MS and me: exploring the impact of multiple sclerosis on perceptions of self.

PURPOSE: The aim of this qualitative study was to explore the impact of multiple sclerosis (MS) on perceptions of self as well as the emotional, social and practical implications of any self-reported changes. METHOD: Twelve participants were interviewed and interpretative phenomenological analysis used to analyse the data. Participants were recruited from a MS hospital clinic in the north-west of England. RESULTS: Four themes were identified although for reasons of space and novelty three were discussed, (i) 'my body didn't belong to me': the changing relationship to body, (ii) 'I miss the way I feel about myself': the changing relationship to self and (iii) 'let's just try and live with it': incorporating yet separating MS from self. CONCLUSIONS: The onset of MS was seen to impact upon self yet impact did not necessarily equate with a loss of self but rather a changed self. Self-related changes did, however, carry the potential to impact negatively upon a person's mood and psychological functioning and consequently, clinicians are encouraged to consider issues relating to self as standard.

Positive adjustment to breast cancer: development of a disease-specific measure and comparison of women diagnosed from 2 weeks to 5 years.

OBJECTIVE: Many women describe 'positive adjustment' as a consequence of having breast cancer. It is unclear whether positive experiences reflect the absence of anxiety and depression or are part of a separate process of adjustment. Existing measures are not specific to breast cancer and may lack validity. Our aims were as follows: (1) to develop a valid questionnaire to measure positive adjustment after breast cancer; (2) to clarify whether it measures aspects distinct from anxiety and depression and (3) to suggest when positive adjustment typically emerges. METHODS: A new measure, the Positive Adjustment Questionnaire (PAQ), was developed and completed by 156 women with breast cancer, allocated to three groups: 2-4 weeks; 6 months-2 years and 2-5 years post-diagnosis. Other questionnaires were used to assess anxiety and depression and test the validity of the PAQ. RESULTS: Principal components analysis of the PAQ identified four domains of positive adjustment; Fulfilment, Re-evaluation, New ways of living and Valuing Life. Women questioned 2-5 years after diagnosis reported more fulfilment, re-evaluation of life and new ways of living than those asked shortly after diagnosis. Differences in these aspects of positive adjustment remained after controlling for anxiety and depression. CONCLUSIONS: This study (1) provides a measure specific to positive adjustment following breast cancer; (2) suggests that positive adjustment is different from anxiety and depression and (3) indicates that positive adjustment is seen in women assessed 2-5 years after diagnosis. Psychological therapies that promote positive adjustment could enhance existing interventions that focus on reducing anxiety and depression.