Influence of Psychotherapy on Longitudinal Change in Emotional and Physical Functioning in Primary Progressive Multiple Sclerosis

Background: A recent literature review found strong evidence that stress was linked with the onset of multiple sclerosis (MS) or relapse of symptoms (Artemiadis, Anagnostouli, & Alexopoulos, 2011). Cognitive, emotional, and behavioral reactions to diagnosis and disease progression were also predictive of illness-related functional impairment (Dennison et al., 2010). Furthermore, there is evidence that for patients with MS, emotional distress, such as depression or anxiety, fatigue, and quality of life are all reciprocally related with disease progression (Pittion-Vouyovitch et al., 2006). The disease progression of MS was also associated with other physiological changes including autonomic dysfunction (Flachenecker et al., 2001). However, several mind-body interventions such as exercise, cognitive-behavior therapy, relaxation, and stress management were beneficial for patients with relapsing-remitting MS (RRMS) to improve stress, locus of control, and emotional distress (Artemiadis et al., 2012), quality of life (Sung et al., 2013), fatigue (van Kessel et al., 2008), and the occurrence of new brain lesions (Mohr, 2012). However, the majority of studies focus on patients with RRMS rather than patients who had primary progressive MS (PPMS). The proposed study is designed to investigate whether or not a group of patients who self-select to receive psychological services have improved courses in their emotional and physical functioning as a result of these services.

Objectives: This study primarily aims to identify whether or not the receipt of psychological services results in positive emotional and physical changes over time for patients diagnosed with PPMS. 

Methods: Participants are 637 patients with PPMS see at the Mellen Center for Multiple Sclerosis at the main campus of the Cleveland Clinic Foundation in Cleveland, Ohio between 01/01/2010 and 12/15/2013. Data was retrospectively gathered using the Knowledge Program Data Registry (Irene Katzan, MD, Cyrus Registry, IRB #07-591). Data elements obtained from the registry include a variety of psychological and medical measures of emotional and physical functioning such as: European Quality of Life, Multiple Sclerosis Performance Scales (MSPS), Patient Health Questionnaire – 9 (PHQ-9), Generalized Anxiety Scale – 7 (GAD-7), Pain Disability Index (PDI), Timed 25-foot walk, and the 9-hole peg test. Demographic data will also be reported.

Results: Data will be analyzed using both multilevel modeling and multivariable regression to evaluate the impact of psychotherapy participation on each domain of emotional and physical functioning.

Conclusions: Data analysis has not yet been completed so conclusions are not yet completed. IRB approval has been received and data has been acquired but is pending final analysis.