ACCEPTANCE AND MINDFULNESS IN MS:
INDIVIDUAL AND COUPLE PERSPECTIVES
Kenneth Pakenham
School of Psychology
The University of Queensland
Australia
Background: Characteristics of MS
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complex neurological disorder
typically degenerative
demyelination of nerve fibres interferes with transmission of impulses
affects approximately 2.5 million persons worldwide (WHO, 2004)
prevalence is twice as high in women as in men
onset 20 - 40
the most common chronic neurological disease among young people
no known cause or cure
course is unpredictable
clinical symptoms vary widely (eg. cognitive impairment, pain, fatigue, loss of
bowel or bladder control, mobility impairments, and emotional changes)
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symptoms affect most, if not all, areas of a person’s life
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20% lifetime prevalence rate for depressive disorders
36% lifetime prevalence rate for anxiety disorders
28% of MS carers report clinically significant levels of distress
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Background
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2 studies investigate the roles of acceptance and
mindfulness in adjusting to MS
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The MS context:
 ‘radical
 present
acceptance’
moment awareness that frequently involves
experiencing the pain of ‘decay’
STUDY 1 (Pakenham & Flemming, 2012)
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Aim: to examine relations between acceptance and
adjustment to MS using a purpose-built scale called
the MS Acceptance Questionnaire (MSAQ).
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Hypothesis: acceptance would be associated with
better adjustment to MS (lower distress & higher
positive affect, life satisfaction & marital adjustment,
& better health).
STUDY 1: method
Data for Study 1 & 2 are drawn from longitudinal research on families
coping with MS
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128 parents with MS completed measures of demographics, illness
& adjustment at Time 1, & measures of acceptance and adjustment
12 months later (Time 2).
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Mean age 43 years (SD = 6.5, range = 30 to 57)
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84% female
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Mean illness duration 7.67 years (SD = 5.75, range = 4 months - 30 yrs)
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MS severity: 32% mild, 56% moderate, 10% severe
STUDY 1: method
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Adjustment Measures; completed at Time 1 & Time 2:
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Health status (Pakenham et al, 1994)
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Life satisfaction (Pavot & Diener, 1993)
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Positive affect (Bradburn, 1969) (Pakenham & Cox, 2008)
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Distress (Depression Anxiety &Stress Scale; Lovibond & Lovibond, 1995)
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Relationship satisfaction (Abbreviated Spanier Dyadic Adjustment Scale;
Sharpley & Rogers, 1984)
STUDY 1: method
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Acceptance & Action Questionnaire (AAQ):
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16-item AAQ (Bond & Bunce, 2003)
2 subscales: Action and Willingness
MS Acceptance Questionnaire (MSAQ):
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Developed with reference to the AAQ & the CPAQ (McCracken, 1998)
Items were adapted to reflect the experience of living with MS
20 (out of 25) items were endorsed by an expert panel and these
constituted the MSAQ
7-point rating scale (1 = never true to 7 = always true)
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higher scores indicating greater acceptance of MS
STUDY 1: Factor analysis of the MSAQ
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Principal Components analysis (orthogonal & oblique rotations):
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Two factors, 51% of the total variance
Action (8 items) 30%
 Willingness (8 items) 22%
 All items loaded >.50
 Internal reliabilities: .87 Action; .79 Willingness
 Correlation .25, p<.01
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Convergent validity:
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MSAQ Action:
AAQ Action (r = .60, p<.01)
 AAQ Willingness (r = .44, p<.01)
 Acceptance coping (r = .58, p<.01)
 Acceptance sense making (r = .62, p<.01)
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MSAQ Willingness
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Acceptance coping (r = .19, p<.05)
STUDY 1: relations between MSAQ &
illness, demographics & adjustment
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Less disability (r=.24, p<.01) & cognitive impairment (r=-.27,
p<.01) related to higher MSAQ Action.
Being in a relationship (F=3.94, p<.01) & being female (F=4.41,
p=.04) were related to higher MSAQ Action.
After controlling for the effects of initial adjustment & relevant
demographic & illness variables (6 covariates):
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MSAQ Action predicted greater positive affect(12%), & health(5%)
& marginal predictor of life satisfaction (2%).
MSAQ Willingness predicted better health but lower positive affect
AAQ (Action) predicted lower distress
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MSAQ 4 – 12% vs. AAQ 4%
STUDY 1: conclusions
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Findings support the beneficial effects of acceptance in
MS
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Although acceptance declined as the disease progressed
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2 MSAQ factors (Action & Willingness) reflect the dual
definition of acceptance consistent with other ACT
acceptance measures
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Sound psychometric properties
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MSAQ was a stronger predictor of adjustment to MS
than the AAQ.
STUDY 1: conclusions
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Mixed findings re MSAQ Willingness:
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Reflect the ambiguous and complex nature of willingness
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EG. willingness to relinquish control of emotional reactions to illness
may have health benefits by dampening emotional reactivity to
illness, including the experience of positive emotions.
Illness acceptance was related to less reliance on coping strategies
focused on dealing with the emotional consequences of illness
(Karademas & Hondronikola, 2010).
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Willingness subscale of the Tinnitus Acceptance Q’aire was
unrelated to adjustment in people with tinnitus (Westin et al, 2008).
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Measurement weaknesses:
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MSAQ Willingness items may tap passive resignation rather than
active acceptance.
Acceptance may be equated with approval
STUDY 2: (Pakenham & Samios, In press)
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To investigate the roles of mindfulness &
acceptance on adjustment in couples coping with
MS by examining:
effects of an individual’s mindfulness & acceptance
on their own adjustment (actor effects) and
 the
effects of their partner’s mindfulness & acceptance
on their adjustment (partner effects) using the
 the
Actor-Partner Interdependence Model (Kenny, Kashy& Cook, 2006)
STUDY 2: hypotheses
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Actor effects: mindfulness & acceptance would be
associated with better adjustment
Partner effects: mindfulness & acceptance in each
partner would be associated with better adjustment in
the other partner
Moderating effects:
the partner effect of mindfulness would moderate the actor
effect of mindfulness on adjustment
 the partner effect of acceptance would moderate the actor
effect of acceptance on adjustment.
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Explored the moderating effects of gender & MS status
(patient vs. spouse) on the actor and partner effects of
mindfulness & acceptance on adjustment.
STUDY 2: method
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69 couples completed Time 1 & Time 2 measures of
mindfulness, acceptance & adjustment
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Dyadic data analytic approach (Kenny, Kashy& Cook, 2006)
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Terminology:
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participants are “patients” or “spouses”
“partner” refers to the other person in the couple
Patients: mean age 42 years; 78% female
Spouses: mean age 43 years; 78% male
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mean duration of caregiving 5.91 years (SD = 4.68; range 1
month to 25 years)
STUDY 2: method
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Acceptance and Mindfulness Time 2
 Acceptance: AAQ (Bond & Bunce, 2003)
 Mindfulness:
Mindful Attention Awareness Scale (Brown
& Ryan, 2003)
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Adjustment measures Times 1 & Time 2:
 Depression
& Anxiety (DASS-21;Lovibond & Lovibond, 1995)
 Life satisfaction
 Positive affect
 Relationship satisfaction
STUDY 2: results
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Actor effects
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mindfulness & acceptance were associated with better
adjustment, although
beneficial actor effects of acceptance were evident across all
adjustment domains (all Bs p<.01) whereas
 beneficial direct effects of mindfulness were only evident on
distress (all Bs p<.01)
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Partner effects
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support for the beneficial impacts of partner acceptance on
actor relationship satisfaction (B=.13,p<.01)
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ie. Individuals perceived better relationship satisfaction when their
partner reported greater acceptance.
Partner effects for mindfulness were not evident.
(B = unstandardised coefficient)
STUDY 2: results
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Actor-Partner Interactions:
 Actor-partner interaction effect on depression (B=.01, p<.05)
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when the actor reported high acceptance & the partner reported low
acceptance, the actor reported lower depression, whereas when both actor &
partner reported high acceptance actors reported higher depression.
Moderating effects of gender & MS status:
 No gender moderating effects
 MS status (patient vs. spouse) moderated:
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Link between mindfulness & relationship satisfaction (B=.08, p<.05)
 mindfulness was related to greater relationship satisfaction for patients,
but was unrelated to relationship satisfaction for spouses.
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Link between acceptance & relationship satisfaction (B=.09, p<.05)
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Acceptance was related to greater relationship satisfaction for spouses,
but was unrelated to relationship satisfaction for patients
Study 2: conclusions
Mindfulness
 Beneficial actor effects of mindfulness on distress
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Absence of any direct effects on positive outcomes
 Similar
to prior findings (Brown & Ryan, 2003)
 Dispositional vs. state mindfulness
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Beneficial effects of mindfulness on relationship
satisfaction for patients, but not for spouses
 Increased
mindfulness evident in patient benefit finding
(Pakenham & Cox, 2009)
Study 2: conclusions
Acceptance
 Beneficial effects of acceptance on all adjustment outcomes
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Beneficial effects of acceptance on relationship satisfaction
for spouses, but not for patients
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caregiving entails many relationship challenges that require
acceptance (Pakenham, 2008)
Greater acceptance protects individuals from depression
when in the context of lower partner acceptance.
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Complementary coping is related to marital adjustment in couples
coping with chronic illness (Badr, 2004).
High values-driven action in each partner may pull them in
different life directions and create existential dilemmas in illness
context – need for couples to recalibrate values.