A Process-based Approach to Psychological Distress in People with Early Multiple Sclerosis

Abstract

Psychological distress is highly prevalent in people with multiple sclerosis (PwMS), with adverse effects on psychological adjustment and quality of life. Factors such as uncertainty, threats to valued roles, stigma, illness representations, and maladaptive coping responses may interact to maintain distress in this population, yet are rarely addressed in an integrated format in existing psychological interventions for PwMS. This uncontrolled exploratory case series presents a process-focused conceptualization of psychological distress in multiple sclerosis (MS) and a linked acceptance and commitment therapy-informed intervention framework targeting proposed maintaining processes in a format intended to be feasible within neurological settings. Three patients with recently diagnosed relapsing-remitting MS received the intervention online, individually, across eight to nine sessions of approximately 60 min. The outcomes included anxiety, depression, illness perceptions, self-efficacy, and resilience, assessed at baseline, postintervention, and 3-month follow-up by an independent rater. Improvements were observed across the outcome measures at postintervention, and were generally maintained at follow-up. The changes in anxiety and depression exceeded commonly reported minimal clinically important difference thresholds, while reliable improvement, indicated by the reliable change index, was observed in resilience. While causal inferences cannot be drawn from an uncontrolled design with three patients, the findings illustrate a theoretically grounded approach to early MS-related distress that warrants further evaluation in controlled studies and may inform psychological interventions targeting adjustment difficulties in MS.