Treatment Response to Internet-Delivered Cognitive Behavioral Therapy for Depression in Multiple Sclerosis
Research Poster Social & Behavioral Sciences 2025 Graduate ExhibitionPresentation by Megan Bradson
Exhibition Number 79
Abstract
Objective: A recent randomized-controlled clinical trial examined the efficacy of an internet-delivered cognitive behavioral therapy (iCBT) intervention designed to treat depressive symptoms in persons with multiple sclerosis (PwMS). The current study aimed to identify the proportion of PwMS who responded to iCBT (stand-alone and guided) for depression compared to a waitlist control group. Methodology: PwMS completed the Beck Depression Inventory-II (BDI-II) and the Mini-International Neuropsychiatric Interview (M.I.N.I) at baseline and post-intervention to measure depressive symptom severity and caseness for major depressive episode (MDE), respectively. Reliable change index (RCI) scores for depressive symptoms were calculated for each participant. Clinical significance was determined using the 95% confidence interval (RCI±1.96). Results: Combining the stand-alone and guided-iCBT (n=147) groups, 89 PwMS (61%) demonstrated a reliable decrease in BDI-II scores, whereas 58 PwMS (39%) did not show a reliable decrease. For waitlist controls (n=77), 19 PwMS (25%) showed a reliable decrease in BDI-II scores, X²(2,N=224)=33.82,p<.001, phi=.39. Similarly, 60 PwMS (60%) in the combined iCBT group (n=100) no longer met caseness for MDE, whereas 40 PwMS (40%) continued to meet caseness for MDE following iCBT. For waitlist controls (n=38), 14 PwMS (37%) no longer met caseness for MDE, X²(1,N=138)=5.94,p=.015,phi=-0.21. Conclusions: MS-specific iCBT was highly effective, with approximately 60% of PwMS showing clinically significant improvements in depression compared with only 25% to 37% of waitlist controls. Still, generally consistent with previous research, about 40% of PwMS did not benefit from iCBT. Future work will investigate factors associated with response to iCBT to better understand differential treatment outcomes.
Importance
With prevalence rates estimated as high as 50%, depression is one of the most common comorbidities observed and is an important determinant of quality of life among persons with MS (PwMS). PwMS face unique barriers to traditional face-to-face psychotherapy, including fatigue, disability/mobility limitations, and cognitive dysfunction due to MS. Specialized therapists who can tailor psychotherapy to the specific needs of PwMS are also not widely available. As such, depression is often suboptimally treated in MS. Our findings indicate that self-guided, internet-delivered cognitive behavioral therapy (iCBT) designed specifically for PwMS is effective in reducing depression symptoms compared with waitlist controls. MS-specific iCBT is a promising, cost-effective, scalable treatment and has the potential to expand access to evidence-based depression treatment for PwMS.