Introduction
Multiple sclerosis is a chronic inflammatory condition that affects the central nervous system. It results from the immune system “attacking” myelin, the material surrounding the axons of many, if not most, neurons within the central nervous system (which includes the brain and spinal cord). Myelin is essential for the normal transmission of nerve impulses; when it is damaged by inflammation in multiple sclerosis, the end result is impaired signal transmission, resulting in neurological symptoms.
Damage may occur anywhere in the brain or spinal cord, wherever there are myelinated nerve fibers present. Symptoms include visual loss, numbness, paralysis, loss of bladder control, slurred speech, cognitive impairment, severe fatigue and many others. Fatigue is by far the most common symptom of MS, affecting up to 90% of patients, and is often the most disabling.
Depression is also very common in MS, affecting between 15% and 45% of patients; estimates of up to 50% for lifetime prevalence have been reported. In addition, perhaps 25% of people suffering from MS have untreated or unrecognized depression.
It seems self-evident that treatment of associated depression will improve the quality of life in MS patients, or in anyone with chronic illness for that matter. The real question is, will treating the depression in people with multiple sclerosis also reduce disability?
Cognitive vs. Emotion-Focused Therapy in Multiple Sclerosis
In a recent study, cognitive therapy was administered by phone to a total of sixty-two patients (sixty-five others received supportive emotion-focused therapy, which helped increase participants’ experiences of their inner worlds). Levels of depression were assessed by using a form of the Beck Depression Inventory and a telephone version of the Hamilton Rating Scale for Depression. Fatigue levels were also measured, and were further sub-categorized into cognitive, social, and physical fatigue. Disability was measured by using Guy’s Neurological Disability Scale.
Therapy was administered by qualified, experienced psychologists. Cognitive techniques focused on helping participants become aware of behaviors and thoughts that were contributing to depression, and develop strategies to help manage them, along with ways to improve and manage MS-related symptoms and their associated life problems. In the emotion-focused group, therapists focused on the therapeutic bond, empathy, and helping participants become aware of and express their needs and emotions in the moment.
Results
Not surprisingly, symptoms of fatigue and depression responded to therapy in both groups. The reduction in fatigue was found to be independent of depression.
In addition, there was a significant reduction in disability in both groups, which was correlated with the reduction in levels of depression. This suggests that in multiple sclerosis, disability and depression are closely linked. Furthermore, it was found that the cognitive therapy group showed a greater decline in disability, independent of the reduction in depression; this further reduction may have been related to reduced symptoms of fatigue. The emotion-focused group did not show as great an impact on MS-related depression and disability as did the cognitive therapy group.
Ordinarily, there is no significant difference in the response of medically-healthy people between the two modalities used here; this suggests that clients with chronic disabling illness may utilize the skills obtained in cognitive therapy in ways that medically healthy clients do not. It would appear that clients with chronic disability may be responding to the skill-related cognitive components that are then used to interpret and help solve problems related to the underlying disability or illness.
It is therefore reasonable to conclude that cognitive therapy, when applied to clients with multiple sclerosis (and by extension perhaps other disabling illnesses), may be useful in reducing chronic disability as well as associated depressive symptoms. This is a useful thing to keep in mind when treating clients with MS, and perhaps those with other disabling illnesses as well.
References:
Hart, S. L., Vella, L., & Mohr, D. C. (2008). Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychology, 27, 230-238.
Mohr, D. C., Hart, S., & Vella, L. (2007). Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy. Health Psychology, 26, 554-563.
