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This study examined the coping strategies of patients with multiple sclerosis using the Coping with Health Injuries and Problems (CHIP) scale and compared patient scores on this measure to demographic and disease-related variables as well as formal indicators of emotional, physical, and cognitive status. Participants were 41 patients diagnosed with MS who were referred for outpatient psychological or neuropsychological assessment. Participants ranged in age from 21-60 years (M = 42.32 years, SD = 9.50). Mean educational level and duration of multiple sclerosis diagnosis for participants were 14.63 years (SD = 2.27, range = 12-20 years) and 8.71 years (SD = 7.51, range = 1-38 years), respectively. In contrast to prior research and expectations, findings revealed that participants reported the highest degree of engagement in CHIP Instrumental Coping strategies followed by Distraction Coping strategies as opposed to Emotional Preoccupation. Scores of patients with multiple sclerosis on the Instrumental Coping and Distraction Coping subscales of the CHIP were found to be significantly higher than those of the scale’s standardization sample. Results also indicated that engagement in Emotional Preoccupation was associated with poorer outcomes, in particular psychological adjustment. CHIP coping strategies were not found to be a function of age, educational level, duration of MS diagnosis, disability status, or gross global cognitive status. Findings provide further validation of the CHIP and support its use in assessing the coping strategies of patients with multiple sclerosis.
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2. Gustavsen, S., Olsson, A., Søndergaard, H.B. et al. The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey. BMC Neurol 2021;21:317.
3. Beatty WW (2008). Assessment for rehabilitation of patients with multiple sclerosis. In ST Gontkovsky and CJ Golden (Eds.), Neuropsychology within the inpatient rehabilitation environment (pp. 99-131). Hauppauge, NY: Nova Science.
4. Green R, Cutter G, Friendly M, Kister I. Which symptoms contribute the most to patients’ perception of health in multiple sclerosis? Mult Scler J Exp Transl Clin. 2017;3(3):2055217317728301.
5. Lakin, L., Davis, B.E., Binns, C.C. et al. Comprehensive approach to management of multiple sclerosis: addressing invisible symptoms—a narrative review. Neurol Ther 2021;10: 75–98.
6. Parker LS, Topcu G, De Boos D, das Nair R. The notion of “invisibility” in people’s experiences of the symptoms of multiple sclerosis: a systematic meta-synthesis. Disabil Rehabil. 2021;43:3276-90.
7. Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. Lancet Neurol. 2008;7(12):1139–51.
8. Sumowski JF, Benedict R, Enzinger C, Filippi M, Geurts JJ, Hamalainen P, et al. Cognition in multiple sclerosis: state of the field and priorities for the future. Neurology. 2018;90(6):278–88.
9. Amato MP, Portaccio E, Goretti B, et al. Cognitive impairment in early stages of multiple sclerosis. Neurol Sci. 2010;31(Suppl 2):S211–S214.
10. Hogancamp WE, Noseworthy JH (1999). Demyelinating disorders of the central nervous system. In CG Goetz and EJ Pappert (Eds.), Textbook of clinical neurology (pp. 970-89). Philadelphia, PA: WB Saunders.
11. Silveira C, Guedes R, Maia D, Curral R, Coelho R. Neuropsychiatric symptoms of multiple sclerosis: state of the art. Psychiatry Investig 2019 Dec;16(12):877-88.
doi: 10.30773/pi.2019.0106. Epub 2019 Dec 9. PMID: 31805761; PMCID: PMC6933139.
12. Gil-González I, Martín-Rodríguez A, Conrad R, et al. Quality of life in adults with multiple sclerosis: a systematic review. BMJ Open 2020;10:e041249.
13. Penley JA, Tomaka J, Wiebe JS. The association of coping to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25(6):551-603. doi: 10.1023/a:1020641400589. PMID: 12462958.
14. Snyder CR, Dinoff BL. (1999). Coping: where have you been? In CR Snyder (Ed.), Coping: the psychology of what works (pp. 3-19). New York, NY: Oxford University Press.
15. Lazarus RS, Folkman S. (1984). Stress, appraisal, and coping. New York, NY: Springer.
16. Erdelyi MH. (1979). Let’s not sweep repression under the rug: toward a cognitive psychology of repression. In JF Kihlstrom and FJ Evans (Eds.), Functional disorders of memory (pp. 355-402). New York, NY: Wiley.
17. Snyder CR. (1985). Collaborative companions: the relationship of self-deception and excuse making. In M Martin (Ed.), Essays in self-deception (pp. 35-51). Lawrence, KS: Regents Press of Kansas.
18. Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav 1980;21:219-39.
19. Bandura A. (1997). Self-efficacy: the exercise of control. New York, NY: W. H. Freeman.
20. Wood SE, Wood ERG. (2002). The world of psychology (4th ed.). Boston, MA: Allyn and Bacon.
21. Lazarus RS, DeLongis A. Psychological stress and coping in aging. Am Psychol 1983;38:245-53.
22. Montel S, Spitz E, Bungener C. Coping strategies in multiple sclerosis patients with frontal cognitive disorders. Eur Neurol 2012;68:84-8.
23. Aldwin CM, Park CL. Coping and physical health outcomes: an overview. Psychol Health 2004;19(3):277-81.
24. Pakenham KI, Stewart CA, Rogers A The role of coping in adjustment to multiple sclerosis-related adaptive demands. Psychol Health Med 1997;2(3):197-211.
25. Goretti B, Portaccio E, Zipoli V, et al. Coping strategies, psychological variables and their relationship with quality of life in multiple sclerosis. Neurol Sci 2009;30:15–20. https://doi.org/10.1007/s10072-008-0009-3.
26. Aikens JE, Fischer JS, Namey M, Rudick RA. A replicated prospective investigation of life stress, coping, and depressive symptoms in multiple sclerosis. J Behav Med 1997;20(5):433-45. doi: 10.1023/a:1025547431847. PMID: 9415854.
27. McCabe MP, McKern S, McDonald E. Coping and psychological adjustment among people with multiple sclerosis. J Psychosom Res 2004;56(3):355-61.
28. Pakenham KI. Adjustment to multiple sclerosis: application of a stress and coping model. Health Psychol 1999;18(4):383–92. https://doi.org/10.1037/0278-6188.8.131.523.
29. Devy R, Lehert P, Varlan E, Genty M, Edan G. Improving the quality of life of multiple sclerosis patients through coping strategies in routine medical practice. Neurol Sci 2015;36(1):85-90. doi: 10.1007/s10072-014-1900-8. Epub 2014 Jul 27. PMID: 25064233.
30. Montel SR, Bungener C. Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis. Mult Scler 2007;13:393-401.
31. Endler NS, Parker JDA. (1992). Coping with Health Injuries and Problems (CHIP) manual. North Tonawanda, NY: Multi-Health Systems.
32. Gontkovsky ST, Nakase-Richard R. (2006). Rehabilitation outcome measures. In Herndon RM (ed.). Handbook of neurologic rating scales (2nd ed., pp. 397-424). New York, NY: Demos.
33. Endler NS, Courbasson CMA, Fillion L. Coping with cancer: the evidence for the temporal stability of the French-Canadian version of the Coping with Health Injuries and Problems (CHIP). Pers Individ Dif 1998;25: 711-17.
34. Endler NS, Parker JDA, Summerfield LJ. Coping with health problems: developing a reliable and valid multidimensional measure. Psychol Assess 1998;10:195-205.
35. Hadjistavropoulos HD, Asmundson GJ, Norton GR. Validation of the Coping with Health, Injuries, and Problems scale in a chronic pain sample. Clin J Pain 1999;15(1):41-9. doi: 10.1097/00002508-199903000-00007. PMID: 10206566.
36. Karademas EC, Zarogiannos A, Stravodimos K, Gyftopoulos A, Konstadinides K. The adaptation of the Coping with Health Injuries and Problems Scale to a sample of Greek patients: validity issues. Hellenic J Psychol 2010;7(2):159–79.
37. Scherer RF, Wiebe FA, Luther DC, Adams JS. Dimensionality of coping: factor stability using the Ways of Coping Questionnaire. Psychol Rep 1988;62:763-70.
38. Kehler MD, Hadjistavropoulos HD. Is health anxiety a significant problem for individuals with multiple sclerosis?J Behav Med 2009;32,150. https://doi.org/10.1007/s10865-008-9186-z.
39. Beck AT, Steer RA, Brown GK. (1996). Beck Depression Inventory-Second Edition manual. San Antonio, TX: The Psychological Corporation.
40. Wang Y-P, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry 2013;35(4):416-31. https://doi.org/10.1590/1516-4446-2012-1048.
41. Watson TM, Ford E, Worthington E, Lincoln, NB. Validation of mood measures for people with multiple sclerosis. Int J MS Care 2014;16(2):105–9. https://doi.org/10.7224/1537-2073.2013-013.
42. Beck AT, Steer RA. Beck Anxiety Inventory manual. San Antonio, TX: The Psychological Corporation.
43. Bardhoshi G, Duncan K, Erford BT. Psychometric meta-analysis of the English version of the Beck Anxiety Inventory. J Couns Dev 2016;94(3):356-73.
44. Hewitt, P. L., & Norton, G. R. The Beck Anxiety Inventory: a psychometric analysis. Psychol Assess 1993;5(4):408–12.
45. Diener E, Emmons RA, Larsen RJ, et al. The Satisfaction with Life Scale. J Pers Assess 1985;49:71-5.
46. Lucas-Carrasco R, Sastre-Garriga J, Galán I, Den Oudsten BL, Power MJ. Preliminary validation study of the Spanish version of the Satisfaction with Life Scale in persons with multiple sclerosis. Disabil Rehabil 2014;36 (12):1001-5.
47. Bamer AM, McMullen K, Deutsch A, et al. Linking scores on the 4- and 5-item versions of the Satisfaction with Life Scale in people with traumatic brain, spinal cord, or burn injury: a National Institute on Disability, Independent Living, and Rehabilitation Research Model System study. J Patient Rep Outcomes 2021;5:59.
48. Derogatis LR. (2000). Brief Symptom Inventory 18: administration, scoring, and procedures manual. Bloomington, MN: Pearson.
49. Derogatis LR., Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med 1983;13(3):595-605.
50. Meachen S-J, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the Brief Symptom Inventory-18 in persons with traumatic brain injury. Arch Phy M Rehab 2008;89:958-65.
51. Franke GH, Ankerhold A, Haase M, et al. The usefulness of the Brief Symptom Inventory 18 (BSI-18) in psychotherapeutic patients. Psychotherapie, Psychosomatik, Medizinische Psychologie 2011;61:82-86. doi: 10.1055/s-0030-1270518. PMID: 21337286.
52. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46(10):1121-3.
doi: 0.1001/archneur.1989.00520460115022. PMID: 2803071.
53. Herndon RM, Greenstein JI. Multiple sclerosis and demyelinating diseases. In Herndon RM (ed.). Handbook of neurologic rating scales (2nd ed., pp. 169-193). New York, NY: Demos.
54. Mills R, Young C, Nicholas R, Pallant J, Tennant A. Rasch analysis of the Fatigue Severity Scale in multiple sclerosis. Mult Scler 2009;15(1):81-7.
doi: 10.1177/1352458508096215. Epub 2008 Aug 28. PMID: 18755824.
55. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental State’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
56. Folstein MF, Folstein SE, Fanjiang G. (2000). Mini-Mental State Examination: clinical guide. Lutz, FL: Psychological Assessment Resources.
57. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-mental State Examination by age and educational level. JAMA 1993;269(18):2386-91.
58. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatrics Soc 1992;40(9): 922-35.
59. Gontkovsky ST. Influence of IQ in interpreting MMSE scores in patients with multiple sclerosis. Aging Neuropsychol Cognition, 2014;21(2):214-21.
60. Gontkovsky ST. Screening cognition during inpatient rehabilitation: a comparison of the Mini-Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in classifying global impairment. Functional Neurology, Rehabilitation, and Ergonomics 2014;4(1):3-11.
61. Aupperle RL, Beatty WW, Shelton Fde N, Gontkovsky ST. Three screening batteries to detect cognitive impairment in multiple sclerosis. Mult Scler 2002;8(5):382-9.
doi: 10.1191/1352458502ms832oa. PMID: 12356204.
62. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444-52.
63. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013;310:
64. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Am Psychol 2002;57:1060-73.
65. Torgersen J, Flaatten H, Engelsen BA, Gramstad A. (2012). Clinical validation of Cambridge Neuropsychological Test Automated Battery in a Norwegian population. J Behav Brain Sci 2012;2:108-16.
66. Jean VM, Paul RH, Beatty WW. Psychological and neuropsychological predictors of coping patterns by patients with multiple sclerosis. J Clinical Psychology. 1999 Jan;55(1):21-26. DOI: 10.1002/(sici)1097-4679(199901)55:1<21::aid-jclp2>3.0.co;2-b. PMID: 10100828.
67. Kaufman, DM (2001). Clinical neurology for psychiatrists (5th ed.). Philadelphia, PA: WB Saunders.
68. Gontkovsky ST. Using CHIP coping strategies to guide cognitive-behavioral treatment of depression and anxiety during acute inpatient rehabilitation: a case study of a patient with paraplegia. J Phys Med Rehabil 2019;1(1):05. Doi: 10.36879/JPMR.19.000005.