Background: Psychosocial interventions are often used as an adjunct to the medical management of multiple sclerosis (MS). However, the efficacy of such approaches for a range of psychosocial indications remains unclear. Objective: To determine the efficacy of psychosocial therapies for people with MS (PwMS). Methods: We searched 6 electronic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, and Clinicaltrials.gov) until April 21, 2016, for randomized controlled trials reporting the effect of psychological interventions for depressive symptoms, anxiety, pain, fatigue, or health-related quality of life (HRQoL) in PwMS. Results: The search yielded 356 articles with 13 included studies (n = 1,617). Benefits of psychological interventions were found for depressive symptoms (Cohen’s d = 0.281), anxiety (d = 0.285), fatigue (d = 0.228), and mental (d = 0.398) and total HRQoL (d = 0.444), but not physical HRQoL. There were insufficient studies to meta-analyze posttreatment outcomes for pain. Interventions were more effective for HRQoL for patients with relapsing-remitting MS and when treatment doses were larger. Cognitive behavioral therapy (CBT) was not efficacious for PwMS when considered alone. Conclusion: Psychosocial interventions have a significant, positive impact across a range of outcomes for PwMS with small, yet consistent, effect sizes. There was some indication that CBT was less efficacious than other interventions. However, this may be due to smaller treatment doses in CBT studies.

1.
Marrie RA, Fisk JD, Yu BN, et al: Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance. BMC Neurol 2013; 13: 16.
2.
Asano M, Finlayson ML: Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int 2014; 2014: 798285.
3.
Fiest KM, Walker JR, Bernstein CN, et al: Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Dis 2016; 5: 12–26.
4.
Mohr DC, Goodkin DE: Treatment of depression in multiple sclerosis: review and meta-analysis. Clin Psychol Sci Pract 1999; 6: 1–9.
5.
Kuspinar A, Rodriguez AM, Mayo NE: The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler J 2012; 18: 1686–1704.
6.
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; 14: 1.
7.
Button KS, Ioannidis JP, Mokrysz C, et al: Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 2013; 14: 365–376.
8.
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269.
9.
Higgins JP, Altman DG, Gøtzsche PC, et al: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343:d5928.
10.
Egger M, Smith GD, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.
11.
Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics 1994: 1088–1101.
12.
Duval S, Tweedie R: Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–463.
13.
Borenstein M, Hedges L, Higgins J, Rothstein H: Comprehensive meta-analysis (version 2). Biostat 2005; 11: 188–191.
14.
Langenmayr A, Schottes N: Psychotherapy with multiple-sclerosis patients. Psychol Rep 2000; 86: 495–508.
15.
Rigby SA, Thornton EW, Young CA: A randomized group intervention trial to enhance mood and self-efficacy in people with mul-tiple sclerosis. Br J Clin Pharmacol 2007; 13: 619–631.
16.
Mohr DC, Hart SL, Julian L, et al: Telephone-administered psychotherapy for depression. Arch Gen Psychiatry 2005; 62: 1007–1014.
17.
Cosio D, Jin L, Siddique J, Mohr DC: The effect of telephone-administered cognitive-behavioral therapy on quality of life among patients with multiple sclerosis. Ann Behav Med 2011; 41: 227–234.
18.
Mohr DC, Hart S, Vella L: Reduction in disability in a randomized controlled trial of te-lephone-administered cognitive-behavioral therapy. Health Psychol 2007; 26: 554–563.
19.
Finlayson M, Preissner K, Cho C, Plow M: Randomized trial of a teleconference-delivered fatigue management program for people with multiple sclerosis. Mult Scler J 2011; 17: 1130–1140.
20.
Thomas S, Thomas PW, Kersten P, et al: A pragmatic parallel arm multi-centre randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based fatigue management programme (FACETS) for people with multiple sclerosis. J Neurol Neurosurg Psychiatry 2013; 84: 1092–1099.
21.
Thomas PW, Thomas S, Kersten P, et al: One year follow-up of a pragmatic multi-centre randomised controlled trial of a group-based fatigue management programme (FACETS) for people with multiple sclerosis. BMC Neurol 2014; 14: 109.
22.
Lincoln NB, Yuill F, Holmes J, Drummond AE, Constantinescu CS, Armstrong S, Phillips C: Evaluation of an adjustment group for people with multiple sclerosis and low mood: a randomized controlled trial. Mult Scler 2011; 17: 1250–1257.
23.
Ehde DM, Elzea JL, Verrall AM, Gibbons LE, Smith AE, Amtmann D: Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: a randomized controlled trial with a one-year follow-up. Arch Phys Med Rehabil 2015; 96: 1945–1958.
24.
Artemiadis AK, Vervainioti AA, Alexopoulos EC, Rombos A, Anagnostouli MC, Darviri C: Stress management and multiple sclerosis: a randomized controlled trial. Arch Clin Neuropsychol 2012; 27: 406–416.
25.
Barlow J, Turner A, Edwards R, Gilchrist M: A randomised controlled trial of lay-led self-management for people with multiple sclerosis. Patient Educ Counsel 2009; 77: 81–89.
26.
Graziano F, Calandri E, Borghi M, Bonino S: The effects of a group-based cognitive behavioral therapy on people with multiple sclerosis: a randomized controlled trial. Clin Rehabil 2014; 28: 264–274.
27.
Grossman P, Kappos L, Gensicke H, et al: MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology 2010; 75: 1141–1149.
28.
Ghafari S, Ahmadi F, Nabavi M, Anoshirvan K, Memarian R, Rafatbakhsh M: Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis. J Clin Nurs 2009; 18: 2171–2179.
29.
Bombardier CH, Cunniffe M, Wadhwani R, Gibbons LE, Blake KD, Kraft GH: The efficacy of telephone counseling for health promotion in people with multiple sclerosis: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 1849–1856.
30.
Schwartz CE: Teaching coping skills enhances quality of life more than peer support: results of a randomized trial with multiple sclerosis patients. Health Psychol 1999; 18: 211–220.
31.
Moss-Morris R, Dennison L, Landau S, Yardley L, Silber E, Chalder T: 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: 251–262.
32.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, Jaeschke R: GRADE guidelines. 1. Introduction: GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011; 64: 383–394.
33.
Shahrbanian S, Duquette P, Kuspinar A, Mayo NE: Contribution of symptom clusters to multiple sclerosis consequences. Qual Life Res 2015; 24: 617–629.
34.
Chiaravalloti ND, DeLuca J: Cognitive impairment in multiple sclerosis. Lancet Neurol 2008; 7: 1139–1151.
35.
Kazantzis N, Whittington C, Dattilio F: Meta-analysis of homework effects in cognitive and behavioral therapy: a replication and extension. Clin Psychol Sci Pract 2010; 17: 144–156.
36.
McEwen BS: Epigenetic interactions and the brain-body communication. Psychother Psychosom 2017; 86: 1–4.
37.
Ackerman KD, Heyman R, Rabin BS, Anderson BP, Houck PR, Frank E, Baum A: Stressful life events precede exacerbations of multiple sclerosis. Psychosom Med 2002; 64: 916–920.
38.
Goodin D, Ebers G, Johnson K, Rodriguez M, Sibley W, Wolinsky J: The relationship of MS to physical trauma and psychological stress: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 1999; 52: 1737–1745.
39.
Karagkouni A, Alevizos M, Theoharides TC: Effect of stress on brain inflammation and multiple sclerosis. Autoimmun Rev 2013; 12: 947–953.
40.
Fava GA, Cosci F, Sonino N: Current psy chosomatic practice. Psychother Psychosom 2017; 86: 13–30.
41.
Mohr DC, Goodkin DE, Likosky W, Gatto N, Baumann KA, Rudick RA: Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis. Arch Neurol 1997; 54: 531–533.
42.
Khan F, Pallant J: Chronic pain in multiple sclerosis: prevalence, characteristics, and impact on quality of life in an Australian community cohort. J Pain 2007; 8: 614–623.
43.
Trojan DA, Arnold D, Collet JP, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, Ducruet T, Narayanan S, Arcelin K: Fatigue in multiple sclerosis: association with disease-related, behavioural and psychosocial factors. Mult Scler 2007; 13: 985–995.
44.
Ehde DM, Gibbons LE, Chwastiak L, Bombardier CH, Sullivan MD, Kraft GH: Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler 2003; 9: 605–611.
45.
Ehde D, Osborne T, Hanley M, Jensen M, Kraft G: The scope and nature of pain in persons with multiple sclerosis. Mult Scler 2006; 12: 629–638.
46.
Morley S, Eccleston C, Williams A: Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999; 80: 1–13.
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