Couples Coping With End-Stage Cancer: The Influence of Attachment, Emotional Support, and Positive Meaning on Psychological Adjustment and Each Other

Abstract

This thesis was concerned with the psychological adjustment of 67 end-stage cancer patients, and three psychosocial variables considered to influence that adjustment: emotional support from spouse, positive meaning, and working models of attachment. Furthermore, this thesis was also concerned with the psychological adjustment of the patients' spouses, and the influence of emotional support from patient and working models of attachment on their adjustment. It was hypothesised that each of these psychosocial variables would directly influence the psychological adjustment of patients and spouses, measured using the negative affectivity scale of the Positive and Negative Affect Scale (PANAS). Furthermore, it was hypothesised that emotional support would influence positive meaning, and working models of attachment would influence both emotional support and positive meaning. Variables were measured via paper and pencil self-report inventories, with the exception of positive meaning, where verbal responses to an open question were coded. Univariate analyses indicated an association between patients' and spouses' emotional support provided by one another and their psychological adjustment. Univariate results also showed that patients' positive meaning was related to patients' psychological adjustment, and that patients' working models of attachment involving higher levels of attachment anxiety were associated with patients' poorer psychological adjustment. All these individual associations remained statistically significant after three control variables related to the patients' physical condition were taken into account. In addition, univariate analyses indicated that attachment was associated with emotional support, and that emotional support was associated with positive meaning. Following univariate analyses, variables were integrated into one model for patients and another for spouses using path analyses. Results were generally consistent with the prior sets of analyses. However, patients' working models of attachment involving higher levels of attachment anxiety no longer had a direct effect on patients' psychological adjustment to statistically significant levels. Rather, the influence of the working models of attachment on patients' psychological adjustment was mediated by emotional support. In addition, patients' positive meaning no longer had a significant direct effect on patients' psychological adjustment. The insignificant path coefficients between attachment anxiety and psychological adjustment, and between positive meaning and psychological adjustment, were attributed to the large amount of variance in negative affect due to emotional support. In summary, this research indicates that emotional support given and received between patients and spouses is important to the psychological adjustment of each party. Furthermore, emotional support influences patients' ability to construe positive meaning in their illness, although positive meaning does not appear to be as critical to the psychological adjustment of patients as emotional support. Working models of attachment influence the psychological adjustment of patients primarily through their influence on emotional support.