Multiple Sclerosis: Cognitive Therapy Eases Anxiety

An MS diagnosis is depressing, but cognitive behavioral therapy helps.

A new study on the effectiveness of early cognitive behavioral therapy (CBT) on recently diagnosed individuals with multiple sclerosis (MS) demonstrates that post-diagnosis treatment alleviates depression and anxiety, and improves quality of life for patients with MS

An interdisciplinary team of psychologists, neurologists, and clinicians at the University of Melbourne, the Melbourne School of Psychological Sciences, and the Florey Institute of Neuroscience and Mental Health, collaborated on the study which determined that an 8-week tailored cognitive behavioral therapy intervention for newly diagnosed patients with MS helped drastically reduce the high levels of depression and anxiety associated with diagnosis and can lead to benefits throughout a patient's lifetime.

Lead researcher Litza A. Kiropoulos, PhD, and colleagues noted that clinically high levels of depression and anxiety are common in individuals with MS, particularly around initial diagnosis of the neurological disorder. There is a "lifetime prevalence of depression" common in half of all individuals with MS. High levels of anxiety are also of concern to psychologists and neurologists treating individuals with MS.

Kiropolos wrote that "anxiety affects between 16% and 45% of the MS population and has been associated with younger age of onset, disease severity, fatigue and severity of depressive symptoms." MS is often diagnosed, as Kiropolos points out, during "a time point when individuals are typically establishing careers, relationships and families. Individuals may also be adapting to the MS diagnosis and symptoms, the burden of uncertainty and dealing with the loss of physical and cognitive functioning, changes in interpersonal relationships, social and work roles and social support and a reduction in positively reinforcing activities."

High levels of depression and anxiety are particularl worrisome in individuals with MS. If symptoms of depression and anxiety are not addressed early there is a significant chance that symptoms will "worsen and contribute to further deterioration" resulting in "exacerbation of MS relapses," they wrote. Kiropolos and colleagues explained that early treatment of depression and anxiety at time of diagnosis can lead to "possible positive impacts on disease processes" potentially reducing long-term MS progression and deterioration and "modifying the trajectory of psychological morbidity."

Thirty individuals diagnosed with MS within five years of the study, and scoring a 10 or higher on the Beck Depression Inventory II (BDI-II) test were selected to participate in the eight-week intervention over the course of the full 20-week study. Half of the participants in the 20-week study were randomly assigned via blind allocation methods to take part in the tailoredeight-week CBT intervention, and half were part of a control group receiving no psychological treatment. The intervention's primary outcome is to "significantly decrease level of depressive symptoms." Secondary outcomes for the CBT intervention address "anxiety, fatigue and pain impact and to contribute to improvements in levels of quality of life, sleep difficulties, MS illness acceptance, active coping skills, social support and resilience (secondary outcomes) in those newly diagnosed with MS."

Participants in both groups were given a range of questionnaires pre-, post-, and at a three- month follow up session to determine the effectiveness of the CBT intervention. Tests included the BDI-II, State Trait Anxiety Inventory (STAI), five Item Modified Fatigue Impact Scale (MFIS-5) Pain Effects Scale (PES, Multiple Sclerosis Quality of Life (MSQOL-54), Pittsburgh Sleep Quality Index (PSQI), Ways of Coping Questionnaire (WCQ), Acceptance of Chronic Health Conditions Scale (ACHC), Perceived Social Support Scale (PSSS), Resilience Scale for Adults (RSA), and those receiving treatment were given several questionnaires assessing patient satisfaction with the CBT intervention.

Kiropolos and colleagues noted a significant difference between questionnaire outcomes and depression/anxiety levels of the two groups, demonstrating that early CBT intervention is effective in treating depression and anxiety and ameliorating quality of life among individuals with MS.

The eight-week session, influenced by Beck's cognitive theoretical model for treatment of depression in adults, focused on individual modules and strategies tailored by Kiropolos into relevant and targeted treatments for MS patients. Those included "progressive muscle relaxation, controlled breathing exercises, pleasant activity scheduling, problem solving skills" and cognitive exercises which assisted patients in managing depression and anxiety symptoms. All participants in the intervention reported that the intervention was "very useful" and "should be offered as part of routine care straight after diagnosis."

The article "A Pilot Randomized Controlled Trial of a Tailored Cognitive Behavioural Therapy Based Intervention for Depressive Symptoms in those Newly Diagnosed with Multiple Sclerosis" was published in the December 2016 issue of BMC Psychiatry.

Related Coverage:

Treating Depression in Multiple Sclerosis

Lifestyle Factors Contribute to Depression in Patients with Multiple Sclerosis

Depression, Fatigue, and the Regional Distribution of Brain Damage in Patients with Multiple Sclerosis