a t u r e o f t h i s s t u d y , p_<. 10  was a c c e p t e d as r e f l e c t i n g s i g n i f i c a n c e i n t h e r e g r e s s i o n analyses. Gender d i f f e r e n c e s on p r e d i c t o r and c r i t e r i o n v a r i a b l e s were examined by c o n d u c t i n g a m u l t i v a r i a t e a n a l y s i s o f variance  (MANOVA).  Assumptions f o r r u n n i n g a r e g r e s s i o n a n a l y s i s were checked and deemed t o be a c c e p t a b l e .  Because c o r r e l a t i o n s  among independent v a r i a b l e s e n t e r e d i n t o t h e r e g r e s s i o n e q u a t i o n were weak, m u l t i c o l l i n e a r i t y was not a problem. Examination of r e s i d u a l p l o t s revealed i n normality,  l i n e a r i t y , homoscedasticity,  no a b n o r m a l i t y o r independence.  These s c a t t e r p l o t s were examined t o ensure t h a t : residuals  (the d i f f e r e n c e between o b t a i n e d  (a) t h e  and p r e d i c t e d  s c o r e s on t h e dependent v a r i a b l e s ) were i n f a c t n o r m a l l y d i s t r i b u t e d around t h e p r e d i c t e d s c o r e s on t h e dependent  57 variables,  (b) r e s i d u a l s had a l i n e a r r e l a t i o n s h i p w i t h  p r e d i c t e d dependent v a r i a b l e s c o r e s , and (c) h o m o s c e d a s i c i t y was normal  (Tabachnick & F i d d e l l ,  1989).  H o m o s c e d a s t i c i t y (a  measure o f u n i f o r m i t y o f r e s i d u a l s a t a l l l e v e l s o f p r e d i c t e d s c o r e s ) was examined v i a s c a t t e r p l o t s and was acceptable. No u n i v a r i a t e o r m u l t i v a r i a t e o u t l i e r s were found except f o r s e e k i n g s o c i a l support c o p i n g e f f i c a c y (a u n i v a r i a t e o u t l i e r ) , which i s d i s c u s s e d i n t h e  Results  s e c t i o n . O u t l i e r s were d e f i n e d as s c o r e s o c c u r r i n g mOre t h a n t h r e e s t a n d a r d d e v i a t i o n s from t h e mean. The presence o f m u l t i v a r i a t e o u t l i e r s was examined u s i n g Mahalanobis distance  (Tabachnick & F i d d e l l ,  1989).  58  Results The purpose o f t h i s e x p l o r a t o r y study was t o examine the s i m i l a r i t y between spouses' p e r c e p t i o n s o f MS f a t i g u e ' and c o u p l e communication, and t h e r e l a t i o n s h i p o f congruence to  coping  efficacy.  Means, s t a n d a r d d e v i a t i o n s , and p e r c e n t a g e s  were  c a l c u l a t e d f o r t h e demographic i n f o r m a t i o n and a r e r e p o r t e d i n Table 1. Next, means and s t a n d a r d d e v i a t i o n s f o r t h e p r e d i c t o r and c r i t e r i o n v a r i a b l e s were c a l c u l a t e d and a r e • r e p o r t e d i n Table 2. F i n a l l y , c o r r e l a t i o n s between p r e d i c t o r and c r i t e r i o n v a r i a b l e s were c a l c u l a t e d and a r e r e p o r t e d i n Table  3. Data were screened  f o r o u t l i e r s , k u r t o s i s , and  skewness, and were found t o be a c c e p t a b l e  (<1.00) w i t h t h r e e  e x c e p t i o n s . The f i r s t two were t h e number o f c h i l d r e n and e t h n i c i t y . One c o u p l e r e p o r t e d h a v i n g 7 c h i l d r e n , and 93% o f spouses were C a u c a s i a n ,  c a u s i n g a l a r g e skew i n b o t h  v a r i a b l e s . F i n a l l y , r e s u l t s of e f f i c a c y of seeking s o c i a l , support were p o s i t i v e l y skewed, p o s s i b l y due t o r e s p o n s e s a c c o r d i n g t o s o c i a l d e s i r a b i l i t y . T h i s w i l l be d i s c u s s e d f u r t h e r i n t h e Discussion  section.  59 Table 1 Demographic C h a r a c t e r i s t i c s o f P a r t i c i p a n t s  Characteristic  Percent  M  (N=120)  £D  Range  Age o f I n d i v i d u a l s w i t h MS  45.65  8.79  24- 65  Age o f W e l l Spouse  46.36  8.94  25- 64  Number o f Years M a r r i e d  1 6.23  1 1 .60  1-42  Number o f Years w i t h MS  9.95  7.31  1 -33  Number o f c h i l d r e n  1 .75  1 .37  0-7  Type o f MS Relapse-Remitting Chronic-Progressive Relapse-Progressive Benign Unknown  26.70 38.30 25.00 6.7 0 3.30  Type o f F a t i g u e Normal Episodic Muscular . MS F a t i g u e More than one Unknown  13.30 11.70 8.30 21.70 40.00 5.00 (table continues)  60 Characteristic  Percent  M  2D  Range  E t h n i c i t y o f I n d i v i d u a l s w i t h MS Caucasian  100.00  E t h n i c i t y o f W e l l Spouses F i r s t Nations Caucasian Asian Afro-Canadian  3.30 93.30 1 .70 1 .70  H i g h e s t L e v e l o f E d u c a t i o n Completed f o r I n d i v i d u a l s w i t h MS D i d not Complete High School Completed H i g h S c h o o l College/Tech School U n i v e r s i t y Degree Graduate Degree  16.70 28.30 35.00 11.70 8.30  H i g h e s t L e v e l o f E d u c a t i o n Completed f o r W e l l Spouses D i d not Complete High S c h o o l Completed High S c h o o l College/Tech School U n i v e r s i t y Degree Graduate Degree  6.60 30.00 36.70 16.70 10.00  Household Income <$24,999 $25,000-$44,999 $45,000-$54,999 >$55,000  16.70 25.00 18.30 40.00 (table continues)  61 Characteristic  Percent  M  Employment S t a t u s o f I n d i v i d u a l s w i t h MS Full-time Part-time Long-term D i s a b i l i t y Volunteer/Student/  8.30 18.30 46.70 23.30  Unemployed S h o r t - t e r m Leave  3.40  Employment S t a t u s o f W e l l Spouses Full-time  (n=59)  78.30  Part-time. 3.30 Long-term D i s a b i l i t y 6 . 7 0 Volunteer/Student/ 10.00 Unemployed Missing 1.70 P r o f e s s i o n s o f I n d i v i d u a l s w i t h MS Prof/Tech/Managerial Clerical/Sales  43.20 20.00  Service Industry Agricultural/Fishing mechanic volunteer/homemaker Missing  6.70 1.70 5.00 18.40 5.00  P r o f e s s i o n s o f W e l l Spouses  (n=56)  Prof/Tech/Managerial Clerical/Sales  48.30 20.00  Service Industry Agricultural/Fishing mechanic volunteer/homemaker Missing  6.70 5.00 8.30 3.30 8.20  (n=57)  SD  Range  Table 2 Means and Standard D e v i a t i o n s o f P r e d i c t o r  and C r i t e r i o n  Variables.  £D  M  Variable  Congruence C o n c e r n i n g  Fatigue  39. 88  1 5.49  Congruence C o n c e r n i n g  Communication  43 . 50  31 .40  74 .62  29 .86  Number o f Years S i n c e D i a g n o s i s  9 .95  7 .31  Avoidance  4 . 57  2 .48  3. 00  2 .40  5. 44  3 .16  L e v e l o f MS F a t i g u e  Coping  Efficacy  S e e k i n g S o c i a l Support Coping P r o b l e m - S o l v i n g Coping  Note.  Efficacy  Efficacy  H i g h e r s c o r e s on c o p i n g e f f i c a c y s u b s c a l e s  i n d i c a t e decreased c o p i n g e f f i c a c y . H i g h e r s c o r e s on congruence c o n c e r n i n g f a t i g u e i n d i c a t e d e c r e a s e d  congruence.  H i g h e r s c o r e s on congruence c o n c e r n i n g communication i n d i c a t e more s a t i s f a c t o r y communication.  63 Table 3 Correlations of Predictor  Variable  1  1. F a t i g u e  •-  2. Congruence  .30*  3. PCA  and C r i t e r i o n V a r i a b l e s  2  3  4  5  .26*  .02  -.28* -  5. Problem  .14  .12  -.15.31*  6. Support  -.09  -.06  -.03  .36** .26  .40* -.19  -.13  .05  -.36** -.19  .01  8. Years M a r r i e d  6 - 7  -.25* -.11  4. A v o i d  7. Years w i t h MS  (N=60).  -.15  -.04 -.25* .04  -.15  .32*  Note. F a t i g u e i s t h e degree o f f a t i g u e e x p e r i e n c e d by.the i n d i v i d u a l w i t h MS, Congruence i s congruence c o n c e r n i n g f a t i g u e impact ( c a l c u l a t e d as a b s o l u t e e r r o r ) , PCA i s p o s i t i v e c o u p l e agreement, A v o i d i s use o f avoidance c o p i n g e f f i c a c y , Problem i s e f f i c a c y o f problem s o l v i n g c o p i n g , and Support i s e f f i c a c y o f s e e k i n g s o c i a l support c o p i n g . * p_<.05 **p_<.01 O v e r a l l , c o r r e l a t i o n m a t r i x i s s i g n i f i c a n t (p_<. 05) u s i n g B a r t l e t t ' s a p p r o x i m a t i o n ( N o r u s i s , 1993; Tabachnick & F i d d e l l , 1989).  64 Research  Questions  F a t i g u e impact.  The f i r s t two r e s e a r c h q u e s t i o n s i n  t h i s study were: "What i s t h e p e r c e p t i o n o f t h e degree o f f a t i g u e impact o f t h e p e r s o n w i t h MS?" and "What i s t h e p a r t n e r ' s p e r c e p t i o n o f t h e degree o f f a t i g u e impact on t h e spouse w i t h MS?" The average l e v e l o f f a t i g u e f o r i n d i v i d u a l s w i t h MS (as measured by The FIS) was 74.62 (.£D=29.86). T h e i r spouses average f o r l e v e l o f f a t i g u e was 59.83 (S_D=33.64) . • F i s k e t a l . (1 994)  r e p o r t e d a mean f a t i g u e  impact s c o r e o f 66.8 (SD=36.0) as p e r c e i v e d by t h e i n d i v i d u a l s w i t h MS. There a r e no normative  data f o r  spouses' r a t i n g o f t h e i r p a r t n e r ' s f a t i g u e because t h i s p r e s e n t study has s e t a p r e c e d e n t i n u s i n g t h e s c a l e f o r spouses as w e l l as i n d i v i d u a l s w i t h MS. A m a t c h e d - p a i r s t.t e s t was performed i n o r d e r t o answer t h e t h i r d question  research  ("What i s t h e s i m i l a r i t y o f t h e p e r c e p t i o n o f  f a t i g u e impact between t h e p e r s o n w i t h MS and t h e i r p a r t n e r ? " ) , r e v e a l i n g a s i g n i f i c a n t d i f f e r e n c e i n t h e degree of f a t i g u e p e r c e i v e d w i t h i n the couple  (t (59)=3.78,  p_<.001). Thus, spouses g e n e r a l l y u n d e r e s t i m a t e d o f f a t i g u e e x p e r i e n c e d by t h e i r p a r t n e r .  t h e degree  65 Congruence o f f a t i g u e impact was measured by t h e method c i t e d i n Wineman e t a l . ' s (1993) s t u d y , i n which t h e a b s o l u t e d i f f e r e n c e s between t h e spouses' s c o r e s on t h e f a t i g u e impact s c a l e items were summed. Thus, t h e h i g h e r t h e congruence s c o r e ,  t h e more a b s o l u t e e r r o r t h e r e was w i t h i n  the c o u p l e c o n c e r n i n g f a t i g u e impact. The average  fatigue  congruence s c o r e was 39.9, SD= 15.4. A f a t i g u e congruence s c o r e o f 0 would i n d i c a t e t h e h i g h e s t p o s s i b l e and  agreement,  a s c o r e o f 160 would i n d i c a t e t h e most extreme  disagreement. Once a g a i n , t h e s e r e s u l t s can not be compared w i t h n o r m a t i v e d a t a because t h i s s t u d y has s e t a p r e c e d e n t i n c a l c u l a t i n g congruence i n f a t i g u e . Congruence o f f a t i g u e impact was a l s o e x p l o r e d u s i n g an a d d i t i o n a l q u e s t i o n a t t h e end o f t h e F I S . F o r i n d i v i d u a l s w i t h MS, an a d d i t i o n a l q u e s t i o n (item 41) was added t o t h e FIS and r e a d "How w e l l do you f e e l your spouse u n d e r s t a n d s your f a t i g u e ? " F o r spouses, t h e q u e s t i o n r e a d "How w e l l do you  f e e l you u n d e r s t a n d your spouse's f a t i g u e ? " The same 4-  point L i k e r t scale  (ranging  from 0 = e x t r e m e l y w e l l t o 4 =  e x t r e m e l y p o o r l y ) . Thus, t h e s m a l l e r  t h e s c o r e on t h i s i t e m ,  the more u n d e r s t a n d i n g t h e r e was. I n d i v i d u a l s w i t h MS had an average s c o r e o f 1.18 ( w e l l ) , and t h e i r spouses, an average  66 o f 1.12 ( w e l l ) . A l t h o u g h w e l l spouses  f e l t they  understood  the impact o f f a t i g u e s l i g h t l y b e t t e r than t h e i r w i t h MS d i d , a t - t e s t r e v e a l e d no s i g n i f i c a n t Congruence o f c o u p l e communication.  spouses  difference.  The f o u r t h r e s e a r c h  q u e s t i o n ("What i s t h e s i m i l a r i t y o f t h e p e r c e p t i o n o f communication  w i t h i n t h e m a r i t a l r e l a t i o n s h i p between t h e  p e r s o n w i t h MS and t h e i r p a r t n e r ? " ) was answered by examining t h e congruence i n c o u p l e communication.  T h i s was  c a l c u l a t e d by o b t a i n i n g a p o s i t i v e c o u p l e agreement s c o r e on the CCS. T h i s s c o r e i s e x p r e s s e d as a p e r c e n t a g e o f t h e number o f items on which a c o u p l e agrees i n a p o s i t i v e d i r e c t i o n . The mean s c o r e i n t h i s s t u d y was 43.5%. Comparison w i t h normative d a t a from t e s t d e v e l o p e r s r e v e a l e d a mean p o s i t i v e c o u p l e agreement s c o r e o f 54% f o r h a p p i l y • m a r r i e d c o u p l e s , and 16% f o r u n h a p p i l y m a r r i e d c o u p l e s (Fowers & O l s o n , 1989). A mean s c o r e f o r a l l c o u p l e s i s 35%. T h e r e f o r e , t h e r e was g r e a t e r c o u p l e agreement i n spouses who p a r t i c i p a t e d i n t h i s study than t h e r e was i n c o u p l e s on whom the i n s t r u m e n t was normed. However, i t i s i m p o r t a n t t o note t h a t c o u p l e s on whom t h e s c a l e was normed were not c o p i n g w i t h c h r o n i c i l l n e s s , so t h e two groups a r e n o t d i r e c t l y comparable.  67 Cronbach's a l p h a i n t h i s study was c a l c u l a t e d f o r p o s i t i v e c o u p l e agreement s c o r e s , and was .82, s u g g e s t i n g t h a t t h e s c a l e has s a t i s f a c t o r y i n t e r n a l c o n s i s t e n c y f o r c o u p l e s i n which one p e r s o n has MS. C o r r e l a t i o n s between p o s i t i v e c o u p l e agreement s c o r e s and t h e o t h e r v a r i a b l e s were c a l c u l a t e d t o e x p l o r e any r e l a t i o n s h i p s between v a r i a b l e s (see Table 3 ) . Congruence i n c o u p l e communication was n e g a t i v e l y c o r r e l a t e d w i t h e f f i c a c y o f avoidance  coping  (r=-.28, p_<.05), s u g g e s t i n g t h a t t h e  more s a t i s f i e d t h e i n d i v i d u a l w i t h MS was w i t h c o u p l e communication, t h e more e f f i c a c i o u s they found  avoidance  c o p i n g t o be. P o s i t i v e . c o u p l e agreement was a l s o n e g a t i v e l y c o r r e l a t e d w i t h t h e l e v e l o f f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS (r=-.25, p_<.05). I n o t h e r words, t h e more f a t i g u e t h e i n d i v i d u a l e x p e r i e n c e d , t h e l e s s congruence t h e r e was i n c o u p l e communication. Even though t h i s i s n o t a strong r e l a t i o n s h i p , i t warrants  some a t t e n t i o n t o a  p o s s i b l e l i n k between f a t i g u e and d i f f i c u l t y understood  feeling  by a spouse. T h i s f i n d i n g i s a l s o noteworthy  because p o s i t i v e c o u p l e agreement s c o r e s were h i g h e r i n t h i s group o f p a r t i c i p a n t s than they a r e i n t h e g e n e r a l  68 p o p u l a t i o n (Olson, 1985). T h e r e f o r e , t h e r e l a t i o n s h i p may' a c t u a l l y be s t r o n g e r than i t appears t o be. Coping e f f i c a c y . A l t h o u g h c o p i n g e f f i c a c y was calculated  f o r each o f t h e t h r e e s u b s c a l e s , i t was n o t  compared w i t h normative been i n v e s t i g a t e d  d a t a because c o p i n g e f f i c a c y has n o t  by d e v e l o p e r s o f t h e C S I . E f f i c a c y  on t h e t h r e e s u b s c a l e s o f t h e CSI were as f o l l o w s : c o p i n g e f f i c a c y , M=4.57, S_D=3.16; p r o b l e m - s o l v i n g e f f i c a c y , M=5.44, SD=3.16; and s e e k i n g s o c i a l  scores avoidance  coping  support  c o p i n g , M=3.0, SD=2.40. A c c o r d i n g t o B a r - T a l and S p i t z e r ' s method (1994), t h e g r e a t e r t h e s c o r e , t h e l e s s the c o p i n g . These r e s u l t s suggest  efficacious  t h a t c o p i n g by s e e k i n g  s o c i a l support was t h e most e f f i c a c i o u s , f o l l o w e d by avoidance,  and then p r o b l e m - s o l v i n g . Normative d a t a on CSI  s u b s c a l e s c o n c e r n i n g use o f c o p i n g s t r a t e g i e s  reveals that  p r o b l e m - s o l v i n g was used t h e most (M=26.55, S_D_=4.82), f o l l o w e d by s e e k i n g s o c i a l support then avoidance  (M=23.42, S_D=5.63), and  (M=19.03, SD=4.37). Q u a n t i t a t i v e comparisons  can n o t be made here as two d i f f e r e n t c o n s t r u c t s have been calculated  ( c o p i n g e f f i c a c y and c o p i n g use, r e s p e c t i v e l y ) .  However, i t i s i n t e r e s t i n g t o note t h a t p r o b l e m - s o l v i n g was  69  used t h e most a c c o r d i n g t o normative d a t a (Amirkhan, but was t h e l e a s t e f f i c a c i o u s i n t h e p r e s e n t  1990),  study.  C o r r e l a t i o n s between measures o f c o p i n g e f f i c a c y and a l l o t h e r v a r i a b l e s were weak, w i t h t h e e x c e p t i o n o f avoidance c o p i n g e f f i c a c y b e i n g p o s i t i v e l y c o r r e l a t e d w i t h ' l e v e l o f f a t i g u e and s e e k i n g s o c i a l support c o p i n g e f f i c a c y b e i n g n e g a t i v e l y c o r r e l a t e d w i t h t h e number o f y e a r s s i n c e diagnosis  ( r _ = - . 2 5',  p_<.05).  T h i s c o r r e l a t i o n , though weak,  suggests t h a t t h e l o n g e r an i n d i v i d u a l has l i v e d w i t h MS, the more e f f i c a c i o u s they found s e e k i n g s o c i a l  support.  In o r d e r t o address t h e f i f t h r e s e a r c h q u e s t i o n ("What i s t h e r e l a t i o n s h i p between s i m i l a r i t y o f p e r c e i v e d f a t i g u e impact, s i m i l a r i t y o f communication, and c o p i n g e f f i c a c y , c o n s i d e r i n g t h e number o f y e a r s s i n c e d i a g n o s i s and l e v e l o f MS f a t i g u e ? " ) , t h r e e s i m u l t a n e o u s m u l t i p l e r e g r e s s i o n a n a l y s e s were performed  f o r t h e t h r e e c o p i n g s u b s c a l e s (see  T a b l e s 4 t o 6 ) . The o v e r a l l model showed t h a t congruence on f a t i g u e impact and communication p a t t e r n s , as w e l l as t h e number o f y e a r s s i n c e d i a g n o s i s and l e v e l o f f a t i g u e accounted  f o r 13% ( a d j u s t e d R  = 7%) o f t h e v a r i a n c e i n  avoidance c o p i n g e f f i c a c y , F ( 4 , 5 5 ) = 2 . 0 2 , p_< . 1 0 .  70 Table 4 M u l t i p l e R e g r e s s i o n A n a l y s i s o f P r e d i c t o r s o f Avoidance Coping E f f i c a c y (N=60)  Variable  Beta  t  p_<  Years s i n c e d i a g n o s i s  -.09  -0.68  .50  .22  1.61  .10  Congruence ( r e : communication)  -.25  -1.88  .07  Congruence  -.09  -0.64  .53  Degree o f f a t i g u e  Note.  (re: fatigue)  B e t a i s the s t a n d a r d i z e d  Percentage of variance  regression  coefficient.  i n e f f i c a c y o f avoidance c o p i n g  accounted f o r by the r e g r e s s i o n : R O v e r a l l , F (4,55)= 2.03, p. <.10.  i s . 13 ( a d j u s t e d ,  .07) .  71 Table 5 M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of Seeking S o c i a l Support Coping E f f i c a c y  (N=60)  Variable  Beta  t  p_<  Degree o f f a t i g u e  -.09  -0.67  .51  -.10  -0.74  .47  -.10  -0.73  .47  -.28  -2.12  .04  Congruence ( r e : communication Congruence  (re: fatigue)  Years s i n c e d i a g n o s i s  Note.  B e t a i s the s t a n d a r d i z e d r e g r e s s i o n c o e f f i c i e n t .  Percentage of v a r i a n c e i n e f f i c a c y of seeking s o c i a l support c o p i n g accounted f o r by the r e g r e s s i o n e q u a t i o n : R ( a d j u s t e d , .02). O v e r a l l , F (4,55)= 1.31, p_< .28.  2  i s .09  72 Table 6 M u l t i p l e Regression  A n a l y s i s of P r e d i c t o r s of Problem-  S o l v i n g Coping E f f i c a c y (N=60)  Variable  Beta  t  p_<  Degree of f a t i g u e  .09  .61  .54  -.13  -.94  .35  Congruence (re f a t i g u e )  -.07  -.53  .59  Years s i n c e d i a g n o s i s  -.04  -.29  .77  Congruence ( r e : communication)  Note.  B e t a i s the s t a n d a r d i z e d r e g r e s s i o n  coefficient.  P e r c e n t a g e of v a r i a n c e i n e f f i c a c y of problem s o l v i n g c o p i n g 2  accounted f o r by the r e g r e s s i o n e q u a t i o n : E  is  .04  ( a d j u s t e d , - . 0 2 ) . O v e r a l l , F (4,55)= .62, p.  <.65.  73 P o s i t i v e c o u p l e agreement accounted variance  f o r most o f t h i s  (J3= -.25, p_<.10). These same p r e d i c t o r v a r i a b l e s  were not s i g n i f i c a n t p r e d i c t o r s o f e i t h e r s e e k i n g support or p r o b l e m - s o l v i n g c o p i n g e f f i c a c y 6,  social  (see T a b l e s 5 and  respectively). Gender d i f f e r e n c e s . F i n a l l y , the s i x t h and  final  r e s e a r c h q u e s t i o n r e g a r d i n g gender d i f f e r e n c e s ("Are  there  any gender d i f f e r e n c e s i n congruence o f f a t i g u e impact, c o u p l e communication, and c o p i n g e f f i c a c y ? " ) was  addressed  by c o n d u c t i n g a MANOVA w i t h gender o f the i n d i v i d u a l w i t h  MS  as the independent v a r i a b l e , and congruence i n communication, congruence i n p e r c e p t i o n o f f a t i g u e impact, and c o p i n g e f f i c a c y s u b s c a l e s as the dependent v a r i a b l e s . s i g n i f i c a n t d i f f e r e n c e s were found  No  [F (5, 54)<1], i n d i c a t i n g  t h a t t h e r e were no s i g n i f i c a n t gender d i f f e r e n c e s i n congruence i n f a t i g u e p e r c e p t i o n , communication p a t t e r n s , o r i n avoidance,  s e e k i n g s o c i a l s u p p o r t , and  problem-solving  c o p i n g e f f i c a c y . Means and s t a n d a r d d e v i a t i o n s are r e p o r t e d i n Table  7.  Post-hoc A n a l y s i s When c o u p l e congruence was  calculated using absolute  e r r o r , i t d i d not c o r r e l a t e w i t h any o f the c o p i n g e f f i c a c y  74 Table 7 Means and S t a n d a r d D e v i a t i o n s o f P r e d i c t o r and C r i t e r i o n V a r i a b l e s f o r Males and Females w i t h MS.  Males (N=13) Variable Congruence ( r e : fatigue)  M 38.88  Congruence ( r e ; 35.88 Communication)  Females  J3D  M  (N=47) S_D  16.18  40.28  15.38  34.47.  46.51  29.99  Avoidance Coping Efficacy  4.61  2.95  4.56  2.30  Seeking S o c i a l Support Coping Efficacy  2.70  2.92  3.12  2.21  Problem-Solving 5.12 Coping E f f i c a c y  2.87  5.56  3.29  75 s u b s c a l e s c o r e s (see Table 3 ) . However, i t was  negatively  c o r r e l a t e d w i t h the number o f y e a r s the c o u p l e had been married  (r= -.36, p_<.05), and p o s i t i v e l y c o r r e l a t e d w i t h the  degree o f f a t i g u e e x p e r i e n c e d by the i n d i v i d u a l w i t h MS (r=.30, p_<.05), s u g g e s t i n g t h a t the l o n g e r c o u p l e s had been m a r r i e d , the more congruent  they were r e g a r d i n g f a t i g u e ,  the more f a t i g u e e x p e r i e n c e d by the i n d i v i d u a l w i t h MS, l e s s congruent  the c o u p l e  and the  was.  C o r r e l a t i o n s between congruence c o n c e r n i n g  fatigue  impact and communication, as w e l l as c o p i n g e f f i c a c y s u b s c a l e s and o t h e r v a r i a b l e s o f i n t e r e s t were, f o r the most p a r t , v e r y weak. T h e r e f o r e , a l t e r n a t i v e methods o f q u a n t i f y i n g congruence c o n c e r n i n g f a t i g u e impact and e f f i c a c y were i n v e s t i g a t e d i n an attempt essence. C o r r e l a t i o n s  coping  to capture t h e i r  are r e p o r t e d i n Appendix G.  Congruence. Congruence c o n c e r n i n g f a t i g u e impact examined by c a l c u l a t i n g R  2  between b o t h spouses'  t o items on the F I S , but a n a l y s e s performed  was  responses  w i t h t h i s method  d i d not r e v e a l any s i g n i f i c a n t r e l a t i o n s h i p s . A l t h o u g h t h i s method o f o p e r a t i o n a l i z i n g congruence may  have r e s u l t e d i n  an i n c r e a s e d u n d e r s t a n d i n g o f the e x t e n t t o which  couples  agreed on c e r t a i n items w i t h i n the s c a l e , i t would not have  76  r e f l e c t e d t h e degree t o which spouses f e l t s i m i l a r l y about the amount o f f a t i g u e e x p e r i e n c e d . F i n a l l y , congruence c o n c e r n i n g f a t i g u e impact  was  c a l c u l a t e d by t a k i n g t h e s t a n d a r d d e v i a t i o n o f t h e d i f f e r e n c e s c o r e s o b t a i n e d by p a r t n e r s on t h e F I S , thus r e f l e c t i n g a measure o f v a r i a b i l i t y  (variable error) rather  than a mean d i f f e r e n c e ( a b s o l u t e e r r o r ) . T h i s method o f measuring t h e w i t h i n c o u p l e v a r i a n c e i s based on a s t u d y by Schutz and Roy ( 1 9 7 3 ) who d i s c u s s e d t h e importance  of using  b o t h v a r i a n c e and mean d i f f e r e n c e s t o measure d i s c r e p a n c y o f performance (congruence between performances on a g i v e n t a s k ) . The l a r g e r t h e v a r i a b l e e r r o r , t h e g r e a t e r t h e degree of v a r i a b i l i t y . C a l c u l a t e d i n t h i s way, f a t i g u e congruence was s i g n i f i c a n t l y related to e f f i c a c y of problem-solving  coping  ( r = . 3 3 , p_<.05), s u g g e s t i n g t h a t t h e more congruent t h e c o u p l e was, t h e more e f f i c a c i o u s t h e i n d i v i d u a l w i t h MS found problem s o l v i n g c o p i n g . I n o r d e r t o g a i n some i n s i g h t i n t o t h e impact  of the  p r e d i c t o r v a r i a b l e s on c o p i n g e f f i c a c y u s i n g v a r i a b l e e r r o r as t h e method o f o p e r a t i o n a l i z i n g f a t i g u e congruence, t h r e e  77 simultaneous m u l t i p l e r e g r e s s i o n the t h r e e c o p i n g s u b s c a l e s  a n a l y s e s were performed  (see Appendices H,  I , and J ) . The  o v e r a l l model showed t h a t congruence on f a t i g u e impact communication p a t t e r n s ,  2  = 6%)  and  as w e l l as the number o f y e a r s  s i n c e d i a g n o s i s and l e v e l o f f a t i g u e accounted (adjusted R  for  f o r 13%  o f the v a r i a n c e i n avoidance  coping  e f f i c a c y , F(4,55)=1.97, p_< . 1 0 . Of a l l the p r e d i c t o r v a r i a b l e s , o n l y congruence c o n c e r n i n g c o u p l e communication approached s i g n i f i c a n c e (£=--.24, p_<.10). These same p r e d i c t o r v a r i a b l e s were e n t e r e d i n t o a second p r e d i c t i n g p r o b l e m - s o l v i n g c o p i n g , and i t was they a l s o accounted variance,  f o r 13%  (adjusted R  regression found  = 7%)  that  o f the  F (55 , 4) =2 . 03 , p_< . 1 0 . I n t h i s a n a l y s i s , congruence  c o n c e r n i n g f a t i g u e impact was (£=.31, p_<.05). The  a significant predictor  f i n a l a n a l y s i s on s e e k i n g s o c i a l s u p p o r t  as a c r i t e r i o n v a r i a b l e y i e l d e d no s i g n i f i c a n t r e s u l t s . Couple communication. A l t h o u g h p o s i t i v e c o u p l e agreement s c o r e s are u s u a l l y used t o i n t e r p r e t the CCS, s c o r e s were a l s o compared t o normative Calculated 10  i n t h i s way,  data i n t h i s  raw  study.  i n d i v i d u a l s can s c o r e anywhere from  (very u n s a t i s f i e d ) t o 50  (extremely s a t i s f i e d ) .  (1985) r e p o r t e d a mean raw c o u p l e s c o r e o f 28.1  Olson  (SD was  not  78  r e p o r t e d ) on t h e CCS. I n t h e p r e s e n t s t u d y , c o u p l e s ' mean s c o r e was 3 6 . 5 8  (SD=7.76), suggesting that  their  s a t i s f a c t i o n w i t h communication was h i g h e r than average. I n a d d i t i o n , t h e degree o f s a t i s f a c t i o n w i t h communication was almost i d e n t i c a l between spouses. The i n d i v i d u a l s w i t h MS had an average CCS raw s c o r e o f 3 6 . 5 3 spouses,  an average o f 3 6 . 6 3  ( S D = 8 . 4 7 ) , and t h e i r  (S_D=9.54). These  results  suggest t h a t spouses r a t e d t h e i r communication p a t t e r n s i n a v e r y s i m i l a r way. Coping use and h e l p f u l n e s s . Because t h e method o f q u a n t i f y i n g c o p i n g e f f i c a c y proposed by B a r - T a l and S p i t z e r (1994)  i s new, and because t h e c o p i n g s c a l e used i n t h i s  s t u d y was not the' one used by t h e s e r e s e a r c h e r s , i t i s p o s s i b l e that important i n f o r m a t i o n concerning coping e f f i c a c y may not have been c a p t u r e d i n t h e p r e s e n t  study.  T h e r e f o r e , t h e degree o f c o p i n g use and h e l p f u l n e s s was c a l c u l a t e d f o r t h e s c a l e used i n t h i s s t u d y i n t h e o r i g i n a l manner suggested by t h e s c a l e d e v e l o p e r  (Amirkhan,  1985).  Scores on t h e avoidance s u b s c a l e were c a l c u l a t e d s l i g h t l y d i f f e r e n t l y because one o f i t s items more than u s u a l " ) was deemed t o be a n e c e s s a r y  ("sleeping coping  s t r a t e g y f o r i n d i v i d u a l s w i t h MS f a t i g u e , r a t h e r than an  79 avoidance  c o p i n g s t r a t e g y . T h e r e f o r e , t h i s i t e m was o m i t t e d  from t h e c a l c u l a t i o n o f t h e avoidance  s u b s c a l e , and items  were d i v i d e d by 10, r a t h e r than by 1 1 . Normative d a t a r e p o r t means and s t a n d a r d d e v i a t i o n s f o r each o f t h e t h r e e s u b s c a l e s o f t h e CSI as f o l l o w s : c o p i n g , M =19.03, SJD=4.37; s e e k i n g s o c i a l s u p p o r t , SD=5.63; and p r o b l e m - s o l v i n g , M=26.55, S_D=4.82  M=23.42,  (Amirkhan,  1990). I n t h e p r e s e n t s t u d y , s i m i l a r r e s u l t s were avoidance  avoidance  found:  c o p i n g , M=16.92, SD=3.78; s e e k i n g s o c i a l  support,  M=20.62, SD=4.80; and p r o b l e m - s o l v i n g , M=27.23, SD=5.15. H e l p f u l n e s s s c o r e s were a l s o s i m i l a r : avoidance  coping,  M=15.12, SD=3.12; s e e k i n g s o c i a l s u p p o r t , M=20.88, SJJ=5.06; and p r o b l e m - s o l v i n g , M=25.78, SD=4.93. Use and h e l p f u l n e s s o f avoidance  c o p i n g were c o r r e l a t e d  w i t h t h e degree o f f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS (r=.45, p_<.001, and r=.41 , p_<.001, r e s p e c t i v e l y ) , a n d , a l s o w i t h c o u p l e congruence c o n c e r n i n g communication (r=-.28, p_<.05, and r=-.30, p_<.05, r e s p e c t i v e l y ) . These r e s u l t s suggest  t h a t t h e more f a t i g u e e x p e r i e n c e d by t h e  i n d i v i d u a l w i t h MS, t h e more they used avoidance the more h e l p f u l they found i t .  c o p i n g , and  These r e s u l t s a l s o  t h a t t h e more congruent t h e c o u p l e s were about  suggest  80  communication, t h e l e s s t h e i n d i v i d u a l s w i t h MS used avoidance  coping.  , H e l p f u l n e s s o f p r o b l e m - s o l v i n g c o p i n g s t r a t e g i e s was c o r r e l a t e d w i t h c o u p l e congruence about communication ( r = . 3 5 , p_<-01), s u g g e s t i n g t h a t the more t h e c o u p l e  agreed  about communication p a t t e r n s , the more h e l p f u l the i n d i v i d u a l w i t h MS found p r o b l e m - s o l v i n g  coping.  In o r d e r t o g a i n some i n s i g h t i n t o t h e impact o f the p r e d i c t o r v a r i a b l e s on c o p i n g  (as opposed t o c o p i n g  e f f i c a c y ) , three simultaneous  m u l t i p l e regression analyses  were performed f o r the t h r e e c o p i n g s u b s c a l e s (see Appendices K, L, and M). The o v e r a l l model showed t h a t congruence on f a t i g u e impact  and communication p a t t e r n s , as  w e l l as the number o f y e a r s s i n c e d i a g n o s i s and l e v e l o f f a t i g u e accounted i n avoidance  f o r 26% ( a d j u s t e d R  2  =20%) o f t h e v a r i a n c e  c o p i n g , F (4 , 55) =4 . 74 , p_<.05. Of the p r e d i c t o r  v a r i a b l e s , the l e v e l o f MS f a t i g u e was t h e most  significant  (£ = . 3 7 , p_<.05), f o l l o w e d by congruence o f c o u p l e communication (£ = - . 2 0 , p_<.10). These same p r e d i c t o r v a r i a b l e s were e n t e r e d i n t o a second r e g r e s s i o n p r e d i c t i n g p r o b l e m - s o l v i n g c o p i n g , and i t was found t h a t they f o r 17%  ( a d j u s t e d R = 11%) 2  o f the v a r i a n c e F  accounted  (4,55)=2.88,  81 p_<.05. Of the p r e d i c t o r v a r i a b l e s , the l e v e l o f MS was t h e most s i g n i f i c a n t  (£ =.34,  p_<.05), f o l l o w e d by  congruence o f c o u p l e communication  (£ = .27, p_<.05) . The  f i n a l a n a l y s i s on s e e k i n g s o c i a l support v a r i a b l e y i e l d e d no s i g n i f i c a n t Specific  fatigue  as an outcome  results.  c o p i n g s t r a t e g i e s r e p o r t e d i n an open-ended  q u e s t i o n a t the end o f the CSI were noted and appear i n Appendix N. Frequency d i s t r i b u t i o n s characteristics,  o f demographic  FIS s c o r e s , CCS s c o r e s , and CSI s c o r e s ,  appear i n Appendices 0, P, Q, and R,  respectively.  82 Discussion The purpose o f t h i s e x p l o r a t o r y study was t o examine the . s i m i l a r i t y between spouses' p e r c e p t i o n s o f MS f a t i g u e and c o u p l e communication, and t h e i r r e l a t i o n s h i p t o c o p i n g e f f i c a c y . The c o n s t r u c t o f congruence w i t h i n t h e m a r i t a l r e l a t i o n s h i p has been e x p l o r e d by o n l y a few r e s e a r c h e r s ( R e i c h e t a l . , 1993; S i l l a r s & S c o t t , 1983; Wineman e t a l . , 1993), and i t i s s t i l l  a d i f f i c u l t construct to capture.  Coping e f f i c a c y , t o o , has been r e s e a r c h e d (Aldwin, 1994; M c H a f f i e ,  i n v a r i o u s ways  1992; F i l i p p & K l a u e r , 1990; Stone  e t a l . , 1991), b u t i t a l s o remains d i f f i c u l t t o q u a n t i f y . For example, some s t u d i e s r e p o r t h a v i n g i n v e s t i g a t e d c o p i n g e f f i c a c y , y e t d i d not r e p o r t r e s u l t s a l . , 1 993)  which suggests  (McNett, 1985; R e i c h e t  t h a t d i f f i c u l t i e s may have  o c c u r r e d i n c a p t u r i n g t h e concept. Congruence o f F a t i g u e Impact The  f i r s t r e s e a r c h q u e s t i o n i n t h i s study was, "What i s  the p e r c e p t i o n o f t h e degree o f f a t i g u e impact o f t h e p e r s o n w i t h MS?", and t h e second q u e s t i o n was, "What i s t h e i r p a r t n e r ' s p e r c e p t i o n o f t h e degree o f f a t i g u e impact on t h e spouse w i t h MS?" The average l e v e l o f f a t i g u e o f i n d i v i d u a l s  83  w i t h MS was 7 4 . 6 2 and t h e i r spouses'  average r a t i n g was  59.83.  The t h i r d r e s e a r c h q u e s t i o n was, "What i s t h e s i m i l a r i t y o f t h e p e r c e p t i o n o f f a t i g u e impact between t h e p e r s o n w i t h MS and t h e i r p a r t n e r ? " I n o r d e r t o address  this  q u e s t i o n , each p a r t n e r ' s p e r c e p t i o n o f f a t i g u e impact, as w e l l as c o u p l e congruence o f f a t i g u e impact, was examined. A t - t e s t r e v e a l e d a s i g n i f i c a n t d i f f e r e n c e i n t h e degree o f f a t i g u e p e r c e i v e d w i t h i n the couple  (£=3.78,  p_<.001).  This  r e s u l t i n d i c a t e s t h a t i n d i v i d u a l s w i t h MS r a t e d t h e i r f a t i g u e as s i g n i f i c a n t l y h i g h e r than d i d t h e i r spouses. . Couple congruence i n f a t i g u e impact was n o t s i g n i f i c a n t l y c o r r e l a t e d with coping e f f i c a c y  (problem-  s o l v i n g , s e e k i n g s o c i a l s u p p o r t , o r a v o i d a n c e ) , b u t i t was n e g a t i v e l y c o r r e l a t e d w i t h t h e number o f y e a r s t h e c o u p l e had been m a r r i e d  (r= - . 3 6 , p _ < . 0 5 ) , and p o s i t i v e l y c o r r e l a t e d  w i t h t h e degree o f f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS ( r = . 3 0 ,  p_<.05).  These r e s u l t s suggest  that couples  who had been m a r r i e d f o r l o n g e r p e r i o d s o f time were more congruent .with one another c o n c e r n i n g f a t i g u e . Wineman .et al.  (1993)  found a s i m i l a r , b u t weaker r e l a t i o n s h i p (r=-  . 2 1 ) . These r e s u l t s a l s o suggest  t h a t t h e more f a t i g u e  84 e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS, t h e l e s s  congruent  the spouses were about i t s impact on t h e i n d i v i d u a l w i t h MS. Because i n d i v i d u a l s w i t h MS u s u a l l y l o o k . h e a l t h y , t h e i r e x p e r i e n c e o f f a t i g u e i s o f t e n not v i s i b l e , and can, therefore,  be m i n i m i z e d by f a m i l y members ( B u r n f i e l d ,  1993).  The d i f f i c u l t y i n u n d e r s t a n d i n g f a t i g u e does not d e c r e a s e as f a t i g u e becomes worse ( F i s k e t a l . , 1994). C o n s e q u e n t l y , t h e more f a t i g u e an i n d i v i d u a l e x p e r i e n c e s , t h e l e s s t h e i r spouse i s l i k e l y t o u n d e r s t a n d i t i f t h e i n d i v i d u a l continues to look healthy. Because o f t h i s problem, i n d i v i d u a l s w i t h MS were asked how w e l l t h e i r spouses u n d e r s t o o d t h e i r f a t i g u e , and t h e w e l l spouses were asked how w e l l they thought  they  u n d e r s t o o d t h e f a t i g u e o f t h e spouse w i t h MS. Both  spouses  agreed on t h i s q u e s t i o n , i n d i c a t i n g t h a t f a t i g u e was w e l l u n d e r s t o o d . A t - t e s t showed no s i g n i f i c a n t d i f f e r e n c e i n b o t h spouses' i m p r e s s i o n s o f how w e l l t h e f a t i g u e i s u n d e r s t o o d . T h i s f i n d i n g i s i n t e r e s t i n g when i t i s c o n s i d e r e d i n c o n j u n c t i o n w i t h t h e r e s u l t s o f t h e t - t e s t on the o v e r a l l F I S i n d i c a t i n g a s i g n i f i c a n t d i f f e r e n c e i n t h e degree o f f a t i g u e p e r c e i v e d w i t h i n t h e c o u p l e (±.= 3.78, ]?_<.001). A l t h o u g h spouses thought they u n d e r s t o o d MS  fatigue  85 w e l l , and a l t h o u g h i n d i v i d u a l s w i t h MS thought t h e i r  spouses  u n d e r s t o o d f a t i g u e w e l l , t h e spouses w i t h o u t MS g e n e r a l l y u n d e r e s t i m a t e d t h e degree o f f a t i g u e e x p e r i e n c e d by t h e i r p a r t n e r . T h i s f i n d i n g i s c o n s i s t e n t w i t h L a z a r u s and Folkman's (1984) t h e o r y t h a t s u b j e c t i v e i m p r e s s i o n s o f a s t r e s s o r may be more u s e f u l than o b j e c t i v e measurement. The moderate n e g a t i v e r e l a t i o n s h i p between f a t i g u e and congruence i n c o u p l e communication  suggests t h a t t h e more  severe t h e f a t i g u e , t h e l e s s s a t i s f i e d c o u p l e s f e e l about t h e i r communication.  S i l l a r s and S c o t t (1983) found t h a t i n  s i t u a t i o n s c o n c e r n i n g s u b j e c t i v e i s s u e s , i n d i v i d u a l s may o v e r e s t i m a t e how much they know about t h e i r spouse, and S i l l a r s  and P i k e  (1985) suggested t h a t m a r i t a l d i s s a t i s f a c t i o n i s  the r e s u l t o f i n e f f e c t i v e communication.  I t f o l l o w s , then,  t h a t t h e r e i s a n e g a t i v e r e l a t i o n s h i p between f a t i g u e and congruence i n communication. C o r b i n and S t r a u s s (1984) found t h a t t h e e x t e n t t o which m a r r i e d p a r t n e r s have a s h a r e d u n d e r s t a n d i n g o f i l l n e s s - r e l a t e d i s s u e s i s l i k e l y r e l a t e d t o how much t h e y share t h e i r thoughts and f e e l i n g s w i t h one a n o t h e r . T h e r e f o r e , i t was e x p e c t e d t h a t t h i s r e l a t i o n s h i p would be s i g n i f i c a n t , as t h e more i n sync c o u p l e s a r e (measured by  86 p o s i t i v e c o u p l e agreement), expect c o n c e r n i n g MS between congruence communication  the more congruence  one  might  f a t i g u e . However, the r e l a t i o n s h i p  o f f a t i g u e impact and c o u p l e  was not s i g n i f i c a n t . There are two  possible  e x p l a n a t i o n s f o r the l a c k o f r e l a t i o n s h i p between t h e s e p r e d i c t o r v a r i a b l e s . The f i r s t i s the u n c o n v e n t i o n a l use o f the FIS ( i . e . , h a v i n g spouses r a t e f a t i g u e ) . Even though i t appears t o be a l o g i c a l method, and d e s p i t e s a t i s f a c t o r y Cronbach's a l p h a s f o r i n d i v i d u a l s w i t h MS and t h e i r spouses, s c a l e v a l i d i t y and r e l i a b i l i t y may The second p o s s i b l e e x p l a n a t i o n  have been compromised.  i s the d i f f i c u l t y i n  q u a n t i f y i n g c o u p l e congruence. A l t h o u g h the method employed i n t h i s s t u d y was c o n s i s t e n t w i t h t h a t o f a s t u d y t h a t reported  s i g n i f i c a n t r e s u l t s i n c o u p l e congruence  et a l . , 1 993), congruence  concerning i l l n e s s  (Wineman  uncertainty,  r a t h e r than f a t i g u e impact, was measured. Because the p r e s e n t s t u d y found a s i g n i f i c a n t d i f f e r e n c e i n b o t h p a r t n e r s ' r a t i n g o f f a t i g u e impact appears t h a t t h e r e may  (±=3.78, p_<.001), i t  have been s i g n i f i c a n t i n c o n g r u e n c e  (or disagreement) w i t h i n the c o u p l e . I t i s p o s s i b l e , t h e n , t h a t t h i s method o f t a p p i n g congruence enough f o r t h i s c o n s t r u c t .  was not s e n s i t i v e  In order to i n v e s t i g a t e  87  a l t e r n a t i v e methods o f o p e r a t i o n a l i z i n g congruence, a n a l y s e s were  post-hoc  conducted.  H e r e a f t e r , t h e terms "couple congruence" and " p o s i t i v e c o u p l e agreement" a r e used i n t e r c h a n g e a b l y — p o s i t i v e c o u p l e agreement b e i n g t h e percentage agrees  o f items on w h i c h t h e c o u p l e  i n a p o s i t i v e d i r e c t i o n on t h e CCS.  Congruence o f f a t i g u e impact  (post-hoc  analysis).  Congruence o f f a t i g u e impact was c a l c u l a t e d as a measure o f v a r i a b l e e r r o r r a t h e r than a b s o l u t e e r r o r . I n o t h e r words, i t was c a l c u l a t e d by t a k i n g t h e s t a n d a r d d e v i a t i o n o f t h e d i f f e r e n c e s c o r e s o b t a i n e d by p a r t n e r s on t h e F I S , thus r e f l e c t i n g a measure o f v a r i a b i l i t y  (variable error) rather  than a mean d i f f e r e n c e ( a b s o l u t e e r r o r ) . The l a r g e r t h e v a r i a b l e e r r o r , t h e l e s s congruence t h e r e i s w i t h i n t h e c o u p l e . T h i s method o f measuring t h e w i t h i n c o u p l e v a r i a n c e i s based on a study by Schutz and Roy (1 973) . C a l c u l a t e d i n t h i s way, congruence was a s i g n i f i c a n t p r e d i c t o r o f problems o l v i n g coping e f f i c a c y  (j3=.31,  p_<.05). T h e r e f o r e , t h e  moderate p o s i t i v e r e l a t i o n s h i p suggests t h a t t h e more congruent t h e c o u p l e was, t h e more e f f i c a c i o u s t h e i n d i v i d u a l w i t h MS found p r o b l e m - s o l v i n g c o p i n g . T h i s f i n d i n g was i n t h e expected d i r e c t i o n , and i s s u p p o r t e d by  . 88 research  conducted by F i f e  "congruence i n e x p e c t a t i o n s  (1985) who s t a t e d  that  within family relationships i s  n e c e s s a r y i f i n t e g r a t i o n i s t o e x i s t and c o n f l i c t i s t o be m i n i m i z e d " (p. 109). T h i s f i n d i n g i s a l s o s u p p o r t e d by Wineman e t a l . (1993) who suggested t h a t when i l l n e s s r e l a t e d perceptions  d i f f e r between husband and w i f e , t h e i r  b e h a v i o u r s and management s t r a t e g i e s may not be s y n c h r o n i z e d . Thus, they may f a i l t o make t h e r o l e adjustments n e c e s s a r y f o r what they deem t o be e f f i c a c i o u s coping. However, congruence ( c a l c u l a t e d as v a r i a b l e e r r o r ) was not a s i g n i f i c a n t p r e d i c t o r o f avoidance o r s e e k i n g s o c i a l support c o p i n g e f f i c a c y f o r i n d i v i d u a l s w i t h MS. These s u r p r i s i n g f i n d i n g s may be due t o t h e f a c t t h a t problems o l v i n g c o p i n g s t r a t e g i e s a r e e x t e r n a l and more e a s i l y recognized  than a r e t h e avoidance and s e e k i n g s o c i a l s u p p o r t  c o p i n g s t r a t e g i e s , which a r e , i n c o n t r a s t , i n t e r n a l p r o c e s s e s . I n s h o r t , I suggest t h a t i t i s e a s i e r t o measure b e h a v i o u r s (overt) than p e r c e p t i o n s  ( c o v e r t ) . These f i n d i n g s  may a l s o be due, i n p a r t , t o a phenomenon r e l a t e d t o c o p i n g with chronic  i l l n e s s put f o r t h by Wineman e t a l . (1 993) . I n  t h e i r study on congruence i n i l l n e s s u n c e r t a i n t y ,  they found  89 t h a t congruence d i d not p r e d i c t two o f t h e i r  criterion  v a r i a b l e s . They suggested t h a t b o t h p a r t n e r s  may be so  f o c u s e d on t h e d i s e a s e  t h a t they a r e not s i g n i f i c a n t l y  a f f e c t e d by t h e o t h e r spouse's p e r c e p t i o n Absolute e r r o r r e f l e c t s the o v e r a l l  of the i l l n e s s . l e v e l of  d i f f e r e n c e s i n s c o r e s , whereas v a r i a b l e e r r o r r e f l e c t s t h e v a r i a b i l i t y of the differences i n scores. measure o f a b s o l u t e research  Congruence (as a  e r r o r ) was o p e r a t i o n a l i z e d based on  by Wineman e t a l . (1993). Congruence (as a measure  of v a r i a b l e e r r o r ) was o p e r a t i o n a l i z e d based on r e s e a r c h by Schutz and Roy (1973). However, these methods o f q u a n t i f y i n g congruence a r e , o t h e r w i s e ,  unprecedented. I t i s p o s s i b l e  t h a t t h e l a c k o f r e l a t i o n s h i p s i s due, i n p a r t , t o t h e d i f f i c u l t y i n capturing  the construct  o f congruence. Because  the methods used t o o p e r a t i o n a l i z e c o u p l e congruence i n t h e present study are r e l a t i v e l y unresearched, future i s needed t o f u l l y u n d e r s t a n d t h e r e s u l t s  research  obtained.  Congruence o f Couple Communication The  fourth research  question  i n t h i s s t u d y was, "What  i s the s i m i l a r i t y of the perception  o f communication w i t h i n  the m a r i t a l r e l a t i o n s h i p between t h e p e r s o n w i t h MS and t h e i r partner?"  The mean p o s i t i v e c o u p l e agreement s c o r e i n  90 t h i s s t u d y was 43.5%, i n d i c a t i n g a h i g h e r than  average  degree o f c o u p l e agreement. There a r e two p o s s i b l e e x p l a n a t i o n s f o r t h i s . F i r s t , a s a m p l i n g b i a s may have been i n a d v e r t e n t l y i n t r o d u c e d because spouses had t o agree t o participate  i n t h e s t u d y t o g e t h e r , thus c o u p l e s who had  d i f f i c u l t y communicating  may have a u t o m a t i c a l l y been  e x c l u d e d from p a r t i c i p a t i n g .  Second, c o u p l e s on whom t h e  s c a l e was normed were not c o p i n g w i t h c h r o n i c i l l n e s s . the h i g h e r than average p o s i t i v e  Given  c o u p l e agreement s c o r e s i n  the p r e s e n t s t u d y , i t appears t h a t these c o u p l e s were communicating  more e f f e c t i v e l y than t h e average c o u p l e , and  were a l s o more s a t i s f i e d . T h i s f i n d i n g i s c o n s i s t e n t w i t h r e s e a r c h conducted by C o r b i n and S t r a u s s (1984) who e x p l o r e d how c o u p l e s work t o g e t h e r t o manage c h r o n i c i l l n e s s . They found t h a t i t was through t a l k i n g t h a t spouses were a b l e t o s t a y i n tune w i t h one a n o t h e r ' s needs and wants, and m a i n t a i n t h e n e c e s s a r y r e s o u r c e s t o cope w i t h c h r o n i c i l l n e s s . The c o u p l e s i n t h i s s t u d y were found t o be i n tune w i t h one another  ( h i g h CCS s c o r e s ) . I t i s p o s s i b l e t h a t  t a l k i n g i s n e c e s s a r y when c h r o n i c i l l n e s s i s p r e s e n t because of numerous d a i l y s t r e s s o r s t h a t a r e more l i k e l y t o o c c u r .  91 C o r r e l a t i o n s between p o s i t i v e c o u p l e agreement s c o r e s and a l l o t h e r v a r i a b l e s were examined i n o r d e r t o e x p l o r e r e l a t i o n s h i p s between them (see Table 3 ) . Congruence i n c o u p l e communication was n e g a t i v e l y c o r r e l a t e d w i t h avoidance  coping e f f i c a c y  (r=-.28, p_<.05), s u g g e s t i n g t h a t  the more s a t i s f i e d t h e i n d i v i d u a l w i t h MS was w i t h c o u p l e communication, t h e more e f f i c a c i o u s they found  avoidance  c o p i n g t o be. T h i s f i n d i n g i s s u r p r i s i n g because one might expect s a t i s f a c t o r y c o u p l e communication t o l e a d t o an i n c r e a s e d a b i l i t y t o cope w i t h , r a t h e r than a v o i d , t h e s t r e s s f u l s i t u a t i o n . I t i s i n t e r e s t i n g that p o s i t i v e  couple  agreement d i d not' appear t o be r e l a t e d t o c o p i n g e f f i c a c y o f s e e k i n g s o c i a l support o r problem s o l v i n g , as s a t i s f a c t o r y c o u p l e communication appears t o be one example o f s e e k i n g s o c i a l support and, perhaps,  a precursor to problem-solving.  Moreover, t h e r e i s some evidence  i n the l i t e r a t u r e that  c o u p l e congruence i n communication h e l p s t h e i n d i v i d u a l w i t h the i l l n e s s t o f e e l more s u p p o r t e d and a b l e t o a d j u s t  (Fife,  1985;  these  H i l t o n , 1994; Wineman e t a l . ,  1993). T h e r e f o r e ,  f i n d i n g s may r e f l e c t d i f f i c u l t i e s i n q u a n t i f y i n g c o p i n g e f f i c a c y r a t h e r than an a c t u a l l a c k o f r e l a t i o n s h i p .  92  P o s i t i v e c o u p l e agreement was a l s o n e g a t i v e l y c o r r e l a t e d w i t h t h e l e v e l o f f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS, s u g g e s t i n g t h a t  t h e more f a t i g u e t h e  i n d i v i d u a l e x p e r i e n c e d , t h e l e s s congruence t h e r e was i n c o u p l e communication. Even though t h i s i s not a s t r o n g r e l a t i o n s h i p , i t warrants  some a t t e n t i o n t o a p o s s i b l e l i n k  between f a t i g u e and d i f f i c u l t y f e e l i n g u n d e r s t o o d spouse. T h i s problem i s u n d e r s c o r e d Burnfield  (1993)  by a  i n t h e l i t e r a t u r e by  and Hubsky and Sears  (1992).  This f i n d i n g  i s a l s o noteworthy because p o s i t i v e c o u p l e agreement s c o r e s were h i g h e r i n t h i s group o f p a r t i c i p a n t s than they a r e i n the g e n e r a l p o p u l a t i o n (Olson, 1 9 8 5 ) .  Therefore, the  r e l a t i o n s h i p may a c t u a l l y be s t r o n g e r than i t appears. Congruence o f c o u p l e communication (post-hoc  analysis).  F i n a l l y , raw s c o r e s on t h e CCS were a n a l y z e d . C o u p l e s ' mean s c o r e was 3 6 . 5 8 , s u g g e s t i n g t h a t s a t i s f a c t i o n w i t h communication was h i g h e r than average.  In a d d i t i o n , the  degree o f s a t i s f a c t i o n w i t h communication was e x t r e m e l y s i m i l a r f o r i n d i v i d u a l s w i t h MS ( 3 6 . 5 3 )  and t h e i r spouses  ( 3 6 . 6 3 ) . T h i s may be a r e f l e c t i o n , i n p a r t , o f t h e f a c t t h a t b o t h spouses had t o agree t o p a r t i c i p a t e i n t h i s s t u d y ,  thus  93 y i e l d i n g a sample w i t h a h i g h e r - t h a n - a v e r a g e l e v e l of c o u p l e communication. Coping E f f i c a c y The  f i f t h r e s e a r c h q u e s t i o n was  "What i s the  r e l a t i o n s h i p between s i m i l a r i t y of p e r c e i v e d  f a t i g u e impact,  s i m i l a r i t y of communication, and c o p i n g e f f i c a c y c o n s i d e r i n g the number of y e a r s s i n c e d i a g n o s i s and the l e v e l of f a t i g u e ? " T h i s was  examined u s i n g t h r e e  m u l t i p l e r e g r e s s i o n analyses (see T a b l e s 4 t o 6 ) . The  MS  simultaneous  f o r the t h r e e c o p i n g  subscales  o v e r a l l model showed t h a t  congruence on f a t i g u e impact and communication p a t t e r n s , w e l l as the number of y e a r s s i n c e d i a g n o s i s and l e v e l f a t i g u e accounted f o r 13%  (adjusted R  2  = 7%)  of the  as  of  variance  i n avoidance c o p i n g e f f i c a c y . P o s i t i v e c o u p l e agreement accounted f o r most of t h i s v a r i a n c e , s u g g e s t i n g  t h a t i t may  be a s t r o n g e r p r e d i c t o r o f avoidance c o p i n g e f f i c a c y t h a n the number of y e a r s w i t h MS The  or the l e v e l of f a t i g u e .  second r e g r e s s i o n demonstrated t h a t congruence on  f a t i g u e impact and communication p a t t e r n s , as w e l l as  the  number of y e a r s s i n c e d i a g n o s i s and l e v e l of f a t i g u e accounted f o r 9%  (adjusted R  = 2%)  o f the v a r i a n c e  s e e k i n g s o c i a l support c o p i n g e f f i c a c y . However, the  in overall  94 model was  not s i g n i f i c a n t . The t h i r d r e g r e s s i o n  (predicting efficacy significant The  o f p r o b l e m - s o l v i n g coping) y i e l d e d  f o u r p r e d i c t o r s t h a t were e n t e r e d i n t o  diagnosis,  no  results.  r e g r e s s i o n a n a l y s i s were: the number o f y e a r s  w i t h MS,  analysis  degree of 1  the  since  f a t i g u e e x p e r i e n c e d by the  congruence c o n c e r n i n g f a t i g u e impact,  individual and  congruence c o n c e r n i n g p o s i t i v e c o u p l e communication. I n the r e g r e s s i o n a n a l y s i s t h a t was  significant,  c o n c e r n i n g c o u p l e communication was o f avoidance c o p i n g e f f i c a c y . was  congruence  a significant  predictor  Congruence c o n c e r n i n g  fatigue  not a s i g n i f i c a n t p r e d i c t o r i n any o f the t h r e e  r e g r e s s i o n a n a l y s e s . There are t h r e e p o s s i b l e e x p l a n a t i o n s f o r t h i s . F i r s t , the concept o f congruence may  not have been  a d e q u a t e l y c a p t u r e d , thus y i e l d i n g no s i g n i f i c a n t  results.  Second, d i f f i c u l t i e s i n q u a n t i f y i n g c o p i n g e f f i c a c y may  have  a f f e c t e d what might o t h e r w i s e have been s i g n i f i c a n t f i n d i n g s . T h i r d , i t i s p o s s i b l e t h a t the degree o f agreement between spouses c o n c e r n i n g MS p r e d i c t o r of coping  f a t i g u e i s not a  significant  efficacy.  C o r r e l a t i o n s between p r e d i c t o r v a r i a b l e s and  coping  e f f i c a c y were weak, w i t h one e x c e p t i o n . Avoidance  coping  95 e f f i c a c y was p o s i t i v e l y c o r r e l a t e d fatigue  w i t h t h e degree o f  e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS  (r=.26,  p_<.05), i n d i c a t i n g t h a t t h e worse t h e f a t i g u e , efficacious  the l e s s  they found avoidance c o p i n g . The o n l y s t u d y t h a t  s p e c i f i c a l l y addresses e f f i c a c y o f s t r a t e g i e s w i t h MS f a t i g u e  used t o cope  found t h a t t h e l o n g e r an i n d i v i d u a l had had  MS, t h e more e f f i c a c i o u s l y they f e l t they were c o p i n g w i t h fatigue  (Sears & Hubsky, 1993). T h e r e f o r e , i t was e x p e c t e d  t h a t t h e l o n g e r an i n d i v i d u a l had been l i v i n g w i t h MS, t h e greater the coping e f f i c a c y i n a l l subscales of the CSI. However, t h i s was not borne out i n t h e p r e s e n t One e x p l a n a t i o n f o r these weak c o r r e l a t i o n s variables efficacy  study. between  i s t h e use o f a new method o f c a l c u l a t i n g (Bar-Tal & S p i t z e r ,  1994). Furthermore,  coping  the coping  s c a l e used i n t h e p r e s e n t s t u d y was not t h e one used by B a r T a l and S p i t z e r . Having employed a complex c a l c u l a t i o n o f c o p i n g e f f i c a c y on a s c a l e o t h e r than t h e one suggested  may  have compromised t h e v a l i d i t y . I t i s i m p o r t a n t t o note t h a t Amirkhan's c o p i n g s c a l e (1990) used i n t h e p r e s e n t yielded  study  Cronbach's a l p h a s c o r e s o f .84, .89, and .93,  respectfully. Clearly,  i n t e r n a l c o n s i s t e n c y was  s i g n i f i c a n t l y lower when c o p i n g e f f i c a c y s c o r e s were  96 c a l c u l a t e d u s i n g t h e CSI. T h e r e f o r e , t h e a s s o c i a t i o n s between v a r i a b l e s t h a t were found w i t h c o p i n g e f f i c a c y a r e noteworthy,  and may a c t u a l l y have been s t r o n g e r had t h e  i n t e r n a l c o n s i s t e n c y o f t h e measure been h i g h e r . I n o r d e r t o understand  the extent of the p o s s i b l e negative e f f e c t s o f  h a v i n g computed c o p i n g e f f i c a c y , post-hoc  a n a l y s e s were done  examining c o p i n g ( r a t h e r than c o p i n g e f f i c a c y ) as p e r Amirkhan's s c a l e . Coping use and h e l p f u l n e s s (post-hoc a n a l y s i s ) . The degree o f c o p i n g use and h e l p f u l n e s s was c a l c u l a t e d f o r t h e s c a l e used i n t h i s s t u d y i n t h e manner suggested by t h e . s c a l e developer  (Amirkhan,  1985). R e s u l t s from r e g r e s s i o n  a n a l y s e s conducted w i t h c o p i n g use s u b s c a l e s c o r e s as c r i t e r i o n v a r i a b l e s were v e r y d i f f e r e n t from those  found  when c o p i n g e f f i c a c y s u b s c a l e s c o r e s were t h e c r i t e r i o n variables  (see Appendices L, M, and N). The o v e r a l l model  showed t h a t congruence on f a t i g u e impact and communication p a t t e r n s , as w e l l as t h e number o f y e a r s s i n c e d i a g n o s i s and l e v e l o f f a t i g u e , accounted  f o r 26% ( a d j u s t e d R  =20%) o f  the v a r i a n c e i n use o f avoidance c o p i n g . Of t h e p r e d i c t o r v a r i a b l e s , t h e l e v e l o f MS f a t i g u e accounted  f o r t h e most  v a r i a n c e , f o l l o w e d by congruence of. c o u p l e communication.  97 The  moderate p o s i t i v e r e l a t i o n s h i p between f a t i g u e  avoidance c o p i n g  i n d i c a t e s t h a t the more s e v e r e the f a t i g u e ,  the more avoidance c o p i n g  an i n d i v i d u a l i s l i k e l y t o  T h i s f i n d i n g i s c o n s i s t e n t w i t h the t h e o r y focused coping  and  use.  t h a t emotion-  tends t o predominate when p e o p l e f e e l  that  the s t r e s s o r i s something t h a t must be endured (Folkman & • Lazarus,  1980).  These same p r e d i c t o r v a r i a b l e s (congruence on  fatigue  impact and communication p a t t e r n s , as w e l l as the number o f years since diagnosis  and  l e v e l of f a t i g u e ) were  entered  i n t o a second r e g r e s s i o n p r e d i c t i n g p r o b l e m - s o l v i n g and  i t was  11%)  found t h a t they accounted f o r 17%  coping,  (adjusted R  o f the v a r i a n c e . Of the p r e d i c t o r v a r i a b l e s , the  o f MS  f a t i g u e accounted f o r the most v a r i a n c e ,  congruence of c o u p l e communication. The  =  level  followed  by  moderate p o s i t i v e  r e l a t i o n s h i p between f a t i g u e and p r o b l e m - s o l v i n g  coping  i n d i c a t e s t h a t the more s e v e r e the f a t i g u e , the more problem-solving f i r s t glance,  coping  an i n d i v i d u a l i s l i k e l y t o use.  t h i s f i n d i n g appears t o be i n c o n s i s t e n t with,  L a z a r u s and Folkman's (1984) t h e o r y coping  At  that problem-focused  tends t o predominate when an i n d i v i d u a l f e e l s t h a t  something can be done about the s i t u a t i o n . However, i t i s  98 l i k e l y t h a t i n d i v i d u a l s w i t h MS f e e l t h a t something can be done t o cope w i t h f a t i g u e , such as t a k i n g naps, o r decreasing t h e i r workload. The f i n a l a n a l y s i s on s e e k i n g s o c i a l s u p p o r t as an outcome v a r i a b l e y i e l d e d no s i g n i f i c a n t r e s u l t s . A p o s s i b l e e x p l a n a t i o n f o r t h i s i s t h a t many p e o p l e admit t o n o t w a n t i n g t o depend on o t h e r s , even though t h e r e i s e v i d e n c e i n t h e l i t e r a t u r e t h a t s o c i a l support i s u s e f u l as a c o p i n g strategy  (DesRosier, C a t a n z a r o , & P i l l e r ,  1994; McNett,  1992; G u l i c k ,  1987). Another p o s s i b l e e x p l a n a t i o n i s t h e  measure i t s e l f .  The s e e k i n g s o c i a l support s u b s c a l e o f t h e  CSI had two items on which almost e v e r y p a r t i c i p a n t commented. These were, "accept sympathy and u n d e r s t a n d i n g from someone" and "accept sympathy and u n d e r s t a n d i n g from a f r i e n d s who have t h e same problem". Most p a r t i c i p a n t s r e a c t e d n e g a t i v e l y t o t h e use o f t h e word "sympathy" r a t h e r than "empathy, and i n some c a s e s , argued t h a t t h e r e were two q u e s t i o n s b e i n g asked i n one. T h e r e f o r e , many p e o p l e t h e y d i d not use t h i s a t a l l ( i n response t o t h e word "sympathy" r a t h e r t h a n i n response t o t h e word "understanding").  said  99 Gender D i f f e r e n c e s F i n a l l y , e x p l o r a t i o n o f t h e s i x t h and f i n a l question:  research  ("Are t h e r e any gender d i f f e r e n c e s i n congruence  o f f a t i g u e impact, c o u p l e communication, and c o p i n g • e f f i c a c y ? " ) r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s i n congruence i n f a t i g u e p e r c e p t i o n , i n avoidance, seeking coping  communication p a t t e r n s , o r  s o c i a l s u p p o r t , and  problem-solving  e f f i c a c y . Because gender d i f f e r e n c e s were e x p l o r e d i n  i n d i v i d u a l s w i t h MS (and n o t i n t h e i r s p o u s e s ) , i t i s i m p o r t a n t t o note t h a t t h e two groups were n o t e q u a l .  There  were 47 women w i t h MS and 13 men. Furthermore, t h e sample was  s m a l l , and n o t r e p r e s e n t a t i v e o f t h e gender breakdown o f  the g e n e r a l p o p u l a t i o n  o f i n d i v i d u a l s w i t h MS.  There were no e x p e c t e d gender d i f f e r e n c e s i n congruence c o n c e r n i n g f a t i g u e . F i s k e t a l . (1994), who d e v e l o p e d t h e FIS,- d i d n o t r e p o r t gender d i f f e r e n c e s i n f a t i g u e , n o r d i d they e x p l o r e congruence o f f a t i g u e impact. Gender d i f f e r e n c e s i n congruence c o n c e r n i n g communication were n o t e x p e c t e d because i n s t r u m e n t d e v e l o p e r s r e p o r t e d v e r y d i f f e r e n c e between men and women's s c o r e s  little  on t h e CCS.  R e s u l t s o f t h i s s t u d y suggest t h a t women were s l i g h t l y more  1 00 s a t i s f i e d w i t h communication p a t t e r n s than were t h e i r male partners. The q u e s t i o n ' o f gender d i f f e r e n c e s i n c o p i n g i s more complex. F i r s t , r e s e a r c h on gender d i f f e r e n c e s i n c o p i n g i s inconclusive  ( B i l l i n g s & Moos, 1981; E n d l e r & P a r k e r , 1990).  The most i m p o r t a n t f a c t o r a f f e c t i n g gender d i f f e r e n c e s appears t o be c o n t r o l l i n g f o r t h e s t r e s s o r . When t h e s t r e s s o r i s c o n t r o l l e d f o r , t h e r e a r e fewer gender . differences  (Long & DeLongis, 1 989) . However, Amirkhan  (1990, 1994) found gender d i f f e r e n c e s on s e e k i n g  social  support c o p i n g , even when t h e s t r e s s o r was c o n t r o l l e d f o r . I n s t u d i e s where no d i f f e r e n c e s were found, i t i s p o s s i b l e t h a t t h e r e were some h i d d e n d i f f e r e n c e s i f men and women responded i n what they b e l i e v e d t o be a s o c i a l l y  desirable  manner (Ptacek e t a l . , 1992). F o r example, some men may n o t w i s h t o admit t h a t they f i n d s e e k i n g s o c i a l support t o be a u s e f u l c o p i n g s t r a t e g y , when i n f a c t i t may be v e r y efficacious. Because t h e s t r e s s o r i n t h e p r e s e n t s t u d y was c o n t r o l l e d f o r ( f a t i g u e ) , and because s o c i a l may,influence  responses,  c o p i n g i s not s u r p r i s i n g .  desirability  t h e l a c k o f gender d i f f e r e n c e s i n  101 Summary I n d i v i d u a l s w i t h MS r a t e d t h e i r f a t i g u e as s i g n i f i c a n t l y h i g h e r than d i d t h e i r spouses. A l t h o u g h no s p e c i f i c hypotheses were put f o r t h  (due t o t h e e x p l o r a t o r y ,  n a t u r e o f t h i s s t u d y ) , t h i s outcome was e x p e c t e d .  Couples  who had been m a r r i e d f o r l o n g e r p e r i o d s o f time were s i g n i f i c a n t l y more congruent w i t h one another c o n c e r n i n g fatigue. This i s consistent with r e s u l t s of previous r e s e a r c h (Wineman e t a l . ,  1993). An unexpected but i m p o r t a n t  f i n d i n g was t h a t t h e more f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS, t h e l e s s congruent t h e spouses were about f a t i g u e ' s impact on t h e i n d i v i d u a l w i t h MS. I m p l i c a t i o n s o f t h i s r e l a t i o n s h i p i n c l u d e a need t o h e l p spouses t o u n d e r s t a n d t h e impact o f f a t i g u e on t h e i n d i v i d u a l who e x p e r i e n c e s i t ,  and t o encourage c o u p l e s t o  communicate t o d e c r e a s e t h e i n c i d e n c e o f m i s c o n c e p t i o n s w i t h i n the m a r i t a l  relationship.  The r e s u l t s c o n c e r n i n g c o p i n g e f f i c a c y a r e mixed. The more s a t i s f i e d t h e i n d i v i d u a l w i t h MS was w i t h c o u p l e communication,  t h e more e f f i c a c i o u s t h e y found  avoidance  c o p i n g t o be. However, p o s i t i v e c o u p l e agreement d i d not appear t o be r e l a t e d t o c o p i n g e f f i c a c y o f s e e k i n g s o c i a l  1 02 support o r problem  s o l v i n g . I n c o n t r a s t t o these  findings,  t h e r e i s some e v i d e n c e i n t h e l i t e r a t u r e t h a t c o u p l e congruence i n communication h e l p s t h e i n d i v i d u a l w i t h t h e . i l l n e s s t o f e e l more s u p p o r t e d and a b l e t o a d j u s t 1994; Wineman e t a l . ,  1993). Furthermore,  (Hilton,  f a t i g u e was  r e l a t e d t o avoidance c o p i n g e f f i c a c y , s u g g e s t i n g t h a t t h e more f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS, t h e l e s s e f f i c a c i o u s they found avoidance c o p i n g , which i s not c o n s i s t e n t w i t h L a z a r u s and Folkman's (1984) t h e o r y o f s t r e s s and c o p i n g . A l t h o u g h congruence c o n c e r n i n g c o u p l e communication was a s i g n i f i c a n t p r e d i c t o r o f avoidance c o p i n g e f f i c a c y , congruence c o n c e r n i n g f a t i g u e was not a s i g n i f i c a n t p r e d i c t o r on any o f t h e t h r e e s u b s c a l e s . T h e r e f o r e , a n a l y s e s were conducted.  post-hoc  F i r s t , c o r r e l a t i o n s between c o p i n g  use, c o p i n g h e l p f u l n e s s , and o t h e r v a r i a b l e s o f i n t e r e s t were c a l c u l a t e d . Second, c o p i n g use s u b s c a l e s (as opposed t o c o p i n g e f f i c a c y ) were used as c r i t e r i o n v a r i a b l e s i n t h e regression analyses. Use and h e l p f u l n e s s o f avoidance c o p i n g were r e l a t e d t o the degree o f c o u p l e congruence c o n c e r n i n g communication, s u g g e s t i n g t h a t t h e more congruent  t h e c o u p l e s were about  1 03  communication, t h e l e s s t h e i n d i v i d u a l s w i t h MS used avoidance  c o p i n g . These r e s u l t s a r e i n t h e e x p e c t e d  d i r e c t i o n , y e t they a r e i n o p p o s i t i o n t o those found u s i n g e f f i c a c y o f avoidance  c o p i n g as a c r i t e r i o n v a r i a b l e .  C o n t r a r y t o f i n d i n g s c o n c e r n i n g avoidance  coping  e f f i c a c y , t h e r e was a moderate r e l a t i o n s h i p between f a t i g u e and avoidance  c o p i n g use and h e l p f u l n e s s , s u g g e s t i n g t h a t  the more f a t i g u e i n d i v i d u a l s w i t h MS e x p e r i e n c e d , t h e more they used avoidance it.  c o p i n g , and t h e more h e l p f u l they  found  T h i s f i n d i n g i s more c o n s i s t e n t w i t h t h e t h e o r y t h a t  emotion-focused  c o p i n g tends t o predominate when p e o p l e  t h a t t h e s t r e s s o r i s something t h a t must be endured & Lazarus,  feel  (Folkman  1980).  F i n a l l y , helpfulness of problem-solving  coping  s t r a t e g i e s was c o r r e l a t e d w i t h c o u p l e congruence about communication, s u g g e s t i n g t h a t t h e more t h e c o u p l e  agreed  .about communication p a t t e r n s , t h e more h e l p f u l t h e i n d i v i d u a l w i t h MS found p r o b l e m - s o l v i n g c o p i n g . T h i s f i n d i n g i s supported  i n s t u d i e s conducted  by F i f e  ( 1 9 8 5 ) and  Wineman e t a l . (1 993) . Because r e l a t i o n s h i p s between p r e d i c t o r and c r i t e r i o n , variables  ( u s i n g c o p i n g e f f i c a c y as t h e c r i t e r i o n v a r i a b l e )  1 04 are c o n t r a r y t o f i n d i n g s c i t e d i n t h e l i t e r a t u r e , and because r e l a t i o n s h i p s between p r e d i c t o r and c r i t e r i o n variables  ( u s i n g c o p i n g use as t h e c r i t e r i o n v a r i a b l e ) a r e  c o n s i s t e n t w i t h t h e l i t e r a t u r e , I suggest t h a t t h e s e r e s u l t s likely reflect difficulties  i n q u a n t i f y i n g coping e f f i c a c y .  Post-hoc r e g r e s s i o n analyses r e s u l t s . When c o p i n g  revealed  (as opposed t o c o p i n g  some i n t e r e s t i n g e f f i c a c y ) was t h e  c r i t e r i o n v a r i a b l e , t h e r e s u l t s were s i m i l a r , except t h a t p r e d i c t o r v a r i a b l e s accounted f o r more v a r i a n c e c o p i n g use s u b s c a l e s  than f o r t h e c o p i n g  i n the  e f f i c a c y subscales.  I n c o n t r a s t , congruence c o n c e r n i n g f a t i g u e ( a b s o l u t e was not a s i g n i f i c a n t p r e d i c t o r o f c o p i n g .  error)  Fatigue  congruence ( c a l c u l a t e d as v a r i a b l e e r r o r r a t h e r t h a n absolute  e r r o r ) was a s i g n i f i c a n t p r e d i c t o r o f problem-  s o l v i n g coping  e f f i c a c y , but not o f avoidance o r s e e k i n g  s o c i a l support c o p i n g e f f i c a c y . A l t h o u g h these a r e p r o m i s i n g  findings, future  research  i s needed t o f u l l y u n d e r s t a n d t h e nuances o f o p e r a t i o n a l i z i n g congruence and c o p i n g e f f i c a c y . Limitations T h i s s t u d y i n v o l v e d an attempt t o q u a n t i f y two r e l a t i v e l y new c o n s t r u c t s ;  (a) congruence o f p e r c e p t i o n o f  1 05 f a t i g u e i n i n d i v i d u a l s w i t h MS and t h e i r spouses, coping e f f i c a c y . Although  I conducted  a thorough  and (b) literature  s e a r c h on b o t h t o p i c s , both c o n s t r u c t s a r e new and have n o t been r i g o r o u s l y s t u d i e d . T h e r e f o r e , t h i s was an e x p l o r a t o r y s t u d y , t h e r e s u l t s o f which a r e v a l i d t o t h e e x t e n t t h a t t h e i n s t r u m e n t s used a r e p s y c h o m e t r i c a l l y sound. Precedent  was  s e t by: a d a p t i n g t h e FIS t o spouses o f i n d i v i d u a l s who a c t u a l l y experience f a t i g u e ,  (b) c a l c u l a t i n g a congruence  s c o r e o f f a t i g u e impact by t a k i n g t h e a b s o l u t e d i f f e r e n c e o f two s c o r e s on t h i s p a r t i c u l a r i n s t r u m e n t , and (c) measuring c o p i n g e f f i c a c y u s i n g a c o p i n g s c a l e o t h e r than t h e one used i n t h e r e s e a r c h i n which t h e c o p i n g e f f i c a c y are d e s c r i b e d ( B a r - T a l & S p i t z e r ,  calculations  1994).  A p o t e n t i a l l i m i t a t i o n t o the study i s t h a t people  may  t e n d t o r a t e t h e s t r a t e g i e s they use as h e l p f u l when t h i s • may not a c t u a l l y be t h e case  (Newman & Revenson, 1 993) . I n  o t h e r words, i t i s p o s s i b l e t h a t , due t o s o c i a l d e s i r a b i l i t y , people may not want t o admit t h a t they use a c o p i n g s t r a t e g y t h a t they do not f e e l i s h e l p f u l , o r v i s a versa. I t i s p o s s i b l e t h a t t h e r e a r e l i m i t a t i o n s i n t h e CSI itself.  Items d e s i g n a t e d t o s u b s c a l e s may confound v a l i d i t y  1 06 o f t h e s c a l e when i t i s used w i t h i n d i v i d u a l s c o p i n g w i t h f a t i g u e . F o r example, " s l e e p i n g more than u s u a l " i s d e s i g n a t e d as avoidance c o p i n g , but was o m i t t e d from t h e c a l c u l a t i o n because i t was deemed t o be a p r o b l e m - s o l v i n g coping strategy, given that f a t i g u e i s the s t r e s s o r . Furthermore,  "watching t e l e v i s i o n more than u s u a l " (an  avoidance c o p i n g s t r a t e g y ) may a c t u a l l y be a p r o b l e m - s o l v i n g c o p i n g s t r a t e g y i f i t a l l o w s t h e i n d i v i d u a l t o r e s t and regain  energy.  A l i m i t a t i o n i n t h i s study i s t h a t c o p i n g e f f i c a c y o f the i n d i v i d u a l w i t h MS o n l y was examined, w i t h o u t  actually  t a k i n g t h e spouse's c o p i n g i n t o c o n s i d e r a t i o n . T h e r e f o r e , t h e r e may be some i n t e r a c t i o n e f f e c t s w i t h i n t h e m a r i t a l r e l a t i o n s h i p t h a t have not been e x p l o r e d (DesRosier e t a l . , 1992; Revenson & M a j e r o v i t z , 1991). Furthermore,  a sampling  b i a s may have been i n t r o d u c e d because t h e p a r t i c i p a n t s comprised a convenience  sample o f c o u p l e s i n which  p a r t n e r s - w e r e w i l l i n g t o p a r t i c i p a t e . Another  both  limitation i s  t h a t t h i s s t u d y used a c r o s s - s e c t i o n a l a n a l y s i s f o r t h e v a r i a b l e s o f i n t e r e s t . T h e r e f o r e , any c o r r e l a t i o n s do not r e f l e c t cause and e f f e c t between these v a r i a b l e s .  1 07 Furthermore, t h e s m a l l sample s i z e d e c r e a s e s t h e power o f the c o r r e l a t i o n s . F u t u r e Research F i s k e t a l . (1994) developed t h e FIS t o enhance t h e u n d e r s t a n d i n g o f t h e impact o f f a t i g u e caused by a m e d i c a l problem on t h e i n d i v i d u a l ' s d a i l y l i f e . P r e v i o u s s t u d i e s had i n v e s t i g a t e d o n l y f a t i g u e s e v e r i t y and f a t i g u e  frequency  (Krupp e t a l . , 1988; Krupp e t a l . , 1989). I n m e e t i n g w i t h p a r t i c i p a n t s , v e r b a l feedback r e f l e c t e d a need f o r more r e s e a r c h on p s y c h o l o g i c a l and  e f f e c t s o f f a t i g u e on i n d i v i d u a l s  t h e i r f a m i l i e s . No q u a n t i t a t i v e s t u d i e s  i n v e s t i g a t e d the s i m i l a r i t y of perception  have  of fatigue i n  couples.. A l t h o u g h t h i s was done i n t h e p r e s e n t s t u d y , more r e s e a r c h i s needed t o v a l i d a t e t h e methodology used t o q u a n t i f y c o u p l e congruence. The c o n s t r u c t  o f congruence  w i t h i n t h e m a r i t a l r e l a t i o n s h i p has been e x p l o r e d by o n l y a few  researchers,  and i t remains a d i f f i c u l t c o n s t r u c t t o  c a p t u r e . The q u e s t i o n o f whether one s h o u l d use a b s o l u t e e r r o r or v a r i a b l e . e r r o r or neither to o p e r a t i o n a l i z e congruence needs much more i n v e s t i g a t i o n . Coping e f f i c a c y , t o o , i s a d i f f i c u l t c o n s t r u c t t o quantify  (McHaffie,  1992; Stone e t a l . , 1991). Some s t u d i e s  1 08 r e p o r t h a v i n g i n v e s t i g a t e d c o p i n g e f f i c a c y , y e t d i d not report results  (McNett,  1985; R e i c h et a l . , 1993)  suggests t h a t d i f f i c u l t i e s may  which  have o c c u r r e d i n c a p t u r i n g  the concept. The method employed i n t h i s s t u d y i s o n l y c i t e d i n one s t u d y  ( B a r - T a l & S p i t z e r , 1994)  and may  not have  a d e q u a t e l y c a p t u r e d c o p i n g e f f i c a c y , thus y i e l d i n g  no  s i g n i f i c a n t r e l a t i o n s h i p i n r e g r e s s i o n a n a l y s e s f o r problems o l v i n g and s e e k i n g s o c i a l support c o p i n g e f f i c a c y . The q u e s t i o n remains as t o whether t h e r e were no  actual  r e l a t i o n s h i p s or whether c o p i n g e f f i c a c y has not been adequately  captured.  Implications for Counsellors Due  t o the e x p l o r a t o r y n a t u r e o f t h i s  study,  i m p l i c a t i o n s are suggested w i t h c a u t i o n . There i s a need f o r r e p l i c a t i o n o f t h i s s t u d y b e f o r e any  specific  recommendations can be made. N e v e r t h e l e s s , i m p l i c a t i o n s f o r c o u n s e l l o r s are  reviewed.  There are f o u r i m p o r t a n t i m p l i c a t i o n s o f t h i s First,  study.  i t p r o v i d e s a d d i t i o n a l r e s e a r c h on c o p i n g e f f i c a c y , a  p o o r l y understood  c o n s t r u c t . Second, i t p r o v i d e s i n c r e a s e d  u n d e r s t a n d i n g o f the congruence o f p e r c e p t i o n o f an i n v i s i b l e symptom such as f a t i g u e i n p e o p l e who  are i l l  and  1 09. t h e i r spouses. T h i r d , i t demonstrates  t h e need t o s e n s i t i z e  the key people i n t h e l i v e s o f those who have f a t i g u e as a symptom, due t o any m e d i c a l problem,  t o t h e impact o f t h i s  i n v i s i b l e symptom on t h e i r d a i l y l i v e s . F i n a l l y , i t i s hoped t h a t t h i s s t u d y w i l l r a i s e awareness o f p h y s i c i a n s , counsellors,  and f a m i l y members who w i s h t o s u p p o r t  those  who have f a t i g u e as a major symptom. I n d i v i d u a l s w i t h MS r a t e d t h e i r f a t i g u e as s i g n i f i c a n t l y h i g h e r than d i d t h e i r spouses. T h i s f i n d i n g has i m p l i c a t i o n s f o r c o u n s e l l o r s  t o o f f e r c o u p l e and group  c o u n s e l l i n g f o r people coping w i t h chronic  illness,  e s p e c i a l l y when t h e symptoms l e n d themselves t o misinterpretation,  as does f a t i g u e . I t i s a l s o i m p o r t a n t t o  note t h a t as f a t i g u e s e v e r i t y i n c r e a s e d , incongruence r e g a r d i n g counsellors  so d i d t h e c o u p l e ' s  fatigue s e v e r i t y . Therefore,  may need t o use a p s y c h o e d u c a t i o n a l  approach  w i t h t h e w e l l spouse as symptoms p r o g r e s s , and encourage open communication  i n c o u p l e s t o decrease t h e i n c i d e n c e  of  m i s c o n c e p t i o n s w i t h i n t h e m a r i t a l r e l a t i o n s h i p . The FIS may prove t o be a u s e f u l o b j e c t i v e assessment t o o l f o r c o u p l e s c o u n s e l l i n g i f i t s use w i t h b o t h spouses has been v a l i d a t e d . I n d i v i d u a l s w i t h MS and t h e i r spouses c o u l d then  discuss  110 t h e i r r e s u l t s w i t h t h e i r c o u n s e l l o r and, h o p e f u l l y , g a i n more i n s i g h t i n t o t h e impact o f f a t i g u e on d a i l y  life.  Couples who had been m a r r i e d f o r l o n g e r p e r i o d s o f time were s i g n i f i c a n t l y more congruent w i t h one another c o n c e r n i n g f a t i g u e . T h e r e f o r e , c o u n s e l l o r s would be prudent t o t a k e note o f t h e l e n g t h o f time t h e c o u p l e has been t o g e t h e r , r a t h e r than t h e number o f y e a r s an i n d i v i d u a l has had MS.  111 References Aldwin, CM. (1994). S t r e s s , c o p i n g and development: An i n t e g r a t i v e p e r s p e c t i v e . 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M a r i t a l s a t i s f a c t i o n i n i n d i v i d u a l s w i t h m u l t i p l e s c l e r o s i s and their partners; i t s interactive effect with l i f e s a t i s f a c t i o n , s o c i a l networks, and d i s a b i l i t y . S e x u a l and M a r i t a l Therapy. 3_, 191-196.  1 20 APPENDIX A ENRICH Couple Communication  S c a l e (sample i t e m s ) .  In t h i n k i n g about your r e l a t i o n s h i p , p l e a s e i n d i c a t e t h e response t h a t b e s t d e s c r i b e s your l e v e l o f agreement w i t h each s t a t e m e n t . The p o s s i b l e responses t o each i t e m range from: 1 strongly agree  2 moderately agree  3 n e i t h e r agree nor d i s a g r e e  4 moderately disagree  5 strongly disagree  1.  I t i s v e r y easy f o r me t o e x p r e s s a l l my t r u e f e e l i n g s t o my p a r t n e r .  5.  I w i s h my p a r t n e r was more w i l l i n g t o share h i s / h e r f e e l i n g s w i t h me.  8.  I am v e r y s a t i s f i e d w i t h how my p a r t n e r and I t a l k w i t h each o t h e r .  9.  I do not always share n e g a t i v e f e e l i n g s I have about my p a r t n e r because I am a f r a i d he/she w i l l get angry.  121  Appendix B P a r t i c i p a n t Consent Form I am a graduate student a t t h e U n i v e r s i t y o f B r i t i s h Columbia (Master o f A r t s , C o u n s e l l i n g P s y c h o l o g y ) . I am c o n d u c t i n g a r e s e a r c h study, under t h e s u p e r v i s i o n o f UBC p r o f e s s o r Dr. Bonnie Long. The t i t l e o f my p r o j e c t i s " P e r c e p t i o n o f F a t i g u e and Communication i n P e o p l e w i t h MS and t h e i r spouses: R e l a t i o n s h i p t o Coping E f f i c a c y " . I am i n t e r e s t e d i n l e a r n i n g more about t h e impact o f f a t i g u e on t h e d a i l y l i f e o f t h e i n d i v i d u a l w i t h MS and t h e i r spouse. I f e e l t h a t t h e knowledge g a i n e d from your p a r t i c i p a t i o n i n t h i s study c o u l d make a v a l u a b l e c o n t r i b u t i o n t o our u n d e r s t a n d i n g o f how an i n v i s i b l e symptom such as f a t i g u e a f f e c t s i n d i v i d u a l s w i t h MS and t h e i r spouses. I f you a r e w i l l i n g t o p a r t i c i p a t e i n t h i s study, you will be asked t o complete two o r t h r e e q u e s t i o n n a i r e s . ( I f you a r e t h e i n d i v i d u a l w i t h MS, you w i l l be asked t o complete t h r e e q u e s t i o n n a i r e s . I f you a r e t h e spouse, you w i l l be asked t o complete two q u e s t i o n n a i r e s ) . T h i s w i l l t a k e a p p r o x i m a t e l y 30 minutes a t a time and p l a c e c o n v e n i e n t f o r you. There a r e no r i s k s a n t i c i p a t e d i n p a r t i c i p a t i o n i n t h i s study. I n f o r m a t i o n g a t h e r e d from t h e q u e s t i o n n a i r e s w i l l remain c o n f i d e n t i a l and w i l l be a c c e s s i b l e o n l y t o m y s e l f , my s u p e r v i s o r , and t h e o t h e r two members o f my t h e s i s committee a t t h e u n i v e r s i t y . Names and o t h e r i d e n t i f y i n g i n f o r m a t i o n w i l l n o t be i n c l u d e d i n t h e f i n a l t h e s i s . Q u e s t i o n n a i r e s w i l l be kept i n a l o c k e d f i l i n g c a b i n e t f o r two y e a r s , a f t e r which time they w i l l be shredded. The i n f o r m a t i o n t h a t w i l l be g a t h e r e d from t h i s p r o j e c t w i l l be a n a l y z e d and t h e r e s u l t s r e p o r t e d i n my M a s t e r ' s t h e s i s , and p o t e n t i a l l y i n j o u r n a l a r t i c l e s t h a t w i l l be accessible to the p u b l i c . Your p a r t i c i p a t i o n i n t h i s study i s e n t i r e l y v o l u n t a r y . I f you d e c i d e not t o p a r t i c i p a t e , o r choose t o withdraw a t any time, your p r e s e n t c a r e by t h e s t a f f a t t h e MS S o c i e t y w i l l n o t be compromised.  1 22  (page 2 o f 2) By s i g n i n g t h i s consent form, you a r e i n d i c a t i n g t h a t you have r e a d and u n d e r s t o o d the purpose o f t h i s s t u d y , and t h a t you are p a r t i c i p a t i n g v o l u n t a r i l y . You w i l l be g i v e n a copy o f t h i s form f o r your r e c o r d s . I f a t any t i m e , you have any q u e s t i o n s , p l e a s e do not h e s i t a t e t o c o n t a c t me a t 822-9199 or Dr. Bonnie Long a t 822-5259.  Signed  Date INVESTIGATOR: Jane W h i t t a l l Graduate Student Department o f C o u n s e l l i n g P s y c h o l o g y U n i v e r s i t y o f B r i t i s h Columbia Telephone: 822-9199 THESIS COMMITTEE SUPERVISOR Dr. Bonnie Long Professor Department o f C o u n s e l l i n g P s y c h o l o g y U n i v e r s i t y o f B r i t i s h Columbia Telephone: 822-5259  1 23  Appendix C F a t i g u e Impact S c a l e  ( s e l e c t e d items)  Below i s a l i s t o f s t a t e m e n t s t h a t d e s c r i b e how f a t i g u e may cause problems i n p e o p l e ' s l i v e s . P l e a s e r e a d each statement c a r e f u l l y , a n d choose one o f t h e f o l l o w i n g o p t i o n s as a response t h a t b e s t i n d i c a t e s HOW MUCH OF A PROBLEM YOU FEEL FATIGUE HAS BEEN FOR YOU THIS PAST MONTH, INCLUDING TODAY. P 0 1 2 3 4  No Problem S m a l l Problem Medium Problem Large Problem Extreme Problem Because o f my f a t i g u e , I f i n d I am more f o r g e t f u l . Because o f my f a t i g u e , I am more i r r i t a b l e and more e a s i l y angered. Because o f my f a t i g u e , I have t o be c a r e f u l about p a c i n g my p h y s i c a l a c t i v i t i e s .  1 24 Appendix D F a t i g u e Impact S c a l e f o r Spouses ( s e l e c t e d i t e m s Below i s a l i s t o f s t a t e m e n t s t h a t d e s c r i b e how f a t i g u e may cause problems i n p e o p l e ' s l i v e s . P l e a s e r e a d each statement c a r e f u l l y , and choose one o f t h e f o l l o w i n g o p t i o n s as a response t h a t b e s t i n d i c a t e s HOW MUCH OF A PROBLEM YOU FEEL FATIGUE HAS BEEN FOR YOUR SPOUSE THIS PAST MONTH, INCLUDING TODAY. 0 1 2 3 4  • No Problem S m a l l Problem Medium Problem Large Problem Extreme Problem  Because o f my spouse's f a t i g u e , s/he f i n d s s/he i s more forgetful. Because o f my spouse's f a t i g u e , s/he i s more i r r i t a b l e and more e a s i l y angered. Because o f my spouse's f a t i g u e , s/he has t obe c a r e f u l about p a c i n g h i s / h e r p h y s i c a l a c t i v i t i e s .  1 25 Appendix E Coping S t r a t e g i e s  Indicator  (sample items)  I am i n t e r e s t e d i n how p e o p l e cope w i t h the problem o f MS f a t i g u e . L i s t e d below are s e v e r a l ways o f c o p i n g . I would l i k e you t o i n d i c a t e (a) t o what e x t e n t you use each o f t h e s e c o p i n g methods and (b) t o what e x t e n t you f i n d them h e l p f u l i f you do use them. Try t o t h i n k o f how your f a t i g u e has a f f e c t e d you over t h e p a s t few weeks o r so. W i t h t h a t i n mind, i n d i c a t e how you cope and how h e l p f u l each c o p i n g s t r a t e g y i s t o you by p u t t i n g an "X" b e s i d e the a p p r o p r i a t e response f o r each c o p i n g b e h a v i o u r l i s t e d on t h e f o l l o w i n g pages. Answer each and e v e r y q u e s t i o n even though some may sound s i m i l a r . I f the answer t o (a) i s "not a t a l l " , you do not need t o answer p a r t ( b ) . P l e a s e c i r c l e your answrs. A c c e p t h e l p from a f r i e n d or r e l a t i v e ? * a) a l o t  a litle  not at a l l  b) h e l p f u l  somewhat h e l p f u l  not a t a l l h e l p f u l  Let your f e e l i n g s out on a f r i e n d ? * a) a l o t  a litle  not at a l l  b) h e l p f u l  somewhat h e l p f u l  not a t a l l h e l p f u l  Daydream about b e t t e r  times?**  a) a l o t  a litle  not at a l l  b) h e l p f u l  somewhat h e l p f u l  not a t a l l h e l p f u l  Spend more time t h a n u s u a l a l o n e ? * * a) a l o t  a litle  not at a l l  b) h e l p f u l  somewhat h e l p f u l  not a t a l l h e l p f u l  T e l l p e o p l e about the s i t u a t i o n because j u s t t a l k i n g about i t h e l p s you t o come up w i t h s o l u t i o n s ? * * * a) a l o t  a litle  not at a l l  b) h e l p f u l  somewhat h e l p f u l  not a t a l l h e l p f u l  1 26 (page 2 o f 2) Weigh your o p t i o n s v e r y c a r e f u l l y ? * * * a)  b)  a lot  helpful  a  litle  somewhat h e l p f u l  not  at a l l  not at a l l h e l p f u l  I s t h e r e a c o p i n g s t r a t e g y t h a t you use t h a t i s not above?  * ** ***  s e e k i n g s o c i a l support avoidance problem-solving  listed  1 27 APPENDIX F Demographic I n f o r m a t i o n Sheet For p u r p o s e s o f s t a t i s t i c a l a n a l y s i s o n l y , p l e a s e answer t h e f o l l o w i n g q u e s t i o n s about y o u r s e l f . Your answers w i l l remain s t r i c t l y c o n f i d e n t i a l . P l e a s e a n s w e r t h e f o l l o w i n g q u e s t i o n s b y p u t t i n g a n "X" beside t h e appropriate response. YOU ARE  SEX  t h e i n d i v i d u a l who h a s MS t h e s p o u s e o f t h e i n d i v i d u a l who h a s MS Male  Female  HOUSEHOLD INCOME L e s s t h a n $15,000 $15,000 t o $24,999 NUMBER OF YEARS  AGE  $25,000 t o $34,999 $35,000 t o $44,999  $45,000-$55,000 G r e a t e r t h a n $55,000  MARRIED (OR IN COMMON-LAW RELATIONSHIP)  TYPE OF MS Relapse-Remitting  MS FATIGUE ( c h e c k w h a t e v e r t y p e ( s ) y o u e x p e r i e n c e ) Normal ( f a t i g u e anyone might have a f t e r a l o n g day) Chronic-Progressive Episodic (marked e n e r g y l o s s , u s u a l l y w i t h d e p r e s s e d mood) Relapse-Progressive Muscular (sudden onset o f weakness, interrupting activity) Benign MS F a t i g u e ( o v e r w h e l m i n g t i r e d n e s s w i t h o u t warning)  NUMBER OF YEARS SINCE DIAGNOSIS NUMBER OF CHILDREN EDUCATION L e s s t h a n G r a d e 12 College o rTechnical school G r a d u a t e d e g r e e (2-3 y r d i p l o m a ) C o m p l e t e d G r a d e 12 U n i v e r s i t y d e g r e e (4-5 y r ) ETHNICITY Native White  Asian  Other  (please s p e c i f y  Indo-Canadian  WORK Are you c u r r e n t l y working? I f e m p l o y e d , do y o u w o r k I f n o t w o r k i n g , a r e y o u o n LTD? Are you on short-term leave? Other OCCUPATION  Yes _F/T _Yes Yes  No P/T? No No  1 28 Appendix G C o r r e l a t i o n s o f V a r i a b l e s C a l c u l a t e d i n Post-hoc  Analysis  (N=60) .  Variable  1  1.Fatigue  -  2.Congruence  3. PCA  .1 5 -.25*  2  3  4  6  7  8  •  -  -.05  -  4.Avoid Use  .45** -.12  -.28*  5.Avoid Help  .41 **  .18  -.30*  6.Problem Use  .22  . 1  7.Problem Help  .1 6  8.Support Use  .09  .02  9.Support H e l p  .09  -.12  8 -.10  -.18  -  .78** .30*  _ 35**  -  . 35** . 05  . 1 3 .77**  .1 2  . 20  .25* .25  .21  . 1 5 .20  1 0 . Y e a r s w i t h MS  -.03  -.23  -.13  - .13  11.Years  -.15  -.22  -.19  .01  Married  5  - .08  . 25* . 1  5  . 1 3 .09  1  8  1  3  07  —  _ 93**  .15- .25  04 - .16 .20 .32*  Note. F a t i g u e i s t h e degree o f f a t i g u e e x p e r i e n c e d by t h e i n d i v i d u a l w i t h MS, Congruence i s t h e congruence c o n c e r n i n g f a t i g u e impact ( c a l c u l a t e d as v a r i a b l e e r r o r ) , PCA i s p o s i t i v e c o u p l e agreement, A v o i d Use i s use o f avoidance c o p i n g , A v o i d Help i s h e l p f u l n e s s o f avoidance c o p i n g , Problem Use i s use o f problem s o l v i n g c o p i n g , Problem Help i s h e l p f u l n e s s o f problems o l v i n g c o p i n g , Support Use i s use o f s e e k i n g s o c i a l support c o p i n g , and Support Help i s h e l p f u l n e s s o f s e e k i n g s o c i a l support coping. * SK.05 **rj<.01  O v e r a l l c o r r e l a t i o n m a t r i x i s s i g n i f i c a n t (p_<.01) u s i n g . B a r t l e t t ' s a p p r o x i m a t i o n ( N o r u s i s , 1993; T a b a c h n i c k & F i d d e l l , 1989).  1 29  Appendix H M u l t i p l e R e g r e e s s i o n A n a l y s i s o f P r e d i c t o r s o f Avoidance Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence (N=60)  Source  Beta  Degree o f f a t i g u e  t  p_<  .19  1.42  .16  Congruence ( r e : communication)  -.24  -1.81  .07  Years s i n c e diagnosis  -.06  -0.50  .66  -.06  0.45  .66  Congruence ( r e : fatigue)  Note.  Beta i s the standardized  Percentage of variance  regression c o e f f i c i e n t .  i n e f f i c a c y o f avoidance c o p i n g 2  accounted f o r by the r e g r e s s i o n e q u a s i o n : R (adjusted,  .06). O v e r a l l , F (4, 55)= 1.97, p  i s . 13 <.11.  1 30 Appendix  I  M u l t i p l e Regreession A n a l y s i s of P r e d i c t o r s of Seeking S o c i a l Support Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as t h e Method o f O p e r a t i o n a l i z i n g Congruence (N=60)  Source  Beta  t  p_<  Degree o f f a t i g u e  -.10  -0.77  .45  Congruence ( r e : communication)  -.10  -0.73  .47  Years s i n c e ' diagnosis  -.30  -2.18  .03  Congruence ( r e : fatigue)  -.12  -0.93  .36  Note.  B e t a i s the s t a n d a r d i z e d  Percentage of variance  regression c o e f f i c i e n t .  i n e f f i c a c y of seeking s o c i a l support  c o p i n g accounted f o r by t h e r e g r e s s i o n e q u a s i o n : R (adjusted,  .02). O v e r a l l , F (4,55)= 1.40, p  <.25.  i s .09  1 31  Appendix J M u l t i p l e R e g r e e s s i o n A n a l y s i s o f P r e d i c t o r s o f Problem S o l v i n g Coping E f f i c a c y U s i n g V a r i a b l e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence (N=60)  Source  Beta  t  p_<  .06  0.49  .62  Congruence ( r e : communication)  -.12  -0.91  .36  Years s i n c e diagnosis  -.02  0.13  .90  .31  2.39  .02  Degree o f f a t i g u e  Congruence ( r e : fatigue)  Note.  B e t a i s the s t a n d a r d i z e d  Percentage of variance  regression  i n e f f i c a c y o f problem s o l v i n g c o p i n g  accounted f o r by the r e g r e s s i o n e q u a s i o n : R (adjusted,  coefficient.  . 0 7 ) . O v e r a l l , F (4,  55)=  i s . 13  2 . 0 3 , p. = . 1 0 .  1 32  Appendix  K  M u l t i p l e R e g r e e s s i o n A n a l y s i s o f P r e d i c t o r s o f Avoidance Coping Use U s i n g A b s o l u t e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence (N=60)  Variable  Beta  Congruence ( r e : fatigue) Congruence ( r e :  t  p_<  0.63  . 53  . 20  •1 .65  .10  .37  2.94  .01  •1 .09  .28  communication) Degree o f f a t i g u e Years  Note.  .1 3  since diagnosis  B e t a i s the s t a n d a r d i z e d  Percentage of variance  coefficient.  i n avoidance c o p i n g accounted f o r by  the r e g r e s s i o n e q u a s i o n : R F  regression  (4, 55)= 4.74, p. <.05.  i s .26 ( a d j u s t e d ,  .20). O v e r a l l ,  1 33 Appendix  L  M u l t i p l e Regreession A n a l y s i s of P r e d i c t o r s of Seeking S o c i a l Support Coping Use U s i n g A b s o l u t e E r r o r as the Method o f O p e r a t i o n a l i z i n g Congruence  Variable  Beta  (N=60)  t  p_<  Congruence ( r e : fatigue)  .13  -0.94  .53  Congruence ( r e : communication)  .06  0.48  .10  -.04  -0.26  .79  - .21  -1.52  .13  Degree o f f a t i g u e Years s i n c e diagnosis  Note.  Beta i s the s t a n d a r d i z e d r e g r e s s i o n c o e f f i c i e n t .  Percentage of v a r i a n c e i n  s e e k i n g s o c i a l support c o p i n g 2  accounted f o r by the r e g r e s s i o n e q u a s i o n : R  i s .06  ( a d j u s t e d , -.005). O v e r a l l , F (4,55)= .93, p ns.  1 34 Appendix M M u l t i p l e R e g r e e s s i o n A n a l y s i s o f P r e d i c t o r s o f Problem S o l v i n g Coping Use U s i n g A b s o l u t e E r r o r as t h e Method o f O p e r a t i o n a l i z i n g Congruence (N=60)  Variable  Beta  Congruence ( r e : fatigue)  -.18  -1 .38  17  Congruence ( r e : communication)  .27  2.11  .04  Degree o f f a t i g u e  .34  2.59  .01  Years since diagnosis  .1 7  1 .31  .20  Note.  Beta i s the standardized  Percentage of variance  regression  coefficient.  i n problem s o l v i n g c o p i n g a c c o u n t e d  f o r by t h e r e g r e s s i o n e q u a s i o n : R O v e r a l l , F (4, 55)= 2.89, p_<.05.  i s . 17 (adjusted,, . 1 1 ) .  1 35 Appendix N L i s t o f Coping S t r a t e g i e s Used t h a t were not on The  Coping  Strategy Indicator h e l p i n g o t h e r p e o p l e (3) dependence on a h i g h e r power f o r guidance and s t r e n g t h p o s i t i v e t h i n k i n g (3) r e s t i n g (3) making a c o n s c i o u s e f f o r t t o a v o i d s t r e s s p a c i n g a c t i v i t i e s (2) j o u r n a l i n g (2) b e i n g c l o s e t o n a t u r e (2) h a v i n g a dog (3) reading m e d i t a t i n g (2) h a v i n g C h r i s t i a n b e l i e f s (praying) (3) s h a r i n g workloads h a v i n g temper tantrums ( t h r o w i n g t h i n g s ) d e n i a l (3) gardening, d r i v i n g i n the c o u n t r y c h o o s i n g not t o p a r t i c i p a t e i n n e g a t i v e d i s c u s s i o n s , music (3) biofeedback ( r e l a x a t i o n ) e x e r c i s e (4) c o n s c i o u s l y t u r n i n g my mind o f f t r y i n g not t o f e e l g u i l t y about s l e e p i n g d u r i n g the day changing a c t i v i t i e s t o l e s s demanding ones k e e p i n g my mind v e r y a c t i v e w a t c h i n g funny movies panic acknowledging l i m i t a t i o n s v i s i t i n g neighbours determination Note Coping s t r a t e g i e s are l i s t e d i n no p a r t i c u l a r o r d e r .  1 36 Appendix O Frequency D i s t r i b u t i o n o f S a l i e n t Demographic C h a r a c t e r i s t i c s of P a r t i c i p a n t s  (N=120)  Characteristic  Range  Frequency  Percent  Age o f I n d i v i d u a l s w i t h MS  24-34 35-44 45-54 55-65  6 20 25 9  10.00 33.30 41.70 15.00  Age o f W e l l Spouse  24-34 35-44 45-54 55-65  5 19 26 10  8.30 31.70 43.30 16.70  Number o f Years M a r r i e d  1-10 11-20 21 -30 31 -40 41 -50  24 13 16 6 1  40.00 21.70 26.60 10.00 .1.70  Number o f Years w i t h MS  1-10 1 1 -20 21-30 31 -40  36 18 16 1  60.00 30.00 8.30 1.70  16 23 15 4 2  26.70 ' 38.30 25.00 6.70 3.30  Type o f MS Relapse-Remitting • Chronic-Progressive Relapse-Progressive Benign Unknown  1 37 Appendix P Frequency D i s t r i b u t i o n  o f S c o r e s on t h e F a t i g u e I m p a c t  Scale  (N=120)  I n d i v i d u a l s w i t h MS  Range  20-39 40-59 60-79 80-99 100-119 120-139 140-160 Well  Spouses  Range  1-19 20-39 40-59 60-79 80-99 100-119 120-139  Frequency  9 11 13 14 9 3 1 Frequency  7 1 1 14 14 5 5 4  Percent  15.00 1 8.30 21 .70 23.30 1 5.00 5.00 1 .70 Percent  11.70 19.30 23.30 23.30 8.30 8.30 6.70  1 38 Appendix Q Frequency D i s t r i b u t i o n o f Scores on the Couple Scale  Communication  (N=60)  P o s i t i v e Couple Agreement  Score 0 10 20 30 40 50 60 70 80 90 100  Frequency 7 7 7 6 7 6 1 4 7 6 2  Percent 11.70 11.70 11.70 10.00 11.70 10.00 1.70 6.70 11.70 10.00 3.30  1 39 Appendix R Frequency D i s t r i b u t i o n o f Coping E f f i c a c y Scores (N=60)  Avoidance Coping E f f i c a c y  Range 0-1.99 2-3.99 4-5.99 6-7.99 8-9.99 10-11 .99  S e e k i n g S o c i a l Support Coping E f f i c a c y  Problem-Solving Coping E f f i c a c y  Range  Frequency  Percent  7 21 17 7 7 1  11.70 35.00 28.30 11.70 11.70 1 .70  Frequency  Percent  0-1.99 2-3.99 4-5.99 6-7 .99 8 - 9 99 1 0-1 1 99 12-13.99  26 19 10 3 0 1 1  43.20 31 . 7 0 16.70 5.00 0.00 1 .70 1 .70  Range  Frequency  Percent  4 21 14 1 1  6.70 35.00 23.30 1 8.30 5.00 6.70 5.00  0-1.99 2-3.99 4-5.99 6-7 .99 8-9.99 10-11 .99 12-13.99  3 4 3  

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