Alexithymia and Illness Perceptions in Persons With Multiple Sclerosis and Their Partners: a dyadic analysis.

Alexithymia and Illness Perceptions in Persons With Multiple Sclerosis and Their Partners: a dyadic analysis. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Alexithymia and Illness Perceptions in Persons With Multiple Sclerosis and Their Partners: a dyadic analysis. Maria Luca, Antonina Luca, Francesco Patti, Guillermo Perez Algorta, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4535061/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Oct, 2024 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Background Illness perceptions (IPs) encompass opinions regarding the nature, severity and curability of a disease. The aim of this cross-sectional study was to investigate the association between alexithymia and IPs among persons with multiple sclerosis (PwMS) and their partners, as well as within the dyads composed of PwMS and partners. Methods PwMS referred to the Multiple Sclerosis Center of the University Hospital “Policlinico-San Marco” from 11th August 2021 to 7th January 2022 and their partners completed a battery of questionnaires, including the Toronto Alexithymia Scale-20 and the Illness Perception Questionnaire Revised. A dyadic data analysis (Actor-Partner Interdependence Model) was performed to test the effect of alexithymic traits both on a person’s own illness perceptions (actor effect) and on the partner’s illness perceptions (partner effect). Results 100 PwMS (71 women; mean age 47.6 ± 10.4 years) and 100 partners (29 women; mean age 49.1 ± 10.8 years), with a mean partnership duration of 20.1 ± 11.7 years, were enrolled. At the dyadic analysis, statistically significant small-to-moderate actor and partner effects were found considering alexithymia (total score and alexithymic facets) and IPs, whereby higher alexithymic traits related to higher negative perceptions (i.e. consequences, emotional representations) and lower positive ones (i.e. coherence, treatment control). Conclusion Our findings support the relationship between alexithymia and negative illness appraisals. This data may inform therapeutic interventions aimed at reducing alexithymic traits, which in turn may reduce negative, and potentially dysfunctional, illness perceptions. Biological sciences/Neuroscience Biological sciences/Psychology illness perceptions alexithymia multiple sclerosis dyad spouse Introduction Individuals with a medical condition construct personal appraisals of their illness. Such appraisals, namely “illness perceptions” (IPs), pertain to several aspects (i.e. consequences, emotional burden) and impact the individuals’ adaptation to the disease [ 1 – 2 ]. Previous studies have reported an association between alexithymia, defined as a deficit of emotional awareness, and negative IPs (e.g. higher consequences, concern) in several medical conditions, including cancer and dermatological disorders [ 3 – 4 ]. However, to date, there are no studies testing the link between alexithymia and illness appraisals in Persons with Multiple Sclerosis (PwMS). This is surprising, since a crucial theme arising from the PwMS’ accounts of their lived experience pertains to “making sense” of their bodily sensations which, in turn, requires efficient body awareness [ 5 ], typically impaired by alexithymia [ 6 ]. Alexithymia is common among PwMS [ 7 ], thus deserving special attention in this population. Indeed, MS is a challenging disease from a physical, emotional and interpersonal point of view [ 8 ], thus requiring adaptive efforts that alexithymic persons might find it more difficult to make. In fact, alexithymia alters the understanding of one’s own bodily sensations [ 9 ], impairs emotional processing [ 10 ] and favors conflictual interpersonal communications [ 11 ]. In light of this, alexithymia could impact on various aspects (physical, emotional, interpersonal) of MS, thus representing a good candidate for being associated with IPs not only at the individual, but also at the dyadic level. Qualitative data consistently indicate fear and shock as common emotions following diagnosis among PwMS and their caregivers [ 8 ]. Considering that caregivers also hold beliefs regarding MS, they could potentially influence the PwMS’s view of the condition. According to the cognitive-transactional model (CTM) of couples’ adaptation of chronic illness, making sense of the illness and effective communication within the couple are crucially important for dyadic coping [ 12 ]. Building upon this model, and somewhat expanding it, this study hypothesizes alexithymia as a possible barrier to both making sense of the illness and effective communication within the couple. To the best of our knowledge, this is the first study focusing on the impact of alexithymic traits on IPs from a dyadic perspective, in any clinical condition. The aims of this cross-sectional study were: 1) investigate the possible association between alexithymic traits and IPs among PwMS and their partners (actor effects); 2) explore the possible association between alexithymic traits and IPs within the couples (dyads) composed of PwMS and their partners (partner effects), while investigating the effect sizes (ES) of the actor and partner effects of alexithymic traits in accordance with the Actor-Partner Interdependence Model (APIM). Methods Study population Persons with multiple sclerosis PwMS referred to the Multiple Sclerosis Center of the University Hospital “Policlinico-San Marco” from 11th August 2021 to 7th January 2022 were invited to participate. Inclusion criteria were: men and women aged ≥ 18 years with a diagnosis of relapsing-remitting MS according to the revised McDonald diagnostic criteria [ 13 ]; Expanded Disability Status Scale (EDSS) [ 14 ] between 2 to 5.5; Montreal Cognitive Assessment (MoCA) ≥ 26 [ 15 ]; being a cohabiting partner, willingness to participate in the study of both members of the couple. Exclusion criteria were: current MS flare up, history of recent attack (< 3 months); concomitant neurological diagnosis of any type, current psychiatric and/or psychological treatments. Partners Cohabiting partners (men and women aged ≥ 18 years) of the person with relapsing-remitting MS were invited to participate. Inclusion criteria were Montreal Cognitive Assessment (MoCA) ≥ 26 [ 15 ] and willingness to participate in the study of both members of the couple. Exclusion criteria were: current psychiatric and/or psychological treatments. Sample size Previous studies investigating the impact of alexithymia on IPs from an individual perspective suggested medium-to-large effect sizes ( d = 0.6–0.7) [ 3 – 4 , 16 ]. Building on the available data, an online calculator (retrieved from https://robert-a-ackerman.shinyapps.io/apimpower/ ) for power analysis for the APIM was used. In order to detect an actor effect with 80% power ( α = 0.05) expecting a medium ES ( d = 0.6), the number of dyads required was 90–100. Assessment Instruments The following questionnaires were administered: 1) Illness Perception Questionnaire Revised, IPQ-R section II, belief scale [ 17 ]: it consists of 38 statements requiring an answer ranging from 1 (“strongly disagree”) to 5 (“strongly agree’’). These statements address seven different IPs dimensions, namely acute/chronic timeline, cyclical timeline, coherence (understanding of the disease), consequences, emotional representations (emotional burden), personal control and treatment control. Higher scores indicate stronger beliefs in relation to the specific dimension. When interpreting the scores, one can empirically attach positive (functional) characteristics to personal control, treatment control and coherence, since they express confidence and optimism towards the illness, and negative (dysfunctional) characteristics to emotional representations and consequences, since they allude to the illness-related suffering and impact in everyday life. The partners completed a version adapted for their use [ 18 ]. All IP dimensions addressed in section II were considered in the descriptive statistics, so as to comprehensively characterize the sample. However, timeline acute/chronic and cyclical were excluded from further analyses. Indeed, not mobilizing any particular coping strategy, timeline may have a limited clinical value [ 19 ]. 2) Toronto Alexithymia Scale-20, TAS-20 [ 20 ]: this 20-items most used self-administered questionnaire for alexithymia consists of three subscales: difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally-oriented thinking (EOT). Every item can be answered through a Likert scale, from 1 (“completely disagree”) to 5 (“completely agree”). 3) Patient Health Questionnaire 4, PHQ-4 [ 21 ]: it is an ultra-brief 4-items composed of the first two items of the Generalized Anxiety Disorder–7 scale (GAD–7) and the Patient Health Questionnaire-8 (PHQ-8), respectively addressing anxious and depressive symptoms. 4) Dyadic Adjustment Scale, DAS [ 22 ]: this is a self-report questionnaire composed of 32 items investigating different aspects of marital quality through the following subscales: dyadic satisfaction (happiness for the relationship), dyadic consensus (agreement on different topics), dyadic cohesion (participating together in activities) and dyadic affectional expression (agreement regarding the expression of feelings). In addition, a DAS total score can be obtained, whereby higher values indicate higher quality of the relationship for both subscales and total score. 5) Multiple Sclerosis Impact Scale-29 version 2, MSIS-29v2 [ 23 ] (administered only to PwMS): this is a 29-item self-report measure of the psycho-physical impact of MS, whereby higher values indicate worse health. Demographic data were recorded for both PwMS and their partners. The EDSS score [ 14 ] was calculated for PwMS. Statistical Analysis Data were analyzed with the Statistical Package for the Social Sciences, version 28. We cleaned the data by considering range and consistency checks. Continuous data (e.g. age, education) were expressed as mean and standard deviation, categorical variables (e.g. sex, work) as number and percentage. Scale scores comparisons between PwMS and partners at the TAS-20 (total score and subscales) and the IPQ-R (all the seven dimensions) questionnaires were performed using t-test analyses. The relationship between TAS-20 with IPQ-R scores in both PwMS and partners was tested using Pearson’s correlations. A dyadic data analysis was then performed in accordance to the APIM [ 24 ], implying the nonindependence of couple data, whereby a variable (predictor) of one member of the dyad can affect the outcome of the other member and vice versa. The analytic method adopted to conduct the dyadic analysis was that of multilevel linear modeling, MLM [ 24 ], advancing the idea of data structure as having multiple levels (level I is the person, level II is the dyad within which the person is nested). To evaluate if alexithymia was associated with illness perceptions in PwMS and their partners, both the effect of the person’s own alexithymic traits [actor effect] and the effect of their partner’s alexithymic traits [partner effect] on IPs were estimated. As the dyads are distinguishable due to their role (PwMS vs caregiver), both actor effects and partner effects were obtained for each member of the couple. More specifically, different statistical models separately including each alexithymic feature (DDF, DIF, EOT or TAS-20 total score) as predictor and each IP dimension (coherence, consequences, emotional representations, personal control or treatment control) as outcome were run. All APIM models (unadjusted and adjusted for possible confounders) were tested in R through an opensource online software interface (retrievable from https://davidakenny.shinyapps.io/APIM_MM/ ). The statistical significance level was set at a p value < 0.05. Results One hundred and sixty potentially eligible PwMS were invited to participate from 11th August 2021 to 7th January 2022. Twenty-eight were not eligible. Of the 132 persons meeting the inclusion criteria, 22 declined participation and 10 did not complete the questionnaires. The final sample consisted of 100 PwMS (71 women; mean age 47.6±10.4 years; education 11.4±3.7 years; 44 employed) and 100 partners (29 women; mean age 49.1±10.8 years; 73 employed) with a mean partnership duration of 20.1±11.7 years. PwMS had a disease duration of 10.5±8.5 years. EDSS was 2.8±1.1. The DAS and the PHQ-4 total scores in the whole sample were respectively 107.3±17.2 and 4.4±3.2 (Supplemental Table 1). Considering the perceived impact of MS (MSIS-29 v2) among PwMS, the physical subscale was 32.3±22 and the psychological one was 41.5±25.4. PwMS presented a statistically significant higher TAS-20 total score and DIF sub-scale than their partners (Supplemental Table 2). As for IPs, PwMS presented statistically significant higher levels of perception of illness-related consequences and lower illness coherence than their partners (Supplemental Table 3). Concerning the relationship between alexithymia and IPs, a statistically significant negative correlation was found between TAS-20 total score and coherence (in both PwMS and partners), as well as between TAS-20 total score and treatment control (partners only). On the contrary, a significant positive correlation was found between TAS-20 total score and emotional representations (in both PwMS and partners). Moreover, TAS-20 total score showed a significant positive correlation with consequences among partners only (Supplemental Table 4). Concerning the dyadic analysis, both actor (the relationship of the person’s own alexithymia with their own IPs) and partner (the relationship of the alexithymia of one dyad member with the IPs of the other member) effects were detected when considering alexithymic traits as predictors of IPs, as detailed below. In a model with DDF as a predictor of IPs , this alexithymic feature showed statistically significant correlations with coherence, consequences and emotional representations. Full details are shown in Table 1. Coherence (actor effect) A statistically significant actor effect was observed in both groups (PwMS r = -.290, p = .003; partners r = -.390, p <.001) for coherence, whereby an increase in DDF correlated with a reduction of coherence. Consequences (actor effect) A statistically significant actor effect was observed (among partners only) for consequences, whereby an increase in DDF related to an increase in consequences ( r = .265, p = .007). Emotional representations (actor effect + partner effect) A statistically significant actor effect was observed in both groups (PwMS r = .325, p <.001; partners r = .319, p = .001) for emotional representations, whereby an increase in DDF correlated with an increase of emotional representations. Moreover, a statistically significant partner effect was observed, whereby an increase of DDF in the partners correlated with higher emotional representations in PwMS ( r = .265, p = .007). See Table 1. Table 1. APIM model, predictor: Difficulty Describing Feeling ROLE EFFECT ESTIMATE 95%CI p-value Beta-value r ES IPs’ dimensions Coherence PwMS Actor -.263 -.436 to -.091 .003 -.298 -.290 Small Partner .012 -.158 to .182 .894 .013 .014 / Partners Actor -.336 -.494 to -.178 < .001 -.380 -.390 Medium Partner -.032 -.192 to .129 .698 -.036 -.039 / Consequences PwMS Actor .133 -.054 to .320 .165 .134 .140 / Partner .125 -.059 to .309 .185 .126 .134 / Partners Actor .270 .074 to .466 .007 .273 .265 Small Partner -.037 -.236 to .162 .715 -.038 -.037 / Emotional representations PwMS Actor .409 .172 to .647 <.001 .331 .325 Medium Partner .323 .089 to .556 .007 .261 .265 Small Partners Actor .369 .150 to .587 .001 .298 .319 Medium Partner -.149 -.371 to .072 .188 -.121 -.133 / Personal control PwMS Actor -.083 -.239 to .074 .302 -.098 -.104 / Partner .036 -.118 to .190 .650 .042 .046 / Partners Actor .119 -.055 to .294 .182 .142 .135 / Partner .074 -.103 to .252 .411 .089 .083 / Treatment control PwMS Actor -.080 -.194 to .034 .173 -.130 -.137 / Partner .027 -.085 to .139 .637 .044 .048 / Partners Actor -.102 -.227 to .023 .112 -.167 -.160 / Partner -.068 -.195 to .059 .297 -.111 -.106 / Abbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p<.05. In a model with DIF as a predictor of IPs , this alexithymic feature showed statistically significant correlations with coherence, consequences, emotional representations and treatment control. Full details (including the magnitude of the effects) are shown in Table 2. Coherence (actor effect) A statistically significant actor effect was observed in both groups (PwMS r = -.295, p = .003; partners r = -.356, p <.001) for coherence, whereby an increase of DIF related to a decrease of coherence. Consequences (actor effect) A statistically significant actor effect was recorded in both groups (PwMS r = .224, p =.025; partners r = .245, p =.014) for consequences, whereby an increase of DIF correlated with an increase of consequences in PwMS and their partners. Emotional representations (actor effect) A statistically significant actor effect was detected in both groups (PwMS r = .453, p <.001; partners r = .347, p <.001) for emotional representations, whereby an increase of DIF correlated with an increase of emotional representations. Treatment control (actor effect) A significant actor effect, for partners only, was observed for treatment control, whereby an increase of DIF determined a reduction of treatment control ( r = -.328, p <.001). See Table 2. Table 2. APIM model, predictor: Difficulty Identifying Feelings ROLE EFFECT ESTIMATE 95%CI p-value Beta-value r ES IPs’ dimensions Coherence PwMS Actor -.150 -.246 to -.053 .003 -.284 -.295 Small Partner -.019 -.135 to .096 .746 -.036 -.033 / Partners Actor -.206 -.313 to -.098 <.001 -.391 -.356 Medium Partner -.054 -.144 to .035 .235 -.104 -.120 / Consequences PwMS Actor .120 .016 to .224 .025 .204 .224 Small Partner .023 -.102 to .148 .719 .039 .037 / Partners Actor .171 .036 to .305 .014 .289 .245 Small Partner .006 -.106 to .119 .912 .011 .011 / Emotional representations PwMS Actor .327 .199 to .455 <.001 .444 .453 Medium Partner .062 -.091 to .216 .426 .085 .081 / Partners Actor .273 .126 to .419 <.001 .371 .347 Medium Partner .059 -.063 to .181 .346 .080 .095 / Personal control PwMS Actor -.056 -.144 to .032 .213 -.112 -.126 / Partner .003 -.103 to .108 .959 .006 .005 / Partners Actor .033 -.088 to .154 .592 .066 .054 / Partner .030 -.071 to .131 .560 .060 .059 / Treatment control PwMS Actor -.049 -.113 to .015 .134 -.135 -.151 / Partner -.009 -.086 to .067 .809 -.026 -.025 / Partners Actor -.139 -.219 to -.060 <.001 -.383 -.328 Medium Partner -.059 -.126 to .007 .082 -.163 -.175 / Abbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p<.05. In a model with EOT as a predictor of IPs , this alexithymic feature showed statistically significant correlations with coherence, personal control and treatment control. Full details (including the magnitude of the effects) are shown in Table 3. Coherence (partner effect) A statistically significant partner effect was observed, whereby an increase of EOT in PwMS correlated with a reduction of coherence in their partners ( r = -.217, p = .030). Personal control (actor effect) A statistically significant actor effect was recorded, among PwMS only, for personal control, whereby an increase of EOT related to a decrease of personal control ( r = -.230, p = .021). Treatment control (actor effect) A significant actor effect, among partners only, was observed for treatment control, since an increase of EOT was linked to a decrease of treatment control ( r = -.234, p = .019). See Table 3. Table 3. APIM model, predictor: Externally-Oriented Thinking ROLE EFFECT ESTIMATE 95%CI p-value Beta-value r ES IPs’ dimensions Coherence PwMS Actor -.040 -.211 to .130 .644 -.049 -.047 / Partner -.055 -.228 to .118 .535 -.067 -.063 / Partners Actor -.088 -.249 to .074 .290 -.106 -.107 / Partner -.178 -.337 to -.019 .030 -.216 -.217 Small Consequences PwMS Actor -.051 -.231 to .130 .584 -.055 -.056 / Partner -.016 -.199 to .168 .868 -.017 -.017 / Partners Actor .041 -.158 to .240 .688 .044 .041 / Partner -.031 -.227 to .165 .755 -.034 -.032 / Emotional representations PwMS Actor .022 -.223 to .268 .859 .019 .018 / Partner .105 -.144 to .355 .410 .091 .084 / Partners Actor -.008 -.235 to .220 .984 -.007 -.007 / Partner .006 -.218 to .229 .961 .005 .005 / Personal control PwMS Actor -.173 -.319 to -.028 .021 -.221 -.230 Small Partner .042 -.106 to .190 .580 .053 .056 / Partners Actor -.118 -.290 to .053 .178 -.151 -.136 / Partner .031 -.138 to .200 .717 .040 .037 / Treatment control PwMS Actor -.021 -.130 to .088 .709 -.037 -.038 / Partner .000 -.111 to .111 .995 .001 .001 / Partners Actor -.143 -.262 to -.025 .019 -.252 -.234 Small Partner -.096 -.212 to .021 .110 -.168 -.161 / Abbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p<.05. Finally, in a model with TAS-20 total score as a predictor of IPs , the scale showed statistically significant correlations with coherence, consequences, emotional representations and treatment control. Full details (including the magnitude of the effects) are shown in Table 4. Coherence (actor effect) A statistically significant actor effect was observed in both groups (PwMS r = -.289, p = .003; partners r = -.384, p <.001) for coherence, whereby an increase of TAS-20 total score correlated with a decrease of coherence. Consequences (actor effect) A statistically significant actor effect was observed among partners only, whereby an increase of TAS-20 total score related to an increase of consequences ( r = .243, p = .014). Emotional representations (actor effect) A significant actor effect was recorded when considering emotional representations in both groups (PwMS r = .371, p <.001; partners r = .305, p = .002), whereby an increase of TAS-20 total score was linked to an increase of emotional representations. Treatment control (actor effect + partner effect) An actor effect was detected, among partners only, for treatment control, whereby an increase of TAS-20 total score related to a decrease of treatment control ( r = -.329, p <.001). Moreover, a statistically significant partner effect was observed, whereby an increase of TAS-20 total score in PwMS related to a decrease of treatment control in the partners ( r = -.207, p = .038). See Table 4. Table 4. APIM model, predictor: TAS-20 total score ROLE EFFECT ESTIMATE 95%CI p-value Beta-value r ES IPs’ dimensions Coherence PwMS Actor -.085 -.142 to -.029 .003 -.286 -.289 Small Partner -.009 -.071 to .052 .767 -.031 -.030 / Partners Actor -.117 -.173 to -.061 <.001 -.393 -.384 Medium Partner -.042 -.093 to .009 .110 -.141 -.161 / Consequences PwMS Actor .047 -.014 to .109 .132 .142 .152 / Partner .020 -.048 to .087 .570 .058 .058 / Partners Actor .090 .019 to .162 .014 .270 .243 Small Partner -.007 -.072 to .059 .838 -.020 -.021 / Emotional representations PwMS Actor .154 .078 to .231 <.001 .370 .371 Medium Partner .072 -.012 to .156 .093 .174 .169 / Partners Actor .129 .049 to .209 .002 .309 .305 Medium Partner .004 -.069 to .077 .917 .009 .011 / Personal control PwMS Actor -.049 -.100 to .001 .057 -.174 -.191 / Partner .010 .045 to .066 .718 .036 .037 / Partners Actor .008 -.056 to .072 .811 .028 .024 / Partner .020 -.039 to .078 .510 .069 .067 / Treatment control PwMS Actor -.029 -.066 to .009 .133 -.139 -.151 Partner .001 -.039 to .042 .944 .007 .007 Partners Actor -.074 -.116 to -.032 <.001 -.358 -.329 Medium Partner -.041 -.080 to -.002 .038 -.199 -.207 Small Abbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p<.05. Sensitivity Analysis A sensitivity analysis considering sex, EDSS and DAS total scores as covariates was performed. After adjusting, the actor effects previously observed between alexithymic traits and consequences disappeared in both groups. For all the other IPs, the majority of the actor effects were confirmed. In particular, as for DDF, the statistically significant actor effect was confirmed in both groups for coherence (PwMS r = -.271, p = .009; partners r = -.296, p = 0.002) and emotional representations (PwMS r = -.296, p = .003; partners r = -.227, p = .022). Considering DIF, the statistically significant actor effect was confirmed only in partners for coherence (r = -.278, p = .004) and treatment control (r= -.251, p= .013) and in both groups for emotional representations (PwMS r = .438, p <.001; partners r = .266, p= .007). Concerning EOT, the statistically significant actor effect among PwMS for personal control (r = -.207, p = .041) was confirmed. Finally, also for the TAS-20 total score, in both groups, the statistically significant actor effect for coherence (PwMS r = -.280, p = .006; partners r = -.288, p =.002) and emotional representations (PwMS r = .366, p <.001; partners r = .207, p = .037) were confirmed. However, the actor effect for treatment control was confirmed only in the partner group (r = -.238, p =.018). The previously found statistically significant partner effect, whereby an increase of EOT in PwMS correlated with a reduction of coherence in their partners (r = -.277, p = .006) was also confirmed. All the other previously detected partner effects were not confirmed in the sensitivity analysis. Discussion In the present study, alexithymia was found to be associated with IPs from both an individual and dyadic perspective. At the individual level, alexithymic traits were positively associated with negative IPs and negatively associated with positive ones, with small-to-medium effect sizes, in both PwMS and their partners. Interestingly, the TAS-20 total score related to almost all IPs. However, a closer look at the alexithymic facets showed peculiar trends. In particular, EOT had no impact on consequences and emotional representations, while being the only facet influencing personal control, whereby higher EOT correlated with lower personal control in PwMS. On the other hand, higher DDF and DIF were both related to higher emotional representations in PwMS and their partners. Moreover, higher DIF and DDF were related to higher consequences in both groups and among partners only, respectively. The differential impact of alexithymic traits on IPs may reflect the nature of alexithymic facets. Indeed, since DDF and DIF are usually accountable for over-responding to emotionally challenging situations [25], their relationship with higher consequences and emotional representations may indicate an exaggeratedly negative appraisal of MS. Conversely, EOT is characterized by concrete thinking, which reduces the sense of mastery over situations [26], the latter potentially explaining the negative correlation between EOT and personal control in our sample. Concerning the partner effects, alexithymic traits in a member of the couple were associated with negative IPs in the other member. More specifically, higher DDF in the partners related to higher emotional representations in the PwMS; higher TAS-20 total score in PwMS related to lower treatment control in the partners; higher EOT in PwMS related to lower coherence in the partners. These findings make sense in light of the interpersonal repercussions of alexithymia. Indeed, individuals with greater alexithymia may appear detached in emotionally charged situations [11]. Hence, their interpersonal life might be more stressful compared to other individuals [27]. In a marital context, persons with alexithymic traits may show (at various levels) lack of empathy and support [11, 28-29]. Generally speaking, the spouse of an alexithymic individual might feel restrained in showing vulnerability [30]. These considerations may help in interpreting the partner effects arising from the APIM analysis. Indeed, it is easy to envision how a PwMS with a partner presenting high DDF might experience higher MS-related emotional burden, since there is little room for sharing emotions and receiving sympathy within the couple. Interestingly, in a study investigating the relationship between alexithymia and dyadic adjustment in a community sample, a negative correlation was reported between DDF and the partner’s dyadic adjustment, with females being more affected by their partner’s emotional repression [30]. This is particularly relevant in our cohort, considering that the group of PwMS is mainly composed of females. Considering the other partner effect, higher alexithymia in PwMS related to lower perception of treatment as effective in controlling MS in their partners. Alexithymic persons (here, alexithymic PwMS) facing stressors tend to avoid uncomfortable topics of discussion (here, MS) and are likely to exhibit behavioral disengagement and denial [31]. In this context, their partners, left alone to deal with medical information, may develop a more pessimistic view of MS as a completely uncontrollable condition. Considering the finding linking higher EOT in the PwMS to lower understanding of MS (coherence) in their partners, it should be noted that externally oriented cognitive style relates to specific deficits: impaired ability to extract useful information due to lack of internal awareness, reduced perspective-taking [10] and poor reflective functioning [32]. Hence, it is apparent how high EOT may decrease the person’s ability to partake in an effective exchange of meaningful information. In particular, the reduced understanding of the emotions prompted by negative situations [10] may significantly impact the couple’s confrontation of stressful topics, ultimately hindering the formation of a clear idea of what MS is. What may seem mere speculations, acquire more value in light of the previously cited CTM, whereby the effective couple’s communication plays a crucial role [12]. Identifying alexithymia as possibly associated with IPs might enrich the already existing theoretical frameworks highlighting the importance of couple’s communication. Our findings have practical implications, encouraging the implementation of tailored psychotherapeutic interventions aimed at reducing alexithymic traits in PwMS and/or their partners, thus facilitating the shaping of functional IPs. Emotionally-focused interventions dedicated to couples may promote functional communication patterns, ultimately improving marital adjustment [33]. Our study has some limitations. Its cross-sectional design does not allow to infer causation. Moreover, due to its preliminary nature, the results are not conclusive. For example, the sensitivity analysis suggested that other aspects (i.e. relationship quality) may play a role. Indeed, it would be naive to reduce the complex mechanisms underlying the formation of IPs to a linear and monocausal process. Hence, many questions remain unanswered and further studies are recommended to disentangle the involved factors and their contribution. Declarations Ethical considerations The study was approved by the Ethics Committee of the University Hospital “Policlinico-San Marco” of Catania, Italy (protocol: 96/2021/PO) and the Faculty of Health and Medicine Research Ethics Committee of Lancaster University, UK (protocol: FHMREC20186) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All the enrolled participants provided written informed consent. Conflict of interest: the authors have nothing to declare. Financial disclosures: none. Author Contribution 1. Research project: A. Conception, B. Organization, C. Execution and design, D. Supervision. 2. Statistical analysis: A. Design, B. Execution, C. Review and critique. 3. Manuscript: A. Writing of the first draft, B. Review and Critique. ML: 1A, 1B, 1C, 2A, 2B, 2C, 3A. AL: 2C, 3B. FP: 1B, 1D, 3B. FJRE: 1A, 1D, 2A, 2C, 3B. GPA: 1A, 1D, 2A, 2C, 3B. Acknowledgments This paper is part of Maria Luca’s publicly defended thesis, conducted in the context of the Mental Health PhD program of Lancaster University (UK). Many thanks to Dr. Lorena Messina for her kind support in the recruitment phase and to the MS Centre group of the University of Catania, in particular Dr. Clara Chisari and Dr. Simona Toscano. Data Availability Research data will be preserved for 10 years in the Lancaster University Publications and Research electronic repository (PURE) but will not be made publicly available in order to not raise concerns about confidentiality for the participants, as foreseen in the research protocol and approved by the study participants. Corresponding author for any data or questions regarding the study: Dr Maria Luca. References Leventhal H, Brissette I, Leventhal EA (2003) The common sense model of self-regulation of health and illness. In: Cameron LC, Leventhal H (eds) The self-regulation of health and illness behaviour. Taylor & Francis Group, UK, pp 42–65. Luca M, Eccles F, Algorta GP, et al. (2022) Illness perceptions and outcome in multiple sclerosis: A systematic review of the literature. Mult Scler Relat Disord article 104180. https://doi.org/10.1016/j.msard.2022.104180 . Barbasio C, Vagelli R, Marengo D, et al. (2015) Illness perception in systemic lupus erythematosus patients: The roles of alexithymia and depression. Compr Psychiatry 63:88–95. https://doi.org/10.1016/j.comppsych.2015.09.004 . Larsen MH, Krogstad AL, Wahl AK (2017) Alexithymia, illness perception and self-management competency in psoriasis. Acta Derm Venereol 97:934–940. https://doi.org/10.2340/00015555-2707 . Nissen N, Lemche J, Reestorff CM, et al. (2021) The lived experience of uncertainty in everyday life with MS. Disabil Rehabil 44:5957–5963. https://doi.org/10.1080/09638288.2021.1955302 . Murphy J, Catmur C, Bird G (2018) Alexithymia is associated with a multidomain, multidimensional failure of interoception: Evidence from novel tests. J Exp Psychol Gen 147:398–408. https://doi.org/10.1037/xge0000366 . Chalah MA, Ayache SS (2017) Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 104:31–47. https://doi.org/10.1016/j.neuropsychologia.2017.07.034 . Luca M, Ortega-Castro N, Patti F (2021) Paediatric multiple sclerosis: A scoping review of patients’ and parents’ perspectives. Children article 11. https://doi.org/10.3390/children9010011 . Pollatos O, Herbert B (2018) Alexithymia and body awareness. In: Luminet O, Bagby RM, Taylor GJ (eds) Alexithymia: Advances in research, theory, and clinical practice. Cambridge University Press, UK, pp 321–333. Luminet O, Nielson KA, Ridout N (2021) Having no words for feelings: Alexithymia as a fundamental personality dimension at the interface of cognition and emotion. Cogn Emot 35:435–448. https://doi.org/10.1080/02699931.2021.1916442 . Pérusse F, Boucher S, Fernet M (2012) Observation of couple interactions: Alexithymia and communication behaviors. Pers Individ Differ 53:1017–1022. https://doi.org/10.1016/j.paid.2012.07.022 . Badr H, Acitelli LK (2017) Re-thinking dyadic coping in the context of chronic illness. Curr Opin Psychol 13:44–48. https://doi.org/10.1016/j.copsyc.2016.03.001 . Thompson AJ, Banwell BL, Barkhof F, et al. (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17:162–173. https://doi.org/10.1016/S1474-4422(17)30470-2 . Kurtzke (1983) Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 33:1444–1452. https://doi.org/10.1212/WNL.33.11.1444 . Nasreddine ZS, Phillips NA, Bédirian V, et al. (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–9. https://doi.org/10.1111/j.1532-5415.2005.53221.x . Okanli AYŞE, Karabulutlu EY, Asi Karakaş S, et al. (2018) Alexithymia and perception of illness in patients with cancer. Eur J Cancer Care 27: Article e12839. https://doi.org/10.1111/ecc.12839 . Moss-Morris R, Weinman J, Petrie K, et al. (2002) The revised illness perception questionnaire (IPQ-R). Psychol Health 17:1–16. https://doi.org/10.1080/08870440290001494 . Bassi M, Falautano M, Cilia S, et al. (2016) Illness perception and well-being among persons with multiple sclerosis and their caregivers. JCPMS 23:33–52. https://doi.org/10.1007/s10880-015-9425-8 . Bassi M, Cilia S, Falautano M, et al. (2020) Illness perceptions and psychological adjustment among persons with multiple sclerosis: The mediating role of coping strategies and social support. Disabil Rehabil 42:3780–3792. https://doi.org/10.1080/09638288.2019.1610511 . Bagby RM, Parker JD, Taylor GJ (1994) The twenty-item Toronto alexithymia scale—I. Item selection and cross-validation of the factor structure. J Psychosom Res 38:23–32. https://doi.org/10.1016/0022-3999(94)90005-1 . Kroenke K, Spitzer RL, Williams JB et al. (2009) An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics 50:613–621. https://doi.org/10.1016/S0033-3182(09)70864-3 . Spanier (1976) Measuring dyadic adjustment: New scales of assessing the quality of marriage and similar dyads. JMF 38:15–28. https://doi.org/10.2307/350547 . Hobart J, Cano S (2009) Improving the evaluation of therapeutic interventions in multiple sclerosis: The role of new psychometric methods. HTA 13:1–200. doi: https://doi.org/10.3310/hta13120 . Kenny DA, Kashy DA, Cook WL (2016) Dyadic data analysis. Guilford Press, New York. Luminet O, Nielson KA, Ridout N (2021) Cognitive-emotional processing in alexithymia: An integrative review. Cogn Emot 35:449–487. https://doi.org/10.1080/02699931.2021.1908231 . Brett G, Dubash S (2023) The sociocognitive origins of personal mastery. JHSB 64:452–468. https://doi.org/10.1177/00221465231167558 . Chen J, Xu T, Jing J, et al. (2011) Alexithymia and emotional regulation: A cluster analytical approach. BMC Psychiatry 11:1–6. https://doi.org/10.1186/1471-244X-11-33 . Bird G, Viding E (2014) The self to other model of empathy: Providing a new framework for understanding empathy impairments in psychopathy, autism, and alexithymia. Neurosci Biobehav Rev 47:520–532. https://doi.org/10.1016/j.neubiorev.2014.09.021 . Goerlich KS (2018) The multifaceted nature of alexithymia–a neuroscientific perspective. Front Psychol article 1614. https://doi.org/10.3389/fpsyg.2018.01614 . Eid P, Boucher S (2012) Alexithymia and dyadic adjustment in intimate relationships: Analyses using the actor partner interdependence model. J Soc Clin Psychol 31:1095–1111. https://doi.org/10.1521/jscp.2012.31.10.1095 . Velasco C, Fernández I, Páez D, et al. (2006) Perceived emotional intelligence, alexithymia, coping and emotional regulation. Psicothema 18:89–94. https://reunido.uniovi.es/index.php/PST/article/view/8425 . Calaresi D, Barberis N (2019) The relationship between reflective functioning and alexithymia. JCDP 1. https://doi.org/10.6092/2612-4033/0110-2107 . Izadi F, Mokhtari E (2021) The effectiveness of emotional-focused couple therapy on reducing the negative emotion schemas and alexithymia as well as increasing marital compatibility. Int J Psychol 15:225–254. https://ijpb.ir/article-1-353-en.pdf . Additional Declarations No competing interests reported. Supplementary Files SupplementalTable1.docx SupplementalTable2.docx SupplementalTable3.docx SupplementalTable4.docx Cite Share Download PDF Status: Published Journal Publication published 24 Oct, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 10 Sep, 2024 Reviews received at journal 08 Sep, 2024 Reviewers agreed at journal 29 Aug, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviews received at journal 01 Jul, 2024 Reviewers agreed at journal 24 Jun, 2024 Reviewers invited by journal 22 Jun, 2024 Editor assigned by journal 20 Jun, 2024 Editor invited by journal 09 Jun, 2024 Submission checks completed at journal 07 Jun, 2024 First submitted to journal 05 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4535061","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":317026776,"identity":"eaebf659-a0cc-49e1-a41c-f5973ed1f05d","order_by":0,"name":"Maria Luca","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACPgglwcDPwNgAZFjwMDAT0MIG0yLZBtYiAdRCQA8bjGFwDKqXgZA1bBLJTzf83GMhb3y/ufnDjxoJGQZ2/gMEtKSZ3ex5JmG47Rhjm2TPMWIcJpHDdoPngAQjSAszkEuclpt/DkjYb25jbP7M8I9ILbeBtiRuYGNskGZsI0YLzzOz2zIHJJJnHEtsk+ztk+BhY2Y2wKuFnz352c03B+ps+5uPP/7w45uNPT//wQf4rcG0l0T1o2AUjIJRMAqwAADCiThH1VJoMAAAAABJRU5ErkJggg==","orcid":"","institution":"Division of Health Research, Faculty of Health and Medicine, Lancaster University","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"","lastName":"Luca","suffix":""},{"id":317026777,"identity":"e8387327-8d7c-48b8-ba08-a15422134a7a","order_by":1,"name":"Antonina Luca","email":"","orcid":"","institution":"Department of Medicine, Kore University of Enna","correspondingAuthor":false,"prefix":"","firstName":"Antonina","middleName":"","lastName":"Luca","suffix":""},{"id":317026778,"identity":"aee5e0f0-3f91-4913-aa66-7867f660d15a","order_by":2,"name":"Francesco Patti","email":"","orcid":"","institution":"Department of Medicine, Surgery and Advanced Technologies “G.F. Ingrassia”, University of Catania","correspondingAuthor":false,"prefix":"","firstName":"Francesco","middleName":"","lastName":"Patti","suffix":""},{"id":317026779,"identity":"26e7b180-bf6a-4a68-9c38-f68ae2687c48","order_by":3,"name":"Guillermo Perez Algorta","email":"","orcid":"","institution":"Division of Health Research, Faculty of Health and Medicine, Lancaster University","correspondingAuthor":false,"prefix":"","firstName":"Guillermo","middleName":"Perez","lastName":"Algorta","suffix":""},{"id":317026781,"identity":"b870adda-2ab3-411d-aecf-781c05d87077","order_by":4,"name":"Fiona Juliet Rosalind Eccles","email":"","orcid":"","institution":"Division of Health Research, Faculty of Health and Medicine, Lancaster University","correspondingAuthor":false,"prefix":"","firstName":"Fiona","middleName":"Juliet Rosalind","lastName":"Eccles","suffix":""}],"badges":[],"createdAt":"2024-06-05 15:14:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4535061/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4535061/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-76702-5","type":"published","date":"2024-10-24T15:58:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67682011,"identity":"61b74817-16ae-44cf-ab2d-e5064aedf806","added_by":"auto","created_at":"2024-10-28 16:12:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1163264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4535061/v1/edfe825c-0b0a-45a7-87cb-cce8b88d1c55.pdf"},{"id":58840012,"identity":"e841e6c8-6aa3-4ce8-bb3f-ac4db591184b","added_by":"auto","created_at":"2024-06-21 21:54:23","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":23674,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4535061/v1/a700c5eb872dde1a3d59b67a.docx"},{"id":58840013,"identity":"30c43051-682e-457b-9b3c-627cf6de7715","added_by":"auto","created_at":"2024-06-21 21:54:23","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":23380,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4535061/v1/b1849a2afe2374bf8160b42b.docx"},{"id":58840230,"identity":"366f5eaa-c1d4-41a5-b549-f8d5b5581ac0","added_by":"auto","created_at":"2024-06-21 22:02:23","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":26151,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable3.docx","url":"https://assets-eu.researchsquare.com/files/rs-4535061/v1/bbe4720e588b237a62e26f27.docx"},{"id":58840015,"identity":"a3c4d9c7-d56a-4792-ac1e-7d7c5568c674","added_by":"auto","created_at":"2024-06-21 21:54:23","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":25570,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable4.docx","url":"https://assets-eu.researchsquare.com/files/rs-4535061/v1/4e1107b1cfeb2a3df76262b6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Alexithymia and Illness Perceptions in Persons With Multiple Sclerosis and Their Partners: a dyadic analysis.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIndividuals with a medical condition construct personal appraisals of their illness. Such appraisals, namely \u0026ldquo;illness perceptions\u0026rdquo; (IPs), pertain to several aspects (i.e. consequences, emotional burden) and impact the individuals\u0026rsquo; adaptation to the disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Previous studies have reported an association between alexithymia, defined as a deficit of emotional awareness, and negative IPs (e.g. higher consequences, concern) in several medical conditions, including cancer and dermatological disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, to date, there are no studies testing the link between alexithymia and illness appraisals in Persons with Multiple Sclerosis (PwMS). This is surprising, since a crucial theme arising from the PwMS\u0026rsquo; accounts of their lived experience pertains to \u0026ldquo;making sense\u0026rdquo; of their bodily sensations which, in turn, requires efficient body awareness [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], typically impaired by alexithymia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlexithymia is common among PwMS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], thus deserving special attention in this population. Indeed, MS is a challenging disease from a physical, emotional and interpersonal point of view [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], thus requiring adaptive efforts that alexithymic persons might find it more difficult to make. In fact, alexithymia alters the understanding of one\u0026rsquo;s own bodily sensations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], impairs emotional processing [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and favors conflictual interpersonal communications [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In light of this, alexithymia could impact on various aspects (physical, emotional, interpersonal) of MS, thus representing a good candidate for being associated with IPs not only at the individual, but also at the dyadic level.\u003c/p\u003e \u003cp\u003eQualitative data consistently indicate fear and shock as common emotions following diagnosis among PwMS and their caregivers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Considering that caregivers also hold beliefs regarding MS, they could potentially influence the PwMS\u0026rsquo;s view of the condition. According to the cognitive-transactional model (CTM) of couples\u0026rsquo; adaptation of chronic illness, making sense of the illness and effective communication within the couple are crucially important for dyadic coping [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Building upon this model, and somewhat expanding it, this study hypothesizes alexithymia as a possible barrier to both making sense of the illness and effective communication within the couple. To the best of our knowledge, this is the first study focusing on the impact of alexithymic traits on IPs from a dyadic perspective, in any clinical condition.\u003c/p\u003e \u003cp\u003eThe aims of this cross-sectional study were: 1) investigate the possible association between alexithymic traits and IPs among PwMS and their partners (actor effects); 2) explore the possible association between alexithymic traits and IPs within the couples (dyads) composed of PwMS and their partners (partner effects), while investigating the effect sizes (ES) of the actor and partner effects of alexithymic traits in accordance with the Actor-Partner Interdependence Model (APIM).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003ePersons with multiple sclerosis\u003c/h2\u003e \u003cp\u003e PwMS referred to the Multiple Sclerosis Center of the University Hospital \u0026ldquo;Policlinico-San Marco\u0026rdquo; from 11th August 2021 to 7th January 2022 were invited to participate. Inclusion criteria were: men and women aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years with a diagnosis of relapsing-remitting MS according to the revised McDonald diagnostic criteria [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; Expanded Disability Status Scale (EDSS) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] between 2 to 5.5; Montreal Cognitive Assessment (MoCA)\u0026thinsp;\u0026ge;\u0026thinsp;26 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]; being a cohabiting partner, willingness to participate in the study of both members of the couple. Exclusion criteria were: current MS flare up, history of recent attack (\u0026lt;\u0026thinsp;3 months); concomitant neurological diagnosis of any type, current psychiatric and/or psychological treatments.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePartners\u003c/h2\u003e \u003cp\u003eCohabiting partners (men and women aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years) of the person with relapsing-remitting MS were invited to participate. Inclusion criteria were Montreal Cognitive Assessment (MoCA)\u0026thinsp;\u0026ge;\u0026thinsp;26 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and willingness to participate in the study of both members of the couple. Exclusion criteria were: current psychiatric and/or psychological treatments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003ePrevious studies investigating the impact of alexithymia on IPs from an individual perspective suggested medium-to-large effect sizes (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.6\u0026ndash;0.7) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Building on the available data, an online calculator (retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://robert-a-ackerman.shinyapps.io/apimpower/\u003c/span\u003e\u003cspan address=\"https://robert-a-ackerman.shinyapps.io/apimpower/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) for power analysis for the APIM was used. In order to detect an actor effect with 80% power (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05) expecting a medium ES (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.6), the number of dyads required was 90\u0026ndash;100.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAssessment Instruments\u003c/h2\u003e \u003cp\u003eThe following questionnaires were administered:\u003c/p\u003e \u003cp\u003e1) \u003cem\u003eIllness Perception Questionnaire Revised, IPQ-R section II, belief scale\u003c/em\u003e [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]: it consists of 38 statements requiring an answer ranging from 1 (\u0026ldquo;strongly disagree\u0026rdquo;) to 5 (\u0026ldquo;strongly agree\u0026rsquo;\u0026rsquo;). These statements address seven different IPs dimensions, namely acute/chronic timeline, cyclical timeline, coherence (understanding of the disease), consequences, emotional representations (emotional burden), personal control and treatment control. Higher scores indicate stronger beliefs in relation to the specific dimension. When interpreting the scores, one can empirically attach positive (functional) characteristics to personal control, treatment control and coherence, since they express confidence and optimism towards the illness, and negative (dysfunctional) characteristics to emotional representations and consequences, since they allude to the illness-related suffering and impact in everyday life.\u003c/p\u003e \u003cp\u003eThe partners completed a version adapted for their use [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. All IP dimensions addressed in section II were considered in the descriptive statistics, so as to comprehensively characterize the sample. However, timeline acute/chronic and cyclical were excluded from further analyses. Indeed, not mobilizing any particular coping strategy, timeline may have a limited clinical value [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e2) \u003cem\u003eToronto Alexithymia Scale-20, TAS-20\u003c/em\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]: this 20-items most used self-administered questionnaire for alexithymia consists of three subscales: difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally-oriented thinking (EOT). Every item can be answered through a Likert scale, from 1 (\u0026ldquo;completely disagree\u0026rdquo;) to 5 (\u0026ldquo;completely agree\u0026rdquo;).\u003c/p\u003e \u003cp\u003e3) \u003cem\u003ePatient Health Questionnaire 4, PHQ-4\u003c/em\u003e [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]: it is an ultra-brief 4-items composed of the first two items of the Generalized Anxiety Disorder\u0026ndash;7 scale (GAD\u0026ndash;7) and the Patient Health Questionnaire-8 (PHQ-8), respectively addressing anxious and depressive symptoms.\u003c/p\u003e \u003cp\u003e4) \u003cem\u003eDyadic Adjustment Scale, DAS\u003c/em\u003e [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]: this is a self-report questionnaire composed of 32 items investigating different aspects of marital quality through the following subscales: dyadic satisfaction (happiness for the relationship), dyadic consensus (agreement on different topics), dyadic cohesion (participating together in activities) and dyadic affectional expression (agreement regarding the expression of feelings). In addition, a DAS total score can be obtained, whereby higher values indicate higher quality of the relationship for both subscales and total score.\u003c/p\u003e \u003cp\u003e5) \u003cem\u003eMultiple Sclerosis Impact Scale-29 version 2, MSIS-29v2\u003c/em\u003e [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] (administered only to PwMS): this is a 29-item self-report measure of the psycho-physical impact of MS, whereby higher values indicate worse health.\u003c/p\u003e \u003cp\u003eDemographic data were recorded for both PwMS and their partners. The EDSS score [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] was calculated for PwMS.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed with the Statistical Package for the Social Sciences, version 28. We cleaned the data by considering range and consistency checks. Continuous data (e.g. age, education) were expressed as mean and standard deviation, categorical variables (e.g. sex, work) as number and percentage. Scale scores comparisons between PwMS and partners at the TAS-20 (total score and subscales) and the IPQ-R (all the seven dimensions) questionnaires were performed using t-test analyses. The relationship between TAS-20 with IPQ-R scores in both PwMS and partners was tested using Pearson\u0026rsquo;s correlations.\u003c/p\u003e \u003cp\u003eA dyadic data analysis was then performed in accordance to the APIM [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], implying the nonindependence of couple data, whereby a variable (predictor) of one member of the dyad can affect the outcome of the other member and vice versa. The analytic method adopted to conduct the dyadic analysis was that of multilevel linear modeling, MLM [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], advancing the idea of data structure as having multiple levels (level I is the person, level II is the dyad within which the person is nested).\u003c/p\u003e \u003cp\u003eTo evaluate if alexithymia was associated with illness perceptions in PwMS and their partners, both the effect of the person\u0026rsquo;s own alexithymic traits [actor effect] and the effect of their partner\u0026rsquo;s alexithymic traits [partner effect] on IPs were estimated. As the dyads are distinguishable due to their role (PwMS vs caregiver), both actor effects and partner effects were obtained for each member of the couple. More specifically, different statistical models separately including each alexithymic feature (DDF, DIF, EOT or TAS-20 total score) as predictor and each IP dimension (coherence, consequences, emotional representations, personal control or treatment control) as outcome were run. All APIM models (unadjusted and adjusted for possible confounders) were tested in R through an opensource online software interface (retrievable from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://davidakenny.shinyapps.io/APIM_MM/\u003c/span\u003e\u003cspan address=\"https://davidakenny.shinyapps.io/APIM_MM/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The statistical significance level was set at a \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOne hundred and sixty potentially eligible PwMS were invited to participate from 11th August 2021 to 7th January 2022. Twenty-eight were not eligible. Of the 132 persons meeting the inclusion criteria, 22 declined participation and 10 did not complete the questionnaires.\u003c/p\u003e\n\u003cp\u003eThe final sample consisted of 100 PwMS (71 women; mean age 47.6\u0026plusmn;10.4 years; education 11.4\u0026plusmn;3.7 years; 44 employed) and 100 partners (29 women; mean age 49.1\u0026plusmn;10.8 years; 73 employed) with a mean partnership duration of 20.1\u0026plusmn;11.7 years. PwMS had a disease duration of 10.5\u0026plusmn;8.5 years. EDSS was 2.8\u0026plusmn;1.1.\u003c/p\u003e\n\u003cp\u003eThe DAS and the PHQ-4 total scores in the whole sample were respectively 107.3\u0026plusmn;17.2 and 4.4\u0026plusmn;3.2 (Supplemental Table 1). Considering the perceived impact of MS (MSIS-29 v2) among PwMS, the physical subscale was 32.3\u0026plusmn;22 and the psychological one was 41.5\u0026plusmn;25.4.\u003c/p\u003e\n\u003cp\u003ePwMS presented a statistically significant higher TAS-20 total score and DIF sub-scale than their partners (Supplemental Table 2).\u003c/p\u003e\n\u003cp\u003eAs for IPs, PwMS presented statistically significant higher levels of perception of illness-related consequences and lower illness coherence than their partners (Supplemental Table 3).\u003c/p\u003e\n\u003cp\u003eConcerning the relationship between alexithymia and IPs, a statistically significant negative correlation was found between TAS-20 total score and coherence (in both PwMS and partners), as well as between TAS-20 total score and treatment control (partners only). On the contrary, a significant positive correlation was found between TAS-20 total score and emotional representations (in both PwMS and partners). Moreover, TAS-20 total score showed a significant positive correlation with consequences among partners only (Supplemental Table 4).\u003c/p\u003e\n\u003cp\u003eConcerning the dyadic analysis, both actor (the relationship of the person\u0026rsquo;s own alexithymia with their own IPs) and partner (the relationship of the alexithymia of one dyad member with the IPs of the other member) effects were detected when considering alexithymic traits as predictors of IPs, as detailed below.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIn a model with DDF as a predictor of IPs\u003c/em\u003e, this alexithymic feature showed statistically significant correlations with coherence, consequences and emotional representations. Full details are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCoherence (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed in both groups (PwMS \u003cem\u003er\u003c/em\u003e = -.290, \u003cem\u003ep\u003c/em\u003e = .003; partners \u003cem\u003er\u003c/em\u003e = -.390, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001) for coherence, whereby an increase in DDF correlated with a reduction of coherence.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsequences (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed (among partners only) for consequences, whereby an increase in DDF related to an increase in consequences (\u003cem\u003er \u003c/em\u003e= .265, \u003cem\u003ep\u003c/em\u003e = .007).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEmotional representations (actor effect + partner effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed in both groups (PwMS \u003cem\u003er\u003c/em\u003e = .325, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001; partners \u003cem\u003er\u003c/em\u003e = .319, \u003cem\u003ep\u003c/em\u003e = .001) for emotional representations, whereby an increase in DDF correlated with an increase of emotional representations. Moreover, a statistically significant partner effect was observed, whereby an increase of DDF in the partners correlated with higher emotional representations in PwMS (\u003cem\u003er\u003c/em\u003e = .265, \u003cem\u003ep\u003c/em\u003e = .007). See Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp; APIM model, predictor: Difficulty Describing Feeling\u003cbr /\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"671\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u003cstrong\u003eROLE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u003cstrong\u003eEFFECT\u003cbr /\u003e ESTIMATE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeta-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003eIPs\u0026rsquo; dimensions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCoherence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.263\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.436 to -.091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.298\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.290\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.158 to .182\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.894\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.336\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.494 to -.178\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026lt;\u003cstrong\u003e.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.380\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.390\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.192 to .129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.698\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsequences\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.054 to .320\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.059 to .309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.185\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.270\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e.074 to .466\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.007\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.273\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.265\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.236 to .162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.715\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEmotional representations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.409\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e.172 to .647\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.325\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.323\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e.089 to .556\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.007\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.261\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.265\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.369\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e.150 to .587\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.298\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.319\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.149\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.371 to .072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.188\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePersonal control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.083\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.239 to .074\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.302\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.098\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.118 to .190\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.650\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.046\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.055 to .294\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.182\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.074\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.103 to .252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.411\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.089\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.083\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTreatment control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.080\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.194 to .034\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e.027\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.085 to .139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.637\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.044\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.048\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.102\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.227 to .023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.160\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"103\"\u003e\n\u003cp\u003e-.068\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003e-.195 to .059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.297\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e-.111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p\u0026lt;.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIn a model with DIF as a predictor of IPs\u003c/em\u003e, this alexithymic feature showed statistically significant correlations with coherence, consequences, emotional representations and treatment control. Full details (including the magnitude of the effects) are shown in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCoherence (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed in both groups (PwMS \u003cem\u003er\u003c/em\u003e = -.295, \u003cem\u003ep\u003c/em\u003e = .003; partners \u003cem\u003er\u003c/em\u003e = -.356, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001) for coherence, whereby an increase of DIF related to a decrease of coherence.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsequences (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was recorded in both groups (PwMS \u003cem\u003er\u003c/em\u003e = .224, \u003cem\u003ep\u003c/em\u003e =.025; partners \u003cem\u003er\u003c/em\u003e = .245, \u003cem\u003ep\u003c/em\u003e =.014) for consequences, whereby an increase of DIF correlated with an increase of consequences in PwMS and their partners.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEmotional representations (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was detected in both groups (PwMS \u003cem\u003er\u003c/em\u003e = .453, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001; partners \u003cem\u003er\u003c/em\u003e = .347, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) for emotional representations, whereby an increase of DIF correlated with an increase of emotional representations.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTreatment control (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA significant actor effect, for partners only, was observed for treatment control, whereby an increase of DIF determined a reduction of treatment control (\u003cem\u003er\u003c/em\u003e = -.328, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001). See Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp; APIM model, predictor: Difficulty Identifying Feelings\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"708\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003eROLE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u003cstrong\u003eEFFECT\u003cbr /\u003e ESTIMATE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeta-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003eIPs\u0026rsquo; dimensions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCoherence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.246 to -.053\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.284\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.295\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.135 to .096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.746\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.033\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.206\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.313 to -.098\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.391\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.356\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.144 to .035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.235\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsequences\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e.016 to .224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e.025\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.204\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.102 to .148\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.719\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.039\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.171\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e.036 to .305\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e.014\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.289\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.245\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.106 to .119\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.912\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEmotional representations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.327\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e.199 to .455\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.444\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.453\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.062\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.091 to .216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.426\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.085\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.081\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.273\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e.126 to .419\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.371\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.347\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.063 to .181\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.346\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.080\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.095\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePersonal control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.144 to .032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.213\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.112\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.003\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.103 to .108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.959\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.033\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.088 to .154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.592\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.066\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.054\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e.030\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.071 to .131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.560\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTreatment control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.113 to .015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.134\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.135\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.086 to .067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.809\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.026\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.219 to -.060\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.383\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.328\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"128\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\n\u003cp\u003e-.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003e-.126 to .007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e.082\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-.163\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e-.175\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p\u0026lt;.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIn a model with EOT as a predictor of IPs\u003c/em\u003e, this alexithymic feature showed statistically significant correlations with coherence, personal control and treatment control. Full details (including the magnitude of the effects) are shown in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCoherence (partner effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant partner effect was observed, whereby an increase of EOT in PwMS correlated with a reduction of coherence in their partners (\u003cem\u003er\u003c/em\u003e = -.217, \u003cem\u003ep\u003c/em\u003e = .030).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePersonal control (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was recorded, among PwMS only, for personal control, whereby an increase of EOT related to a decrease of personal control (\u003cem\u003er\u003c/em\u003e = -.230, \u003cem\u003ep\u003c/em\u003e = .021).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTreatment control (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA significant actor effect, among partners only, was observed for treatment control, since an increase of EOT was linked to a decrease of treatment control (\u003cem\u003er \u003c/em\u003e= -.234, \u003cem\u003ep\u003c/em\u003e = .019). See Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp; APIM model, predictor: Externally-Oriented Thinking\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"680\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eROLE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003eEFFECT\u003cbr /\u003e ESTIMATE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeta-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003eIPs\u0026rsquo;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003edimensions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCoherence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.040\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.211 to .130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.644\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.228 to .118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.535\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.063\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.088\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.249 to .074\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.290\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.178\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.337 to -.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.030\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.216\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.217\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsequences\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.231 to .130\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.584\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.199 to .168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.868\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.041\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.158 to .240\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.688\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.044\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.041\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.227 to .165\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.755\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.034\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEmotional representations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.223 to .268\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.859\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.019\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.105\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.144 to .355\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.410\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.091\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.235 to .220\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.984\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.218 to .229\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.961\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePersonal control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.173\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.319 to -.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.021\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.221\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.230\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.106 to .190\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.580\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.053\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.056\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.290 to .053\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.178\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.138 to .200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.717\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.040\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTreatment control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.130 to .088\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.709\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.111 to .111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.995\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.143\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.262 to -.025\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e.019\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.252\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"160\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.096\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-.212 to .021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.161\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p\u0026lt;.05.\u003c/p\u003e\n\u003cp\u003eFinally, \u003cem\u003ein a model with TAS-20 total score as a predictor of IPs\u003c/em\u003e, the scale showed statistically significant correlations with coherence, consequences, emotional representations and treatment control. Full details (including the magnitude of the effects) are shown in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCoherence (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed in both groups (PwMS \u003cem\u003er\u003c/em\u003e = -.289, \u003cem\u003ep \u003c/em\u003e= .003; partners \u003cem\u003er\u003c/em\u003e = -.384, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001) for coherence, whereby an increase of TAS-20 total score correlated with a decrease of coherence.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsequences (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant actor effect was observed among partners only, whereby an increase of TAS-20 total score related to an increase of consequences (\u003cem\u003er\u003c/em\u003e = .243, \u003cem\u003ep\u003c/em\u003e = .014).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEmotional representations (actor effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA significant actor effect was recorded when considering emotional representations in both groups (PwMS \u003cem\u003er\u003c/em\u003e = .371, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001; partners \u003cem\u003er\u003c/em\u003e = .305, \u003cem\u003ep\u003c/em\u003e = .002), whereby an increase of TAS-20 total score was linked to an increase of emotional representations.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTreatment control (actor effect + partner effect)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAn actor effect was detected, among partners only, for treatment control, whereby an increase of TAS-20 total score related to a decrease of treatment control (\u003cem\u003er\u003c/em\u003e = -.329, \u003cem\u003ep\u003c/em\u003e \u0026lt;.001). Moreover, a statistically significant partner effect was observed, whereby an increase of TAS-20 total score in PwMS related to a decrease of treatment control in the partners (\u003cem\u003er\u003c/em\u003e = -.207, \u003cem\u003ep\u003c/em\u003e = .038). See Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. APIM model, predictor: TAS-20 total score\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"671\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eROLE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003eEFFECT\u003cbr /\u003e ESTIMATE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eBeta-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eIPs\u0026rsquo;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003edimensions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCoherence\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.085\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.142 to -.029\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.286\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.289\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.071 to .052\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.767\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.031\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.030\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.173 to -.061\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.393\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.384\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.093 to .009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.110\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.141\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.161\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsequences\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.047\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.014 to .109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.152\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.048 to .087\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.570\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.058\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.058\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.090\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e.019 to .162\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e.014\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.270\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.243\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.072 to .059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.838\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEmotional representations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.154\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e.078 to .231\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.370\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.371\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.012 to .156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.169\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e.049 to .209\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.309\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.305\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.069 to .077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.917\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePersonal control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.049\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.100 to .001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.057\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.191\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e.045 to .066\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.718\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.036\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.008\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.056 to .072\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.811\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.024\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.039 to .078\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.069\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.067\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e/\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTreatment control\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePwMS\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.029\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.066 to .009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.151\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.039 to .042\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.944\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cem\u003ePartners\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eActor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.074\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.116 to -.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;.001\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.358\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.329\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eMedium\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ePartner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-.041\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e-.080 to -.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e.038\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-.199\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-.207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eSmall\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. APIM: Actor-Partner Interdependence Model; PwMS: persons with multiple sclerosis; CI: confidence interval; ES: effect size. Bold values: p\u0026lt;.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA sensitivity analysis considering sex, EDSS and DAS total scores as covariates was performed.\u003c/p\u003e\n\u003cp\u003eAfter adjusting, the actor effects previously observed between alexithymic traits and consequences disappeared in both groups. For all the other IPs, the majority of the actor effects were confirmed. In particular, as for DDF, the statistically significant actor effect was confirmed in both groups for coherence (PwMS r = -.271, p = .009; partners r = -.296, p = 0.002) and emotional representations (PwMS r = -.296, p = .003; partners r = -.227, p = .022). Considering DIF, the statistically significant actor effect was confirmed only in partners for coherence (r = -.278, p = .004) and treatment control (r= -.251, p= .013) and in both groups for emotional representations (PwMS r = .438, p \u0026lt;.001; partners r = .266, p= .007). Concerning EOT, the statistically significant actor effect among PwMS for personal control (r = -.207, p = .041) was confirmed. Finally, also for the TAS-20 total score, in both groups, the statistically significant actor effect for coherence (PwMS r = -.280, p = .006; partners r = -.288, p =.002) and emotional representations (PwMS r = .366, p \u0026lt;.001; partners r = .207, p = .037) were confirmed. However, the actor effect for treatment control was confirmed only in the partner group (r = -.238, p =.018).\u003c/p\u003e\n\u003cp\u003eThe previously found statistically significant partner effect, whereby an increase of EOT in PwMS correlated with a reduction of coherence in their partners (r = -.277, p = .006) was also confirmed. All the other previously detected partner effects were not confirmed in the sensitivity analysis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, alexithymia was found to be associated with IPs from both an individual and dyadic perspective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the individual level, alexithymic traits were positively associated with negative IPs and negatively associated with positive ones, with small-to-medium effect sizes, in both PwMS and their partners. Interestingly, the TAS-20 total score related to almost all IPs. However, a closer look at the alexithymic facets showed peculiar trends. In particular, EOT had no impact on consequences and emotional representations, while being the only facet influencing personal control, whereby higher EOT correlated with lower personal control in PwMS. On the other hand, higher DDF and DIF were both related to higher emotional representations in PwMS and their partners. Moreover, higher DIF and DDF were related to higher consequences in both groups and among partners only, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe differential impact of alexithymic traits on IPs may reflect the nature of alexithymic facets. Indeed, since DDF and DIF are usually accountable for over-responding to emotionally challenging situations [25], their relationship with higher consequences and emotional representations may indicate an exaggeratedly negative appraisal of MS. Conversely, EOT is characterized by concrete thinking, which reduces the sense of mastery over situations [26], the latter potentially explaining the negative correlation between EOT and personal control in our sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConcerning the partner effects, alexithymic traits in a member of the couple were associated with negative IPs in the other member. More specifically, higher DDF in the partners related to higher emotional representations in the PwMS; higher TAS-20 total score in PwMS related to lower treatment control in the partners; higher EOT in PwMS related to lower coherence in the partners.\u003c/p\u003e\n\u003cp\u003eThese findings make sense in light of the interpersonal repercussions of alexithymia. Indeed, individuals with greater alexithymia may appear detached in emotionally charged situations [11]. Hence, their interpersonal life might be more stressful compared to other individuals [27]. In a marital context, persons with alexithymic traits may show (at various levels) lack of empathy and support [11, 28-29]. Generally speaking, the spouse of an alexithymic individual might feel restrained in showing vulnerability [30]. These considerations may help in interpreting the partner effects arising from the APIM analysis.\u003c/p\u003e\n\u003cp\u003eIndeed, it is easy to envision how a PwMS with a partner presenting high DDF might experience higher MS-related emotional burden, since there is little room for sharing emotions and receiving sympathy within the couple. Interestingly, in a study investigating the relationship between alexithymia and dyadic adjustment in a community sample, a negative correlation was reported between DDF and the partner\u0026rsquo;s dyadic adjustment, with females being more affected by their partner\u0026rsquo;s emotional repression [30]. This is particularly relevant in our cohort, considering that the group of PwMS is mainly composed of females.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering the other partner effect, higher alexithymia in PwMS related to lower perception of treatment as effective in controlling MS in their partners. Alexithymic persons (here, alexithymic PwMS) facing stressors tend to avoid uncomfortable topics of discussion (here, MS) and are likely to exhibit behavioral disengagement and denial [31]. In this context, their partners, left alone to deal with medical information, may develop a more pessimistic view of MS as a completely uncontrollable condition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering the finding linking higher EOT in the PwMS to lower understanding of MS (coherence) in their partners, it should be noted that externally oriented cognitive style relates to specific deficits: impaired ability to extract useful information due to lack of internal awareness, reduced perspective-taking [10] and poor reflective functioning [32]. Hence, it is apparent how high EOT may decrease the person\u0026rsquo;s ability to partake in an effective exchange of meaningful information. In particular, the reduced understanding of the emotions prompted by negative situations [10] may significantly impact the couple\u0026rsquo;s confrontation of stressful topics, ultimately hindering the formation of a clear idea of what MS is. What may seem mere speculations, acquire more value in light of the previously cited CTM, whereby the effective couple\u0026rsquo;s communication plays a crucial role [12]. Identifying alexithymia as possibly associated with IPs might enrich the already existing theoretical frameworks highlighting the importance of couple\u0026rsquo;s communication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings \u0026nbsp;have practical implications, encouraging the implementation of tailored psychotherapeutic interventions aimed at reducing alexithymic traits in PwMS and/or their partners, thus facilitating the shaping of functional IPs. Emotionally-focused interventions dedicated to couples may promote functional communication patterns, ultimately improving marital adjustment [33].\u003c/p\u003e\n\u003cp\u003eOur study has some limitations. Its cross-sectional design does not allow to infer causation. Moreover, due to its preliminary nature, the results are not conclusive. For example, the sensitivity analysis suggested that other aspects (i.e. relationship quality) may play a role. Indeed, it would be naive to reduce the complex mechanisms underlying the formation of IPs to a linear and monocausal process. Hence, many questions remain unanswered and further studies are recommended to disentangle the involved factors and their contribution.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003eEthical considerations\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the University Hospital \u0026ldquo;Policlinico-San Marco\u0026rdquo; of Catania, Italy (protocol: 96/2021/PO) and the Faculty of Health and Medicine Research Ethics Committee of Lancaster University, UK (protocol: FHMREC20186) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All the enrolled participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e the authors have nothing to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial disclosures:\u003c/strong\u003e none.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003e1. Research project: A. Conception, B. Organization, C. Execution and design, D. Supervision. 2. Statistical analysis: A. Design, B. Execution, C. Review and critique. 3. Manuscript: A. Writing of the first draft, B. Review and Critique. ML: 1A, 1B, 1C, 2A, 2B, 2C, 3A. AL: 2C, 3B. FP: 1B, 1D, 3B. FJRE: 1A, 1D, 2A, 2C, 3B. GPA: 1A, 1D, 2A, 2C, 3B.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThis paper is part of Maria Luca\u0026rsquo;s publicly defended thesis, conducted in the context of the Mental Health PhD program of Lancaster University (UK). Many thanks to Dr. Lorena Messina for her kind support in the recruitment phase and to the MS Centre group of the University of Catania, in particular Dr. Clara Chisari and Dr. Simona Toscano.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eResearch data will be preserved for 10 years in the Lancaster University Publications and Research electronic repository (PURE) but will not be made publicly available in order to not raise concerns about confidentiality for the participants, as foreseen in the research protocol and approved by the study participants. Corresponding author for any data or questions regarding the study: Dr Maria Luca.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeventhal H, Brissette I, Leventhal EA (2003) The common sense model of self-regulation of health and illness. In: Cameron LC, Leventhal H (eds) The self-regulation of health and illness behaviour. Taylor \u0026amp; Francis Group, UK, pp 42\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuca M, Eccles F, Algorta GP, et al. (2022) Illness perceptions and outcome in multiple sclerosis: A systematic review of the literature. Mult Scler Relat Disord article 104180. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.msard.2022.104180\u003c/span\u003e\u003cspan address=\"10.1016/j.msard.2022.104180\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarbasio C, Vagelli R, Marengo D, et al. (2015) Illness perception in systemic lupus erythematosus patients: The roles of alexithymia and depression. Compr Psychiatry 63:88\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.comppsych.2015.09.004\u003c/span\u003e\u003cspan address=\"10.1016/j.comppsych.2015.09.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarsen MH, Krogstad AL, Wahl AK (2017) Alexithymia, illness perception and self-management competency in psoriasis. Acta Derm Venereol 97:934\u0026ndash;940. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2340/00015555-2707\u003c/span\u003e\u003cspan address=\"10.2340/00015555-2707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNissen N, Lemche J, Reestorff CM, et al. (2021) The lived experience of uncertainty in everyday life with MS. Disabil Rehabil 44:5957\u0026ndash;5963. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638288.2021.1955302\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2021.1955302\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy J, Catmur C, Bird G (2018) Alexithymia is associated with a multidomain, multidimensional failure of interoception: Evidence from novel tests. J Exp Psychol Gen 147:398\u0026ndash;408. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/xge0000366\u003c/span\u003e\u003cspan address=\"10.1037/xge0000366\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChalah MA, Ayache SS (2017) Alexithymia in multiple sclerosis: A systematic review of literature. Neuropsychologia 104:31\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.neuropsychologia.2017.07.034\u003c/span\u003e\u003cspan address=\"10.1016/j.neuropsychologia.2017.07.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuca M, Ortega-Castro N, Patti F (2021) Paediatric multiple sclerosis: A scoping review of patients\u0026rsquo; and parents\u0026rsquo; perspectives. Children article 11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/children9010011\u003c/span\u003e\u003cspan address=\"10.3390/children9010011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePollatos O, Herbert B (2018) Alexithymia and body awareness. In: Luminet O, Bagby RM, Taylor GJ (eds) Alexithymia: Advances in research, theory, and clinical practice. Cambridge University Press, UK, pp 321\u0026ndash;333.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuminet O, Nielson KA, Ridout N (2021) Having no words for feelings: Alexithymia as a fundamental personality dimension at the interface of cognition and emotion. Cogn Emot 35:435\u0026ndash;448. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02699931.2021.1916442\u003c/span\u003e\u003cspan address=\"10.1080/02699931.2021.1916442\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;russe F, Boucher S, Fernet M (2012) Observation of couple interactions: Alexithymia and communication behaviors. Pers Individ Differ 53:1017\u0026ndash;1022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.paid.2012.07.022\u003c/span\u003e\u003cspan address=\"10.1016/j.paid.2012.07.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadr H, Acitelli LK (2017) Re-thinking dyadic coping in the context of chronic illness. Curr Opin Psychol 13:44\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.copsyc.2016.03.001\u003c/span\u003e\u003cspan address=\"10.1016/j.copsyc.2016.03.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson AJ, Banwell BL, Barkhof F, et al. (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17:162\u0026ndash;173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S1474-4422(17)30470-2\u003c/span\u003e\u003cspan address=\"10.1016/S1474-4422(17)30470-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurtzke (1983) Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 33:1444\u0026ndash;1452. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1212/WNL.33.11.1444\u003c/span\u003e\u003cspan address=\"10.1212/WNL.33.11.1444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNasreddine ZS, Phillips NA, B\u0026eacute;dirian V, et al. (2005) The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1532-5415.2005.53221.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1532-5415.2005.53221.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkanli AYŞE, Karabulutlu EY, Asi Karakaş S, et al. (2018) Alexithymia and perception of illness in patients with cancer. Eur J Cancer Care 27: Article e12839. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ecc.12839\u003c/span\u003e\u003cspan address=\"10.1111/ecc.12839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoss-Morris R, Weinman J, Petrie K, et al. (2002) The revised illness perception questionnaire (IPQ-R). Psychol Health 17:1\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/08870440290001494\u003c/span\u003e\u003cspan address=\"10.1080/08870440290001494\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassi M, Falautano M, Cilia S, et al. (2016) Illness perception and well-being among persons with multiple sclerosis and their caregivers. JCPMS 23:33\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10880-015-9425-8\u003c/span\u003e\u003cspan address=\"10.1007/s10880-015-9425-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBassi M, Cilia S, Falautano M, et al. (2020) Illness perceptions and psychological adjustment among persons with multiple sclerosis: The mediating role of coping strategies and social support. Disabil Rehabil 42:3780\u0026ndash;3792. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638288.2019.1610511\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2019.1610511\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagby RM, Parker JD, Taylor GJ (1994) The twenty-item Toronto alexithymia scale\u0026mdash;I. Item selection and cross-validation of the factor structure. J Psychosom Res 38:23\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0022-3999(94)90005-1\u003c/span\u003e\u003cspan address=\"10.1016/0022-3999(94)90005-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JB et al. (2009) An ultra-brief screening scale for anxiety and depression: The PHQ\u0026ndash;4. Psychosomatics 50:613\u0026ndash;621. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0033-3182(09)70864-3\u003c/span\u003e\u003cspan address=\"10.1016/S0033-3182(09)70864-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpanier (1976) Measuring dyadic adjustment: New scales of assessing the quality of marriage and similar dyads. JMF 38:15\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2307/350547\u003c/span\u003e\u003cspan address=\"10.2307/350547\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHobart J, Cano S (2009) Improving the evaluation of therapeutic interventions in multiple sclerosis: The role of new psychometric methods. HTA 13:1\u0026ndash;200. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3310/hta13120\u003c/span\u003e\u003cspan address=\"10.3310/hta13120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKenny DA, Kashy DA, Cook WL (2016) Dyadic data analysis. Guilford Press, New York.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuminet O, Nielson KA, Ridout N (2021) Cognitive-emotional processing in alexithymia: An integrative review. Cogn Emot 35:449\u0026ndash;487. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02699931.2021.1908231\u003c/span\u003e\u003cspan address=\"10.1080/02699931.2021.1908231\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrett G, Dubash S (2023) The sociocognitive origins of personal mastery. JHSB 64:452\u0026ndash;468. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/00221465231167558\u003c/span\u003e\u003cspan address=\"10.1177/00221465231167558\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Xu T, Jing J, et al. (2011) Alexithymia and emotional regulation: A cluster analytical approach. BMC Psychiatry 11:1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-244X-11-33\u003c/span\u003e\u003cspan address=\"10.1186/1471-244X-11-33\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBird G, Viding E (2014) The self to other model of empathy: Providing a new framework for understanding empathy impairments in psychopathy, autism, and alexithymia. Neurosci Biobehav Rev 47:520\u0026ndash;532. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.neubiorev.2014.09.021\u003c/span\u003e\u003cspan address=\"10.1016/j.neubiorev.2014.09.021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoerlich KS (2018) The multifaceted nature of alexithymia\u0026ndash;a neuroscientific perspective. Front Psychol article 1614. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2018.01614\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2018.01614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEid P, Boucher S (2012) Alexithymia and dyadic adjustment in intimate relationships: Analyses using the actor partner interdependence model. J Soc Clin Psychol 31:1095\u0026ndash;1111. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1521/jscp.2012.31.10.1095\u003c/span\u003e\u003cspan address=\"10.1521/jscp.2012.31.10.1095\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVelasco C, Fern\u0026aacute;ndez I, P\u0026aacute;ez D, et al. (2006) Perceived emotional intelligence, alexithymia, coping and emotional regulation. Psicothema 18:89\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://reunido.uniovi.es/index.php/PST/article/view/8425\u003c/span\u003e\u003cspan address=\"https://reunido.uniovi.es/index.php/PST/article/view/8425\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalaresi D, Barberis N (2019) The relationship between reflective functioning and alexithymia. JCDP 1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.6092/2612-4033/0110-2107\u003c/span\u003e\u003cspan address=\"10.6092/2612-4033/0110-2107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzadi F, Mokhtari E (2021) The effectiveness of emotional-focused couple therapy on reducing the negative emotion schemas and alexithymia as well as increasing marital compatibility. Int J Psychol 15:225\u0026ndash;254. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ijpb.ir/article-1-353-en.pdf\u003c/span\u003e\u003cspan address=\"https://ijpb.ir/article-1-353-en.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"illness perceptions, alexithymia, multiple sclerosis, dyad, spouse","lastPublishedDoi":"10.21203/rs.3.rs-4535061/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4535061/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIllness perceptions (IPs) encompass opinions regarding the nature, severity and curability of a disease. The aim of this cross-sectional study was to investigate the association between alexithymia and IPs among persons with multiple sclerosis (PwMS) and their partners, as well as within the dyads composed of PwMS and partners.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePwMS referred to the Multiple Sclerosis Center of the University Hospital \u0026ldquo;Policlinico-San Marco\u0026rdquo; from 11th August 2021 to 7th January 2022 and their partners completed a battery of questionnaires, including the Toronto Alexithymia Scale-20 and the Illness Perception Questionnaire Revised. A dyadic data analysis (Actor-Partner Interdependence Model) was performed to test the effect of alexithymic traits both on a person\u0026rsquo;s own illness perceptions (actor effect) and on the partner\u0026rsquo;s illness perceptions (partner effect).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e100 PwMS (71 women; mean age 47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 years) and 100 partners (29 women; mean age 49.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 years), with a mean partnership duration of 20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7 years, were enrolled. At the dyadic analysis, statistically significant small-to-moderate actor and partner effects were found considering alexithymia (total score and alexithymic facets) and IPs, whereby higher alexithymic traits related to higher negative perceptions (i.e. consequences, emotional representations) and lower positive ones (i.e. coherence, treatment control).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur findings support the relationship between alexithymia and negative illness appraisals. This data may inform therapeutic interventions aimed at reducing alexithymic traits, which in turn may reduce negative, and potentially dysfunctional, illness perceptions.\u003c/p\u003e","manuscriptTitle":"Alexithymia and Illness Perceptions in Persons With Multiple Sclerosis and Their Partners: a dyadic analysis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-21 21:54:18","doi":"10.21203/rs.3.rs-4535061/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-10T05:56:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-08T19:07:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"310286256717543000798586856718712071832","date":"2024-08-29T16:43:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44056075613824989891298546284302743466","date":"2024-07-28T12:09:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-01T11:23:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250019501484164263502122107556956996694","date":"2024-06-24T09:02:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-22T11:49:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-20T19:58:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-09T20:41:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-07T09:47:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-05T15:13:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cdf2f87a-33d0-4168-8631-a40c87a7e5b6","owner":[],"postedDate":"June 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33525071,"name":"Biological sciences/Neuroscience"},{"id":33525072,"name":"Biological sciences/Psychology"}],"tags":[],"updatedAt":"2024-10-28T16:05:06+00:00","versionOfRecord":{"articleIdentity":"rs-4535061","link":"https://doi.org/10.1038/s41598-024-76702-5","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-10-24 15:58:11","publishedOnDateReadable":"October 24th, 2024"},"versionCreatedAt":"2024-06-21 21:54:18","video":"","vorDoi":"10.1038/s41598-024-76702-5","vorDoiUrl":"https://doi.org/10.1038/s41598-024-76702-5","workflowStages":[]},"version":"v1","identity":"rs-4535061","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4535061","identity":"rs-4535061","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}