Cognitive behavioural therapy for MS-related fatigue explained: A longitudinal mediation analysis

Area of Science:

• Neuroscience
• Psychology
• Rehabilitation Medicine

Background:

• Cognitive behavioural therapy (CBT) is effective for reducing fatigue in Multiple Sclerosis (MS) patients immediately post-treatment.
• The specific psychological mechanisms driving these changes during and after CBT remain largely unexplored.

Purpose of the Study:

• To identify psychological mediators of fatigue reduction during and after CBT in MS patients.
• To understand the process of change in fatigue levels within the TREFAMS-CBT trial.

Main Methods:

• Analysis of a randomized clinical trial (TREFAMS-CBT) involving 91 MS patients.
• Assessed psychological factors including illness cognitions, self-efficacy, coping, sleepiness, concentration, physical activity, and mood at multiple time points (baseline, 8, 16, 26, 52 weeks).
• Employed the product-of-coefficients approach with bootstrap confidence intervals to analyze mediation.

Main Results:

• During CBT, fatigue reduction was mediated by improved fatigue perceptions, increased physical activity, reduced sleepiness, decreased helplessness, and better physical functioning.
• Post-treatment, increases in fatigue were linked to reduced physical activity, poorer concentration, and increased sleepiness.

Conclusions:

• Optimizing CBT for MS fatigue could involve targeting fatigue perceptions, physical activity, sleepiness, helplessness, and physical functioning.
• Sustaining treatment benefits requires continued focus on enhancing physical activity, concentration, and managing sleepiness.