Suffering, Meaning-Making, and Emotional Processing in Individuals with Rheumatoid Arthritis

Rosemarie Buttery

Research output: ThesisDoctoral Thesis


Cassell (2004) conceptualized suffering as “a state of severe distress associated with events that threaten the intactness of the person”, he described the experience of suffering as being built from three interlinked dimensions: 1) our understanding of what the threat is, what caused it and how it functions, 2) our perceived controllability of the threat, how curable it is, and 3) what this means for our future in terms of how long it will last and how it will change us. Krikorian, and Román (2015) suggest that the physical symptoms of illness impact on suffering by causing psychological distress. This psychological distress, in turn, influences an existential loss of meaning which then impacts on adjustment thus further increasing suffering. The current study aims to gain a sense of suffering among patients with rheumatoid arthritis and to investigate its causes and correlates. A sample of 99 adults with a diagnosis of rheumatoid arthritis was recruited and participants completed the PRISM task, a visual metaphor technique which measures “self-illness separation”, quantitative distance representing an individual’s perception of the intrusiveness or controllability of their illness which is consistent with Cassell’s (1991) conception of suffering. The participants then completed a battery of self-report questionnaires measuring disease activity, mood, two aspects of positive meaning-making: sense making and benefit-finding, and measures of 15 different emotional processing difficulties. As predicted, disease activity, anxiety and depression were positively correlated with higher levels of suffering. However, positive meaning-making was not associated suffering for either positive sense-making or perceived benefit-finding. Four emotional processing difficulties: incomprehensibility, guilt, non-acceptance of feelings, and rumination were significantly positively correlated with suffering, but regression analysis showed that only disease activity uniquely predicted suffering in the sample. These findings further reinforce the importance of managing physical symptoms in rheumatoid arthritis patients, as well as supporting patients to reducing anxiety and depression in response to their illness and symptoms.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Ellett, Lyn, Supervisor
Award date4 Sept 2019
Publication statusUnpublished - 8 Jul 2019

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