Exploring the interplay of abstinence self-efficacy, locus of control, and perceived social support in substance use disorder recovery.

INTRODUCTION: Substance use disorder (SUD) poses a significant public health challenge globally, with substantial impacts on physical and social well-being. This study investigates the interplay between abstinence self-efficacy (ASE), locus of control (LOC), perceived social support (PSS), and various socio-demographic and psychosocial factors among individuals undergoing SUD rehabilitation. METHODS: Researchers obtained permission from drug rehabilitation centers in Assam, India, and conducted orientation programs for prospective participants. A total of 144 participants, aged 18-65 years, predominantly from rural areas participated in the study. Data was collected through one-to-one interviews, covering socio-demographic history, drug abuse, and administering scales for ASE, LOC and PSS. Collected data underwent digitization and subsequent descriptive and inferential statistical analyses. RESULTS: Significant associations were found between ASE and socio-demographic variables, family dynamics, and drug use history, highlighting the importance of considering these factors in SUD rehabilitation. Disturbed family relationships were linked to diminished ASE and higher risk of relapse, emphasizing the role of family support in recovery. Additionally, a negative correlation was observed between ASE and LOC, suggesting that individuals with higher ASE tend to have a more internal locus of control, which positively influences recovery outcomes. Moreover, positive correlations were found between ASE and PSS, particularly from family members, underscoring the importance of social support in fostering recovery. Regression analysis further elucidated the relationships between ASE, LOC, and PSS, emphasizing the predictive value of LOC and the impact of family support on ASE. CONCLUSION: Findings of this study have several implications for developing targeted interventions aimed at strengthening ASE, promoting internal locus of control, and enhancing social support systems.

Substance use disorder (SUD) is a major public health concern today, characterized by the compulsive and prolonged use of harmful psychoactive substances, leading to various physical and social dysfunctions. This study explores the relationships between abstinence self-efficacy (ASE), locus of control (LOC), perceived social support (PSS), and various socio-demographic factors in individuals undergoing SUD rehabilitation in Assam, India. The focus of the study is to find out various factors which can facilitate the process of drug rehabilitation. Data from 144 participants aged 18­65 were collected through interviews and standardized scales. Results indicate that ASE is significantly associated with socio-demographic variables, family dynamics, and drug use history. Disturbed family relationships were linked to lower ASE and higher risk of relapse, while a higher ASE was correlated with an internal LOC and greater PSS, especially from family. The study highlights the clinical significance of considering background factors like marital status, employment status, family relationship dynamics, and abstinence period in treatment planning to provide personalized care.

Trajectories of polysubstance use: Are past-year internalizing and externalizing problems associated with trajectories of polysubstance use over time?

OBJECTIVE: Polysubstance use among adults has been a public health concern in the U.S. and is associated with adverse consequences. This study aimed to identify the longitudinal trajectory of polysubstance use and test whether internalizing and externalizing problems predict it. METHODS: Data of adults aged 18 and older (N = 15076) were extracted from the Waves 1-5 Population Assessment of Tobacco and Health Study (2013-2019). Group-Based Trajectory Modeling was performed to identify the trajectory of polysubstance use. Examined substances included use of cigarettes, e-cigarettes, excessive alcohol, cannabis, painkillers, and cocaine in past 30 days from all waves. Weighted multinomial logistic regressions were conducted to investigate the associations between internalizing and externalizing problems and the trajectory of polysubstance use, controlling for demographic variables. RESULTS: Five trajectory groups were identified: (1) No to minimal polysubstance use risk (45.6 %); (2) Polysubstance use-low risk (10.7 %); (3) Cigarette-leading polysubstance use-high risk (23.5 %); (4) Cigarette-cannabis co-leading polysubstance use-high risk (12.3 %); and (5) Cannabis-leading polysubstance use-high risk (7.8 %). Compared with Group 1, higher internalizing problems predicted the membership of Group 3 [Relative risk ratio (RRR) range: 1.07-1.17] and Group 4 (RRR range: 1.04-1.21). Compared with Group 1, higher externalizing problems predicted the membership of Group 5 (RRR range: 1.01-1.10). CONCLUSIONS: Prevention efforts should consider internalizing problems and associated trajectories of high-risk polysubstance use (e.g., cigarette-leading and cigarette-cannabis co-leading) as well as externalizing problems and associated trajectories of high-risk polysubstance use (e.g., cannabis-leading), when designing interventions to prevent polysubstance use.

Road safety attitude and behaviour among motorcycle riders in Ghana: A focus on traffic locus of control and health belief.

Road traffic accident is a leading cause of death and various life deformities worldwide. This burden is even higher among motorcycle riders in lower-to-middle-income countries. Despite the various interventions made to address the menace, the fatalities continue to be on the ascendency. One major area that has received little attention is the attitude and behaviour of motorcycle riders. The present study aimed to examine the contribution of traffic Locus of Control (LoC) and health belief on road safety attitude and behaviour. 317 motorcycle riders participated in the study. The participants completed a questionnaire comprising various sections such as motorcycle riding behaviour, road safety attitude, risk perception, the intention to use helmets, and traffic LoC. The results showed a significant positive correlation between road safety attitude and behaviour (r (295) = .33, p < .001). Drifting towards internal LoC was associated with more positive behaviour on the roads (r (295) = -.23, p < .001). Intention to use helmet, health motivation, perceived susceptibility, perceived benefits, and perceived barriers were the factors in the health belief model that were associated with road safety attitude (r (295) = .404, p < .001). Finally, the multiple linear regression model showed that road safety attitude and traffic LoC made significant contributions to road user behaviour [F(3, 293) = 13.73, p < .001]. These findings have important implications towards shaping responsible behaviour among motorcycle riders.

Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic.

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors-internal locus of control, impatience, optimism bias, and aspirations-and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women's use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers' influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks. JEL CODES: I12, D10, D91, I30.

The mediating role of health behaviors in the relationship between internal locus of control and life satisfaction in public health students.

Well-being is a continuous process requiring decisions and actions to maintain or build health. This study examines the indirect effect of health locus of control on life satisfaction via healthy behaviors based on living systems theory. Participants were 730 students of various majors related to medicine and health, aged between 19 and 30 (M = 22.29, SD = 1.64), including 79.04% women. Self-report measures were used to assess life satisfaction, multidimensional health locus of control, and health behavior. Women scored higher than men on the total health behavior scale, especially in a healthy diet and preventive behavior. Men scored higher than women on internal health locus of control (HLC), while women scored higher than men on the powerful others HLC in making decisions about their health. The study confirmed the mediating effect of healthy behavior on the relationship between the internal HLC and life satisfaction. The present mechanism highlights the crucial role of internal motivation in increasing subjective well-being by maintaining health behaviors among young adults. The role of intervention programs focused on improving internal HLC and health behaviors is discussed.

Mechanisms mediating ethnoracial discrimination and suspiciousness in Asian, Black, and Hispanic United States college students.

BACKGROUND: Despite the robust relationship between ethnoracial discrimination and positive psychotic-like experiences (PLEs) like subclinical suspiciousness in adulthood, the underlying mechanisms remain underexamined. Investigating the mechanisms previously implicated in trauma and positive PLEs - including negative-self schemas, negative-other schemas, perceived stress, dissociative experiences, and external locus of control - may inform whether ethnoracial discrimination has similar or distinct effects from other social stressors. METHOD: We examined the indirect effects of experiences of discrimination (EOD) to suspicious PLEs and total positive PLEs through negative-self schemas, negative-other schemas, perceived stress, dissociative experiences, and external locus of control in Asian (nAsian = 268), Black (nBlack = 301), and Hispanic (nHispanic = 129) United States college students. RESULTS: Among Asian participants, results indicated a significant indirect effect of EOD to suspicious PLEs and EOD to positive PLEs via perceived stress, and EOD to positive PLEs via negative-self schemas. Among Hispanic participants, results indicated a significant indirect effect of EOD to suspicious PLEs and EOD to positive PLEs via dissociative experiences. No mechanisms appeared significant in Black participants nor were any significant direct effects observed across models, despite them reporting significantly greater experiences of ethnoracial discrimination. CONCLUSIONS: Our findings suggest some shared but potentially distinct mechanisms contribute to increased suspicious PLEs and positive PLEs in Asian, Black, and Hispanic college students, with results differing by group, compared to the mechanisms underlying trauma and positive PLEs, with implications for the treatment of PLEs in college students exposed to ethnoracial discrimination.

Adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in children and adolescents: A longitudinal study.

BACKGROUND: Adverse childhood experiences (ACEs) have a profound impact on individuals, shaping their long-term health and life opportunities. This study delves into the complex ties between ACEs and the socioemotional development of Australian children and youth by examining the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors. METHODS: This study utilized data from the Longitudinal Study of Australian Children and employed the generalized estimating equation method to investigate the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in Australian children and adolescents. RESULTS: Adverse childhood experiences such as physical punishment, hostile parenting, parental conflicts, separation, financial strain, and parental mental health issues increased the risk of externalizing and internalizing behaviors while reducing prosocial behaviors. The risk increases with the number of ACEs, as evidenced by the incidence ratio (IR); for example, for externalizing behaviors, an ACEs score of one leads to IR = 1.69, while an ACEs score of 4 results in IR = 3.34. Similar trends were observed for internalizing and prosocial behaviors. LIMITATIONS: The presence of imbalanced longitudinal data, arising from variations in the number of observations across different time points, challenges robust inferences. Furthermore, this study investigates the relationship between ACEs and behavioral problems, without establishing causality. Consequently, the results should be interpreted with caution. CONCLUSIONS: The findings of this study highlight that adverse childhood experiences significantly influence behavioral outcomes in children and adolescents. These findings underscore the critical need for early detection and intervention to mitigate the consequences of traumatic childhood experiences.

Bodily Autonomy and Trauma: Understanding the Nature of the Association Between Sexual Trauma, an External Locus of Control, and Depressive Symptoms.

There is growing evidence suggesting an increased perception of control is associated with reduced psychological distress among survivors of sexual trauma. The current study advances the extant literature by investigating the association between depressive symptoms, sexual trauma, and an external locus of control or the perception life events are outside one's own control. To do so, we analyze data from the New Family Structures Study, a nationally representative survey of U.S. adults ages 18-39. Results from ordinary least square regression analyses suggest sexual trauma and an external locus of control are associated with significantly greater depressive symptoms and that external control exacerbates the association between sexual trauma and depression. Such findings suggest future research should investigate environmental control for sexual trauma survivors in areas such as prenatal care and the justice system.

A serial mediation model reveals the association between parental over-protection and academic entitlement among nursing students.

The study aims to explore the influence of parental over-protection on academic entitlement of nursing students, and examine the mediating roles of external locus of control and psychological entitlement. The study sampled two medical universities in Guizhou and Yunnan provinces, China. Participants were nursing students in grades one to four (N = 1003; mean age = 19.51 years; 81.95% female). Using a structural equation model, we examined the mediating effect of external locus of control and psychological entitlement on parental over-protection and academic entitlement. The results show that there was a significant correlation between all variables, and external locus of control and psychological entitlement played a serial mediating role between parental over-protection and academic entitlement. Our findings suggest that academic entitlement of nursing students can be reduced by adjusting parental rearing behaviors, reducing students' psychological entitlement, and teaching them how to form a healthier attribution style.

Cultural values, parenting, and child adjustment in the United States.

We examined whether cultural values, conformity and parenting behaviours were related to child adjustment in middle childhood in the United States. White, Black and Latino mothers (n = 273), fathers (n = 182) and their children (n = 272) reported on parental individualism and collectivism, conformity values, parental warmth, monitoring, family obligation expectations, and child internalising and externalising behaviours. Mean differences, bivariate correlations and multiple regression analyses were performed on variables of interest. Collectivism in mothers and fathers was associated with family obligation expectations and parental warmth. Fathers with higher conformity values had higher expectations of children's family obligations. Child internalising and externalising behaviours were greater when Latino families subscribed to individualistic values. These results are discussed in the context of cultural values, protective and promotive factors of behaviour, and race/ethnicity in the United States.

Do aversive well-being comparisons mediate the effects of childhood adversity on anxiety and depression?

BACKGROUND: Childhood adversity (CA) is strongly associated with depression and anxiety in later life. Many adults with a history of CA may have internalized an insecure self-concept, which may contribute to negative evaluations of one's current well-being relative to different standards. Yet, there is lack of research on well-being comparisons in adults with a history of CA. OBJECTIVE: We examined aversive well-being comparisons (i.e., comparisons threatening the comparer's motives) in the context of CA and their predictive value in depression and anxiety beyond self-esteem, emotion regulation, and external control beliefs. Further, we investigated whether well-being comparison processes mediate the relationship between CA and depression and anxiety. PARTICIPANTS AND SETTING: We conducted a two-wave longitudinal study with 942 adult participants (mean age: 31.56 years, SD = 10.49, 18-75 years). METHODS: Participants completed measures of CA, aversive well-being comparisons (social, temporal, counterfactual, and criteria-based comparisons), self-esteem, emotion regulation, and locus of control at two time points, three months apart. RESULTS: CA was significantly linked to more frequent aversive well-being comparisons. These comparisons were associated with greater discrepancies relative to the comparison standard and a more negative affective impact, ultimately contributing to higher levels of subsequent anxiety and depression symptoms. Comparison frequency emerged as key mediator, highlighting potential pathways through which CA affects adult mental health. These associations emerged despite controlling for established variables in this context, namely self-esteem, emotion regulation, and external locus of control. CONCLUSION: Our findings underscore the unique importance of aversive well-being comparisons in individuals with a history of CA.

Do early midlife work characteristics predict 20-year change in control beliefs?

Previous research showed the importance of control beliefs for many life outcomes. The present study examines associations between subjectively perceived work environment and objectively measured work activities at the beginning of midlife as a central developmental phase in the context of work, with control beliefs across the subsequent 20 years. We analyzed four-wave longitudinal data from N = 374 participants (born 1950-1952; Mage baseline = 44 years, SD = 1; 44% women) from the Interdisciplinary Longitudinal Study of Adult Development and Aging within a structural equation modeling framework. Over 20 years and overall, internal control beliefs were stable, while external control beliefs decreased. Individuals who reported higher task variety and better social integration at work at baseline also reported higher levels of control beliefs for positive life outcomes. In addition, higher social integration at work at baseline was related to lower levels of external control beliefs. Work characteristics at baseline were not associated with individual differences in change in control beliefs across the 20-year observational interval. In summary, our findings suggest that work experiences at the prime of job-related development around the midst of the fifth decade of life do not play a major role in subsequent control beliefs development across 20 years. However, investigations measuring control beliefs as well as work characteristics continuously over a long period of time are necessary to shed light on reciprocal influences between work and personality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The chain mediating effect of learning goal distress and excessive learning motivation from unknown locus of control on migrant middle school students' learning anxiety.

The prevalence of learning anxiety among Chinese migrant middle school students is a notable concern in academia. There is a wealth of research on the effects of internal and external locus of control on learning anxiety, but there is still a lack of research on unknown locus of control. To grasp the situation of migrant middle school students in terms of learning anxiety, to understand the relationship between migrant middle school students' unknown locus of control and learning anxiety, this study surveyed 351 migrant middle school students, using Mental Health Test, Multidimensional Measure of Children's Perceptions of Control, Middle School Students Learning Motivation Scale to do the questionnaire survey. The data analysis conducted through SPSS software revealed the following findings: (1) There is a positive prediction of learning anxiety from an unknown locus of control (ß = 0.139, p < 0.05). (2) Unknown locus of control indirectly influences learning anxiety through both learning goal distress and excessive learning motivation. Learning goal distress and excessive learning motivation partially mediate the relationship between unknown locus of control and learning anxiety. The total magnitude of the indirect effects is 0.15 (p<0.05). The effect is significant, but the size of the effect is small and the issue of generalizability should be considered. The research findings suggest that the unknown locus of control indirectly affects learning anxiety through difficulties with learning goals and excessive learning motivation. It is suggested that increasing opportunities for students to make independent choices and to develop their sense of self-control in daily lessons; guiding students to set appropriate learning goals, avoiding too high or too low, emphasizing refinement of goals and the combination of long-term and short-term goals.

Development of the Food-Related Control Scale for Long-Term Care.

OBJECTIVE: Develop and test a Food-Related Control Scale (FRCS) measuring resident-perceived control in long-term care food service. DESIGN: A bank of 15 initial items based on a multidimensional locus of control construct was developed initially. Expert review, cognitive interviews, a pilot study, and factor analysis were used to validate the instrument and assess reliability. SETTING: Individual phone-based cognitive interviews and 16 skilled nursing facilities in the US. PARTICIPANTS: Cognitive interviews included a convenience sample of independently living adults aged ≥ 65 (n = 13), whereas the pilot study included skilled nursing facility-residing adults (n = 166). VARIABLES MEASURED: Perception of food-related control in a long-term care setting. ANALYSIS: Cognitive interviews were analyzed to develop items. Quantitative data from skilled nursing facility residents were analyzed using SAS software for structural equation modeling and factor analysis. RESULTS: A 2-dimensional construct (9 items) of the FRCS demonstrated reliability with factor analysis. Concurrent validity within the locus of control construct was demonstrated with the Multidimensional Health Locus of Control Scale (standardized estimate of 0.430; P < 0.1). CONCLUSIONS AND IMPLICATIONS: The FRCS may be used to determine how residents in long-term care perceive control over their food experiences. Further testing is necessary to determine the appropriateness of the FRCS for different population uses.

The education-health gradient: Revisiting the role of socio-emotional skills.

Is the education-health gradient inflated because both education and health are associated with unobserved socio-emotional skills? We find that the gradient in health behaviors and outcomes is reduced by about 15 to 50% from accounting for fine-grained personality facets and up to another 50% from Locus of Control. Traditional aggregated Big-Five scales, however, have a much smaller contribution to the gradient. We use sibling-fixed effects to net out the contribution from genes and shared childhood environment, decomposing the gradient into its components with an order-invariant method. We rely on a large survey (N = 28,261) linked to high-quality Danish administrative registers with information on parental background and objectively measured diagnoses and care use. Accounting for Locus of Control yields the strongest gradient reduction in self-rated health status and objective diagnoses (30%-50%), and in health behaviors the most important factor is Extraversion, a skill that has been shown to be malleable in interventions.

The Relation between Residential Mobility and Internalizing and Externalizing Problems in Adolescence: The Role of Subjective Moving Experience, Gender, and Friendship Quality.

Adolescent residential mobility can be a stressful life event, potentially aggravating internalizing or externalizing problems. However, the longitudinal effects of residential mobility are understudied and may be context-dependent. This study investigates the longitudinal associations between adolescent residential mobility and internalizing and externalizing problems. Additionally, this study examines for whom residential moves are most detrimental by including subjective moving experience, gender, and friendship quality before the move as moderators. Longitudinal data from 2,029 adolescents (51% female) from the TRacking Adolescents' Individual Lives Survey (TRAILS) were used (Mage [SD] at T1 = 11.1 [0.55], T2 = 13.6 [0.52], and T3 = 16.3 [0.70]). Results from stepwise multi-level random-effect models showed that adolescents who experienced an unpleasant move remained stable in internalizing problems, while others decreased over time. Adolescents who moved increased stronger in externalizing problems than adolescents who did not move, independent of whether they experienced the move as unpleasant. Gender and friendship quality before the move did not moderate the relation between residential mobility and internalizing or externalizing problem development. These results emphasize that residential moves in adolescence, especially when experienced as unpleasant, can have long-lasting negative effects on adolescent development.

Physical activity as a mediator in the relationship between health locus of control and health-related quality of life in multiple sclerosis patients with different disease duration.

BACKGROUND: The importance of undertaking physical activity for functioning of patients with multiple sclerosis (MS) has been repeatedly highlighted. However, the research on the role of physical activity in shaping the quality of life of patients with different disease duration is scarce. OBJECTIVE: The aim of this study was to identify the mediating role of physical activity in the relationship between health locus of control (HLoC) and health-related quality of life in MS patients with varying disease duration. METHODS: The study included 339 patients with MS from rehabilitation centers. The Multiple Sclerosis Impact Scale (MSIS-29) was used to measure health-related quality of life, physical activity was assessed by the Godin Leisure Time Exercise Questionnaire (GLTEQ) and the Health Locus of Control Questionnaire was used to measure HLoC. RESULTS: Physical activity has been shown to be a mediator in the relationship between intrinsic HLoC and health-related quality of life particularly in patients with longer disease duration. Intrinsic HLoC was positively associated with engaging in physical activity, which in turn was positively associated with the physical component of quality of life in patients with longer (indirect effect: ß = -0.077, p < 0.05) and moderate (ß = -0.040, p < 0.05) duration of illness. CONCLUSION: The results highlight the importance of psychological resources for undertaking quality-of-life-related physical activity by MS patients with long disease duration. Particularly important here is the internal HLoC, which promotes physical activity that increases the chance of a high quality of life.

Passive green space exposure leading to lower aggression: The mediating role of sense of control.

Green spaces, integral to natural environments, have been extensively studied for their positive impact on mental health, yet their influence on social behavior, particularly aggression, is less explored. While prior research has predominantly emphasized the effects of actively engaging with nature, the significant role of passive nature exposure-a more common daily occurrence-has often been overlooked. We conducted two studies to explore the influence of passive green space exposure on aggression and the mediating effect of the sense of control. Study 1 (N = 240) utilized a cross-sectional survey to assess the relationship between passive green space exposure, sense of control, and aggression. Study 2 (N = 260) employed a single-factor between-subjects experimental design to further explore these relationships in a controlled environment. The results from both studies indicated that passive green space exposure is negatively related to aggression, and that this relationship is partially mediated by an increased sense of control. Specifically, passive green space exposure was found to negatively predict aggression by bolstering individuals' sense of control. These findings underscore the potential of enhancing the sense of control through environmental factors like green spaces as an effective strategy to reduce aggression. This study enriches our understanding of the broader impacts of green spaces, extending beyond mental health to include social behaviors. We discussed both the theoretical and practical implications of our findings, highlighting how urban planning and environmental design can incorporate green spaces to foster community well-being and mitigate aggressive behaviors.

Structural relations of illness perception, fatigue, locus of control, self-efficacy, and coping strategies in patients with multiple sclerosis: a cross-sectional study.

BACKGROUND: Patients with multiple sclerosis (MS) experience extensive problems due to fatigue and illness perception. Reducing these problems may improve these patients' quality of life (QoL). Accordingly, the current study is aimed at investigating the mediating role of self-efficacy, locus of control, coping strategy, and outcome expectancy in the relationship between illness perception and fatigue severity in patients with MS. METHODS: In a cross-sectional analytical study, data of 172 MS patients were collected by self-report questionnaires including illness perception questionnaires (IPQ-R), Multiple Sclerosis Self-Efficacy (MSSES) scale, health locus of control (MHLC), coping strategies in MS(CMSS), outcome expectancy, level of physical activity (IPAQ-SF), patient activation measure (PAM-13) and fatigue severity scale (FSS). The data were analyzed using linear and multiple regression analysis in SPSS software version 24 (SPSS Inc., Chicago, IL, USA). RESULTS: The final model explained 62% of the fatigue variance. Illness perception both directly and indirectly (through self-efficacy, physical activity level, internal health locus of control, patient activation, and negative coping strategies) could predict the participants' fatigue severity. Among the mediating variables, internal health locus of control, self-efficacy, and negative coping strategies had the greatest impact, respectively. moreover, outcome expectancy variable did not a mediating role in the aforementioned relationship. CONCLUSIONS: To enhance the well-being of MS patients and to improve the efficiency of treating MS related fatigue, a comprehensive treatment protocol is needed, encompassing psychological factors affecting fatigue severity.