Centre for the Clinical Applications of Health Psychology, University of Southampton, Southampton, UK.
J Psychosom Res. 2010 Oct;69(4):353-61. doi: 10.1016/j.jpsychores.2010.04.009. Epub 2010 Jun 9.
This study investigated a cognitive-behavioural model of adjustment to multiple sclerosis (MS). It aimed to determine the contribution of cognitions and behaviours to the explanation of two distinct adjustment outcomes above and beyond measures of MS severity. Illness-related functional impairment was anticipated to be most strongly related to unhelpful thoughts and behaviours that were specific for MS and the experience of symptoms. Psychological distress was hypothesised to be most strongly related to more general unhelpful cognitions about the self and emotions.
Ninety-four people with MS completed questionnaires. Correlations and hierarchical multiple regressions determined the relative contribution of illness severity, cognitions, and behaviours to the prediction of psychological distress and functional impairment.
Illness-related functional impairment was related to disease severity, progressive versus relapsing-remitting disease, and unhelpful illness perceptions and cognitive and behavioural responses to symptoms. Illness severity factors accounted for a significant 23.7% of the variance in functional impairment (P<.001). Cognitive and behavioural variables explained a further 22.6% of the variance (P<.001), with behavioural responses to symptoms emerging as the strongest predictor. The correlates of distress were unhelpful beliefs about the self, unhelpful beliefs about emotions, acceptance, and unhelpful cognitive responses to symptoms and illness perceptions. Illness severity factors explained only 2.2% of the variance in distress (P>.05), while cognitive and behavioural variables accounted for 37.1% (P<.001). Unhelpful beliefs about the self were the strongest predictor.
Longitudinal and experimental research is required to investigate potential causal relationships. However, the cognitions and behaviours identified as important for adjustment are potentially modifiable and thus may be useful to address within interventions for adjustment to MS.
本研究调查了多发性硬化症（MS）适应的认知行为模型。其旨在确定认知和行为对除 MS 严重程度测量之外的两个不同适应结果的解释的贡献。预计与 MS 特异性和症状体验相关的无益思想和行为与疾病相关的功能障碍关系最密切。心理困扰被假设与对自我和情绪的更一般的无益认知关系最密切。
94 名 MS 患者完成了问卷调查。相关性和分层多元回归确定了疾病严重程度、认知和行为对预测心理困扰和功能障碍的相对贡献。
疾病相关的功能障碍与疾病严重程度、进展性与复发缓解性疾病、无益的疾病认知以及对症状的认知和行为反应有关。疾病严重程度因素解释了功能障碍的 23.7%的显著差异（P<.001）。认知和行为变量进一步解释了 22.6%的差异（P<.001），症状的行为反应是最强的预测因子。困扰的相关因素包括对自我的无益信念、对情绪的无益信念、接受以及对症状和疾病认知的无益认知反应。疾病严重程度因素仅解释了困扰的 2.2%的差异（P>.05），而认知和行为变量则占 37.1%（P<.001）。对自我的无益信念是最强的预测因子。
需要进行纵向和实验研究以调查潜在的因果关系。然而，确定为适应重要的认知和行为是潜在可改变的，因此可能有助于解决多发性硬化症适应干预中的问题。
