UBC Theses and Dissertations

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UBC Theses and Dissertations

Social comparison and coping with multiple sclerosis Hemphill, Kenneth John 1989

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SOCIAL COMPARISON AND COPING WITH MULTIPLE SCLEROSIS By KENNETH JOHN HEMPHILL B.A., The U n i v e r s i t y of B r i t i s h Columbia, 1987 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN THE FACULTY OF GRADUATE STUDIES (Department of Psychology) We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1989 © K e n n e t h John Hemphill, 1989 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 agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Psychology The University of British Columbia Vancouver, Canada Date August 29. 1989 DE-6 (2/88) i i ABSTRACT One h u n d r e d f o r t y - t h r e e p e o p l e w i t h m u l t i p l e s c l e r o s i s p a r t i c i p a t e d i n t h e p r e s e n t s t u d y , w h i c h was an a t t e m p t t o e x t e n d f i n d i n g s i n t h e s o c i a l c o m p a r i s o n l i t e r a t u r e . The m a i n g o a l s were t o i n v e s t i g a t e 1) t h e e f f e c t s o f t i m e s i n c e d i a g n o s i s a n d f u n c t i o n a l s t a t u s on s o c i a l c o m p a r i s o n s a n d m e n t a l h e a l t h , a nd 2 ) a f f e c t i v e c o n s e q u e n c e s s u b s e q u e n t t o c o m p a r i s o n s w i t h o t h e r s . To a t t a i n t h e f o r m e r o b j e c t i v e , r e s p o n d e n t s were d i v i d e d i n t o t h r e e g r o u p s . G r o u p one c o n s i s t e d o f r e s p o n d e n t s who h a d been d i a g n o s e d w i t h MS l e s s t h a n t h r e e y e a r s a g o . G r o u p two p a r t i c i p a n t s i n c l u d e d p e o p l e who h a d been d i a g n o s e d b e t w e e n f i v e a n d t e n y e a r s a g o , m a t c h e d on a c a s e - b y - c a s e b a s i s t o g r o u p one r e s p o n d e n t s on f u n c t i o n a l s t a t u s (a m e a s u r e o f p h y s i c a l d i s a b i l i t y ) . G r o u p t h r e e was c o m p r i s e d o f t h o s e who h a d a l s o been d i a g n o s e d f i v e t o t e n y e a r s p r i o r , w i t h more e x t r e m e c a s e s of t h e d i s e a s e t h a n r e s p o n d e n t s i n g r o u p s one a n d t w o . I n c o n t r a s t t o downward c o m p a r i s o n t h e o r y ( w h i c h w o u l d p r e d i c t t h a t g r o u p s one a n d t h r e e w o u l d be most l i k e l y t o d o w n w a r d l y compare and l e a s t l i k e l y t o u p w a r d l y compare due t o t h e i r g r e a t e r t h r e a t ) , t h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s on f r e q u e n c i e s of c o m p a r i n g w i t h w o r s e o f f o t h e r s . M o r e o v e r , p a r t i c i p a n t s i n g r o u p t h r e e were s l i g h t l y more l i k e l y t o make c o m p a r i s o n s w i t h b e t t e r o f f o t h e r s t h a n r e s p o n d e n t s i n g r o u p s one a n d t w o . I n t h e o v e r a l l s a m p l e , an i n t e r e s t i n g p a t t e r n o f a s s o c i a t i o n s e m e r g e d b e t w e e n s o c i a l c o m p a r i s o n s , a f f e c t i v e c o n s e q u e n c e s , a n d a v a r i e t y o f o t h e r m e a s u r e s . Low l e v e l s o f s e l f - e s t e e m a n d h i g h l e v e l s o f d e p r e s s i o n w e r e p o s i t i v e l y c o r r e l a t e d w i t h m a k i n g u p w a r d c o m p a r i s o n s , y e t w e r e u n a s s o c i a t e d w i t h d o w n w a r d c o m p a r i s o n s . O p t i m i s m was u n r e l a t e d t o e i t h e r . P e o p l e l o w e r on s e l f - e s t e e m a n d h i g h e r on d e p r e s s i o n w e r e more l i k e l y t o r e p o r t f e e l i n g w o r s e s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s ( e s p e c i a l l y b e t t e r o f f o t h e r s ) , y e t w e r e no more o r l e s s l i k e l y t o r e p o r t f e e l i n g b e t t e r t h a n t h e i r c o u n t e r p a r t s . R e s p o n d e n t s h i g h e r on o p t i m i s m w e r e more l i k e l y t o r e p o r t f e e l i n g b e t t e r s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s , y e t w e r e no m o r e o r l e s s l i k e l y t o r e p o r t f e e l i n g w o r s e t h a n t h o s e l o w e r on o p t i m i s m . O v e r a l l , r e s p o n d e n t s r e p o r t e d f e e l i n g b e t t e r more o f t e n t h a n w o r s e when c o m p a r i n g b o t h u p w a r d a n d d o w n w a r d . R e s p o n d e n t s w e r e a s k e d a b o u t s o c i a l c o m p a r i s o n s on two d i m e n s i o n s : p h y s i c a l c o n d i t i o n a n d c o p i n g a b i l i t y . Downward c o m p a r i s o n s w e r e c o r r e l a t e d w i t h more e x t r e m e a f f e c t (made r e s p o n d e n t s f e e l b o t h b e t t e r a n d w o r s e ) on t h e p h y s i c a l c o n d i t i o n t h a n c o p i n g d i m e n s i o n , p r e s u m a b l y b e c a u s e o f i n c r e a s e d s a l i e n c e , i m p a c t o f f o r c e d c o m p a r i s o n s , p e r c e i v e d c o n t r o l l a b i l i t y , a n d d i s t o r t a b i l i t y o f i n f o r m a t i o n . C o n s i s t e n t w i t h t h e n o t i o n t h a t d o w n w a r d c o m p a r i s o n s a r e n o t r e g a r d e d a s s o c i a l l y a c c e p t a b l e y e t h a v e i m p o r t a n t p s y c h o l o g i c a l i m p l i c a t i o n s , p e r c e i v e d a p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s was u n a s s o c i a t e d w i t h u p w a r d c o m p a r i s o n s , y e t p o s i t i v e l y c o r r e l a t e d w i t h d o w n w a r d c o m p a r i s o n s . i v A d d i t i o n a l l y , a p p r o p r i a t e n e s s was p o s i t i v e l y r e l a t e d t o f e e l i n g g ood when c o m p a r i n g downward b u t n o t u p w a r d . As a w h o l e , t h e f i n d i n g s s u p p o r t t h e n o t i o n t h a t s o c i a l c o m p a r i s o n s a r e n o t i n t r i n s i c a l l y p o s i t i v e o r n e g a t i v e , a n d d e m o n s t r a t e t h e i m p o r t a n c e o f c o n s i d e r i n g d i m e n s i o n s o f c o m p a r i s o n . C o r r o b o r a t i n g p r e v i o u s r e s e a r c h , r e s p o n d e n t s d e m o n s t r a t e d a p o s i t i v i t y b i a s , t h a t i s , t h e y b e l i e v e d t h e y were d o i n g b e t t e r t h a n o t h e r s w i t h MS, t h e y d o w n w a r d l y c o m p a r e d more t h a n t h e y u p w a r d l y c o m p a r e d , a n d t h e y r e p o r t e d f e e l i n g b e t t e r a f t e r m a k i n g c o m p a r i s o n s more t h a n t h e y f e l t w o r s e . H e n c e , b o t h downward a n d u p w a r d c o m p a r i s o n s seem t o be u s e d t o a t t a i n p s y c h o l o g i c a l b e n e f i t , a l t h o u g h r e s p o n d e n t s l o w e r on s e l f - e s t e e m a n d h i g h e r on d e p r e s s i o n a r e more l i k e l y t o r e p o r t n e g a t i v e a f f e c t i v e c o n s e q u e n c e s . V TABLE OF CONTENTS A b s t r a c t i i Acknowledgements ix I. I n t r o d u c t i o n A. Overview of F e s t i n g e r ' s s o c i a l comparison theory .. 1 B. C o n t r a s t i n g s o c i a l comparison and downward comparison t h e o r i e s 2 C. An overview of downward comparison theory 3 D. S o c i a l comparison and coping 5 E. P o p u l a t i o n under i n v e s t i g a t i o n : M u l t i p l e s c l e r o s i s . 12 I I . Issues of i n v e s t i g a t i o n A. Time-frame of s t r e s s f u l l i f e experience 15 B. A f f e c t i v e consequences of comparisons 22 I I I . Method A. Recruitment of respondents 28 B. Sample 28 C. Procedure 30 D. Q u e s t i o n n a i r e completion 30 E. Dependent measures 31 1 . Optimism 31 2. Self-esteem 31 3. Depression 32 4. L i f e events 32 v i 5. S o c i a l comparisons 33 6. Upward comparisons 33 7. Downward comparisons 33 8. Other comparisons 34 9. A f f e c t i v e consequences 34 10. Appropriateness of making comparisons 35 1 1 . Contact with others with MS 35 12. H e a l t h 36 13. T r a j e c t o r y 36 14. Personal c o n t r o l 37 15. Demographics 37 IV. R e s u l t s A. Analyses by group 1. Demographic v a r i a b l e s 39 2. Age, education, and income confounds 40 3. Standardized measures 41 4. S i g n i f i c a n t l i f e e x p eriences 42 5. Frequencies of upward comparisons 43 6. Frequencies of downward comparisons 43 7. A f f e c t i v e consequences 43 8. Contact with others with MS 44 9. P h y s i c a l h e a l t h 45 10. T r a j e c t o r y 47 11. Personal p s y c h o l o g i c a l c o n t r o l 47. v i i B . O v e r a l l s a m p l e a n a l y s e s 1 . C o m p a r i s o n s c o r r e l a t e d w i t h o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n 4 7 2 . C o m p a r i s o n s a n d t r a j e c t o r y 4 9 3 . C o m p a r i s o n s a n d p e r s o n a l c o n t r o l 5 0 4 . C o r r e l a t i o n s w i t h f u n c t i o n a l s t a t u s 51 5 . U p w a r d a n d d o w n w a r d c o m p a r i s o n s 5 2 6 . C o n t a c t w i t h o t h e r s 5 2 7 . A p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s 5 2 C . A f f e c t i v e c o n s e q u e n c e s f r o m m a k i n g c o m p a r i s o n s 1 . P o s i t i v e v e r s u s n e g a t i v e a f f e c t i v e c o n s e q u e n c e s 5 3 2 . C o m p a r i s o n s o n t h e p h y s i c a l c o n d i t i o n v e r s u s c o p i n g d i m e n s i o n s 5 4 3 . U p w a r d v e r s u s d o w n w a r d c o m p a r i s o n s 5 5 D . G e n d e r d i f f e r e n c e s , 5 6 V . D i s c u s s i o n A . P s y c h o l o g i c a l f u n c t i o n i n g 5 8 B . S o c i a l c o m p a r i s o n f u n c t i o n o f s u p p o r t g r o u p s 61 C . P r e d i c t i o n s b a s e d o n d o w n w a r d c o m p a r i s o n t h e o r y . . . 6 2 D . A f f e c t i v e c o n s e q u e n c e s f r o m s o c i a l c o m p a r i s o n s . . . . 63> E . C o m p a r i s o n s , a d j u s t m e n t , t r a j e c t o r y , a n d p e r c e i v e d c o n t r o l 64 F . P h y s i c a l c o n d i t i o n v e r s u s c o p i n g 6 6 v i i i G. F l e x i b i l i t y o f downward c o m p a r i s o n s 67 H. P o s i t i v i t y b i a s e s 68 I . A p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s 69 J . B a r r i e r s t o s o c i a l c o m p a r i s o n 70 K. P o t e n t i a l l y i m p o r t a n t m e t h o d o l o g i c a l c o n s i d e r a t i o n s 71 F o o t n o t e s 74 R e f e r e n c e s 76 A p p e n d i c e s 83 i x A c k n o w l e d g e m e n t s I w o u l d l i k e t o a c k n o w l e d g e s e v e r a l p e o p l e who h a v e c o n t r i b u t e d i n many ways t o make c o m p l e t i o n o f t h i s t h e s i s p o s s i b l e . D a r r i n Lehman h a s done f a r more t h a n i s r e q u i r e d o f a s u p e r v i s o r , p r o v i d i n g b o t h i n t e l l e c t u a l g u i d a n c e a n d e n c o u r a g e m e n t . He h a s been e x t r e m e l y r e s o u r c e f u l a n d i n s i g h t f u l a t a l l s t a g e s , a n d h a s c o n t r i b u t e d i m m e a s u r a b l y t o t h e f i n a l p r o d u c t . I am i n d e b t e d t o t h e o t h e r members o f my c o m m i t t e e , R e b e c c a C o l l i n s , A n i t a D e L o n g i s , a n d K e i t h Dobson f o r t h e i r i n v a l u a b l e s u g g e s t i o n s r e g a r d i n g d a t a a n a l y s i s a n d c o n t e n t o f t h e m a n u s c r i p t . I w o u l d l i k e t o e x p r e s s my a p p r e c i a t i o n t o C a r o l A n t h o n y a t t h e MS S o c i e t y , who s p e n t t i m e c o - o r d i n a t i n g v o l u n t e e r s , s e r v i n g a s a r e s o u r c e p e r s o n , a n d o v e r c o m i n g s e e m i n g l y i n s u r m o u n t a b l e o b s t a c l e s a s d e a d l i n e s a p p r o a c h e d . T h i s p r o j e c t was c o m p l e t e d w i t h t h e h e l p o f v o l u n t e e r s a t t h e MS S o c i e t y , who f a c i l i t a t e d t h e m a i l i n g p r o c e s s by s t u f f i n g a n d a d d r e s s i n g e n v e l o p e s . I w o u l d l i k e t o t h a n k t o G e r r y B r i g g s a n d a l l o f t h e p e o p l e w i t h m u l t i p l e s c l e r o s i s a t t h e Chimo A c h i e v e m e n t C e n t e r who c o m p l e t e d an e a r l i e r v e r s i o n o f t h e q u e s t i o n n a i r e and o f f e r e d v a l u a b l e s u g g e s t i o n s f o r r e v i s i o n . My f a m i l y h a s been e x t r e m e l y s u p p o r t i v e a n d h a s h e l p e d me t o a t t a i n my g o a l s t h r o u g h t h e i r u n d e r s t a n d i n g a n d l o v e . I am g r a t e f u l f o r t h e i r e n c o u r a g e m e n t . L a s t l y , I w o u l d l i k e t o t h a n k a l l o f t h e p a r t i c i p a n t s w i t h m u l t i p l e s c l e r o s i s who t o o k X time to p a r t i c i p a t e i n the study and share t h e i r e x p e r i e n c e s . With t h e i r a s s i s t a n c e , I hope I have helped to c o n t r i b u t e to what i s known about coping with m u l t i p l e s c l e r o s i s . 1 I . I n t r o d u c t i o n F e s t i n g e r ' s (1954) s o c i a l comparison t h e o r y was p r i m a r i l y based on l a b o r a t o r y s t u d i e s and was o r i g i n a l l y a p p l i e d t o the a p p r a i s a l of a b i l i t i e s and o p i n i o n s . In r e c e n t y e a r s , f i e l d r e s e a r c h has extended the t h e o r e t i c a l and e m p i r i c a l f o c u s of s o c i a l comparison t h e o r y t o i n c l u d e p e o p l e e x p e r i e n c i n g s t r e s s f u l l i f e e v e n t s . I n l i n e w i t h t h i s l a t t e r a pproach, the main fo c u s of the p r e s e n t study i s t o e x p l o r e s o c i a l comparison and i t s use among p e o p l e w i t h M u l t i p l e S c l e r o s i s (MS). F i r s t , s o c i a l c omparison and downward comparison t h e o r i e s a r e summarized and c o n t r a s t e d , f o l l o w e d by a l i t e r a t u r e r e v i e w of s o c i a l comparison and c o p i n g . Then, p r e d i c t i o n s c o n c e r n i n g time e l a p s e d s i n c e d i a g n o s i s and f u n c t i o n a l s t a t u s , as w e l l as a f f e c t i v e consequences from s o c i a l c o m p a r i s o n s , a r e p r e s e n t e d . A. Overview of F e s t i n g e r ' s s o c i a l comparison t h e o r y S o c i a l comparison t h e o r y , proposed by F e s t i n g e r (1954), i s con c e r n e d w i t h the e x t e n t t o which we u t i l i z e o t h e r s as s o u r c e s of i n f o r m a t i o n t o a s s e s s our o p i n i o n s and a b i l i t i e s . F e s t i n g e r (1954) b e l i e v e s t h e r e i s a d r i v e toward s e l f - e v a l u a t i o n ( o b t a i n i n g an a c c u r a t e p e r c e p t i o n of s e l f ) and, when p o s s i b l e , we w i l l employ o b j e c t i v e s t a n d a r d s ( n o n - s o c i a l i n f o r m a t i o n ) . However, when the v e r i d i c a l i t y of p a r t i c u l a r judgments or the assessment of performances cannot be d i r e c t l y a s c e r t a i n e d , we w i l l e v a l u a t e o u r s e l v e s v i a comparisons w i t h s i m i l a r o t h e r s ( s o c i a l i n f o r m a t i o n ) . Comparisons w i t h s i m i l a r o t h e r s a f f o r d more a c c u r a t e a p p r a i s a l of our own performance and a t t i t u d e s than 2 do comparisons with divergent others. For example, a novice chess player w i l l not compare him or herself with those who have spent years perfecting their s k i l l s . Although there are s i m i l a r i t i e s regarding evaluation of opinions and a b i l i t i e s , differences between the two are also acknowledged: one may change opinions rather e a s i l y , but a l t e r i n g a b i l i t i e s may be somewhat more d i f f i c u l t to accomplish. Objective standards are also less l i k e l y to be available to judge opinions than a b i l i t i e s . Moreover, since there i s value placed upon achievement (in Western culture, at l e a s t ) , there are simultaneous pressures to accomplish uniformity of a b i l i t y and improve personal performance. Thus, s o c i a l quiescence i s less l i k e l y to occur with respect to a b i l i t i e s than opinions. B. Contrasting s o c i a l comparison and downward comparison  theories Festinger's theory largely focused on the evaluative function of s o c i a l comparison, which i s based upon the assumption that individuals are problem-solvers who c a r e f u l l y and l o g i c a l l y integrate information. As such, people are assumed to gather information and function as i n t u i t i v e s c i e n t i s t s who are unbiased and r a t i o n a l . In contrast, downward comparison theory focuses on self-enhancement, which i s aimed at obtaining information about the self which i s favorable (Hakmiller, 1966; W i l l s , 1981). According to t h i s l a t t e r view, the environment i s cognitively construed in such a way that desirable pieces of information are s e l e c t i v e l y focused upon. Negative information about the s e l f 3 may be s y s t e m a t i c a l l y d i s t o r t e d o r i n t e r p r e t e d i n a p o s i t i v e f a s h i o n ( T a y l o r & B r o w n , 1 9 8 8 ) . W h i l e s e l f - e v a l u a t i o n and s e l f -e n h a n c ement may a p p e a r t o be m u t u a l l y e x c l u s i v e , t h e y a r e a c t u a l l y e n d p o i n t s on a c o n t i n u u m ( W i l l s , 1 9 8 7 ) . A b a l a n c e b e t w e e n t h e two must be m a i n t a i n e d o r l e a r n i n g w i l l n o t o c c u r b e c a u s e o f a f a i l u r e t o l i n k b e h a v i o r t o e n v i r o n m e n t a l c o n t i n g e n c i e s . A l t e r n a t i v e l y , t h o s e who l a c k s e l f - e n h a n c i n g i l l u s i o n s may be a t r i s k t o d e v e l o p d e p r e s s i o n ( T a y l o r & Brown, 1 9 8 8 ) . W h i l e b o t h s o c i a l c o m p a r i s o n t h e o r y and downward c o m p a r i s o n t h e o r y a r e c o n c e r n e d w i t h t h e e x t e n t t o w h i c h o t h e r s a r e v i e w e d r e l a t i v e t o t h e s e l f , e a c h w i l l p r e d o m i n a t e i n d i f f e r e n t c i r c u m s t a n c e s . S p e c i f i c a l l y , u n d e r l o w s t r e s s s o c i a l c o m p a r i s o n p r o c e s s e s a r e more l i k e l y ( p e o p l e w i l l c ompare w i t h s i m i l a r o t h e r s ) , w h e r e a s u n d e r c o n d i t i o n s o f t h r e a t downward c o m p a r i s o n w i l l p r e v a i l ( p e o p l e w i l l c ompare w i t h d i s s i m i l a r o r w o r s e o f f o t h e r s ) ( G r u d e r , 1 9 7 7 ) 1 . C. An o v e r v i e w o f downward c o m p a r i s o n t h e o r y H a k m i l l e r ( 1 9 6 6) c o n d u c t e d t h e f i r s t s t u d y t h a t q u e s t i o n e d t h e b e l i e f t h a t s o c i a l c o m p a r i s o n i s u t i l i z e d s o l e l y f o r s e l f -a s s e s s m e n t . H a k m i l l e r h y p o t h e s i z e d t h a t s u b j e c t s u n d e r c o n d i t i o n s o f h i g h t h r e a t s h o u l d c o m p a r e w i t h d i s s i m i l a r i n f e r i o r o t h e r s more t h a n s u b j e c t s c o n f r o n t e d w i t h low t h r e a t . The p r e d i c t i o n was b o r n e o u t by t h e d a t a . I n t h e w o r d s o f H a k m i l l e r , downward c o m p a r i s o n s e r v e d a " d e f e n s i v e f u n c t i o n . " S u c h c o m p a r i s o n s d i m i n i s h t h e i m p a c t o f t h r e a t , a s e v i d e n c e d by t h e 4 f a c t t h a t a r e d u c t i o n o f e x p r e s s e d d i s t u r b a n c e was m e n t i o n e d o n l y by h i g h t h r e a t s u b j e c t s . W i l l s ( 1 9 8 1) i n t e g r a t e d r e s e a r c h f i n d i n g s o f H a k m i l l e r ( 1 9 6 6 ) a n d o t h e r i n v e s t i g a t o r s a n d a d v a n c e d a t h e o r y o f downward c o m p a r i s o n , w h i c h i s b a s e d upon t h e b a s i c p r i n c i p l e t h a t one may e n h a n c e f e e l i n g s o f p e r s o n a l w o r t h u n d e r t h r e a t e n i n g c o n d i t i o n s by c o m p a r i n g t h e s e l f w i t h a n o t h e r who i s w o r s e o f f . The f o l l o w i n g s e c t i o n r e v i e w s W i l l s ' s c e n t r a l a r g u m e n t s . Downward c o m p a r i s o n i s l a r g e l y a m o t i v a t i o n a l - c o g n i t i v e t h e o r y . W i l l s ( 1 9 8 1 ) t h e o r i z e d t h a t downward c o m p a r i s o n i s p r e d o m i n a n t l y u t i l i z e d i n s i t u a t i o n s i n w h i c h i n s t r u m e n t a l a c t i o n i s i m p o s s i b l e o r i m p r a c t i c a l . When one i s c o n f r o n t e d w i t h t h r e a t s t o s e l f - e s t e e m , w h i c h i s d e f i n e d i n t e r m s o f t h e d e g r e e t o w h i c h one v a l u e s o n e s e l f ( R e b e r , 1 9 8 6 ) , s u b j e c t i v e w e l l - b e i n g i s d e c r e a s e d a n d n e g a t i v e a f f e c t p r e v a i l s . One method o f r e s t o r i n g a n d m a i n t a i n i n g a s e n s e o f w e l l - b e i n g i s t o engage i n downward c o m p a r i s o n . A l t h o u g h one may f e e l b e t t e r a b o u t h i s o r h e r s i t u a t i o n by c o m p a r i n g w i t h someone who i s w o r s e o f f o r e q u a l l y u n f o r t u n a t e , when g i v e n t h e o p p o r t u n i t y t h e f o r m e r c o m p a r i s o n i s p r e f e r r e d ( W i l l s , 1 9 8 1 ) . Downward c o m p a r i s o n may be r e l a t i v e l y p a s s i v e i n c e r t a i n c i r c u m s t a n c e s , when s a l i e n t o t h e r s a r e c h o s e n by v i r t u e o f v a r i o u s a s s o c i a t i o n s o r s i t u a t i o n a l o p p o r t u n i t i e s , a s e x e m p l i f i e d by t h e f e a r - a f f i l i a t i o n e f f e c t ( S c h a c h t e r , 1959) a n d humor l i t e r a t u r e ( Z i l l m a n n & C a n t o r , 1 9 7 6 ) . I n o t h e r c i r c u m s t a n c e s , downward c o m p a r i s o n may be a c t i v e l y i n i t i a t e d , e i t h e r by v e r b a l 5 d e n i g r a t i o n o f a n o t h e r p e r s o n (known a s s c a p e g o a t i n g ) o r by a d m i n i s t e r i n g p h y s i c a l harm ( t e r m e d h o s t i l e a g g r e s s i o n a n d d i s p l a c e d a g g r e s s i o n ) ( W i l l s , 1 9 8 1 ) . A c t i v e c o g n i t i v e downward c o m p a r i s o n i n t h e a b s e n c e o f o v e r t b e h a v i o r may a l s o o c c u r ( T a y l o r , Wood, & L i c h t m a n , 1 9 8 3 ) . S i n c e downward c o m p a r i s o n may be v i e w e d a s a h o m e o s t a t i c m e c h a n i s m t o e n h a n c e s u b j e c t i v e w e l l - b e i n g when i t i s l o w e r e d , W i l l s ( 1 9 8 1 ) p r o p o s e d t h o s e who a r e c h r o n i c a l l y o r t e m p o r a r i l y low i n s e l f - e s t e e m w i l l be e s p e c i a l l y l i k e l y t o engage i n c o m p a r i s o n w i t h a l e s s f o r t u n a t e o t h e r . T h o s e c h o s e n a s t h e t a r g e t s o f downward c o m p a r i s o n w i l l p r e d o m i n a n t l y be l o w s t a t u s i n d i v i d u a l s , who a r e c o n s i d e r e d a c c e p t a b l e t o d e r o g a t e by t h e p r e v a i l i n g c u l t u r e . N o n e t h e l e s s , t h e r e i s a c e r t a i n a m b i v a l e n c e a b o u t c o m p a r i n g t h e s e l f w i t h o t h e r s who a r e w o r s e o f f : on t h e one h a n d , s u b s t a n t i a l p s y c h o l o g i c a l b e n e f i t may be g a i n e d f r o m d o i n g s o i n t h e f o r m o f t e n s i o n r e d u c t i o n a n d p o s i t i v e mood e l e v a t i o n . On t h e o t h e r h a n d , t h e r e a r e s o c i a l norms w h i c h do n o t v i e w downward c o m p a r i s o n a s an a d m i r a b l e p r o c e s s a n d d i s c o u r a g e t h e u s e o f s u c h p r o c e d u r e s t o a c e r t a i n d e g r e e ( c f . B r i c k m a n & B u l m a n , 1 9 7 7 ) . M o r e o v e r , n o t e v e r y b o d y w i l l d e m o n s t r a t e downward c o m p a r i s o n i n r e s p o n s e t o a v e r s i v e s t i m u l i , s i n c e t h e p r o c e s s e s a r e l e a r n e d c o g n i t i v e s t r a t e g i e s t h a t a r e s u b j e c t t o i n d i v i d u a l - d i f f e r e n c e s , a s a r e o t h e r l e a r n e d b e h a v i o r s ( W i l l s , 1 9 8 1 ) . D. S o c i a l c o m p a r i s o n a n d c o p i n g A l t h o u g h s o c i a l c o m p a r i s o n h a s been i n v e s t i g a t e d f o r o v e r 6 t h r e e d e c a d e s , o n l y r e c e n t l y h a s r e s e a r c h f o c u s e d on t h e u s e o f s o c i a l c o m p a r i s o n a s a c o p i n g m e c h a n i s m . C u r r e n t l y , t h e s p e c i f i c m e c h a n i s m s i n v o l v e d a r e n o t w e l l u n d e r s t o o d , a l t h o u g h some t e n t a t i v e f i n d i n g s may be a d v a n c e d . As p r e v i o u s l y n o t e d , W i l l s ( 1 9 8 1 ) p r o p o s e d t h a t p e r s o n s e x p e r i e n c i n g n e g a t i v e a f f e c t a s a r e s u l t o f l o w e r e d s e l f - e s t e e m may a t t e m p t t o r e s t o r e t h e i r s u b j e c t i v e w e l l - b e i n g by downward c o m p a r i s o n . A l t h o u g h r e s e a r c h h a s more o r l e s s s u p p o r t e d s u c h a n o t i o n , r e c e n t e v i d e n c e s u g g e s t s t h r e a t i s n e i t h e r a n e c e s s a r y n o r s u f f i c i e n t p r e c o n d i t i o n f o r downward c o m p a r i s o n p r o c e s s e s t o be e v i n c e d . W h i l e some s t u d i e s h a v e f o u n d t h a t p e r s o n s l o w i n t r a i t s e l f - e s t e e m may make downward c o m p a r i s o n s ( F r i e n d & G i l b e r t , 1 9 7 3 ) , o t h e r s t u d i e s h a v e f o u n d t h a t when t h r e a t e n e d , i n d i v i d u a l s h i g h i n s e l f - e s t e e m d e n i g r a t e o u t g r o u p s when g r o u p m e m b e r s h i p h a s e v a l u a t i v e i m p l i c a t i o n s ( C r o c k e r & S c h w a r t z , 1985; C r o c k e r Thompson, McGraw, & I n g e r m a n , V 9 8 7 ) . As w e l l , p e o p l e may h a v e a t e n d e n c y t o e v a l u a t e t h e m s e l v e s f a v o r a b l y r e l a t i v e t o o t h e r s , i n t h e a b s e n c e o f t h r e a t (Wood, i n p r e s s ) . V a r i o u s downward c o m p a r i s o n s t r a t e g i e s may be e m p l o y e d i n o r d e r t o p r o t e c t s e l f - e s t e e m . A c c o r d i n g t o W i l l s ( 1 9 8 7) a n d t o work by T a y l o r a n d h e r c o l l e a g u e s ( T a y l o r e t a l . , 1983; s e e a l s o Wood, T a y l o r , & L i c h t m a n , 1 9 8 5 ) , i n d i v i d u a l s c a n i m a g i n e w o r s e a l t e r n a t i v e s ( t e r m e d " h y p o t h e t i c a l w o r s e w o r l d s " ) s o t h a t one a p p e a r s a d v a n t a g e d i n r e l a t i o n t o what c o u l d h a v e h a p p e n e d . A p a s s i v e f o r m o f downward c o m p a r i s o n i n v o l v e s an a c c i d e n t a l o r c o i n c i d e n t a l v i e w i n g o f a d i s a d v a n t a g e d t a r g e t . M o r e o v e r , one 7 may d e v i a t e f r o m l o g i c a l i n f o r m a t i o n - p r o c e s s i n g a p p r o a c h e s by s e l e c t i v e l y a b s t r a c t i n g p o s i t i v e a t t r i b u t e s a b o u t t h e s e l f o r a s s u m i n g n e g a t i v e a t t r i b u t e s a r e common i n t h e p o p u l a t i o n . A c t i v e u s e o f c o m p a r i s o n may i n v o l v e s e l e c t i v e f o c u s i n w h i c h one c h o o s e s a t a r g e t who i s s i m i l a r i n t e r m s o f a d j u s t m e n t , y e t i s w o r s e o f f on a p a r t i c u l a r d i m e n s i o n . A l t e r n a t i v e l y , one may c h o o s e a s a t a r g e t an e q u a l l y u n f o r t u n a t e o t h e r who i s c o p i n g w o r s e t h a n t h e s e l f w i t h some p a r t i c u l a r a s p e c t . S e l e c t i v e t a r g e t c h o i c e may be a c c o m p l i s h e d by s e e k i n g o u t someone who i s w o r s e t h a n t h e s e l f w i t h r e s p e c t t o many d i m e n s i o n s , a l t h o u g h s u c h a s t r a t e g y may be q u i t e r e s t r i c t i v e . T a y l o r e t a l . ( 1 9 8 3 ) e x a m i n e d v a r i o u s c o p i n g s t r a t e g i e s u t i l i z e d by b r e a s t c a n c e r p a t i e n t s . A c c o r d i n g t o t h e s e a u t h o r s , e x p e r i e n c i n g a s t r e s s f u l l i f e e v e n t i s an a v e r s i v e s t a t e a n d i n d i v i d u a l s l a b e l l e d a s v i c t i m s w i l l e ngage i n s e l e c t i v e e v a l u a t i o n a s a s e l f - e n h a n c i n g s t r a t e g y . B r i e f l y , s i t u a t i o n s a r e c o g n i t i v e l y c o n s t r u c t e d so t h a t t h e b e n e f i c i a l a s p e c t s o f an u n f o r t u n a t e s i t u a t i o n a r e s t r e s s e d . I n a d d i t i o n t o t h r e e s t r a t e g i e s m e n t i o n e d e a r l i e r ( c o m p a r i s o n w i t h a d i s a d v a n t a g e d t a r g e t , s e l e c t i n g a d i m e n s i o n o f c o m p a r i s o n on w h i c h t h e s e l f i s a d v a n t a g e d , a n d t h e c r e a t i o n o f h y p o t h e t i c a l w o r s e w o r l d s ) , s e l e c t i v e e v a l u a t i o n i n c l u d e s f i n d i n g m e a n i n g f r o m t h e n e g a t i v e e x p e r i e n c e by c o n s t r u i n g b e n e f i t f r o m i t , a n d m a n u f a c t u r i n g n o r m a t i v e s t a n d a r d s o f a d j u s t m e n t w i t h w h i c h t h e s e l f c o m p a r e s f a v o r a b l y . I n a f o l l o w - u p a r t i c l e (Wood e t a l . , 1 9 8 5 ) , t h e e f f i c a c y o f 8 f o u r c o m p a r i s o n s t r a t e g i e s i n b r e a s t c a n c e r p a t i e n t s was e x a m i n e d . The s u p e r c o p e r p e r s p e c t i v e , w h i c h i s b a s e d on t h e a s s u m p t i o n t h a t c o n t a c t w i t h c o m p a r i s o n o t h e r s may be u n a v a i l a b l e f o r many p a t i e n t s , was n o t s u p p o r t e d . E v i d e n c e f o r t h e s i m i l a r i t y h y p o t h e s i s , w h i c h s u g g e s t s c o m p a r i s o n s a r e made w i t h s i m i l a r o t h e r s , was m i x e d s i n c e p a t i e n t s made a p r e p o n d e r a n c e o f c o m p a r i s o n s w i t h o t h e r c a n c e r p a t i e n t s , y e t r a r e l y c o m p a r e d t h e m s e l v e s w i t h t h o s e who were s i m i l a r i n t e r m s o f p h y s i c a l s t a t u s , l i f e s i t u a t i o n s , o r r e l a t e d a t t r i b u t e s . W h i l e a few c o m p a r i s o n s were made w i t h a d v a n t a g e d o t h e r s ( u p w a r d c o m p a r i s o n s ) , by f a r t h e most p r e v a l e n t c o m p a r i s o n s were w i t h d i s a d v a n t a g e d o t h e r s (downward c o m p a r i s o n ) . I n c o n t r a s t t o t h e p r o p o s i t i o n by W i l l s ( 1 9 8 1 ) , Wood e t a l . ( 1 9 8 5 ) d i d n o t f i n d t h a t t h r e a t l e a d s t o downward c o m p a r i s o n . H o wever, Wood e t a l . ( 1 9 8 5 ) u s e d o b j e c t i v e m e a s u r e s o f t h r e a t s u c h a s s e v e r i t y o f s u r g e r y a n d p r o g n o s i s , w h i c h may n o t c o r r e s p o n d w i t h p a t i e n t s ' s u b j e c t i v e i m p r e s s i o n s . Even s o , e v i d e n c e was p r o v i d e d f o r t h e s u g g e s t i o n t h a t downward c o m p a r i s o n s may f u n c t i o n t o p r o t e c t t h e c a n c e r p a t i e n t f r o m b e i n g o v e r w h e l m e d by f r i g h t e n i n g new c i r c u m s t a n c e s , s i n c e women who h a d r e c e n t l y r e c e i v e d s u r g e r y were more l i k e l y t o d o w n w a r d l y c o m p a r e t h a n t h o s e who h a d been o p e r a t e d on some t i m e e a r l i e r . S c h u l z a n d D e c k e r ( 1 9 8 5 ) i n t e r v i e w e d s p i n a l - c o r d i n j u r e d p e r s o n s who h a d been i n v o l v e d i n a c c i d e n t s an a v e r a g e o f t w e n t y y e a r s e a r l i e r . The a u t h o r s f o u n d o n l y l i m i t e d s u p p o r t f o r t h e u s e o f downward c o m p a r i s o n s . F o r e x a m p l e , o n l y 2 5 % o f 9 r e s p o n d e n t s m e n t i o n e d c o m p a r i s o n s w i t h o t h e r d i s a b l e d p e r s o n s , 16% s a i d t h e y c o m p a r e d t h e m s e l v e s w i t h n o n d i s a b l e d p e r s o n s , a n d t h e r e s t s a i d t h e y d i d n ' t compare t h e m s e l v e s w i t h a n y p a r t i c u l a r g r o u p o f p e r s o n s . I n a d d i t i o n , s p i n a l - c o r d i n j u r e d p e r s o n s r e a d i l y i m a g i n e d h y p o t h e t i c a l b e t t e r w o r l d s ( w h i c h c a n be c o n t r a s t e d w i t h T a y l o r e t a l . , 1983) a n d r a t e d t h e i r c u r r e n t l i f e s i t u a t i o n a s l e s s f a v o r a b l e t h a n i t h a d been f o r t h e m s e l v e s p r i o r t o t h e a c c i d e n t . N o n e t h e l e s s , t h e r e was some s u p p o r t f o r t h e u s e o f downward c o m p a r i s o n s , s i n c e r e s p o n d e n t s s e l e c t i v e l y f o c u s e d on a d v a n t a g e d a t t r i b u t e s , a t t a c h e d m e a n i n g a n d b e n e f i t t o t h e s t r e s s f u l l i f e e x p e r i e n c e , a n d b a s e d s t a n d a r d s o f a d j u s t m e n t on a t t r i b u t e s a t w h i c h t h e y c o u l d e x c e l . Q u i t e p o s s i b l y , t h e s e r e s p o n d e n t s may h a v e been u t i l i z i n g s o c i a l c o m p a r i s o n s more o f t e n i n t h e i r e v e r y d a y l i v e s t h a n t h e y a d m i t t e d , y e t be c o n f u s e d by t h e way t h e q u e s t i o n was a s k e d . I n d e e d , S c h u l z a n d D e c k e r ( 1 9 8 5 ) m e n t i o n e d t h a t some p e o p l e h a d d i f f i c u l t y r e s p o n d i n g . A l o n g i t u d i n a l q u e s t i o n n a i r e s t u d y was c o n d u c t e d by Thompson ( 1 9 8 5 ) , i n w h i c h p e o p l e whose homes were b u r n e d by f i r e were c o n t a c t e d i m m e d i a t e l y a f t e r t h e i n c i d e n t a n d a g a i n one y e a r l a t e r . The a u t h o r e x a m i n e d f i v e 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 u s e d t o r e e v a l u a t e t h e e v e n t a s a p o s i t i v e o ne. T h e s e i n c l u d e d f i n d i n g s i d e b e n e f i t s s u c h a s i n c r e a s i n g f a m i l i a l c o n t a c t a n d s u p p o r t , downward c o m p a r i s o n , i m a g i n i n g w o r s e s i t u a t i o n s , f o r g e t t i n g t h e n e g a t i v e , a n d r e d e f i n i n g t h e s i t u a t i o n i n a way t h a t o n e ' s e x p e c t a t i o n s d i d n o t e x c e e d l i k e l y o u t c o m e s . The f i v e m e t h o d s were h i g h l y i n t e r c o r r e l a t e d , a n d were e n d o r s e d by t h e 10 m a j o r i t y o f r e s p o n d e n t s . F o c u s i n g on p o s i t i v e a s p e c t s o f t h e s t r e s s f u l e v e n t was s i g n i f i c a n t l y c o r r e l a t e d w i t h e f f e c t i v e c o p i n g , i m m e d i a t e l y a f t e r t h e f i r e a n d one y e a r l a t e r . P o s i t i v e r e e v a l u a t o r s a l s o m e n t i o n e d f e w e r p h y s i c a l symptoms and more p o s i t i v e a f f e c t a t b o t h t i m e i n t e r v a l s . M o l l e m a n , P r u y n , a n d v a n K n i p p e n b e r g ( 1 9 8 6 ) i n v e s t i g a t e d s o c i a l c o m p a r i s o n among a g e n e r a l p o p u l a t i o n o f c a n c e r p a t i e n t s v i a q u e s t i o n n a i r e . The a u t h o r s d e r i v e d h y p o t h e s e s a c c o r d i n g t o c l a s s i c a l f o r m u l a t i o n s p r o p o s e d by F e s t i n g e r ( 1 9 5 4 ) . As p r e d i c t e d , p a t i e n t s p r e f e r r e d e x p e r t s o u r c e s t o n o n - e x p e r t o n e s t o r e d u c e u n c e r t a i n t y . Y e t , when p r o f e s s i o n a l o p i n i o n was u n a v a i l a b l e p a t i e n t s had a n e e d f o r s o c i a l c o m p a r i s o n w i t h f e l l o w p a t i e n t s . C o n t r a r y t o t h e f i n d i n g s by Wood e t a l . ( 1 9 8 5 ) , M o l l e m a n e t a l . ( 1 9 8 6) f o u n d an o v e r w h e l m i n g p r e f e r e n c e f o r r e s p o n d e n t s t o compare w i t h f e l l o w p a t i e n t s who were s i m i l a r o r s l i g h t l y b e t t e r o f f . H o w e v e r , t h e two s t u d i e s d i f f e r i n t e r m s o f t h e ways i n w h i c h c o m p a r i s o n s were o p e r a t i o n a l i z e d . M o l l e m a n e t a l . ( 1 9 8 6 ) a s k e d s u b j e c t s a b o u t who t h e y w o u l d p r e f e r t o i n t e r a c t w i t h , w h e r e a s Wood e t a l . ( 1 9 8 5 ) c o d e d e x p l i c i t c o m p a r i s o n s t a t e m e n t s . T a y l o r and L o b e l ( i n p r e s s ) h a v e n o t e d t h a t p e o p l e u n d e r t h r e a t p r e f e r t o e v a l u a t e t h e m s e l v e s a g a i n s t w o r s e o f f o t h e r s (downward e v a l u a t i o n ) , y e t a f f i l i a t e w i t h b e t t e r o f f o t h e r s ( u p w a r d c o n t a c t s ) . T h u s , d i v e r g e n t f i n d i n g s i n t h e s o c i a l c o m p a r i s o n l i t e r a t u r e h i g h l i g h t t h e n e e d t o d i s t i n g u i s h b e t w e e n o p e r a t i o n a l d e f i n i t i o n s o f s o c i a l c o m p a r i s o n s a n d t h e d i s c r e p a n t n e e d s a s s o c i a t e d w i t h them. 11 A f f l e c k , T e n n e n , P f e i f f e r , F i f i e l d , & Rowe ( 1 9 8 7 a ) p r o v i d e d d a t a on downward c o m p a r i s o n s among m o t h e r s o f h i g h - r i s k i n f a n t s a n d p e o p l e a f f l i c t e d w i t h r h e u m a t o i d a r t h r i t i s . M o t h e r s o f h i g h - r i s k i n f a n t s were i n t e r v i e w e d e i t h e r d u r i n g o r s h o r t l y a f t e r t h e i r n ewborn was i n t h e i n t e n s i v e c a r e u n i t a n d r h e u m a t o i d a r t h r i t i s p a t i e n t s were i n t e r v i e w e d an a v e r a g e o f t e n y e a r s (SD = 8.25 y e a r s ) p o s t - o n s e t o f i l l n e s s . M o t h e r s n o t o n l y t e n d e d t o v i e w t h e i r c h i l d ' s i l l n e s s a s l e s s s e v e r e t h a n a v e r a g e , t h e y a l s o p e r c e i v e d a d j u s t m e n t a s b e t t e r . C o m p a r a b l e r e s u l t s were o b t a i n e d w i t h t h e a r t h r i t i s s a m p l e . T h e r e were no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s b e t w e e n t h e s a m p l e s on e i t h e r o f t h e s e r a t i n g s . M o t h e r s o f h i g h - r i s k i n f a n t s m a i n l y p r o v i d e d downward c o m p a r i s o n s b a s e d on t h e c h i l d ' s m e d i c a l c o n d i t i o n a n d w o r s e p o s s i b l e h y p o t h e t i c a l o u t c o m e s , w h e r e a s a r t h r i t i s p a t i e n t s r e f e r r e d a l m o s t e x c l u s i v e l y t o s e v e r i t y o f i l l n e s s . Few u n f a v o r a b l e c o m p a r i s o n s were s p o n t a n e o u s l y m e n t i o n e d by any r e s p o n d e n t s . I n t e r e s t i n g l y , s e l f - r e p o r t s o f mood were u n r e l a t e d t o t h e number o r t y p e o f s o c i a l c o m p a r i s o n s made. N o n e t h e l e s s , a r t h r i t i s p a t i e n t s who v i e w e d t h e i r i l l n e s s a s l e s s s e v e r e t h a n o t h e r s were p e r c e i v e d a s b e t t e r a d j u s t e d by h e a l t h c a r e p r o v i d e r s , c o n t r o l l i n g f o r a c t u a l i l l n e s s s e v e r i t y . A l l o f t h e work d i s c u s s e d t h u s f a r i s b a s e d on t h e a s s u m p t i o n t h a t a c o m p a r i s o n i n a g i v e n d i r e c t i o n ( u p w a r d o r downward) w i l l be a s s o c i a t e d w i t h a p a r t i c u l a r a f f e c t i v e r e a c t i o n ( u p w a r d - n e g a t i v e , d o w n w a r d - p o s i t i v e ) . R e c e n t l y , Buunk, C o l l i n s , V a n Y p e r e n , T a y l o r , a n d D a k o f (1989) h a v e e x t e n d e d t h e 12 o r i g i n a l downward c o m p a r i s o n f o r m u l a t i o n by s u g g e s t i n g t h a t c o m p a r i s o n s c a n p r o d u c e e i t h e r p o s i t i v e o r n e g a t i v e f e e l i n g s d e p e n d i n g upon how one i n t e r p r e t s t h e i n f o r m a t i o n . F o r i n s t a n c e , w h i l e downward c o m p a r i s o n s c a n make one f e e l l u c k y a n d g r a t e f u l , t h e y c a n a l s o i n c r e a s e o n e ' s a n x i e t i e s a n d f e a r s a b o u t g e t t i n g w o r s e i n t h e f u t u r e ( c f . , Wood e t a l . , 1 9 8 5 ) . S i m i l a r l y , u p w a r d c o m p a r i s o n s c a n l e a d a p e r s o n t o f e e l f r u s t r a t e d a n d d e p r e s s e d b e c a u s e one i s n o t a s f o r t u n a t e a s o t h e r s , b u t t h e y c a n a l s o h a v e a c o m f o r t i n g a n d i n s p i r a t i o n a l e f f e c t b e c a u s e i t i s p o s s i b l e f o r one t o i m p r o v e . I n Buunk e t a l . ( 1 9 8 9 ) , w h i l e p e r c e i v e d s e l f c o n t r o l o v e r d a i l y symptoms a n d t h e f u t u r e o f o n e ' s i l l n e s s were n e g a t i v e l y c o r r e l a t e d w i t h f e e l i n g b a d a s a r e s u l t o f m a k i n g c o m p a r i s o n s , p e r c e i v e d o t h e r c o n t r o l was u n r e l a t e d t o n e g a t i v e a f f e c t . I n a d d i t i o n , n e g a t i v e a f f e c t a s a c o n s e q u e n c e o f m a k i n g u p w a r d a n d downward c o m p a r i s o n s was s i g n i f i c a n t l y more common among c a n c e r p a t i e n t s w i t h l o w , r a t h e r t h a n h i g h , s e l f - e s t e e m . E. P o p u l a t i o n u n d e r i n v e s t i g a t i o n ; M u l t i p l e s c l e r o s i s M u l t i p l e s c l e r o s i s (MS) was c h o s e n a s t h e p o p u l a t i o n t o s t u d y f o r s e v e r a l r e a s o n s . F i r s t , s i n c e t h e e t i o l o g y o f MS a n d c o n t r o l o f d e g e n e r a t i o n a r e b e y o n d p r e s e n t m e d i c a l e x p e r t i s e , c o g n i t i v e c o p i n g m e c h a n i s m s may be e s p e c i a l l y l i k e l y a n d i m p o r t a n t . T h i s a s s u m p t i o n i s s u p p o r t e d by W i l l s ' s ( 1 9 8 7 ) c o n t e n t i o n t h a t downward c o m p a r i s o n s w i l l be more p r e v a l e n t when i n s t r u m e n t a l a c t i o n i s i m p r a c t i c a l o r i m p o s s i b l e . S e c o n d , t h e d i s e a s e h a s an unknown t r a j e c t o r y , a l t h o u g h t h o s e w i t h MS may be more l i k e l y t o d e t e r i o r a t e t h a n t h o s e who h a v e been a f f l i c t e d 13 w i t h i n j u r i e s s u c h a s p a r a p l e g i a . I n o t h e r w o r d s , MS p r e s e n t s an o n g o i n g t h r e a t a n d a d a p t a t i o n may i n v o l v e d i f f e r e n t c o g n i t i v e c o n c o m i t a n t s t h a n n e g a t i v e l i f e e v e n t s where t h e t r a j e c t o r y i s r e l a t i v e l y s t a b l e . T h i r d , t h e p o p u l a t i o n f r o m w h i c h t h e s a m p l e was d rawn ( B r i t i s h C o l u m b i a D i v i s i o n o f t h e M u l t i p l e S c l e r o s i s S o c i e t y o f C a n a d a ) r e p r e s e n t s a f a i r l y l a r g e c r o s s - s e c t i o n o f i n d i v i d u a l s w i t h MS. MS i s t h e most common c e n t r a l n e r v o u s s y s t e m d i s e a s e among y o u n g a d u l t s i n C a nada ( G r o e t z i n g e r , 1 9 8 6 ) . I n i t i a l l y , a d i a g n o s i s i s u s u a l l y made by e l i m i n a t i n g o p t i o n s , s i n c e no s p e c i f i c m e d i c a l t e s t e x i s t s f o r p o s i t i v e d i a g n o s i s . MS i s a d e g e n e r a t i v e n e u r o l o g i c a l d i s e a s e i n w h i c h d e m y e l i n a t i o n o f a x o n s o c c u r s , r e s u l t i n g i n v i s u a l i m p a i r m e n t , p a r a l y s i s , s h a k y h a n d s , l o s s o f b l a d d e r a n d b o w e l c o n t r o l , s p e e c h p r o b l e m s , w e a k n e s s , numbness, a n d l o s s o f c o o r d i n a t i o n o r b a l a n c e ( P a v l o u , 1 9 8 4 ) . H o w e v e r , t h e r e i s s u b s t a n t i a l v a r i a t i o n b e t w e e n p e o p l e and e v e n w i t h i n t h e same p e r s o n a c r o s s t i m e , d e p e n d i n g upon t h e a r e a i n t h e c e n t r a l n e r v o u s s y s t e m t h a t i s a f f e c t e d . Symptoms may come and go o v e r a p e r i o d o f y e a r s a n d p r e d i c t i o n o f e x a c e r b a t i o n s i s d i f f i c u l t i f n o t i m p o s s i b l e : one may l i v e w i t h r e l a t i v e l y m i l d symptoms t h r o u g h o u t t h e c o u r s e o f t h e d i s e a s e o r may end up c o n f i n e d t o a w h e e l c h a i r o r b e d . The u n c e r t a i n t y o f symptom e x a c e r b a t i o n s ( a w o r s e n i n g o r r e a p p e a r a n c e o f symptoms l a s t i n g a t l e a s t 24 h o u r s ) i s one o f t h e m a j o r s t r e s s o r s t h a t t h o s e w i t h MS e x p e r i e n c e ( D a v i s , P a v l o u , & H a r t i n g s , 1 9 8 6 ) . A l a c k o f c o n t r o l o v e r symptoms a n d d i s e a s e c o u r s e may l e a d t o d i f f i c u l t i e s 14 p l a n n i n g f o r t h e f u t u r e . B e c a u s e t h e d i s e a s e u s u a l l y s t r i k e s b e t w e e n 20 a n d 40 y e a r s o f age ( S e l a n d , 1 9 8 4 ) , p e o p l e w i t h MS may be c o n c e r n e d a b o u t i s s u e s r e g a r d i n g c h i l d - b e a r i n g a n d c h i l d -r e a r i n g , s e l f - s u f f i c i e n c y , c a r e e r a s p i r a t i o n s , a n d g e n e r a l m o b i l i t y . A l t h o u g h MS i t s e l f i s u s u a l l y n o t f a t a l , l i f e e x p e c t a n c y may be a f f e c t e d by r e s p i r a t o r y a n d / o r u r i n a r y i n f e c t i o n s ( V a n d e r P l a t e , 1 9 8 4 ) . C a n ada i s a h i g h - r i s k c o u n t r y f o r d e v e l o p i n g t h e d i s e a s e , s i n c e a r e a s f u r t h e r away f r o m t h e e q u a t o r a r e more l i k e l y t o be a f f e c t e d ( M a t t h e w s , A c h e s o n , B a t c h e l o r , & W e l l e r , 1 9 8 5 ) . Women a r e more p r o n e t o d e v e l o p MS t h a n men, a s a r e t h o s e who l i v e i n a r e a s w i t h h i g h s t a n d a r d s o f s a n i t a t i o n ( L e c h t e n b e r g , 1 9 8 8 ) . W h i l e t h e e t i o l o g y o f MS i s unknown a t t h e p r e s e n t t i m e , r e s e a r c h e r s b e l i e v e t h e d i s e a s e may be c a u s e d by a v i r u s , d e f e c t s i n t h e autoimmune s y s t e m , o r g e n e t i c s u s c e p t i b i l i t y ( D e v i n s & S e l a n d , 1 9 8 7 ) . The t r e a t m e n t o f MS i s e q u a l l y e l u s i v e , a l t h o u g h s p e c i f i c symptoms may be a l l e v i a t e d somewhat by m e d i c a t i o n o r s u r g i c a l t r e a t m e n t s . 15 I I . I s s u e s o f i n v e s t i g a t i o n A l t h o u g h t h e s t u d i e s r e v i e w e d a b o v e h a v e s h e d some l i g h t on t h e u s e o f s o c i a l c o m p a r i s o n w i t h i n t h e c o p i n g c o n t e x t , a g r e a t d e a l i s s t i l l l e f t t o be u n d e r s t o o d . B e l o w , s p e c i f i c i s s u e s t o be i n v e s t i g a t e d a r e o u t l i n e d a n d m e t h o d o l o g i c a l c o n c e r n s a d d r e s s e d . A. T i m e - f r a m e o f s t r e s s f u l l i f e e x p e r i e n c e A s e l e c t i o n o f r e s p o n d e n t s on t h e b a s i s o f t i m e e l a p s e d s i n c e d i a g n o s i s i s p o t e n t i a l l y i m p o r t a n t f r o m t h e p o i n t o f v i e w o f MS r e s e a r c h s p e c i f i c a l l y , a n d s o c i a l c o m p a r i s o n r e s e a r c h g e n e r a l l y . F i r s t , i n v e s t i g a t o r s h a v e n o t e d t h a t t h e amount o f t i m e one h a s h a d MS may a f f e c t a d j u s t m e n t ( D e v i n s & S e l a n d , 1 9 8 7 ) . H o w e v e r , an e x a m i n a t i o n o f t h e l i t e r a t u r e r e v e a l s t h a t , a s i d e f r o m c o r r e l a t i n g d u r a t i o n o f i l l n e s s w i t h o t h e r v a r i a b l e s , few r e s e a r c h e r s h a v e u t i l i z e d t i m e - f r a m e a s an i n d e p e n d e n t v a r i a b l e . H a l l i g a n a n d R e z n i k o f f ( 1 9 8 5 ) a n d B r o o k s a n d M a t s o n ( 1 9 8 2 ) a r e n o t a b l e e x c e p t i o n s . The f o r m e r a u t h o r s s e l e c t e d t h r e e g r o u p s o f 20 MS o u t p a t i e n t s : p e o p l e who h a d t h e d i s e a s e f o r : 1) l e s s t h a n f i v e y e a r s , 2) b e t w e e n f i v e a n d 15 y e a r s , o r 3) more t h a n 15 y e a r s . B r o o k s a n d M a t s o n ( 1 9 8 2 ) c o n d u c t e d a l o n g i t u d i n a l s t u d y o v e r a s e v e n y e a r p e r i o d , a l t h o u g h no p a t i e n t s who h a d h a d MS f o r l e s s t h a n e i g h t y e a r s were i n c l u d e d . S e c o n d , b e c a u s e downward c o m p a r i s o n h a s been p o s t u l a t e d a s a c o p i n g m e c h a n i s m ( T a y l o r e t a l . , 1983; W i l l s , 1 9 81, 1 9 8 7 ) , p e o p l e may b e n e f i t more f r o m m a k i n g s u c h c o m p a r i s o n s a t some s t a g e s t h a n o t h e r s . G i v e n t h a t t h r e a t i s p r o b a b l y g r e a t e s t e i t h e r e a r l y i n 16 t h e p r o c e s s o r i m m e d i a t e l y f o l l o w i n g a s e t b a c k ( o r e x a c e r b a t i o n ) , i t makes s e n s e t o assume t h a t t h e s e p e r i o d s w i l l be t h e most l i k e l y t o e l i c i t downward c o m p a r i s o n s . I f p e o p l e a r e f a r enough away f r o m t h e t h r e a t ( e . g . , f r o m d i a g n o s i s o r f r o m t h e l a t e s t s e t b a c k ) , t h e y may n o t h a v e a s g r e a t a n e e d f o r downward c o m p a r i s o n s a s a c o p i n g t e c h n i q u e . T h i s t i m e - f r a m e p r e d i c t i o n s u g g e s t s t h a t downward c o m p a r i s o n i s a f l u i d p r o c e s s t h a t one h o l d s a n d t h e n a b a n d o n s when t h e n e e d i s no l o n g e r t h e r e ( o r a s S c h u l z & D e c k e r , 1985, m e n t i o n , when t h e i n d i v i d u a l h a s " a d a p t e d " a n d i s no l o n g e r i n t h e p r o c e s s o f a d a p t a t i o n ) . B e c a u s e i n c a p a c i t a t i o n i s a n o t h e r p o t e n t i a l s o u r c e o f t h r e a t , q u i t e p o s s i b l y t h o s e who h a v e h a d t h e d i s e a s e f o r s e v e r a l y e a r s a n d h a v e r e s t r i c t e d m o b i l i t y w i l l a l s o h a v e a s t r o n g n e e d t o make downward c o m p a r i s o n s . On t h e o t h e r h a n d , downward c o m p a r i s o n c o u l d a l s o be a s t a b l e p r o c e s s w h i c h , o n c e p u t i n p l a c e , r e m a i n s a s a way o f h e l p i n g p e o p l e r e s o l v e t h e i r f e a r s a n d u n c e r t a i n t i e s . T h i s l a t t e r p r e d i c t i o n w o u l d be s u p p o r t e d i f downward c o m p a r i s o n s were m e n t i o n e d by r e s p o n d e n t s e q u a l l y o f t e n a t d i f f e r e n t t i m e s i n t h e c o p i n g p r o c e s s . A l l o f t h e p r e l i m i n a r y e m p i r i c a l e v i d e n c e i s c o n s i s t e n t w i t h t h e f o r m e r p r e d i c t i o n : downward c o m p a r i s o n s a r e more p r e v a l e n t s h o r t l y a f t e r o n s e t o f t h e n e g a t i v e l i f e e x p e r i e n c e . C o r r e l a t i o n a l d a t a f r o m b r e a s t c a n c e r p a t i e n t s s u g g e s t downward c o m p a r i s o n s may be u s e d more o f t e n by p a t i e n t s who r e c e n t l y r e c e i v e d s u r g e r y t h a n t h o s e who h a v e been c o p i n g w i t h t h e i l l n e s s f o r a l o n g e r p e r i o d o f t i m e (Wood e t a l . , 1 9 8 5 ) . S i m i l a r l y , 1 7 A f f l e c k e t a l . ( 1 9 8 7 a ) f o u n d t h a t r e c e n t l y d i a g n o s e d r h e u m a t o i d a r t h r i t i s p a t i e n t s made more downward c o m p a r i s o n s i n t e r m s o f i l l n e s s s e v e r i t y t h a n d i d t h e i r c o u n t e r p a r t s who h a d n o t b e e n r e c e n t l y d i a g n o s e d . M o r e o v e r , m o t h e r s o f h i g h - r i s k i n f a n t s made more downward c o m p a r i s o n s t h a n a r t h r i t i s p a t i e n t s (who h a d b e e n d e a l i n g w i t h t h e i r p r o b l e m f o r a l o n g e r t i m e ) . S c h u l z a n d D e c k e r ' s ( 1 9 8 5 ) f i n d i n g , t h a t s p i n a l - c o r d i n j u r e d p e r s o n s d i d n o t d o w n w a r d l y compare v e r y much, i s c o n s i s t e n t w i t h t h e n o t i o n t h a t downward c o m p a r i s o n s a r e s u p e r f l u o u s o n c e one h a s a d a p t e d t o a n e g a t i v e l i f e e v e n t , s i n c e t h e i r r e s p o n d e n t s h a d been d e a l i n g w i t h t h e d i s a b i l i t y f o r an a v e r a g e o f two d e c a d e s . One p o t e n t i a l l y i m p o r t a n t way t h e p r e s e n t s t u d y d i f f e r s f r o m p r e v i o u s r e s e a r c h i s t h a t most i n v e s t i g a t o r s h a v e s t u d i e d i l l n e s s e s i n w h i c h t h e p r o g n o s i s i s p o s i t i v e , s t a b l e , o r a t l e a s t n o t c l e a r l y d e t e r i o r a t i n g . F o r i n s t a n c e , p e r s o n s who h a v e s p i n a l - c o r d i n j u r i e s a r e n o t l i k e l y t o s u f f e r a f u r t h e r r e d u c t i o n i n m o b i l i t y c a p a c i t y . S i m i l a r l y , i f s u r g e r y o r c h e m o t h e r a p y i s s u c c e s s f u l , i n d i v i d u a l s w i t h b r e a s t c a n c e r may n e v e r have a r e c u r r e n c e o f symptoms a n d may l i v e a r e l a t i v e l y n o r m a l e x i s t e n c e . I n c o n t r a s t , t h e t r a j e c t o r y o f t h o s e w i t h MS i s more u n c e r t a i n , a n d p h y s i c a l d e t e r i o r a t i o n i s a p o s s i b i l i t y . I f downward c o m p a r i s o n i s an e f f e c t i v e c o p i n g m e c h a n i s m , a l a c k o f d i f f e r e n c e s i n t h e u s e o f c o m p a r i s o n s a t v a r i o u s p o i n t s s u b s e q u e n t t o b e i n g d i a g n o s e d w i t h MS may be due t o d i f f e r e n t t r a j e c t o r i e s a s s o c i a t e d w i t h d i f f e r e n t i l l n e s s e s o r d i s a b i l i t i e s . Downward c o m p a r i s o n s among t h o s e w i t h MS may be h i g h s h o r t l y 18 a f t e r b e i n g d i a g n o s e d b e c a u s e o f a d j u s t m e n t s t h a t must be made i n o n e ' s l i f e . P e r h a p s t h o s e w i t h MS may u t i l i z e downward c o m p a r i s o n s more, l e s s , o r e q u a l l y o f t e n , r i g h t a f t e r d i a g n o s i s a n d y e a r s l a t e r , d e p e n d i n g upon l e v e l o f d i s a b i l i t y . T h o s e whose p h y s i c a l c a p a c i t y h a s b een r e l a t i v e l y u n a f f e c t e d by t h e d i s e a s e may u s e downward c o m p a r i s o n s l e s s t h a n t h e y d i d e a r l i e r , w h e r e a s t h o s e who h a v e d e t e r i o r a t e d may u s e downward c o m p a r i s o n s e q u a l l y o f t e n ( o r more) a f t e r b e i n g a f f l i c t e d w i t h t h e d i s e a s e f o r a number o f y e a r s . P a s t r e s e a r c h e r s h a v e o n l y c o r r e l a t e d t i m e e l a p s e d s i n c e d i a g n o s i s w i t h downward c o m p a r i s o n s . I n t h e p r e s e n t s t u d y , t i m e 2 f r a m e w i l l be i n c l u d e d a s an i n d e p e n d e n t v a r i a b l e a n d d i f f e r e n c e s on downward c o m p a r i s o n s a s a r e s u l t o f t h i s c a t e g o r i c a l d i s t i n c t i o n w i l l be i n v e s t i g a t e d ( f o r more d e t a i l s , s e e " S a m p l e " s e c t i o n ) . O t h e r p r e d i c t i o n s may be a d v a n c e d b a s e d upon a d i v i s i o n o f r e s p o n d e n t s a c c o r d i n g t o t i m e - f r a m e . The u n d e r l y i n g t e n e t o f downward c o m p a r i s o n t h e o r y i s t h a t t h r e a t l e a d s t o a r e d u c t i o n i n p o s i t i v e a f f e c t a n d s e l f - e s t e e m , i n c r e a s e d n e g a t i v e a f f e c t , a n d a n e e d t o b o o s t s u b j e c t i v e w e l l - b e i n g ( H a k m i l l e r , 1 9 6 6 ) . M o r e o v e r , W i l l s ( 1 9 8 1 ) s t a t e s t h a t p e r s o n s l o w i n s e l f - e s t e e m h a v e a g r e a t e r n e e d f o r s e l f - e n h a n c e m e n t a n d a r e t h e r e f o r e more l i k e l y t o e ngage i n downward c o m p a r i s o n t h a n i n d i v i d u a l s h i g h i n s e l f -e s t e e m ( " p e r s o n a l i t y c o r o l l a r y " ) . E v e n t h o u g h e m p i r i c a l l i t e r a t u r e s u p p o r t s s u c h c o n t e n t i o n s ( G i b b o n s , 1986; W i l s o n & B e n n e r , 1 9 7 1 ) , t h e r e a r e c o n f l i c t i n g d a t a and i n t e r p r e t a t i o n s . 19 W h i l e d e p r e s s i v e s d e m o n s t r a t e d no c o n s i s t e n t b i a s t o d e p r e c i a t e t h e m s e l v e s r e l a t i v e t o o t h e r s , t h e y were l e s s l i k e l y t o engage i n s e l f - e n h a n c e m e n t t h a n n o n d e p r e s s i v e s ( C r o c k e r , K a y n e , & A l l o y , 1985; T a b a c h n i k , C r o c k e r , & A l l o y , 1 9 8 3 ) . I n a d d i t i o n , C r o c k e r e t a l . ( 1 9 8 7 ) f o u n d t h a t a l t h o u g h p e o p l e low i n s e l f - e s t e e m e v a l u a t e o t h e r s n e g a t i v e l y , t h e s e e v a l u a t i o n s do n o t r e f l e c t s e l f - e n h a n c e m e n t . D e r o g a t i o n o f o u t g r o u p s ( r e l a t i v e t o i n g r o u p s ) was more common among i n d i v i d u a l s h i g h i n s e l f - e s t e e m t h a n l o w s e l f - e s t e e m . B a s e d on p r e d i c t i o n s f r o m downward c o m p a r i s o n t h e o r y , i t l o g i c a l l y f o l l o w s t h a t l e v e l o f t h r e a t w i l l be a s s o c i a t e d w i t h downward c o m p a r i s o n s , o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n . I n t h e p r e s e n t s t u d y , t h r e a t i s o p e r a t i o n a l i z e d i n t e r m s o f f u n c t i o n a l s t a t u s a n d y e a r o f d i a g n o s i s . P r e s u m a b l y , t h o s e who a r e more p h y s i c a l l y i m p a i r e d o r who have been r e c e n t l y d i a g n o s e d a r e t h e most t h r e a t e n e d . I t i s h y p o t h e s i z e d t h a t more t h r e a t e n e d r e s p o n d e n t s w i l l make more downward c o m p a r i s o n s , h a v e l o w e r o p t i m i s m , l o w e r s e l f - e s t e e m , a n d h i g h e r d e p r e s s i o n s c o r e s . I f t h e a b o v e p r e d i c t i o n i s b o r n e o u t by t h e d a t a , s e v e r a l i n t e r p r e t a t i o n s a r e p o s s i b l e , two o f w h i c h a r e d i s c u s s e d h e r e . F i r s t , t h e c a u s a l l i n k may be s u c h t h a t h i g h t h r e a t , l o w o p t i m i s m , l o w s e l f - e s t e e m , a n d h i g h d e p r e s s i o n l e a d t o more downward c o m p a r i s o n s . S e c o n d , t h e a s s o c i a t i o n b e t w e e n v a r i a b l e s may be s p u r i o u s . B e c a u s e t h e p r e s e n t s t u d y i s c o r r e l a t i o n a l , t h e i n f l u e n c e o f t h i r d v a r i a b l e s c a n n o t be e n t i r e l y r u l e d o u t ( c f . Thompson, 1 9 8 5 ) . One v a r i a b l e t h a t may c r e a t e a s p u r i o u s r e l a t i o n s h i p b e t w e e n c o m p a r i s o n s a n d : o p t i m i s m , s e l f - e s t e e m and 20 d e p r e s s i o n i s c o n t a c t w i t h o t h e r p e o p l e who h a v e MS. C o n c e i v a b l y , r e s p o n d e n t s who h a v e t a k e n p a r t i n s u p p o r t g r o u p s o r who h a v e f r i e n d s w i t h MS may become more o r l e s s o p t i m i s t i c , d e p r e s s e d , o r h a v e t h e i r s e l f - e s t e e m s a l t e r e d . On t h e one h a n d , c o n t a c t w i t h o t h e r s w i t h MS may make one f e e l t h a t t h e f u t u r e i s h o p e l e s s a n d r e i n f o r c e t h e n o t i o n t h a t o n e ' s own d e t e r i o r a t i o n i s i n e v i t a b l e . On t h e o t h e r h a n d , c o n t a c t w i t h o t h e r p e o p l e w i t h MS may s e r v e t o i n s p i r e one t o b e l i e v e t h a t , w h i l e MS c r e a t e s some l i m i t a t i o n s , t h e y a r e n o t i n s u r m o u n t a b l e a n d one may s t i l l l i v e a w o r t h w h i l e e x i s t e n c e . C o n t a c t w i t h o t h e r s w i t h MS may l e a d one t o t h i n k more a b o u t c o m p a r i s o n s g e n e r a l l y . I n o t h e r w o r d s , c o n t a c t may prompt i n d i v i d u a l s w i t h MS t o u t i l i z e o t h e r s a s s o u r c e s o f i n f o r m a t i o n more r e a d i l y t h a n w o u l d be t h e c a s e i f c o m p a r i s o n t a r g e t s w e re n o t a v a i l a b l e . C o n t a c t w i t h o t h e r s w i l l be s t a t i s t i c a l l y c o n t r o l l e d t o t e s t f o r t h e s e p o s s i b i l i t i e s . S i m i l a r l y , a r e l a t i o n s h i p b e t w e e n downward c o m p a r i s o n a n d o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n may be a c c o u n t e d f o r by s e v e r i t y o f i l l n e s s . P e r h a p s t h o s e who h a v e b e t t e r a d j u s t m e n t s c o r e s h a v e a l s o s u f f e r e d l e s s a n d a r e a b l e t o a c c u r a t e l y r e c o g n i z e t h a t o t h e r s a r e w o r s e o f f t h a n t h e y a r e . I f downward c o m p a r i s o n s e r v e s a u s e f u l c o p i n g f u n c t i o n , t h e n a c o r r e l a t i o n b e t w e e n c o m p a r i s o n s a n d f u n c t i o n i n g s h o u l d s t i l l r e m a i n s i g n i f i c a n t , i n d e p e n d e n t o f a c t u a l s e v e r i t y o f i l l n e s s ( c f . A f f l e c k e t a l . , 1 9 8 7 a ) . T h i s a l t e r n a t i v e e x p l a n a t i o n w i l l be t e s t e d by c o n t r o l l i n g f o r s e v e r i t y o f i l l n e s s . C u r r e n t e v i d e n c e on t h e l i n k b e t w e e n use o f downward 21 c o m p a r i s o n s a n d f u n c t i o n i n g i s m i x e d . A f f l e c k e t a l . ( 1 9 8 7 a ) f o u n d a p o s i t i v e a s s o c i a t i o n f o r a r t h r i t i s p a t i e n t s , b u t n o t f o r m o t h e r s o f h i g h - r i s k i n f a n t s . D i f f e r e n t i a l d e p e n d e n t m e a s u r e s f o r t h e two p o p u l a t i o n s may be r e s p o n s i b l e f o r t h e c o n f l i c t i n g r e s u l t s : a v a l i d a t e d i n s t r u m e n t was a v a i l a b l e t o a s s e s s a d j u s t m e n t f o r a r t h r i t i s p a t i e n t s ( G l o b a l A d j u s t m e n t t o I l l n e s s S c a l e , G A I S , D e r o g a t i s , 1 9 7 5 ) , b u t n o t f o r m o t h e r s ' a d j u s t m e n t . I n s t e a d , t h e a u t h o r s r e l i e d on j u d g e m e n t s o f r e a l i s t i c a p p r a i s a l o f t h e c h i l d ' s c o n d i t i o n by m o t h e r s a s r a t e d by n u r s e s . Wood e t a l . ( 1 9 8 5 ) a l s o e m p l o y e d t h e GAIS ( D e r o g a t i s , 1975) t o m e a s u r e f u n c t i o n i n g , b u t d i d n o t f i n d a c o r r e l a t i o n w i t h t h i s m e a s u r e a n d downward c o m p a r i s o n s f o r b r e a s t c a n c e r p a t i e n t s . I n c o n t r a s t , Thompson ( 1 9 8 5 ) f o u n d a l i n k b e t w e e n t h e u s e o f downward c o m p a r i s o n s a n d c o p i n g f o r p e o p l e whose h o u s e s h a d been b u r n e d i n f i r e s , b a s e d on a d i r e c t q u e s t i o n o f c o p i n g a n d m e a s u r e s o f p h y s i c a l symptoms, p o s i t i v e e m o t i o n s a nd p l e a s u r e . T h e s e d i s c r e p a n t f i n d i n g s ( t w o c o n f i r m a t o r y , two d i s c o n f i r m a t o r y ) may be a t t r i b u t a b l e t o t h e f a c t t h a t t h e u s e o f downward c o m p a r i s o n s may be a d a p t i v e f o r o n l y c e r t a i n t y p e s o f n e g a t i v e l i f e e x p e r i e n c e s , s u c h a s c h r o n i c i l l n e s s e s . A l t e r n a t i v e l y , downward c o m p a r i s o n s may be a d a p t i v e f o r many d i f f e r e n t t y p e s o f n e g a t i v e l i f e e x p e r i e n c e s , y e t were n o t w e l l a s s e s s e d by i n s t r u m e n t s t h a t h a d n o t been v a l i d a t e d . E v e n i n t h e Wood e t a l . ( 1 9 8 5 ) s t u d y , i n w h i c h a p s y c h o m e t r i c a l l y s o u n d i n s t r u m e n t was e m p l o y e d , t h e l a c k o f s t a t i s t i c a l s i g n i f i c a n c e may be due t o t h e f a c t t h a t p h y s i c i a n s a n d i n t e r v i e w e r s were n o t p r o v i d e d w i t h e n o u g h i n f o r m a t i o n t o a c c u r a t e l y make an a s s e s s m e n t o f a d j u s t m e n t . 22 One must b e a r i n m i n d , h o w e v e r , t h a t t h e i n t e r p r e t a t i o n o f c o r r e l a t i o n s may be c o n f u s i n g . One t h e one h a n d , t h e more downward c o m p a r i s o n s t h a t a r e made, t h e b e t t e r one may f e e l . On t h e o t h e r h a n d , t h e w o r s e one i s d o i n g , t h e more downward c o m p a r i s o n s one w i l l make. I n o t h e r w o r d s , i f c o m p a r i s o n s a r e c o n c e p t u a l i z e d a s a p r o c e s s o c c u r r i n g a l o n g a c o n t i n u u m , c o r r e l a t i o n s w i l l mean d i f f e r e n t t h i n g s d e p e n d i n g on t h e p o i n t t h a t one i s i n t h e p r o c e s s o f a d a p t a t i o n . B. A f f e c t i v e c o n s e q u e n c e s o f c o m p a r i s o n s R e s e a r c h e r s h a v e r e p e a t e d l y d e m o n s t r a t e d t h a t c o m p a r i n g w i t h o t h e r s may h a v e e m o t i o n a l c o n s e q u e n c e s ( S c h a c h t e r , 1 9 5 9 ) , r a n g i n g f r o m g e n e r a l i z e d a r o u s a l ( J a m i e s o n & K a s z o r , 1 9 8 6 ) , t o c a l m , f e a r , a n d d e s p e r a t i o n ( H a n s s o n , N o u l l e s , & B e l l o v i c h , 1 9 8 2 ) . As d i s c u s s e d a b o v e , Buunk e t a l . ( 1 9 8 9 ) e x t e n d e d t h e o r i g i n a l downward c o m p a r i s o n m o d e l t o e x p l a i n why downward c o m p a r i s o n s do n o t a l w a y s h e l p one f e e l b e t t e r a n d u p w a r d c o m p a r i s o n s do n o t a l w a y s make one f e e l w o r s e . To r e v i e w , c o m p a r i s o n s may make one f e e l b e t t e r o r w o r s e d e p e n d i n g on how t h e s i t u a t i o n i s c o n s t r u e d . I f one i s d o i n g p o o r l y r e l a t i v e t o o t h e r s , one may f o c u s on t h e f a c t t h a t i m p r o v e m e n t i s p o s s i b l e o r c o n c e n t r a t e on t h e u n f a v o r a b l e s i t u a t i o n one i s c o n f r o n t e d w i t h . S i m i l a r l y , l e a r n i n g t h a t a n o t h e r i s w o r s e o f f p r o v i d e s i n f o r m a t i o n t h a t one i s d o i n g b e t t e r o r t h a t i t i s p o s s i b l e f o r t h e s e l f t o d e t e r i o r a t e on t h e d i m e n s i o n u n d e r c o n s i d e r a t i o n . N e g a t i v e a f f e c t i v e c o n s e q u e n c e s may be a v o i d e d by f o c u s i n g on t h e p o s i t i v e a s p e c t s , w h e r e a s c o n c e n t r a t i n g on t h e n e g a t i v e i n f o r m a t i o n t h a t a 23 s i t u a t i o n p r o v i d e s may make one f e e l w o r s e , r e g a r d l e s s o f w h e t h e r one e n g a g e s i n downward o r upwa r d c o m p a r i s o n . I n t h e o r y , o n e ' s p h y s i c a l c o n d i t i o n a n d how w e l l one i s c o p i n g w i t h MS a r e o r t h o g o n a l d i m e n s i o n s , s o t h a t one may be h i g h on o n e , b o t h , o r n e i t h e r . E m p i r i c a l e v i d e n c e s u p p o r t s t h e n o t i o n t h a t s o c i a l c o m p a r i s o n s may be made on p h y s i c a l d i m e n s i o n s ( A f f l e c k e t a l . , 1987a; Wood e t a l . , 1985) a n d l i f e s i t u a t i o n ( S c h u l z & D e c k e r , 1 9 8 5 ) . I n a d d i t i o n , r e s p o n d e n t s o f t e n s e e t h e m s e l v e s a s b e t t e r o f f t h a n o t h e r s i n t e r m s o f c o p i n g o r a d j u s t m e n t ( A f f l e c k e t a l . , 1987a; P e a r l i n & S c h o o l e r , 1978; T a y l o r , A s p i n w a l l , D a k o f , & R e a r d o n , 1989; Wood e t a l . , 1 9 8 5 ) . C o m p a r i s o n s i n w h i c h t a r g e t s s e l e c t e d a r e downward on t h e p h y s i c a l d i m e n s i o n , b u t n o t t h e c o p i n g d i m e n s i o n , h a v e been r e p o r t e d ( T a y l o r , 1983; T a y l o r e t a l . , 1983) H o w e v e r , e v e n t h o u g h r e s e a r c h h a s d e m o n s t r a t e d t h a t c o m p a r i s o n s may be made on t h e c o p i n g a n d / o r p h y s i c a l h e a l t h d i m e n s i o n s , no s t u d i e s h a v e s y s t e m a t i c a l l y i n v e s t i g a t e d t h e a f f e c t i v e c o n s e q u e n c e s o f m a k i n g s u c h c o m p a r i s o n s . P e r h a p s downward c o m p a r i s o n s a r e t h r e a t e n i n g o n l y when t h e y a r e r e l a t e d t o p h y s i c a l c o n d i t i o n a n d n o t when t h e y a r e a s s o c i a t e d w i t h c o p i n g . I f s o , s u c h r e s u l t s may b e , a t l e a s t i n p a r t , a s s o c i a t e d w i t h p e r c e p t i o n s o f c o n t r o l . P a s t r e s e a r c h e r s h a v e f o u n d t h a t t h e p e r c e p t i o n o f g r e a t e r p e r s o n a l c o n t r o l may be c o r r e l a t e d w i t h e l e v a t e d mood and a d j u s t m e n t ( A f f l e c k , T e n n e n , P f e i f f e r , & F i f i e l d , 1987b; T a y l o r , L i c h t m a n , & Wood, 1 9 8 4 ) . H o w e v e r , MS, w h i c h i s a d i s e a s e o f t e n a s s o c i a t e d w i t h a 24 d e t e r i o r a t i n g t r a j e c t o r y , may l e a d r e s p o n d e n t s t o b e l i e v e t h e y h a v e l i m i t e d c o n t r o l o v e r t h e c o u r s e o f t h e i r i l l n e s s . I n c o n t r a s t , r e s p o n d e n t s may f e e l t h e y c a n e x e r c i s e more p e r s o n a l c o n t r o l o v e r how t h e y c o p e w i t h t h e i r s i t u a t i o n t h a n t h e i r p h y s i c a l c o n d i t i o n b e c a u s e c o p i n g may be p e r c e i v e d a s i n f l u e n c e d t o a g r e a t e r d e g r e e by v o l i t i o n a n d e f f o r t . C o r r o b o r a t i n g s u c h a s u g g e s t i o n , W e i n e r , P e r r y , a n d M a g n u s s o n ( 1 9 8 8 ) n o t e t h a t p h y s i c a l l y b a s e d s t i g m a s were p e r c e i v e d a s o n s e t - u n c o n t r o l l a b l e , w h e r e a s m e n t a l - b e h a v i o r a l s t i g m a s were r e g a r d e d a s o n s e t -c o n t r o l l a b l e . I f t h e r e s u l t s o f W e i n e r e t a l . ( 1 9 8 8 ) r e g a r d i n g p e r c e p t i o n s o f c o n t r o l may be g e n e r a l i z e d t o t h e p h y s i c a l c o n d i t i o n / c o p i n g d i m e n s i o n s among p e o p l e w i t h MS, a n d p e r c e p t i o n s o f c o n t r o l a r e a s s o c i a t e d w i t h l e s s n e g a t i v e a f f e c t , r e s p o n d e n t s i n t h e p r e s e n t s t u d y may be more l i k e l y t o r e p o r t f e e l i n g b a d a s a r e s u l t o f m a k i n g downward c o m p a r i s o n s r e l a t e d t o p h y s i c a l c o n d i t i o n t h a n t h o s e r e l a t e d t o c o p i n g . A l t h o u g h Buunk e t a l . ( 1 9 8 9 ) f o u n d t h a t s e l f - e s t e e m a n d p e r s o n a l c o n t r o l were a s s o c i a t e d o n l y w i t h n e g a t i v e a f f e c t i v e c o n s e q u e n c e s o f c o m p a r i s o n s ( a l s o p r e d i c t e d h e r e ) , t h r e e a d d i t i o n a l v a r i a b l e s f r o m t h e p r e s e n t s t u d y seem p o t e n t i a l l y i n t e r e s t i n g : o p t i m i s m , d e p r e s s i o n , and b e l i e f s a b o u t t r a j e c t o r y . G e n e r a l l y , p e o p l e a r e o v e r l y o p t i m i s t i c a b o u t what w i l l h a p p e n t o them i n t h e f u t u r e . U n d e r g r a d u a t e s r a t e t h e i r c h a n c e s a s b e i n g g r e a t e r t h a n a v e r a g e o f e x p e r i e n c i n g p o s i t i v e e v e n t s ( W e i n s t e i n , 1980) a n d l e s s t h a n a v e r a g e o f e x p e r i e n c i n g n e g a t i v e l i f e e v e n t s t h a n o t h e r s ( P e r l o f f & F e t z e r , 1 9 8 6 ) . O p t i m i s m a s a 25 d i s p o s i t i o n a l v a r i a b l e h a s been d e f i n e d a s a g e n e r a l i z e d e x p e c t a n c y t h a t g ood t h i n g s w i l l h a p p e n i r r e s p e c t i v e o f c a u s a l a n d s i t u a t i o n a l i n f l u e n c e s ( S c h e i e r & C a r v e r , 1 9 8 5 ) . I n o t h e r w o r d s , o p t i m i s t s a n t i c i p a t e good o u t c o m e s and a r e i n c l i n e d t o p e r c e i v e a c t i o n s and e v e n t s i n a f a v o r a b l e manner. I n c o n t r a s t , p e s s i m i s t s e x p e c t t h i n g s w i l l n o t go t h e i r way a n d i n t e r p r e t i n f o r m a t i o n i n a n e g a t i v e f a s h i o n . B a s e d on s e l f - r e p o r t m e a s u r e s i n a p r o s p e c t i v e s t u d y , o p t i m i s m was i n v e r s e l y c o r r e l a t e d w i t h symptoms, e v e n when i n i t i a l symptom l e v e l s were p a r t i a l l e d o u t ( S c h e i e r & C a r v e r , 1 9 8 5 ) . I n a d d i t i o n , o p t i m i s t i c a n d d e p r e s s e d p a t i e n t s were p e r c e i v e d d i f f e r e n t l y by h e a l t h p r o f e s s i o n a l s i n t e r m s o f f e e l i n g s , a d j u s t m e n t , l i k e a b l e n e s s , p r o g n o s i s , a n d e v e n t r e a t m e n t s t r a t e g i e s , e s p e c i a l l y f o r l e s s s t i g m a t i z e d c o n d i t i o n s ( W e s t b r o o k & N o r d h o l m , 1 9 8 6 ) . O t h e r f i n d i n g s i n h e a l t h p s y c h o l o g y s u p p o r t t h e i d e a t h a t d i s p o s i t i o n a l o p t i m i s m i s a m e d i a t o r o f how p e o p l e r e s p o n d t o s t r e s s ( S c h e i e r , W e i n t r a u b , & C a r v e r , 1 9 8 6 ) . B e c a u s e o p t i m i s t s l o o k on t h e b r i g h t s i d e o f l i f e , i t i s p r e d i c t e d t h a t t h o s e h i g h e r on o p t i m i s m w i l l be more l i k e l y t o r e p o r t f e e l i n g g o o d a f t e r c o m p a r i n g w i t h o t h e r s t h a n r e s p o n d e n t s l o w e r on o p t i m i s m , b u t no more o r l e s s l i k e l y t o f e e l b a d . P e o p l e who a r e d e p r e s s e d t e n d t o p r e s e n t t h e m s e l v e s more n e g a t i v e l y t h a n t h o s e who a r e n o t (Coyne & G o t l i b , 1 9 8 3 ) . M o r e o v e r , w h i l e n o n d e p r e s s e d p e o p l e a r e b i a s e d t o w a r d p o s i t i v e e v a l u a t i o n , m i l d l y d e p r e s s e d p e o p l e d i s p l a y l e s s b i a s e d p a t t e r n s o f r e s p o n d i n g (Ruehlman & W e s t , 1 9 8 5 ) . V u l n e r a b l e d e p r e s s i v e s 26 r e c a l l b o t h p o s i t i v e a n d n e g a t i v e f e a t u r e s o f s e l f - r e f e r e n t m a t e r i a l , w h e r e a s n o n d e p r e s s i v e s r e c a l l more n o n - d e p r e s s e d -c o n t e n t a d j e c t i v e s ( K u i p e r , O l i n g e r , M a c D o n a l d , & Shaw, 1 9 8 5 ) . T a y l o r a n d Brown ( 1 9 8 8 ) r e v i e w e v i d e n c e i n d i c a t i n g t h a t d e p r e s s i v e s a r e l e s s l i k e l y t o d e m o n s t r a t e i l l u s i o n s o f c o n t r o l , m a s t e r y a n d o p t i m i s m t h a n t h e i r n o n - d e p r e s s e d c o u n t e r p a r t s . T a k e n a s a w h o l e , t h e d e p r e s s i o n l i t e r a t u r e s u g g e s t s t h e h y p o t h e s i s t h a t d e p r e s s e d p e o p l e w i l l be more l i k e l y t o r e p o r t n e g a t i v e a f f e c t s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s t h a n t h o s e who a r e n o n d e p r e s s e d . C o n s i s t e n t w i t h t h e f i n d i n g s o f Buunk e t a l . ( 1 9 8 9 ) , no d i f f e r e n c e s a r e p r e d i c t e d f o r p o s i t i v e a f f e c t i v e c o n s e q u e n c e s . P e o p l e who v i e w t h e i r t r a j e c t o r y i n r o u g h l y n e g a t i v e t e r m s may be f e a r f u l b e c a u s e s e e i n g o t h e r s d o i n g w o r s e p r o v i d e s a t h r e a t e n i n g v i e w o f t h e f u t u r e ( C o a t e s & W i n s t o n , 1983; Wood e t a l . , 1 9 8 5 ) . W h i l e s u c h a s u g g e s t i o n seems r e a s o n a b l e , Buunk e t a l . ( 1 9 8 9 ) f o u n d t h a t c a n c e r p a t i e n t s ' o b j e c t i v e l i k e l i h o o d o f g e t t i n g b e t t e r o r w o r s e was u n r e l a t e d t o e m o t i o n a l r e s p o n s e s t o c o m p a r i s o n s . However, t h e m e a s u r e o f p r o g n o s i s was an o b j e c t i v e o n e , b a s e d on an o n c o l o g i s t ' s r a t i n g on a f i v e - p o i n t s c a l e ( r a n g i n g f r o m g r a v e p r o g n o s i s t o p r o b a b l e c u r e ) . I n t h e p r e s e n t s t u d y , t h e m e a s u r e o f t r a j e c t o r y i s a s u b j e c t i v e e v a l u a t i o n f r o m t h e MS p a t i e n t h i m o r h e r s e l f a b o u t t h e f u t u r e . S i n c e s o c i a l c o m p a r i s o n h a s r e c e n t l y b een r e g a r d e d a s l a r g e l y an a c t i v e , c o g n i t i v e t h e o r y ( P e r l o f f & F e t z e r , 1986; Wood e t a l . , 1 9 8 5 ) , p e r h a p s a f f e c t i v e c o n s e q u e n c e s o f c o m p a r i s o n s w i l l be more h i g h l y 27 a s s o c i a t e d w i t h s u b j e c t i v e r e s p o n s e s a b o u t t r a j e c t o r y t h a n o b j e c t i v e m e a s u r e s . B e c a u s e o f t h e f e a r o f g e t t i n g w o r s e , i t i s h y p o t h e s i z e d t h a t an u n f a v o r a b l e p e r c e p t i o n o f t h e f u t u r e w i l l be r e l a t e d t o n e g a t i v e a f f e c t i v e c o n s e q u e n c e s o f c o m p a r i n g w i t h o t h e r s ( e s p e c i a l l y i n t h e downward d i r e c t i o n ) , b u t u n r e l a t e d t o p o s i t i v e a f f e c t i v e c o n s e q u e n c e s . 28 I I I . M e t h o d A. R e c r u i t m e n t o f r e s p o n d e n t s P a r t i c i p a n t s were o b t a i n e d t h r o u g h t h e B r i t i s h C o l u m b i a D i v i s i o n o f t h e M u l t i p l e S c l e r o s i s S o c i e t y o f C a n a d a . I n o r d e r t o u p d a t e a n d e x t e n d p e r s o n a l i n f o r m a t i o n c u r r e n t l y on f i l e , t h e MS S o c i e t y , i n c o n j u n c t i o n w i t h o u r r e s e a r c h g r o u p , s e n t o u t a C o n f i d e n t i a l R e g i s t r a t i o n Form t o a l l o f i t s c l i e n t s a n d members who a r e l i s t e d on t h e i r m a s t e r l i s t a s h a v i n g MS. The f o r m i n c l u d e s r e l e v a n t d a t a , s u c h a s name, g e n d e r , m a r i t a l s t a t u s , y e a r o f d i a g n o s i s , p a r t i c i p a t i o n i n s e l f - h e l p g r o u p s , a n d f u n c t i o n a l s t a t u s . S i x h u n d r e d f i f t y - s e v e n f o r m s were c o m p l e t e d a n d r e t u r n e d . T h u s , r e s p o n d e n t s were s e l e c t e d f r o m a l a r g e p o o l o f p o s s i b l e c a n d i d a t e s , i n s t e a d o f h o s p i t a l i z e d o r n e u r o l o g y c l i n i c p a t i e n t s . The i n c l u s i o n o f j u s t t h e l a t t e r t y p e s o f p a r t i c i p a n t s p r e s u m a b l y b i a s e s t o w a r d more s e v e r e c a s e s , b e c a u s e t h e y a r e l i k e l y t o be e x p e r i e n c i n g e x a c e r b a t i o n s o r u n d e r g o i n g d i a g n o s i s ( V a n d e r P l a t e , 1 9 8 4 ) . A d m i t t e d l y , h o w e v e r , no s e l e c t i o n p r o c e s s i s f r e e f r o m f l a w s , a nd M i l e s ( 1 9 7 9 ) h a s n o t e d t h a t M u l t i p l e S c l e r o s i s S o c i e t y members may be more l i k e l y t o d i s a s s o c i a t e f r o m t h e h e a l t h y c o m m u n i t y t h a n nonmembers. B. Sample T h r e e g r o u p s o f r e s p o n d e n t s were c h o s e n f o r t h e p r e s e n t s t u d y , b a s e d on a n s w e r s p r o v i d e d on t h e C o n f i d e n t i a l R e g i s t r a t i o n F orm. S p e c i f i c a l l y , p a r t i c i p a n t s were s e l e c t e d a c c o r d i n g t o t h e i r 1) y e a r o f d i a g n o s i s , a n d 2) f u n c t i o n a l s t a t u s . The f u n c t i o n a l s t a t u s s c a l e was a d a p t e d f r o m K u r t z k e ( 1 9 5 5 , 1965) t o 29 m e a s u r e t h e d e g r e e o f p h y s i c a l d i s a b i l i t y i n p e o p l e w i t h MS. A l t h o u g h K u r t z k e ' s s c a l e was c o m p l e t e d by d o c t o r s , f o r p r a c t i c a l r e a s o n s , r e s p o n d e n t s i n t h e p r e s e n t s t u d y f i l l e d o u t t h e m e a s u r e t h e m s e l v e s ( s e e A p p e n d i x A f o r t h e m o d i f i e d s c a l e ) . T h e r e f o r e , m e d i c a l j a r g o n was e x c l u d e d , w h i l e a t t h e same t i m e m a i n t a i n i n g t h e r e l e v a n t d i s t i n c t i o n s b e t w e e n c a t e g o r i e s . The h i g h e r s c o r e r e c e i v e d , t h e g r e a t e r i m p a i r m e n t due t o n e u r o l o g i c d y s f u n c t i o n . G r o u p one c o n s i s t e d o f i n d i v i d u a l s who d i s c o v e r e d t h e y h a d MS w i t h i n t h e p a s t t h r e e y e a r s . G r o u p two was c o m p r i s e d o f t h o s e w i t h MS who h a d been d i a g n o s e d b e t w e e n f i v e a n d t e n y e a r s a g o , m a t c h e d on a c a s e - b y - c a s e b a s i s t o g r o u p one r e s p o n d e n t s a c c o r d i n g t o f u n c t i o n a l s t a t u s . G r o u p t h r e e was c o m p r i s e d o f t h o s e a l s o d i a g n o s e d b e t w e e n f i v e a n d t e n y e a r s a g o , who s c o r e d a t l e a s t f i v e on t h e n i n e - p o i n t c o n t i n u u m on f u n c t i o n a l s t a t u s ( t h e m i d t o h i g h r a n g e ) . The d i v i s i o n o f g r o u p s i n t h i s manner w i l l e n a b l e t e s t i n g o f t h e t i m e - f r a m e a n d f u n c t i o n a l s t a t u s p r e d i c t i o n s d e s c r i b e d e a r l i e r . A t o t a l o f 187 q u e s t i o n n a i r e s w e re s e n t t o 65, 6 1 , and 61 p o t e n t i a l r e s p o n d e n t s i n g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y . One h u n d r e d f o r t y - t h r e e were c o m p l e t e d a n d r e t u r n e d , y i e l d i n g a r e s p o n s e r a t e o f 76%. B e c a u s e i t i s p o s s i b l e t h a t t h o s e i n g r o u p t h r e e w o u l d f i n d i t d i f f i c u l t t o w r i t e b e c a u s e o f r e d u c e d p h y s i c a l c a p a c i t y a n d / o r e m o t i o n a l i m p a i r m e n t , r e s p o n s e r a t e s were c a l c u l a t e d a c r o s s g r o u p s . G r o u p s one ( 8 3 % ) a n d two ( 7 9 % ) r e t u r n e d a p p r o x i m a t e l y t h e same p e r c e n t a g e o f q u e s t i o n n a i r e s ; t h o s e i n g r o u p t h r e e ( 6 5 % ) 30 2 r e s p o n d e d s l i g h t l y , b u t n o t s i g n i f i c a n t l y , l e s s o f t e n , X ( 2 , N = 143) = 4.65, p < .10. To d e t e r m i n e i f t h o s e who r e f u s e d were a c t u a l l y p h y s i c a l l y w o r s e o f f t h a n t h o s e who r e t u r n e d t h e q u e s t i o n n a i r e , f u n c t i o n a l s t a t u s s c o r e s were c o m p a r e d f o r g r o u p t h r e e . T h e r e was a t r e n d f o r p e o p l e who were more p h y s i c a l l y d i s a b l e d n o t t o c o m p l e t e a n d r e t u r n t h e q u e s t i o n n a i r e , t ( 5 9 ) = 1 .74. p_ < .10. C. P r o c e d u r e A f t e r p o t e n t i a l r e s p o n d e n t s were s e l e c t e d a c c o r d i n g t o y e a r o f d i a g n o s i s a n d f u n c t i o n a l s t a t u s , q u e s t i o n n a i r e s ( s e e A p p e n d i x B) a n d a c c o m p a n y i n g l e t t e r s ( s e e A p p e n d i x C) were s e n t w i t h t h e h e l p o f an MS S o c i e t y s t a f f member a n d s e v e r a l v o l u n t e e r s . The m a i l - o u t p r o c e s s was a c o m p l i c a t e d a n d a r d u o u s one, s o t h a t t h e r e s e a r c h e r s d i d n o t h a v e a c c e s s t o names and a d d r e s s e s . T h e r e f o r e , a n o n y m i t y was a s s u r e d t o e a c h r e s p o n d e n t , who, i f t h e y were w i l l i n g , c o m p l e t e d t h e q u e s t i o n n a i r e and r e t u r n e d i t i n a s e l f - a d d r e s s e d s t a m p e d e n v e l o p e . D. Q u e s t i o n n a i r e C o m p l e t i o n B e c a u s e t h o s e i n g r o u p t h r e e a r e more s e v e r e l y d i s a b l e d t h a n r e s p o n d e n t s i n t h e o t h e r two g r o u p s , p a r t i c i p a n t s were a s k e d i f t h e y c o m p l e t e d t h e q u e s t i o n n a i r e t h e m s e l v e s o r i f someone e l s e f i l l e d i n a n s w e r s a s t h e y d i c t a t e d r e s p o n s e s . G r o u p s d i f f e r e d on t h i s q u e s t i o n , X 2 ( 2 , N = 137) = 13.76, p_ < .001. N i n e t y - f o u r , 96, a n d 7 3 % i n g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y , c o m p l e t e d q u e s t i o n n a i r e s by t h e m s e l v e s . T h u s , a l t h o u g h more p e o p l e i n g r o u p t h r e e h a d o t h e r s mark t h e a n s w e r s , t h e m a j o r i t y i n a l l g r o u p s w o r k e d a l o n e . 31 E. D e p e n d e n t m e a s u r e s The q u e s t i o n n a i r e i s p r e s e n t e d i n A p p e n d i x B. P r e v i o u s l y d e v e l o p e d m e a s u r e s were u t i l i z e d when a v a i l a b l e a n d c h o s e n i f , i n a d d i t i o n t o t h e i r c o n t e n t , 1) i n f o r m a t i o n r e g a r d i n g t h e p s y c h o m e t r i c a c c e p t a b i l i t y o f t h e i n s t r u m e n t was a v a i l a b l e , 2) t h e s c a l e was e a s y t o a d m i n i s t e r , a n d 3) t h e s c a l e was b r i e f . O t h e r w i s e , o r i g i n a l q u e s t i o n s were c o n s t r u c t e d o r a d a p t e d f r o m o t h e r r e s e a r c h e r s . 1. O p t i m i s m The L i f e O r i e n t a t i o n T e s t (LOT; S c h e i e r & C a r v e r , 1985) i s a m e a s u r e o f d i s p o s i t i o n a l o p t i m i s m . ' The LOT i s p r e s e n t e d on f i v e -p o i n t s c a l e s ( r a n g i n g f r o m s t r o n g l y d i s a g r e e t o s t r o n g l y a g r e e ) a n d c o m p r i s e d o f t w e l v e i t e m s , f o u r o f w h i c h a r e f i l l e r i t e m s t o h e l p p r e v e n t r e s p o n d e n t s f r o m g u e s s i n g t h e p u r p o s e o f t h e s c a l e . Of t h e e i g h t s c o r e d i t e m s , f o u r a r e k e y e d i n a p o s i t i v e d i r e c t i o n , a n d f o u r a r e k e y e d i n a n e g a t i v e d i r e c t i o n , t o c o n t r o l f o r r e s p o n s e a c q u i e s c e n c e . The LOT p o s s e s s e s a d e q u a t e c o n s t r u c t , c o n v e r g e n t and d i s c r i m i n a n t v a l i d i t y , i n t e r n a l c o n s i s t e n c y , a n d t e s t - r e t e s t r e l i a b i l i t y ( S c h e i e r & C a r v e r , 1 9 8 5 ) . 2. S e l f - e s t e e m S e l f - e s t e e m was a s s e s s e d u s i n g R o s e n b e r g ' s ( 1 9 6 5 ) s e l f -e s t e e m s c a l e , a w i d e l y u s e d 1 0 - i t e m m e a s u r e o f t h e s e l f -a c c e p t a n c e a s p e c t o f s e l f - e s t e e m . Q u e s t i o n s were p r e s e n t e d on f o u r - p o i n t s c a l e s ( r a n g i n g f r o m s t r o n g l y d i s a g r e e t o s t r o n g l y a g r e e ) . A d e q u a t e t e s t - r e t e s t r e l i a b i l i t y , c o n v e r g e n t , d i s c r i m i n a n t , a n d p r e d i c t i v e v a l i d i t y h a v e been r e p o r t e d ( R o b i n s o n & S h a v e r , 1 9 7 3 ) . 32 3. D e p r e s s i o n The 2 0 - i t e m C e n t e r f o r E p i d e m i o l o g i c S t u d i e s D e p r e s s i o n S c a l e (CES-D; R a d l o f f , 1975; 1977) was u s e d i n t h e p r e s e n t s t u d y t o m e a s u r e n e g a t i v e a f f e c t . Q u e s t i o n s were p r e s e n t e d on f o u r -p o i n t s c a l e s a n d p a r t i c i p a n t s were a s k e d t o i n d i c a t e how o f t e n d u r i n g t h e p a s t week ( r a r e l y , some o f t h e t i m e , a m o d e r a t e amount, o r a l m o s t a l l o f t h e t i m e ) t h e y f e l t o r b e h a v e d i n a number o f way s . The CES-D i s a s e l f - r e p o r t s c a l e w h i c h i s c o m p r i s e d o f i t e m s f r o m p r e v i o u s l y v a l i d a t e d l o n g e r s c a l e s . I n c o n t r a s t t o p r e v i o u s d e p r e s s i o n s c a l e s t h a t h a v e been u s e d p r i m a r i l y f o r d i a g n o s i s a n d e v a l u a t i o n o f i l l n e s s i n c l i n i c a l p o p u l a t i o n s , t h e CES-D m e a s u r e s l e v e l s o f d e p r e s s i o n among t h e g e n e r a l p o p u l a t i o n , w i t h an e m p h a s i s upon mood. A d e q u a t e v a l i d i t y , i n t e r n a l c o n s i s t e n c y , a n d t e s t - r e t e s t r e l i a b i l i t y a r e r e p o r t e d by R a d l o f f ( 1 9 7 7 ) . 4. L i f e e v e n t s S u b j e c t s were a s k e d t o c h e c k w h i c h o f t e n i t e m s , i f a n y , had h a p p e n e d t o them s i n c e b e i n g d i a g n o s e d w i t h MS. The s t r e s s f u l l i f e e x p e r i e n c e s i n c l u d e d : 1) become ( r e ) m a r r i e d , 2) l o s t a s p o u s e t h r o u g h d e a t h , 3) l o s t a j o b o r been l a i d o f f , 4) h a d a s e r i o u s p e r s o n a l i n j u r y ( e x c l u d i n g MS s y m p t o m s ) , 5) r e t i r e d , 6) ha d a d e c l i n e i n f i n a n c i a l s t a t u s , 7) been d i v o r c e d , 8) become s e p a r a t e d , 9) h a d a s p o u s e l o s t t h e i r j o b o r g e t l a i d o f f , a n d 10) h a d someone i n t h e i m m e d i a t e f a m i l y e x p e r i e n c e a s e r i o u s p e r s o n a l i n j u r y o r i l l n e s s . 33 5. S o c i a l c o m p a r i s o n s A m a j o r f o c u s o f t h i s t h e s i s r e l a t e s t o s o c i a l c o m p a r i s o n s a n d , t h e r e f o r e , a number o f t h e s e t y p e s o f q u e s t i o n s were a s k e d . B e c a u s e t h e r e a r e no s c a l e s a v a i l a b l e t o m e a s u r e t h e c o n s t r u c t s o f i n t e r e s t , i t e m s were d e v e l o p e d s p e c i f i c a l l y f o r t h e p r e s e n t s t u d y o r were a d a p t e d f r o m o t h e r r e s e a r c h e r s . A l l c o m p a r i s o n s q u e s t i o n s w e re c o d e d on L i k e r t s c a l e s , r a n g i n g f r o m one ( n e v e r ) t o n i n e ( a l m o s t a l w a y s ) . 6. Upward c o m p a r i s o n s T h r e e q u e s t i o n s , a d a p t e d f r o m T a y l o r ( 1 9 8 6 ) , were a s k e d a b o u t t h e e x t e n t t o w h i c h r e s p o n d e n t s made u p w a r d c o m p a r i s o n s . F o r e a c h q u e s t i o n , p a r t i c i p a n t s were a s k e d , "How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e b e t t e r o f f t h a n y o u r s e l f w i t h r e s p e c t t o , " f o l l o w e d by 1) " l e v e l o f d i s a b i l i t y , p r o g n o s i s , o r o t h e r d i s e a s e - r e l a t e d i s s u e s , " 2) " a b i l i t y t o c o p e w i t h t h e c o n d i t i o n a n d i t s c o n s e q u e n c e s , " and 3) " l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y ? " A c o m p o s i t e s c o r e f o r u p w a r d c o m p a r i s o n s was f o r m e d by summing t h e t h r e e i n d i v i d u a l i t e m s . I n t e r - i t e m c o r r e l a t i o n s r a n g e d b e t w e e n .55 a n d .67. 7. Downward c o m p a r i s o n s The same t h r e e q u e s t i o n s r e g a r d i n g u p w a r d c o m p a r i s o n s were m o d i f i e d a p p r o p r i a t e l y a n d a s k e d a b o u t w o r s e o f f o t h e r s . A downward c o m p a r i s o n c o m p o s i t e was f o r m e d by summing t h e t h r e e i t e m s f o r w o r s e o f f o t h e r s . I n t e r - i t e m c o r r e l a t i o n s r a n g e d b e t w e e n .36 a n d .63. 34 8. O t h e r c o m p a r i s o n s R e s p o n d e n t s were a s k e d two q u e s t i o n s r e l a t i n g t o c o m p a r i s o n s w i t h o t h e r s who do n o t h a v e MS: "How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o p e o p l e , " f o l l o w e d by 1) " w i t h o t h e r i l l n e s s e s o r d i s a b i l i t i e s ( e . g . , h e a r t a t t a c k s , c a n c e r , s t r o k e s , d i a b e t e s ) , " a n d 2) " y o u r age who do n o t h a v e MS o r any o t h e r i l l n e s s o r d i s a b i l i t y ? " 9. A f f e c t i v e c o n s e q u e n c e s A l l r e s p o n d e n t s were a s k e d q u e s t i o n s t h a t were m o d i f i e d f r o m Buunk e t a l . ( 1 9 8 9) r e g a r d i n g f e e l i n g s p r o d u c e d a f t e r c o m p a r i n g w i t h o t h e r s w i t h MS. Buunk e t a l . a s k e d r e s p o n d e n t s f o u r q u e s t i o n s r e g a r d i n g how o f t e n t h e y : f e e l b e t t e r when c o m p a r i n g u p w a r d , f e e l b e t t e r when c o m p a r i n g downward, f e e l w o r s e when c o m p a r i n g u p w a r d , a n d f e e l w o r s e when c o m p a r i n g downward. An e l e m e n t m i s s i n g f r o m Buunk e t a l . ' s ( 1 9 8 9) q u e s t i o n s i s t h e p o t e n t i a l l y i m p o r t a n t d i s t i n c t i o n b e t w e e n c o p i n g ( i . e . , how w e l l one i s d e a l i n g w i t h t h e d i s e a s e ) a n d p h y s i c a l c o n d i t i o n ( i . e . , e x t e n t o f p h y s i c a l l i m i t a t i o n o r s y m p t o m s ) . The o r i g i n a l f o u r q u e s t i o n s were r e w o r d e d t o i n c l u d e t h e c o p i n g / p h y s i c a l c o n d i t i o n d i s t i n c t i o n , r e s u l t i n g i n e i g h t q u e s t i o n s . The f o l l o w i n g i s t h e d o w n w a r d / p h y s i c a l c o n d i t i o n / n e g a t i v e a f f e c t c o m p a r i s o n q u e s t i o n : "Some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e w o r s e o f f t h a n t h e y a r e w i t h r e s p e c t t o t h e i r p h y s i c a l c o n d i t i o n makes them f e e l w o r s e , t h a t i s , i n c r e a s e s t h e i r f e a r s a n d a n x i e t i e s a b o u t g e t t i n g w o r s e t h e m s e l v e s . How o f t e n h a v e y o u had t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? " The s e v e n o t h e r 35 a f f e c t i v e c o n s e q u e n c e s q u e s t i o n s t h a t were a s k e d r e l a t e t o 1) d o w n w a r d / p h y s i c a l c o n d i t i o n / p o s i t i v e a f f e c t , 2) d o w n w a r d / c o p i n g / n e g a t i v e a f f e c t , 3) d o w n w a r d / c o p i n g / p o s i t i v e a f f e c t , 4) u p w a r d / p h y s i c a l c o n d i t i o n / n e g a t i v e a f f e c t , 5) u p w a r d / p h y s i c a l c o n d i t i o n / p o s i t i v e a f f e c t , 6) u p w a r d / c o p i n g / n e g a t i v e a f f e c t , a n d 7) u p w a r d / c o p i n g / p o s i t i v e a f f e c t . S e v e r a l s c a l e s were f o r m e d , summing v a r i o u s a f f e c t i v e c o n s e q u e n c e s i t e m s . A l l o f t h e f e e l i n g good q u e s t i o n s were a d d e d t o make a p o s i t i v e a f f e c t i v e c o n s e q u e n c e s c o m p o s i t e . The p o s i t i v e a f f e c t i v e c o n s e q u e n c e s s c a l e was f u r t h e r s u b d i v i d e d i n t o f e e l i n g g o od a s a r e s u l t o f c o m p a r i n g : 1) up o r 2) down. S i m i l a r l y , t h e i t e m s i n w h i c h one f e l t w o r s e a s a r e s u l t o f m a k i n g c o m p a r i s o n s were summed t o f o r m a n e g a t i v e a f f e c t i v e c o n s e q u e n c e s s c a l e , w h i c h was s u b d i v i d e d i n t o f e e l i n g b a d f r o m c o m p a r i n g 1) up a n d 2) down. 10. A p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s P a r t i c i p a n t s were t o l d , "Some p e o p l e d o n ' t f e e l i t i s r i g h t t o c o m p a r e t h e m s e l v e s w i t h o t h e r s a n d t r y t o a v o i d d o i n g s o . I n c o n t r a s t , some p e o p l e f e e l c o m p a r i n g w i t h o t h e r s i s u s e f u l t o g a i n i n f o r m a t i o n . " S u b s e q u e n t l y , r e s p o n d e n t s were a s k e d , "How a p p r o p r i a t e o r i n a p p r o p r i a t e do y o u t h i n k i t i s t o compare y o u r s e l f w i t h o t h e r s who ha v e MS?" 11. C o n t a c t w i t h o t h e r s w i t h MS I n i t i a l l y , r e s p o n d e n t s were a s k e d , "How many p e o p l e w i t h MS do y o u know?" R e c o g n i z i n g t h a t s u p p o r t g r o u p m e m b e r s h i p may s u b s t a n t i a l l y a f f e c t c o n t a c t w i t h s i m i l a r o t h e r s , t h o s e w i t h MS 36 were a s k e d 1) i f t h e y c u r r e n t l y b e l o n g t o s u c h a g r o u p , a n d 2) i f t h e y a t t e n d e d one i n t h e p a s t . I f r e s p o n d e n t s a n s w e r e d a f f i r m a t i v e l y t o e i t h e r o f t h e a b o v e q u e s t i o n s , t h e y were a s k e d t o e s t i m a t e how many m e e t i n g s t h e y h a d gone t o . F i n a l l y , t h o s e who h a d a t t e n d e d s u p p o r t g r o u p s were a s k e d , " I n g e n e r a l , do y o u t h i n k t h e o t h e r g r o u p members h a v e i l l n e s s e s t h a t a r e much l e s s s e v e r e , a l i t t l e l e s s s e v e r e , a b o u t t h e same, a l i t t l e more s e v e r e , o r much more s e v e r e t h a n y o u r s ? " R e s p o n s e s were m a r k e d on a f i v e - p o i n t s c a l e . 12. H e a l t h E i g h t q u e s t i o n s t a p p i n g h e a l t h were a s k e d . T h e s e i n c l u d e d , a g l o b a l r a t i n g ("In g e n e r a l , how w o u l d y o u r a t e y o u r h e a l t h ? " ) , a t e m p o r a l c o m p a r i s o n q u e s t i o n ("How h a s y o u r p h y s i c a l h e a l t h c h a n g e d o v e r t h e p a s t y e a r ? " ) , a c o p i n g q u e s t i o n ( " O v e r a l l , how w e l l do y o u t h i n k y o u a r e c o p i n g w i t h M S ) , a n d two r e l a t i v e q u e s t i o n s ("Compared w i t h o t h e r e v e n t s t h a t h a v e h a p p e n e d i n y o u r l i f e , how s e v e r e i s y o u r MS" a n d "Compared w i t h o t h e r s w i t h MS, how s e v e r e do y o u f e e l y o u r MS i s ? " ) . I n a d d i t i o n , e a c h r e s p o n d e n t was a s k e d i f he o r she h a d s u f f e r e d any symptoms o f MS ( w e a k n e s s , v i s i o n o r c o - o r d i n a t i o n p r o b l e m s , e t c . ) i n t h e p a s t y e a r ? A f f i r m a t i v e r e s p o n s e s were f o l l o w e d by two q u e s t i o n s : 1) "How many e p i s o d e s o f symptoms h a v e y o u h a d ? " a n d 2) "How s e r i o u s were t h e e p i s o d e s o v e r a l l ? " The l a t t e r q u e s t i o n was a s k e d on a f o u r - p o i n t s c a l e r a n g i n g f r o m n o t a t a l l s e r i o u s t o v e r y s e r i o u s . 13. T r a j e c t o r y T h r e e q u e s t i o n s r e g a r d i n g r e s p o n d e n t s ' p e r c e p t i o n s o f t h e 37 t h e c o u r s e o f i l l n e s s were i n c l u d e d on n i n e - p o i n t s c a l e s : 1) " I n t h e f u t u r e , how do y o u t h i n k y o u r c a p a c i t y t o a c c o m p l i s h t a s k s w i l l c h a n g e , i f a t a l l ? " ( r a n g i n g f r o m g e t a l o t w o r s e t o g e t a l o t b e t t e r ) , 2) " R e l a t i v e t o how y o u a r e c o p i n g r i g h t now, how w e l l do y o u t h i n k y o u w i l l c o p e i n t h e f u t u r e ? " ( r a n g i n g f r o m much w o r s e t o much b e t t e r ) , a n d 3) "How l i k e l y t o do t h i n k i t i s t h a t y o u r symptoms w i l l g e t w o r s e o r r e c u r ? " ( r a n g i n g f r o m n o t a t a l l l i k e l y t o e x t r e m e l y l i k e l y ) . I n t e r - i t e m c o r r e l a t i o n s f o r t h e t h r e e i t e m s r a n g e d b e t w e e n .32 a n d .59. 14. P e r s o n a l c o n t r o l T h r e e q u e s t i o n s r e g a r d i n g p e r c e i v e d s e l f - c o n t r o l , p r e s e n t e d on n i n e - p o i n t s c a l e s ( r a n g i n g f r o m a b s o l u t e l y no c o n t r o l t o e x t r e m e amount o f c o n t r o l ) , were a d a p t e d f r o m A f f l e c k e t a l . ( 1 9 8 7 b ) . E a c h o f t h e q u e s t i o n s b e g a n , "How much p e r s o n a l c o n t r o l do y o u " a n d were f o l l o w e d by 1) " t h i n k y o u h a v e o v e r y o u r d a i l y symptoms, t h a t i s t h e amount o f p a i n , f a t i g u e , d i s c o m f o r t , a n d i m m o b i l i t y y o u e x p e r i e n c e f r o m d a y t o d a y , " 2) " t h i n k y o u h a v e o v e r t h e m e d i c a l c a r e a n d t r e a t m e n t o f y o u r i l l n e s s , " a n d 3) " b e l i e v e y o u h a v e o v e r t h e l o n g - t e r m c o u r s e o f y o u r u n d e r l y i n g d i s e a s e , t h a t i s , w h e t h e r i t w i l l i m p r o v e o r a t l e a s t n o t w o r s e n i n t h e f u t u r e ? " B e c a u s e i t e m two i s c o n c e p t u a l l y d i f f e r e n t f r o m t h e o t h e r two i t e m s , i t was n o t i n c l u d e d i n t h e c o m p o s i t e o f p e r c e i v e d p e r s o n a l c o n t r o l . The i n t e r - i t e m c o r r e l a t i o n f o r t h e r e m a i n i n g two i t e m s was .58. 15. D e m o g r a p h i c s E a c h p a r t i c i p a n t was a s k e d q u e s t i o n s r e g a r d i n g e d u c a t i o n , 38 c o m b i n e d f a m i l y i n c o m e , g e n d e r , m a r i t a l s t a t u s , a g e , and e m p l o y m e n t . 39 I V . R e s u l t s A. A n a l y s e s by G r o u p 1. D e m o g r a p h i c v a r i a b l e s ANOVA's were p e r f o r m e d on c o m b i n e d f a m i l y i ncome a n d e d u c a t i o n . The g r o u p s were s i g n i f i c a n t l y d i f f e r e n t on b o t h o f t h e s e m e a s u r e s , F ( 2 , 137) = 5.36, p_ < « 0 1 a n d £ ( 2> 1 3 9 > = 5.03, p_ < .01, r e s p e c t i v e l y . R e s p o n d e n t s i n g r o u p s o n e , two, a n d t h r e e h a d mean c o m b i n e d f a m i l y i n c o m e s o f $ 3 7 , 5 0 0 , $ 3 7 , 5 0 0 , a n d $25 , 0 0 0 . The a v e r a g e e d u c a t i o n f o r t h e c o r r e s p o n d i n g g r o u p s was 12.87, 13.17, a n d 11.68 y e a r s . T u k e y ' s HSD r e v e a l e d t h a t f o r b o t h o f t h e s e d e m o g r a p h i c v a r i a b l e s , g r o u p s one a n d two were s i g n i f i c a n t l y h i g h e r t h a n g r o u p t h r e e , b u t n o t d i f f e r e n t f r o m one a n o t h e r . The r e d u c e d income i n g r o u p t h r e e may b e , a t l e a s t i n p a r t , a c c o u n t e d f o r by t h e f a c t t h a t r e s p o n d e n t s i n t h a t g r o u p were l e s s l i k e l y t o be e m p l o y e d t h a n t h o s e i n t h e o t h e r two g r o u p s ( 3 2 % , 3 3 % , a n d 12%, f o r g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y ) , X ( 2 , N = 143) = 6.13, p < .05, p r e s u m a b l y due t o t h e i r d e c r e a s e d m o b i l i t y . The e d u c a t i o n a l d i f f e r e n c e i s l e s s e a s i l y e x p l a i n e d . MS i s a d i s e a s e t h a t u s u a l l y i s d i a g n o s e d a f t e r c o m p l e t i o n o f h i g h s c h o o l , b u t n o t n e c e s s a r i l y u n i v e r s i t y , f o r many p e o p l e . P e r h a p s t h e d i f f e r e n c e b e t w e e n g r o u p s i s due t o t h e f a c t t h a t many o f t h o s e who were d i a g n o s e d w i t h MS who i n t e n d e d t o c o m p l e t e o r r e t u r n t o s c h o o l were u n a b l e t o do s o b e c a u s e o f t h e i r symptoms. C o n s i s t e n t w i t h t h e g e n d e r c o m p o s i t i o n o f t h e d i s e a s e i n t h e g e n e r a l p o p u l a t i o n ( S c h e i n b e r g , 1 9 8 3 ) , t h e p r e s e n t s a m p l e was 7 5 % 40 f e m a l e a nd 2 5 % m a l e . No d i f f e r e n c e s were f o u n d a c r o s s g r o u p on g e n d e r . I n a d d i t i o n , 13% were s i n g l e , 6% s e p a r a t e d , 6% d i v o r c e d , 69% m a r r i e d , a n d 6% w i d o w e d . A s i d e f r o m a g r e a t e r p r o p o r t i o n o f r e s p o n d e n t s i n g r o u p s two ( 6 % ) a n d t h r e e ( 1 2 % ) who were widowed 2 t h a n t h o s e i n g r o u p one ( 0 % ) , X ( 2 , N = 142) = 6.52, p_ < .05, no d i f f e r e n c e s were f o u n d f o r any o f t h e o t h e r m a r i t a l s t a t u s c a t e g o r i e s . B e c a u s e t h e t h r e e g r o u p s were s e l e c t e d a c c o r d i n g t o y e a r o f d i a g n o s i s , i t makes s e n s e t h a t r e s p o n d e n t s v a r i e d a c c o r d i n g t o age (Ms were 42, 46, a n d 52 y e a r s o l d f o r g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y ) , F ( 2 , 125)=8.08, p/c.001. H o w e v e r , u n e x p e c t e d l y , f o l l o w - u p T u k e y ' s HSD r e v e a l e d t h a t , a l t h o u g h g r o u p s one a n d t h r e e d i f f e r e d , one a n d two d i d n o t . One p o s s i b i l i t y f o r t h e r e s u l t s may be due t o t h e f a c t t h a t t h o s e who have more s e r i o u s d i s a b i l i t i e s a r e d i a g n o s e d l a t e r i n l i f e . 2. Age, e d u c a t i o n , a n d income c o n f o u n d s B e c a u s e t h e t h r e e g r o u p s d i f f e r e d on i n c o m e , a g e , a n d e d u c a t i o n , c o r r e l a t i o n s b e t w e e n t h e s e v a r i a b l e s a n d a l l o f t h e o t h e r i t e m s a n d s c a l e s were c a l c u l a t e d . An e x a m i n a t i o n o f t h e s e c o r r e l a t i o n s i n d i c a t e d t h a t , w i t h t h e e x c e p t i o n o f s i g n i f i c a n t a s s o c i a t i o n s b e t w e e n t h e t h r e e p o t e n t i a l l y c o n f o u n d i n g v a r i a b l e s and t h e p s y c h o l o g i c a l a d j u s t m e n t v a r i a b l e s , a n d f u n c t i o n a l s t a t u s , t h e c o r r e l a t i o n s were a l l e i t h e r modest o r n o n - e x i s t e n t . M o r e o v e r , p a r t i a l l i n g o u t t h e e f f e c t s o f i n c o m e , a g e , a n d e d u c a t i o n h a d no s i g n i f i c a n t i m p a c t upon t h e g r o u p d i f f e r e n c e a n a l y s e s o f o p t i m i s m , s e l f - e s t e e m , a n d f u n c t i o n a l s t a t u s , a n d 41 o n l y s l i g h t l y m o d i f i e d t h e a n a l y s i s o f d e p r e s s i o n a c r o s s g r o u p s . T h u s , ANOVA's r a t h e r t h a n ANCOVA's a r e r e p o r t e d b e l o w f o r a l l o f t h e g r o u p d i f f e r e n c e s a n a l y s e s . 3. S t a n d a r d i z e d m e a s u r e s R e l i a b i l i t y c o e f f i c i e n t s ( C r o n b a c h ' s a l p h a s ) were c o m p u t e d f o r e a c h o f t h e s t a n d a r d i z e d s c a l e s a n d were .84, .86, a n d .89 f o r o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n , r e s p e c t i v e l y . The t h r e e s c a l e s were s i g n i f i c a n t l y r e l a t e d t o one a n o t h e r . O p t i m i s m c o r r e l a t e d . 61, a n d -.44 w i t h s e l f - e s t e e m a n d d e p r e s s i o n , r e s p e c t i v e l y ( b o t h r s < . 0 0 1 ) . S e l f - e s t e e m a n d d e p r e s s i o n ( r = -.38, p_ < .001) were a l s o a s s o c i a t e d . The m o d e r a t e l y h i g h c o r r e l a t i o n s b e t w e e n t h e v a r i a b l e s s u g g e s t t h a t t h e y a r e r e l a t e d , y e t c o n c e p t u a l l y d i s t i n c t . O v e r a l l , t h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s on d i s p o s i t i o n a l o p t i m i s m , a s m e a s u r e d by t h e L i f e O r i e n t a t i o n T e s t , F ( 2 , 134) = 1.31, n s . , o r s e l f - e s t e e m , F ( 2 , 135) = 2.46, n s . The t h r e e g r o u p s v a r i e d a c c o r d i n g t o d e p r e s s i o n F ( 2 , 113) = 3.44, £ < .05. T u k e y ' s HSD r e v e a l e d t h a t o v e r a l l o n l y g r o u p two (M = 9.45) was l e s s d e p r e s s e d t h a n g r o u p t h r e e (M = 1 4 . 6 5 ) , a l t h o u g h t h e mean f o r g r o u p one (M = 13.62) was o n l y s l i g h t l y l o w e r t h a n t h a t o f g r o u p t h r e e . The i t e m s i n w h i c h d i f f e r e n c e s were f o u n d b e y o n d t h e .05 l e v e l o f s i g n i f i c a n c e were " I f e l t d e p r e s s e d , " " I f e l t t h a t e v e r y t h i n g I d i d was an e f f o r t , " " I t h o u g h t my l i f e h a d been a f a i l u r e , " " I f e l t f e a r f u l , " a n d " I h a d c r y i n g s p e l l s . " P r e s u m a b l y , d e p r e s s i o n d i f f e r e n c e s a c r o s s g r o u p s r e f l e c t t h e way i n w h i c h t h e d i s e a s e i s p e r c e i v e d . R e s p o n d e n t s 42 i n g r o u p one a r e o r i e n t i n g t o t h e d i s e a s e a n d a r e l i k e l y f e a r f u l a b o u t i t s c o u r s e , a n d r e f l e c t i n g upon a d j u s t m e n t s t h a t n e e d t o be made due t o t h e u n c e r t a i n t y a s s o c i a t e d w i t h MS. I n c o n t r a s t , t h o s e i n g r o u p t h r e e know what t o e x p e c t and a r e more e x p e r i e n c e d w i t h t h e symptoms, y e t h a v e an o v e r a l l i n c r e a s e d l e v e l o f n e g a t i v e a f f e c t , p r e s u m a b l y due t o r e d u c e d c a p a c i t y t o f u n c t i o n r e l a t i v e t o r e s p o n d e n t s i n g r o u p t w o . 4. S i g n i f i c a n t l i f e e x p e r i e n c e s I f d i f f e r e n c e s a r e f o u n d b e t w e e n g r o u p s on v a r i o u s m e a s u r e s , one e x p l a n a t i o n m i g h t be t h a t t h e y a r e a r e s u l t o f d i f f e r e n t i a l l i f e e x p e r i e n c e s , a n d n o t t h e i l l n e s s p e r s e . F o r e x a m p l e , r e s p o n d e n t s i n g r o u p t h r e e , b e c a u s e o f t h e i r l i m i t e d p h y s i c a l c a p a c i t y , may be more l i k e l y t o h a v e l o s t t h e i r j o b s o r been l a i d o f f . I f g r o u p t h r e e r e s p o n d e n t s e x p e r i e n c e more n e g a t i v e a f f e c t a n d l e s s p o s i t i v e a f f e c t t h a n p a r t i c i p a n t s i n t h e o t h e r two g r o u p s , i t may be b e c a u s e o f t h e l o s s o f an i m p o r t a n t c a r e e r , o r s o u r c e o f s o c i a l c o n t a c t w i t h o t h e r s . To t e s t f o r s u c h a h y p o t h e s i s , t e n p o s s i b l e s t r e s s f u l l i f e e v e n t s w e re i n v e s t i g a t e d . The g r o u p s h a d c o m p a r a b l e r e s p o n s e s on t h e f o l l o w i n g i t e m s : become ( r e ) m a r r i e d , l o s t a s p o u s e t h r o u g h d e a t h , l o s t y o u r j o b o r been l a i d o f f , h a d a s e r i o u s p e r s o n a l i n j u r y ( e x c l u d i n g MS s y m p t o m s ) , r e t i r e d , h a d a d e c l i n e i n f i n a n c i a l s t a t u s , become d i v o r c e d , become s e p a r a t e d , a n d h a d a s p o u s e l o s t t h e i r j o b o r 2 g e t l a i d o f f ( a l l X v a l u e s were n s . ) . I n f a c t , t h e o n l y i t e m i n w h i c h g r o u p d i f f e r e n c e s were f o u n d p e r t a i n e d t o someone i n t h e i m m e d i a t e f a m i l y h a v i n g a s e r i o u s p e r s o n a l i n j u r y o r i l l n e s s , 43 X 2 ( 2 , N = 142) = 8 . 3 8 , p_ < .05. N i n e t e e n , 4 3 % , and 4 1 % i n g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y , e n d o r s e d t h e l a t t e r i t e m . I f a B o n f e r r o n i a l p h a i s e m p l o y e d t o a d j u s t f o r t h e number o f t e s t s c o n d u c t e d (.05 / 10 = . 0 0 5 ) , a l l t e n i t e m s a r e n o n s i g n i f i c a n t . T h e r e f o r e , t h e c o m p e t i n g e x p l a n a t i o n o f s i g n i f i c a n t l i f e e x p e r i e n c e s c a n n o t a c c o u n t f o r d i f f e r e n c e s b e t w e e n g r o u p s . 5. F r e q u e n c i e s o f u p w a r d c o m p a r i s o n s D i f f e r e n c e s were f o u n d b e t w e e n t h e t h r e e g r o u p s r e g a r d i n g t h e amount o f c o m p a r i s o n s w i t h o t h e r s who a r e b e t t e r o f f w i t h r e s p e c t t o d i s e a s e - r e l a t e d i s s u e s , F ( 2 , 140) = 5.32, p < .01. F o l l o w - u p T u k e y ' s HSD r e v e a l e d t h a t t h o s e i n g r o u p t h r e e made more u p w a r d c o m p a r i s o n s t h a n t h e o t h e r two g r o u p s , w h i c h were n o t s i g n i f i c a n t l y d i f f e r e n t f r o m one a n o t h e r (Ms were 2.89, 2.52, a n d 3.98, f o r g r o u p s o n e , t w o , a n d t h r e e , r e s p e c t i v e l y ) . The t h r e e g r o u p s made s i m i l a r r e s p o n s e s when a n s w e r i n g q u e s t i o n s r e g a r d i n g u p w a r d c o m p a r i s o n s r e g a r d i n g a b i l i t y t o c o p e w i t h MS a n d i t s c o n s e q u e n c e s , F ( 2 , 140) = 1.80, n s . , a n d l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y , F ( 2 , 140) = 1.28, n s . 6. F r e q u e n c i e s o f downward c o m p a r i s o n s T h e r e were no g r o u p d i f f e r e n c e s f o r f r e q u e n c y o f downward c o m p a r i s o n s on t h e i t e m s p e r t a i n i n g t o d i s e a s e - r e l a t e d i s s u e s , a b i l i t y t o c o p e , o r l e v e l o f s u p p o r t . 7. A f f e c t i v e c o n s e q u e n c e s I n a d d i t i o n t o t h e t y p e s o f c o m p a r i s o n s made, a n a l y s e s were c o n d u c t e d a c c o r d i n g t o f e e l i n g s p r o d u c e d a f t e r c o m p a r i n g w i t h o t h e r s . T h e r e was a t e n d e n c y f o r r e s p o n d e n t s i n g r o u p s one (M = 44 19.16) a n d t h r e e (M = 19.35) t o f e e l g o od a s a r e s u l t o f m a k i n g c o m p a r i s o n s more o f t e n t h a n t h o s e i n g r o u p two (M = 1 5 . 7 2 ) , F ( 2 , 136) = 2.71 g = .07. T h i s f i n d i n g was e n t i r e l y due t o t h e upward c o m p a r i s o n q u e s t i o n s (F ( 2 , 137) = 5.00, p_ < . 0 1 ) , s i n c e no d i f f e r e n c e was f o u n d f o r t h e downward c o m p a r i s o n q u e s t i o n s (F ( 2 , 137) = .37, n s . ) . P r e s u m a b l y , t h o s e i n g r o u p s one a n d t h r e e h a v e more o f a n e e d t o f e e l b e t t e r a f t e r u p w a r d l y c o m p a r i n g , b e c a u s e t h e y a r e e i t h e r j u s t r e c e n t l y c o p i n g w i t h t h e i l l n e s s o r a r e p h y s i c a l l y d i s a b l e d . O v e r a l l , t h e r e were no s i g n i f i c a n t d i f f e r e n c e s b e t w e e n g r o u p s r e g a r d i n g f e e l i n g bad s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s , F ( 2 , 137) = 1.94, n s . ) . H o w e v e r , when b r o k e n down a c c o r d i n g t o c o m p a r i s o n t y p e , t h e r e was a t r e n d c o n s i s t e n t w i t h t h e f e e l i n g g o od c o m p o s i t e . T h u s , f o r t h e u p w a r d c o m p a r i s o n q u e s t i o n s (F ( 2 , 138) = 2.81, p =.06), r e s p o n d e n t s i n g r o u p t h r e e (M = 5.22) r e p o r t e d t h e h i g h e s t a f f e c t , f o l l o w e d by one (M = 4.64) a n d two (M = 3 . 5 3 ) . No d i f f e r e n c e was f o u n d f o r t h e downward c o m p a r i s o n q u e s t i o n s (F ( 2 , 137) = .68, n s . ) . I n sum, t h e o v e r a l l p a t t e r n o f r e s u l t s r e v e a l e d t h a t t h o s e i n g r o u p s one a n d t h r e e r e p o r t e d f e e l i n g b e t t e r a n d somewhat w o r s e more o f t e n a s a r e s u l t o f m a k i n g u p w a r d c o m p a r i s o n s t h a n t h o s e i n g r o u p two. T h e r e were no g r o u p d i f f e r e n c e s f o r a n y o f t h e downward c o m p a r i s o n q u e s t i o n s . 8. C o n t a c t w i t h o t h e r s w i t h MS T h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s i n t e r m s o f t h e number o f p e r s o n s w i t h MS t h a t r e s p o n d e n t s knew, F ( 2 , 128) = .42, n s . T h u s , g r o u p d i f f e r e n c e s r e p o r t e d a b o v e c a n n o t be r e l a t e d t o p e r c e i v e d d i f f e r e n t i a l c o n t a c t . 45 O v e r a l l , 37% o f r e s p o n d e n t s b e l o n g e d t o a s u p p o r t g r o u p a t t h e t i m e t h e q u e s t i o n n a i r e was c o m p l e t e d , a n d an a d d i t i o n a l 11% h a d a t t e n d e d a s u p p o r t g r o u p i n t h e p a s t . T h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s on e i t h e r o f t h e s e m e a s u r e s . T h e r e was a n o n s i g n i f i c a n t t r e n d f o r t h e number o f s u p p o r t g r o u p m e e t i n g s a t t e n d e d , when a n a l y s e s were c o n d u c t e d by g r o u p , F ( 2 , 64) = 2.78, p = .07. The means were 9.24, 26.10 , a n d 15.00 f o r g r o u p s o n e , two, a n d t h r e e , r e s p e c t i v e l y . P r e s u m a b l y , t h o s e who h a v e been r e c e n t l y d i a g n o s e d h a v e n o t h a d a s much o p p o r t u n i t y t o a t t e n d t h e s e g r o u p s . G r o u p d i f f e r e n c e s e merged on t h e q u e s t i o n a s k i n g r e s p o n d e n t s who h a d a t t e n d e d s u p p o r t g r o u p s how s e v e r e t h e y t h o u g h t o t h e r g r o u p members' i l l n e s s e s w e r e , r e l a t i v e t o t h e i r own, F ( 2 , 66) = 3.90, g < .05. As e x p e c t e d , t h e o r d e r i n g o f means c o n f o r m s t o a c t u a l i l l n e s s s t a t u s . A l t h o u g h p e o p l e i n g r o u p s one (M = 3.92) a n d two (M = 4.00) were s i m i l a r i n r e p o r t i n g t h a t o t h e r g r o u p members a r e a p p r o x i m a t e l y "a l i t t l e more s e v e r e " t h a n t h e m s e l v e s , o n l y g r o u p two a n d g r o u p t h r e e (M = 3.08) were s i g n i f i c a n t l y d i f f e r e n t . T h o s e i n g r o u p t h r e e r e p o r t e d t h a t o t h e r g r o u p members were " a b o u t t h e same" a s o n e s e l f i n t e r m s o f i l l n e s s s e v e r i t y . 9. P h y s i c a l h e a l t h I n t e r e s t i n g l y , when a s k e d " I n g e n e r a l , how w o u l d y o u r a t e y o u r h e a l t h ? " t h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s , F ( 2 , 138) = .76, n s . (Ms were 6.31, 6.19, a n d 5.83 f o r g r o u p s o n e , two , a n d t h r e e , r e s p e c t i v e l y ) . The s i m i l a r i t y a c r o s s g r o u p s i s 46 s u r p r i s i n g g i v e n t h a t r e s p o n d e n t s i n g r o u p t h r e e were c h o s e n s p e c i f i c a l l y b e c a u s e o f t h e i r p o o r f u n c t i o n a l s t a t u s a n d some were l a r g e l y o r e n t i r e l y d e p e n d e n t upon o t h e r s f o r t h e i r c a r e . When a s k e d c o m p a r a t i v e q u e s t i o n s , h o w e v e r , g r o u p d i f f e r e n c e s e m e r g e d . To t h e q u e s t i o n , "Compared w i t h o t h e r e v e n t s t h a t h a v e h a p p e n e d i n y o u r l i f e , how s e v e r e i s y o u r MS?" p a r t i c i p a n t s i n g r o u p s one (M = 6.25) a n d t h r e e (M = 6.55) were more l i k e l y t o a d m i t t h a t t h e i r MS was q u i t e s e v e r e , r e l a t i v e t o t h o s e i n g r o u p two (M = 5 . 0 6 ) , F ( 2 , 138) = 5.61, p_ < .005. I n t e r e s t i n g l y , g r o u p one r e s p o n d e n t s were n o t s i g n i f i c a n t l y d i f f e r e n t f r o m g r o u p t h r e e r e s p o n d e n t s , p r e s u m a b l y due t o g r o u p o n e ' s more r e c e n t d i a g n o s i s . When a s k e d on t h e same f i v e - p o i n t s c a l e , "Compared w i t h o t h e r s w i t h MS, how s e v e r e do y o u f e e l y o u r MS i s ? " r e s p o n d e n t s i n g r o u p s one (M = 2.25) a n d two (M = 1.95) were l e s s l i k e l y t o a d m i t t h e i r MS was more s e v e r e t h a n r e s p o n d e n t s i n g r o u p t h r e e (M = 2 . 8 8 ) , F ( 2 , 133) = 8.38, p_ < .001. However, e v e n r e s p o n d e n t s i n g r o u p t h r e e r e p o r t e d on t h e f a v o r a b l e s i d e o f t h e m i d - p o i n t . O v e r a l l , 9 2 % a n s w e r e d a f f i r m a t i v e l y t o a q u e s t i o n a s k i n g i f t h e y h a d h a d any symptoms o f MS ( w e a k n e s s , v i s i o n o r c o -o r d i n a t i o n p r o b l e m s , e t c . ) i n t h e p a s t y e a r . The l a c k o f 2 d i f f e r e n c e s a c r o s s g r o u p s , X ( 2 , N = 143) = 2.37, n s . , i n d i c a t e s t h e p e r v a s i v e n e s s o f symptoms e x p e r i e n c e d by a l l p e o p l e w i t h MS. T h e r e were g r o u p d i f f e r e n c e s , h o w e v e r , i n t e r m s o f t h e p e r c e i v e d s e r i o u s n e s s o f t h e e p i s o d e s , F ( 2 , 125) = 8.03, p < .001. T u k e y ' s HSD i n d i c a t e d t h a t r e s p o n d e n t s f r o m g r o u p t h r e e (M = 47 2.63) r e p o r t e d more s e r i o u s e p i s o d e s t h a n t h o s e f r o m g r o u p two (M = 1 . 8 9 ) . G r o u p one (M = 2.27) d i d n o t d i f f e r f r o m e i t h e r o f t h e o t h e r g r o u p s . 10. T r a j e c t o r y I n t e r e s t i n g l y , p a r t i c i p a n t s i n t h e t h r e e g r o u p s r e g a r d e d t h e i r f u t u r e s i m i l a r l y . T h e r e were no d i f f e r e n c e s r e g a r d i n g p e r c e i v e d c a p a c i t y t o a c c o m p l i s h t a s k s , a b i l i t y t o c o p e w i t h MS, o r v i e w i n g t h e symptoms a s g e t t i n g w o r s e o r r e c u r r i n g i n t h e f u t u r e ( a l l 2 s > ' 2 0 ) . 11. P e r s o n a l p s y c h o l o g i c a l c o n t r o l P e r c e p t i o n s o f p e r s o n a l c o n t r o l o v e r d a i l y symptoms v a r i e d a c r o s s g r o u p s , F ( 2 , 138) = 5.47, 2 < .005. T h o s e i n g r o u p t h r e e (M = 5.03) p e r c e i v e d l e s s c o n t r o l t h a n t h o s e i n g r o u p one (M = 6.28) o r two (M = 6 . 2 8 ) . C o n t r o l o v e r t h e m e d i c a l c a r e a n d t r e a t m e n t , F ( 2 , 139) = .71, n s . , a n d l o n g - t e r m c o u r s e o f t h e d i s e a s e , F ( 2 , 139) = 1.20, n s . , was s i m i l a r i n t h e t h r e e g r o u p s , r e f l e c t i n g t h e l i m i t e d k n o w l e d g e a b o u t MS a n d how t o d e a l e f f e c t i v e l y w i t h i t . 3 B. O v e r a l l s a m p l e a n a l y s e s 1. C o m p a r i s o n s c o r r e l a t e d w i t h o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n A s e r i e s . o f a n a l y s e s were c a l c u l a t e d t o d e t e r m i n e w h e t h e r o r n o t t h o s e w i t h MS v a r y i n g i n t e r m s o f o p t i m i s m , s e l f - e s t e e m , a n d d e p r e s s i o n a l s o d i f f e r e d on m a k i n g v a r i o u s t y p e s o f u p w a r d a n d downward c o m p a r i s o n s a n d t h e i r a f f e c t i v e c o n s e q u e n c e s . The a n a l y s e s w e re c o n d u c t e d i n two ways. F i r s t , s i m p l e c o r r e l a t i o n s 48 were c a l c u l a t e d ( e . g . , s e l f - e s t e e m a n d u p w a r d c o m p a r i s o n s ) a n d , s e c o n d , p a r t i a l c o r r e l a t i o n s were c a l c u l a t e d , c o n t r o l l i n g f o r t h e e f f e c t s o f t h e o t h e r two s c a l e s ( e . g . , c o n t r o l l i n g f o r d e p r e s s i o n a n d o p t i m i s m ) . The p a t t e r n s o f c o r r e l a t i o n s were i d e n t i c a l f o r b o t h s e l f - e s t e e m a n d d e p r e s s i o n , e i t h e r h o l d i n g t h e o t h e r two s c a l e s c o n s t a n t o r n o t . The r e s u l t s f o r o p t i m i s m c h a n g e d a f t e r p a r t i a l l i n g o u t t h e e f f e c t s o f s e l f - e s t e e m a n d d e p r e s s i o n . S p e c i f i c a l l y , b o t h s e l f - e s t e e m (r_ = - . 3 4 , p a r t i a l r = - . 2 1 , b o t h p_s < .01) a n d d e p r e s s i o n (£ = .27, p a r t i a l £ = .15, b o t h 2 s < .05) were s i g n i f i c a n t l y r e l a t e d w i t h m a k i n g u p w a r d c o m p a r i s o n s . A f t e r p a r t i a l l i n g o u t t h e e f f e c t s o f s e l f - e s t e e m a n d d e p r e s s i o n , o p t i m i s m was u n r e l a t e d t o m a k i n g u p w a r d c o m p a r i s o n s . I n t e r e s t i n g l y , none o f t h e t h r e e s c a l e s were c o r r e l a t e d w i t h m a k i n g downward c o m p a r i s o n s . As n o t e d e a r l i e r , Buunk e t a l . ( 1 9 8 9) f o u n d t h a t t h o s e h i g h on s e l f - e s t e e m r e p o r t e d f e e l i n g w o r s e a f t e r m a k i n g c o m p a r i s o n s l e s s o f t e n t h a n t h o s e l o w on s e l f - e s t e e m . No d i f f e r e n c e s were f o u n d f o r f e e l i n g b e t t e r . The same r e l a t i o n s h i p b e t w e e n a f f e c t i v e c o n s e q u e n c e s and s e l f - e s t e e m was e x p e c t e d i n t h e p r e s e n t s t u d y . I n a d d i t i o n , i t was h y p o t h e s i z e d t h a t t h i s r e l a t i o n s h i p w o u l d g e n e r a l i z e t o d e p r e s s i o n . I n s u p p o r t o f t h e s e p r e d i c t i o n s , b o t h s e l f - e s t e e m (_r = - . 3 5 , p a r t i a l r = - . 1 6 , b o t h 2S < .05) a n d d e p r e s s i o n (r_ = .39, p a r t i a l v_ = .27, b o t h g s < .01) were s i g n i f i c a n t l y c o r r e l a t e d w i t h f e e l i n g w o r s e a f t e r m a k i n g c o m p a r i s o n s , m o s t l y due t o n e g a t i v e a f f e c t i v e c o n s e q u e n c e s a f t e r m a k i n g u p w a r d c o m p a r i s o n s . A f t e r c o n t r o l l i n g f o r t h e o t h e r 49 two s c a l e s , o p t i m i s m was u n r e l a t e d t o f e e l i n g w o r s e . As e x p e c t e d , o p t i m i s m ( r = .22, p a r t i a l r = .25, b o t h p_s < w a s s i g n i f i c a n t l y c o r r e l a t e d w i t h f e e l i n g b e t t e r a f t e r m a k i n g c o m p a r i s o n s , a l s o due m o s t l y t o u p w a r d c o m p a r i s o n s . S e l f - e s t e e m a n d d e p r e s s i o n were u n r e l a t e d t o p o s i t i v e a f f e c t i v e c o n s e q u e n c e s . T h u s , s e l f - e s t e e m a n d d e p r e s s i o n a r e a s s o c i a t e d w i t h m a k i n g u p w a r d c o m p a r i s o n s and w i t h f e e l i n g w o r s e a f t e r c o m p a r i n g , w h i l e o p t i m i s m i s r e l a t e d t o f e e l i n g b e t t e r a f t e r c o m p a r i n g . As n o t e d e a r l i e r , s i g n i f i c a n t a s s o c i a t i o n s b e t w e e n c o m p a r i s o n s and a d j u s t m e n t w o u l d be e s p e c i a l l y c o m p e l l i n g i f t h e r e l a t i o n s h i p s h e l d when c o n t r o l l i n g f o r a c t u a l s e v e r i t y o f i l l n e s s ( a s m e a s u r e d by f u n c t i o n a l s t a t u s ) a n d c o n t a c t w i t h s i m i l a r o t h e r s . When e a c h o f t h e s e e f f e c t s were p a r t i a l l e d o u t , none o f t h e a n a l y s e s c h a n g e d a p p r e c i a b l y . T h u s , t h e r e l a t i o n s h i p s a r e n o t d e p e n d e n t upon f u n c t i o n a l s t a t u s o r amount o f c o n t a c t w i t h s i m i l a r o t h e r s . 2. C o m p a r i s o n s a n d t r a j e c t o r y Buunk e t a l . ( 1 9 8 9 ) r e p o r t e d t h a t p r o g n o s i s , an i n d e p e n d e n t a s s e s s m e n t o f t h e f u t u r e p r o v i d e d by p h y s i c i a n s , was u n a s s o c i a t e d w i t h a f f e c t i v e c o n s e q u e n c e s f r o m m a k i n g c o m p a r i s o n s . The a u t h o r s i n t e r p r e t t h e i r r e s u l t s i n t e r m s o f t h e i m p o r t a n c e o f s u b j e c t i v e f a c t o r s o v e r o b j e c t i v e o n e s , s u g g e s t i n g t h a t a r a t i n g o f t h e f u t u r e p r o v i d e d by r e s p o n d e n t s may h a v e d i s t i n g u i s h e d b e t w e e n g r o u p s t o a g r e a t e r e x t e n t t h a n p h y s i c i a n s ' r a t i n g s . I n t h e p r e s e n t s t u d y , a s u b j e c t i v e a s s e s s m e n t o f t r a j e c t o r y was u s e d . M o s t o f t h e c o m p o s i t e s c o r e s were 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 50 w i t h t h e t r a j e c t o r y s c a l e , i n c l u d i n g t h e u p w a r d c o m p a r i s o n s c o m p o s i t e (r_ = - . 0 9 ) , downward c o m p a r i s o n s c o m p o s i t e ( r = . 1 7 ) , p o s i t i v e a f f e c t i v e c o n s e q u e n c e s c o m p o s i t e ( r = . 1 1 ) , a n d n e g a t i v e a f f e c t i v e c o n s e q u e n c e s c o m p o s i t e (r_ = - . 1 7 ) . H o w e v e r , one s i g n i f i c a n t c o r r e l a t i o n o f n o t e , w h i c h i s i n t h e p r e d i c t e d d i r e c t i o n , i s t h a t t h o s e who v i e w t h e i r f u t u r e l e s s o p t i m i s t i c a l l y were more l i k e l y t o r e p o r t n e g a t i v e a f f e c t i v e c o n s e q u e n c e s (r_ = - . 2 1 , p_ < .01) a f t e r c o m p a r i n g w i t h o t h e r s who were w o r s e o f f . I n sum, v i e w i n g o n e ' s f u t u r e p o s i t i v e l y i s n o t c o r r e l a t e d w i t h m a k i n g v a r i o u s t y p e s o f c o m p a r i s o n s , o r p o s i t i v e a f f e c t i v e c o n s e q u e n c e s , b u t i n v e r s e l y a s s o c i a t e d w i t h n e g a t i v e a f f e c t i v e c o n s e q u e n c e s f r o m downward c o m p a r i s o n s . 3. C o m p a r i s o n s and p e r s o n a l c o n t r o l T h e r e w ere no s i g n i f i c a n t c o r r e l a t i o n s b e t w e e n p e r c e i v e d p e r s o n a l c o n t r o l a nd any o f t h e c o m p a r i s o n s s c a l e s . C o n s i s t e n t w i t h t h e f i n d i n g s o f Buunk e t a l . ( 1 9 8 9 ) , i t was p r e d i c t e d t h a t t h o s e l o w e r on p e r c e i v e d p e r s o n a l c o n t r o l w o u l d be more l i k e l y t o r e p o r t f e e l i n g w o r s e a s a r e s u l t o f m a k i n g c o m p a r i s o n s w i t h o t h e r s . No d i f f e r e n c e s were e x p e c t e d f o r f e e l i n g b e t t e r a s a r e s u l t o f m a k i n g c o m p a r i s o n s . C o n t r a r y t o e x p e c t a t i o n s , t h e c o r r e l a t i o n b e t w e e n p e r c e i v e d p e r s o n a l c o n t r o l a n d t h e n e g a t i v e a f f e c t i v e c o n s e q u e n c e s c o m p o s i t e (r_ = -.17) was n o t s i g n i f i c a n t . As h y p o t h e s i z e d , no a s s o c i a t i o n was f o u n d b e t w e e n p e r c e i v e d p e r s o n a l c o n t r o l a n d t h e p o s i t i v e a f f e c t i v e c o n s e q u e n c e s c o m p o s i t e (£ = . 1 8 ) . 51 4. C o r r e l a t i o n s w i t h f u n c t i o n a l s t a t u s H i g h e r f u n c t i o n a l s t a t u s s c o r e s i n d i c a t e g r e a t e r p h y s i c a l d i s a b i l i t y . A s e r i e s o f c o r r e l a t i o n s were c o m p u t e d t o t e s t t h e n o t i o n t h a t d i s e a s e s t a t e a f f e c t s i m p o r t a n t p s y c h o l o g i c a l v a r i a b l e s . C o r r o b o r a t i n g t h i s s u g g e s t i o n , i n c r e a s e d p h y s i c a l c a p a c i t y was a s s o c i a t e d w i t h t h e p e r c e p t i o n t h a t one i s c u r r e n t l y c o p i n g w e l l w i t h MS (£ = - . 2 2 , £ < .01) and t h e b e l i e f t h a t one w i l l c o p e b e t t e r i n t h e f u t u r e r e l a t i v e t o now ( r = - . 2 1 . p_ < . 0 1 ) . The b e t t e r one was d o i n g p h y s i c a l l y , t h e more p e r c e i v e d p e r s o n a l c o n t r o l o v e r d a i l y symptoms (r_ = - . 3 0 , £ < .001) a n d c o u r s e o f t h e i l l n e s s ( r = - . 2 8 , £ < . 0 0 1 ) . V e r i d i c a l p e r c e p t i o n o f i l l n e s s was i n d i c a t e d by t h e s t r o n g c o r r e l a t i o n b e t w e e n f u n c t i o n a l s t a t u s a n d a r a t i n g a b o u t t h e s e v e r i t y o f o n e ' s MS r e l a t i v e t o o t h e r s (r_ = .64, £ < . 0 0 1 ) . I n t e r e s t i n g l y , a g l o b a l r a t i n g o f h e a l t h was u n a s s o c i a t e d w i t h d e g r e e o f p h y s i c a l d i s a b i l i t y ( r = -.18) . B a s e d on downward c o m p a r i s o n t h e o r y , i t was p r e d i c t e d t h a t f u n c t i o n a l s t a t u s ( a n i n d i c a t o r o f t h r e a t ) w o u l d be c o r r e l a t e d w i t h s e l f - e s t e e m , d e p r e s s i o n , o p t i m i s m , a n d downward c o m p a r i s o n s . I n s u p p o r t o f t h e s e p r e d i c t i o n s , f u n c t i o n a l s t a t u s was n e g a t i v e l y r e l a t e d t o s e l f - e s t e e m (r_ = - . 2 6 , £ < .001) a n d p o s i t i v e l y a s s o c i a t e d w i t h d e p r e s s i o n (r_ = .22, £ < . 0 1 ) . H o w e v e r , f u n c t i o n a l s t a t u s was u n r e l a t e d t o o p t i m i s m ( r = 0 . 1 6 ) , downward c o m p a r i s o n s ( r = - . 0 9 ) , p o s i t i v e a f f e c t i v e c o n s e q u e n c e s ( r = -. 0 1 ) , a n d n e g a t i v e a f f e c t i v e c o n s e q u e n c e s ( r = . 0 9 ) . F u n c t i o n a l s t a t u s a n d u p w a r d c o m p a r i s o n s ( r = .28, £ < .001) were 52 s i g n i f i c a n t l y a s s o c i a t e d , s u c h t h a t t h o s e w i t h g r e a t e r d i s a b i l i t y w ere more l i k e l y t o c ompare w i t h b e t t e r o f f o t h e r s . 5. Upward a n d downward c o m p a r i s o n s T - t e s t s were p e r f o r m e d t o d e t e r m i n e w h e t h e r u p w a r d o r downward c o m p a r i s o n s were more f r e q u e n t . Downward c o m p a r i s o n s were more p r e v a l e n t t h a n u p w a r d c o m p a r i s o n s f o r e a c h o f t h e t h r e e q u e s t i o n s . P e o p l e w i t h MS c o m p a r e d t h e m s e l v e s w i t h o t h e r s d o i n g w o r s e t h a n t h e m s e l v e s more o f t e n t h a n t h o s e d o i n g b e t t e r r e g a r d i n g d i s e a s e - r e l a t e d i s s u e s , t ( l 4 2 ) = 6.39, £ < . 0 0 1 , a b i l i t y t o c o p e w i t h t h e c o n d i t i o n a n d i t s c o n s e q u e n c e s , t ( l 4 2 ) = 6.60, £ < . 0 0 1 , a n d l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y , t ( l 4 2 ) = 3.98, £ < .001. 6. C o n t a c t w i t h o t h e r s The more p e o p l e w i t h MS t h e r e s p o n d e n t knew, t h e more l i k e l y he o r she c o m p a r e d w i t h b e t t e r o f f o t h e r s ( r = .30, £ < . 0 0 1 ) , b u t n o t w o r s e o f f o t h e r s ( r = 2 0 ) . P r e s u m a b l y , s u c h u p w a r d c o m p a r i s o n s were i n t e r p r e t e d i n a s e l f - e n h a n c i n g manner, s i n c e t h e more p e o p l e w i t h MS known by t h e p a r t i c i p a n t , t h e more l i k e l y he o r s h e was t o f e e l b e t t e r s u b s e q u e n t t o c o m p a r i n g w i t h them ( r = .29, p < . 0 0 1 ) . No r e l a t i o n s h i p h e l d f o r c o n t a c t w i t h o t h e r s a n d n e g a t i v e a f f e c t p r o d u c e d f r o m m a k i n g c o m p a r i s o n s (r_ = . 1 1 ) . P a r t i c i p a n t s who f e l t i t was more a p p r o p r i a t e t o c ompare w i t h o t h e r s w i t h MS a l s o knew more o f t h e s e p e o p l e (r_ = .23, £ < .01 ) . 7. A p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s R e s p o n d e n t s who f e l t i t was more a p p r o p r i a t e t o c ompare w i t h 53 o t h e r s w i t h MS made more downward c o m p a r i s o n s (r_ = .28, p < .001) t h a n t h e i r c o u n t e r p a r t s . H owever, p e r c e i v e d a p p r o p r i a t e n e s s was n o t a s s o c i a t e d w i t h f r e q u e n c y o f u p w a r d c o m p a r i s o n s (r_ = . 1 0 ) . P e o p l e who b e l i e v e d i t was a p p r o p r i a t e t o c ompare w i t h o t h e r s w i t h MS r e p o r t e d f e e l i n g b e t t e r more o f t e n s u b s e q u e n t t o d o i n g s o ( r = .36, p < . 0 0 1 ) , e s p e c i a l l y i n t h e c a s e o f c o m p a r i n g w i t h w o r s e o f f o t h e r s ( r = .39, p < . 0 0 1 ) . N e g a t i v e a f f e c t i v e c o n s e q u e n c e s were u n c o r r e l a t e d w i t h p e r c e i v e d a p p r o p r i a t e n e s s o f c o m p a r i n g w i t h o t h e r s w i t h MS (r_ = . 0 6 ) . C. A f f e c t i v e c o n s e q u e n c e s f r o m m a k i n g c o m p a r i s o n s 1. P o s i t i v e v e r s u s n e g a t i v e a f f e c t i v e c o n s e q u e n c e s F o u r p a i r e d t _ - t e s t s were c o n d u c t e d , k e e p i n g c o m p a r i s o n t a r g e t and p h y s i c a l c o n d i t i o n v e r s u s c o p i n g d i m e n s i o n s c o n s t a n t . I n o t h e r w o r d s , o n l y t h e a f f e c t i v e c o n s e q u e n c e s w ere v a r i e d . C o n s i s t e n t w i t h downward c o m p a r i s o n t h e o r y , i t was p r e d i c t e d t h a t p o s i t i v e a f f e c t w o u l d be r e p o r t e d t o a g r e a t e r e x t e n t t h a n n e g a t i v e a f f e c t s u b s e q u e n t t o m a k i n g downward c o m p a r i s o n s . E m p i r i c a l s u p p o r t f o r s u c h a p r e d i c t i o n i s i n d i c a t e d by t h e f a c t t h a t r e s p o n d e n t s m e n t i o n e d f e e l i n g b e t t e r (M = 5.59) t o a g r e a t e r e x t e n t t h a n f e e l i n g w o r s e (M = 3.73) a f t e r c o m p a r i n g i n a downward d i r e c t i o n i n t e r m s o f p h y s i c a l c o n d i t i o n , t ( 1 4 0 ) = 7.17, 2 < .001. The same r e s u l t s were f o u n d f o r c o p i n g , t ( 1 3 9 ) = 5.51, 2 < .001. The means were 4.30 a n d 2.71 f o r f e e l i n g b e t t e r a n d f e e l i n g w o r s e , r e s p e c t i v e l y . H o w e v e r , i n c o n t r a s t t o t h e o r i g i n a l n o t i o n t h a t u p w a r d c o m p a r i s o n s a r e a s s o c i a t e d w i t h n e g a t i v e a f f e c t , t h o s e w i t h MS a l s o r e p o r t e d f e e l i n g b e t t e r (M = 54 4.08) more t h a n w o r s e (M = 2.31) s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s b e t t e r o f f , f o r p h y s i c a l c o n d i t i o n , t ( l 4 0 ) = 6.73, p < .001. S i m i l a r l y , r e s p o n d e n t s r e p o r t e d f e e l i n g b e t t e r (M = 3.95) more o f t e n t h a n w o r s e (M = 2.14) when c o m p a r i n g u p w a r d on t h e c o p i n g d i m e n s i o n , t ( 1 4 0 ) = 6.62, p <.001. The c o n s i s t e n c y o f r e s u l t s s u g g e s t s t h a t , o v e r a l l , p e o p l e f e e l b e t t e r more o f t e n t h a n w o r s e a f t e r c o m p a r i n g w i t h o t h e r s , r e g a r d l e s s o f t h e d i m e n s i o n ( c o p i n g v e r s u s p h y s i c a l ) o r d i r e c t i o n ( u p w a r d o r downward) w i t h w h i c h c o m p a r i s o n s a r e made. 2. C o m p a r i s o n s on t h e p h y s i c a l c o n d i t i o n v e r s u s c o p i n g d i m e n s i o n s An a d d i t i o n a l f o u r p a i r e d t - t e s t s were p e r f o r m e d , h o l d i n g c o m p a r i s o n t a r g e t a n d a f f e c t i v e c o n s e q u e n c e s c o n s t a n t . I t was p r e d i c t e d t h a t i n d i v i d u a l s w i t h MS w o u l d be more l i k e l y t o e v i n c e n e g a t i v e a f f e c t i v e r e a c t i o n s a s a r e s u l t o f m a k i n g c o m p a r i s o n s r e l a t e d t o p h y s i c a l c o n d i t i o n t h a n t h o s e r e l a t e d t o c o p i n g , when c o m p a r i n g downward b u t n o t when c o m p a r i n g u p w a r d . The t - t e s t f o r downward c o m p a r i s o n s on t h e p h y s i c a l c o n d i t i o n (M = 3.71) v e r s u s c o p i n g (M = 2.71) d i m e n s i o n was s i g n i f i c a n t , t ( l 3 9 ) = 5.60, p < .001. T h i s , c o u p l e d w i t h a n o n s i g n i f i c a n t t - t e s t f o r up w a r d c o m p a r i s o n s , c o n f i r m e d t h e h y p o t h e s i s . P r e s u m a b l y , r e s p o n d e n t s who s e e o t h e r s d o i n g w o r s e t h a n t h e m s e l v e s f e e l t h r e a t e n e d b e c a u s e o f t h e p o s s i b i l i t y t h a t t h e y , t o o , may d e t e r i o r a t e . N e g a t i v e a f f e c t may be muted on t h e c o p i n g d i m e n s i o n b e c a u s e o f t h e p e r c e p t i o n t h a t one may e x e r c i s e g r e a t e r c o n t r o l w i t h r e g a r d t o how w e l l one i s a d j u s t i n g , when c o m p a r e d w i t h p h y s i c a l 55 c o n d i t i o n . H o w e v e r , i n d i v i d u a l s a l s o r e p o r t e d f e e l i n g b e t t e r , t h a t i s , l u c k y a n d g r a t e f u l t h e y were n o t i n w o r s e s h a p e t h e m s e l v e s , more o f t h e t i m e when c o m p a r i n g downward on t h e p h y s i c a l c o n d i t i o n , a s c o m p a r e d t o c o p i n g , d i m e n s i o n , t ( l 3 9 ) = 5.27, p_ < .001. A p p a r e n t l y , b o t h f e a r a nd c o m f o r t may be o b t a i n e d by m a k i n g c o m p a r i s o n s w i t h o t h e r s who a r e p h y s i c a l l y w o r s e o f f . To p u t i t a n o t h e r way, downward c o m p a r i s o n s were a s s o c i a t e d w i t h more e x t r e m e a f f e c t on t h e p h y s i c a l c o n d i t i o n t h a n t h e c o p i n g d i m e n s i o n . T h e r e were no d i f f e r e n c e s b e t w e e n t h e d i m e n s i o n s f o r u p w a r d c o m p a r i s o n s r e s u l t i n g i n p o s i t i v e a f f e c t . 3. Upward v e r s u s downward c o m p a r i s o n s F o u r p a i r e d t - t e s t s were c o n d u c t e d , k e e p i n g a f f e c t i v e c o n s e q u e n c e s a n d t h e c o p i n g / p h y s i c a l c o n d i t i o n d i m e n s i o n s c o n s t a n t . O n l y t h e d i r e c t i o n o f c o m p a r i s o n s , u p w a r d v e r s u s downward, was v a r i e d . R e s p o n d e n t s f e l t w o r s e more o f t e n when c o m p a r i n g downward (M = 3.73) t h a n u p w a r d (M = 2.30) on t h e p h y s i c a l c o n d i t i o n d i m e n s i o n , t ( l 4 0 ) = 6.27, p < .001, a n d t h e c o p i n g d i m e n s i o n , t ( l 3 9 ) = 3.11, p_ < .005, (Ms w e re 2.71 a n d 2.14 f o r downward a n d u p w a r d c o m p a r i s o n s , r e s p e c t i v e l y ) . I n t e r e s t i n g l y , i n d i v i d u a l s a l s o r e p o r t e d f e e l i n g b e t t e r when c o m p a r i n g downward (M = 5.62) t h a n u p w a r d (M = 4.10) on t h e p h y s i c a l c o n d i t i o n d i m e n s i o n , t ( l 3 9 ) = 5.33, p_ < .001. No d i f f e r e n c e s were f o u n d b e t w e e n u p w a r d (M = 3.96) a n d downward c o m p a r i s o n (M = 4.31) g r o u p s f o r f e e l i n g b e t t e r a s a r e s u l t o f m a k i n g c o m p a r i s o n s on t h e c o p i n g d i m e n s i o n , J:(139) = 1*16, n s . , a l t h o u g h t h e means a r e c o n s i s t e n t w i t h t h e n o t i o n t h a t downward 56 c o m p a r i s o n s l e a d t o more p o s i t i v e a f f e c t t h a n u p w a r d c o m p a r i s o n s on t h e c o p i n g d i m e n s i o n . O v e r a l l , downward c o m p a r i s o n s were a s s o c i a t e d w i t h more e x t r e m e a f f e c t i v e c o n s e q u e n c e s t h a n u p w a r d c o m p a r i s o n s on t h e p h y s i c a l c o n d i t i o n d i m e n s i o n a n d somewhat more e x t r e m e a f f e c t on t h e c o p i n g d i m e n s i o n . D. G e n d e r d i f f e r e n c e s The o v e r a l l s a m p l e was d i v i d e d a c c o r d i n g t o g e n d e r t o d e t e r m i n e i f m a l e s and f e m a l e s d i f f e r a c c o r d i n g t o t h e s t a n d a r d i z e d s c a l e s a n d / o r s o c i a l c o m p a r i s o n q u e s t i o n s . No d i f f e r e n c e s were f o u n d on o p t i m i s m , t ( 1 3 5 ) = .99, n s . , s e l f -e s t e e m , t ( 1 3 6 ) = .36, n s . , o r d e p r e s s i o n , t ( 1 3 4 ) = .04, n s . M o r e o v e r , m a l e s and f e m a l e s were e q u a l l y l i k e l y t o make u p w a r d c o m p a r i s o n s , t ( 1 4 1 ) = .53, n s . , a n d downward c o m p a r i s o n s , t (141) = 1.51, n s . The o n l y s i g n i f i c a n t g e n d e r d i f f e r e n c e s were d e t e c t e d on t h e downward c o m p a r i s o n / p h y s i c a l d i m e n s i o n q u e s t i o n s . F e m a l e s (M = 5.96) were more l i k e l y t h a n m a l e s (M = 4.50) t o r e p o r t f e e l i n g b e t t e r a s a r e s u l t o f m a k i n g s u c h c o m p a r i s o n s , t (139) = 2.68, p < .01. Y e t , f e m a l e s ( M = 4.10) were a l s o more l i k e l y t o f e e l w o r s e t h a n m a l e s (M = 2.69) s u b s e q u e n t t o c o m p a r i n g w i t h o t h e r s w i t h MS who a r e p h y s i c a l l y w o r s e o f f , t ( 1 3 9 ) = 2.87, 2 < .005. T h u s , f e m a l e s r e p o r t more e x t r e m e a f f e c t t h a n m a l e s when c o m p a r i n g w i t h more p h y s i c a l l y d e b i l i t a t e d o t h e r s . 57 V. D i s c u s s i o n The r e s u l t s o f t h e p r e s e n t s t u d y s u g g e s t a number o f t h e o r e t i c a l a n d e m p i r i c a l e x t e n s i o n s f o r work i n t h e a r e a o f s o c i a l c o m p a r i s o n . The p u r p o s e o f t h i s d i s c u s s i o n i s t o h i g h l i g h t some o f t h e i m p o r t a n t i s s u e s . F i r s t , e v e n t h o u g h many p r e d i c t i o n s f r o m t h e downward c o m p a r i s o n l i t e r a t u r e were s u p p o r t e d , some were n o t . T h u s , r e s p o n d e n t s i n g r o u p s one a n d t h r e e were no more l i k e l y t h a n t h o s e i n g r o u p two t o make downward c o m p a r i s o n s , a n d p a r t i c i p a n t s i n g r o u p t h r e e were more l i k e l y t h a n t h o s e i n g r o u p s one a n d two t o make u p w a r d c o m p a r i s o n s on d i s e a s e - r e l a t e d i s s u e s . S e c o n d , c o r r o b o r a t i n g p a s t r e s e a r c h (Buunk e t a l . , 1 9 8 9 ) , u p w a r d a n d downward c o m p a r i s o n s were n o t p e r c e i v e d a s i n t r i n s i c a l l y a f f e c t i v e , t h a t i s , r e s p o n d e n t s d i d n o t a l w a y s r e p o r t f e e l i n g b a d s u b s e q u e n t t o c o m p a r i n g u p w a r d a n d f e e l i n g g o od s u b s e q u e n t t o c o m p a r i n g downward. I n f a c t , p a r t i c i p a n t s were more l i k e l y t o r e p o r t p o s i t i v e t h a n n e g a t i v e a f f e c t i v e c o n s e q u e n c e s f r o m e i t h e r t y p e o f c o m p a r i s o n . T h i r d , t h e a f f e c t i v e c o n s e q u e n c e s r e s u l t s o f Buunk e t a l . ( 1 9 8 9 ) were r e p l i c a t e d a n d e x t e n d e d f o r s e l f - e s t e e m , a n d g e n e r a l i z e d t o d e p r e s s i o n . T h u s , s e l f - e s t e e m a n d d e p r e s s i o n were r e l a t e d t o m a k i n g u p w a r d c o m p a r i s o n s a n d n e g a t i v e a f f e c t i v e c o n s e q u e n c e s , b u t n o t downward c o m p a r i s o n s o r p o s i t i v e a f f e c t i v e c o n s e q u e n c e s . I n c o n t r a s t , h i g h l y o p t i m i s t i c p e o p l e f e l t b e t t e r , b u t n o t w o r s e , a f t e r m a k i n g c o m p a r i s o n s . F o u r t h , t h e n e e d t o h i g h l i g h t d i m e n s i o n s o f c o m p a r i s o n i s i n d i c a t e d by t h e e x t r e m i t y o f a f f e c t i v e c o n s e q u e n c e s f r o m c o m p a r i n g w i t h w o r s e o f f o t h e r s on 58 t h e p h y s i c a l c o n d i t i o n , r e l a t i v e t o t h e c o p i n g d i m e n s i o n ; r e s u l t s a r e i n t e r p r e t e d i n t e r m s o f s a l i e n c y , t h e i m p a c t o f f o r c e d c o m p a r i s o n s , p e r c e i v e d c o n t r o l l a b i l i t y o f i l l n e s s , a n d d i s t o r t a b i l i t y o f i n f o r m a t i o n . F i f t h , ' a s a w h o l e , t h e f i n d i n g s s u g g e s t t h a t p e o p l e ' s downward c o m p a r i s o n s a r e l e s s s i t u a t i o n a l l y c o n s t r a i n e d a n d more f l e x i b l e t h a n u p w a r d c o m p a r i s o n s . S i x t h , p o s i t i v i t y b i a s e s were d e t e c t e d , s u c h t h a t i n d i v i d u a l s f a v o r a b l y i n t e r p r e t t h e i r a d j u s t m e n t a n d e x t e n t o f d i s a b i l i t y , a n d make more downward c o m p a r i s o n s t h a n u p w a r d c o m p a r i s o n s . S e v e n t h , t h e a m b i v a l e n c e o f m a k i n g downward c o m p a r i s o n s i s i n d i c a t e d by t h e f a c t t h a t b e l i e f s o f a p p r o p r i a t e n e s s were r e l a t e d t o downward, b u t n o t u p w a r d , c o m p a r i s o n s . E i g h t h , b a r r i e r s t o s o c i a l c o m p a r i s o n s h o u l d be c o n s i d e r e d , g i v e n t h a t r e s p o n d e n t s r e p o r t o n l y a m odest amount o f c o m p a r i s o n s a n d m i n i m a l a f f e c t i v i t y a s s o c i a t e d w i t h t h e s e c o m p a r i s o n s . B e f o r e d i s c u s s i n g t h e s e r e s u l t s , h o w e v e r , an e x a m i n a t i o n o f p s y c h o l o g i c a l f u n c t i o n i n g s c o r e s o f t h e p r e s e n t s a m p l e r e l a t i v e t o a v a i l a b l e norms i s i n c l u d e d , a l o n g w i t h a b r i e f o v e r v i e w o f t h e s o c i a l c o m p a r i s o n f u n c t i o n o f s u p p o r t g r o u p s . A c o n c l u d i n g comment r e g a r d i n g m e t h o d o l o g i c a l c o n s i d e r a t i o n s o f MS r e s e a r c h i s p r e s e n t e d . A. P s y c h o l o g i c a l f u n c t i o n i n g E l e v a t e d d e p r e s s i o n s c o r e s h a v e c o n s i s t e n t l y b een f o u n d i n MS p o p u l a t i o n s ( B a r e t z & S t e p h e n s o n , 1981; W h i t l o c k & S i s k i n d , 1 9 8 0 ) , a n d many v i e w n e g a t i v e a f f e c t a s t h e most common symptom o f t h e d i s e a s e ( s e e V a n d e r P l a t e , 1984, f o r a r e v i e w ) . R e s p o n d e n t s i n g r o u p s one a n d t h r e e r e p o r t e d h i g h e r l e v e l s o f 59 d e p r e s s i o n t h a n t h o s e i n g r o u p t w o , a l t h o u g h o n l y g r o u p s two a n d t h r e e were s t a t i s t i c a l l y d i f f e r e n t . P r e s u m a b l y , p e o p l e i n g r o u p one a r e d e p r e s s e d b e c a u s e o f r e c e n t l y o b t a i n e d k n o w l e d g e t h e y h a v e a c h r o n i c , p o t e n t i a l l y d e b i l i t a t i n g d i s e a s e . The t r a n s i t i o n f r o m n o n - d i s a b l e d t o d i s a b l e d s t a t u s n e c e s s i t a t e s many u n e x p e c t e d a d j u s t m e n t s , s u c h a s t h e i n a b i l i t y t o p l a n f o r t h e f u t u r e , r e d u c e d c a r e e r a s p i r a t i o n s , s h a t t e r e d a s s u m p t i o n s r e g a r d i n g b e l i e f s o f i n v u l n e r a b i l i t y , a n d u n c e r t a i n t y a s s o c i a t e d w i t h t h e d i s e a s e . G r o u p t h r e e r e s p o n d e n t s , on t h e o t h e r h a n d , a r e a l s o d e p r e s s e d , y e t h a v e d i f f e r e n t c o n c e r n s . B e c a u s e o f t h e i r r e d u c e d p h y s i c a l c a p a c i t y a n d r e a l i z a t i o n o f t h e l i m i t e d a v a i l a b i l i t y a n d e f f e c t i v e n e s s o f m e d i c a l i n t e r v e n t i o n , a d j u s t m e n t s must be made r e g a r d i n g i n c r e a s e d d e p e n d e n c e a n d d e c r e a s e d m o b i l i t y . R e d u c e d s e x u a l f u n c t i o n i n g ( B a r r e t t , 1984) a n d s o c i a l c o n t a c t s ( D a v i s , 1973) may a l s o be p r o b l e m s e s p e c i a l l y l i k e l y t o o c c u r among g r o u p t h r e e r e s p o n d e n t s . A l t h o u g h t h e r e were g r o u p d i f f e r e n c e s , one may r e a s o n a b l y a s k i f r e s p o n d e n t s i n t h e p r e s e n t s a m p l e were more d e p r e s s e d t h a n non-MS p e r s o n s . To h e l p a n s w e r t h i s q u e s t i o n , a c o m p a r i s o n o f d e p r e s s i o n s c o r e s i n t h e p r e s e n t s a m p l e was made w i t h t h r e e p r o b a b i l i t y s a m p l e s o f h o u s e h o l d s i n K a n s a s C i t y a n d W a s h i n g t o n C o u n t y , c o l l a p s e d a c r o s s g e n d e r ( R a d l o f f , 1 9 7 7 ) . The A m e r i c a n n a t i o n a l s a m p l e s h ad a v e r a g e s c o r e s b e t w e e n 7.94 a n d 9.25, s i m i l a r t o s c o r e s r e p o r t e d by g r o u p two (M = 9.45) r e s p o n d e n t s i n t h e p r e s e n t s t u d y . G r o u p t h r e e h a d t h e h i g h e s t mean s c o r e (M = 1 4 . 6 5 ) , f o l l o w e d by g r o u p one (M = 1 3 . 6 2 ) , t h u s i n d i c a t i n g 60 s l i g h t l y e l e v a t e d d e p r e s s i o n s c o r e s c o m p a r e d w i t h non-MS s a m p l e s . H owever, r e l a t i v e t o a s a m p l e o f p a t i e n t s r e s i d i n g i n a p r i v a t e p s y c h i a t r i c f a c i l i t y (M = 24.42; R a d l o f f , 1 9 7 7 ) , a v e r a g e d e p r e s s i o n s c o r e s i n t h e p r e s e n t s t u d y were c o n s i d e r a b l y l o w e r . C a u t i o n s h o u l d be e x e r c i s e d i n i n t e r p r e t i n g r e s u l t s o f p s y c h o l o g i c a l f u n c t i o n i n g , b e c a u s e i t e m s on d e p r e s s i o n m e a s u r e s may be i n d i c a t i v e o f t h e d i s e a s e i t s e l f , r a t h e r t h a n i t s i m p a c t ( D e v i n s & S e l a n d , 1 9 8 7 ) . F o r e x a m p l e , i t e m s on t h e CES-D s u c h a s " I h a d t r o u b l e k e e p i n g my m i n d on what I was d o i n g " ( i n more a d v a n c e d c a s e s o f MS), " I f e l t t h a t e v e r y t h i n g I d i d was an e f f o r t , " " a n d " I c o u l d n o t g e t v g o i n g , ' " may r e f l e c t symptoms o f t h e d i s e a s e . I n a d d i t i o n , b e c a u s e women t e n d t o r e p o r t h i g h e r d e p r e s s i o n s c o r e s t h a n m a l e s ( R a d l o f f , 1 9 7 5 ) , a n d t h e p r e s e n t s a m p l e was p r e d o m i n a n t l y f e m a l e ( 7 5 % ) , d e p r e s s i o n s c o r e s a r e l i k e l y t o be a r t i f i c i a l l y i n f l a t e d when c o m p a r e d t o a random s a m p l e o f h o u s e h o l d s . T h e r e f o r e , c o n s i d e r i n g f a c t o r s t h a t may a r t i f i c i a l l y e l e v a t e d e p r e s s i o n s c o r e s , t h e p r e s e n t d a t a p r o v i d e no e v i d e n c e o f p a t h o l o g i c a l l e v e l s o f d e p r e s s i o n among p e o p l e w i t h MS. C o n s i s t e n t w i t h t h e f i n d i n g s f o r d e p r e s s i o n , o p t i m i s m s c o r e s i n t h e p r e s e n t s a m p l e a c r o s s g r o u p s (Ms were 2 2 . 2 5 , 2 1 . 1 3 , a n d 20.44 f o r g r o u p s o ne, t w o , a n d t h r e e , r e s p e c t i v e l y ) were s i m i l a r t o s c o r e s o b t a i n e d by u n d e r g r a d u a t e m a l e s (M = 21.03) a n d f e m a l e s (M = 21.41) ( S c h e i e r & C a r v e r , 1 9 8 5 ) . I n c o n t r a s t t o W a l s h a n d W a l s h ( 1 9 8 7 ) , who f o u n d t h a t s e l f - e s t e e m s c o r e s were h i g h e s t among p e o p l e w i t h MS w i t h g r e a t e s t p h y s i c a l c a p a c i t y , i n t h e 61 p r e s e n t s t u d y , g r o u p s o n e , t w o , a n d t h r e e were c o m p a r a b l e i n t e r m s o f s e l f - e s t e e m . W i t h t h e e x c e p t i o n o f g r o u p d i f f e r e n c e s a c c o r d i n g t o d e p r e s s i o n , t h e o v e r a l l p a t t e r n o f r e s u l t s f o r t h e s t a n d a r d i z e d p s y c h o l o g i c a l m e a s u r e s i s c o n s i s t e n t w i t h t h e f i n d i n g t h a t d u r a t i o n o f i l l n e s s h a s l i m i t e d e f f e c t s on a d j u s t m e n t ( Z e l d o w & P a v l o u , 1 9 8 4 ) . B. S o c i a l c o m p a r i s o n f u n c t i o n o f s u p p o r t g r o u p s I n s t e a d o f m a i n t a i n i n g c o n t a c t w i t h u n a f f l i c t e d p e e r s who h a v e l i t t l e i n common w i t h t h e m s e l v e s ( e s p e c i a l l y i f t h e d i s e a s e i s s e v e r e ) , t h e p e r s o n w i t h MS may j o i n a s u p p o r t o r s e l f - h e l p g r o u p o r d e v e l o p f r i e n d s h i p s w i t h o t h e r p e o p l e w i t h MS. A p p a r e n t l y , t h e n e e d t o e v a l u a t e o n e s e l f a g a i n s t , o r r e m a i n i n c o n t a c t w i t h , o t h e r s w i t h MS i s s t r o n g , a s e v i d e n c e d by t h e f a c t t h a t f u l l y one h a l f o f t h e p r e s e n t s a m p l e was e i t h e r c u r r e n t l y i n v o l v e d i n a s u p p o r t g r o u p o r h a d a t t e n d e d one i n t h e p a s t . One r e a s o n t o j o i n a s u p p o r t g r o u p may be t h e d e s i r e t o s e e i f t h e r e a r e s i m i l a r o t h e r s w i t h w h i c h t o s h a r e e x p e r i e n c e s a n d d e f i n e t h e i l l n e s s . P a v l o u ( 1 9 8 4) n o t e s t h a t , i n r e c e n t l y - f o r m e d g r o u p s , members a r e r e l i e v e d when e x p l i c i t s o c i a l c o m p a r i s o n s w i t h o t h e r members a r e made by t h e g r o u p l e a d e r , s u c h a s " I ' l l b e t e v e r y o n e h a s been l o o k i n g a r o u n d t o s e e whose symptoms a r e m i l d a n d whose a r e more s e v e r e " ( p . 3 4 1 ) . A l t h o u g h c o m p a r i s o n s may be h e l p f u l t o a s s e s s t h e n o r m a l i t y o f o n e ' s r e a c t i o n s t o t h e d i s e a s e a n d e x p e c t a t i o n s f o r t h e f u t u r e , c o n t a c t may s o m e t i m e s r e s u l t i n n e g a t i v e e m o t i o n s . F o r e x a m p l e , one p e r s o n a t a m e e t i n g s a i d "When I w a l k e d i n and saw two w h e e l c h a i r s , I r e a l l y g o t t e n s e , 62 a n d I t h o u g h t t h a t s e e i n g p e o p l e who were w o r s e r e a l l y m i g h t h u r t me" ( p . 3 4 3 ) . P e o p l e w i t h MS may r e a c t n e g a t i v e l y t o downward c o m p a r i s o n s b e c a u s e o f t h e b e l i e f t h a t t h e y may g e t w o r s e t h e m s e l v e s . S u c h a b e l i e f i s s u p p o r t e d by t h e f i n d i n g t h a t r e s p o n d e n t s w i t h MS who were more w o r r i e d a b o u t t h e i r f u t u r e were a l s o more l i k e l y t o h a v e n e g a t i v e a f f e c t i v e c o n s e q u e n c e s f r o m c o m p a r i n g w i t h o t h e r s w o r s e o f f t h a n t h e m s e l v e s . C. P r e d i c t i o n s b a s e d on downward c o m p a r i s o n t h e o r y C o n s i s t e n t w i t h W i l l s ' s ( 1 9 8 1 ) p r o p o s i t i o n t h a t p e o p l e c o n f r o n t e d w i t h t h r e a t s t o s e l f - e s t e e m w i l l p r i m a r i l y compare w i t h t h o s e w o r s e o f f t h a n t h e m s e l v e s , downward c o m p a r i s o n s were more p r e v a l e n t t h a n u p w a r d c o m p a r i s o n s r e g a r d i n g d i s e a s e - r e l a t e d i s s u e s , c o p i n g w i t h MS a n d i t s c o n s e q u e n c e s , a n d l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y . T h e s e d a t a c o r r o b o r a t e Wood e t a l . ( 1 9 8 5 ) , who n o t e t h a t , o f f r e e - r e s p o n s e c o m p a r i s o n s , 9 5 % f o r p h y s i c a l s i t u a t i o n a n d 6 3 % f o r c o p i n g a b i l i t y were i n t h e downward d i r e c t i o n . H o w e v e r , n o t a l l o f t h e e v i d e n c e f r o m t h e p r e s e n t s t u d y i s c o n s i s t e n t w i t h p r e v i o u s f i n d i n g s i n t h e downward c o m p a r i s o n l i t e r a t u r e . As may be r e c a l l e d , a l l o f t h e p r e l i m i n a r y e v i d e n c e i s c o n s i s t e n t w i t h t h e n o t i o n t h a t downward c o m p a r i s o n s a r e u t i l i z e d e a r l y on a f t e r o n s e t o f a s t r e s s f u l l i f e e v e n t ( A f f l e c k e t a l . , 1987a; S c h u l z & D e c k e r , 1985; Wood e t a l . , 1 9 8 5 ) , p r e s u m a b l y due t o i n c r e a s e d t h r e a t . As w e l l , i t h a s been s u g g e s t e d t h a t t h o s e e x p e r i e n c i n g more symptoms w i l l make more downward c o m p a r i s o n s ( W i l l s , 1 9 8 1 ) . I f i t i s t r u e t h a t r e s p o n d e n t s i n g r o u p t h r e e a r e more t h r e a t e n e d t h a n t h o s e i n 6 3 g r o u p two by v i r t u e o f d e c r e a s e d p h y s i c a l c a p a c i t y , a n d t h o s e i n g r o u p one a r e more t h r e a t e n e d t h a n t h o s e i n g r o u p two b e c a u s e o f a d j u s t m e n t s t h a t must be made s h o r t l y a f t e r b e i n g d i a g n o s e d w i t h MS, t h e p r e s e n t f i n d i n g s a r e i n c o n s i s t e n t w i t h t h o s e i n t h e downward c o m p a r i s o n l i t e r a t u r e . T h e r e were no d i f f e r e n c e s b e t w e e n g r o u p s on downward c o m p a r i s o n s , t h a t i s , more t h r e a t e n e d i n d i v i d u a l s were no more l i k e l y t o make downward c o m p a r i s o n s t h a n t h o s e l e s s t h r e a t e n e d . M o r e o v e r , p a r t i c i p a n t s i n g r o u p t h r e e made more u p w a r d c o m p a r i s o n s on d i s e a s e - r e l a t e d i s s u e s t h a n r e s p o n d e n t s i n g r o u p s one a n d t w o . How c a n t h e s e d a t a be r e c o n c i l e d w i t h p r e v i o u s f i n d i n g s ? A l t h o u g h more t h r e a t e n e d i n d i v i d u a l s may ha v e a g r e a t e r n e e d t o d o w n w a r d l y c o m p a r e , t h e y may a l s o r e a l i z e t h a t t h e r e a r e more b e t t e r o f f o t h e r s w i t h w h i c h t o compare t h a n t h o s e who a r e p h y s i c a l l y w o r s e . The q u e s t i o n s e m p l o y e d i n t h e p r e s e n t s t u d y may h a v e been more s e n s i t i v e t o t h i s l a t t e r i s s u e t h a n q u e s t i o n s u s e d i n p a s t s t u d i e s . A r e f o r m u l a t i o n o f downward c o m p a r i s o n t h e o r y may be a p p r o p r i a t e g i v e n t h e s e new d a t a . The more t h r e a t e n e d someone i s , t h e more t h e y may d o w n w a r d l y compare a n d t h e l e s s t h e y may u p w a r d l y c o m p a r e , c o n t r o l l i n g f o r t h e number o f p o s s i b l e u p w a r d c o m p a r i s o n a n d downward c o m p a r i s o n t a r g e t s a v a i l a b l e t o them. D. A f f e c t i v e c o n s e q u e n c e s f r o m s o c i a l c o m p a r i s o n s I n a g r e e m e n t w i t h downward c o m p a r i s o n t h e o r y ( W i l l s , 1 9 8 1 ) , t h e most commonly r e p o r t e d a f f e c t i v e c o n s e q u e n c e s were f e e l i n g g o o d a s a r e s u l t o f m a k i n g downward c o m p a r i s o n s on t h e p h y s i c a l 64 c o n d i t i o n (M = 5.90) a n d c o p i n g (M = 4.31) d i m e n s i o n s . I n t h e p r e s e n t s t u d y , a n d c o n t r a r y t o downward c o m p a r i s o n t h e o r y , t h e n e x t most commonly e n d o r s e d i t e m s were f e e l i n g b e t t e r s u b s e q u e n t t o c o m p a r i n g u p w a r d on t h e p h y s i c a l c o n d i t i o n (M = 4.08) a n d c o p i n g (M = 3.95) d i m e n s i o n s . T h u s , t h e most commonly e n d o r s e d i t e m s ( u p w a r d a n d downward) were a l l a s s o c i a t e d w i t h p o s i t i v e a f f e c t . Downward c o m p a r i s o n s were n o t a l w a y s s e l f - e n h a n c i n g , h o w e v e r , a s i n d i c a t e d by h i g h e s t n e g a t i v e a f f e c t on p h y s i c a l c o n d i t i o n (M = 3 . 7 3 ) , f o l l o w e d by n e g a t i v e a f f e c t f r o m downward c o m p a r i s o n s on t h e c o p i n g d i m e n s i o n (M = 2 . 7 1 ) . F i n a l l y , t h e l e a s t e n d o r s e d i t e m s were f e e l i n g w o r s e a f t e r c o m p a r i n g w i t h b e t t e r o f f o t h e r s on t h e p h y s i c a l c o n d i t i o n (M = 2.30) a n d c o p i n g (M = 2.14) d i m e n s i o n s . The o r d e r i n g o f means i n t h e p r e s e n t s t u d y f o r t h e a f f e c t i v e c o n s e q u e n c e s i t e m s ( c o l l a p s i n g a c r o s s p h y s i c a l c o n d i t i o n a n d c o p i n g d i m e n s i o n s ) was e x a c t l y t h e same a s t h a t r e p o r t e d by Buunk e t a l . ( 1 9 8 9 ) , c o n f i r m i n g t h e s u g g e s t i o n t h a t u p w a r d a n d downward c o m p a r i s o n s a r e n o t i n t r i n s i c a l l y a f f e c t i v e . D e p e n d i n g upon w h e t h e r one f o c u s e s on t h e g o o d o r b a d a s p e c t s t h a t a c o m p a r i s o n p r o v i d e s , p o s i t i v e o r n e g a t i v e a f f e c t i v e c o n s e q u e n c e s may p r e v a i l . E. C o m p a r i s o n s , a d j u s t m e n t , t r a j e c t o r y , a n d p e r c e i v e d  c o n t r o l Buunk e t a l . ( 1 9 8 9 ) r e p o r t e d t h a t c a n c e r p a t i e n t s w i t h h i g h s e l f - e s t e e m a n d p e r c e i v e d p e r s o n a l c o n t r o l were l e s s l i k e l y t o f e e l bad a s a r e s u l t o f c o m p a r i n g w i t h o t h e r s . I n t h e p r e s e n t s t u d y , t h e f i n d i n g s f o r s e l f - e s t e e m were r e p l i c a t e d , a l t h o u g h t h e 65 p e r s o n a l c o n t r o l r e s u l t s were n o t . T h i s l a c k o f a r e l a t i o n s h i p w i t h p e r c e i v e d c o n t r o l i s p e r h a p s due t o t h e l i m i t e d k n o w l e d g e t h a t i s a v a i l a b l e r e g a r d i n g t h e t r e a t m e n t o f MS a n d c o n t r o l o v e r t h e symptoms a n d d i s e a s e c o u r s e . C l e a r l y , more r e s e a r c h i s n e e d e d t o a d d r e s s t h i s q u e s t i o n . I n b o t h s t u d i e s , an a s s e s s m e n t o f t h e f u t u r e was u n r e l a t e d t o a f f e c t i v e c o n s e q u e n c e s , w i t h t h e i n t e r e s t i n g e x c e p t i o n o f t h e g r e a t e r l i k e l i h o o d o f f e e l i n g w o r s e s u b s e q u e n t t o m a k i n g downward c o m p a r i s o n s among t h o s e who v i e w e d t h e i r f u t u r e n e g a t i v e l y i n t h e p r e s e n t s t u d y . Buunk e t a l . ( 1 9 8 9 ) h a d o n c o l o g i s t s r a t e p r o g n o s i s on a f i v e - p o i n t s c a l e ( l = g r a v e p r o g n o s i s , 5 = p r o b a b l e c u r e ) , w h i l e i n t h e p r e s e n t s t u d y , s u b j e c t i v e a s s e s s m e n t s o f t h e f u t u r e were p r o v i d e d by t h e r e s p o n d e n t s . A l t h o u g h o t h e r r e s e a r c h e r s s h o u l d d e t e r m i n e w h e t h e r o r n o t t h e s e r e s u l t s a r e r o b u s t , t e n t a t i v e f i n d i n g s f r o m two d i f f e r e n t p o p u l a t i o n s ( c a n c e r p a t i e n t s a n d p e o p l e w i t h M S ) , u s i n g d i f f e r e n t r a t i n g p r o c e d u r e s , and d i f f e r e n t r a t e r s ( o n c o l o g i s t s v e r s u s p a t i e n t s ) s u g g e s t t h a t a s s e s s m e n t s o f t h e f u t u r e a r e u n r e l a t e d t o a f f e c t i v e c o n s e q u e n c e s f r o m c o m p a r i s o n s , e x c e p t f o r f e e l i n g b a d when c o m p a r i n g downward. The p r e s e n t r e s u l t s e x t e n d t h o s e r e p o r t e d by Buunk e t a l . ( 1 9 8 9 ) by d e m o n s t r a t i n g t h a t , i n a d d i t i o n t o s e l f - e s t e e m , a f f e c t i v e c o n s e q u e n c e s were a l s o r e l a t e d t o d e p r e s s i o n a n d o p t i m i s m . H o w e v e r , t h e r e s u l t s f o r o p t i m i s m were d i f f e r e n t t h a n t h o s e f o r s e l f - e s t e e m a n d d e p r e s s i o n . S p e c i f i c a l l y , w h i l e s e l f -e s t e e m a n d d e p r e s s i o n were s i g n i f i c a n t l y c o r r e l a t e d w i t h m a k i n g u p w a r d c o m p a r i s o n s and w i t h n e g a t i v e a f f e c t i v e c o n s e q u e n c e s f r o m 66 making comparisons, optimism was s i g n i f i c a n t l y r e l a t e d to f e e l i n g b e t t e r a f t e r making comparisons. Because o p t i m i s t s are able to focus on the f a v o r a b l e a s p e c t s of i n f o r m a t i o n ( T a y l o r & Brown, 1988), i t makes sense that optimism i s a s s o c i a t e d with p o s i t i v e a f f e c t i v e consequences. The r e s u l t s f o r s e l f - e s t e e m and de p r e s s i o n may be i n t e r p r e t e d i n terms of the a b i l i t y of some people to s e l e c t i v e l y f i l t e r out and a v o i d the negative i m p l i c a t i o n s of s i t u a t i o n s ( T a y l o r & Brown, 1988). A s u b s t a n t i a l l i t e r a t u r e on d e p r e s s i o n i n d i c a t e s that people who are depressed are more l i k e l y to see both the p o s i t i v e and negative a s p e c t s , whereas non-depressed i n d i v i d u a l s are b i a s e d toward the p o s i t i v e (Kuiper et a l . , 1985; Ruehlman & West, 1985) The present f i n d i n g s suggest that such a r a t i o n a l e may be extended to i n c l u d e the p e r s o n a l i t y dimension of s e l f - e s t e e m ( c f . Buunk et a l . , 1989; T a y l o r & Brown, 1988). F. P h y s i c a l c o n d i t i o n versus coping The p h y s i c a l c o n d i t i o n dimension was always endorsed with more extreme a f f e c t by respondents than the corresponding q u e s t i o n s f o r the coping dimension, although o n l y the downward comparison q u e s t i o n s d i f f e r e d s i g n i f i c a n t l y from one another. Because p h y s i c a l c o n d i t i o n i s probably more s a l i e n t than coping, one's p h y s i c a l s t a t u s r e l a t i v e to others may be h i g h l i g h t e d . A d d i t i o n a l l y , p h y s i c a l c o n d i t i o n comparisons are f o r c e d upon a person to a g r e a t e r extent than those r e l a t e d to coping and may, t h e r e f o r e , gain added a f f e c t i v e p o t e n t i a l . One may not f e e l as bad subsequent to comparing with another who i s coping more 67 p o o r l y t h a n w i t h a n o t h e r who i s p h y s i c a l l y w o r s e o f f , b e c a u s e o f t h e b e l i e f t h a t c o p i n g i s c o n t r o l l a b l e t o a g r e a t e r e x t e n t t h a n p h y s i c a l c o n d i t i o n ( c f . W e i n e r e t a l . , 1 9 8 8 ) . A n o t h e r e x p l a n a t i o n r e g a r d i n g m o r e e x t r e m e a f f e c t a s s o c i a t e d w i t h d o w n w a r d c o m p a r i s o n s on t h e p h y s i c a l c o n d i t i o n d i m e n s i o n r e l a t e s t o d i s t o r t a b i l i t y o f i n f o r m a t i o n . I n o t h e r w o r d s , b e c a u s e p h y s i c a l c o n d i t i o n i s o b s e r v a b l e , w h e r e a s c o p i n g i s n o t , t h e r e i s a g r e a t e r c a p a c i t y i n t h e l a t t e r c a s e t o a l t e r i n f o r m a t i o n . T h u s , one may n o t h a v e a s s t r o n g n e g a t i v e a f f e c t i v e c o n s e q u e n c e s f r o m d o w n w a r d l y c o m p a r i n g on c o p i n g b e c a u s e o f t h e b e l i e f t h a t d i s t r e s s e d i n d i v i d u a l s a r e d o i n g b e t t e r t h a n t h e y a c t u a l l y a r e . I n s u p p o r t o f s u c h a s u g g e s t i o n , f a m i l y a n d f r i e n d s o f p e o p l e who h a v e c o m m i t t e d s u i c i d e f r e q u e n t l y s t a t e t h a t t h e y d i d n o t r e a l i z e t h e d e c e a s e d was s o d e p r e s s e d . G . F l e x i b i l i t y o f d o w n w a r d c o m p a r i s o n s T h e m o r e p e o p l e w i t h MS r e s p o n d e n t s knew t h e m o r e l i k e l y t h e y w e r e t o make u p w a r d , b u t n o t d o w n w a r d , c o m p a r i s o n s . P a r t i c i p a n t s who h a d l i m i t e d p h y s i c a l c a p a c i t y w e r e j u s t a s l i k e l y t o make d o w n w a r d c o m p a r i s o n s a s t h e i r b e t t e r o f f c o u n t e r p a r t s , e v e n t h o u g h t h e l a t t e r g r o u p h a s more p o t e n t i a l d o w n w a r d c o m p a r i s o n t a r g e t s a v a i l a b l e w i t h w h i c h t o c o m p a r e . F r e q u e n c i e s o f u p w a r d c o m p a r i s o n s w e r e a s s o c i a t e d w i t h s e l f -e s t e e m a n d d e p r e s s i o n ; n o n e o f t h e s t a n d a r d i z e d a d j u s t m e n t s c a l e s w e r e c o r r e l a t e d w i t h f r e q u e n c i e s o f d o w n w a r d c o m p a r i s o n s . T o g e t h e r , t h e s e f i n d i n g s s u g g e s t t h e f l e x i b i l i t y o f d o w n w a r d c o m p a r i s o n s , a t l e a s t r e l a t i v e t o u p w a r d c o m p a r i s o n s , a n d a r e 68 c o n s i s t e n t w i t h t h e n o t i o n t h a t u p w a r d c o m p a r i s o n s a r e more c o n s t r a i n e d by t h e e n v i r o n m e n t t h a n downward c o m p a r i s o n s . The r e s u l t s a l s o s u g g e s t t h a t p e o p l e may be c r e a t i v e i n m a k i n g c o m p a r i s o n s w i t h w o r s e o f f o t h e r s . T a y l o r a n d h e r c o l l e a g u e s ( T a y l o r , 1983; Wood e t a l . , 1985) h a v e d e m o n s t r a t e d t h a t r e s p o n d e n t s may m a n u f a c t u r e h y p o t h e t i c a l w o r s e o f f o t h e r s o r f o c u s on d i m e n s i o n s i n w h i c h one i s a d v a n t a g e d . S u c h s t r a t e g i e s a r e f a r l e s s commonly e m p l o y e d f o r u p w a r d c o m p a r i s o n s , p r e s u m a b l y b e c a u s e p s y c h o l o g i c a l b e n e f i t may be more r e a d i l y o b t a i n e d by d o w n w a r d l y c o m p a r i n g , a t l e a s t f o r t h e g o a l o f e v a l u a t i o n f o r t h e p u r p o s e s o f s e l f - e n h a n c e m e n t ( T a y l o r & L o b e l , i n p r e s s ) . H. P o s i t i v i t y b i a s e s T h r o u g h o u t t h e c o p i n g l i t e r a t u r e , i t h a s been n o t e d t h a t p e o p l e who h a v e e x p e r i e n c e d s t r e s s f u l l i f e e v e n t s a r e v e r y p o s i t i v e a b o u t t h e i r a b i l i t y t o a d j u s t t o t h e i r c i r c u m s t a n c e s , r e g a r d l e s s o f how u n d e s i r a b l e t h e y may be. P e o p l e b e l i e v e t h e y a r e c o p i n g b e t t e r t h a n o t h e r s d e a l i n g w i t h s i m i l a r s t r e s s o r s ( P e a r l i n & S c h o o l e r , 1 9 7 8 ) . S u c h r e s u l t s h a v e been f o u n d f o r c a n c e r p a t i e n t s ( T a y l o r , F a l k e , M a z e l , & H i l s b e r g , 1 9 8 8 ) , m o t h e r s o f h i g h r i s k i n f a n t s a n d a r t h r i t i s p a t i e n t s ( A f f l e c k e t a l . , 1 9 8 7 a ) , a n d t h e b e r e a v e d (Lehman, H e m p h i l l , E l l a r d , & Wortman, 1 9 8 9 ) . I n t h e p r e s e n t s t u d y , r e s p o n d e n t s c o n s i s t e n t l y d e m o n s t r a t e d f a v o r a b l e o u t l o o k s . F o r e x a m p l e , p a r t i c i p a n t s , e v e n t h o s e i n g r o u p t h r e e , who were r e l a t i v e l y s e v e r e l y d i s a b l e d , r a t e d t h e i r h e a l t h a s s i x on a n i n e - p o i n t s c a l e . On t h e same n i n e - p o i n t s c a l e , p a r t i c i p a n t s b e l i e v e d t h e i r mean c o p i n g l e v e l 69 was s e v e n . When t h e c o r r e s p o n d i n g p o s i t i v e a n d n e g a t i v e a f f e c t i v e c o n s e q u e n c e s i t e m s were c o m p a r e d , r e s p o n d e n t s f e l t b e t t e r more o f t e n t h a n w o r s e a f t e r c o m p a r i n g . F i n a l l y , on a v e r a g e , r e s p o n d e n t s r a t e d t h e m s e l v e s a s "somewhat l e s s s e v e r e " t h a n o t h e r s w i t h MS w i t h r e g a r d t o i l l n e s s s e v e r i t y . T h u s , on b o t h a b s o l u t e a n d c o m p a r a t i v e r a t i n g s , r e s p o n d e n t s were i n c l i n e d t o e n d o r s e f a v o r a b l e e n d p o i n t s on t h e c o n t i n u u m . I . A p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s A l t h o u g h t h e b e n e f i t s o f c o m p a r i n g w i t h o t h e r s h a v e been w e l l - d o c u m e n t e d i n t h e s o c i a l c o m p a r i s o n l i t e r a t u r e , t h e r e a r e a l s o c o s t s ( B r i c k m a n & B u l m a n , 1 9 7 7 ) . T h u s , W i l l s ' s ( 1 9 8 1 ) a m b i v a l e n c e p r i n c i p l e r e l a t e s t o t h e f a c t t h a t c o m p a r i n g w i t h w o r s e o f f o t h e r s makes one f e e l b e t t e r , y e t s u c h c o m p a r i s o n s a r e n o t r e g a r d e d a s s o c i a l l y a p p r o p r i a t e . I n l i n e w i t h t h i s r e a s o n i n g , r e s p o n d e n t s h i g h e r on p e r c e i v e d a p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s r e p o r t e d a g r e a t e r number o f downward, b u t n o t u p w a r d , c o m p a r i s o n s . P r e s u m a b l y , p e o p l e who b e l i e v e c o m p a r i n g w i t h o t h e r s i s an i m p o r t a n t o r u s e f u l way t o g a i n i n f o r m a t i o n a l s o a r e more l i k e l y t o f e e l good a s a r e s u l t o f c o m p a r i n g w i t h t h o s e who a r e w o r s e o f f . P r e c i s e l y t h i s p a t t e r n o f r e s u l t s was f o u n d : r e s p o n d e n t s h i g h e r on p e r c e i v e d a p p r o p r i a t e n e s s were more l i k e l y t o r e p o r t p o s i t i v e a f f e c t i v e c o n s e q u e n c e s s u b s e q u e n t t o c o m p a r i n g w i t h w o r s e o f f o t h e r s , b u t n o t b e t t e r o f f o t h e r s . A l t h o u g h i t a l s o m i g h t be e x p e c t e d t h a t p e r c e i v e d a c c e p t a b i l i t y s h o u l d be a s s o c i a t e d w i t h r e d u c e d n e g a t i v e f e e l i n g s ( s u c h a s g u i l t ) a f t e r m a k i n g downward c o m p a r i s o n s , no a s s o c i a t i o n b e t w e e n 70 n e g a t i v e a f f e c t i v e c o n s e q u e n c e s a n d b e l i e f s o f a p p r o p r i a t e n e s s was f o u n d . J . B a r r i e r s t o s o c i a l c o m p a r i s o n The d i s c u s s i o n o f a p p r o p r i a t e n e s s o f m a k i n g c o m p a r i s o n s r a i s e s a r e l a t e d i s s u e . I f s o c i a l c o m p a r i s o n s a r e u s e f u l i n t h e c o p i n g p r o c e s s , why do r e s p o n d e n t s r e p o r t on t h e " n e v e r " s i d e o f t h e m i d p o i n t on a l l b u t one o f t h e f i f t e e n s o c i a l c o m p a r i s o n i t e m s ( t h e e x c e p t i o n was t h e p h y s i c a l c o n d i t i o n / d o w n w a r d c o m p a r i s o n / f e e l b e t t e r q u e s t i o n ) ? R e s p o n d e n t s i n Buunk e t a l . ' s ( 1 9 8 9 ) c a n c e r s a m p l e a l s o r e p o r t e d a f f e c t i v e c o n s e q u e n c e s b e l o w t h e m i d p o i n t on two o f t h e f o u r i t e m s . One p o s s i b i l i t y h a s t o do w i t h i m p e d i m e n t s t o s o c i a l c o m p a r i s o n t h a t p e o p l e who h a v e e x p e r i e n c e d n e g a t i v e l i f e e v e n t s a r e c o n f r o n t e d w i t h . A l t h o u g h p e o p l e d e s i r e i n f o r m a t i o n r e g a r d i n g t h e a p p r o p r i a t e n e s s o f r e a c t i o n s when e x p e r i e n c i n g n e g a t i v e e m o t i o n s ( C o a t e s & P e t e r s o n , 1 9 8 2 ) , a s i n s t r e s s f u l s i t u a t i o n s , s u c h c o n d i t i o n s may make a f f i l i a t i o n w i t h o t h e r s l e s s l i k e l y ( T a y l o r , Buunk, & A s p i n w a l l , i n p r e s s ) . I n a d d i t i o n , b e c a u s e o f t h e r a r i t y o f MS a n d l a c k o f p u b l i c i t y r e g a r d i n g i t s e f f e c t s , c o m p a r i s o n t a r g e t s may n o t be a v a i l a b l e o r r e a d i l y o b t a i n e d . B e c a u s e MS symptoms s u c h a s w e a k n e s s , l o s s o f s e n s a t i o n , a n d v i s u a l i m p a i r m e n t a r e " i n v i s i b l e " i n t h a t t h e y a r e n o t d i r e c t l y o b s e r v a b l e ( D e v i n s & S e l a n d , 1 9 8 7 ) , e v e n i f a c o m p a r i s o n t a r g e t i s l o c a t e d , a c c u r a t e c o m p a r i s o n s r e g a r d i n g d i s e a s e s t a t e a n d i m m o b i l i t y may be d i f f i c u l t t o a s c e r t a i n . P e o p l e e x p e r i e n c i n g n e g a t i v e l i f e e v e n t s may be u n l i k e l y t o 71 s h a r e t h e i r t h o u g h t s a n d f e e l i n g s w i t h o t h e r s , b e c a u s e o f t h e d e v a l u a t i o n o f p e r s o n s w i t h i l l n e s s e s a n d d i s a b i l i t i e s ( G o f f m a n , 1 9 6 3 ) . T h i s t e n d e n c y may be e x a c e r b a t e d among t h o s e w i t h c h r o n i c i l l n e s s e s , b e c a u s e t h e y c a n n o t r e t a i n t h e i r " n o r m a l " s t a t u s ( B r o o k s & M a t s o n , 1 9 8 2 ) . E v e n among t h o s e who a r e e x p e r i e n c i n g a s i m i l a r p r o b l e m , e x c h a n g e o f i n f o r m a t i o n u s u a l l y o c c u r s i n s o c i a l l y d e s i r a b l e ways ( T a y l o r e t a l . , i n p r e s s ) . T h u s , among MS s u p p o r t g r o u p s , i t h a s been r e c o g n i z e d t h a t t h e r e i s a t e n d e n c y t o be p o l i t e a n d h e l p f u l , a n d a v o i d c o n f r o n t a t i o n ( P a v l o u , 1 9 8 4 ) . T a l k i n g a b o u t some i s s u e s may be c o n s i d e r e d t a b o o o r l e a d t o d i s c o m f o r t , so t h a t d i s c u s s i o n s o f n e u r o l o g i c a l l y b a s e d s e x u a l d i f f i c u l t i e s a r e r a r e o r d e a l t w i t h i n g e n e r a l i t i e s , l e a d i n g t o a l a c k o f i n f o r m a t i o n r e g a r d i n g t h e e x t e n t t o w h i c h o t h e r s s u f f e r f r o m t h e same p r o b l e m . K. P o t e n t i a l l y i m p o r t a n t m e t h o d o l o g i c a l c o n s i d e r a t i o n s T h e r e a r e a number o f f a c t o r s t h a t s h o u l d be c o n s i d e r e d when c o n d u c t i n g p s y c h o l o g i c a l r e s e a r c h w i t h p e o p l e w i t h MS t h a t , f o r p r a c t i c a l r e a s o n s , c o u l d n o t be f o l l o w e d f o r t h e p r e s e n t s t u d y . To b e g i n , t h e d i a g n o s i s may be u n c e r t a i n , i n p a r t due t o t h e l a c k o f s p e c i f i c l a b o r a t o r y t e s t t o a c c u r a t e l y i d e n t i f y t h e p r e s e n c e o f t h e d i s e a s e . T h e r e f o r e , d i a g n o s e s s h o u l d be c o n s i d e r e d p o s s i b l e , p r o b a b l e , o r d e f i n i t e ; t o e n s u r e t h a t r e l e v a n t p e r s o n s a r e i n c l u d e d a s r e s e a r c h p a r t i c i p a n t s , o n l y t h o s e who a r e c o n s i d e r e d t o have t h e d i s e a s e w i t h a h i g h d e g r e e o f c e r t a i n t y s h o u l d be i n c l u d e d ( B r o w n , 1 9 8 0 ) . A l s o , b e c a u s e r e s e a r c h e r s have f o u n d t h a t MS may r e s u l t i n i m p a i r m e n t i n n e u r o p s y c h o l o g i c a l 72 f u n c t i o n i n g ( H e a t o n , N e l s o n , Thompson, B u r k s , & F r a n k l i n , 1 9 8 5 ) , e s p e c i a l l y i n a r e a s o f s h o r t - t e r m memory a n d a b s t r a c t r e a s o n i n g ( P e y s e r , E d w a r d s , P o s e r , & F i l s k o v , 1 9 8 0 ) , m i n i m i z i n g s u c h e f f e c t s may be d e s i r a b l e . P o s s i b i l i t i e s i n c l u d e s c r e e n i n g o u t p a t i e n t s who a r e e s p e c i a l l y i m p a i r e d , a n d a s s e s s i n g c o g n i t i v e d e f i c i t s a n d s t a t i s t i c a l l y c o n t r o l l i n g f o r them ( D e v i n s & S e l a n d , 1987) . I n i t i a l l y , r e c e n t l y d i a g n o s e d p a r t i c i p a n t s were d e f i n e d a s t h o s e who h a d b een d i a g n o s e d l e s s t h a n one y e a r a g o . H o w e v e r , i n o r d e r t o o b t a i n a l a r g e e n o u g h s a m p l e , a l l p a r t i c i p a n t s who h a d been d i a g n o s e d up t o t h r e e y e a r s p r i o r h ad t o be s e l e c t e d f r o m t h e MS S o c i e t y ' s f i l e s . T h e r e f o r e , t h e n e w l y d i a g n o s e d g r o u p was n o t a s r e c e n t a s w o u l d h a v e been h o p e d , a l t h o u g h no s t u d y h a s b e en l o c a t e d where p a r t i c i p a n t s h a d been d i a g n o s e d l e s s t h a n one y e a r a g o . F i n a l l y , one c o n s i d e r a t i o n o f t h e d i s e a s e t h a t may d i f f e r e n t i a l l y i m p a c t on p s y c h o l o g i c a l v a r i a b l e s i s d i s e a s e a c t i v i t y . Whenever p o s s i b l e , r e s p o n d e n t s s h o u l d be d i v i d e d a c c o r d i n g t o w h e t h e r o r n o t t h e y h a v e r e l a p s i n g - r e m i t t i n g v s . c h r o n i c p r o g r e s s i v e f o r m s o f MS, a s t h o s e w i t h t h e l a t t e r t y p e may be more d e p r e s s e d ( M c l v o r , R i k l a n , & R e z n i k o f f , 1 9 8 4 ) , h a v e g r e a t e r e m o t i o n a l d i s t u r b a n c e ( D a l o s , R a b i n s , B r o o k s , & O ' D o n n e l l , 1 9 8 3 ) , a n d n e u r o p s y c h o l o g i c a l i m p a i r m e n t i n c o g n i t i v e , s e n s o r y , a n d m o t o r d o m a i n s ( H e a t o n e t a l . , 1 9 8 5 ) . R e l a t e d t o t h i s , r e s p o n d e n t s s h o u l d be d i f f e r e n t i a t e d a c c o r d i n g t o w h e t h e r o r n o t t h e y a r e c u r r e n t l y e x p e r i e n c i n g an e x a c e r b a t i o n , and an 73 a s s e s s m e n t o f i t s s e v e r i t y s h o u l d be made, b e c a u s e r e l a p s e i s a c c o m p a n i e d by a d i f f e r e n t c l i n i c a l p i c t u r e t h a n when t h e i l l n e s s i s i n r e m i s s i o n ( D e v i n s & S e l a n d , 1 9 8 7 ) . 74 F o o t n o t e s 1 W h i l e t h e l i t e r a t u r e g e n e r a l l y s u p p o r t s t h e s e f i n d i n g s , t h e r e a r e s p e c i a l c i r c u m s t a n c e s i n w h i c h d i s s i m i l a r o t h e r s may be c h o s e n i n t h e a b s e n c e o f t h r e a t . T h u s , W h e e l e r e t a l . ( 1 9 6 9 ) f o u n d t h a t when s u b j e c t s w e re unaware o f t h e r a n g e o f s c o r e s , t h e y p r e f e r r e d t o o b t a i n a n c h o r p o i n t s by l e a r n i n g t h e m a r k s o f t h o s e who s c o r e d h i g h e s t a n d l o w e s t . I n a s i m i l a r v e i n , M e t t e e a n d S m i t h ( 1 9 7 7 ) p r o p o s e t h a t d i s s i m i l a r o t h e r s may r e d u c e u n c e r t a i n t y b e t t e r t h a n s i m i l a r o t h e r s a n d , s o m e t i m e s , p r o v i d e l e s s n e g a t i v e a f f e c t i v e p o t e n c y . M o r e o v e r , d i s s i m i l a r o t h e r s a r e s o u r c e s o f i m p o r t a n t s e l f - e v a l u a t i v e i n f o r m a t i o n i n t h a t t h e y h e l p d e t e r m i n e what one i s n o t , a s w e l l a s p r o v i d e i n f o r m a t i o n a b o u t what one i s f r o m a d i f f e r e n t p e r s p e c t i v e . C o n f i d e n c e i n c e r t a i n j u d g m e n t s may be e n h a n c e d when s h a r e d by a d i s s i m i l a r o t h e r , s i n c e v a r i o u s b i a s e s a r e n o t p r e s e n t ( G o e t h a l s & N e l s o n , 1 9 7 3 ) . U n d e r c i r c u m s t a n c e s i n w h i c h i n d i v i d u a l s a r e c o n v i n c e d a b o u t t h e c o r r e c t n e s s o f t h e i r o p i n i o n s , t h o s e w i t h o p p o s i n g b e l i e f s may be s o u g h t i n an a t t e m p t t o b o l s t e r o n e ' s w o r t h ( G o r d o n , 1 9 6 6 ) . A l t h o u g h i n d i v i d u a l s may o f t e n c ompare w i t h s i m i l a r o t h e r s , a s u b s t a n t i a l l i t e r a t u r e a r g u e s t h a t p e o p l e s t r i v e t o m a i n t a i n a s e n s e o f d i s t i n c t i v e n e s s ( M c G u i r e & M c G u i r e , 1981; T e s s e r , 1 9 8 0 ) , a l t h o u g h t h i s may n o t o c c u r on a l l d i m e n s i o n s ( C a m p b e l l , 1986; M a r k s , 1 9 8 4 ) . 2 T i m e - f r a m e s h o u l d be r e g a r d e d a s a q u a s i - e x p e r i m e n t a l v a r i a b l e r a t h e r t h a n a t r u e i n d e p e n d e n t v a r i a b l e b e c a u s e i t i s n o t 75 m a n i p u l a t e d . W h i l e c o n t r o l i s l a c k i n g w i t h s u c h a p r o c e d u r e , t h e r e a r e no s u b j e c t s e l f - s e l e c t i o n p r o b l e m s b e c a u s e r e s p o n d e n t s h a v e n o t c h o s e n w h i c h g r o u p t h e y a r e g o i n g t o be i n ( t h a t i s , t i m e e l a p s e d s i n c e d i a g n o s i s i s n o t a f a c t o r t h a t r e s p o n d e n t s may w i l l f u l l y c h o o s e ) . More s u b t l e f o r m s o f s e l f - s e l e c t i o n may be a p r o b l e m , t h o u g h , s i n c e o n l y t h o s e who f i l l o u t t h e q u e s t i o n n a i r e s a n d m a i l them b a c k w i l l be i n c l u d e d i n t h e d a t a a n a l y s i s . 3 B e c a u s e a number o f c o r r e l a t i o n s w e re c a l c u l a t e d f o r t h e o v e r a l l s a m p l e a n a l y s e s , a c o n s e r v a t i v e a l p h a (p_ < .01) was u s e d b e f o r e r e j e c t i n g t h e n u l l h y p o t h e s i s , u n l e s s o t h e r w i s e i n d i c a t e d . 76 R e f e r e n c e s A f f l e c k , G., T e n n e n , H., P f e i f f e r , C , & F i f i e l d , J . ( 1 9 8 7 b ) . A p p r a i s a l s o f c o n t r o l a nd p r e d i c t a b i l i t y i n a d a p t i n g t o a c h r o n i c d i s e a s e . J o u r n a l o f P e r s o n a l i t y a n d S o c i a l  P s y c h o l o g y , 53, 2 7 3 - 2 7 9 . A f f l e c k , G., T e n n e n , H., P f e i f f e r , C , F i f i e l d , J . , & Rowe, J . ( 1 9 8 7 a ) . Downward c o m p a r i s o n a n d c o p i n g w i t h s e r i o u s m e d i c a l p r o b l e m s . A m e r i c a n J o u r n a l o f O r t h o p s y c h i a t r y , 57, 5 7 0 - 5 7 8 . B a r e t z , R.M., & S t e p h e n s o n , G.R. ( 1 9 8 1 ) . E m o t i o n a l r e s p o n s e s t o m u l t i p l e s c l e r o s i s . P s y c h o s o m a t i c s , 22, 117-127. B a r r e t t , F.M. ( 1 9 8 4 ) . S e x u a l i m p l i c a t i o n s o f m u l t i p l e s c l e r o s i s . I n A.F. S i m o n s ( E d . ) , M u l t i p l e s c l e r o s i s : P s y c h o l o g i c a l and  s o c i a l a s p e c t s ( p p . 5 4 - 7 1 ) . L o n d o n : W i l l i a m Heinemann M e d i c a l B o o k s L t d . B r i c k m a n , P., & B u l m a n , R . J . ( 1 9 7 7 ) . P l e a s u r e a n d p a i n i n s o c i a l c o m p a r i s o n . I n J.M. S u i s & R.L. M i l l e r ( E d s . ) , S o c i a l  c o m p a r i s o n p r o c e s s e s : T h e o r e t i c a l a n d e m p i r i c a l  p e r s p e c t i v e s ( p p . 1 4 9 - 1 8 6 ) . B r o o k s , N.A., & M a t s o n , R.R. ( 1 9 8 2 ) . S o c i a l - p s y c h o l o g i c a l a d j u s t m e n t t o m u l t i p l e s c l e r o s i s : A l o n g i t u d i n a l s t u d y . S o c i a l S c i e n c e a n d M e d i c i n e , 16, 2 1 2 9 - 2 1 3 5 . Brown, J.R. ( 1 9 8 0 ) . P r o b l e m s i n e v a l u a t i n g new t r e a t m e n t s f o r m u l t i p l e s c l e r o s i s . N e u r o l o g y , 30, 8-11. Buunk, B.P., C o l l i n s , R.L., V a n Y p e r e n , N., T a y l o r , S.E., & D a k o f , G.A. ( 1 9 8 9 ) . The a f f e c t i v e c o n s e q u e n c e s o f s o c i a l  c o m p a r i s o n : E i t h e r d i r e c t i o n h a s i t s ups a n d downs. M a n u s c r i p t s u b m i t t e d f o r p u b l i c a t i o n . C a m p b e l l , J.D. ( 1 9 8 6 ) . S i m i l a r i t y a n d u n i q u e n e s s : The e f f e c t s o f a t t r i b u t e t y p e , r e l e v a n c e , a n d i n d i v i d u a l d i f f e r e n c e s i n s e l f - e s t e e m a n d d e p r e s s i o n . J o u r n a l o f P e r s o n a l i t y a n d  S o c i a l P s y c h o l o g y , 5 0 , 2 8 1-294. C o a t e s , D., & P e t e r s o n , ; B . A . ( 1 9 8 2 ) . D e p r e s s i o n a n d d e v i a n c e . I n G. Weary & H. M i r e l s ( E d s . ) , I n t e g r a t i o n s o f c l i n i c a l a n d  s o c i a l p s y c h o l o g y ( p p . 1 5 4 - 1 7 0 ) . New Y o r k : O x f o r d P r e s s . C o a t e s , D., & W i n s t o n , T. ( 1 9 8 3 ) . C o u n t e r a c t i n g t h e d e v i a n c e o f d e p r e s s i o n : P e e r s u p p o r t g r o u p s f o r v i c t i m s . J o u r n a l o f  S o c i a l I s s u e s , 39, 169-194. C o y n e , J . C . , & G o t l i b , I.H. ( 1 9 8 3 ) . The r o l e o f c o g n i t i o n i n d e p r e s s i o n : A c r i t i c a l a p p r a i s a l . P s y c h o l o g i c a l B u l l e t i n , 94, 4 7 2 - 5 0 5 . 77 C r o c k e r , J . , K a y n e , N.T., & A l l o y , L.B. ( 1 9 8 5 ) . C o m p a r i n g t h e s e l f w i t h o t h e r s i n d e p r e s s e d a n d n o n d e p r e s s e d c o l l e g e s t u d e n t s : R e p l y t o M c C a u l e y . J o u r n a l o f P e r s o n a l i t y a n d  S o c i a l P s y c h o l o g y , 48, 1579-1583. C r o c k e r , J . , & S c h w a r t z , I . ( 1 9 8 5 ) . P r e j u d i c e a n d i n g r o u p f a v o r i t i s m i n a m i n i m a l i n t e r g r o u p s i t u a t i o n : E f f e c t s o f s e l f - e s t e e m . P e r s o n a l i t y a n d S o c i a l P s y c h o l o g y B u l l e t i n , 11 , 379-386. C r o c k e r , J . , Thompson, L . L . , McGraw, K.M., & I n g e r m a n , C. ( 1 9 8 7 ) . 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P e r s o n a l i t y a n d S o c i a l  P s y c h o l o g i c a l B u l l e t i n . T a y l o r , S.E., F a l k e , R.A., M a z e l , R.M., & H i l s b e r g , B. ( 1 9 8 8 ) . S o u r c e s o f s a t i s f a c t i o n a n d d i s s a t i s f a c t i o n among members o f c a n c e r s u p p o r t g r o u p s . I n B. H. G o t t l i e b ( E d . ) , M a r s h a l l i n g  s o c i a l s u p p o r t : F o r m a t s , p r o c e s s e s , a n d e f f e c t s ( p p . 187-2 0 8 ) . Newbury P a r k , CA: Sage P u b l i c a t i o n s , I n c . T a y l o r , S.E., L i c h t m a n , R.R., & Wood, J.V. ( 1 9 8 4 ) . A t t r i b u t i o n s , b e l i e f s a b o u t c o n t r o l , a n d a d j u s t m e n t t o b r e a s t c a n c e r . J o u r n a l o f P e r s o n a l i t y a n d S o c i a l P s y c h o l o g y , 46, 4 8 9 - 5 0 2 . T a y l o r , S.E., & L o b e l , M. ( i n p r e s s ) . S o c i a l c o m p a r i s o n a c t i v i t y u n d e r t h r e a t : Downward e v a l u a t i o n a n d u p w a r d c o n t a c t s . P s y c h o l o g i c a l R e v i e w . T a y l o r , S.E., Wood, J.V., & L i c h t m a n , R.R. ( 1 9 8 3 ) . I t c o u l d be w o r s e : S e l e c t i v e e v a l u a t i o n a s a r e s p o n s e t o v i c t i m i z a t i o n . J o u r n a l o f S o c i a l I s s u e s , 3 9 , 19-40. T e s s e r , A. ( 1 9 8 0 ) . S e l f - e s t e e m m a i n t e n a n c e i n f a m i l y d y n a m i c s . J o u r n a l o f P e r s o n a l i t y a n d S o c i a l P s y c h o l o g y , 39, 7 7 - 9 1 . Thompson, S.C. ( 1 9 8 5 ) . F i n d i n g p o s i t i v e m e a n i n g i n a s t r e s s f u l e v e n t a n d c o p i n g . B a s i c a n d A p p l i e d S o c i a l P s y c h o l o g y , 6, 279 - 2 9 5 . V a n d e r P l a t e , C. ( 1 9 8 4 ) . P s y c h o l o g i c a l a s p e c t s o f m u l t i p l e s c l e r o s i s a n d i t s t r e a t m e n t : T o w a r d a b i o p s y c h o l o g i c a l p e r s p e c t i v e . H e a l t h P s y c h o l o g y , 3, 253-2 7 2 . W a l s h , P.A., & W a l s h , A. ( 1 9 8 7 ) . S e l f - e s t e e m a n d d i s e a s e a d a p t a t i o n among m u l t i p l e s c l e r o s i s p a t i e n t s . The J o u r n a l o f  S o c i a l P s y c h o l o g y , 127, 6 6 9 - 6 7 1 . W e i n e r , B., P e r r y , R.P., & M a g n u s s o n , J . ( 1 9 8 8 ) . An a t t r i b u t i o n a l a n a l y s i s o f r e a c t i o n s t o s t i g m a s . J o u r n a l o f P e r s o n a l i t y a n d  S o c i a l P s y c h o l o g y , 55, 7 3 8 - 7 4 8 . 82 W e i n s t e i n , N.D. ( 1 9 8 0 ) . U n r e a l i s t i c o p t i m i s m a b o u t f u t u r e l i f e e v e n t s . J o u r n a l o f P e r s o n a l i t y a n d S o c i a l P s y c h o l o g y , 39, 8 0 6 - 8 2 0 . W e s t b r o o k , M.T., & N o r d h o l m , L.A. ( 1 9 8 6 ) . E f f e c t s o f d i a g n o s i s on r e a c t i o n s t o p a t i e n t o p t i m i s m a n d d e p r e s s i o n . R e h a b i l i t a t i o n  P s y c h o l o g y , 3 1 , 79-94 . W h e e l e r , L., S h a v e r , K.G., J o n e s , R.A., G o e t h a l s , G.R., C o o p e r , J . , R o b i n s o n , J . E . , G r u d e r , C.L., & B u t z i n e , K.W. ( 1 9 6 9 ) . F a c t o r s d e t e r m i n i n g t h e c h o i c e o f a c o m p a r i s o n o t h e r . J o u r n a l o f E x p e r i m e n t a l S o c i a l P s y c h o l o g y , 5, 2 1 9 - 2 3 2 . W h i t l o c k , F.A., & S i s k i n d , M.M. ( 1 9 8 0 ) . D e p r e s s i o n a s a m a j o r symptom o f m u l t i p l e s c l e r o s i s . J o u r n a l o f N e u r o l o g y ,  N e u r o s u r g e r y , a n d P s y c h i a t r y , 4 3 , 8 6 1 - 8 6 5 . W i l l s , T.A. ( 1 9 8 1 ) . Downward c o m p a r i s o n p r i n c i p l e s i n s o c i a l p s y c h o l o g y . P s y c h o l o g i c a l B u l l e t i n , 90, 2 4 5 - 2 7 1 . W i l l s , T.A. ( 1 9 8 7 ) . Downward c o m p a r i s o n a s a c o p i n g m e c h a n i s m . I n C R . S n y d e r & C. F o r d ( E d s . ) , C o p i n g w i t h n e g a t i v e l i f e  e v e n t s : C l i n i c a l a n d s o c i a l - p s y c h o l o g i c a l p e r s p e c t i v e s ( p p . 243-268) . New Y o r k : A c a d e m i c P r e s s . W i l s o n , S.R., & B e n n e r , L.A. ( 1 9 7 1 ) . The e f f e c t s o f s e l f - e s t e e m a n d s i t u a t i o n upon c o m p a r i s o n c h o i c e s d u r i n g a b i l i t y e v a l u a t i o n . S o c i o m e t r y , 34, 3 8 1 - 3 9 7 . Wood, J.V. ( i n p r e s s ) . C o n t e m p o r a r y S o c i a l C o m p a r i s o n T h e o r y . P s y c h o l o g i c a l B u l l e t i n . Wood, J. V . , T a y l o r , S.E., & L i c h t m a n , R.R. ( 1 9 8 5 ) S o c i a l c o m p a r i s o n i n a d j u s t m e n t t o b r e a s t c a n c e r . J o u r n a l o f  P e r s o n a l i t y a n d S o c i a l P s y c h o l o g y , 49, 1169-1183. Z e l d o w , P.B., & P a v l o u , M. ( 1 9 8 4 ) . P h y s i c a l d i s a b i l i t y , l i f e s t r e s s , a n d p s y c h o s o c i a l a d j u s t m e n t i n m u l t i p l e s c l e r o s i s . The J o u r n a l o f N e r v o u s a nd M e n t a l D i s e a s e , 172, 80-84. Z i l l m a n n , D., & C a n t o r , J.R. ( 1 9 7 6 ) . A d i s p o s i t i o n t h e o r y o f humor a n d m i r t h . I n T. Chapman & H. F o o t ( E d s . ) , Humor a n d  l a u g h t e r : T h e o r y , r e s e a r c h a n d a p p l i c a t i o n s . L o n d o n : W i l e y . 83 A p p e n d i x A #1. I am a b l e t o w a l k . My a c t i v i t y l e v e l i s n o t a f f e c t e d . #2. I am a b l e t o w a l k . My a c t i v i t y l e v e l i s m i n i m a l l y a f f e c t e d : s l i g h t w e a k n e s s a n d / o r m i l d s e n s o r y a n d / o r v i s u a l d i s t u r b a n c e s . #3. I am a b l e t o w a l k . My a c t i v i t y l e v e l i s m o d e r a t e l y  a f f e c t e d : w e a k n e s s , c o - o r d i n a t i o n a n d / o r b a l a n c e d i s t u r b a n c e s . #4. I am a b l e t o w a l k . My a c t i v i t y l e v e l i s more n o t i c e a b l y  a f f e c t e d : i n c r e a s e d w e a k n e s s c o - o r d i n a t i o n a n d / o r b a l a n c e d i s t u r b a n c e . I am s e l f - s u f f i c i e n t a n d a b l e t o be up a n d a b o u t f o r some 12 h o u r s a d a y . #5. I am a b l e t o w a l k . My a c t i v i t y l e v e l i s r e l a t i v e l y s e v e r e l y  a f f e c t e d . I r e q u i r e s p e c i a l p r o v i s i o n s ( p a r t - t i m e w o r k / r e s t p e r i o d s ) i n o r d e r t o manage a f u l l d a y o f w o r k / a c t i v i t y . #6. I r e q u i r e a w a l k i n g a i d f o r m o b i l i t y : c a n e , w a l k e r , f o r e a r m c r u t c h e s , l e g b r a c e . #7. I r e q u i r e a w h e e l c h a i r f o r m o b i l i t y : m a n u a l , e l e c t r i c , s c o o t e r , I am a b l e t o t r a n s f e r i n d e p e n d e n t l y ( e n t e r a n d l e a v e t h e w h e e l c h a i r on my o w n ) . #8. I r e q u i r e p a r t i a l b e d r e s t . I r e q u i r e a w h e e l c h a i r f o r m o b i l i t y : m a n u a l , e l e c t r i c . I am a b l e t o o p e r a t e t h e w h e e l c h a i r i n d e p e n d e n t l y ( e f f e c t i v e u s e o f a r m s ) . I r e q u i r e p a r t i a l a s s i s t a n c e w i t h t r a n s f e r s : human, m e c h a n i c a l ( g r a b b a r s / t r a n s f e r b o a r d ) . #9. I am t o t a l l y d e p e n d e n t upon o t h e r s f o r a l l my c a r e n e e d s ( b a t h i n g , t o i l e t i n g , e a t i n g , d r e s s i n g , t r a n s f e r r i n g , e t c . ) . I am a b l e t o o p e r a t e an e l e c t r i c w h e e l c h a i r w i t h an a d a p t i v e  d e v i c e ( i . e . , s i p a n d p u f f , c h i n o r h e a d c o n t r o l m e c h a n i s m ) . Appendix B 84 D a t e : M u l t i p l e S c l e r o s i s Q u e s t i o n n a i r e F o r e a c h q u e s t i o n , p l e a s e a n s w e r i n t h e a p p r o p r i a t e s p a c e , o r c i r c l e t h e d e s i r e d r e s p o n s e . P l e a s e a n s w e r q u e s t i o n s i n t h e o r d e r t h e y a p p e a r i n t h e b o o k l e t . I f y o u make an e r r o r a n d w i s h t o mark an a l t e r n a t i v e a n s w e r f o r a q u e s t i o n , c r o s s o u t t h e u n d e s i r e d r e s p o n s e and c l e a r l y mark t h e a p p r o p r i a t e c h o i c e . T h e r e a r e no r i g h t o r wrong a n s w e r s ; we a r e o n l y i n t e r e s t e d i n y o u r h o n e s t o p i n i o n s . Some q u e s t i o n s may a p p e a r v e r y s i m i l a r , s o i t i s i m p o r t a n t f o r y o u t o r e a d t h e q u e s t i o n s v e r y c a r e f u l l y b e f o r e a n s w e r i n g them. We r e a l i z e p e o p l e w i t h MS h a v e symptoms t h a t v a r y a c r o s s t i m e . P l e a s e a n s w e r t h e q u e s t i o n s i n t h i s b o o k l e t a c c o r d i n g t o how y o u a r e f e e l i n g r i g h t now, u n l e s s o t h e r w i s e i n d i c a t e d . A l s o , p l e a s e n o t e t h a t t h e q u e s t i o n n a i r e i s p r i n t e d on b o t h s i d e s o f e a c h p a g e . Thank y o u v e r y much f o r y o u r p a r t i c i p a t i o n ! LOT Please read the items below and i n d i c a t e the extent to which you agree with each of them, using the f o l l o w i n g response format: 1 STRONGLY DISAGREE 2 DISAGREE 3 NEUTRAL 4 AGREE 5 STRONGLY AGREE Try to be as a c c u r a t e and honest as you can when answering the q u e s t i o n s . Try not to l e t your answer to one q u e s t i o n i n f l u e n c e your answers to other q u e s t i o n s . 1 . In u n c e r t a i n times, I u s u a l l y expect the b e s t . 2 . I t ' s easy f o r me to r e l a x . 3. I f something can go wrong f o r me, i t w i l l . 4. I always look on the b r i g h t s i d e of t h i n g s . 5. I'm always o p t i m i s t i c about my f u t u r e . 6. I enjoy my f r i e n d s a l o t . 7. I t ' s important f o r me to keep busy. 8. I h a r d l y ever expect t h i n g s to go my way. 9. Things never work out the way I want them t o . 1 0 . I don't get upset too e a s i l y . 1 1 . I'm a b e l i e v e r i n the idea t h a t "every c l o u d has a s i l v e r l i n i n g . " 1 2 . I r a r e l y count on good t h i n g s happening to me. ROS P l e a s e r e a d t h e i t e m s b e l o w a n d i n d i c a t e t h e e x t e n t t o w h i c h y o u a g r e e w i t h e a c h o f them, u s i n g t h e f o l l o w i n g r e s p o n s e f o r m a t : 1 STRONGLY DISAGREE 2 DISAGREE 3 AGREE 4 STRONGLY AGREE A g a i n , t r y t o be a s a c c u r a t e a n d h o n e s t a s y o u c a n when a n s w e r i n g t h e q u e s t i o n s . T r y n o t t o l e t y o u r a n s w e r t o one q u e s t i o n i n f l u e n c e y o u r a n s w e r s t o o t h e r q u e s t i o n s . 1. I f e e l t h a t I'm a p e r s o n o f w o r t h , a t l e a s t on an e q u a l b a s i s w i t h o t h e r s . 2. I f e e l t h a t I h a v e a number o f good q u a l i t i e s . 3. A l l i n a l l , I am i n c l i n e d t o f e e l t h a t I am a f a i l u r e . 4. I am a b l e t o do t h i n g s a s w e l l a s most o t h e r p e o p l e . 5. I f e e l I do n o t h a v e much t o be p r o u d o f . 6. I t a k e a p o s i t i v e a t t i t u d e t o w a r d m y s e l f . 7. On t h e w h o l e , I am s a t i s f i e d w i t h m y s e l f . 8. I w i s h I c o u l d h a v e more r e s p e c t f o r m y s e l f . 9. I c e r t a i n l y f e e l u s e l e s s a t t i m e s . 10. A t t i m e s I t h i n k I am no g o o d a t a l l . 87 CES-D Below i s a l i s t of the ways you might have f e l t or behaved. Please indicate how often you have f e l t t h i s way during the past  week. 1 RARELY OR NONE OF THE TIME (Less than 1 Day). 2 SOME OR A LITTLE OF THE TIME (1-2 Days). 3 OCCASIONALLY OR A MODERATE AMOUNT OF TIME (3-4 Days). 4 ALMOST ALL OF THE TIME (5-7 Days). During the past week: 1. I was bothered by things that usually don't bother me. 2. I did not feel l i k e eating; my appetite was poor. 3. I f e l t I could not shake off the blues even with help from my family or friends. 4. I f e l t that I was just as good as other people. 5. I had trouble keeping my mind on what I was doing. 6. I f e l t depressed. 7. I f e l t that everything I did was an e f f o r t . 8. I f e l t hopeful about the future. 9. I thought my l i f e had been a f a i l u r e . 10. I f e l t f e a r f u l . 11. My sleep was r e s t l e s s . 12. I was happy. 13. I talked less than usual. 14. I f e l t lonely. 15. People were unfriendly. 16. I enjoyed l i f e . 17. I had crying s p e l l s . 18. I f e l t sad. 19. I f e l t that people d i s l i k e me. 20. I could not get "going." 88 L i f e Events Below i s a l i s t of events that can happen to people. Since the  time you have been diagnosed with MS, please indicate whether any of these things has happened to you by t i c k i n g the appropriate space: No, has not happened or inappropr iate Yes, has happened 1. ) Become (re)married? 2. ) Lost a spouse through death? 3. ) Lost your job or been l a i d off? 4. ) Had a serious personal injury (excluding MS symptoms)? 5. ) Retired? 6 . ) Had a decline in your f i n a n c i a l status? 7. ) Been divorced? 8. ) Become separated? 9 . ) Had a spouse lose th e i r job or get l a i d off? 10. ) Someone in your immediate family had a serious personal injury or i l l n e s s ? If yes, what was the month and year during which that happened? month/year month/year month/year month/year month/year month/year month/year month/year month/year month/year 89 I n t h e f o l l o w i n g t h r e e s e t s o f q u e s t i o n s , we w i l l a s k y o u how y o u see y o u r s e l f r e l a t i v e t o o t h e r s . F o r e x a m p l e , y o u m i g h t want t o know how much a l i k e o r d i f f e r e n t y o u a r e f r o m o t h e r p e o p l e who h a v e MS. P l e a s e t r y t o remember any i n s t a n c e s , i f a n y , when y o u hav e c o m p a r e d y o u r s e l f w i t h o t h e r s i n a n s w e r i n g t h e f o l l o w i n g q u e s t i o n s . Upward C o m p a r i s o n s A1.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e b e t t e r o f f t h a n y o u r s e l f w i t h r e s p e c t t o l e v e l o f d i s a b i l i t y , p r o g n o s i s , o r o t h e r d i s e a s e - r e l a t e d i s s u e s ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS A2.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e b e t t e r o f f t h a n y o u r s e l f w i t h r e s p e c t t o a b i l i t y t o c o p e w i t h t h e c o n d i t i o n a n d i t s c o n s e q u e n c e s ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS A3.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e b e t t e r of,f t h a n y o u r s e l f w i t h r e s p e c t t o t h e l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS Downward C o m p a r i s o n s B1.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e w o r s e o f f t h a n y o u r s e l f w i t h r e s p e c t t o l e v e l o f d i s a b i l i t y , p r o g n o s i s , o r o t h e r d i s e a s e - r e l a t e d i s s u e s ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS B2.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e w o r s e o f f t h a n y o u r s e l f w i t h r e s p e c t t o a b i l i t y t o c o p e w i t h t h e c o n d i t i o n a n d i t s c o n s e q u e n c e s ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS 90 B 3 . ) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o o t h e r p e o p l e w i t h MS who a r e w o r s e o f f t h a n y o u r s e l f w i t h r e s p e c t t o t h e l e v e l o f s u p p o r t p r o v i d e d by f r i e n d s a n d f a m i l y ? 1 2 NEVER 8 ALMOST ALWAYS O t h e r C o m p a r i s o n s Q u e s t i o n s C1.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o p e o p l e w i t h o t h e r i l l n e s s e s o r d i s a b i l i t i e s ( e . g . , h e a r t a t t a c k s , c a n c e r , s t r o k e s , d i a b e t e s ) ? 1 2 NEVER 8 9 ALMOST ALWAYS C2.) How o f t e n h a v e y o u c o m p a r e d y o u r s e l f t o p e o p l e y o u r age who do n o t h a v e MS o r any o t h e r i l l n e s s o r d i s a b i l i t y ? 1 2 NEVER 8 9 ALMOST ALWAYS F e e l i n g s From C o m p a r i s o n s P l e a s e n o t e t h a t t h e n e x t e i g h t q u e s t i o n s w i l l a p p e a r v e r y s i m i l a r . H o w e v e r , when y o u r e a d them c l o s e l y y o u w i l l r e a l i z e t h e y a r e e a c h a s k i n g s o m e t h i n g d i f f e r e n t . Some o f t h e q u e s t i o n s p e r t a i n t o p h y s i c a l c o n d i t i o n , t h a t i s , t h e s e r i o u s n e s s o f y o u r symptoms; o t h e r s p e r t a i n t o c o p i n g , t h a t i s , how w e l l y o u a r e d e a l i n g w i t h y o u r MS. P l e a s e r e a d e a c h q u e s t i o n c a r e f u l l y so t h e d i s t i n c t i o n s become a p p a r e n t . D1.) Some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e d o i n g b e t t e r t h a n t h e y a r e w i t h r e s p e c t t o t h e i r p h y s i c a l c o n d i t i o n makes them f e e l w o r s e , t h a t i s , f r u s t r a t e d o r d e p r e s s e d t h e y a r e n o t i n b e t t e r s h a p e t h e m s e l v e s . How o f t e n have y o u h a d t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 NEVER 4 8 9 ALMOST ALWAYS D2.) Then a g a i n , some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e d o i n g b e t t e r t h a n t h e y a r e w i t h r e s p e c t t o t h e i r p h y s i c a l  c o n d i t i o n makes them f e e l b e t t e r , t h a t i s , i n s p i r e d o r c o m f o r t e d . How o f t e n have y o u h a d t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 NEVER 8 9 ALMOST ALWAYS D3.) Some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e c o p i n g b e t t e r t h a n t h e y a r e makes them f e e l w o r s e , t h a t i s , f r u s t r a t e d o r d e p r e s s e d t h e y a r e n o t i n b e t t e r s h a p e t h e m s e l v e s . How o f t e n h a v e y o u h a d t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS D4.) Then a g a i n , some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e c o p i n g b e t t e r t h a n t h e y a r e makes them f e e l b e t t e r , t h a t i s , i n s p i r e d o r c o m f o r t e d . How o f t e n h a v e y o u had t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS D5.) Some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e w o r s e o f f t h a n t h e y a r e w i t h r e s p e c t t o t h e i r p h y s i c a l c o n d i t i o n makes them f e e l b e t t e r , t h a t i s , l u c k y a n d g r a t e f u l t h e y a r e n o t i n w o r s e s h a p e t h e m s e l v e s . How o f t e n h a v e y o u had t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS D6.) Then a g a i n , some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e w o r s e o f f t h a n t h e y a r e w i t h r e s p e c t t o t h e i r p h y s i c a l  c o n d i t i o n makes them f e e l w o r s e , t h a t i s , i n c r e a s e s t h e i r f e a r s a n d a n x i e t i e s a b o u t g e t t i n g w o r s e t h e m s e l v e s . How o f t e n h a v e y o u had t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS D7.) Some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e c o p i n g l e s s e f f e c t i v e l y t h a n t h e y a r e makes them f e e l b e t t e r , t h a t i s , l u c k y a n d g r a t e f u l t h e y a r e c o p i n g a s w e l l a s t h e y a r e . How o f t e n h a v e y o u h a d t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS D8.) Then a g a i n , some p e o p l e s a y t h a t s e e i n g o t h e r s w i t h MS who a r e c o p i n g l e s s e f f e c t i v e l y t h a n t h e y a r e makes them f e e l w o r s e , t h a t i s , i n c r e a s e s t h e i r f e a r s a n d a n x i e t i e s a b o u t g e t t i n g w o r s e t h e m s e l v e s . How o f t e n h a v e y o u h a d t h o u g h t s t h a t a r e s i m i l a r t o t h e s e ? 1 2 3 4 5 6 7 8 9 NEVER ALMOST ALWAYS 92 A p p r o p r i a t e n e s s o f M a k i n g C o m p a r i s o n s E1.) Some p e o p l e d o n ' t f e e l i t i s r i g h t t o compare t h e m s e l v e s w i t h o t h e r s a n d t r y t o a v o i d d o i n g s o . I n c o n t r a s t , some p e o p l e f e e l c o m p a r i n g w i t h o t h e r s i s u s e f u l t o g a i n i n f o r m a t i o n . How a p p r o p r i a t e o r i n a p p r o p r i a t e do y o u t h i n k i t i s t o compare y o u r s e l f w i t h o t h e r s who h a v e MS? 1 2 3 4 5 6 7 8 9 NOT AT A L L COMPLETELY APPROPRIATE APPROPRIATE E1a.) P l e a s e b r i e f l y e x p l a i n why y o u f e e l t h e way y o u do a b o u t c o m p a r i n g y o u r s e l f w i t h o t h e r s : C o n t a c t w i t h O t h e r s w i t h MS F1 . ) How many p e o p l e w i t h MS do y o u know? F2.) Do y o u c u r r e n t l y b e l o n g t o a s u p p o r t g r o u p ? NO YES F3.) Have y o u a t t e n d e d a s u p p o r t g r o u p i n t h e p a s t ? NO YES F4 . ) I f y o u h a v e a t t e n d e d a s u p p o r t g r o u p , a b o u t how many m e e t i n g s h a v e y o u gone t o ? F5.) I f y o u h a v e a t t e n d e d a s u p p o r t g r o u p , i n g e n e r a l do y o u t h i n k t h e o t h e r g r o u p members h a v e i l l n e s s e s t h a t a r e much l e s s s e v e r e , a l i t t l e l e s s s e v e r e , a b o u t t h e same, a l i t t l e more s e v e r e , o r much more s e v e r e t h a n y o u r s ? 1 2 3 4 5 MUCH A L I T T L E ABOUT A L I T T L E MUCH LESS LESS THE MORE MORE SEVERE SEVERE SAME SEVERE SEVERE 93 H e a l t h G1.) I n g e n e r a l , how w o u l d y o u r a t e y o u r h e a l t h ? 1 2 3 4 5 6 7 8 9 POOR EXCELLENT G2.) How h a s y o u r p h y s i c a l h e a l t h c h a n g e d o v e r t h e p a s t y e a r ? 1 2 3 4 5 IT HAS I T HAS I T HAS I T HAS I T HAS GOTTEN GOTTEN A STAYED GOTTEN A GOTTEN A MUCH L I T T L E ABOUT L I T T L E LOT WORSE WORSE THE SAME BETTER BETTER G3.) O v e r a l l , how w e l l do y o u t h i n k y o u a r e c o p i n g w i t h MS? 1 2 3 4 5 6 7 8 9 POORLY EXCELLENT G4.) Compared w i t h o t h e r e v e n t s t h a t h a v e h a p p e n e d i n y o u r l i f e , how s e v e r e i s y o u r MS? 1 2 3 4 5 6 7 8 9 NOT AT A L L EXTREMELY SEVERE SEVERE G5.) Compared w i t h o t h e r s w i t h MS, how s e v e r e do y o u f e e l y o u r MS i s ? 1 2 3 4 5 MUCH SOMEWHAT ABOUT SOMEWHAT MUCH LESS LESS THE MORE MORE SEVERE SEVERE SAME SEVERE SEVERE F u t u r e H1.) I n t h e f u t u r e , how do y o u t h i n k y o u r c a p a c i t y t o a c c o m p l i s h t a s k s w i l l c h a n g e , i f a t a l l ? 1 2 3 4 5 6 7 8 9 GET A LOT STAY THE GET A WORSE SAME LOT BETTER H2.) R e l a t i v e t o how y o u a r e c o p i n g r i g h t now, how w e l l do y o u t h i n k y o u w i l l c o p e i n t h e f u t u r e ? 1 2 3 4 5 6 7 8 9 MUCH MUCH WORSE BETTER 94 H3.) How l i k e l y do y o u t h i n k i t i s t h a t y o u r symptoms w i l l g e t w o r s e o r r e c u r ? 1 2 3 4 5 6 7 8 9 NOT AT A L L EXTREMELY L I K E L Y L I K E L Y C o n t r o l 1 1 . ) How much p e r s o n a l c o n t r o l do y o u t h i n k y o u ha v e o v e r y o u r d a i l y symptoms, t h a t i s t h e amount o f p a i n , f a t i g u e , d i s c o m f o r t , a n d i m m o b i l i t y y o u e x p e r i e n c e f r o m d ay t o d a y ? J 1 2 3 4 5 6 7 8 9 ABSOLUTELY EXTREME AMOUNT NO CONTROL OF CONTROL 12. ) How much p e r s o n a l c o n t r o l do y o u t h i n k y o u h a v e o v e r t h e m e d i c a l c a r e a n d t r e a t m e n t o f y o u r i l l n e s s ? 1 2 3 4 5 6 7 8 9 ABSOLUTELY EXTREME AMOUNT NO CONTROL OF CONTROL 13.) How much p e r s o n a l c o n t r o l do y o u b e l i e v e y o u ha v e o v e r t h e l o n g - t e r m c o u r s e o f y o u r u n d e r l y i n g d i s e a s e , t h a t i s , w h e t h e r i t w i l l i m p r o v e o r a t l e a s t n o t w o r s e n i n t h e f u t u r e ? 1 2 3 4 5 6 7 8 9 ABSOLUTELY EXTREME AMOUNT NO CONTROL OF CONTROL E d u c a t i o n J 1 . ) What i s t h e h i g h e s t g r a d e o f s c h o o l o r y e a r o f c o l l e g e y o u hav e c o m p l e t e d ? GRADES OF SCHOOL COLLEGE 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17+ Income F o r s t a t i s t i c a l p u r p o s e s o n l y , we w o u l d l i k e t o g e t an i d e a a b o u t t h e f i n a n c i a l s i t u a t i o n o f o u r p a r t i c i p a n t s . K1.) P l e a s e c h e c k t h e one amount t h a t b e s t r e p r e s e n t s t h e c o m b i n e d income o f a l l members o f y o u r f a m i l y l i v i n g i n y o u r r e s i d e n c e i n 1988 b e f o r e t a x e s . LESS THAN $5,000 $ 5 , 0 0 0 - $ 1 4 , 9 9 9 $ 1 5 , 0 0 0 " $ 2 4 , 9 9 9 $ 2 5 , 0 0 0 - $ 3 4 , 9 9 9 $ 3 5 , 0 0 0 - $ 4 4 , 9 9 9 $ 4 5 , 0 0 0 - $ 5 4 , 9 9 9 $ 5 5 , 0 0 0 - $ 6 4 , 9 9 9 $ 6 5 , 0 0 0 - $ 7 4 , 9 9 9 MORE THAN $75,000 S u p p o r t L 1 .) O v e r a l l , how s u p p o r t e d do y o u f e e l by y o u r f a m i l y members and f r i e n d s ? 95 1 2 EXTREMELY UNSUPPORTED 8 9 EXTREMELY SUPPORTED L 2 . ) What t h i n g s , i f a n y , do y o u w i s h f a m i l y members o r f r i e n d s w o u l d do t o be s u p p o r t i v e t h a t t h e y a r e c u r r e n t l y n o t d o i n g ? P l e a s e l i s t a s many t h o u g h t s t h a t come t o m i n d . L 3 . ) I n t h e t i m e s i n c e y o u r d i a g n o s i s , what t h i n g s h a v e o t h e r s s a i d o r done t h a t h a v e been e s p e c i a l l y h e l p f u l t o y o u i n c o p i n g w i t h y o u r MS? L 4 . ) S o m e t i m e s , i n t r y i n g t o h e l p , p e o p l e may s a y o r do t h i n g s t h a t a r e n o t i n f a c t h e l p f u l . I n t h e t i m e s i n c e y o u r d i a g n o s i s , what t h i n g s h a v e o t h e r s s a i d o r done t h a t have n o t been h e l p f u l , o r t h a t h a v e u p s e t y o u , made y o u a n g r y , o r o f f e n d e d y o u ? L 5 . ) Why do y o u t h i n k o t h e r s s a i d o r d i d t h e u n h e l p f u l t h i n g s i n q u e s t i o n L 4 ? I n o t h e r w o r d s , what do y o u t h i n k c a u s e d them t o a c t t h e way t h e y d i d ? Q u e s t i o n n a i r e C o m p l e t i o n M1.) D i d y o u c o m p l e t e t h i s q u e s t i o n n a i r e by y o u r s e l f , o r d i d someone e l s e f i l l i n t h e a n s w e r s a s y o u d i c t a t e d r e s p o n s e s ? I c o m p l e t e d t h e q u e s t i o n n a i r e by m y s e l f . Someone e l s e f i l l e d i n t h e a n s w e r s a s I d i c t a t e d r e s p o n s e s . THANK YOU VERY MUCH FOR YOUR PA R T I C I P A T I O N ! 

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