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Multiple Sclerosis (MS) is a chronic degenerative disease of the central nervous system. MS often...
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• Multiple Sclerosis (MS) is a chronic degenerative disease of the central nervous system. MS often develops during the prime of life and is characterized by unpredictable neurological and behavioral impairments. In addition to the physical component, MS is also accompanied by significant emotional and psychological difficulties such as anxiety and depression. • A growing body of evidence indicates Acceptance and Commitment Therapy (ACT) has great potential to be effective for many psychological problems common to those suffering with MS, namely anxiety (Roemer & Orsillo, 2007), depression (Zettle & Rains, 1989) and chronic pain ( Dahl, Wilson, & Nilsson, 2004). • The chronic and debilitating nature of MS highlights the need for interventions aimed at improving quality of life. The current project investigated the effectiveness of a brief ACT intervention coupled with a three month self-help protocol on health and behavioral outcomes in a sample of adults suffering with MS. • Our intent was to evaluate the usefulness of the ACT workshop focusing on acceptance, mindfulness, and value- guided action, in terms of its impact on psychological, behavioral, and quality of life outcomes linked with MS. Living Well With Multiple Sclerosis: Evaluation of a Half-Day ACT Workshop and Quality of Life Outcomes JeanMarie Bianchi, Sean C. Sheppard, John P. Forsyth, Edward J. Hickling, & Daniel Silverman INTRODUCTION INTRODUCTION METHODS METHODS DISCUSSION DISCUSSION •Participants: • Participants included 30 individuals suffering from MS (Male = 9; Female = 21). The majority of participants were Caucasian (80.6%), Black (3.2%), and Hispanic (3.2%) The average age of participants was 49.3 years (Sd = 10.31), and average age of onset of MS was 33.73 years (Sd = 14.73). •Procedure • Participants were recruited through physician referral and were assigned to either an experimental (n = 18) or a wait-list control (n = 12) group. • The experimental group attended a half-day ACT workshop designed to provide experiential training in mindfulness skills, defusion strategies, and value-guided action. Additionally, they were provided with a self-help CD-ROM and worksheet exercises designed to reinforce the content of the workshop. The control group will be offered the same workshop and self-help protocol after the 3 month experimental phase. • The experimental group was assessed immediately post- workshop (Time 1) and again after 3 months (Time 2). The control group was assessed over equivalent time intervals in concordance with the staggered enrollment procedure. •Measures • A brief half-day ACT workshop appeared to confer some benefit on extent of thought suppression, pain impairment, and depression. Though the effect sizes were large, other assessed indices did not differ significantly from Time 1 to Time 2. This may be an issue of the tests being underpowered. Though preliminary, the present results suggest that a brief ACT intervention may be helpful for persons suffering from MS. • We are currently wrapping up data collection for the control condition and some remaining workshop attendees. This will position us to rule out competing explanations for the observed effects in the workshop group (e.g., regression to the mean, repeated testing) while also improving statistical power and our ability to draw more meaningful conclusions from the data. • Interestingly, greater levels of mindfulness were strongly associated with more self-compassion, lower thought suppression, better mental health, lower depression scores, and decreased effects of pain on behavior. As mindfulness is a main target of the workshop, we anticipate that it may confer broadband benefits across a wide range of psychological and emotional indices of mental health and suffering linked with MS. • Significant zero-order correlations indicate that that many of the symptoms and difficulties commonly experienced by individuals with MS (e.g. depression, the effect of pain, etc.) are related to ACT-central constructs such as suppression, mindfulness, and self- compassion. These findings suggest the importance of acceptance and its corollaries in countering the toxic effects of suppression and avoidance. • Taken together, these results suggest that mindfulness and acceptance based approaches, such as ACT, have the potential to improve quality of life and affect positive change for individuals suffering from MS. • Ongoing data collection and analyses will focus on comparisons from Time 1 to Time 2 between the experimental and wait-list control conditions to further explore the potential benefit of mindfulness and acceptance-based interventions in improving quality of life and other positive behavioral outcomes for individuals with MS and other chronic diseases. Future work will involve exploration of factors that might RESULTS RESULTS MAAS SCS WBSI MHI BDI PES MAAS --------- ---- .639** -.444* .707** -.683** -.220 SCS --------- ---- -.551** .744** -.688** -.191 WBSI --------- ---- -.550** .581** .195 MHI --------- ---- -.805** -.425* BDI --------- ---- .504** PES --------- ---- ** p<.01 * p<.05 CORRELATION MATRIX • Beck Depression Inventory (BDI) • Mental Health Inventory (MHI) • Pain Effects Scale (PES) • Mindful Attention Awareness Scale (MAAS) • Self-Compassion Scale (SCS) • White Bear Suppression Inventory (WBSI) •The significant zero-order correlations calculated from Time 1 scores across both conditions serve as preliminary evidence that the incorporated measures are accurately measuring the constructs in the manner in which they were intended. • As expected, the lower levels of mental health (i.e., MHI) were associated with greater thought suppression, more depression, and more negative effects of pain on behavior. By contrast, ACT-related concepts, namely self- compassion and mindfulness, were both positively associated with greater levels of mental health. Measure Outcome p Partial Eta Squared White Bear Suppression Improved <.001 .790 Pain Effects Scale Improved .026 .533 Beck Depression Inventory Improved .043 .420 Self-Compassion Scale RD .183 .201 Mental Health Inventory RD .070 .352 ANOVA Note. F (1,8). RD= right direction. N= 9 REFERENCES REFERENCES • Dahl, J., Wilson, K.G., & Nilsson A. (2004) Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802. • Roemer, L., & Orsillo, S.M. (2007) An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38, 72-85. • Zettle, R.D., & Rains, J.C. (1989) Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45(3), 436-445. • In the experimental condition, significant positive differences were found between Time 1 and Time 2 for the WBSI, the PES, and the BDI. • No other effects were significant; though changes are in the right direction.
Transcript of Multiple Sclerosis (MS) is a chronic degenerative disease of the central nervous system. MS often...
• Multiple Sclerosis (MS) is a chronic degenerative disease of the central nervous system. MS often develops during the prime of life and is characterized by unpredictable neurological and behavioral impairments. In addition to the physical component, MS is also accompanied by significant emotional and psychological difficulties such as anxiety and depression.
• A growing body of evidence indicates Acceptance and Commitment Therapy (ACT) has great potential to be effective for many psychological problems common to those suffering with MS, namely anxiety (Roemer & Orsillo, 2007), depression (Zettle & Rains, 1989) and chronic pain ( Dahl, Wilson, & Nilsson, 2004).
• The chronic and debilitating nature of MS highlights the need for interventions aimed at improving quality of life. The current project investigated the effectiveness of a brief ACT intervention coupled with a three month self-help protocol on health and behavioral outcomes in a sample of adults suffering with MS.
• Our intent was to evaluate the usefulness of the ACT workshop focusing on acceptance, mindfulness, and value-guided action, in terms of its impact on psychological, behavioral, and quality of life outcomes linked with MS.
Living Well With Multiple Sclerosis: Evaluation of a Half-Day ACT Workshop and Quality of Life Outcomes
JeanMarie Bianchi, Sean C. Sheppard, John P. Forsyth, Edward J. Hickling, & Daniel Silverman
INTRODUCTIONINTRODUCTION
METHODSMETHODS
DISCUSSIONDISCUSSION
•Participants:
• Participants included 30 individuals suffering from MS (Male = 9; Female = 21). The majority of participants were Caucasian (80.6%), Black (3.2%), and Hispanic (3.2%) The average age of participants was 49.3 years (Sd = 10.31), and average age of onset of MS was 33.73 years (Sd = 14.73).
•Procedure
• Participants were recruited through physician referral and were assigned to either an experimental (n = 18) or a wait-list control (n = 12) group.
• The experimental group attended a half-day ACT workshop designed to provide experiential training in mindfulness skills, defusion strategies, and value-guided action. Additionally, they were provided with a self-help CD-ROM and worksheet exercises designed to reinforce the content of the workshop. The control group will be offered the same workshop and self-help protocol after the 3 month experimental phase.
• The experimental group was assessed immediately post-workshop (Time 1) and again after 3 months (Time 2). The control group was assessed over equivalent time intervals in concordance with the staggered enrollment procedure.
•Measures
• A brief half-day ACT workshop appeared to confer some benefit on extent of thought suppression, pain impairment, and depression. Though the effect sizes were large, other assessed indices did not differ significantly from Time 1 to Time 2. This may be an issue of the tests being underpowered. Though preliminary, the present results suggest that a brief ACT intervention may be helpful for persons suffering from MS.
• We are currently wrapping up data collection for the control condition and some remaining workshop attendees. This will position us to rule out competing explanations for the observed effects in the workshop group (e.g., regression to the mean, repeated testing) while also improving statistical power and our ability to draw more meaningful conclusions from the data.
• Interestingly, greater levels of mindfulness were strongly associated with more self-compassion, lower thought suppression, better mental health, lower depression scores, and decreased effects of pain on behavior. As mindfulness is a main target of the workshop, we anticipate that it may confer broadband benefits across a wide range of psychological and emotional indices of mental health and suffering linked with MS.
• Significant zero-order correlations indicate that that many of the symptoms and difficulties commonly experienced by individuals with MS (e.g. depression, the effect of pain, etc.) are related to ACT-central constructs such as suppression, mindfulness, and self-compassion. These findings suggest the importance of acceptance and its corollaries in countering the toxic effects of suppression and avoidance.
• Taken together, these results suggest that mindfulness and acceptance based approaches, such as ACT, have the potential to improve quality of life and affect positive change for individuals suffering from MS.
• Ongoing data collection and analyses will focus on comparisons from Time 1 to Time 2 between the experimental and wait-list control conditions to further explore the potential benefit of mindfulness and acceptance-based interventions in improving quality of life and other positive behavioral outcomes for individuals with MS and other chronic diseases. Future work will involve exploration of factors that might improve the effectiveness of the workshop and self-help protocol while decreasing attrition.
RESULTSRESULTS
MAAS SCS WBSI MHI BDI PES
MAAS ------------- .639** -.444* .707** -.683** -.220
SCS ------------- -.551** .744** -.688** -.191
WBSI ------------- -.550** .581** .195
MHI ------------- -.805** -.425*
BDI ------------- .504**
PES -------------
** p<.01 * p<.05
CORRELATION MATRIX
•Beck Depression Inventory (BDI)•Mental Health Inventory (MHI) •Pain Effects Scale (PES)
•Mindful Attention Awareness Scale (MAAS) •Self-Compassion Scale (SCS)•White Bear Suppression Inventory (WBSI)
•The significant zero-order correlations calculated from Time 1 scores across both conditions serve as preliminary evidence that the incorporated measures are accurately measuring the constructs in the manner in which they were intended.
• As expected, the lower levels of mental health (i.e., MHI) were associated with greater thought suppression, more depression, and more negative effects of pain on behavior. By contrast, ACT-related concepts, namely self-compassion and mindfulness, were both positively associated with greater levels of mental health.
Measure Outcome p Partial Eta Squared
White Bear Suppression
Improved <.001 .790
Pain Effects Scale Improved .026 .533
Beck Depression Inventory
Improved .043 .420
Self-Compassion
Scale
RD .183 .201
Mental Health Inventory
RD .070 .352
ANOVA
Note. F (1,8). RD= right direction. N= 9
REFERENCESREFERENCES
• Dahl, J., Wilson, K.G., & Nilsson A. (2004) Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802.• Roemer, L., & Orsillo, S.M. (2007) An open trial of an acceptance-based behavior therapy for generalized anxiety disorder. Behavior Therapy, 38, 72-85.• Zettle, R.D., & Rains, J.C. (1989) Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45(3), 436-445.
• In the experimental condition, significant positive differences were found between Time 1 and Time 2 for the WBSI, the PES, and the BDI.
• No other effects were significant; though changes are in the right direction.
