Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression.

OBJECTIVE: While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. DESIGN: MS patients (N=127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. MAIN OUTCOME MEASURES: Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. RESULTS: Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. CONCLUSION: Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS.     

The first year after diagnosis: psychological impact on people with multiple sclerosis

The impact of multiple sclerosis (MS) diagnosis on newly diagnosed individuals remains so far little explored. Our aim is to outline affective, personality and quality of life (QoL) correlates of MS patients shortly after MS diagnosis. Thirty-eight (22 F and 16 M) newly-diagnosed MS patients (mean interval from diagnosis communication 4.7 ± 3.8 months, range 1–12 months) underwent the Montgomery–Åsberg Depression Rating Scale and a comprehensive psychological evaluation: Beck Depression Inventory-II, State-Trait Anxiety Inventory, Psychophysiological Questionnaire-Revised, Fear Survey Schedule, Maudsley Obsessional-Compulsive Questionnaire, Impact of Event Scale-Revised, Personal Meaning Questionnaire, Problem Solving Inventory and Multiple Sclerosis Quality of Life-54. The Expanded Disability Status Scale was assessed during the neurological examination. Depressive symptomatology, only partially related to disability, was observed in approximately 40% of patients. The prevalent approach to MS diagnosis was one of avoidance in 65.8% of cases. QoL reductions in self-perception and psychological well-being emerged, together with a peculiar perception of change in health that was not related to neurological disability. With regard to personality assessment, depressive personal meaning organization correlates inversely with important QoL measures. Newly-diagnosed patients go through a complex network of psychological changes still in the initial phases immediately after diagnosis. A thorough understanding of these adjusting aspects by the neurologist could be crucial in improving patients’ QoL, participation in relevant disease decisions and adherence to pharmacological therapy.     

Longitudinal associations between mindfulness and well-being in people with multiple sclerosis

Background/Objective: Depression, anxiety, fatigue, and sleep problems are typical conditions reported in people with multiple sclerosis (MS), often resulting in a reduction of their quality of life (QOL) and well-being. Mindfulness is a multifaceted and complex construct that has been increasingly explored for its correlated to well-being. Despite preliminary evidence, longitudinal data about the impact of mindfulness on QOL in MS remain limited. In addition, Langerian mindfulness, one of the prominent approaches to mindfulness, is yet unexplored in this field. The study aims to examine the longitudinal relationships between two forms of mindfulness (Langerian and contemplative) and QOL, anxiety, depression, fatigue, and sleep. Method: Within a larger randomized controlled trial of an online mindfulness-based stress reduction intervention, a cohort of 156 people with MS was recruited and assessed for both mindfulness constructs, QOL, anxiety, depression, fatigue, and sleep problems. Assessments were repeated after 2 and after another 6 months. Results: Both mindfulness constructs were highly correlated with all investigated outcomes. Both Langerian and contemplative mindfulness predicted higher QOL, lower anxiety, depression, fatigue, and sleep, over time. Conclusions: In both approaches dispositional mindfulness is a protective factor against depression, anxiety, fatigue, and sleep in people with MS.     

Is Maternal Fatigue Mediating the Relationship Between Maternal Depression and Child Outcomes?

Fatigue, a subjective state that has been defined as a decreased capacity for physical or mental activity, has many behavioral similarities to depression (e.g., weariness, difficulty concentrating, diminished motivation). We hypothesized that fatigue might mediate the relationship between depression and poor child outcomes. A sample of mothers (14 well women, 57 with multiple sclerosis, and 36 with rheumatoid arthritis) completed an online survey where they reported on their fatigue (using the Modified Fatigue Impact Scale), depression (using the 20-item Center for Epidemiological Studies Depression Scale), child internalizing and externalizing behaviors (using the Child Behavior Checklist), and child prosocial behaviors (using a 10-item abbreviated Positive Behavior Scale). Maternal fatigue mediated the relationship between maternal depression and the total problems T-score on the Child Behavior Checklist but a mediated relationship was not found for the Positive Behavior Scale. Findings are discussed in light of the need to elucidate the relationship between maternal fatigue, depression, and child outcomes.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Does a short self‐compassion intervention for students increase healthy self‐regulation? A randomized control trial

The primary aim of this study was to examine the effects of a two‐week self‐compassion course on healthy self‐regulation (personal growth self‐efficacy and healthy impulse control) and unhealthy self‐regulation (self‐judgment and habitual negative self‐directed thinking) in university students. We also examined the effects on self‐compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting‐list control group in a multi‐baseline randomized control trial. Healthy self‐control was measured by the Personal Growth Initiative Scale (PGIS) and the Self‐Control Scale; unhealthy self‐control was measured by the Non‐judgement subscale from the Five‐Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State‐Trait Anxiety Inventory (STAI‐trait), the Major Depression Inventory (MDI), and the Self‐Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention‐group in personal growth self‐efficacy and healthy impulse‐control and reductions in self‐judgment and habitual negative self‐directed thinking, as well as increases in self‐compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six‐month follow‐up for personal growth self‐efficacy, self‐judgment and habitual negative self‐directed thinking; as well as for self‐compassion, anxiety and depression. Concluding, a short self‐compassion course seems an effective method of increasing self‐compassion and perceived control over one's life for university students, as well as increasing mental health.     

Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression

In treating an acute episode of winter depression, cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy are comparably efficacious, with improvement in depression symptoms during CBT-SAD mediated by reduced seasonal beliefs (i.e., maladaptive thoughts about the seasons, light availability, and weather). Here, we tested whether the enduring benefit of CBT-SAD over light therapy following treatment is associated with offsetting seasonal beliefs during CBT-SAD. Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6 weeks of light therapy or group CBT-SAD and followedup one and two winters after treatment. Outcomes measured during treatment and at each follow-up included depression symptoms on the Structured Clinical Interview for the Hamilton Rating Scale for Depression—SAD Version and Beck Depression Inventory—Second Edition. Candidate mediators measured at pre-, mid-, and posttreatment were SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); brooding rumination (Ruminative Response Scale-Brooding subscale; RRS-B); and chronotype (Morningness-Eveningness Questionnaire; MEQ). Latent growth curve mediation models found a significant positive path from treatment group to the slope of SBQ during treatment, with CBT-SAD showing larger improvements in seasonal beliefs with overall change in seasonal beliefs in the medium-effect range, and significant positive paths from SBQ slope to depression scores at the first and second winter follow-ups, indicating greater change towards more flexible seasonal beliefs during active treatment was associated with less severe depression symptoms following treatment. Estimated indirect effects (treatment group → SBQ change * SBQ change → outcome) were also significant at each follow-up for each outcome with β_indirect ranging from .091 to .162. Models also found significant positive paths from treatment group to the slope of MEQ and RRS-B during treatment, with light therapy showing a greater increase in “morningness” and CBT-SAD showing a greater decrease in brooding during active treatment; however, neither construct emerged as a mediator of follow-up depression scores. Change in seasonal beliefs during treatment mediates both the acute antidepressant and long-term effects of CBT-SAD and explains lower depression severity following CBT-SAD relative to light therapy.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

Use of a text of psychomotor ability in an expanded role

To examine the use of a test of psychomotor ability of disabled persons, a group of 118 persons with permanent impairment of one hand were given the disability rating together with the O'Connor Finger Dexterity Test. Scores showed a substantial correlation of .69 between these two instruments. Scores on the Finger Dexterity Test were strongly correlated to the activities of daily living subscale of the Hand Disability Rating Scale (.88), while rating of disability was not. Age appeared unrelated to either test or disability scores.     

Rational-Emotive Behavior Therapy in the Treatment of Adult Victims of Childhood Sexual Abuse

This study investigated the effectiveness of Rational-emotive behavior therapy in the treatment of adult victims of childhood sexual abuse. A sample of 42 women, seeking help for their psychological distress associated with childhood sexual abuse, was selected by means of an assessment interview and the Trauma Sympton Checklist, and randomly assigned to a treatment (n=28) and a delayed treatment control group (n=14). The treatment group participated in 10 weekly sessions of group Rational-emotive behavior therapy and was followed up 8 weeks after termination of treatment. Repeated measurements were obtained by means of the Beck Depression Inventory, State-Trait Anxiety Scale, State-Trait Anger Scale, Guilt Inventory, Coopersmith Self-Esteem Inventory and Golombok-Rust Inventory of Sexual Satisfaction. Results indicated significant reductions in depression, State anxiety, State anger, State guilt and low self-esteem. These improvements were maintained at follow-up.     

Efficacy of Guided iCBT for Depression and Mediation of Change by Cognitive Skill Acquisition

Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change in cognitive skills or behavioral activation mediated subsequent change in depression. The sample was 89 individuals randomized to guided iCBT (n = 59) or waitlist (n = 30). Participants were 75% female, 72% Caucasian, and 33 years old on average. The PHQ9 was the primary outcome measure. Mediators were the Competencies of Cognitive Therapy Scale–Self Report and the Behavioral Activation Scale for Depression–Short Form. Treatment was Beating the Blues plus manualized coaching. Outcomes were analyzed using linear mixed models, and mediation with a bootstrap resampling approach. The iCBT group was superior to waitlist, with large effect sizes at posttreatment (Hedges’ g = 1.45). Dropout of iCBT was 29% versus 10% for waitlist. In the mediation analyses, the acquisition of cognitive skills mediated subsequent depression change (indirect effect = -.61, 95% bootstrapped biased corrected CI: -1.47, -0.09), but increases in behavioral activation did not. iCBT is an effective treatment for depression, but dropout rates remain high. Change in iCBT appears to be mediated by improvements in the use of cognitive skills, such as critically evaluating and restructuring negative thoughts.     

Postural Control Complexity and Fatigue in Minimally Affected Individuals with Multiple Sclerosis

This study investigated changes in postural control complexity in people with multiple sclerosis (PwMS) before and after a fatigue protocol. Thirteen minimally affected PwMS (1.53 ± 1.03- Expanded Disability Status Scale) and 12 non-MS controls. Postural test included quiet stance on a force platform under two visual conditions (saccades and fixation) before and after a fatigue protocol. Postural complexity was assessed through the multiscale entropy. A three-way ANOVA showed a main effect of fatigue in the medial-lateral direction (p <0.007), with fatigue protocol reducing postural complexity in both groups. No differences were found between groups or visual conditions. Minimally affected PwMS demonstrated similar postural complexity compared with non-MS controls under both visual tasks and showed similar decrements in postural complexity as a result of fatigue.     

Personality functioning in patients with a progressive course of multiple sclerosis

This study intended to describe general personality functioning in patients with a progressive course of multiple sclerosis. 55 consecutive rehabilitation inpatients with progressive course of multiple sclerosis were assessed with a multimethod test battery: the Expanded Disability Status Scale, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Rosenberg Self-esteem Scale, and the Rorschach Test administered and scored with Comprehensive System. The control group comprised 55 healthy participants with similar sociodemographic characteristics. Specific differences were found for both cognitive and affective aspects, as the patients with progressive course of multiple sclerosis had less positive self-image, less effective mediation processing, and an affective approach to reality. Present data illustrated the usefulness of examining patients with a progressive course of multiple sclerosis to identify abilities and difficulties in cognitive and affective patterns, and support better adaptation to relationships and the environment.     

Depression,Positive and Negative Affect,Optimism and Health-Related Quality of Life in Recently Diagnosed Multiple Sclerosis Patients: The Role of Identity,Sense of Coherence,and Self-efficacy

The study aimed to describe the levels of depression, positive and negative affect, optimism and health-related quality of life (HRQOL) in a group of recently diagnosed multiple sclerosis (MS) patients (up to 3 years since the diagnosis), taking into account gender, age, and disease duration differences, and to investigate the possible role of identity, sense of coherence (SOC), and self-efficacy in MS (SEMS) on patients’ depression, positive and negative affect, optimism, and HRQOL. The cross-sectional study involved 90 MS patients (61% women; age: M = 37, SD = 12) with an Expanded Disability Status Scale score between 1 and 4 (mild to moderate disability). Patients completed measures of depression (CESD-10), positive and negative affect (PANAS), optimism (LOT-R), HRQOL (SF-12), identity motives, SOC, and SEMS. Depression scores were near the cut-off level for clinically significant depressive symptoms, and negative affect was higher and HRQOL was lower than those in the general population. Women and younger patients reported better adjustment as time passes since the diagnosis. Results of multiple regressions indicated that higher SOC was related to higher mental health, lower negative affect and lower depression. Higher SEMS was predictive of greater positive affect and lower negative affect, whereas higher identity satisfaction was predictive of higher positive affect and optimism and lower depression. The results suggest the usefulness of addressing identity redefinition, SOC and self-efficacy in psychological interventions aimed at promoting patients’ adjustment to MS.     

Cognitive and Behavioral Contributions to Depression Severity,Quality of Life,and Functioning Among People Living With HIV in South Africa

Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.     

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.     

Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder

Cognitive-behavioral therapy (CBT) incorporating exposure and response prevention is a first line treatment for obsessive-compulsive disorder (OCD). Although, the efficacy of CBT in reducing OCD symptoms is well documented, less is known about its effects on quality of life (QOL). In the current study, functional impairment aspects of QOL (as measured by the Sheehan Disability Scale) were assessed among 70 adult outpatients with OCD before and after CBT. Statistically significant improvements in QOL and large pre- to post-treatment effect sizes were observed for work, social, and family functioning. Improvements in social and family functioning were predicted by improvements in OCD symptom severity even after controlling for improvements in depressive symptoms. In addition, clinically significant change in OCD symptoms and QOL were highly related, although there was a subset of participants whose symptoms improved without corresponding improvements in QOL. These results suggest that the effects of CBT may extend beyond OCD symptom reduction to QOL.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.     

Psychological wellbeing of Turkish university students with physical impairments: an evaluation within the stress-vulnerability paradigm

Generally, universities in developing countries offer little in the way of provisions and support (material, emotional, etc.) for disabled students. Therefore, disabled students experience considerable burdens and barriers in their educational life. This study investigated the psychological wellbeing of disabled Turkish university students by examining influences on stress-related growth and psychological distress. Disability is defined within the framework of a social model. According to this view, impairment refers to the functional limitation(s) that affect(s) a person's body, whereas disability refers to the loss or limitation of opportunities owing to social, physical or psychological obstacles. Seventy disabled university students with physical impairments were administered a questionnaire package, including a sociodemographic information sheet, Ways of Coping Questionnaire, Stress-Related Growth Scale, Multidimensional Scale of Social Support, Life Events Inventory, and Brief Symptom Inventory. Snowball sampling was used and voluntary participation was essential. The results showed that disability burden, daily hassles, and helplessness coping were significant predictors of psychological symptoms. For stress-related growth the only variable that appeared significant was problem-solving coping. The results pointed out that there may be different pathways to distress and growth. In order to decrease psychological distress and enhance growth in disabled university students, disability awareness programs, changes in the barriers in the academic and physical environments of the university campuses, and coping skills training to increase problem-focused coping and to combat helplessness may prove to be effective. Reducing daily hassles for the disabled students is likely to contribute to their wellbeing by decreasing their burdens. Also, a more disability-friendly environment is likely to be empowering for disabled university students.     

Dialectical Behavior Group Therapy is Feasible and Reduces Emotional Dysfunction in Multiple Sclerosis

We examined whether dialectical behavior therapy (DBT) was feasible and effective in multiple sclerosis (MS). A convenience sample of 20 patients with anxiety or depression symptoms received either DBT (n = 10) or standard medical care (n = 10). The DBT protocol was found to be feasible in the MS population studied (e.g., good retention and acceptability). For the DBT group, significant improvements were demonstrated in self-rated and clinician-rated depressive symptoms, clinician-rated anxiety symptoms, self-rated general psychopathology symptoms, and quality of life. In contrast, the standard medical care group retained for exploratory purposes showed no significant improvements. This pilot work provides preliminary support for the utility of DBT in MS, but further work is needed to clarify this benefit using a large, randomized controlled approach.