Document Type : Original Article
Authors
Department of Psychology, Tarbiat Modares University, Tehran, Iran
Abstract
AIM AND BACKGROUND: Multiple sclerosis (MS) is a long‑course incurable disease as well as an
unknown prognosis causing patients to experience a variety of psychological outcomes. Meanwhile,
inability to control the disease‑related uncertainty leads to the use of maladaptive coping strategies,
causing more psychological distress. This study investigated the effectiveness of intervention focused
on the intolerance of uncertainty on psychological distress and quality of life in MS patients.
MATERIALS AND METHODS: This research adopted a true experimental design. All phases of the
study were conducted online due to the COVID‑19 pandemic during 2021 in Tehran. The statistical
population of the study was purposefully selected from among MS patients and was randomly assigned
to three groups of 20: IU intervention and two control groups (cognitive behavioral therapy (CBT)
and treatment as usual (TAU) groups). The study included pre‑test, post‑test, and follow‑up stages.
The outcome measures of the study included the Depression Anxiety Stress Scale (DASS‑21) as
well as Multiple Sclerosis Quality of Life‑54 (MSQoL‑54). Mixed analysis of variance was used to
analyze the data.
RESULTS: The results showed that IU intervention compared to CBT, is more effective on
psychological distress (depression P = 0.006, anxiety P = 0.01, and stress P = 0.01) and quality of
life (P = 0.001) in MS patients. Nonetheless, IU‑focused intervention is more effective than TAU on
psychological distress (depression P = 0.0001, anxiety P = 0.0001, stress P = 0.0001) as well as
quality of life (P = 0.0001) in these patients.
CONCLUSIONS: IU‑based intervention can reduce psychological distress and improve quality of
life of MS patients. Accepting uncertainty can reduce the anxiety and stress of MS patients which
can increase the quality of life of these patients.
Keywords
- Gil‑González I, Martín‑Rodríguez A, ConradR, Pérez‑San‑Gregorio
MÁ. Quality of life in adults with multiple sclerosis: A systematic
review. BMJ Open 2020;10:e041249.
2. Mohamadirizi S, Shaygannejad V, Mohamadirizi S,
Tolou‑GhamariZ. The effect of electronic education on knowledge
of patients with multiple sclerosis. J Edu Health Promot 2017;6:10.
3. Akbari A, Shamsaei F, Sadeghian E, Mazdeh M, Tapak L. Effect
of progressive muscle relaxation technique on selfesteem and
selfefficacy in multiple sclerosis patients: A clinical trial study.
J Educ Health Promot 2022;11:1‑10.
4. Jeong A, Oleske DM, Holman J. Epidemiology of pediatric‑onset
multiple sclerosis: A systematic review of the literature. J Child
Neurol 2019;34:705‑12.
5. Soheili M, Nazari F, Shaygannejad V, Valiani M. A comparison
the effects of reflexology and relaxation on the psychological
symptoms in women with multiple sclerosis. J Educ Health
Promot 2017;6:11.
6. Fransen NL, Hsiao C‑C, van der Poel M, Engelenburg HJ,
Verdaasdonk K, Vincenten MC, et al. Tissue‑resident memory
T cells invade the brain parenchyma in multiple sclerosis white
matter lesions. Brain 2020;143:1714‑30.
7. Fisher PL, Salmon P, Heffer‑Rahn P, Huntley C, Reilly J,
Cherry MG. Predictors of emotional distress in people with
multiple sclerosis: A systematic review of prospective studies.
J Affect Disord 2020;276:752‑64.
8. Wilski M, Gabryelski J, Brola W, Tomasz T. Health‑related quality
of life in multiple sclerosis: Links to acceptance, coping strategies
and disease severity. Disabil Health J 2019;12:608‑14.
9. Tabarsi S, Zakeri MM, Rezapur R, Ebrahimi L. Effectiveness of
progressive muscle relaxation training on psychological distress
of woman’s with multiple sclerosis. J Rehab Med 2019;7:71‑9.
10. Ohayashi H. Psychological Distress: Symptoms, Causes, and
Coping: Nova Science Publishers; 2012.
11. Patten SB, Marrie RA, Carta MG. Depression in multiple sclerosis.
Int Rev Psychiatry 2017;29:463‑72.
12. Solaro C, Gamberini G, Masuccio FG. Depression in multiple
sclerosis: Epidemiology, aetiology, diagnosis and treatment. CNS
Drugs 2018;32:117‑33.
13. Hanna M, Strober LB. Anxiety and depression in multiple
sclerosis (MS): Antecedents, consequences, and differential
impact on well‑being and quality of life. Mult Scler Relat Disord
2020;44:102261.
14. Vickrey B, Hays RD, Harooni R, Myers LW, Ellison GW.
A health‑related quality of life measure for multiple sclerosis.
Qual Life Res1995;4:187‑206. - 15. Azimian M, Arian M, Shojaei SF, Doostian Y, Barmi BE,
Khanjani MS. The effectiveness of group hope therapy training
on the quality of life and meaning of life in patients with multiple
sclerosis and their family caregivers. Iran J Psychiatry 2021;16:260.
16. Urits I, Adamian L, Fiocchi J, Hoyt D, Ernst C, Kaye AD, et al.
Advances in the understanding and management of chronic
pain in multiple sclerosis: A comprehensive review. Curr Pain
Headache Rep 2019;23:1‑11.
17. Gromisch ES, Kerns RD, Czlapinski R, Beenken B, Otis J, Lo AC,
et al. Cognitive behavioral therapy for the management of multiple
sclerosis–related pain: A randomized clinical trial. Int J MS Care
2020;22:8‑14.
18. Majendie CM, Dysch L, Carrigan N. Cognitive behavioral therapy
for insomnia (CBT‑I) for an adult with multiple sclerosis. Clin
Case Stud 2017;16:115‑31.
19. Van den Akker L, Beckerman H, Collette E, Knoop H,
Bleijenberg G, Twisk J, et al. Cognitive behavioural therapy for
MS‑related fatigue explained: A longitudinal mediation analysis.
J Psychosom Res 2018;106:13‑24.
20. Shareh H, Robati Z. Effect of cognitive‑behavioral group therapy
on pain self‑efficacy, fatigue, life expectancy and depression in
patients with multiple sclerosis: A randomized controlled clinical
trial. Iran J Psychiatry Clin Psychol 2021;26:418‑31.
21. van den Akker LE, Beckerman H, Collette EH, Twisk JW,
Bleijenberg G, Dekker J, et al. Cognitive behavioral therapy
positively affects fatigue in patients with multiple sclerosis: Results
of a randomized controlled trial. Mult Scler 2017;23:1542‑53.
22. Crigger NJ. Testing an uncertainty model for women with
multiple sclerosis. ANS Adv Nurs Sci 1996;18:37‑47.
23. Nissen N, Lemche J, Reestorff CM, Schmidt M ,
Skjerbæk AG, Skovgaard L, et al. The lived experience of
uncertainty in everyday life with MS. Disabil Rehabil 2021:1‑7.
doi: 10.1080/09638288.2021.1955302.
24. Alschuler KN, Beier ML. Intolerance of uncertainty: Shaping an
agenda for research on coping with multiple sclerosis. Int J MS
Care 2015;17:153‑8.
25. Boswell JF, Thompson-Hollands J, Farchione TJ, Barlow DH.
Intolerance of uncertainty: A common factor in the treatment of
emotional disorders. J Clin Psychol 2013;69:630‑45.
26. Barlow DH, Farchione TJ, Bullis JR, Gallagher MW,
Murray‑Latin H, Sauer‑Zavala S, et al. The unified protocol for
transdiagnostic treatment of emotional disorders compared with
diagnosis‑specific protocols for anxiety disorders: A randomized
clinical trial. JAMA Psychiatry 2017;74:875‑84.
27. Molton IR, Koelmel E, Curran M, von Geldern G, Ordway A,
Alschuler KN. Pilot intervention to promote tolerance for
uncertainty in early multiple sclerosis. Rehabil Psychol
2019;64:339.
28. Germino BB, Mishel MH, Crandell J, Porter L, Blyler D,
Jenerette C, et al. Outcomes of an uncertainty management
intervention in younger African American and Caucasian breast
cancer survivors. Oncol Nurs Forum 2013;40:82‑92.
29. Beheshti N, Zemestani M, Rezaei F. Comparing the effectiveness of
cognitive behavioral therapy focused on intolerance of uncertainty
and pharmacotherapy on worry, intolerance of uncertainty, and
cognitive avoidance in patients with generalized anxiety disorder.
Iran J Psychiatry Clin Psychol 2018;24:240‑55.
30. Hebert EA, Dugas MJ. Behavioral experiments for intolerance
of uncertainty: Challenging the unknown in the treatment of
generalized anxiety disorder. Cogn Behav Pract 2019;26:421‑36.
31. Gall MD, Borg WR, Gall JP. Educational Research: An
Introduction: Longman Publishing; 1996.
32. Sinclair S, Siefert C, Salvin‑Mulfrod J, Stein M, Renna M, Blais M.
Psychometric evaluation and normative data for the depression,
anxiety, and stress scales‑21 (DASS‑21) in a nonclinical sample
of U.S. adults. 2012; Epub 35(3):259‑79.
33. Akin A, Çetın B. The depression anxiety and stress scale (DASS):
The study of validity and reliability. Educational Sciences. Theory
Pract 2007;7:260‑8.
34. Manafi S, Dehshiri Gh. Fear of disease progression in patients with
cancer and multiple sclerosis and its relationship with emotional
problems. J Health Psychol 2017;6:115‑30.
35. Vickrey BG. Multiple Sclerosis Quality of life (MSQOL)‑54
Instrument. Los Angeles: University of California, Los Angeles;
1995.
36. VickreyB, HaysRD, HarooniR, MyersL, EllisonG. Ahealth‑related
quality of life measure for multiple sclerosis. Quality Life Res 1995;
4:187‑206.
37. Borhani A, Ghaem H. Quality of life in patients with multiple
sclerosis (MS): Translation and cultural adaptation of QoL‑54 MS
questionnaire. Iran J Neurol 2005;4:40‑56.
38. Ghielen I, Rutten S, Boeschoten RE, Houniet‑de Gier M,
van Wegen EE, van den Heuvel OA, et al. The effects of cognitive
behavioral and mindfulness‑based therapies on psychological
distress in patients with multiple sclerosis, Parkinson’s disease
and Huntington’s disease: Two meta‑analyses. J Psychosom Res
2019; 122:43‑51.
39. Shareh H, AsgharkhahE. The effectiveness of group metacognitive
therapy on metacognitive components and resiliency of women
with multiple sclerosis. Iran J Psychiatry Clin Psychol 2016;
22:3‑16.
40. Mills N, Allen J. Mindfulness of movement as a coping strategy
in multiple sclerosis: A pilot study. Gen Hosp Psychiatry
2000;22:425‑31.
41. Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S.
Mindfulness based interventions in multiple sclerosis‑A
systematic review. BMC Neurol 2014;14:15.
42. Mohamadirizi S, Shaygannejad V, Mohamadirizi S. The survey
of mindfulness in multiple sclerosis patients and its association
with attachment style. J Edu Health Promot 2017;6:7.
43. Soheili M, Nazari F, Shaygannejad V, Valiani M. A comparison
the effects of reflexology and relaxation on the psychological
symptoms in women with multiple sclerosis. J Edu Health Promot
2017;6:11.
44. Mohebbi B, Sabouri M, Tol A. Application of health education
and promotion theory‑based interventions on patients with
cardiovascular disease: A systematic review. J Edu Health Promot
2021;10:236.
)