Living with multiple sclerosis

238 Pages·2006·0.77 MB·English

Care Receiving: The Relationship Between Attachment and
Reactions to Being Helped, Relationship Functioning, and
Perceived Quality of Life in a Sample of Individuals with Multiple Sclerosis

A Thesis Submitted to the College of

Graduate Studies and Research

in Partial Fulfillment of the Requirements

for the Degree of Doctor of Philosophy

in the Department of Psychology

University of Saskatchewan

Saskatoon

By
Karen Lea Litke

© Copyright Karen Lea Litke, March 2006. All rights reserved.
Attachment and Care Receiving i

PERMISSION TO USE
In presenting this thesis in partial fulfillment of the requirements for a
Postgraduate degree from the University of Saskatchewan, I agree that the Libraries of
this University may make it freely available for inspection. I further agree that
permission for copying of this thesis in any manner, in whole or in part, for scholarly
purposes may be granted by the professor or professors who supervised my thesis work
or, in their absence, by the Head of the Department or the Dean of the College in which
my thesis work was done. It is understood that any copying or publication or use of this
thesis or parts thereof for financial gain shall not be allowed without my written
permission. It is also understood that due recognition shall be given to me and to the
University of Saskatchewan in any scholarly use which may be made of any material in
my thesis.
Requests for permission to copy or to make other use of material in this thesis in
whole or part should be addressed to:
Head of the Department of Psychology
University of Saskatchewan
Arts Building, Room 154
9 Campus Drive
Saskatoon, SK
S7N 5A5
Attachment and Care Receiving ii
ABSTRACT
In healthy adult relationships both participants serve as attachment figures and
caregivers, with each partner seeking and providing care for the other as needed (Hazan
& Shaver, 1987). However, chronic illness may result in one individual requiring
disproportionately more care without being able to fully reciprocate. The purpose of
this research was to investigate the relevance of attachment as a predictor of care
receiving, relationship, and health related variables, in a sample of adults experiencing a
chronic illness. This investigation employed survey methodology, and 68 individuals
with Multiple Sclerosis (MS) participated. Hierarchical multiple regression analyses
supported theoretically derived hypotheses. Attachment, conceptualized in terms of the
orthogonal constructs of attachment anxiety and attachment avoidance, was found to be
a relevant construct in predicting self-reported reaction to care receiving, relationship
functioning and quality of life in a sample of individuals with MS. Analyses revealed
that elevated attachment anxiety is associated with feelings such as anger,
embarrassment, and indebtedness in response to receiving help, while elevated
attachment avoidance predicted care receiver perceptions that they were being
discouraged from continued independence. In terms of relationship functioning, care
receivers with elevated attachment anxiety and care receivers with elevated attachment
avoidance reported less trust, acceptance, and intimacy in their relationships, and were
less committed to their relationships and their relationship partners. Additionally,
elevated attachment avoidance was predictive of lower overall relationship satisfaction.
Finally, elevated attachment anxiety predicted poorer mental health and overall quality
of life, while elevated attachment avoidance predicted poorer physical health.
Interactions between attachment constructs and type of caregiver (spouse/partner vs.
other) were observed in several analyses suggesting that attachment anxiety exerts its
strongest influence within committed relationships, whereas the power of attachment
avoidance appears to be generally more pervasive. The results of this investigation can
be understood within the context of the biopsychosocial model of coping with chronic
illness. Knowledge of attachment style may be clinically useful as it provides insight
Attachment and Care Receiving iii
into individuals’ behaviour and emotional experiences in relationships. Attachment-
informed interventions may lead to improvement in relationships and subsequent
improvement in psychological functioning and physical heath.
Attachment and Care Receiving iv
ACKNOWLEDGEMENTS

I would like to thank my faculty supervisor, Margaret Crossley for her personal
and financial commitment to this research. Throughout this long endeavor, Margaret’s
support and encouragement have been steadfast. I am especially grateful for her
organizational skills and attention to detail (qualities which I strive to develop in
myself), which contributed substantially to the quality of this dissertation and helped
ensure this project came to completion.
I am also very grateful for having an exceptional doctoral committee and wish to
thank Karen Lawson, Debra Morgan, Dorothy Forbes, and Margaret McKim, for giving
generously of their time, and expertise. Special thanks are extended to Karen Lawson,
for her assistance with data analyses. Thanks also to Heather Hadjistavropoulos for
serving as my external examiner. The seriousness with which she approached the task
and the diligence with which she read my document were obvious.
I also extend my thanks to the MS society of Canada: Saskatchewan Division,
and Alberta Division, Edmonton Chapter, and to all the individuals who volunteered
their time to participate in this research.
This research was partially funded by the Community University Institute for
Social Research. I am grateful that this organization, with its focus on community
based, quality of life research, saw potential in me and this investigation.
I would also like to thank Sunrise Health Region for acknowledging the
importance of education by allowing me time to finish this dissertation, and to members
of the Child and Youth team at Mental Health Services for their encouragement and
support.
Attachment and Care Receiving v
DEDICATION
This dissertation is dedicated to the members of my family, all of whom have
given much to see this task completed.
To my husband Darrell. Thank you for taking this journey with me. Thank you
for staying up late and getting up early, just to spend extra time with me. Thank you for
the many little things you do each day, which have made it easier for me to focus on my
academics, and for rearranging your life to help me achieve my goals. Thank you for
reminding me of the things that are really important and for infusing our life with
laughter. I could not have been successful without your love, encouragement and
endless, unquestioning support.
To my children Liam, Nikolas, and Gabriella. Thank you for being an endless
source of inspiration, love and affection. You are each, already, my greatest
achievements, and always will be. As this document marks the end of one phase of my
life, I look forward to having more time in which to be present in your lives.
To my parents, Marilyn and Oscar Ostmoen. Thank you for encouraging me to
pursue my goals and for believing in me so I could believe in myself. Thank you for all
the practical and emotional support you have given me without expectation and for your
patience over my many years of education. Thank you for always being there for me no
matter what, because you always have been. Without you, and all that you have done
for me, given me, and instilled in me I would not be the person I am today, and could
never have successfully completed my doctoral work. Thank you.
Finally, I would like to dedicate this work to all the friends who have shared this
journey with me, their contribution to my life, and the completion of this project cannot
be underestimated. While all are important, I want to make special mention of Tara
Turner. Tara has been an unfailing support, both practically and emotionally, and she
continues to inspire me.
Attachment and Care Receiving vi
TABLE OF CONTENTS

PERMISSION TO USE ..................................................................................................... i

ABSTRACT........................................................................................................................ii

ACKNOWLEDGEMENTS..............................................................................................iv

DEDICATION....................................................................................................................v

TABLE OF CONTENTS..................................................................................................vi

LIST OF TABLES.............................................................................................................xi

LIST OF FIGURES..........................................................................................................xv

1. GENERAL INTRODUCTION TO THE THEORETICAL ORIENTATION
AND PURPOSE OF THIS INVESTIGATION.....................................................1
2. ATTACHMENT THEORY .7
2.1 The Foundations of Attachment Theory .......................................................7
2.1.1 John Bowlby.......................................................................................7
2.1.2 Mary Ainsworth .9
2.1.2 Theoretical Development.1
2.1.2 Empirical Foundations.....................................................................16
2.2 Fundamentals of Attachment Theory..........................................................19
2.2.1 The Biological and Evolutionary Foundations of Attachment......19
2.2.1.1 Control Systems Theory .....................................................21
2.2.2 The Attachment Bond ........................................................................22
2.2.3 Working Models.25
2.3 Attachment Style ..........................................................................................26
2.3.1 Secure Attachment Style.....................................................................27
2.3.2 Avoidant Attachment Style................................................................27
2.3.3 Anxious/ambivalent Attachment Style .............................................28
2.3.4 Disorganized/disoriented Attachment Style .....................................29
2.4 The Development of Attachment ................................................................30
Attachment and Care Receiving vii
3. ADULT ATTACHMENT AND CLOSE RELATIONSHIPS.......................... 33
3.1 Conceptualizing Love as an Attachment Process .................................... 34
3.2 The Relevance of Attachment to Individuals in Close Relationships...... 42
3.3 Measuring Attachment ................................................................................43
3.4 Attachment and Relationship Functioning............................................... 46
3.4.1 Attachment and Relationship Satisfaction
in Maried Individuals.47

3.4.2 Attachment and Relationship Satisfaction
in Dating Relationships....................................................................48

3.4.3 Additional Research Findings
Relevant to Attachment in Close Relationships.............................49

3.4.4 Attachment and Relationship Satisfaction
in Adult Friendships .........................................................................51
3.5 Attachment and Affect regulation............................................................ 52
3.6 Conceptualizing Attachment: A matter of type or dimensions? ............. 54
4. CAREGIVING .60
4.1 Caregiving and Atachment . 61
4.1.1 Attachment and Caregiving in the Context of Health Decline..... 66
5. CARE RECEIVING.68
5.1 Attachment Style and Care Receiving.........................................................68
5.2 Care Receiving in the Context of Health Decline ................................... 70
5.2.1 Attachment and Care Receiving
in the Context of Health Decline ................................................. 74
5.2.1.1 The Biopsychosocial Model ........................................... 74
5.2.1.2 Attachment and Care Receiving in the
Context of Health Decline: Theoretical Connections.................. 77
6. MULTIPLE SCLEROSIS ................................................................................. 78
6.1 What is MS? ............................................................................................ 78
6.2 Disease Classifications and Symptoms ................................................... 80
6.3 Coping with MS ...................................................................................... 81
6.3 Quality of Life Research in MS............................................................... 84
Attachment and Care Receiving viii
7. THE CURRENT STUDY: RATIONALE AND HYPOTHESES .................... 86
7.2 Reaction to Care Receiving ..................................................................... 86
7.3 Reaction to Caregiving ............................................................................ 88
7.4 Relationship Functioning. 89
7.5 Perceived Quality of Life ........................................................................ 91
7.5.1. Individuals with MS . 91
7.5.2 Caregivers. 92
8. METHODS. 94
8.1 Participants . 94
8.2 The Survey Instrument ............................................................................ 94
8.2.1 Section 1 - The impact of MS on Quality of Life........................ 95
8.2.1.1 Multiple Sclerosis Quality of Life – 54
and Rand 36-Item Short Form Health Survey ............... 95
8.2.1.2 Coping with Multiple Sclerosis Scale ............................ 99
8.2.2.3 Coping with MS Caregiving Index............................... 101
8.2.2 Section 2 - Relationship Characteristics.................................... 103
8.2.2.1 Experiences in Close Relationships Inventory (ECR).. 103
8.2.2.2 Relationship Rating Form............................................. 103
8.2.3 Section 3 - Accepting Help / Caregiving................................... 106
8.2.3.1 Reactions to Being Helped ........................................... 108
8.2.3.2 The Zarit Burden Interview.......................................... 108
8.2.4 Section 4 - General Participant information.............................. 109
9. RESULTS AND DISCUSSION...................................................................... 109
9.1 Sample Characteristics . 109
9.1.1 Survey Response . 109
9.1.2 Mising Data. 109
9.1.3 Demographics. 110
9.1.4 Attachment . 111
9.1.5 Close Relationships . 113
9.2 Analysis of the Dependent Measures .................................................... 114
9.3 Care Receiving . 116
Attachment and Care Receiving ix
9.3.1 Reliability of Care Receiving Scales......................................... 116
9.3.2 Preliminary Analysis of Care Receiving Data........................... 117
9.3.3 Analysis of Care Receiving Scales............................................ 119
9.3.3.1 Specific Reactions to Help and Indebtedness............... 120
9.3.3.2 Appropriateness, Sufficiency and Helping Intentions.. 122
9.3.3.3 Self Esteem Reactions to Help ..................................... 125
9.3.3.4 Discouragement of Independence ................................ 127
9.3.3.5 Encouragement of Dependence.................................... 129
9.3.3.6 Overprotection.............................................................. 130
9.3.9. Discussion of the Care Receiving Analyses.............................. 133
9.4 Relationship functioning in the Sample of Individuals with MS .......... 140
9.4.1 RRF Viability . 143
9.4.2 RRF Intimacy . 144
9.4.3 RRF Pasion . 146
9.4.4 RRF Care . 147
9.4.5 RRF Commitment . 148
9.4.6 RRF Conflict/Ambivalence . 150
9.4.7 RRF Global Satisfaction............................................................ 152
9.4.8. Discussion of Relationship Functioning Analysis..................... 153
9.5 Quality of Life ....................................................................................... 157
9.5.1 MSQoL-54 Physical Health Composite .................................... 159
9.5.2 MSQoL-54 Mental Health Composite ...................................... 160
9.5.3 MSQoL-54 Overall Quality of Life........................................... 161
9.5.4 Coping with Multiple Sclerosis Scale ....................................... 162
9.5.5 Discussion of Quality of Life Analyses..................................... 164
9.6 Caregiving . 167
9.6.1 Results and Discusion . 167
9.7 Care Receiver-Caregiver Couples ......................................................... 172
9.7.1 Results and Discusion . 172