The Relationship Between Career Thoughts and Adjustment for Individuals With Multiple Sclerosis

Abstract

The study investigated the relationship between the psychosocial adjustment and dysfunctional career thoughts for adults with multiple sclerosis. The Reactions to Impairment and Disability Inventory measured psychosocial adjustment, and the Career Thoughts Inventory measured dysfunctional career thoughts. The results found that (a) higher levels of depression were associated with higher levels of decision-making confusion and commitment anxiety and (b) higher levels of adjustment were associated with lower levels of decision-making confusion. Rehabilitation counselor implications are discussed.

Keywords

counseling career/vocational adjustment to disability(ies)

Multiple sclerosis (MS) is a disease involving a normal immune system response that causes demyelination to the central nervous system. There are approximately 250,000 to 400,000 individuals with MS in the United States with about 200 new cases diagnosed each week (National Institute of Neurological Disorders and Stroke, 2015; National Multiple Sclerosis Society, 2015). The prognosis for individuals with MS is uncertain with approximately 80% experiencing a relapsing–remitting course where relapses are followed by remissions with primary progressive, progressive relapsing, secondary progressive courses accounting for the other 20% (National Multiple Sclerosis Society, 2015; Noseworthy, Lucchinetti, Rodriguez, & Weinshenker, 2000).

A diagnosis of MS requires the individual to adjust to a variety of symptoms and stressful psychosocial issues. For example, individuals with MS experience both physical and psychological challenges such as fatigue, numbness, sexual dysfunction, memory problems, depression, and anxiety (Alschuler, Ehde, & Jensen, 2013; Amato, Zipoli, & Portaccio, 2006; Dennison, Moss-Morris, & Chalder, 2009; Hartoonian, Turner, Terrill, Beier, & Day, 2015; National Multiple Sclerosis Society, 2015; Rabinowitz & Arnett, 2009; Simmons, Tribe, & McDonald, 2010). Because onset typically occurs when an individual is of employment age (National Multiple Sclerosis Society, 2015), the person must consider the impact of the multiple sclerosis on their ability to meet the demands of their current job. This will require individuals to examine alternative employment options more consistent with their physical abilities and a potential reduction in workload. Examining how their diagnosis of MS affects these employment options and career decisions is often stressful and can be dynamic in nature (Simmons et al., 2010). Career decisions are often stressful because the individual must make important decisions involving conflicting emotions with each potential career option having an important consequence on the individual’s life (Reardon, Lenz, Sampson, & Peterson, 2000; Sampson, Peterson, Lenz, Reardon, & Saunders, 1996).

An important factor that has a high potential to affect the career decision-making process is the individual level of adjustment. While other studies have investigated the relationship between dysfunctional career thoughts and psychological constructs (e.g., Lustig, Zanskas, & Strauser, 2012; Strauser, Lustig, & Ciftci, 2008), no study has investigated the relationship between psychosocial adjustment and dysfunctional career thoughts for individuals with MS.

Because career thoughts are cognitively mediated, one’s cognition is an important factor that affects vocational development and career decision making (Lustig & Strauser, 2003; Sampson et al., 1996; Sampson, Reardon, Peterson, & Lenz, 2004; Strauser, Lustig, Keim, Ketz, & Malesky, 2002). The Cognitive Information Processing (CIP; Sampson et al., 2004) approach provides a theoretical framework for understanding career interventions that focus on cognition as a central aspect of the career decision-making process. Research provides support and individuals vocational behavior is cognitively mediated and influenced by the interaction between once for occasional cognitions, behaviors, and environment (Bertoch, Lenz, Reardon, & Peterson, 2014; Galles & Lenz, 2013; Keller, Briggs, & Gysbers, 1982; Kleiman et al., 2004). Individuals who verbalize negative or dysfunctional statements regarding the career decision-making process tend to experience a greater difficulty in engaging in career problem solving or may choose to avoid making necessary career decision altogether (Sampson et al., 2004). The CIP approach to career counseling has been used with individuals with disabilities to assist in securing the cognitive, affective, and behavioral skills necessary to make effective career decisions (Dipeolu, 2007; Dipeolu, Reardon, & Sampson Burkhead, 2002; Painter, Prevatt, & Welles, 2008). The development of the CIP approach posits that individuals have dysfunctional clear thoughts regarding the of making career decisions as indicated by difficulty (a) initiating or maintaining the career decision-making process because of affective barriers and difficulty in understanding how to make a decision and (b) committing to a career choice because of the anxiety about potential outcomes or difficulty relating to managing the complexity of career decision making is indicated by (c) problems effectively integrating the opinions of others with regard to their career decision. These three dysfunctional career thoughts are identified as decision-making confusion, commitment and anxiety, and external conflict (Sampson et al., 1996; Sampson et al., 2004).

Dysfunctional career thoughts have been associated with psychosocial adjustment problems. Research has provided strong support for the relationship between dysfunctional career thoughts and tendencies toward perfectionism and overgeneralization, communication apprehension, fear of commitment to a relationship, ruminative thought patterns, anxiety, depression, and lower levels of psychological well-being, self-worth, and sense of coherence (Austin, Dahl, & Wagner, 2010; Judge & Locke, 1993; Lustig & Strauser, 2002; Lustig et al., 2012; Meyer-Griffith, Reardon, & Hartley, 2009; Newman, Fuqua, & Seaworth, 1989; Pavindy, Bullock, Reardon, & Kelly, 2008; Serling & Betz, 1990; Walker & Peterson, 2012). There is a particularly strong relationship between problems making career decisions and depression (Gadassi, Waser, & Gati, 2015; Lustig et al., 2012; Rottinghaus, Jenkins, & Jantzer, 2009; Saunders, Peterson, Sampson, & Reardon, 2000; Smith & Betz, 2009). For example, Rottinghaus et al. (2009) found that in college students who were undecided about their careers more likely to be depressed. Walker and Peterson (2012) found that depression symptoms were associated with career indecision in dysfunctional career thoughts. In a study involving college students, dysfunctional career thoughts were related to increased career and life stress (Bullock-Yowell, Peterson, Reardon, Leierer, & Reed, 2011). Finally, Dipeolu et al. (2002) found that higher levels of psychosocial adjustment were related to lower levels of decision-making confusion, commitment and anxiety, external conflict, and overall dysfunctional career thoughts.

Research has also focused on the relationship between disability status in dysfunctional career thoughts. While some research support a nonsignificant relationship between disability status and dysfunctional career thoughts (Dipeolu et al., 2002; Strauser et al., 2002) other research has found a significant relationship (Lustig et al., 2012; Strauser, Lustig, & Uruk, 2004, 2006; Strauser, Wagner, Wong, & O’Sullivan, 2013). Although the extant research provides evidence that there is a relationship between dysfunctional career thoughts and psychological problems, the research investigating the relationship between disability status and dysfunctional career thoughts is equivocal.

Individuals with MS experienced a number of significant adjustment problems related to the diagnosis ongoing impact of the illness (McCabe & Battista, 2004). Depression and anxiety are more prevalent in individuals with MS relative to individuals without MS (Dalton & Heinrichs, 2005; Hartoonian et al., 2015; Kinsinger, Lattie, & Mohr, 2010). Individuals with MS experience stress related to (a) family disruption and caregiver burden, (b) cognitive limitations, (c) the quality of relationships, (d) illness uncertainty, and (e) pessimism (Amato et al., 2006; Bambara, Turner, Williams, & Haselkorn, 2014; Bowen, MacLehose, & Beaumont, 2011; Dennison et al., 2009; Jones & Amtmann, 2014; McNulty, Livneh, & Wilson, 2004). Individuals with MS also experienced the range of work-related problems such as higher rates of unemployment (Rumrill, Koch, & Wohlford, 2013). Research regarding postdiagnosis employment has found that the main reasons people with MS leave work are (a) lower work capacity related to symptoms, specifically fatigue, problems with legs or feet, memory and concentration problems, balance and heat sensitivity; (b) stress related to required work and effort; and (c) a doctor’s advice to leave employment (McCabe & Battista, 2004; Simmons et al., 2010). One consequence of leaving employment is that the individual must often make difficult career decisions.

There is evidence that individuals with MS adjust over time. While Irvine, Davidson, Hoy, and Lowe-Strong (2009) found that the initial diagnosis cause negative reactions including the Nile, concealment and diminished confidence, 5 years later, they were more social and optimistic but also likely to be unemployed, experience problems related to dependency, and feel most people did not understand their disease. Other studies found that, over time, global quality-of-life improved and anxiety decreased (Hartoonian et al., 2015; McCabe, Stokes, & McDonald, 2009). Finally, in a study investigating the psychosocial consequences of MS, 9 years after the initial diagnosis, most individuals with MS had adjusted and found benefits associated with her illness such as improved relationships with others and an increased appreciation for life (Mohr et al., 1999).

Livneh and Antonak (1990) described the adjustment process is a series of reactions to the onset of the disability. Within this framework, five nonadaptive and two adaptive reactions were identified (Livneh & Antonak, 1990). Nonadaptive reactions included (a) shock, defined as psychic numbness to the onset of the impairment; (b) anxiety, defined as an alarm response to the initial trauma; (c) depression, defined as a grief response with associated feelings of helplessness and hopelessness; (d) internalized anger, defined as a self directed feelings of resentment and dislike; and (e) externalized anger, defined as other directed anger. Adaptive reactions included knowledge meant, defined as the intellectual acceptance of that future implications of the disability, and adjustment, defined as emotional acceptance of the disability into one’s self-concept (Livneh & Antonak, 1990).

Based on CIP theory and Adjustment theory, it is thought that the adaptive stages of psychosocial adjustment would result in lower levels of dysfunctional career thoughts and the nonadaptive stages of psychosocial adjustment would result in higher levels of dysfunctional career thoughts. Specifically, the following research questions will guide this study:

Research Question 1: What is the impact of adaptive stages of psychosocial adjustment (acknowledgment, adjustment) and nonadaptive stages of psychosocial adjustment (shock, anxiety, depression, internalize anger, externalize hostility) on the decision-making confusion dimension of dysfunctional career thoughts?

Research Question 2: What is the impact of adaptive stages of psychosocial adjustment (acknowledgment, adjustment) and nonadaptive stages of psychosocial adjustment (shock, anxiety, depression, internalize anger, externalize hostility) on the commitment anxiety dimension of dysfunctional career thoughts?

Research Question 3: What is the impact of adaptive stages of psychosocial adjustment (acknowledgment, adjustment) and nonadaptive stages of psychosocial adjustment (shock, anxiety, depression, internalize anger, externalize hostility) on the external conflict dimension of dysfunctional career thoughts?

Method

Participants

The participants for this study were 94 individuals with MS who were at least 18 years old. Participants ranged in age from 22 to 63 (M = 44.0; SD = 10.9), with 16% (n = 15) between ages 22 and 30, 48% (n = 45) between ages 31 and 50, and 36% (n = 34) older than 50. Most participants were female (87%; n = 82). Most participants were married (52%; n = 49) with 30% (n = 28) single, and 18% (n = 17) separated, widowed, or unidentified. Most respondents were Caucasian (84%; n = 79) with 14% (n = 13) African American, and 2% (n = 2) Asian. Seventy-five percent had completed either a bachelor’s or graduate degree (n = 71), while 11% (n = 10) had completed junior college or vocational school, and 14% (n = 13) had a high school diploma. The age of onset of the MS ranged from 14 to 56 years of age (M = 33.4; SD = 9.9). The number of years since onset of MS ranged from less than one to 36 (M = 8.9; SD = 9.4).

Instruments

Career Thoughts Inventory (CTI)

The CTI (Sampson et al., 1996) is based on a CIP theoretical approach to career development and career services (Peterson, Sampson, & Reardon, 1991) and a cognitive therapy approach to mental health and mental health services (Beck, 1976; Beck, Rush, Shaw, & Emery, 1979). For the purposes of the instrument, career thoughts are defined as outcomes of one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plans, and/or strategies related to career problem solving and decision making. The CTI consists of 48 items and produces three construct scales: (a) the decision-making confusion scale measures the extent to which an individual’s emotions or lack of decision-making skill knowledge interferes with his or her ability to make a career decision, (b) the commitment anxiety scale measures the impact anxiety has on a person’s ability to commit to a career decision, and (c) the external conflict scale measures how well the person utilizes input from others and his or her self-perception in decision making. Respondents used a 4-point rating scale with responses ranging from 0 (Strongly Disagree) to 3 (Strongly Agree). Examples of items are as follows: (a) No field of study or occupation interests me at this time (decision-making confusion), (b) the views of important people in my life interfere with choosing a field of study or occupation (external conflict), (c) I’m afraid of overlooking an occupation (commitment anxiety). Summing the items yields a total score. For the purposes of the current study, the CTI-total was not used for analysis. Evidence of the validity of the CTI is provided by Sampson et al. (1996). Principal components analysis provided support for three factors, specifically, decision-making confusion, commitment anxiety, and external conflict. Correlations between the four scales of the CTI and measures of similar constructs (i.e., My Vocational Situation, Career Decision Scale, Career Decision Profile, and Revised NEO Personality Inventory) provide support for the convergent validity of the CTI. Finally, the CTI scores were significantly different between college students seeking career services and students not seeking career services, providing evidence of the criterion-related validity of the CTI. According to the CTI test manual (Sampson et al., 1996), internal consistency reliability coefficients have been reported between .90 and .94 for decision-making confusion, .79 and .91 for commitment anxiety, and .74 and .81 for external conflict. In the present study internal consistency reliability coefficients of .94 for decision-making confusion, .89 for commitment anxiety, and .79 for external conflict were found.

Reactions to Impairment and Disability Inventory (RIDI)

The RIDI (Livneh & Antonak, 1990) is a 60-item multidimensional scale measuring personal reactions to the onset of a physical disability (Livneh & Antonak, 1991). The RIDI consists of eight scales, specifically, shock (seven items), anxiety (eight items), denial (seven items), depression (eight items), internalized anger (seven items), externalized hostility (eight items), acknowledgment (seven items), and adjustment (eight items). The denial scale was not used in the present study. Each item is rated on a 4-point scale, with 1 = never (reaction is never experienced), 2 = rarely (reaction is seldom experienced, one to four times per month), 3 = sometimes (reaction is occasionally experienced, five to 10 times per month), and 4 = often (reaction is frequently experienced, 10 or more times per month). Each scale had a range of 7 to 28 for the 7-item scales (e.g., shock, denial, external hostility, and acknowledgment) and 8 to 32 for the 8-item scales (e.g., anxiety, depression, internal anger, and adjustment). For each scale, a higher score indicates a more frequent reaction. For example, a higher shock scale score indicates a higher frequency of a shock reaction and a higher acknowledgment scale score indicates a higher frequency of an acknowledgment reaction. Responses to the items for each scale are added to provide a global scale score. The scales of the RIDI were related to a hypothesized temporal structure where nonadaptive reactions were related to chronicity and nonadaptive reactions were experienced more often in the past than present (Livneh & Antonak, 1991). Factor analytic techniques also provide support for the scale structure (Livneh & Antonak, 1997). Internal consistency reliability coefficients (Cronbach’s α) for each scale have been reported, with coefficients of shock = .75, anxiety = .73, depression = .78, internalized anger = .74, externalized hostility = .79, acknowledgment = .77, and adjustment = .85 (Livneh & Antonak, 1997). In the present study, the following internal consistency reliability coefficients were found: shock = .79, anxiety = .80, depression = .86, internalized anger = .83, externalized hostility = .72, acknowledgment = .72, and adjustment = .85.

Procedures

Participants completed a survey consisting of demographic questions, the RIDI (Livneh & Antonak, 1990), and the CTI (Sampson et al., 1996). Data collection involved completion of an online survey posted to the National Multiple Sclerosis Society’s website. Individuals with MS who were at least 18 years of age were invited to participate. Participants were informed that their participation was voluntary, that all data collected would be confidential, and that they were free to withdraw at any time without penalty. In addition, participants were informed that responses were collected on a secure network. One hundred twenty individuals completed the survey. Twenty-one surveys were unusable because of a large number (>5%) of incomplete responses. The remaining 99 surveys contained complete responses. Five surveys were eliminated because the respondents were above age 65 and assumed to be out of the labor market. The total sample used for analysis was 94.

Statistical Analysis

Given that the variables of primary interest were all continuous, scatterplots were used to verify the linear relationship between subscales of career thoughts (i.e., decision-making confusion, external conflict, and commitment anxiety) and measures of psychosocial adjustment (i.e., shock, anxiety, depression, internalized anger, externalized hostility, acknowledgment, and adjustment). Once their linear relationships were confirmed (the 21 scatterplots were omitted due to space limitation), the bivariate relations between the two groups of variables were then quantified using Pearson correlations (see Table 1). Next, a multivariate analysis of variance (MANOVA) was conducted to examine whether career thoughts varied for individuals of different demographic characteristics (gender, age, and level of education). The demographic factors that contributed significantly to differences in career thoughts would be included as control variables in the subsequent analysis.

Table 1.

Descriptive Information.

Information type	Minimum	Maximum	M	SD
Age	22	63	44.03	10.994
Level of education	3.0	6.0	4.9	1.0
DMC	14.0	46.0	23.2	7.9
Z (DMC)	14.1	34.5	20.0	5.0
CA	10.0	31.0	19.1	5.7
Z (CA)	12.0	30.5	20.0	5.0
EC	5.0	16.0	8.4	2.9
Z (EC)	14.2	33.1	20.0	5.0
Shock	7.0	25.0	14.2	4.2
Z (shock)	11.4	33.0	20.0	5.0
Anxiety	8.0	27.0	14.1	4.7
Z (anxiety)	13.4	33.8	20.0	5.0
Depression	8.0	30.0	15.7	5.3
Z (depression)	12.8	33.4	20.0	5.0
Internalized	8.0	29.0	13.6	4.4
Z (internalized)	13.6	37.6	20.0	5.0
Externalized	7.0	24.0	11.9	3.6
Z (externalized)	13.2	36.8	20.0	5.0
Acknowledgment	7.0	27.0	20.5	4.0
Z (ACK)	3.1	28.2	20.0	5.0
Adjustment	8.0	32.0	24.9	5.2
Z (ADJ)	3.9	26.8	20.0	5.0

Note. Z = variables standardized with M = 20, SD = 5; DMC = decision-making confusion; CA = commitment anxiety; EC = external conflict.

After the preliminary analysis, linear multiple regression was used to examine how nonadaptive and adaptive stages of psychosocial adjustment influenced individuals’ career decision making in detail, and provide answers to the research questions. Three models of identical structure were constructed, one for each of the three outcome measures (decision-making confusion, external conflict, and commitment anxiety). In all three models, the five nonadaptive stages of psychosocial adjustment and the two adaptive stages of psychosocial adjustment (acknowledgment and adjustment) were entered simultaneously along with control variables. Because the CTI and RIDI have different response scales and varying numbers of items measuring the subscales, all dependent and independent variables were standardized with a mean of 20 and standard deviation of 5 to make the variable relationships more comparable across models (Hinkle, Wiersma, & Jurs, 2003). In other words, the values of mean and standard deviation were chosen to approximate the distributions of the original subscale scores and to aid easier interpretation of statistical findings. Note that alpha = .05 was used in all tests of significance throughout the analysis.

Results

The descriptive information of the original and standardized variables is available in Table 1. The linear correlations between variables, as shown in Table 2, provide a descriptive summary of the bivariate relationships. The three subscales of CTI had relatively strong correlations (0.60–0.76); similarly, the subscales measuring nonadaptive stages in RIDI had Pearson correlations ranging between 0.54 and 0.74. These values provided evidence of internal consistency among the subscales as well as support of convergent validity. In the meantime, the low and/or negative correlations between nonadaptive and adaptive subscales were evidence of discriminant validity. It is important to note that the moderate but significant correlations (the majority were between 0.30 and 0.50, with a level of significance at .01) between CTI and RIDI subscales suggested a pattern that those with maladaptive adjustment is related to stronger CTI dysfunction, whereas those with better adaptive adjustments appeared to exhibit low CTI dysfunction, indicating potential relationships that are worth further investigation.

Table 2.

Pearson Correlations Between Dependent and Independent Variables.

Variable	1	2	3	4	5	6	7	8	9
1. DMC
2. CA	.76**
3. EC	.60**	.70**
4. Shock	.43**	.27**	.32**
5. Anxiety	.24*	.16	.27*	.69**
6. Depression	.59**	.39**	.35**	.74**	.58**
7. Anger	.43**	.26*	.30**	.59**	.54**	.67**
8. Hostility	.36**	.26*	.34**	.67**	.64**	.60**	.60**
9. Acknowledgment	−.22*	.02	.02	.03	.05	−.16	−.05	.38**
10. Adjustment	−.51**	−.18	−.23*	−.31**	−.24*	−.51**	−.35**	.26*	.54**

Note. DMC = decision-making confusion; CA = commitment anxiety; EC = external conflict.

*p < .05. **p < .01.

Results of the MANOVA model with decision-making confusion, external conflict, and commitment anxiety as the dependent variables indicated there were no significant gender, F(1, 88) = 1.073; p = .365, and age, F(1, 88) = 1.245; p = .298, differences in career thoughts. Nonetheless, individuals of different educational levels had significant differences in decision-making confusion (p = .003). The Box’s M test of covariance had a p = .02, suggesting the homogeneity of covariance was in question. Nonetheless, the MANOVA served only as a preliminary step to identify potential control variables; given the strong significance, education were to be included as a control variable in subsequent regression analysis.

Using nonadaptive and adaptive stages as independent variables, three regression models of identical structured were constructed, one with each of the three CTI subscales as the dependent variable. All values of the Variance Inflation Factor (VIF) were lower than 5, indicating that the three models were free of multicollinearity. In addition to linearity, analysis of residuals also suggested the models met the assumptions normality and homoscedasticity. Details of the three regression models are presented in Table 3. Among the nonadaptive stages of psychosocial adjustment, depression appeared to be the most influential factor with regard to respondents’ career thoughts, significantly increasing their levels of decision-making confusion (β = .41, p = .007) and commitment anxiety (β = .44, p = .016) even with all other nonadaptive and adaptive stages of psychosocial adjustment controlled for. Moreover, adjustment (β = −.26, p = .023) as an adaptive stage of psychosocial adjustment significantly contributed to reducing individuals’ decision-making confusion.

Table 3.

Linear Regression Models With Power Analysis.

	Z (DMC)			Z (CA)			Z (EC)
	Model 1^a	Partial R²	Estimated power	Model 2^b	Partial R²	Estimated power	Model 3^c	Partial R²	Estimated power
Intercept	−0.167			−1.514			−0.924
Education	−0.092	.012	0.18	−0.042	.002	0.07	−0.073	.005	0.10
Z (shock)	0.016	.004	0.09	−0.007	<.001	<0.06	0.008	.001	0.06
Z (anxiety)	−0.043	.037	0.47	−0.028	.011	0.17	−0.003	<.001	<0.06
Z (depression)	0.082**	.082	0.82	0.088*	.067	0.73	0.027	.007	0.13
Z (internalized)	0.007	.001	0.06	−0.001	<.001	<0.06	0.003	<.001	<0.06
Z (externalized)	0.020	.008	0.14	0.016	.003	0.08	0.034	.015	0.22
Z (ACK)	0.001	<.001	<0.06	0.023	.010	0.16	0.025	.012	0.18
Z (ADJ)	−0.052*	.059	0.67	−0.006	<.001	<0.06	−0.031	.014	0.21

Note. DMC = decision-making confusion; CA = commitment anxiety; EC = external conflict; ACK = acknowledgment; ADJ = adjustment.

R² = .435, p < .001. ^bR² = .173, p < .034. ^cR² = .170, p < .038.

p < .05. **p < .01.

Four nonadaptive stages of psychosocial adjustment measures, including shock, anxiety, internalized anger, and externalized hostility, and the adaptive stage of acknowledgment, were found not to be related to the respondents’ career thoughts in any significant manner, which appeared to be inconsistent with the patterns shown in the correlations in Table 2. The inconsistency can be explained from two perspectives. First, Pearson correlations presented in Table 2 measure bivariate relationship, whereas the regression coefficients measure the partial correlation, which is the strength of association between the independent and dependent variables with other independent variables controlled for. For instance, anger did not contributed significantly to decision-making confusion because their covariance was largely accounted for by another variable in the model—depression. Second, the power of the study was severely limited by the small sample size (n = 94) and a model using eight independent variables. As shown in Table 3, only the three cases of significance had a power greater than .60; in comparison, 20 of the total of 24 tests (8 × 3) of significance had a power lower than .25.

Based on the values of model R², the stages of psychosocial adjustment explained a substantial amount of variance in decision-making confusion (approximately 44%), and more limited, but still significant, amount of variance in commitment anxiety (approximately 17%) and external conflict (approximately 17%). All three model R²s are statistically significant, with an estimated power of .99 in all three cases. The significant amounts of variances explained in the regression models indicated that psychosocial adjustment has significant impact on an individuals’ dysfunctional career thoughts, particularly on decision-making confusion, with depression having the most significant influence on the individuals’ capability to make career decisions.

Discussion

This study focused on the impact of adjustment to disability on dysfunctional career thoughts, specifically, decision-making confusion, commitment anxiety, and external conflict. It was thought that the nonadaptive stages of psychosocial adjustment (shock, anxiety, depression, internalized anger, and externalized hostility) would result in higher levels of dysfunctional career thoughts and the adaptive stages of psychosocial adjustment (acknowledgment, adjustment) would result in lower levels of dysfunctional career thoughts. First, the results found that higher levels of depression were associated with difficulty regarding the capability of making career decisions as indicated by higher levels of decision-making confusion and commitment anxiety. Second, higher levels of adjustment were associated with lower levels of decision-making confusion. Third, the nonadaptive stages of psychosocial adjustment, including shock, anxiety, internalized anger, and externalized hostility, and one adaptive reaction, acknowledgment, were not related to the respondents’ career thoughts. Thus, as expected, the relationships between depression, decision-making confusion and commitment anxiety and the relationship between adjustment and decision-making confusion was supported. The expected relationships between the remaining nonadaptive stages of psychosocial adjustment and acknowledgment were not supported.

The present study is supported by the extant literature. For example, Lustig et al. (2012) found a positive relationship between commitment anxiety and depression in a sample of adults with disabilities. In a sample of undergraduates, Walker and Peterson (2012) also found a positive relationship between decision-making confusion and commitment anxiety, and depression. The Lustig et al. study also found a relationship between external conflict and depression, which the present study did not. Other studies (Gadassi et al., 2015; Rottinghaus et al., 2009; Saunders et al., 2000; Smith & Betz, 2009) provide support for the relationship between career decision-making difficulty and depression. In a study investigating the relationship between psychosocial adjustment and dysfunctional career thoughts, college students with learning disabilities measuring higher in psychosocial adjustment measured lower in decision-making confusion (Dipeolu et al., 2002). While Dipeolu found a relationship between adjustment and commitment anxiety and external conflict, the present study did not.

An important finding of this study is that for individuals with MS, depression appears to have a unique impact on one’s capability (decision-making confusion and commitment anxiety) of making career decisions but not on issues related to complexity (external conflict). This finding is important because it suggests that for this group of individuals, depression is affecting the individual’s ability to engage in the cognitive processes necessary to process career information and take actionable steps necessary in the career decision-making process. One possible explanation for this finding is that the onset of MS usually occurs after an individual is established in a career and as a result the individual’s postdiagnosis focus may be primarily directed at job retention or changing jobs to meet one’s residual functional capacity. The focus on job retention, change, and potential loss is likely amplified by the episodic nature of MS and the uncertainty regarding exacerbations and the associated residual physical and mental depreciation impact on current job demands. In contrast, managing issues related to family and significant others do not appear to be affected, and this may stem from age of onset typically occurring after significant personal and social relationships have been developed.

Rehabilitation Counselor Implications

Two conclusions can be made with respect to the results. First, higher levels of depression, defined as grief response with associated feelings of helplessness and hopelessness, were associated with individuals whose emotions or lack of decision-making skill knowledge interfered with their ability to make a career decision (decision-making confusion) and who experienced anxiety concerning committing to a career decision (commitment anxiety). Depression can lead to errors in thinking that affect the ability to make effective career decisions. Counselors can consider utilizing cognitive restructuring to assist the client in recognizing and changing career thoughts that negatively affect the ability to make effective career decisions (Saunders et al., 2000). When assisting an individual with MS in making an effective career decision, the rehabilitation counselor should also consider the psychosocial adjustment of the client. If a client seeks assistance with making a career decision and is experiencing depression, the rehabilitation counselor should consider addressing the depression prior to working on making a career decision.

Second, because adjustment contributed to reducing an individuals’ decision-making confusion, focusing on the level of adjustment of the client may be beneficial when assisting the client in making an effective career decision. Adjustment is defined as the emotional acceptance of the disability into one’s self-concept. The results suggest that difficulty emotionally integrating the disability into ones sense of themselves interferes with their ability to think clearly about making a career decisions. As a result, discussing this aspect of the client’s adjustment may improve the client’s clarity with respect to making a career decision.

Limitations

First, this study utilized an ex post facto design. A limitation of ex post facto designs is the difficulty determining a causal link between variables. Second, because the study utilized a convenience sample there is uncertainty regarding a difference between respondents and nonrespondents with respect to the study variables. Finally, because the participants completed the survey online, it is possible that the participants were different than most individuals with MS (e.g., better educated). One method to examine nonresponse bias is to compare early to late respondents with late respondents acting as proxies for nonrespondents (Lineback & Thompson, 2010). Using the chi-square statistic for gender, ethnicity, education, and marital status and t tests for age and age of onset, no differences were found between early and late respondents. With respect to the generalizability of the present study, the sample consisted of 87% female and 84% Caucasian respondents. National studies indicate that individuals with MS are more likely to be female and Caucasian (National Multiple Sclerosis Society, 2015).

Future Research

The current study is a preliminary investigation into the relationship between adjustment and dysfunctional career thoughts. Additional research in the following areas is warranted. First, only one of the adaptive reactions was significant. While adjustment, the emotional acceptance of the disability, was found to be significant, the intellectual acceptance of one’s disability did not show a significant relationship to dysfunctional career thoughts. Replication of this finding would be important. If the finding were supported, it would have important implications for rehabilitation counselors with respect to the impact of adjustment on career decision making. Second, the current study did not measure the functional effect of the MS. It may be that the level of severity of the client’s condition mediates the relationship between adjustment and dysfunctional career thoughts. Finally, the current study involved respondents who were not currently in career counseling. Research could focus on whether the relationship between the study’s variables would hold when the participants were in active career counseling with a rehabilitation counselor.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

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