More questions than answers: Why is cognitive dysfunction associated with less use of evidence-based psychotherapy in...

Cognitive-behavioural therapy (CBT) and mindfulness-based interventions (MBI) can reduce depressive symptoms and anxiety in people with multiple sclerosis (pwMS). Yet, psychotherapy remains underutilized by pwMS.

To evaluate whether cognitive dysfunction is linked to psychotherapy use in pwMS.

In a consecutive sample of 253 pwMS who received psychiatric treatment at a Canadian neuropsychiatry clinic, cognitive impairment (CI) was defined as scores >1.5 SD below normative data on >2 Minimal Assessment of Cognitive Function in MS tests. Prior psychiatric treatment use was stratified into medications alone, evidence-based psychotherapies (CBT or MBI), or supportive/unspecified psychotherapies. Covariates included age, sex, education, employment, Expanded Disability Status Scale (EDSS) scores, disease duration, subtype, disease-modifying therapy use, and Hospital Anxiety and Depression Scale scores. Multinomial logistic regression models were undertaken to evaluate the relationship between CI and prior psychiatric treatment use, adjusting for covariates.

Mean age was 43.3 years, 73.5% were female, median EDSS was 2.0, 51.0% had CI, and 36.0% had received CBT or MBI. Controlling for confounding variables, CI was associated with reduced use of evidence-based psychotherapy (OR=0.34, 95%CI[0.15-0.79], p = 0.012), but not supportive/unspecified psychotherapy (OR=0.79, 95%CI[0.37-1.71], p = 0.55).

Among pwMS, cognitive dysfunction is independently connected to decreased use of evidence-based psychotherapies.