Relations between acceptance of multiple sclerosis and positive and negative adjustments

The association between body image and psychological outcomes in multiple sclerosis. A systematic review

BACKGROUND

Multiple sclerosis (MS) is a demyelinating autoimmune condition, in which body image may be altered due to a range of biopsychosocial factors. The aim of this review was to examine whether there is a relationship between body image and psychological outcomes in MS, in order to guide clinical intervention development.

METHODS

PsycINFO, Medline, CINAHL and Scopus databases were searched systematically in November 2023 for eligible studies, using terms relating to MS and body image. Quantitative studies, published in English, that examined the relationship between body image and psychological outcomes in adults with MS were included. The QualSyst tool was used to assess risk of bias across studies. Screening and quality appraisal was verified by the third author. A narrative synthesis was used to report patterns in findings.

RESULTS

Thirteen studies (ten cross-sectional and three intervention studies) met inclusion criteria and were included in the final review. The sample size across all included studies totalled 1533. The results suggested that positive body image was associated with improved mood, lower anxiety, increased self-esteem, and better quality of life. However, the causal nature of these relationships was unclear.

CONCLUSION

The findings offer preliminary evidence to suggest that a more negative body image is associated with higher levels of psychological distress in MS, indicating that body image may be a target for intervention. Further research is necessary to provide a greater understanding of this association, and to inform future clinical practice.

Disability, health-related quality of life, and self-concept change in people with multiple sclerosis: A moderated mediation

BACKGROUND

Disability is a key factor related to self-concept change following a Multiple Sclerosis (MS) diagnosis. Psychosocial factors (e.g., social integration, marital support) are also associated with changing self-concept in people with MS (pwMS). What remains unclear however, is whether psychosocial factors account for the relationship between disability and self-concept change. The current study aimed to investigate the potential mediation effect of Health-Related Quality of Life (HRQoL) on the relationship between disability and self-concept change in pwMS, and whether relationship satisfaction is a moderator of the mediated relationship.

METHOD

Nine hundred and ninety-five pwMS (79.5 % female; Age M = 59.72 years, SD = 11.15) completed measures of disability, HRQoL, and self-concept change. Of these participants, seven hundred and twenty-six pwMS who indicated they were currently in a relationship also completed a measure of relationship satisfaction.

RESULTS

A moderated mediation (conditional process) analysis indicated that the relationship between disability and self-concept change was partially mediated by HRQoL. A further parallel mediation found that across the eight subdomains of HRQoL, only participants' reported levels of 'relationships' and 'coping' significantly mediated the relationship between disability and self-concept change. However, for those participants in a relationship, relationship satisfaction did not moderate any mediation effects.

CONCLUSION

The findings highlight the role that perceptions of HRQoL in some domains may have in explaining the relationship between disability and self-concept change. Further research is needed to explicate the causal direction of these relationships through longitudinal studies.

Neuropsychology intervention for managing invisible symptoms of MS (NIMIS-MS) group: A pilot effectiveness and acceptability study

BACKGROUND

People with MS (pwMS) commonly experience a range of hidden symptoms, including cognitive impairment, anxiety and depression, fatigue, pain, and sensory difficulties. These "invisible" symptoms can significantly impact wellbeing, relationships, employment and life goals. We developed a novel bespoke online group neuropsychological intervention combining psychoeducation and cognitive rehabilitation with an Acceptance and Commitment Therapy (ACT)-informed approach for pwMS in an acute tertiary hospital. This 'Neuropsychological Intervention for Managing Invisible Symptoms' in MS (NIMIS-MS) consisted of 6 sessions, each with a psychoeducation and ACT component. The content included psychoeducation around managing cognitive difficulties, fatigue, pain, sleep and other unpleasant sensations in MS with the general approach of understanding, monitoring, and recognising patterns and potential triggers. Specific cognitive rehabilitation and fatigue management strategies were introduced. The ACT-informed component focussed on three core ACT areas of the 'Triflex' of psychological flexibility (Harris, 2019): Being Present, Opening Up, and Doing What Matters.

METHODS

118 pwMS attended the NIMIS-MS group intervention which was delivered 14 times in six-week blocks over an 18-month period. To evaluate the effectiveness and acceptability, participants completed measures of depression and anxiety (HADS), functional impairment (WSAS), Values- Progress (VQ) and Values- Obstruction (VQ), and Acceptance of MS (MSAS) pre and post NIMIs-MS group intervention. Qualitative feedback was obtained during focus groups after the final session and via online feedback questionnaires RESULTS: Pre-post analysis showed that symptoms of depression and anxiety were significantly lower and acceptance of MS was significantly higher following completion of the NIMIS-MS group. Qualitative feedback showed that participants reported that they felt more equipped to manage the "invisible" symptoms of MS following completion of the group, and benefited from using ACT-based strategies and techniques. Participants highly valued the peer support that evolved during the NIMIS-MS groups. The online format was considered more accessible than in-person groups, due to less concerns of travel time, cost, fatigue, and comfort and infection.

CONCLUSION

Evaluation suggests that our novel NIMIS-MS groups is an acceptable, beneficial and feasible approach for providing neuropsychological interventions to individuals with MS.

Illness representation in patients with multiple sclerosis: A preliminary narrative medicine study

Background

The development of personalized interventions aimed at coping with multiple sclerosis is enriched by the understanding of patients' representations of the illness.

Objective

The aim of this study was to investigate the association between patients' illness representations versus contextual factors (i.e. presence/absence and type of caregiver, engagement, frequency and type of rehabilitation), fatigue, pain, and neurological impairment.

Methods

Interviews of 28 patients were analysed through an automated text analysis procedure. After a systematic labelling procedure four illness representations were identified: daily life, search for meaning of the disease, relationship to people and the diagnosis, coping and physical growth.

Results

Findings showed that the representation of the relational aspects of the illness was associated with the caregiver's presence, while the representation related to coping and growth tended to be associated with participation in rehabilitation programs. Moreover, the representation related to daily life was associated with lower levels of fatigue compared to the representation related to coping and growth, and with higher levels of neurological impairment compared to the representations related to coping and growth and the relational aspects of the illness.

Conclusion

Exploring illness representations is a key step that can help health professionals to get an integrated perspective that could be useful in designing and calibrating interventions according to specific patient needs.

Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment

Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential.

AIM

To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model.

MATERIALS AND METHODS

A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI).

RESULTS

The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (β = -0.83), followed by functional activity (β = -0.18) and prefrontal symptoms (β = 0.15). The latter two are negatively related to psychological well-being (β = -0.16 and β = -0.75, respectively).

CONCLUSIONS

Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy

OBJECTIVE

To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy.

DESIGN

A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses.

MAIN OUTCOME MEASURES

Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed.

RESULTS

33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged.

CONCLUSION

A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.

A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions

BACKGROUND

Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available.

PURPOSE

To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions.

METHODS

PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.

RESULTS

Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire (n = 21 studies). One hundred and four health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently, and were used in all included neurological conditions. COMET domains most frequently coded were emotional functioning/well-being (n = 50), physical functioning (n = 32), role functioning (n = 22) and psychiatric (n = 22).

CONCLUSIONS

This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures.

Sexual Rehabilitation and Relational Satisfaction in People with Multiple Sclerosis and their Partners

Sexuality is an integral part of our existence. Multiple Sclerosis (MS) can complicate the lifelong course of sexual development and the ways in which one defines and expresses sexuality. Unfortunately, these issues are not adequately addressed by the health professionals involved in the rehabilitation process. Present research attempts to study the effect that can arise on the sexual and relational satisfaction of couples having a partner with MS after the implementation of a sexual rehabilitation program. 60 couples where one partner has MS and the other does not, were divided into three groups and accepted the PLISSIT (PLISSIT stands for Permission, Limited Information, Specific Suggestions, Intensive Therapy) sexual rehabilitation program as follows: Group a (n = 40, control group) completed self-referencing questionnaires at three times (initial measurement, after 10 weeks and 6 months later), group b (n = 40) did 10 weeks of sexual counselling and completed the same questionnaires at the same times and group c (n = 40) followed the PLISSIT programme and was evaluated in the same way at the same times. The implementation of PLISSIT improved Sexual Dysfunction (SD) levels, increased sexual satisfaction between partners along with general relational satisfaction. PLISSIT can be used by professionals involved in the management of the disease as a comprehensive psychosexual rehabilitation program for MS patients and their partners.

Assisted Reproductive Techniques in Multiple Sclerosis: Recommendations from an Expert Panel

INTRODUCTION

Multiple sclerosis (MS) is mainly diagnosed in women of reproductive age. However, there is a paucity of guidelines jointly prepared by neurologists and gynaecologists on managing women with MS and the desire for motherhood. Therefore, in this review we propose recommendations for such cases, with an particular focus on those requiring assisted reproductive techniques (ART).

METHODS

A group of seven MS experts (4 neurologists and 3 gynaecologists) came together for three discussion sessions to achieve consensus.

RESULTS

The recommendations reported here focus on the importance of early preconception counselling, the management of disease-modifying therapies before and during ART procedures, important considerations for women with MS regarding ART (intrauterine insemination, in vitro fertilisation and oocyte cryopreservation) and the paramount relevance of multidisciplinary units to manage these patients.

CONCLUSIONS

Early preconception consultations are essential to individualising pregnancy management in women with MS, and an early, well-planned, spontaneous pregnancy should be the aim whenever possible. The management of women with MS and the desire for motherhood by multidisciplinary units is warranted to ensure appropriate guidance through the entire pregnancy.

Neuropathic pain, cognitive fusion, and alexithymia in patients with multiple sclerosis: Cross-sectional evidence for an explanatory model of anxiety symptoms

Multiple sclerosis (MS) presents a high prevalence, a marked increase worldwide, and a relevant impact on patients, public health, and society. Anxiety often cooccurs with MS and can contribute to the worsening of MS symptoms. However, knowledge about predictors of anxiety in Patients with MS (PwMS) is scarce.

OBJECTIVE

This preliminary study explored a novel model for anxiety symptoms in PwMS, including neuropathic pain (NeP), cognitive fusion (CF), experiential avoidance (EA), and alexithymia as explanatory factors.

METHOD

This cross-sectional study integrated two independent convenience samples: 107 PwMS recruited from the Portuguese Society for Multiple Sclerosis and 97 age- and gender-matched participants without the MS diagnosis (no-MS sample) recruited from the Portuguese general population. Self-report questionnaires that measured the constructs included in the model were administered to both groups.

RESULTS

PwMS showed significantly higher values regarding anxiety symptoms and their explanatory variables (NeP, CF, EA, alexithymia) in comparison to non-MS participants. In the MS sample, no correlations were found between anxiety symptoms and sociodemographic and clinical characteristics. NeP, CF, and alexithymia showed significant correlations with anxiety symptoms and significantly explained this symptomatology in simple linear regression models. Thus, these variables were retained in the multiple linear regression model and emerged as significant regressors that together explained 38% of the variance in anxious symptomatology in PwMS.

CONCLUSIONS

This preliminary study provides novel evidence on NeP and some maladaptive emotion regulation strategies related to EA/psychological inflexibility, as vulnerability to anxiety in PwMS can be considerably increased by CF and alexithymia. Clinical implications were discussed.

A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND): study protocol

BACKGROUND

Motor neuron disease (MND) is a rapidly progressive, fatal neurodegenerative disease that predominantly affects motor neurons from the motor cortex to the spinal cord and causes progressive wasting and weakening of bulbar, limb, abdominal and thoracic muscles. Prognosis is poor and median survival is 2-3 years following symptom onset. Psychological distress is relatively common in people living with MND. However, formal psychotherapy is not routinely part of standard care within MND Care Centres/clinics in the UK, and clear evidence-based guidance on improving the psychological health of people living with MND is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT) may be particularly suitable for people living with MND and may help improve their psychological health.

AIMS

To assess the clinical and cost-effectiveness of ACT modified for MND plus usual multidisciplinary care (UC) in comparison to UC alone for improving psychological health in people living with MND.

METHODS

The COMMEND trial is a multi-centre, assessor-blind, parallel, two-arm RCT with a 10-month internal pilot phase. 188 individuals aged ≥ 18 years with a diagnosis of definite, laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis, and additionally the progressive muscular atrophy and primary lateral sclerosis variants, will be recruited from approximately 14 UK-based MND Care Centres/clinics and via self-referral. Participants will be randomly allocated to receive up to eight 1:1 sessions of ACT plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and at 6- and 9-months post-randomisation. The primary outcome will be quality of life at six months. Secondary outcomes will include depression, anxiety, psychological flexibility, health-related quality of life, adverse events, ALS functioning, survival at nine months, satisfaction with therapy, resource use and quality-adjusted life years. Primary analyses will be by intention to treat and data will be analysed using multi-level modelling.

DISCUSSION

This trial will provide definitive evidence on the clinical and cost-effectiveness of ACT plus UC in comparison to UC alone for improving psychological health in people living with MND.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN12655391. Registered 17 July 2017, https://www.isrctn.com/ISRCTN12655391 .

PROTOCOL VERSION

3.1 (10/06/2020).

Adjusting to living with Parkinson's disease; a meta-ethnography of qualitative research

PURPOSE

Parkinson's disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question "how do individuals adjust to PD?"

METHOD

A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach.

RESULTS

After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: "maintaining a coherent sense of self", "feeling in control" and "holding a positive mindset". Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing.

CONCLUSION

The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson's disease and supporting future wellbeing.IMPLICATIONS FOR REHABILITATIONIndividual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson's disease.Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual's understanding and experience of the disease.

Quality of Life of Schoolchildren Living with a Long-Term Sick Parent: The Role of Tasks at Home, Life Circumstances and Social Support

This study investigates whether there are differences in quality of life-i.e., psychosomatic complaints and life satisfaction-between schoolchildren with and without a chronically ill or disabled parent at home. It also examines the role played by the intensity of tasks, life circumstances, and social support at home and school. In 2017, a Dutch representative sample of adolescents aged between 12 and 16 (from the Health Behaviour in School-aged Children study) completed a questionnaire about illness of family members, tasks at home, life circumstances and characteristics, social support, psychosomatic complaints and life satisfaction. In total, 5470 schoolchildren who did not have a parent with a chronic illness and 652 who did have a parent with a chronic illness were selected (average age 13.9). Stepwise multilevel logistic regression analyses in STATA were used. Schoolchildren with an ill parent had more psychosomatic complaints and lower life satisfaction than their counterparts without an ill parent, even when controlling for extra task hours, specific life circumstances and characteristics (e.g., more likely to be growing up in a single-parent family or stepfamily and more likely to be female), and lower perceived support. These aspects are also predictors of a lower quality of life. Professionals should address these aspects of the life of schoolchildren with a sick parent in such a way that they are facilitated to make a successful transition to adulthood.

The Effectiveness of Group Hope Therapy Training on the Quality of Life and Meaning of Life in Patients with Multiple Sclerosis and Their Family Caregivers

Objective: Multiple sclerosis is a chronic, progressive neurological disease that, due to its special nature, has various physical and mental influences on the patients and their family's lives, decreasing the quality of life and threatening the meaning of life. The purpose of the present study was to evaluate the effectiveness of the group hope therapy training on the quality and the meaning of life in patients with multiple sclerosis and their family caregivers.

Method: This quasi-experimental study was performed using pretest-posttest and control group. Thirty patients with multiple sclerosis along with 30 family caregivers who got low to medium scores on the Meaning in Life questionnaire by Steger (MLQ), Multiple Sclerosis Impact Scale (MSIS-29), and the Iranian Quality of Life questionnaire (IRQOL) for the caregivers were selected purposively. Then, the patients were randomly divided into two groups of 15 individuals in experimental and 15 individuals in control groups. The caregivers were grouped in the same manner. The protocol of group hope therapy training was carried out through eight two-hour sessions in two weeks separately on two experimental groups (the patients and the caregivers), and finally the posttest was given to four experimental and control groups.

Results: The results of the data showed that the meaning of life in both the patient and the caregiver experimental groups increased significantly (P < 0.001), but there was no significant change in the patient and the caregiver control groups.

Conclusion: Group hope therapy training is an effective intervention for improving the meaning of life and the quality of life in patients with multiple sclerosis. Also, any psychological intervention that aims to improve the quality of life in patients in an advanced stage of the disease requires attention to both the physical and the mental issues at the same time. Although group hope therapy training has improved the meaning of life in such patients, it did not have a significant impact on the quality of life. Therefore, paying attention to the stages of multiple sclerosis and the physical condition of the patients during the therapeutic intervention and adopting necessary complementary interventions seems to be essential.

The Role of Disease Acceptance, Life Satisfaction, and Stress Perception on the Quality of Life Among Patients With Multiple Sclerosis: A Descriptive and Correlational Study

PURPOSE

The aim of this study was to evaluate the relationship between illness acceptance, life satisfaction, stress intensity, and their impact on the quality of life (QOL) in patients with multiple sclerosis (MS).

DESIGN

Descriptive and correlational study.

METHODS

A group of 100 patients with MS responded to the Expanded Disability Status Scale, the World Health Organization Quality of Life Brief (WHOQOL-BREF) Scale, the Acceptance of Illness Scale (AIS), the Perceived Stress Scale (PSS-10), the Satisfaction With Life Scale (SWLS), and a sociodemographic questionnaire.

FINDINGS

A significant relationship was shown between the mean scores of AIS, SWLS, PSS-10, and WHOQOL-BREF; however, there was no relationship between the mean scores of AIS, SWLS, PSS-10, WHOQOL-BREF and the Expanded Disability Status Scale.

CONCLUSION

Quality of life in patients with MS is positively affected by higher level of disease acceptance and life satisfaction as well as a lower level of perceived stress.

CLINICAL RELEVANCE

Rehabilitation nurses should consider the patient's disease acceptance, QOL, perceived stress, disability level, and satisfaction of life in planning and implementing a comprehensive rehabilitation plan.

Cardiac-specific experiential avoidance predicts change in general psychological well-being among patients completing cardiac rehabilitation

Previous studies have shown that experiential avoidance (EA) is associated with physical and psychological well-being in medical and non-medical samples. The aims of the present study were to evaluate the reciprocal association between psychological well-being and EA over time among cardiac rehabilitation (CR) patients with moderately to severely low levels of psychological well-being. Pre-CR data on demographic characteristics, measures of psychological well-being, and cardiac-specific EA were collected from 915 CR patients, as well as post-CR psychological well-being and EA data, from 800 of these patients. A cross-lagged model was estimated to examine the relationship between EA and psychological well-being among patients with moderately to severely low levels of psychological well-being based on questionnaire scores. Both EA and psychological well-being significantly changed during CR and were negatively associated with each other at both pre- and post-CR. Results from cross-lagged structural equation modeling supported a nonreciprocal association between EA and psychological well-being during CR. Pre-CR assessment of EA in patients showing low levels of well-being at the beginning of CR could help to identify patients at risk for worse psychological outcomes. EA could be a promising target of psychological treatments administered during CR.

Predictors of emotional distress in people with multiple sclerosis: A systematic review of prospective studies

BACKGROUND

Emotional distress (defined as any negative mood state, including anxiety, depression, trauma symptoms and global distress) is common in people with multiple sclerosis (PwMS). To develop more integrated care for PwMS requires a better understanding of causal variables underlying persistent emotional distress. This systematic review critically appraised and synthesised the findings of prospective studies investigating predictors of emotional distress in PwMS.

METHOD

CINAHL, Medline, and PsycINFO, were systematically searched for: i) prospective cohort studies with ≥1-month follow-up period, which; ii) evaluated baseline clinical and demographic, social and/or psychosocial predictors of emotional distress; iii) presented results for adults with MS; and iv) used validated measures to assess emotional distress. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale.

RESULTS

Thirteen studies, reported in 17 papers, were included. A wide range of outcome measures and statistical methods were used. The most reliable finding was that baseline emotional distress and stress-coping variables predicted emotional distress. Less robust support was found for income, negative cognitive illness appraisals and poor social support. No other variables often predicted emotional distress.

LIMITATIONS

Lack of consistency across included studies may limit confidence in the results obtained.

CONCLUSIONS

Little is currently known about how or why some people become and remain distressed following a diagnosis of MS, whilst others do not. However, psychological and social factors such as emotional distress and stress-coping variables appear to be important. A better understanding of the psychological factors underpinning distress in PwMS is needed.

Psychological flexibility and inflexibility as sources of resiliency and risk during a pandemic: Modeling the cascade of COVID-19 stress on family systems with a contextual behavioral science lens

BACKGROUND

The coronavirus disease (COVID-19) pandemic and the historic economic shutdown and stay-at-home efforts to slow its spread have radically impacted the lives of families across the world, completely disrupting routines and challenging them to adjust to new health risks as well as to new work and family demands. The current study applied a contextual behavioral science lens to the spillover hypothesis of Family Systems Theory to develop a multi-stage mechanistic model for how COVID-19 stress could impact family and child functioning and how parents' psychological flexibility could shape those processes.

METHODS

A total of 742 coparents (71% female; 84% Caucasian, 85% married, M = 41 years old) of children (ages 5-18, M = 9.4 years old, 50% male) completed an online survey from March 27th to the end of April 2020.

RESULTS

Path analyses highlighted robust links from parent inflexibility to all components of the model, predicting: greater COVID-19 stress, greater coparenting discord and family discord, greater caustic parenting, and greater parent and child distress. Parent flexibility was associated with greater family cohesion, lower family discord and greater use of constructive parenting strategies (inductive, democratic/autonomy supportive, positive). Results further suggested that COVID-19 stressors predicted greater family and coparent discord, which in turn predicted greater use of caustic parenting (reactive, inconsistent, aggressive), which in turn predicted greater child and parent distress.

CONCLUSIONS

The current results highlight parental flexibility and inflexibility as key points of intervention for helping families navigate the current global health crisis, highlighting the crucial role they play in the lives of families.

Psychological factors associated with self-management in multiple sclerosis

OBJECTIVE

Patient's engagement in their own treatment has been shown to improve clinical outcomes. A better understanding of the association between self-management in multiple sclerosis (MS) and potentially modifiable psychological factors may provide clinicians with strategies to design and stimulate better patient activation for self-managing health. Therefore, in this study, we examined whether cognitive factors, namely self-efficacy, acceptance of illness, optimism, and health locus of control (HLC), are associated with self-management in MS.

METHODS

This is a cross-sectional study. A total of 382 patients with MS who completed the MS Self-Management Scale-Revised and the questionnaires that measure self-efficacy, optimism, illness acceptance, and HLC were included in the study.

RESULTS

A hierarchical multiple regression revealed that power of others' HLC (b = 0.42, P ≤ .001), optimism (b = 0.27, P ≤ .01), internal HLC (b = -0.11, P = .017), and self-efficacy (b = 0.11, P = .031), together with control variables (longer disease duration and higher disability), explained 30% of the variance in the dependent variable.

CONCLUSIONS

In the case of MS, self-management is associated with patient's perception that healthcare professionals control their health, higher self-efficacy, optimism, and, surprisingly, lower internal HLC. The results of this study indicate the vital role of the healthcare staff in encouraging the patients with MS toward activities related to self-management and provide new insights on the psychological intervention aimed at improving self-management by patients.

Self-concept, illness acceptance and depressive and anxiety symptoms in people with multiple sclerosis

Little research has examined the relationship between self-concept and depressive and anxiety symptoms and whether this is moderated by illness acceptance in individuals with multiple sclerosis. Results of an online self-report survey completed by 515 individuals with multiple sclerosis revealed that self-concept was negatively associated with depressive and anxiety symptoms with illness acceptance moderating the association such that individuals with highest self-concept and illness acceptance had the lowest levels of depressive and anxiety symptoms. Findings lend support to psychological interventions that focus on increasing illness acceptance and fostering positive self-concept in individuals with multiple sclerosis.

Construct validity and test-retest reliability of the Swedish version of the Acceptance of Chronic Health Conditions Scale

The Acceptance of Chronic Health Conditions Scale was developed to measure acceptance in chronic health conditions like multiple sclerosis (MS) and has been translated into Swedish (The Swedish Acceptance of Chronic Health Conditions Scale). The purpose of the present study was to evaluate construct validity and test-retest reliability of the Swedish Acceptance of Chronic Health Conditions Scale in a sample of 138 people with MS. Predefined hypotheses about relationships between the Swedish Acceptance of Chronic Health Conditions Scale and other measures, and the scale's ability to differentiate between groups were explored. Evaluations of reliability and measurement error were performed for both Swedish Acceptance of Chronic Health Conditions Scale sum scores and individual items. Most (78%) a priori formulated construct validity hypotheses were confirmed. Reliability was considered good (intraclass correlation coefficient = 0.80, and weighted kappa values ranging from 0.29 to 0.74). Measurement errors were acceptable (standard error of measurement 3.3 points, limits of agreement -7.5 and 10, and percentage agreement ranging from 42% to 58%). The findings give evidence of both satisfactory construct validity and test-retest reliability and indicate that the Swedish Acceptance of Chronic Health Conditions Scale can be considered for use in both research and clinical practice.

Adjustment to multiple sclerosis and identity satisfaction among newly diagnosed women: what role does motherhood play?

The present study aimed to describe the levels of depressive symptoms, affective well-being and identity satisfaction in a group of women recently diagnosed with multiple sclerosis (MS), accounting for differences in age, motherhood, and disease duration. Moreover, the role of identity satisfaction in depressive symptoms and affective well-being was evaluated, examining the moderating effect of motherhood. The study involved 74 women, aged between 19 and 57 years (Mean = 37.7 years, SD = 10.7 years). Thirty-two women (43.2%) had children, aged between 2 and 29 years. All women had relapsing-remitting multiple sclerosis (RRMS) and mild to moderate disability. Mothers experienced greater depressive symptoms than childless women. Moreover, motherhood moderated the effect of disease duration on adjustment, with mothers reporting greater depressive symptoms, less affective well-being and less identity satisfaction than childless women as time passed since the diagnosis. Finally, greater identity satisfaction was related to less depressive symptoms and greater affective well-being, with a moderating effect of motherhood. The results outline the relevance of the process of identity redefinition for women's adjustment to MS early in the illness. Moreover, the results underscore the need to take into account the additional burden of motherhood when promoting women's adjustment to MS.

The Effects of Illness Cognition on Resilience and Quality of Life in Korean Adolescents and Young Adults with Leukemia

Purpose: The purpose of this study was to examine the effects of illness cognition on resilience and quality of life (QOL) in adolescents with leukemia. Methods: This study used a cross-sectional, descriptive design. The study was conducted at a hospital in Seoul, Korea. The target population of this study was 72 adolescents and young adults (AYA) who received follow-up visit for leukemia. Participants completed measures of their resilience, illness cognition (i.e., helplessness, acceptance, and perceived benefits), and QOL. The correlation between the study variables was analyzed using Pearson's correlation coefficient, while the impacts on resilience and QOL were analyzed using hierarchical multiple regression. Results: Acceptance, which is a subcategory of illness cognition, was associated with resilience and QOL of AYA leukemia survivors. After acceptance was included in model 2 using the hierarchical multiple regression analysis, the increased explanatory powers of resilience and QOL were 23% and 33%, respectively. Conclusion: The results suggest that acceptance, which is a subcategory of illness cognition, may be an important factor for resilience and QOL in AYA leukemia survivors.

Relapsing-remitting multiple sclerosis: an interpretative phenomenological analysis of dyadic dynamics

BACKGROUND

Multiple sclerosis, a chronic degenerative disease, impacts persons with the disease and their caregivers, usually the spouse. Few studies have considered the dyadic adjustment to the disease, and even fewer have considered the type of multiple sclerosis. This study aimed to explore the experiences and strategies of couples in which one spouse had relapsing-remitting multiple sclerosis using dyadic interpretative phenomenological analysis.

METHODS

Six couples agreed to participate in the study. Semi-structured interviews were conducted with both spouses together to observe their interactions.

RESULTS

Three higher-order themes emerged from the analyses. First, "each is stuck in its own bubble" represents a situation in which each spouse fights on his or her own side to avoid the disease or to avoid the suffering associated with it. Second, "the breakdown of communication" highlights disconnected emotional communication that protects each person but weakens the couple. Third, "the alienated couple" indicates that the two spouses are both emotionally distant and physically united, which prevents them from talking about difficult things.

CONCLUSION

These results demonstrate the importance of supporting the couple before avoidance strategies for fighting the disease are put in place and become entrenched. Implications for rehabilitation The persons with relapsing-remitting multiple sclerosis and their partner struggle with the disease in their own anti-depressive bubble using avoidance individual strategies, and leading to a breakdown in the emotional communication between the two partners. Individual intervention centered on acceptance would allow each of the partners to experience psychological events and to limit strategies of avoidance. Dyadic support would allow the two partners to maintain emotional communication to preserve their relationship. These two complementary interventions could be provided as early as possible for the couples before the avoidance strategies and the distance between the two partners become entrenched.

Post-diagnostic lived experiences of individuals with essential tremor

Purpose: This research study aimed to explore the lived experience of individuals with essential tremor.Method: This study was qualitative in nature and informed by interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with a relatively homogenous sample of nine individuals with a diagnosis of essential tremor.Results: Three major themes were constructed: "But they often look at you like you're some drug addict or smackhead": Social attitudes to difference; "I just couldn't do it anymore": The restrictive nature of essential tremor; and "You've got to cope; you've got to learn to fight different ways": Rescuing some normality amid physical deterioration.Conclusion: This study offers much needed experiential understanding and interpretation of one of the most prevalent neurological conditions with regard to the emotions associated with specific day-to-day experiences, the restrictions placed upon everyday practicalities and the coping strategies employed. This study has highlighted the need for health care professionals to provide individuals with information regarding psychological support, and a need for more public awareness campaigns centred around essential tremor.Implications for rehabilitationJudgements of others and being unable to conform to social norms results in social embarrassment and anxiety for people with essential tremor.Public awareness campaigns could help reduce the stigma experienced by people with essential tremor.The emotional response to the physical limitations of essential tremor can also be complex and particular to the individual and signposting to psychological support may be helpful.

Third-Wave Therapies for Long-Term Neurological Conditions: A Systematic Review to Evaluate the Status and Quality of Evidence

Background: Adults with long-term neurological conditions can face complex challenges including anxiety and depression. Emerging research suggests the utility of third-wave approaches (the third development of psychotherapies) in working transdiagnostically with these difficulties.

Aims: This systematic review sought to summarise and appraise the quality of published empirical studies using third-wave therapies such as Compassion Focused Therapy; Acceptance and Commitment Therapy; and Mindfulness-Based Cognitive Therapy or Mindfulness-Based Stress Reduction.

Method: Review procedures followed PRISMA guidelines, with 437 abstracts screened, 24 full-text articles retrieved and 19 studies found to meet inclusion criteria. Six out of seven randomised studies had unclear or high risk of bias, whilst the majority of non-randomised studies were considered moderate quality.

Results: Overall, studies reported a statistically significant reduction in emotional distress. Of the 13 studies that used model-specific process measures, 10 found statistically significant improvements in transdiagnostic factors.

Discussion: The findings indicate that third-wave therapies show promise in addressing transdiagnostic difficulties within neurological conditions. A number of methodological and conceptual issues for the included studies were highlighted during the quality appraisal process. Clinical implications include consideration of intervention length and use of outcome measures. Research implications are discussed by considering the progressive stages of development for behavioural treatments.

"I can do more than I thought I could": exploring the online blogs from the Sailing Sclerosis Oceans of Hope journey

Background: Diagnosis of a chronic, unpredictable, and incurable disease such as multiple sclerosis can have profound effects on emotional wellbeing. The Sailing Sclerosis Foundation provided an opportunity for 94 individuals living with multiple sclerosis from 16 countries to challenge themselves by sailing aboard the Oceans of Hope yacht, as it circumnavigated the globe over a 17-month period in 2014 and 2015. We explored the psychosocial outcomes of this unique journey.Methods: Deductive thematic analysis was used to analyze 206 blogs posted online by participants to the Sailing Sclerosis website during and after their journey.Results: Four major themes were identified: (1) the challenges of the journey; (2) teamwork and camaraderie that arose from sharing a diagnosis in common; (3) reframing mindsets as people acknowledged and adjusted to their diagnosis; and (4) empowerment and personal growth with hope rediscovered. The blogs suggested psychosocial outcomes of the journey included lower levels of depression, better quality of life, more positive well-being, an increase in self-esteem, reduced anxiety, lower stress levels, and better life satisfaction, as well as increased social support and empowerment.Conclusion: Numerous psychosocial benefits are achievable when individuals with multiple sclerosis are provided with opportunities and support to challenge themselves.Implications for RehabilitationA diagnosis of multiple sclerosis does not necessarily have to mean a sedentary lifestyle and social isolation.Psychological adjustment to a diagnosis of multiple sclerosis, changes in mindset, and rediscovering hope and optimism can be achieved by adventurous means outside clinical settings.We encourage clinicians, policy makers, and funding bodies to think 'outside the box' when developing and supporting programs for individuals living with chronic illnesses.

Use of coping strategies in multiple sclerosis: Association with demographic and disease-related characteristics✰

BACKGROUND

Coping positively and negatively influences psychosocial and other outcomes in multiple sclerosis (MS), but there is conflicting evidence about the use of different coping strategies and their associations with demographic and disease characteristics. Our aims were to examine which coping strategies are used by a large sample of people with MS, then to identify any associations between demographic and disease related factors with use of individual coping strategies.

METHODS

Participants in the Trajectories of Outcomes in Neurological Conditions (TONiC) study completed the Coping Orientations to Problems Experienced (COPE60) questionnaire. Relationships between demographic and clinical characteristics and coping strategies were examined by multiple ordinal logistic regression to assess the effect of each potential predictor after adjustment for other possible covariates.

RESULTS

From 722 patients, the most commonly used strategy was Acceptance, followed by Active Coping, Planning and Positive Reinterpretation and Growth. All but two strategies showed significant associations with demographic and clinical characteristics. The most marked effects were found for Restraint, with people in employment 2.1 times as likely to utilise this strategy compared to those unemployed, and Seeking of Emotional Social Support and Focus on and Venting of Emotions, which were utilised twice as much by women compared to men. Behavioural and Mental Disengagement were highly associated with greater disability and not being in employment.

CONCLUSION

Clinicians should be aware of several disease and demographic characteristics that are associated with use of potentially maladaptive coping strategies.

Young adults' adjustment to a recent diagnosis of multiple sclerosis: The role of identity satisfaction and self-efficacy

BACKGROUND

Although multiple sclerosis (MS) is often diagnosed during young adulthood (18-30 years), there is a lack of knowledge on the psychological adjustment to the illness among recently diagnosed young adult patients.

OBJECTIVE/HYPOTHESIS

The aims of the study were to describe the adjustment to MS (depression, positive and negative affect) in a group of young adult patients and to investigate the role of identity satisfaction and self-efficacy in MS on adjustment. We hypothesized that the relationship between identity satisfaction and adjustment was mediated by self-efficacy (goal setting and symptom management).

METHODS

The cross-sectional study involved 66 patients (63.6% women) with a mean age of 25.2 years (SD = 3.4) who had been diagnosed for no more than three years. Patients completed measures of identity satisfaction (Identity Motives Scale), Self-efficacy in MS (SEMS), Depression (CESD-10), Positive and Negative Affect (PANAS). Data were analyzed through factorial ANOVAs and hierarchical regression analysis.

RESULTS

Thirty-eight percent of patients reported depressive symptoms and negative affect mean score was higher than in the general population. Higher identity satisfaction was directly related to lower depression. Self-efficacy in goal setting partially mediated the relationship between identity satisfaction and positive affect, whereas self-efficacy in symptom management totally mediated the effect of identity satisfaction on negative affect. All results were significant at p < 0.05.

CONCLUSIONS

The results suggest the usefulness of addressing identity redefinition and self-efficacy in psychological interventions aimed at promoting young adults' adjustment to MS in an early phase of the illness.

Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis

Background

The experience of psychological distress is prevalent in people with multiple sclerosis (MS), including high levels of stress, anxiety, and depression. It has been shown that people with MS use less adaptive coping compared with healthy individuals. This study examined the ability of coping strategies to predict maladaptive and adaptive psychosocial outcomes across areas of stress, depression, anxiety, and quality of life (QOL) in people with MS.

Methods

107 people with MS completed measures of depression (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), QOL (Multiple Sclerosis Quality of Life-54), stress (Daily Hassles Scale), and coping (COPE inventory).

Results

Consistent with expectations, depression, frequency of stress, trait anxiety, and mental health QOL were predicted by adaptive and maladaptive coping styles. Severity of stressful events was predicted by maladaptive, but not adaptive, coping styles. Depression and mental health QOL were most prominently connected to coping use. Emotional preoccupation and venting showed the strongest relationship with poorer psychosocial outcomes, whereas positive reinterpretation and growth seemed to be most beneficial.

Conclusions

The results of this study highlight the importance of intervention programs targeting specific coping strategies to enhance psychosocial adjustment for people with MS.

Couples coping with sensory loss: A dyadic study of the roles of self- and perceived partner acceptance

OBJECTIVES

Hearing-, vision-, and dual-sensory loss have been linked to relational and psychological distress among adults with sensory loss (AWSLs) and their spouses. Regardless, research on factors associated with couples' adjustment is lacking. This study examined the stability and strength of associations between self-acceptance of sensory loss, perceived partner acceptance of sensory loss, and relationship satisfaction and psychological distress among AWSLs and their spouses over time.

DESIGN

A total of 122 AWSLs and their spouses completed an online survey at two time points over a 6-month period.

METHODS

A multigroup (i.e., time 1 and time 2) actor-partner interdependence model assessed the stability and strength of actor and partner effects of self-acceptance and perceived partner acceptance on each partner's relationship satisfaction and psychological distress over time.

RESULTS

No moderation by time was identified, indicating stability in associations over the 6-month period. Overall, both actor and partner effects were evident. Specifically, self-acceptance among AWSLs was inversely associated with own psychological distress and the relationship satisfaction of spouses. Self-acceptance by spouses was inversely associated with the psychological distress of AWSLs and spouses. Perception of spouse acceptance by AWSLs was positively associated with own and spouse relationship satisfaction.

CONCLUSIONS

Interventions targeting acceptance that incorporate a family systems perspective may be beneficial in alleviating psychological and relational distress among couples coping with sensory loss. Statement of contribution What is already known on this subject? The experience of hearing and/or vision loss has been linked to heightened distress both psychologically and within intimate relationships. Prior research has demonstrated a link between an individual's ability to accept their sensory loss and healthier well-being. What does this study add? This is the first dyadic study of sensory loss acceptance and its link to relationship satisfaction and distress. Acceptance operates interpersonally protecting against distress for those with sensory loss and their spouses. Perceiving that one's spouse accepts the sensory loss is important for both partner's relationship satisfaction.

Short Report: Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis

Background

Acceptance and commitment therapy (ACT) is the most widely used and researched recent variant of cognitive behavioral therapy and has been shown to increase quality of life in people with chronic illnesses, including multiple sclerosis (MS). However, few MS health practitioners are trained in ACT. This study evaluated a 2-day ACT training workshop for Italian psychologists working with people with MS.

Methods

Data were collected via online questionnaires from 34 psychologists before the workshop, after the workshop, and at 6-month follow-up. Two sets of variables were measured at each assessment: primary outcomes (well-being, negative affect, positive affect, and job satisfaction) and ACT processes (values, mindfulness, psychological flexibility, and cognitive defusion). A separate online workshop evaluation questionnaire and an ACT knowledge examination were administered after the workshop.

Results

Most participants (94%) acknowledged the potential beneficial effects of the workshop on their work. Almost all participants reported their intention to apply ACT clinically. More than 90% of participants indicated that the workshop was efficacious. All participants scored higher than 75% on the examination. Mindfulness increased from after the workshop to follow-up; however, there were no statistically significant changes in other variables. Correlations suggested beneficial associations between the ACT processes and the primary outcomes.

Conclusions

Results suggest that ACT training is personally and professionally helpful for psychologists in the MS field.

Matching and accepting assistive technology in multiple sclerosis: A focus group study with people with multiple sclerosis, carers and occupational therapists

To explore experiences and perceptions of assistive technology, 14 people with multiple sclerosis, 5 carers and 4 occupational therapists participated in focus groups. Transcripts were analysed thematically drawing from illness self-regulation theory. Identified themes are as follows: critical multiple sclerosis events (developing symptoms/disability, delayed diagnosis and coping, public reaction and multiple sclerosis progression to assistive technology), matching assistive technology for continued use (acceptance of multiple sclerosis and assistive technology, realistic expectations, occupational therapist responsiveness, timing is crucial and carers and others) and impact of assistive technology (promoting or losing independence, stigma and embarrassment and redefining the carer). Acceptance and communication among those involved ensures assistive technology matches needs and maximises health and psychosocial outcomes.

Coping with Multiple Sclerosis Scale: Reconsideration of the Factorial Structure

BACKGROUND

The Coping with Multiple Sclerosis Scale (CMSS) was developed to assess coping strategies specific to multiple sclerosis (MS). Despite its wide application in MS research, psychometric support for the CMSS remains limited to the initial factor analytic investigation by Pakenham in 2001.

METHODS

The current investigation assessed the factor structure and construct validity of the CMSS. Participants with MS (N = 453) completed the CMSS, as well as measures of disability related to MS (Multiple Sclerosis Impact Scale), quality of life (World Health Organization Quality of Life Brief Scale), and anxiety and depression (Hospital Anxiety and Depression Scale).

RESULTS

The original factor structure reported by Pakenham was a poor fit to the data. An alternate seven-factor structure was identified using exploratory factor analysis. Although there were some similarities with the existing CMSS subscales, differences in factor content and item loadings were found. Relationships between the revised CMSS subscales and additional measures were assessed, and the findings were consistent with previous research.

CONCLUSIONS

Refinement of the CMSS is suggested, especially for subscales related to acceptance and avoidance strategies. Until further research is conducted on the revised CMSS, it is recommended that the original CMSS continue to be administered. Clinicians and researchers should be mindful of lack of support for the acceptance and avoidance subscales and should seek additional scales to assess these areas.

Psychological Predictors of Anxiety and Depression in Parkinson's Disease: A Systematic Review

OBJECTIVES

Parkinson's disease (PD) is a neurodegenerative disorder, affecting the motor system with psychological difficulties also frequently reported. While explanations for psychological difficulties are historically situated within a biomedical framework, more recently the relevance of psychological determinants has become a research focus. This review therefore examines this relationship with the two most commonly reported psychological difficulties (anxiety and depression) in people with PD.

METHOD

Databases were systematically searched up to December 17, 2013, identifying 24 studies meeting inclusion criteria.

RESULTS

Significant predictors of heightened anxiety and depression included increased emotion-focused coping; less problem-focused coping; lower perceived control; more dominant beliefs about PD as part of a person's identity and influence on life; less social support and more avoidant personality types.

CONCLUSIONS

Relationships between some specific psychological predictors and depression and anxiety seem well supported. The complexity of relationships between these psychological determinants should be taken into consideration when delivering psychological interventions.

Intolerance of Uncertainty: Shaping an Agenda for Research on Coping with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic and progressive neurologic condition that, by its nature, carries uncertainty as a hallmark characteristic. Although all patients face uncertainty, there is variability in how individuals cope with its presence. In other populations, the concept of "intolerance of uncertainty" has been conceptualized to explain this variability such that individuals who have difficulty tolerating the possibility of future occurrences may engage in thoughts or behaviors by which they attempt to exert control over that possibility or lessen the uncertainty but may, as a result, experience worse outcomes, particularly in terms of psychological well-being. This topical review introduces MS-focused researchers, clinicians, and patients to intolerance of uncertainty, integrates the concept with what is already understood about coping with MS, and suggests future steps for conceptual, assessment, and treatment-focused research that may benefit from integrating intolerance of uncertainty as a central feature.

Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial

BACKGROUND

Multiple health behavior change can ameliorate adverse effects of cancer.

PURPOSE

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

METHODS

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

RESULTS

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037).

CONCLUSIONS

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (

TRIAL REGISTRATION NUMBER

ACTRN12608000399392).

Towards a better understanding of MS pain: a systematic review of potentially modifiable psychosocial factors

OBJECTIVE

Pain is a common symptom of Multiple Sclerosis (MS). Biomedical treatments achieve only modest reductions in pain severity suggesting that this approach may be too narrow. The aim of this systematic review was to assess evidence for associations between modifiable psychosocial factors and MS pain severity and pain interference and use this evidence to develop a preliminary biopsychosocial model of MS pain.

METHODS

Empirical studies of pain in MS utilising standardised pain severity and pain interference measures were included. Online databases (Cochrane, PsychInfo, EMBASE, CINAHL, Medline, Web of Science and World Cat) and reference sections of included articles were searched, and corresponding authors contacted to identify unpublished studies. Information about design, sample size, MS type, time since diagnosis, psychosocial and pain measures and key findings were extracted. Thirty-one studies were assessed for quality and a narrative synthesis was conducted.

RESULTS

Similar to primary chronic pain, most studies reported small to medium associations between several psychosocial factors and pain severity and interference. Pain catastrophizing showed consistently strong associations with pain interference. Preliminary findings revealed a strong correlation between pain acceptance and pain interference. However, fear-avoidance appeared less important in MS, and other forms of behavioural avoidance were not explored.

CONCLUSIONS

A preliminary model of MS pain outlining specific psychosocial factors is presented with a conceptual formulation from both traditional, and contextual, cognitive-behavioural perspectives. Pain catastrophizing, acceptance, and endurance, as opposed to fear avoidance, responses are highlighted as potentially important treatment targets in MS, and directions for future research are outlined.

‘It feels like someone is hammering my feet’: Understanding pain and its management from the perspective of people with multiple sclerosis

Background:

Pain affects around 63% of people with multiple sclerosis (pwMS). Biomedical treatments demonstrate limited efficacy. More research is needed to understand pain from the individual’s perspective in order to better inform a patient-centred approach that improves engagement, self-management and outcome.

Objective:

The objective of this paper is to explore pwMS’ experience and responses to pain, and their perspectives on pain management.

Methods:

Twenty-five in-depth, semi-structured telephone interviews were conducted. Interviews were audiotaped, transcribed and analysed using an inductive thematic analysis approach with elements of grounded theory.

Results:

Key themes included vivid descriptions of pain and beliefs that pain is unpredictable, a sign of damage and may worsen. Anger was a common emotional response. Two dominant pain management themes emerged: one related to pain reduction and another to acceptance. Those focusing on pain reduction appeared to engage in cycles in which they struggled with symptoms and experienced continued distress.

Conclusion:

Findings identify pain-related beliefs, emotional reactions and disparate pain-management attitudes. All may influence pwMS’ responses to pain and what they ask of their clinicians. Uncovering pwMS’ personal beliefs about pain, and introducing a broader biopsychosocial understanding of pain in the clinical context, may provide opportunities to rectify potentially unhelpful management choices and enhance pain acceptance.

A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease

Mindfulness-based interventions can successfully target negative perseverative cognitions such as worry and thought suppression, but their acceptability and effectiveness in people with long-term conditions is uncertain. We therefore pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. We used a sequential mixed-methods approach that measured change in worry and thought suppression and qualitatively explored acceptability, feasibility, and user experience with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. Positive impacts of mindfulness-based interventions on psychological health may relate to acquisition and development of meta-cognitive skills but this needs experimental confirmation.

Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance

This study investigated the roles of mindfulness and acceptance on adjustment in couples coping with multiple sclerosis (MS) by examining the effects of an individual's mindfulness and acceptance on their own adjustment (actor effects) and the effects of their partner's mindfulness and acceptance on their adjustment (partner effects) using the Actor-Partner Interdependence Model. The study was a cross-sectional standard dyadic design that collected data from couples coping with MS. Sixty-nine couples completed measures of mindfulness, acceptance and adjustment (depression, anxiety, life satisfaction, positive affect and relationship satisfaction). As hypothesised there were actor effects of mindfulness and acceptance on better adjustment, however, the beneficial actor effects of mindfulness were only evident on depression and anxiety. The actor effects of both mindfulness and acceptance on relationship satisfaction were moderated by MS status. Regarding partner effects, there was support for the beneficial impact of acceptance on partner relationship satisfaction. In addition, the partner effect of acceptance moderated the actor effect of acceptance on depression, such that the actor effect on lower depression was weaker when the partner reported high acceptance. Findings support the roles of mindfulness and acceptance in shaping individual and dyadic adjustment in couples coping with chronic illness.