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

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

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.

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How and for whom - Accepted Manuscript
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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

Identifiers

Local EPrints ID: 438822
URI: http://eprints.soton.ac.uk/id/eprint/438822
ISSN: 0005-7967
PURE UUID: 266fb1d9-1262-4cc2-b39f-9f3a089bdf26
ORCID for Laura Dennison: ORCID iD orcid.org/0000-0003-0122-6610

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Date deposited: 25 Mar 2020 17:30
Last modified: 17 Sep 2022 04:01

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Contributors

Author: Trudie Chalder
Author: Kimberley Goldsmith
Author: Joanna Hudson
Author: Laura Dennison ORCID iD
Author: Rona E Moss-morris

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