Intervention Review

Psychological interventions for multiple sclerosis

  1. Peter W Thomas1,*,
  2. Sarah Thomas1,
  3. Charles Hillier2,
  4. Kate Galvin3,
  5. Roger Baker1

Editorial Group: Cochrane Multiple Sclerosis Group

Published Online: 25 JAN 2006

Assessed as up-to-date: 29 MAY 2005

DOI: 10.1002/14651858.CD004431.pub2

How to Cite

Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004431. DOI: 10.1002/14651858.CD004431.pub2.

Author Information

  1. 1

    Poole Hospital NHS Trust, Dorset Research and Development Support Unit, Poole, Dorset, UK

  2. 2

    Poole Hospital NHS Trust, Department of Neurology, Poole, Dorset, UK

  3. 3

    Bournemouth University, School of Health and Social Care, Bournemouth, Dorset, UK

*Peter W Thomas, Dorset Research and Development Support Unit, Poole Hospital NHS Trust, Cornelia House, Longfleet Road, Poole, Dorset, BH15 2JB, UK. Peter.Thomas@poole.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences.

Objectives

To assess the effectiveness of psychological interventions for people with MS.

Search methods

We searched the Cochrane MS Group Specialised Register (December 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004 ), MEDLINE (January 1966 to December 2004), PsychINFO (January 1887 to December 2004), CINAHL (January 1982 to December 2004) and 14 others. We searched reference lists of articles, wrote to corresponding authors of the 13 papers identified by June 2004, and searched for trials in progress using 3 research registers.

Selection criteria

Randomised controlled trials of interventions described as wholly or mostly based on psychological theory and practice, in people with MS. Primary outcome measures were disease specific and general quality of life, psychiatric symptoms, psychological functioning, disability, and cognitive outcomes. Secondary outcome measures were number of relapses, pain, fatigue, health care utilisation, changes in medication, and adherence to other therapies.

Data collection and analysis

Pertinent studies were identified from abstracts by one author. Full papers were independently compared to selection criteria by four authors. Key details were extracted from relevant papers using a standard format, and studies scored on three dimensions of quality. The review is organised into four mini-reviews (MR) dependent on the intervention's target population; people with cognitive impairments (MR1), people with moderate to severe disability (MR2), people with MS (no other criteria) (MR3), and people with depression (MR4).

Main results

Overall 16 studies were identified and included. MR1: three trials (n=145). Some evidence of effectiveness of cognitive rehabilitation on cognitive outcomes, although this was difficult to interpret because of the large number of outcome measures used. MR2: three trials (n=80). One small trial suggesting psychotherapy may help with depression. MR3: seven studies (n=688). Some evidence that cognitive behavioural therapy may help people adjust to, and cope with, having MS (three trials). The other trials were diverse in nature and some difficult to interpret because of multiple outcome measures. MR4: three trials (n=93). Two small studies of cognitive behavioural therapy showed significant improvements in depression.

Authors' conclusions

The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychological treatments to help improve the quality of life of people with multiple sclerosis

In many countries MS is the most common neurological disorder among young adults. Its impact can be overwhelming with the person facing the likelihood of reduced physical function and of disability, with consequent disruptions in education, employment, sexual and family functioning, friendships and activities of daily living. MS can have a considerable impact on the individual's sense of self, especially if they can no longer perform previously valued activities. Unpleasant side effects from medication may also occur. Mood disorders such as depression and anxiety are common in people with MS, and are often a result of finding it difficult to adjust to, and cope with, having the disorder. Cognitive functioning (the mental processes of memory, concentration, reasoning and judgement) can also be affected. Therefore a diagnosis of MS can have substantial psychological consequences.

The authors of this review wanted to assess the effectiveness of psychological interventions (such as those addressing cognitive functioning, thoughts, mood and behaviour) for people with MS. This was done by considering their effect on quality of life, mood, cognitive functioning and disability in particular, but also on pain, fatigue, and use of other health related services and treatments.

Sixteen relevant studies were identified and included in this review. They have researched a variety of different interventions, having different purposes, and so a single overall definite conclusion cannot be made. However the authors cautiously conclude that Cognitive Behavioural Therapy, a therapy that addresses thoughts and behaviours, can help people with MS adjust to, and cope with, having MS, and can help them if they get depressed.

Psychological interventions can potentially help people with MS in many ways, including the management of symptoms such as pain and fatigue. Additional studies are needed, particularly those that include larger numbers of people.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

多發性硬化症的心理治療

因為多發性硬化症(MS)的不可預測性、可變性和增加失能的可能性,意味這些患者可能也常會產生相當大的心理問題。

目標

評估MS病人心理治療的成效。

搜尋策略

至2004年12月為止,我們檢索了19個資料庫;Cochrane MS Group Specialised Register, Cochrane Central Register of Controlled Trials(CENTRAL), MEDLINE, PsychINFO, CINAHL,及其他14個資料庫。我們也檢索文章的參考文獻列表,在2004年6月前寫信給13篇文章的通信作者,並搜索了3個研究登錄庫,尋找正在進行中的試驗。

選擇標準

我們選擇實施在MS病人身上,採用心理學理論及實作之的隨機對照試驗。初級成果的評估包括:針對疾病的和一般的生活品質評估,精神症狀,心理功能,失能和認知成果。次級成果的評估為:復發次數,疼痛,疲勞,保健服務的利用,藥物的改變,和採取其他療法。

資料收集與分析

一位審查員先從摘要中找出切題的研究報告。4位審查員分別獨立比較全文中的選取標準。使用標準格式從文件中提取關鍵的細節,,並從三個層面上評估研究的品質分數。本回顧分析依據介入治療的目標族群,由四個小型評論(minireveiws, MR)所組成;認知障礙患者(MR1),中度和重度失能患者(MR2),MS患者(無其他標準)(MR3),和憂鬱症患者(MR4)。

主要結論

最後確定收錄了16個研究。 MR1:3項試驗(n = 145)。部分證據顯示復健後的認知功能改善,但因用以評估成效的方式太多,使得真正的效果難以衡量。MR2:3項試驗(n = 80)。其中一個小型試驗顯示心理治療可改善憂鬱症。MR3:7項試驗(n = 688)。部分證據顯示,認知行為療法可幫助人們適應和面對自身疾病(3項試驗)。其他的試驗則因試驗本身性質變化大,及評估成效的方式太多,因此難以衡量成果。MR4:三項試驗(n = 93)。兩項小型研究顯示認知行為治療能顯著改善憂鬱症。

作者結論

各式各樣的心理治療方式在很多層面都能夠給予MS患者適切的幫助。本次的回顧分析並沒有得到明確的結論。但是有合理的證據表明,認知行為治療,有利於改善憂鬱症,並幫助患者適應和面對自身疾病。

翻譯人

本摘要由新光醫院鍾禎智翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

心理療法可以幫助患有多發性硬化症(MS)的病人。證據表明許多治療是有益的。在很多地方,MS是年輕成人非常常見的神經疾病。疾病的影響是非常大,因為病人面臨的可能是身體功能的降低和失能,造成教育、就業、性功能、家庭功能、朋友關係和日常生活的破壞。MS這種疾病對個人的自尊也有相當大的影響,尤其是當患者無法再執行先前有自己覺得有價值的活動時。藥物也可能會產生擾人的副作用。情緒問題如憂鬱症、焦慮都是MS病人常見的症狀,往往造成病人難以面對和適應自己的疾病。認知功能(記憶力,注意力,推理和判斷力) 也會受到影響。因此,被診斷MS之後可能產生巨大的心理影響。 本文作者藉著這次的回顧分析試著評估心理治療(例如針對認知功能,思想,情緒和行為)對MS病人的效果。藉由評估患者治的療是否影響其生活品質、情緒、認知功能和失能的情形,也評估病人疼痛、疲勞、和使用其他健康相關的服務和治療狀況。16個相關的研究被納入本次回顧分析中。這些研究包含了多種不同的治療措施,治療目標也各不相同,因此無法得到單一的結論。然而,總結來說,認知行為治療對於MS患者適應和面對自身疾病是有幫助的。對於患者的沮喪心情,也有一些療效。心理治療可在許多層面幫助MS病人,包括症狀的管理,如疼痛、疲勞等。目前尚需更多並包含更大量患者數的研究。