Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial

Abstract

Background Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder. Methods Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity. Results The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001). Conclusion The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.

Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Medical Conditions: A Systematic Review

“…Of the nine research studies included in the systematic review, only one was a prevention study [ 43 ], while the rest were treatment studies. Most were published in the USA ( n = 4) [ 43 , 44 , 45 , 46 ] and Iran ( n = 4) [ 40 , 47 , 48 , 49 ], while the remaining study was published in Sweden [ 50 ], between 2012 and 2020. The sample size of the different research works ranged from 2 to 70 participants.…”

“…In relation to the sample’s genders, three studies included only women [ 43 , 47 , 48 ] and one included an exclusively male sample [ 45 ]. Of the remaining five [ 40 , 44 , 46 , 49 , 50 ], the proportion of participants was mostly women, 60% versus 40%.…”

“…The included research studies targeted different medical conditions, specifically: breast cancer [ 46 ]; irritable bowel syndrome [ 50 ]; HIV [ 44 ]; chronic pain [ 44 , 50 ]; idiopathic Parkinson’s disease [ 46 ]; multiple sclerosis [ 48 , 49 ]; and infertility problems [ 47 ]. The most frequent EDs were anxiety disorders and depression.…”

“…In design terms, two were pilot studies done with a single group [ 43 , 45 ], two were a single-case experimental design [ 46 , 50 ], one was a case study [ 44 ], and four were RCTs [ 40 , 47 , 48 , 49 ]. In the RCTs, the control condition was a waiting list in one [ 40 ], in which they received usual pharmacological treatment, as well as information about the medical condition, and an active condition in the remaining three research studies.…”

“…In the RCTs, the control condition was a waiting list in one [ 40 ], in which they received usual pharmacological treatment, as well as information about the medical condition, and an active condition in the remaining three research studies. The three active control conditions were a mindfulness-based psychological intervention (MBSR) [ 47 ] and two psychosocial interventions: psycho-educational and supportive [ 48 , 49 ]. In turn, five designs included follow-up measures at 3 months [ 44 , 45 , 47 , 48 , 50 ] and one study conducted follow-up at 6 weeks after the intervention ended [ 46 ].…”