Journal Article

Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial

Kessels, Roy P. C., Bertens, Dirk, Nauta, Ilse M., van Dam, Maureen, Fasotti, Luciano, Speckens, Anne E. M., de Jong, Brigit A., Uitdehaag, Bernard M. J.

2024

Overview

Background Multiple sclerosis (MS) frequently gives rise to depressive and anxiety symptoms, but these are often undertreated. This study investigated the effect of mindfulness-based cognitive therapy (MBCT) and cognitive rehabilitation therapy (CRT) on psychological outcomes and quality of life (QoL), and whether they mediate treatment effects on MS-related cognitive problems. Methods This randomized controlled trial included MS patients with cognitive complaints ( n  = 99) and compared MBCT ( n  = 32) and CRT ( n  = 32) to enhanced treatment as usual ( n  = 35). Baseline, post-treatment and 6-months follow-up assessments included patient-reported outcome measures (PROMS) and cognitive outcomes (self-reported and neuropsychological assessment). PROMS concerned psychological symptoms, well-being, QoL, and daily life function. Linear mixed models indicated intervention effects on PROMS and mediation effects of PROMS on cognitive outcomes. Results MBCT positively affected depressive symptoms (Cohen’s d ( d ) = −0.46), fatigue ( d  = −0.39), brooding ( d  = −0.34), mindfulness skills ( d  = 0.49), and mental QoL ( d  = −0.73) at post-treatment. Effects on mindfulness skills remained significant 6 months later ( d  = 0.42). CRT positively affected depressive symptoms ( d  = −0.46), mindfulness skills ( d  = 0.37), and mental QoL ( d  = −0.45) at post-treatment, but not at 6-month follow-up. No effects on anxiety, well-being, self-compassion, physical QoL, and daily life function were found. Treatment effects on self-reported, but not objective, cognition were mediated by psychological symptoms and mindfulness skills. Conclusions MBCT and CRT reduced a wide array of psychological symptoms and improved mental QoL. These improvements seemed to impact self-reported cognitive problems after both treatments, whereas objective cognitive improvements after MBCT seemed independent of improvement in psychological symptoms. Future studies should investigate long-term sustainability of these beneficial effects. Trial registration The trial was prospectively registered in the Dutch Trial registry on 31 May 2017 (NL6285; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6459 ).

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Anxiety / Clinical trials / Cognition & reasoning / Medicine / Medicine & Public Health / Mental depression / Mindfulness / Multiple sclerosis / Neurology / Neuroradiology / Neurosciences / Original Communication / Quality of life / Rehabilitation / Self report / Well being