In collaboration with Payame Noor University and Iranian Health Psychology Association

Document Type : Scientific Research

Authors

1 Associate Professor, Department of Psychology, University of Maragheh, Maragheh, Iran

2 Assistant Professor, Department of Psychology, University of Maragheh, Maragheh, Iran.

3 PhD Student in Psychology, University of Tabriz, Tabriz, Iran.

Abstract

Objective: Multiple Sclerosis MS is one of the debilitating neurological disorders, which, in addition to neuro-motor disorders, manifests with symptoms such as anxiety, weakness, and reduced problem-solving ability, leading to numerous physical and mental disorders. The present study aimed to investigating the effectiveness of cognitive-behavioral therapy in reducing levels of anxiety and pathological worry among MS patients with symptoms of generalized anxiety disorder. Method: The method of the current research was a semi-experimental design with a pre-test - post-test with a control group. The statistical population of the research includes 40 women diagnosed with generalized anxiety disorder and MS, who had referred to the neurology clinic, using structured diagnostic interview based on DSM5 and using available sampling, 20 individuals randomly assigned to the experimental and control groups. The experimental group underwent cognitive behavioral intervention for 12 sessions, while the control group received no intervention. Pennsylvania Anxiety Questionnaire (1990) and Kettle Anxiety Scale (1957) administered before and after the intervention for both groups. Data analyzed using covariance analysis and SPSS version 26 software. Results: The findings of the research showed that cognitive behavioral therapy improved anxiety in the experimental group (P>0.001) and cognitive behavioral therapy caused 56% changes in anxiety variables. Additionally, cognitive behavioral therapy reduced the mean of pathological worry in the experimental group (P>0.001) and cognitive behavioral therapy caused 46% changes in the variable of pathological worry. Conclusion: According to the findings of the research, it can concluded that cognitive therapy for generalized anxiety disorder is the most effective treatment for reducing anxiety symptoms, and the combination of cognitive behavioral therapy is more effective than treatments that are used alone. This therapeutic approach helps people became aware of the thoughts and imaginations that cause anxiety and teaches them to express themselves and shed their incompatible cognitive responses, and finally it facilitates testing the reality of his hypotheses and applying methods of interpretation and labeling of emotional stimuli that activated when facing stressful situations in a relative manner

Keywords

Main Subjects

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed. Text Revision). Washington, DC: American Psychiatric Association.
Anhoque F, Domingues S, Carvalho T, Teixeira A, Domingues A. (2001). Anxiety and depressive symptoms in clinically isolated syndrome and multiple sclerosis. Arq Neuropsiquiatr, 69(6):882-6.
Askey Jones S, David A, Silber E, Shaw P, Chalder T. (2013). Cognitive behavior therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study. Behav Res Ther, 51, 648–55.
Barlow, D. H. (2002). Anxiety and its disorder: The nature and treatment of anxiety and panic (2nded.). New York: Guilford Press.
Barlow, D. H. F., & Hofman, S. G. (1997). Efficacy and dissemination of psychological treatments. In D.M. clart G. G. Fairburn. (Eds.), Science and practice of cognitive behavior therapy (pp. 95-117). Oxford: Oxford University Press.
Beiske A. G, Svensson E, Sandanger I, Czujko B, Pedersen E. D, Aarseth J. H, Myhr K. (2008). M. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol, 15(2): 239-45.
Bol Y, Duits AA, Hupperts RMM, Vlaeyen JWS, Verhey FRJ. (2009). the psychology of fatigue in patients with multiple sclerosis: A review. J Psychosom Res, 66, 3-11.
Borkovec, T. D. & Ruscio, A. M. (2001). Psychotherapy for generalized anxiety disorder. Journal of Clinical Psychiatry, 62(11), 37–42.
Borkovoc, T., Whismsn, M. (1996). Psychological treatment for GAD. In: mavissakalian, M., Prien, R.F., Long-term treatment for anxiety disorders. Washington DC, American Psychiatry Press.
Chelminski, I., & Zimmerman, M. (2003). Pathological worry in depressed and anxious patients. Journal of Anxiety Disorders, 17, 533-546.
Chwastiak L.A, Ehde D.M. (2007). Psychiatric Issues in Multiple Sclerosis. Psychiatric Clin North Am, 30(4):803-17.
Covin, R., Ouimet, A. J., Seeds, P. M., & Dozois, D. J. A. (2008). A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, 22, 108-116.
Dennison L, Moss R, Chalder T. (2009). A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev, 29: 141-53.
Esdenia, S., Musa Al-Rezaei, A, Saadatmand, S., Sepahrian Azar, F., & Torabzadeh, N. (2013). Investigating the effectiveness of cognitive-behavioral intervention on improving depression levels and reducing anxiety symptoms in patients with multiple sclerosis (MS). Journal of Medical Sciences Studies, 25 (11), 1023-1032. (in Persian)
Esdenia, S., Sepahrian, F., Torabzadeh, N., Rezaei, A., Homayoni, R., Mafsari, M, et al. (2013). The effectiveness of health education on improving sleep quality and reducing the symptoms of migraine headaches in people with multiple sclerosis. Isfahan: 10th International MS Congress of Iran. (in Persian)
Goldman, CG. (2005). The Goldman consensus statement on depression in multiple sclerosis. Mult Scalera. 11, 328-37.
Hazlett-Stevens, H. (2008). Psychological approaches to generalized anxiety disorder: A clinician’s guide to assessment and treatment. New York, NY: Springer.
Hind D, Cotter J, Thake A, Bradburn M, Cooper C, Isaac C, et al. (2014). Cognitive behavioral therapy for the treatment of depression in people with multiple sclerosis: a systematic review and met analysis. BMC Psychiatry, 14:5.
Iglesias Mangolini, Vitor, Laura Helena Andrade Francisco Lotufo-Neto Yuan-Pang Wang, (2019), Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence, https://www.scielo.br/j/clin/a/4XfwjbNKfG9x3nk8vSGzN3f/?lang=en.
Jong-Meyer, R. D., Beck, B., & Riede, K. (2009). Relationships between rumination, worry, intolerance of uncertainty and meta-cognitive beliefs. Personality and Individual Differences, 46, 547-551.
Julian LJ, Mohr DC. (2006). Cognitive predictors of response to treatment for depression in multiple sclerosis. J Neuropsychiatry Clin Neurosci, 18(3):356–63.
Khazri Moghadam, N., Ghorbani, N., Bahrami, E., & Rostami, R. (2012). The effectiveness of group therapy on reducing the psychological symptoms of MS patients. Clinical Psychology, 4(1), 13-22. (in Persian)
Kirchner, T., Lara, S. (2010). Stress and depression symptoms in patients with multiple sclerosis: the mediating role of the loss of social functioning. Acta Neurological Scand, 12(4): 215 – 221
Korostil M, Feinstein A. (2007). Anxiety disorders and their clinical correlates in multiple sclerosis patients. J Mult Scler, 13: 67-72.
Maier, W., Ganske, M., Freyberyer, H. T., Linz, M., Heun, R. Q., & Lecrabier, Y. (2000). Generalized anxiety disorder (ICD-10) in primary care from a cross-Cultural perspective: A Valid diagnostic entity? Acta Psychiatrica scandinavica, 202, 29-36.
Malcomson KS, Dunwoody L, Low- Strong AS. (2007). Psychological intervention in people with multeple sclerosise. J Neurol, 254: 1-13.
Meyer TJ, Miller ML, Metzger RL, Borkovec TD. (1990). Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 28(6): 487–495.
Mitsonis CI, Zervas IM, Mitropoulos PA, Dimopoulos NP, Soldatos CR, Potagas CM, et al.(2008). The impact of stressful life events on risk of relapse in women with MS. Euro Psychiatry Journal, 23(8): 497-504.
Mohamad NE, Sidik SM, Akhtari-Zavare M, Gani NA. (2021).The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study. BMC Public Health. 4, 21(1):438.
Mohr DC, Boudewyn AC, Goodkin D C, Bostrom A, Epstein, L. (2001). Comparative outcomes for individual cognitive-behavior therapy sup portive-exp ressive group psychotherapy and sertraline for the treatment of depression in multiple sclerosis. J Clin Psychol, 69, 942-9.
Mohr DC, Hart SL, Goldberg A. (2003). Effects of treatment for depression on fatigue in multiple sclerosis. Psychosom Med, 65:542–7. 65, 542–7.
Potagas C, Mitsonis C, Watier L, Dellatolas G, Retziou A, Mitropoulos PA, et al.(2008). Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: a prospective study. Int MS J, 14 (9): 1262–1268.
Sharifi, V., Asadi, S.M., Mohammadi, M.R., Amini, H., Kaviani, H., Semnani, Y., Shakibnia, A., Shahrivar, Z., Davari Ashtiani, R., Hakim Shoushtari, M., Sedigh, A., & Jalali Roudsari, M.. (2004). Reliability and feastibility of the Persian version of the structured diagnostic interview for DSM-IV (SCID). Advances in cognative science, 6(1-2), 10-22. SID. https://sid.ir/paper/82756/en. (in Persian)
Taggart HM. (1998). Multiple sclerosis update. Orthop Nurs, 17: 23-9.
Thornton EW, Tedman S, Rigby S, BashForth H, Young C. (2006). Worries and concerns of patients with multiple sclerosis: development of an assessment scule. Mult Scler, 12(2):196-203.
Visschedijk MA, Collette EH. (2004). Development of a cognitive behavioral group intervention programme for patients with multiple sclerosis: an exploratory study. Psychol Rep, 95: 735-46