Perceived Uncertainty, Spiritual Well-Being, and Psychosocial Adaptation in Individuals With Multiple Sclerosis Kristy McNulty, Hanoch Livneh, and Lisa M. Wilson Portland State University Objective: To examine the role of spiritual well-being as a mediator and moderator between perceived uncertainty and psychosocial adaptation to multiple sclerosis (MS). Participants and Design: Fifty individuals (40 women, 10 men) diagnosed with multiple sclerosis. Main Outcome Measures: Self- report measures on illness uncertainty, spiritual (religious and existential) well-being, and psychosocial adjustment to illness were analyzed by a series of hierarchical multiple regression analyses. Results: Both uncertainty and spiritual well-being independently predicted psychosocial adjustment to MS after the influence of demographic and disability-related variables were considered. Spiritual well-being demon- strated a mediator effect but, mostly, failed to show a moderator effect. Conclusion: Spiritual well-being exerts an appreciable influence on adaptation to MS and also acts to mitigate the impact of uncertainty on adaptation. Rehabilitation psychologists may wish to consider its beneficial role as part of their clinical work. Multiple sclerosis (MS), one of the most common disabling diseases of young adults, is an inflammatory demyelinating disor- der of the central nervous system with an estimated prevalence of about 250,000 –350,000 individuals in the United States (Devins & Shnek, 2000; Kalb, 1996; Schapiro, 1998). First symptoms usually appear at the young adult age, but the disease may also become evident later in life. The course of MS is highly variable and makes studies of etiology and possible mechanisms of treatment chal- lenging. Because of MS’s highly variable clinical course, individ- ual outcomes cannot be reliably predicted. For many individuals, MS starts with a relapsing–remitting pattern with episodic exac- erbations of neurological dysfunction, which remit completely or partially. Over the years, for most individuals, the disease develops into the secondary progressive form with accumulated disability (Lublin & Reingold, 1996). Psychosocial Correlates of MS The intrusion of MS is a highly stressful life event, with the potential of posing major challenges and obstacles to everyday functioning. Adaptation to MS requires not only an initial adjust- ment to the diagnosis of the condition, but also continuous efforts of readjustment due to the erratic nature of the symptoms (Matson & Brooks, 1977). The heterogeneous nature of MS introduces a wide array of challenges, many of which center around the stress engendered by the uncertainty and unpredictability of its course (Devins & Shnek, 2000). Associated problems, such as poor symp- tom control, fatigue, sexual dysfunction, social isolation, failed efforts to manage medical crises, unsuccessful therapy, role strains, fear of symptom exacerbation, and physical deterioration despite adherence to the medical regimen, further contribute to uncertainty and counteract attempts at successful adjustment to MS (Minden & Schiffer, 1990; Strauss et al., 1984). Research, however, has suggested that spiritual and religious variables may attenuate the impact of uncertainty on psychosocial maladjustment (Brooks & Matson, 1982; Crigger, 1996). Perceived Illness Uncertainty Certainty and predictability of outcomes are valued in Western cultures. When individuals face chronic disabling conditions that have uncertain outcomes, they search for an illusive cure for their problems to counteract system breakdown (Mishel, 1990). Per- ceived uncertainty addresses how meaning is constructed for ill- ness-related events (Mishel, 1988). As defined by Mishel (1981, 1997), it is the cognitive state created when the decision maker is unable to assign definite values to objects and events or is unable to accurately predict outcomes because sufficient cues are lacking. The subjective experience of uncertainty dominates the perceptual field when the features of the event are ambiguous, complex, unpredictable, and lack adequate information. Lazarus and Folk- man (1984) emphasized the importance of uncertainty in coping and described a coping process in which appraisal is central. They suggested that ambiguity and the resulting uncertainty can gener- ate stress and inhibit effective coping. This has lead many re- searchers and theorists to view uncertainty as one of the greatest challenges in successful adaptation to chronic illness. Indeed, research with a variety of disease states has consistently demon- strated that chronically ill individuals who experience increased levels of uncertainty report diminished levels of overall adjustment to their condition (e.g., Brashers, Neigid, Reynolds, & Hass, 1998; Mishel, Hostetter, King, & Graham, 1984; Mullins, Chaney, Pace, & Hartman, 1997; Mullins et al., 2001; Neville, 1998; Sanders- Dewey, Mullins, & Chaney, 2001). Kristy McNulty, Hanoch Livneh, and Lisa M. Wilson, Rehabilitation Counseling Program, Portland State University. Correspondence concerning this article should be addressed to Hanoch Livneh, PhD, Rehabilitation Counseling Program, Graduate School of Education, Portland State University, P.O. Box 751, Portland, OR 97207. E-mail: livnehh@pdx.edu Rehabilitation Psychology 2004, Vol. 49, No. 2, 91–99 Copyright 2004 by the Educational Publishing Foundation 0090-5550/04/$12.00 DOI: 10.1037/0090-5550.49.2.91 91