Date of Award

Summer 6-2019

Document Type


Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)


Clinical Psychology

First Advisor/Committee Member

Thane M. Erickson

Second Advisor/Committee Member

Michelle Toshima

Third Advisor/Committee Member

Jacob Bentley


Patients with multiple sclerosis (MS) are at significant risk for decreased quality of life, partly due to associated cognitive impairment (Højsgaard Chow et al., 2018). A discrepancy often exists between objective and perceived measures of cognitive impairment (Middleton et al., 2006); the paths through which they predict quality of life for MS patients remain unclear (Baumstarck-Barrau, et al., 2011). Objective cognitive functioning as well as one’s perceptions of it may differentially impact quality of life, and therefore may or may not act through the same mechanisms to impact quality of life. Depression is one possible mediator known to impact quality of life in MS patients (Göksel Karatepe et al., 2011). Additionally, strengths such as gratitude may impact quality of life in chronic diseases like MS. Gratitude allows patients to extend focus beyond themselves, increasing appreciation for other parts of life despite experiencing a medical condition (Büssing et al., 2014). The purpose of the present study was to examine the effects of cognitive impairment on quality of life via depression symptoms, and how these effects might be moderated by gratitude in a cross-sectional study with participants formally diagnosed with MS. Participants (N = 128) completed a short battery to assess cognitive function and self-report measures of depression, perceived cognitive functioning, quality of life, and gratitude. Consistent with hypotheses, both perceived and objective cognitive functioning predicted quality of life through depression. This provides support for the idea that one’s experience of cognitive impairment impacts depressed mood and might lead to impaired quality of life. Contrary to hypotheses, gratitude did not moderate links between cognitive functioning (perceived nor objective) and depression, depression and quality of life, nor the indirect effect between cognitive functioning (perceived nor objective) and quality of life via depression with gratitude acting on the “A” and “B” paths. However, even after controlling for other study variables, gratitude predicted lower depression and higher quality of life. These results offer further understanding of cognitive functioning (objective and perceived) and the impact of depression on quality of life in MS, and bear implications for how gratitude may contribute to well-being beyond known processes.

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