Doctor of Psychology (Clinical)
Department of Psychology, Faculty of Health and Behavioural Sciences
Berea, Gabrielle, Adjustment to Multiple Sclerosis: application of the Fennell Four Phase Model and identification of effective social support, Doctor of Psychology (Clinical) thesis, Department of Psychology, Faculty of Health and Behavioural Sciences, University of Wollongong, 2010. http://ro.uow.edu.au/theses/3140
This thesis investigated the specific aspects of support which people with Multiple Sclerosis (PwMS) perceive as helpful and unhelpful. While social support in general has been found to enhance adjustment, assist emotional wellbeing and maintain quality of life (QoL) for PwMS, the Multiple Sclerosis (MS) research does not provide a comprehensive understanding of the specific aspects of social support which are helpful and unhelpful. This thesis also tested the relevance of the Fennell Four Phase Model (FFPM) for adjustment to MS and explored whether perceptions of helpful and unhelpful social support differed according to adjustment levels. Many models of adjustment to chronic illness do not consider the support network and focus on only the psychological aspects of adjustment. The FFPM (Fennell, 1993; Fennell, 1995; Fennell, 2003a) is a multistage model which maps the adjustment process of chronic illness by addressing the physical/behavioural domain, social/interactive domain and psychological domain. Most importantly the model acknowledges the importance of the support network in adjusting to chronic illness. Two studies were carried out. The initial study investigated social support and took into account not only different categories of support but also different sources of support. Twenty individuals with MS were interviewed regarding the specific actions they found helpful and unhelpful from various potential support providers. Results provided a comprehensive behavioural understanding of what PwMS experience as helpful and unhelpful from key support providers. Specifically, emotional support was considered crucial in intimate relationships. Other PwMS were uniquely helpful by providing informational support, optimism, hope and emotional support. Results indicated the importance and need for greater informational assistance from medical professionals. The second study investigated the adjustment process for PwMS through the FFPM iv and aimed to examine if individuals in different phases of adjustment had different perspectives of helpful and unhelpful support. Results supported the relevance of the four phases (Crisis, Stabilisation, Resolution and Integration) of the model for PwMS. No significant findings were found among phases in perceptions of helpful and unhelpful social support, indicating that regardless of levels of adjustment PwMS have similar social support needs. Individuals in each of the phases were found to have significant differences in emotional states, ways of coping, satisfaction with life and self reported moodiness, anxiety, QoL and coping levels. Findings indicated that regardless of an individual’s level of adjustment to MS, certain types of supportive and unsupportive behaviours continued to be relevant. The FFPM appears to accurately map the journey and struggles of PwMS. Results from this research can be used to enhance social support with interventions and educational programs for key support providers and also to understand a patient’s current adjustment phase, implement appropriate treatment strategies and support.