Symptom Changes in MS Following Psychological Interventions
Symptom Changes in MS Following Psychological Interventions
Database and article references search provided a list of 220 papers. Twenty-two articles met the criteria for the inclusion in the review. Included studies and their properties are reported in Table 1.
Overall, a total of 5,705 subjects with MS were included in the analysis, with a large study that included 3,623 subjects. Setting aside that study, sample sizes ranged from 14 to 240 subjects. Most of these studies included people with MS with a limited physical disability (e.g., EDSS < 5.5) and with the average disease duration of 8 years and a mean age over 40 years. Articles that were included describe different psychological interventions for people with MS including cognitive-behavioral interventions, relaxation training, meditation, and stress management and coping skill promotion. There was variability about the duration of the intervention ranging from a week to two years, with an average length of two months. Control groups were composed primarily of subjects on a waiting-list or by no additional treatment group (usual care only). Four studies referred to a comparison between interventions, with controls receiving what was characterized as a less efficacious treatment or a gold-standard comparison.
Psychological variables were primary outcomes in all the included papers. The impact of the interventions on these outcomes was generally positive. Overall, psychological treatments produced an improvement in quality of life and psychological well-being, reducing depressive symptoms, anxiety and perceived stress. Most of the psychological treatments obtained positive effects. These effects were emphasized when the comparison was between the treatment and a usual care or a waiting-list control group.
The majority of the psychological effects on the physical symptoms were assessed using self-report measures, referencing the perception of physical variables or symptoms (e.g., fatigue, pain), or the perception of general physical health. Following the psychological intervention, perceptions of general health improved, with higher scores on the physical subscales on quality of life questionnaires. One symptom positively affected by psychological treatments is fatigue, in which subjects from experimental groups often reported a significant decrease in fatigue along with a subsequent reduction in physical limitations related to tiredness. Similarly, improvements in sleep disturbances, physical vitality, and vigor were reported. Psychological interventions also appeared to reduce the perception of pain.
Changes in physical issues do not result only from self-reported questionnaires but few studies investigated these changes with objective measurements. Results indicate that a stress-management intervention reduces the number of brain lesions associated with the relapsing-remitting process of MS, with a consequent reduction of crisis. A short patient education program successfully reduced the number of relapses, compared to controls. Furthermore, successful treatment of depression (either with psychological or pharmacological interventions) resulted associated with a reduction in non-specific and antigen-specific interferon production.
In general, with the caveat of the limited number of studies involved, when the psychological intervention lead to a better psychological outcome, such as the reduction of depressive symptoms or the improvement in psychological well-being, the assessed physical outcomes were positively influenced. A correlation can be observed between the extent of changes from a psychological perspective and the size of change in MS symptoms. More intense and efficacious psychological interventions lead to higher changes on a physical level than less intense behavioral treatments.
Articles included in the review seldom formally assessed the level of disability making it impossible to deeply investigate this aspect of findings. Future studies would benefit from a greater focus on assessment of disability in terms of functioning and inclusion of more non-self-report measures pre and post-intervention.
Results
Database and article references search provided a list of 220 papers. Twenty-two articles met the criteria for the inclusion in the review. Included studies and their properties are reported in Table 1.
Overall, a total of 5,705 subjects with MS were included in the analysis, with a large study that included 3,623 subjects. Setting aside that study, sample sizes ranged from 14 to 240 subjects. Most of these studies included people with MS with a limited physical disability (e.g., EDSS < 5.5) and with the average disease duration of 8 years and a mean age over 40 years. Articles that were included describe different psychological interventions for people with MS including cognitive-behavioral interventions, relaxation training, meditation, and stress management and coping skill promotion. There was variability about the duration of the intervention ranging from a week to two years, with an average length of two months. Control groups were composed primarily of subjects on a waiting-list or by no additional treatment group (usual care only). Four studies referred to a comparison between interventions, with controls receiving what was characterized as a less efficacious treatment or a gold-standard comparison.
Psychological variables were primary outcomes in all the included papers. The impact of the interventions on these outcomes was generally positive. Overall, psychological treatments produced an improvement in quality of life and psychological well-being, reducing depressive symptoms, anxiety and perceived stress. Most of the psychological treatments obtained positive effects. These effects were emphasized when the comparison was between the treatment and a usual care or a waiting-list control group.
The majority of the psychological effects on the physical symptoms were assessed using self-report measures, referencing the perception of physical variables or symptoms (e.g., fatigue, pain), or the perception of general physical health. Following the psychological intervention, perceptions of general health improved, with higher scores on the physical subscales on quality of life questionnaires. One symptom positively affected by psychological treatments is fatigue, in which subjects from experimental groups often reported a significant decrease in fatigue along with a subsequent reduction in physical limitations related to tiredness. Similarly, improvements in sleep disturbances, physical vitality, and vigor were reported. Psychological interventions also appeared to reduce the perception of pain.
Changes in physical issues do not result only from self-reported questionnaires but few studies investigated these changes with objective measurements. Results indicate that a stress-management intervention reduces the number of brain lesions associated with the relapsing-remitting process of MS, with a consequent reduction of crisis. A short patient education program successfully reduced the number of relapses, compared to controls. Furthermore, successful treatment of depression (either with psychological or pharmacological interventions) resulted associated with a reduction in non-specific and antigen-specific interferon production.
In general, with the caveat of the limited number of studies involved, when the psychological intervention lead to a better psychological outcome, such as the reduction of depressive symptoms or the improvement in psychological well-being, the assessed physical outcomes were positively influenced. A correlation can be observed between the extent of changes from a psychological perspective and the size of change in MS symptoms. More intense and efficacious psychological interventions lead to higher changes on a physical level than less intense behavioral treatments.
Articles included in the review seldom formally assessed the level of disability making it impossible to deeply investigate this aspect of findings. Future studies would benefit from a greater focus on assessment of disability in terms of functioning and inclusion of more non-self-report measures pre and post-intervention.
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