How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated...

Area of Science:

• Psychology
• Neuroscience
• Clinical Medicine

Background:

• Multiple Sclerosis (MS) significantly impacts patients' quality of life, causing distress and functional impairment.
• Cognitive Behavioural Therapy (CBT) has shown promise in managing MS-related distress.
• Understanding the mechanisms through which CBT exerts its effects is crucial for optimizing treatment.

Purpose of the Study:

• To investigate the mediating role of cognitive-behavioural variables in CBT's effectiveness for MS.
• To examine whether these mediating mechanisms differ between participants with and without clinical distress at baseline.
• To explore how CBT influences distress and functional impairment in MS patients.

Main Methods:

• Secondary analysis of the saMS (supportive adjustment for multiple sclerosis) randomised controlled trial involving 94 participants.
• Randomization to either saMS CBT or supportive listening (SL) with outcomes assessed at 12 months.
• Structural equation modeling and mediated-moderation analyses to assess mediation by cognitive-behavioural variables at 15 weeks.

Main Results:

• CBT significantly reduced distress and functional impairment compared to SL, particularly in participants with clinical distress.
• Illness acceptance and reduced embarrassment avoidance behaviors mediated CBT's effect on distress.
• Changes in beliefs about processing emotions mediated CBT's effect on functional impairment.
• Mediation effects were significant only in the subgroup with clinical distress at baseline.

Conclusions:

• CBT improves adjustment in MS patients by enhancing illness acceptance and emotional processing, and reducing avoidance behaviors.
• These mechanisms are most prominent in individuals experiencing significant clinical distress.
• Targeting these cognitive-behavioural factors may enhance CBT interventions for MS.