Objective This study examined the feasibility and acceptability of an Individual Internet Intervention (III) embedded and integrated into an Internet Support Group (ISG) with the ultimate goal of enhancing adherence and learning, compared to an individual internet invention alone. Method Thirty-one post-treatment cancer survivors were randomized in groups of seven to nine to either the 8-week III+ISG intervention or the 8-week III condition. Seventeen participants met HADS criteria for depressive symptoms (HADS>=8). Results Among all participants, the mean number of logins over 8 weeks was 20.8±17.7 logins for the III+ISG compared to 12.5±12.5 in III-only (p=0.15). Two participants in the III+ISG dropped out, compared to 5 in III (p=0.39). Among the 17 participants with depressive symptoms at baseline, both the Onward and the III-only condition showed large reductions in the HADS-dep (d=1.27 & 0.89, respectively). Improvement over time and time×treatment effects only reached trend significance levels (ps=0.07 & 0.12) as this pilot was not powered to detect these differences. Conclusion Both the III+ISG and III-only demonstrated pre-post reductions in depressive symptoms and high rates of utilization compared to other web-based treatments for depression. While it is premature to make any determination as to the efficacy of the interventions tested in this feasibility study, these results indicate that pursuing the III+ISG model as well as standard IIIs, may be fruitful areas of future research.

Background Stressful life events have long been suspected to contribute to multiple sclerosis (MS) disease activity. The few studies examining the relationship between stressful events and neuroimaging markers have been small and inconsistent. This study examined whether different types of stressful events and perceived stress could predict development of brain lesions. Methods This was a secondary analysis of 121 patients with MS followed for 48 weeks during a randomized controlled trial comparing Stress Management Therapy for MS to a waitlist control. Patients underwent MRI’s every 8 weeks. Monthly, patients completed an interview measure assessing stressful life events, and self-report measures of perceived stress, anxiety, and depressive symptoms, which were used to predict the presence of gadolinium enhancing (Gd+) and T2 lesions on MRI’s 29–62 days later. Participants classified stressful events as positive or negative. Negative events were considered “major” if they involved physical threat or threat to the patient’s family structure, and “moderate” otherwise. Results Positive stressful events predicted decreased risk for subsequent Gd+ lesions in the control group (OR=.53 for each additional positive stressful event, 95% CI=.30–.91) and less risk for new or enlarging T2 lesions regardless of group assignment (OR=.74, 95% CI=.55–.99). Across groups, major negative stressful events predicted Gd+ lesions (OR=1.77, 95% CI=1.18–2.64) and new or enlarging T2 lesions (OR=1.57, 95% CI=1.11–2.23), while moderate negative stressful events, perceived stress, anxiety, and depressive symptoms did not. Conclusions Major negative stressful events predict increased risk for Gd+ and T2 lesions, while positive stressful events predict decreased risk.

Objective Although some studies have suggested a relationship between MS exacerbations and psychological distress, methodological weaknesses limit their conclusions. This study was aimed to determine whether pseudo- and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms. Methods This was a secondary analysis of 121 patients with MS who were followed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a phone-administered symptom checklist and neurological exam. Results Both pseudo-exacerbations and confirmed exacerbations were associated with concurrent somatic depressive, β = .16 and β = .33, respectively, ps < .05, affective depressive, β = .17, p = .02 and β = .12, p = .06, and anxiety symptoms, β = .24 and β = .20, ps < .01, controlling for baseline symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms, β = .19 and β = .20, respectively, ps < .01. A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudo-exacerbations, odds ratio [OR] = 1.54, p = .02, while increased somatic depressive symptoms predicted confirmed exacerbations, OR = 1.59, p = .01. Conclusion Patients with MS experiencing pseudo- or confirmed exacerbations should be assessed and monitored for depressive and anxiety symptoms, and confirmed exacerbations are particularly concerning in patients with a history of depression. The psychological or psychiatric antecedents of MS exacerbations generate new hypotheses on etiologies of confirmed and pseudo-exacerbations. Trial Registration ClinicalTrials.gov (NCT00147446).