The Relationship Between Multi-Process Integrative Self-Regulation, Sense of Coherence, and Levels of Disability in Patients with Multiple Sclerosis

 Multiple Sclerosis (MS) is an inflammatory autoimmune, and progressive disease associated with the inflammation of the central nervous system due to demyelination. Despite the numerous biological investigations about MS patients by Iranian researchers; however, only a few studies have addressed disability in patients with MS, mainly focusing on its physical aspects, not the psychological ones. Further, some studies outlined a significant association between psychological resources and physical functions in patients with MS. The multi–process model of integrative self–regulation and sense of coherence has formulated two sets of integrative, psychological resources. The present study aimed to investigate the associations of integrative self–regulation processes, including integrative self–knowledge, self–control, self–compassion, mindfulness, and sense of coherence dimensions, including comprehensibility, manageability, and meaningfulness, with disability in patients with MS.

 The present cross–sectional, analytical, and the fundamental study was conducted in 2019 in various service centers for patients with MS in Tehran and Qom Cities, Iran. The study population included patients with MS living in Tehran and Qom. The statistical sample included 452 patients with MS living in Tehran and Qom. The study's inclusion criteria included the definitive and documented diagnosis of MS by a neurologist, aged 18 to 60 years, the ability to communicate in Persian effectively, and providing informed consent forms. Patients who underwent psychotherapy during the study, whose diagnosis of MS was not definitive, developed obvious cognitive and mental disabilities, underwent spinal anesthesia or general anesthesia surgery over the past month. Severe and chronic comorbidities (e.g., psychotic disorders & cancer illness) and for the past 6 months were involved in divorce/separation, and the loss of first–degree relatives was excluded from the study. A convenience sampling method was used for data collection. The sample was gathered via a multi–center approach to reach a representative sample. The required data were collected by Determined Disease Stages (PDDS) (Learmonth et al., 2013), Orientation to Life Questionnaire–13 (OLQ–13) (Antonovsky, 1987), Integrative Self–knowledge Scale (ISK) (Qorbani et al., 2008), Brief Self–Control Scale (BSCS) (Tangney et al., 2004), Self–Compassion Scale–Short Form (SCS–SF) (Raes et al., 2011), and Mindfulness Attention Awareness Scale (MAAS) (Brown e& Ryan, 2003. Statistical analysis at two levels of descriptive statistics (including mean, standard deviation, frequency, & percentage) and inferential statistics (including Pearson correlation test & hierarchical multiple regression tests) was performed in SPSS.

 The obtained results revealed that disability with meaningfulness in life (r= 0.10, p<0.05), integrative self–knowledge (r=–0.13, p<0.01), self–control (r=–0.12, p<0.01) and self–compassion (r=–0.12, p<0.05) indicated a marginally significant relationship. In predicting disability, in addition to the contextual variables of age (β=0.35, p<0.001) and gender (β=0.24, p<0.001), only the self–compassion (β=–0.17, p=0. 007) played a predicting role.

 The disability of MS may not be associated with a severe reduction in integrative psychological resources, as opposed to other studies. However, future studies with longitudinal and intervention designs to investigate the causal relationships and patient benefit can target integrative self–regulation processes, especially compassion for patients themselves.