The efficacy of cognitive behavioural therapy for depression and anxiety in multiple sclerosis: A systematic review and meta-analysis

Exploring the Therapeutic Role of Coach-Guided Videoconferencing Expressive Writing in Multiple Sclerosis: A Qualitative Study

Background/Objectives: Emotional changes significantly affect people with multiple sclerosis (PwMS), often leading to negative psychological symptoms including grief. Effective management of these symptoms can foster personal growth, increase confidence, and renew hope. While expressive writing has demonstrated psychological benefits in processing trauma and chronic conditions, its effects on PwMS remain underexplored. This study aimed to address this gap by examining the experiences of PwMS who participated in a 10-week coach-guided videoconferencing expressive writing program. Methods: Twenty-five adults with MS from 10 different states across the United States participated in a 10-week coach-guided videoconferencing expressive writing program. After they completed the program, participants were interviewed individually via Zoom using a structured guide. Interviews explored participants' experiences and perceptions of the program. All interviews were audio-recorded and transcribed verbatim for analysis. Interview transcripts were analyzed using thematic analysis within a phenomenological framework. Results: Analysis revealed four themes reflecting therapeutic benefits received from the expressive writing program. These themes included Improved Emotional Processing, Promoting Healing; Therapeutic Coping; Radical Acceptance Through Deeper Understanding and Self-Forgiveness; and Empowerment Through Self-Discovery and Transformation. Conclusions: The findings highlight participants' psychological progression from emotional processing to transformation, emphasizing the program's role in guiding them through their experiences of grief and other emotions related to their MS. This process provided them with both a sense of empowerment and a renewed outlook on life. Results suggest that expressive writing is a promising intervention that offers PwMS an accessible tool for emotional well-being and self-discovery.

COMBAT-MS (group-based cognitive remediation and behavioural approaches to intervention in multiple sclerosis)

BACKGROUND

Cognitive impairment (CI) and psychological distress are prevalent and interrelated in persons with multiple sclerosis (PwMS). Holistic interventions are needed to support psychosocial adjustment.

OBJECTIVE

To evaluate the effects of a combined group-based cognitive behavioural therapy (CBT) and cognitive training (CT) program on cognitive and psychosocial outcomes in PwMS.

METHOD

This randomized controlled trial involved 105 PwMS allocated to a 10-week group-based intervention or treatment-as-usual control. Assessments were conducted at baseline (BL), three months post-intervention (3MFU), and 12 months post-intervention (12MFU). Due to the COVID-19 pandemic, the intervention transitioned from in-person to telehealth, enabling comparative analyses of delivery modes. Primary outcomes were quality of life and a memory composite score. Secondary outcomes included measures of processing speed, executive functioning, depression, anxiety, subjective cognitive impairment, coping strategies, and social support. Longitudinal changes were analysed using Linear Mixed Models (LMM).

RESULTS

Face-to-face participants demonstrated significant post-intervention improvements in vitality and positive coping, maintained at 12MFU. At 12MFU, additional gains in general health and emotional support were observed. Fatigue impact improved significantly at 12MFU in the telehealth and control groups but not the face-to-face group. At 12MFU, memory composite scores improved significantly in the face-to-face intervention group but not in the telehealth intervention group. Memory composite scores also improved significantly in the control group at 12MFU. No significant changes were found in other cognitive or psychosocial outcomes.

CONCLUSION

The COMBAT-MS program, integrating CBT and CT, demonstrates feasibility and potential efficacy in improving cognitive and psychosocial health in PwMS, with outcome variability influenced by the mode of delivery.

Not for everyone: Factors influencing who receives psychotherapy in people with multiple sclerosis

BACKGROUND

Although depression and anxiety are common in people with multiple sclerosis (pwMS), access to psychotherapy remains limited.

OBJECTIVES

This study aimed to identify clinical factors that predict use of psychotherapy among pwMS.

METHODS

From a retrospective chart review of a tertiary neuropsychiatry clinic in Toronto, Canada, data were obtained for 267 pwMS who received neuropsychiatric treatment (either with antidepressants or psychotherapy). Candidate predictor variables included demographics (e.g. age, sex), disease-related factors (e.g. disease duration, MS subtype, Expanded Disability Status Scale (EDSS) score), symptom data (e.g. Hospital Anxiety and Depression Scale sub-scales for anxiety and depression, five-item Modified Fatigue Impact Scale), and other treatment use (e.g. disease-modifying therapies, psychotropic medications). A backward stepwise logistic regression analysis identified predictors of psychotherapy use (p<.05).

RESULTS

Mean age was 46.97 years, 70.41 % were female, median EDSS was 2.50, 63.30 % had relapsing illness, and 22.47 % received psychotherapy. Increased EDSS scores (OR=0.74, 95 % CI 0.58-0.95, p=.02) and prolonged disease duration (OR=0.94, 95 % CI 0.89-0.99, p=.03) predicted decreased use of psychotherapy.

CONCLUSIONS

Neurological disability and disease duration may influence psychotherapy use among pwMS. Studies are now needed to evaluate contributors to these associations to expand access to non-pharmacological treatments for pwMS.

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Neuropsychiatric Symptoms in Multiple Sclerosis (MS)-A Review and Insight into Possible Mechanisms of Action

Introduction: Neuropsychiatric symptoms such as depression and anxiety are a significant burden on patients with multiple sclerosis (MS). Their pathophysiology is complex and yet to be fully understood. There is an urgent need for non-invasive treatments that directly target the brain and help patients with MS. One such possible treatment is transcranial direct current stimulation (tDCS), a popular and effective non-invasive brain stimulation technique. Methods: This mechanistic review explores the efficacy of tDCS in treating depression and anxiety in MS while focusing on the underlying mechanisms of action. Understanding these mechanisms is crucial, as neuropsychiatric symptoms in MS arise from complex neuroinflammatory and neurodegenerative processes. This review offers insights that may direct more focused and efficient therapeutic approaches by investigating the ways in which tDCS affects inflammation, brain plasticity, and neural connections. Searches were conducted using the PubMed/Medline, ResearchGate, Cochrane, and Google Scholar databases. Results: The literature search yielded 11 studies to be included in this review, with a total of 175 patients participating in the included studies. In most studies, tDCS did not significantly reduce depression or anxiety scores as the studied patients did not have elevated scores indicating depression and anxiety. In the few studies where the patients had scores indicating mild/moderate dysfunction, tDCS was more effective. The risk of bias in the included studies was assessed as moderate. Despite the null or near-null results, tDCS may still prove to be an effective treatment option for depression and anxiety in MS, because tDCS produces a neurobiological effect on the brain and nervous system. To facilitate further work, several possible mechanisms of action of tDCS have been reported, such as the modulation of the frontal-midline theta, reductions in neuroinflammation, the modulation of the HPA axis, and cerebral blood flow regulation. Conclusions: Although tDCS did not overall demonstrate positive effects in reducing depression and anxiety in the studied MS patients, the role of tDCS in this area should not be underestimated. Evidence from other studies indicates the effectiveness of tDCS in reducing depression and anxiety, but the studies included in this review did not include patients with sufficient depression or anxiety. Future studies are needed to confirm the effectiveness of tDCS in neuropsychiatric dysfunctions in MS.