A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis

Abstract

BackgroundTo examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis.MethodsThe current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention.ResultsLarge between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66–1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17–1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as ‘very useful’, and most (73.4%) reported that the intervention had addressed their problems ‘completely’.ConclusionsThese data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371).

The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

“…The included studies were published between 2003 and 2017 and reported 11 RCTs ( 34 , 35 , 41 – 45 , 47 – 50 , 52 , 53 ), 4 pilot RCTs ( 40 , 43 , 46 , 55 ), 1 experimental and control groups pre-test/post-test pilot study ( 39 ), 1 observational study ( 56 , 57 ), 1 single group pre-test and post-test pilot study ( 54 ), and 2 single-group pre-test and post-test studies ( 33 , 51 ). The countries where the included studies took place were Turkey ( 33 ), the United States of America ( 41 , 45 ), Germany ( 42 ), Switzerland ( 53 ), Belgium ( 44 ), Australia ( 34 , 43 , 54 ), Italy ( 52 ), Iran ( 35 , 39 , 50 ), United Kingdom ( 40 , 46 – 48 , 51 ), Netherlands ( 56 , 57 ), and New Zealand ( 49 , 55 ).…”

“…Of the 16 included intervention and control studies, 10 studies ( 35 , 39 – 43 , 46 – 48 , 50 , 53 ) compared psychological interventions against non-active controls and 6 studies ( 34 , 44 , 45 , 49 , 52 , 55 ) compared psychological interventions against active controls. In four studies, two psychological interventions of interest were compared: CBT and supportive-expressive group (psychotherapy) ( 45 ); self-management occupational therapy (CBT) and relaxation therapy ( 44 ); and CBT and relaxation ( 49 ); and eye movement desensitization and reprocessing (EMDR) and relaxation therapy ( 52 ); respectively.…”

Computerized Cognitive Behavioral Therapy for Treatment of Depression in Multiple Sclerosis

“…It is unclear, however, whether the lack of effect is due to lack of uptake in the intervention because computerized sessions were incomplete for many patients (a median of one of the six sessions in MoodGYM completed and a median of two of the eight sessions in Beating the Blues completed). be highly effective in reducing depressive symptoms in patients with MS, [34][35][36] with one study suggesting that CBT may be as effective as pharmacotherapy. 37 In this study, patients with MS and depression were treated with weekly therapist-administered CBT, supportiveexpressive group psychotherapy, or sertraline (doses varying from 50-200 mg).…”

Pilot study on the effects of cognitive behavioral therapy on depression among Japanese patients with multiple sclerosis

“…In fact, another study of small numbers of patients in the UK showed that CBT can be effective in routine clinical practice for MS patients with depression and anxiety. 21 In the present study, there was a possibility that the scores of thinking/fatigue of FAMS might be improved after the CBT intervention in some patients. As for QOL evaluated by FAMS, total scores increased after the fourth and the eighth sessions relative to baseline, although they were not statistically significant.…”

“…20 In contrast, there is another report of the effectiveness of CBT for improving depressive symptoms for the long term. 21 In the present study, there was a possibility that the scores of thinking/fatigue of FAMS might be improved after the CBT intervention in some patients. Further research is required to confirm the effects of CBT, and longer-term follow up to evaluate the effectiveness of CBT is required in future studies.…”