How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated moderation analysis

The supportive adjustment for multiple sclerosis (saMS) randomised controlled trial showed cognitive behavioural therapy (CBT) reduced distress at 12-months compared to supportive listening (SL). Larger changes in distress and functional impairment following CBT occurred in participants with clinical distress at baseline. This secondary analysis investigates whether CBT treatment effects occur through pre-defined CBT mechanisms of change in the total cohort and clinically distressed subgroup. 94 participants were randomised to saMS CBT or SL. Primary outcomes were distress and functional impairment (12 months). Mediators included cognitive-behavioural variables at post-treatment (15 weeks). Structural equation mediation and mediated-moderation models adjusting for baseline confounders assessed mediation overall and by distress level. Significant mediation was found but only for those with clinical distress at baseline. Illness acceptance (−0.20, 95% confidence interval −0.01 to −0.46) and reduced embarrassment avoidance behaviours (−0.22, −0.02 to −0.58) mediated CBT's effect on distress. Changes in beliefs about processing emotions (−0.19, −0.001 to −0.46) mediated CBT's effect on functional impairment. saMS CBT had effects on distress and functional impairment via some of the hypothesised mechanisms drawn from a theoretical model of adjustment for MS but only among participants with clinical distress at baseline. Increasing acceptance and emotional expression and decreasing embarrassment avoidance improves MS adjustment.

Cognitive-behavioural therapy, Distress, Functional impairment, Mediation and mediated moderation analysis, Multiple sclerosis, Randomised clinical trial

10.1016/j.brat.2020.103594

0005-7967

Chalder, Trudie

cb09653b-2c1e-4dfc-bb13-c6e8ca918602

Goldsmith, Kimberley

081d71e5-c45d-4feb-bb76-4d4566005bb9

Hudson, Joanna

383f9969-e883-4765-b1f7-674fca78540f

Dennison, Laura

15c399cb-9a81-4948-8906-21944c033c20

Moss-morris, Rona E

a502f58a-d319-49a6-8aea-9dde4efc871e

May 2020

Chalder, Trudie

cb09653b-2c1e-4dfc-bb13-c6e8ca918602

Goldsmith, Kimberley

081d71e5-c45d-4feb-bb76-4d4566005bb9

Hudson, Joanna

383f9969-e883-4765-b1f7-674fca78540f

Dennison, Laura

15c399cb-9a81-4948-8906-21944c033c20

Moss-morris, Rona E

a502f58a-d319-49a6-8aea-9dde4efc871e

Chalder, Trudie, Goldsmith, Kimberley, Hudson, Joanna, Dennison, Laura and Moss-morris, Rona E (2020) How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated moderation analysis. Behaviour Research and Therapy, 128, [103594]. (doi:10.1016/j.brat.2020.103594).

Record type: Article

Abstract

Text

How and for whom - Accepted Manuscript

Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (1MB)

More information

Accepted/In Press date: 21 February 2020

e-pub ahead of print date: 22 February 2020

Published date: May 2020

Additional Information: Funding Information: Dr. Goldsmith reports grants from NIHR , grants from Juvenile Diabetes Research Foundation , grants from Stroke Foundation , outside the submitted work. Funding Information: Thank you to the nurse-therapists Sarah Morton and Sally Baynes. Thank you also to our colleagues at the NHS MS Services at Southampton University Hospital Trust and King's College Hospital Trust: Alan Turner, Chris Halfpenny, Ian Galea, Sheila Chartres, Jane Ware, Jane Cameron, Hazel Daniel, Stephanie Heath, Eli Silber, Joan Regan, Pauline Shaw, Fiona Barnes and Sally Jones. Thank you to the independent members of our Trial Steering Committee: Alison Wearden, Charlie Bloom, Rebecca Walwyn and Ed Holloway. Thank you to the patients who took part in the study. This paper represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (funding for KG and TC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Funding Information: This paper represents independent research part funded (RMM, TC and KG) by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King's College London . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. We would also like to acknowledge the original funders of the trial, the MS Society. Publisher Copyright: © 2020

Keywords: Cognitive-behavioural therapy, Distress, Functional impairment, Mediation and mediated moderation analysis, Multiple sclerosis, Randomised clinical trial