title: Being in- or out-of-sync: couples' adaptation to change in multiple sclerosis.
abstract: OBJECTIVE
  To examine how couples adapt to the challenges of multiple sclerosis (MS) and to identify possible risk factors for relational stress.
  
  
  METHODS
  Semi-structured interviews were conducted with eight couples to explore how participants defined and identified the strengths and challenges in their relationship, negotiated role changes and received external support. Conceptual frameworks on how families adapt to chronic illness guided within and across case analyses. We identified patterns in the couples' current responses to the demands and stressors of MS.
  
  
  RESULTS
  Two patterns of adaptation to MS were identified as being 'in-sync' or 'out-of-sync'. Characteristics of the four couples currently in-sync included having a relapsing-remitting type of MS, which proceeded at a pace that enabled both partners to maintain their social roles and identity, and a collaborative problem solving style. The four couples currently out-of-sync had a rapid progression of MS, loss of employment before retirement age, differences in personal styles that shifted from being complementary to oppositional in the face of increased demands and struggles with parenting adolescent children.
  
  
  CONCLUSIONS
  Clinicians can use these data to assess possible relational strain in couples with MS and identify families who might benefit from referrals to family therapy or other relational support.
authors.affiliation: Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA 98195-7120, USA. tigiba@u.washington.edu
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Megan A
authors.initials: MA
authors.lastname: Morris
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Yorkston
authors.forename: Robin F
authors.initials: RF
authors.lastname: Gray
authors.forename: Kurt L
authors.initials: KL
authors.lastname: Johnson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D012307:Risk Factors; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological