The Effectiveness of Mindfulness-Integrated Cognitive-Behavioral Therapy on Sleep Quality, Anxiety, and Fatigue in Patients with Multiple Sclerosis: A Randomized Clinical Trial
,
Abstract
Background and Objective: Multiple sclerosis (MS) is a chronic disease, which results in numerous medical problems, as well as psychological symptoms such as anxiety, low sleep quality, and fatigue. These problems usually result in deteriora-tion of clinical symptoms and low efficacy of the patients. The current study investigated the effectiveness of mindfulness-integrated cognitive-behavioral therapy (MICBT) on sleep quality, anxiety, and fatigue in patients with MS.
Materials and Methods: Twenty patients with MS were randomly assigned to MICBT or control groups. Data collec-tion tools were Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Fatigue Severity Scale (FSS). Measurements were performed in three stages including before the intervention, after the end of the intervention, and in a follow-up phase. One-way analysis of covariance (ANCOVA) was performed with SPSS to compare the results between the two groups.
Results: A significant reduction in anxiety (d = 0.62) and fatigue (d = 0.56) and a significant increase in sleep quality (d = 0.56) were observed in the experimental group compared to the control group (P < 0.05). The results also were kept in follow-up phase.
Conclusion: MICBT is effective on the anxiety, sleep quality, and fatigue in patients with MS. As a result, mental health professionals can take advantage of this treatment to address the psychological problems of these patients.
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2. Hauser SL, Goodin DS. Multiple sclerosis and oth-er demyelinating diseases. In: Kasper D, Fauci A, Hauser S, et al, J, editors. Harrison's principles of in-ternal medicine. 16th ed. New York, NY: McGraw-Hill; 2004. p. 2461-71.
3. Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev 2009; 29: 141-53.
4. Thomas PW, Thomas S, Hillier C, et al. Psycholog-ical interventions for multiple sclerosis. Cochrane Da-tabase Syst Rev 2006; 1: CD004431.
5. Minden SL, Schiffer RB. Depression and mood dis-orders in multiple sclerosis. Neuropsychiatry, Neuropsy-chology and Behavioral Neurology 1991; 4: 62-77.
6. Schiaffino KM, Shawaryn MA, Blum D. Assessing the psychosocial impact of multiple sclerosis: learning from research on rheumatoid arthritis. Journal of Neu-rologic Rehabilitation 1996; 10: 81-9.
7. Fiest KM, Fisk JD, Patten SB, et al. Comorbidity is associated with pain-related activity limitations in mul-tiple sclerosis. Mult Scler Relat Disord 2015; 4: 470-6.
8. Marrie RA, Reingold S, Cohen J, et al. The inci-dence and prevalence of psychiatric disorders in multi-ple sclerosis: A systematic review. Mult Scler 2015; 21: 305-17.
9. Noy S, Achiron A, Gabbay U, et al. A new ap-proach to affective symptoms in relapsing-remitting multiple sclerosis. Compr Psychiatry 1995; 36: 390-5.
10. Feinstein A, O'Connor P, Gray T, et al. The effects of anxiety on psychiatric morbidity in patients with multiple sclerosis. Mult Scler 1999; 5: 323-6.
11. Potagas C, Mitsonis C, Watier L, et al. Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: A prospective study. Mult Scler 2008; 14: 1262-8.
12. Mohr DC, Hart SL, Julian L, et al. Association be-tween stressful life events and exacerbation in multiple sclerosis: A meta-analysis. BMJ 2004; 328: 731.
13. Lerdal A, Celius EG, Krupp L, et al. A prospective study of patterns of fatigue in multiple sclerosis. Eur J Neurol 2007; 14: 1338-43.
14. Morris G, Maes M. Myalgic encephalomyeli-tis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics. BMC Med 2013; 11: 205.
15. Induruwa I, Constantinescu CS, Gran B. Fatigue in multiple sclerosis - a brief review. J Neurol Sci 2012; 323: 9-15.
16. Brown RF, Valpiani EM, Tennant CC, et al. Longi-tudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis. Psychol Psychother 2009; 82: 41-56.
17. Bamer AM, Johnson KL, Amtmann D, et al. Preva-lence of sleep problems in individuals with multiple sclerosis. Mult Scler 2008; 14: 1127-30.
18. Tachibana N, Howard RS, Hirsch NP, et al. Sleep problems in multiple sclerosis. Eur Neurol 1994; 34: 320-3.
19. Bamer AM, Johnson KL, Amtmann DA, et al. Be-yond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple scle-rosis. Clin Epidemiol 2010; 2010: 99-106.
20. Ferini-Strambi L. Sleep disorders in multiple scle-rosis. Handb Clin Neurol 2011; 99: 1139-46.
21. Lobentanz IS, Asenbaum S, Vass K, et al. Factors influencing quality of life in multiple sclerosis patients:
Disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand 2004; 110: 6-13.
22. Clark CM, Fleming JA, Li D, et al. Sleep disturb-ance, depression, and lesion site in patients with multi-ple sclerosis. Arch Neurol 1992; 49: 641-3.
23. Mosarrezaii A, Ghasemzadeh N, Rahimi-Golkhandan A, et al. Sleep quality in patients with multiple sclerosis. J Sleep Sci 2018; 3:17-20.
24. Fiest KM, Walker JR, Bernstein CN, et al. System-atic review and meta-analysis of interventions for de-pression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord 2016; 5: 12-26.
25. Hind D, Cotter J, Thake A, et al. Cognitive behav-ioural therapy for the treatment of depression in people with multiple sclerosis: A systematic review and meta-analysis. BMC Psychiatry 2014; 14: 5.
26. Hofmann SG, Sawyer AT, Witt AA, et al. The ef-fect of mindfulness-based therapy on anxiety and de-pression: A meta-analytic review. J Consult Clin Psy-chol 2010; 78: 169-83.
27. Cayoun BA. Mindfulness-integrated CBT: Princi-ples and practice. Hoboken, NJ: Wiley; 2012.
28. Cayoun B. MiCBT Mindfulness-integrated cogni-tive behaviour therapy: General principles and guide-lines. Hobart, Australia: The MiCBT Institute; 2009.
29. Wickham KT. The effect of mindfulness-integrated cognitive behaviour therapy (MiCBT) on the experi-ence of addiction [MSc Thesis]. Hobart, Australia: University of Tasmania; 2013.
30. Baker AL, Kavanagh DJ, Kay-Lambkin FJ, et al. Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: Outcomes to 36-months. J Subst Abuse Treat 2014; 46: 281-90.
31. Yazdanimehr R, Omidi A, Sadat Z, et al. The effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women: A ran-domized clinical trial. J Caring Sci 2016; 5: 195-204.
32. Bahrani S, Zargar F, Yousefipour G, et al. The ef-fectiveness of mindfulness-integrated cognitive behav-ior therapy on depression, anxiety, and stress in fe-males with multiple sclerosis: A single blind random-ized controlled trial. Iran Red Crescent Med J 2017; 19: e44566.
33. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
34. Farrahi MJ, Nakhaee N, Sheibani V, et al. Reliabil-ity and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
35. Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: Psychometric proper-ties. J Consult Clin Psychol 1988; 56: 893-7.
36. Hossein Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 2008; 66(2): 136-140. [In Persian].
37. Krupp LB, LaRocca NG, Muir-Nash J, et al. The fatigue severity scale. Application to patients with mul-tiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-3.
38. Azimian M, Shahvarughi Farahani A, Dadkhah A, et al. Fatigue Severity Scale: The psychometric proper-ties of the Persian-Version in patients with multiple sclerosis. Res J Biol Sci 2009; 4: 974-7.
39. Munoz San JA, Oreja-Guevara C, Cebolla LS, et al. Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: The contribution of mindfulness-based interventions. Neurologia 2016; 31: 113-20.
40. Simpson R, Booth J, Lawrence M, et al. Mindful-ness based interventions in multiple sclerosis--a sys-tematic review. BMC Neurol 2014; 14: 15.
41. Burschka JM, Keune PM, Oy UH, et al. Mindful-ness-based interventions in multiple sclerosis: Benefi-cial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol 2014; 14: 165.
42. Becker TM. Efficacy of MiCBT for family carers: Reducing psychological distress and improving mind-fulness self-efficacy[ MSc Thesis]. Hobart, Australia: University of Tasmania; 2014.
43. Grossman P, Kappos L, Gensicke H, et al. MS quality of life, depression, and fatigue improve after mindfulness training: A randomized trial. Neurology 2010; 75: 1141-9.
44. Gross CR, Kreitzer MJ, Reilly-Spong M, et al. Mindfulness-based stress reduction versus pharma-cotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY) 2011; 7: 76-87.
45. Ong JC, Shapiro SL, Manber R. Combining mind-fulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behav Ther 2008; 39: 171-82.
46. Cayoun BA. Mindfulness-integrated CBT for well-being and personal growth: Four steps to enhance inner calm, self-confidence and relationships. Hoboken, NJ: Wiley-Blackwell; 2015.
47. Zargar F, Farid AA, Atef-Vahid MK, et al. Com-paring the effectiveness of acceptance-based behavior therapy and applied relaxation on acceptance of inter-nal experiences, engagement in valued actions and quality of life in generalized anxiety disorder. J Res Med Sci 2013; 18: 118-22.
48. Baer RA. Self-focused attention and mechanisms of change in mindfulness-based treatment. Cogn Behav Ther 2009; 38: 15-20.
49. Cayoun BA. Mindfulness Meditation in the Treat-ment of Trauma, Depression and Addiction [Online]. [cited 2019 May 12]; Available from: URL: https://mindfulness.net.au/publications/pdfs/Unpublished-articles/cayoun-asd-mdd-bingedrinking.pdf
50. Osborn R, Girgis M, Morse S, et al. Mindfulness-integrated CBT (MiCBT) for reducing distress in par-ents of children with intellectual disability (ID): A case series. J Dev Phys Disabil 2018; 30: 559-68.
2. Hauser SL, Goodin DS. Multiple sclerosis and oth-er demyelinating diseases. In: Kasper D, Fauci A, Hauser S, et al, J, editors. Harrison's principles of in-ternal medicine. 16th ed. New York, NY: McGraw-Hill; 2004. p. 2461-71.
3. Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev 2009; 29: 141-53.
4. Thomas PW, Thomas S, Hillier C, et al. Psycholog-ical interventions for multiple sclerosis. Cochrane Da-tabase Syst Rev 2006; 1: CD004431.
5. Minden SL, Schiffer RB. Depression and mood dis-orders in multiple sclerosis. Neuropsychiatry, Neuropsy-chology and Behavioral Neurology 1991; 4: 62-77.
6. Schiaffino KM, Shawaryn MA, Blum D. Assessing the psychosocial impact of multiple sclerosis: learning from research on rheumatoid arthritis. Journal of Neu-rologic Rehabilitation 1996; 10: 81-9.
7. Fiest KM, Fisk JD, Patten SB, et al. Comorbidity is associated with pain-related activity limitations in mul-tiple sclerosis. Mult Scler Relat Disord 2015; 4: 470-6.
8. Marrie RA, Reingold S, Cohen J, et al. The inci-dence and prevalence of psychiatric disorders in multi-ple sclerosis: A systematic review. Mult Scler 2015; 21: 305-17.
9. Noy S, Achiron A, Gabbay U, et al. A new ap-proach to affective symptoms in relapsing-remitting multiple sclerosis. Compr Psychiatry 1995; 36: 390-5.
10. Feinstein A, O'Connor P, Gray T, et al. The effects of anxiety on psychiatric morbidity in patients with multiple sclerosis. Mult Scler 1999; 5: 323-6.
11. Potagas C, Mitsonis C, Watier L, et al. Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: A prospective study. Mult Scler 2008; 14: 1262-8.
12. Mohr DC, Hart SL, Julian L, et al. Association be-tween stressful life events and exacerbation in multiple sclerosis: A meta-analysis. BMJ 2004; 328: 731.
13. Lerdal A, Celius EG, Krupp L, et al. A prospective study of patterns of fatigue in multiple sclerosis. Eur J Neurol 2007; 14: 1338-43.
14. Morris G, Maes M. Myalgic encephalomyeli-tis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics. BMC Med 2013; 11: 205.
15. Induruwa I, Constantinescu CS, Gran B. Fatigue in multiple sclerosis - a brief review. J Neurol Sci 2012; 323: 9-15.
16. Brown RF, Valpiani EM, Tennant CC, et al. Longi-tudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis. Psychol Psychother 2009; 82: 41-56.
17. Bamer AM, Johnson KL, Amtmann D, et al. Preva-lence of sleep problems in individuals with multiple sclerosis. Mult Scler 2008; 14: 1127-30.
18. Tachibana N, Howard RS, Hirsch NP, et al. Sleep problems in multiple sclerosis. Eur Neurol 1994; 34: 320-3.
19. Bamer AM, Johnson KL, Amtmann DA, et al. Be-yond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple scle-rosis. Clin Epidemiol 2010; 2010: 99-106.
20. Ferini-Strambi L. Sleep disorders in multiple scle-rosis. Handb Clin Neurol 2011; 99: 1139-46.
21. Lobentanz IS, Asenbaum S, Vass K, et al. Factors influencing quality of life in multiple sclerosis patients:
Disability, depressive mood, fatigue and sleep quality. Acta Neurol Scand 2004; 110: 6-13.
22. Clark CM, Fleming JA, Li D, et al. Sleep disturb-ance, depression, and lesion site in patients with multi-ple sclerosis. Arch Neurol 1992; 49: 641-3.
23. Mosarrezaii A, Ghasemzadeh N, Rahimi-Golkhandan A, et al. Sleep quality in patients with multiple sclerosis. J Sleep Sci 2018; 3:17-20.
24. Fiest KM, Walker JR, Bernstein CN, et al. System-atic review and meta-analysis of interventions for de-pression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord 2016; 5: 12-26.
25. Hind D, Cotter J, Thake A, et al. Cognitive behav-ioural therapy for the treatment of depression in people with multiple sclerosis: A systematic review and meta-analysis. BMC Psychiatry 2014; 14: 5.
26. Hofmann SG, Sawyer AT, Witt AA, et al. The ef-fect of mindfulness-based therapy on anxiety and de-pression: A meta-analytic review. J Consult Clin Psy-chol 2010; 78: 169-83.
27. Cayoun BA. Mindfulness-integrated CBT: Princi-ples and practice. Hoboken, NJ: Wiley; 2012.
28. Cayoun B. MiCBT Mindfulness-integrated cogni-tive behaviour therapy: General principles and guide-lines. Hobart, Australia: The MiCBT Institute; 2009.
29. Wickham KT. The effect of mindfulness-integrated cognitive behaviour therapy (MiCBT) on the experi-ence of addiction [MSc Thesis]. Hobart, Australia: University of Tasmania; 2013.
30. Baker AL, Kavanagh DJ, Kay-Lambkin FJ, et al. Randomized controlled trial of MICBT for co-existing alcohol misuse and depression: Outcomes to 36-months. J Subst Abuse Treat 2014; 46: 281-90.
31. Yazdanimehr R, Omidi A, Sadat Z, et al. The effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women: A ran-domized clinical trial. J Caring Sci 2016; 5: 195-204.
32. Bahrani S, Zargar F, Yousefipour G, et al. The ef-fectiveness of mindfulness-integrated cognitive behav-ior therapy on depression, anxiety, and stress in fe-males with multiple sclerosis: A single blind random-ized controlled trial. Iran Red Crescent Med J 2017; 19: e44566.
33. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989; 28: 193-213.
34. Farrahi MJ, Nakhaee N, Sheibani V, et al. Reliabil-ity and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16: 79-82.
35. Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: Psychometric proper-ties. J Consult Clin Psychol 1988; 56: 893-7.
36. Hossein Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J 2008; 66(2): 136-140. [In Persian].
37. Krupp LB, LaRocca NG, Muir-Nash J, et al. The fatigue severity scale. Application to patients with mul-tiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121-3.
38. Azimian M, Shahvarughi Farahani A, Dadkhah A, et al. Fatigue Severity Scale: The psychometric proper-ties of the Persian-Version in patients with multiple sclerosis. Res J Biol Sci 2009; 4: 974-7.
39. Munoz San JA, Oreja-Guevara C, Cebolla LS, et al. Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: The contribution of mindfulness-based interventions. Neurologia 2016; 31: 113-20.
40. Simpson R, Booth J, Lawrence M, et al. Mindful-ness based interventions in multiple sclerosis--a sys-tematic review. BMC Neurol 2014; 14: 15.
41. Burschka JM, Keune PM, Oy UH, et al. Mindful-ness-based interventions in multiple sclerosis: Benefi-cial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol 2014; 14: 165.
42. Becker TM. Efficacy of MiCBT for family carers: Reducing psychological distress and improving mind-fulness self-efficacy[ MSc Thesis]. Hobart, Australia: University of Tasmania; 2014.
43. Grossman P, Kappos L, Gensicke H, et al. MS quality of life, depression, and fatigue improve after mindfulness training: A randomized trial. Neurology 2010; 75: 1141-9.
44. Gross CR, Kreitzer MJ, Reilly-Spong M, et al. Mindfulness-based stress reduction versus pharma-cotherapy for chronic primary insomnia: A randomized controlled clinical trial. Explore (NY) 2011; 7: 76-87.
45. Ong JC, Shapiro SL, Manber R. Combining mind-fulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behav Ther 2008; 39: 171-82.
46. Cayoun BA. Mindfulness-integrated CBT for well-being and personal growth: Four steps to enhance inner calm, self-confidence and relationships. Hoboken, NJ: Wiley-Blackwell; 2015.
47. Zargar F, Farid AA, Atef-Vahid MK, et al. Com-paring the effectiveness of acceptance-based behavior therapy and applied relaxation on acceptance of inter-nal experiences, engagement in valued actions and quality of life in generalized anxiety disorder. J Res Med Sci 2013; 18: 118-22.
48. Baer RA. Self-focused attention and mechanisms of change in mindfulness-based treatment. Cogn Behav Ther 2009; 38: 15-20.
49. Cayoun BA. Mindfulness Meditation in the Treat-ment of Trauma, Depression and Addiction [Online]. [cited 2019 May 12]; Available from: URL: https://mindfulness.net.au/publications/pdfs/Unpublished-articles/cayoun-asd-mdd-bingedrinking.pdf
50. Osborn R, Girgis M, Morse S, et al. Mindfulness-integrated CBT (MiCBT) for reducing distress in par-ents of children with intellectual disability (ID): A case series. J Dev Phys Disabil 2018; 30: 559-68.
| Files | ||
| Issue | Vol 4 No 1-2 (2019): Winter-Spring | |
| Section | Original Article(s) | |
| Keywords | ||
| Multiple sclerosis; Mindfulness; Cognitive behavioral therapy; Sleep | ||
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How to Cite
1.
Pouyanfard S, Mohammadpour M, Parvizifard A akbar, Foroughi A akbar. The Effectiveness of Mindfulness-Integrated Cognitive-Behavioral Therapy on Sleep Quality, Anxiety, and Fatigue in Patients with Multiple Sclerosis: A Randomized Clinical Trial. J Sleep Sci. 2019;4(1-2):1-8.
