S Evidence statements

Three RCTs that assessed the utility of neuropsychological compensatory training, psychotherapy and coping skills training for persons with MS were identified (Ib). The first RCT assessed the effectiveness of traditional psychotherapy compared to participation in a 'current affairs' topic group or no intervention. The results showed psychotherapy to be superior on two of the four outcome measures assessed, namely depression and locus of control. However, it had no significant effect on either anxiety levels or levels of self-esteem.18 The second RCT examined a coping skills group compared to non-directive peer telephone support. The coping skills group entailed formal therapist support and considerable contact time, whilst the telephone support group was informal and only entailed one hour a month. No overall differences between the groups were observed on any of the five outcome measures.19 The last RCT compared neuropsychological compensatory training to supportive psychotherapy. The results indicated beneficial effects on measures of social aggression, but no difference between the groups on measures of depression or personality change.20

One controlled clinical trial (CCT) compared client-centred psychotherapy to a no-treatment control in patients with MS. The results indicated beneficial effects on four of the seven outcome measures assessed, with all of these being within inter- or intra-personal domains21 (IIa). Two further CCTs were identified that examined therapeutic groups for persons with either MS or spinal cord injury. However, both of these studies reported only within subject results and therefore no comparison could be made as to the efficacy of the interventions between the groups.22,23

Two uncontrolled pre-post studies examining coping skills training and stress management instruction were also included. The first study assessed coping skills training in patients with MS. The results showed an overall beneficial effect on measurements of depression, physical mobility and emotional reaction.24 The second study examined the efficacy of stress management instruction in patients with disease of mixed aetiology. The results showed a positive effect on two of the four outcome measures assessed24,25 (III).

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Do Not Panic

Do Not Panic

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