Florence Nightingale School of Nursing & Midwifery, Room 1.17, James Clerk Maxwell Building, London, UK.
Behav Res Ther. 2013 Oct;51(10):648-55. doi: 10.1016/j.brat.2013.04.001. Epub 2013 Apr 25.
Mental health problems such as depression and anxiety are common in Multiple Sclerosis (MS) and are often under treated.
This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous randomised controlled trials (RCTs) of cognitive behaviour therapy (CBT) in this population.
49 patients were deemed appropriate for CBT and 29 accepted treatment. Assessments were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale. Results in the form of a standardized effect of treatment were compared with five previous RCTs.
The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety. The uncontrolled effect size was large but inferior to those found in published RCTs.
Cognitive behaviour therapy is effective for people with MS in routine clinical practice. Possible limits on effectiveness include more liberal patient selection, lack of specificity in rating scales and heterogeneity of target problems. Given the high rates of distress in this population, routine psychological interventions within neurology services are justifiable. Future research should aim to maximise CBT in such settings.
抑郁和焦虑等心理健康问题在多发性硬化症（MS）中很常见，但往往得不到充分治疗。
本文报告了针对多发性硬化症患者常见精神障碍的认知行为疗法服务的临床效果，并将其与该人群中之前的认知行为疗法（CBT）随机对照试验（RCT）进行了比较。
49 名患者被认为适合接受 CBT，其中 29 名接受了治疗。在基线和治疗结束时进行评估，包括医院焦虑和抑郁量表。以治疗的标准化效应的形式报告结果，并与五项之前的 RCT 进行比较。
该临床服务的结果表明，抑郁和焦虑均有统计学显著改善。未控制的效应量较大，但低于已发表的 RCT 中发现的效应量。
认知行为疗法在常规临床实践中对多发性硬化症患者有效。可能对疗效的限制包括更宽松的患者选择、评定量表缺乏特异性以及目标问题的异质性。鉴于该人群中存在较高的痛苦率，神经病学服务中常规进行心理干预是合理的。未来的研究应旨在最大限度地提高此类环境中的 CBT 效果。
