Target Area: Adjustment/ Coping, Quality of life, Activities of daily living
Moss-Morris et al. (2013). J Consult Clin Psych
PEDro score - 7/10
81(2), 251-262.
Method/Results
Rehabilitation Program
Design
Aims: (i) to assess whether an 8-session nurse Study Design: multicentre RCT
led CBT program leads to better adjustment in
early stage MS (lower levels of psychological
 Population: Ambulatory people with
distress and functional impairment) compared
early stage, mild to moderate severity
to 8 sessions of supportive listening; (ii) to
multiple sclerosis (≤ 10 years MS
determine whether treatment effects are
diagnosis).
moderated by baseline distress, social support,
 Groups:
1. Cognitive Behavioural Therapy (CBT, and treatment preference.
n = 48)
2. Supportive listening (SL, n = 46)
Materials: CBT and SL manuals for nurses, CBT
(69.1% female, mean age = 41.7 years)
and SL patient manuals, telephone,
questionnaires.
 Setting: Two UK-based university
hospitals offering MS outpatient
services
Treatment Plan:
 Duration: Both therapies comprised 8
individual sessions over a 10 week
Primary outcome measures:
period; the first session lasted 80-90
 The General Heath Questionnaire (GHQminutes, remaining sessions lasted 50
12) for general distress
minutes and 1 hour.
 The Work and Social Adjustment Scale
(WSAS) for illness-related functional
 Procedure: Trained nurse-therapists,
impairment.
administered one-to-one sessions; the
first and fourth sessions were held faceto-face and all others were held over
Secondary outcome measure:
the phone. Therapists followed written
 The Acceptance of Chronic Health
manuals for both interventions, and
Conditions Scale (ACHC)
participants both groups received
 The Psychological Vulnerability Scale
treatment manuals. Questionnaires
(PVS)
were completed at baseline (Week 0),
 The Beliefs and Emotions Scale (BES)
mid-therapy (Week 5), post-therapy
 The EuroQol (EQ-5D) for quality of life in
(Week 15), 6 month (26 week) and 12
functional, physical, and psychosocial
month (Week 52) follow-up.
domains.
 Content: - The CBT package comprised a
nine-chapter manual, with activities and
Results: Both post-therapy and at 12-month
homework sheets, which focused on
follow-up, the CBT group had significantly lower
optimising day-to-day functioning and
distress, but non-significantly lower functional
minimising distress and symptoms
impairment compared to the SL group. Groups
within the constraints of MS. Also
were equivalent on illness acceptance postincluded, was a 10-page information
therapy and at 12-month follow-up; in the CBT
booklet to give to family and/or
group unhelpful thoughts (PVS) and beliefs
caregivers. - The SL treatment
about emotions (BES) were significantly and
participants were given the opportunity
marginally-significantly reduced post-therapy,
to talk freely about their thoughts,
both not at 12-month follow-up. Quality of life
feelings, and experiences of MS and its
was equivalent for the two groups both at
baseline, and at 12-month follow-up.
impact on their life. The therapist’s role
Target Area: Adjustment/ Coping, Quality of life, Activities of daily living
Exploratory analyses reveal that CBT led to
was non-directive and drew on listening
greater reductions on distress and impairment
skills derived from counselling
for participants with poor social support and/or
techniques, such as empathising,
clinically-defined baseline distress levels.
reflecting, and summarising.
Treatment effects were not moderated by
preference.