Efficacy of Cognitive Behavioral Therapy on Mental Health and Social Function in Patients with Multiple Sclerosis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGJia-qi ^1,2 , ZHANGHong-yue ^1,2 , TANGXin ³ , ZHANGChun-yan ⁴ ,  LIWei-hui ⁴

1. Department of Occupational Therapy, Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu 610041, China;
3. Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong, China;
4. Mental Health Institute, the Second Hospital of Xiangya, Zhongnan University, Changsha 410011, China;

Corresponding author：

LIWei-hui, Email: 744700965@qq.com

Keywords：

Cognitive behavioral therapy; Multiple sclerosis; Mental health; Social function; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160147

Video：

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Objective To systematically review the efficacy of cognitive behavioral therapy (CBT) for improving mental health and social functions in patients with multiple sclerosis (MS). Methods We searched PubMed, EMbase, The Cochrane Library (Issue 4, 2016), CBM and CNKI from inception to May 2016, to collect randomized controlled trials (RCT) about CBT on mental health and social function in patients with MS. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 1 102 patients were included. The results of meta-analysis showed that, the HADS scores (depression: MD=-1.28, 95%CI-2.07 to-0.48, P=0.002; anxiety: MD=-1.52, 95%CI-2.99 to-0.06, P=0.04), BDI scores (MD=-9.11, 95% CI-15.82 to-2.40, P=0.008), HRDS scores (MD=-7.23, 95% CI-13.65 to-0.82, P=0.03), Chalder scores (MD=-4.88, 95% CI-6.61 to-3.16, P < 0.000 01), MFIS scores (MD=-2.98, 95% CI-4.52 to-1.44, P=0.000 2) and GHQ-12 scores (MD=-3.61, 95%CI-5.20 to-2.02, P < 0.000 01) in the CBT group were lower than that in the control group. No significant difference was found in WSAS scores (MD=-1.98, 95%CI-4.88 to 0.93, P=0.18) between two groups. Conclusion CBT may be effective for improving the negative mental experience, fatigue and quality of life in MS. No evidence to support CBT has benefits in social functions. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality studies.

Citation： ZHANGJia-qi, ZHANGHong-yue, TANGXin, ZHANGChun-yan, LIWei-hui. Efficacy of Cognitive Behavioral Therapy on Mental Health and Social Function in Patients with Multiple Sclerosis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 953-961. doi: 10.7507/1672-2531.20160147 Copy

1.	Noseworthy JH, Lucchinetti C, Rodriguez M, et al. Multiple sclerosis. N Engl J Med, 2000, 343(13):938-952.
2.	Cheng Q, Cheng XJ, Jiang GX, et al. Multiple sclerosis in Chinahistory and future. Multiple Sclerosis, 2009, 15:655-660.
3.	Kelleher KJ, Spence W, Solomonidis S, et al. Ambulatory rehabilitation in multiple sclerosis. Disabil Rehabil, 2009, 31(20): 1625-1632.
4.	Kalb R. The emotional and psychological impact of multiple sclerosis relapses. J Neurol Sci, 2007, 256:29-33.
5.	van Kessel K, Moss-Morris R. Understanding multiple sclerosis fatigue:a synthesis of biological and psychological factors. J Psychosom Res, 2006, 61(5):583-585.
6.	Yu, CH, Mathiowetz V. Systematic review of occupational therapyrelated interventions for people with multiple sclerosis:Part 1. Activity and participation. Am J Occup Ther, 2014, 68:27-32.
7.	WHO. International Classification of Functioning, Disability, and Health. Geneva:WHO Press; 2001.
8.	马云, 李占江, 徐子燕, 等.认知行为治疗对精神分裂症患者应对方式的影响.中国临床心理学杂志, 2013, 21(3):455-457.
9.	Livermore N, Sharpe L, McKenzie D, et al. Panic attacks and panic disorder in chronic obstructive pulmonary disease:A cognitive behavioral perspective. Respir Med, 2010, 104, 1246-1253.
10.	田浪, 曹晓翼.认知行为疗法对乳腺癌患者失眠治疗效果的系统评价.中国循证医学杂志, 2013, 13(1):70-77.
11.	Dennison L, Moss-Morris R. Cognitive-behavioral therapy:what benefit can it offer people with multiple sclerosis? Expert Rev Neurother, 2010, 10(9):1383-1390.
12.	Fernie BA, Kollmann J, Brown RG. Cognitive behavioural interventions for depression in chronic neurological conditions:a systematic review. J Psychosom Res, 2015, 78(5):411-419.
13.	Hind D, Cotter J, Thake A, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis:a systematic review and meta-analysis. BMC Psychiatry, 2014, 9:1-13.
14.	McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis:guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol, 2001, 50(1):121-127.
15.	Poser CM, Brinar VV. Diagnostic criteria for multiple sclerosis. Clin Neurol Neurosurg, 2001, 103:1-11.
16.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011]. Cochrane Collaboration, 2008. Available at:www. cochrane-handbook. Org.
17.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327:557-560.
18.	Larcombe NA, Wilson PH. An evaluation of cognitive-behaviour therapy for depression in patients with multiple sclerosis. Br J Psychiatry, 1984, 145:366-371.
19.	Mohr DC, Boudewyn AC, Goodkin DE, et al. Comparative outcomes for individual cognitive-behavior therapy, supportiveexpressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol, 2001, 69: 942-949.
20.	van Kessel K, Moss-Morris R, Willoughby E, et al. A Randomized Controlled Trial of Cognitive Behavior Therapy for Multiple Sclerosis Fatigue. Psychosom Med, 2008, 70(2):205-213.
21.	Forman AC, Lincoln NB. Evaluation of an adjustment group for people with multiple sclerosis:a pilot randomized controlled trial. Clin Rehabil, 2010, 24:211-221.
22.	Lincoln NB, Yuill F, Holmes J, et al. Evaluation of an adjustment group for people with multiple sclerosis and low mood:a randomized controlled trial. Mult Scler, 2011, 17(10):1250-1257.
23.	Cooper CL, Hind D, Parry GD, et al. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis:external pilot trial. Trials, 2011, 12:1-14.
24.	Moss-Morris R, McCrone P, Yardley L, et al. A pilot randomised controlled trial of an Internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue. Behav Res Ther, 2012, 50(6):415-421.
25.	Moss-Morris R, Dennison L, Landau S, et al. A Randomized Controlled Trial of Cognitive Behavioral Therapy (CBT) for Adjusting to Multiple Sclerosis (the saMS Trial):Does CBT Work and for Whom Does It Work? J Consult Clin Psychol, 2013, 81(2): 251-262.
26.	陈秋丽, 张晓明, 赵淑霞, 等.认知行为疗法对多发性硬化抑郁预后的影响研究.临床合理用药, 2013, 6(8):15-16.
27.	Fischer A, Schröder J, Vettorazzi E, et al. An online programme to reduce depression in patients with multiple sclerosis:a randomised controlled trial. Lancet Psychiatry, 2015, 2(3):217-223.
28.	van Kessel K, Wouldes T, Moss-Morris R. A New Zealand pilot randomized controlled trial of a web-based interactive selfmanagement programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue. Clin Rehabi, 2015:1-9.
29.	Beck AT. The past and future of cognitive therapy. J Psychother Pract Res, 1997, 6(4):276-284.
30.	Jones C, Hacker D, Cormac I, et al. Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev, 2012, 18(4):CD008712.
31.	Kielhofner G. The basic concept of human occupation Model of human occupation:Theory and application(4th ed.). Baltimore, MD: Lippincott, Williams & Wilkins, 2008:11-23.
32.	Mroz TM, Pitonyak JS, Fogelberg D, et al. Client Centeredness and Health Reform:Key Issues for Occupational Therapy. Am J Occup Ther, 2015, 69(5):1-8.
33.	National Institute for Health and Clinical Excellence. Depression in adults with a chronic physical health problem:treatment and management. NICE Clinical Guideline 91. London:NICE, 2009.
34.	Lysandropoulos AP, Havrdova E, ParadigMS Group. 'Hidden' factors influencing quality of life in patients with multiple sclerosis. Eur J Neurol, 2015, 22:28-33.
35.	van Ballegooijen W, Cuijpers P, van Straten A, et al. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression:a meta-analysis. PLoS One, 2014, 16, 9(7):e100674.
36.	Amatya B, Galea MP, Kesselring J, et al. Effectiveness of telerehabilitation interventions in persons with multiple sclerosis:A systematic review. Mult Scler Relat Disord, 2015, 4(4):358-369.
37.	Gega L, Smith J, Reynolds S. Cognitive behaviour therapy (CBT) for depression by computer vs. therapist:patient experiences and therapeutic processes. Psychother Res, 2013, 23(2):218-231.
38.	Cole MB. Group Dynamics in Occupational therapy:The Theoretical Basis and Practice Application of Group Intervention. Slack Incorporated, 2012:155-192.
39.	Moll SE, Tryssenaar J, Good CR. Psychotherapy:a profile of current occupational therapy practice in Ontario. Can J Occup Ther, 2013, 80(5):328-336.
40.	于晨, 刘欣娟, 黄菊, 等.心理干预对脑卒中后抑郁治疗效果的系统评价, 中国循证医学杂志, 2011, 11(6):670-680.

1. Noseworthy JH, Lucchinetti C, Rodriguez M, et al. Multiple sclerosis. N Engl J Med, 2000, 343(13):938-952.
2. Cheng Q, Cheng XJ, Jiang GX, et al. Multiple sclerosis in Chinahistory and future. Multiple Sclerosis, 2009, 15:655-660.
3. Kelleher KJ, Spence W, Solomonidis S, et al. Ambulatory rehabilitation in multiple sclerosis. Disabil Rehabil, 2009, 31(20): 1625-1632.
4. Kalb R. The emotional and psychological impact of multiple sclerosis relapses. J Neurol Sci, 2007, 256:29-33.
5. van Kessel K, Moss-Morris R. Understanding multiple sclerosis fatigue:a synthesis of biological and psychological factors. J Psychosom Res, 2006, 61(5):583-585.
6. Yu, CH, Mathiowetz V. Systematic review of occupational therapyrelated interventions for people with multiple sclerosis:Part 1. Activity and participation. Am J Occup Ther, 2014, 68:27-32.
7. WHO. International Classification of Functioning, Disability, and Health. Geneva:WHO Press; 2001.
8. 马云, 李占江, 徐子燕, 等.认知行为治疗对精神分裂症患者应对方式的影响.中国临床心理学杂志, 2013, 21(3):455-457.
9. Livermore N, Sharpe L, McKenzie D, et al. Panic attacks and panic disorder in chronic obstructive pulmonary disease:A cognitive behavioral perspective. Respir Med, 2010, 104, 1246-1253.
10. 田浪, 曹晓翼.认知行为疗法对乳腺癌患者失眠治疗效果的系统评价.中国循证医学杂志, 2013, 13(1):70-77.
11. Dennison L, Moss-Morris R. Cognitive-behavioral therapy:what benefit can it offer people with multiple sclerosis? Expert Rev Neurother, 2010, 10(9):1383-1390.
12. Fernie BA, Kollmann J, Brown RG. Cognitive behavioural interventions for depression in chronic neurological conditions:a systematic review. J Psychosom Res, 2015, 78(5):411-419.
13. Hind D, Cotter J, Thake A, et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis:a systematic review and meta-analysis. BMC Psychiatry, 2014, 9:1-13.
14. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis:guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol, 2001, 50(1):121-127.
15. Poser CM, Brinar VV. Diagnostic criteria for multiple sclerosis. Clin Neurol Neurosurg, 2001, 103:1-11.
16. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1[updated March 2011]. Cochrane Collaboration, 2008. Available at:www. cochrane-handbook. Org.
17. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327:557-560.
18. Larcombe NA, Wilson PH. An evaluation of cognitive-behaviour therapy for depression in patients with multiple sclerosis. Br J Psychiatry, 1984, 145:366-371.
19. Mohr DC, Boudewyn AC, Goodkin DE, et al. Comparative outcomes for individual cognitive-behavior therapy, supportiveexpressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol, 2001, 69: 942-949.
20. van Kessel K, Moss-Morris R, Willoughby E, et al. A Randomized Controlled Trial of Cognitive Behavior Therapy for Multiple Sclerosis Fatigue. Psychosom Med, 2008, 70(2):205-213.
21. Forman AC, Lincoln NB. Evaluation of an adjustment group for people with multiple sclerosis:a pilot randomized controlled trial. Clin Rehabil, 2010, 24:211-221.
22. Lincoln NB, Yuill F, Holmes J, et al. Evaluation of an adjustment group for people with multiple sclerosis and low mood:a randomized controlled trial. Mult Scler, 2011, 17(10):1250-1257.
23. Cooper CL, Hind D, Parry GD, et al. Computerised cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis:external pilot trial. Trials, 2011, 12:1-14.
24. Moss-Morris R, McCrone P, Yardley L, et al. A pilot randomised controlled trial of an Internet-based cognitive behavioural therapy self-management programme (MS Invigor8) for multiple sclerosis fatigue. Behav Res Ther, 2012, 50(6):415-421.
25. Moss-Morris R, Dennison L, Landau S, et al. A Randomized Controlled Trial of Cognitive Behavioral Therapy (CBT) for Adjusting to Multiple Sclerosis (the saMS Trial):Does CBT Work and for Whom Does It Work? J Consult Clin Psychol, 2013, 81(2): 251-262.
26. 陈秋丽, 张晓明, 赵淑霞, 等.认知行为疗法对多发性硬化抑郁预后的影响研究.临床合理用药, 2013, 6(8):15-16.
27. Fischer A, Schröder J, Vettorazzi E, et al. An online programme to reduce depression in patients with multiple sclerosis:a randomised controlled trial. Lancet Psychiatry, 2015, 2(3):217-223.
28. van Kessel K, Wouldes T, Moss-Morris R. A New Zealand pilot randomized controlled trial of a web-based interactive selfmanagement programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue. Clin Rehabi, 2015:1-9.
29. Beck AT. The past and future of cognitive therapy. J Psychother Pract Res, 1997, 6(4):276-284.
30. Jones C, Hacker D, Cormac I, et al. Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia. Cochrane Database Syst Rev, 2012, 18(4):CD008712.
31. Kielhofner G. The basic concept of human occupation Model of human occupation:Theory and application(4th ed.). Baltimore, MD: Lippincott, Williams & Wilkins, 2008:11-23.
32. Mroz TM, Pitonyak JS, Fogelberg D, et al. Client Centeredness and Health Reform:Key Issues for Occupational Therapy. Am J Occup Ther, 2015, 69(5):1-8.
33. National Institute for Health and Clinical Excellence. Depression in adults with a chronic physical health problem:treatment and management. NICE Clinical Guideline 91. London:NICE, 2009.
34. Lysandropoulos AP, Havrdova E, ParadigMS Group. 'Hidden' factors influencing quality of life in patients with multiple sclerosis. Eur J Neurol, 2015, 22:28-33.
35. van Ballegooijen W, Cuijpers P, van Straten A, et al. Adherence to Internet-based and face-to-face cognitive behavioural therapy for depression:a meta-analysis. PLoS One, 2014, 16, 9(7):e100674.
36. Amatya B, Galea MP, Kesselring J, et al. Effectiveness of telerehabilitation interventions in persons with multiple sclerosis:A systematic review. Mult Scler Relat Disord, 2015, 4(4):358-369.
37. Gega L, Smith J, Reynolds S. Cognitive behaviour therapy (CBT) for depression by computer vs. therapist:patient experiences and therapeutic processes. Psychother Res, 2013, 23(2):218-231.
38. Cole MB. Group Dynamics in Occupational therapy:The Theoretical Basis and Practice Application of Group Intervention. Slack Incorporated, 2012:155-192.
39. Moll SE, Tryssenaar J, Good CR. Psychotherapy:a profile of current occupational therapy practice in Ontario. Can J Occup Ther, 2013, 80(5):328-336.
40. 于晨, 刘欣娟, 黄菊, 等.心理干预对脑卒中后抑郁治疗效果的系统评价, 中国循证医学杂志, 2011, 11(6):670-680.

Chinese Journal of Evidence-Based Medicine

Efficacy of Cognitive Behavioral Therapy on Mental Health and Social Function in Patients with Multiple Sclerosis: A Meta-analysis

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