Internet-based therapy may reduce depression symptoms in people with MS

October 02, 2023
A new study showed an internet-delivered, cognitive behavioral therapy program reduced depressive symptoms in multiple sclerosis patients. The online program may offer an effective and easily accessible way to manage depression and lead to better quality of life for persons with MS.

MS is a neurological disease caused by the immune system attacking the brain, nerves, and spinal cord. The disease affects more than 2.8 million people globally, with greater occurrence in areas farther from the equator. The first onset of the disease usually appears in patients between the ages of 20 and 40.

Depression is linked to cognitive impairments in individuals with MS. Patients may have issues encoding new memories or trouble with concentration and information processing. These impairments can negatively affect relationships with partners, friends, and coworkers and make it more likely that the individual quits their job or cuts their working hours prematurely. Patients with depression also are less likely to take their MS medications, which may contribute to worsening disease progression over time. 

Previous studies have shown that talk therapies, such as CBT, could help treat depression in people with MS. Current research suggests that in MS, CBT has generally proven to be more effective than antidepressant treatments. They may be preferable because they are noninvasive and do not require the patient to take additional medication. However, given the high demand for therapy, patients may have to wait months before they can see a therapist. They may also have trouble finding a professional who specializes in working with people with neurological disorders.

At the core of CBT is the idea that thoughts cause feelings, so the reason somebody may be depressed is that they have unrealistically negative thoughts about themselves, the world around them, and the future. An important goal of CBT is to help the individual challenge and change those thoughts so they’re more realistic, adaptive, and positive. An international team of researchers wanted to see if an online, self-paced therapy program could be a valuable treatment option for patients with MS.

The researchers enrolled 279 participants – diagnosed with MS and exhibiting clinically significant depression at five locations across the United States and Germany – into an existing internet-delivered CBT program modified to address issues affecting individuals with MS. They used the Beck Depression Inventory-II to take a baseline assessment of the participants’ depressive symptoms at the start of the study and after 12 weeks. The inventory measures the severity of depressive symptoms, with scores from 0-13 indicating minimal depression, 14-19 mild depression, 20-28 moderate depression, and 29-63 severe depression.

After taking baseline depressive measurements, the researchers randomly assigned the participants to a stand-alone iCBT group, a guided iCBT group, or a waitlist control group. The stand-alone and guided iCBT groups had access to the iCBT program, with the guided iCBT group receiving a weekly check-in email from a therapist. The waitlist control group was offered access to the online program after six months. The 10-week iCBT program was divided into weekly modules that covered diverse themes — such as behavioral activation, mindfulness and acceptance, and expressive writing and forgiveness — designed to engage patients in activities that promote more positive thinking and behaviors.

The researchers reassessed all patients after the iCBT groups completed the program. They found that the average BDI-II score for the stand-alone iCBT group decreased from approximately 24 to 15 points, or from moderate to just above minimal depression levels. The average score for the guided iCBT group decreased from approximately 25 to 17 points, while the control group’s mean score decreased from nearly 21 to 20 points.

The findings show that tailoring a CBT program specifically for MS and delivering it online can be an effective, accessible approach for treating depression in MS, researchers said. Having the ability to treat depression immediately can help individuals with MS delay disease progression, improve quality of life, and avoid future depressive episodes, they added.

The study’s authors are digging deeper into the data to see if they can identify patient profiles that could signal that an individual may respond positively to therapy treatments. The information could help doctors and mental health professionals identify better, personalized approaches for patients.

The team published their findings in the journal The Lancet Digital Health.

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