Psychological interventions for multiple sclerosis.

Source
Cochrane Database of Systematic Reviews. (1):CD004431, 2006.

BACKGROUND:

The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences.

OBJECTIVES:

To assess the effectiveness of psychological interventions for people with MS.

CONCLUSIONS:

"The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS."

MS is a complex disease, and, potentially, there are many different ways in which psychological interventions can help. This is reflected in the diversity of approaches that have been identified in this review. Interventions can differ by their target population, purpose, whether group-based or one-to-one, the psychological theories and models from which they are derived, and so on. The review shows that considerable creativity and innovation has gone into developing and adapting these interventions. The downside of this is that, in general, interventions have been evaluated in single studies only, and often with limited sample size.

Cognitive behavioural therapy was the most frequently used psychological approach. In all but one of these seven studies the purpose of the intervention was either to treat depression or (broadly) to give people skills to help them cope with having MS (albeit in different ways). A related question is whether people with MS should be regularly assessed for depression and other psychiatric problems. Clearly effective treatments need to be available before regular assessment becomes worthwhile.

There were no studies focussing on psychological approaches to managing common symptoms of MS such as fatigue and pain. However, there are Cochrane systematic reviews suggesting that cognitive behavioural approaches may be useful in adults with chronic pain and people with Chronic Fatigue Syndrome. Clearly interventions like these would need to be adapted for, and evaluated in, people with MS.

The evidence for the effectiveness of interventions to help people with cognitive impairments was inconclusive, partly because of the large number of outcome measures that are frequently used in this type of study, and partly because of small sample size. Further, the small number of studies actually conducted (all three of which tested different interventions) means that it is difficult to generalise about whether psychological approaches to treating cognitive impairment are helpful.