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Cognitive behavioural therapy (CBT) for adjustment to early stage multiple sclerosis: Manual development and a randomised controlled trial comparing CBT to supportive listening
DOI 10.1186/ISRCTN91377356
ClinicalTrials.gov identifier
EudraCT number
Public title Cognitive behavioural therapy (CBT) for adjustment to early stage multiple sclerosis: Manual development and a randomised controlled trial comparing CBT to supportive listening
Scientific title
Acronym saMS (Supportive Adjustment for Multiple Sclerosis)
Serial number at source RHM MED 0726
Study hypothesis Multiple sclerosis (MS) is a chronic progressive degenerative neurological disease affecting around 1 in 1,000 people in the UK. Although rarely fatal, MS produces a range of unpleasant and disabling symptoms. The course of MS is idiosyncratic and unpredictable and although the majority of patients experience a relapsing-remitting form of the illness, ultimately most patients experience a transition towards persistent disability. The nature and presentation of MS poses multiple psychosocial challenges. Individuals are faced with uncertainty about the future, unpleasant and unpredictable symptoms, treatment regimes and drug side effects. Since MS can have profound consequences including disruptions to life goals, employment, income, relationships, social and leisure activities and daily activities, it is unsurprising that it poses challenges for psychological adjustment.

The purpose of this study is to develop and test an intervention based upon the principals of cognitive behavioural therapy (CBT) to assist people in the early stages of MS to adjust to living with the disease.

The study aims to:
1. Develop a CBT manualised programme for adjusting to MS that can be delivered by general nurses receiving basic training in CBT and regular supervision
2. Determine whether patients with early stage MS who undertake a CBT course for adjustment to MS will demonstrate significantly greater reductions in key adjustment outcomes (less distress, and improvements in work and social adjustment) than those assigned to a Supportive Listening comparison condition
3. Examine the changes in beliefs, cognitions and behaviours in the two treatment groups and determine whether changes in these variables mediate improvements in distress and work and social adjustment
4. Conduct a cost-effectiveness analysis of the interventions
5. Evaluate the interventions from a patient perspective using qualitative methods
Lay summary http://www.southampton.ac.uk/samstrial/trial/about_the_trial1.html
Ethics approval Approved by the Thames Valley Research Ethics Committee in February 2007 (ref: 07/MRE12/6)
Study design Randomised controlled trial
Countries of recruitment United Kingdom
Disease/condition/study domain Multiple sclerosis
Participants - inclusion criteria 1. Definite diagnosis of MS
2. Diagnosed within the last 10 years
3. Some degree of ambulation (with aid if necessary). Equivalent to Extended Disability Status Scale (EDSS) <6.5
4. Stabilised on medication (Disease modifying drugs: minimum of 3 months since started; Anti-depressants: stable dose for minimum of 2 months)
Participants - exclusion criteria 1. Gross cognitive impairment that would make participation in therapy problematic or distressing (must score >20 on Telephone Interview for Cognitive Status-Modified to be eligible)
2. Serious psychological disorders for whom treatment would be inappropriate (including psychotic disorders of active substance abuse)
3. Other co-morbid serious chronic illness (e.g., a malignancy)
4. Currently participating in other psychological therapies
Anticipated start date 31/01/2008
Anticipated end date 31/01/2009
Status of trial Completed
Patient information material Patient information can be found at: http://www.soton.ac.uk/samstrial/links/index.html
Target number of participants 100
Interventions Participants will be randomly allocated to either the CBT or Supportive Listening arm.

CBT arm:
Participants in the CBT arm will look at the way that their thoughts, feelings, behaviours and physiology interact and influence how MS affects their lives. The treatment is structured and different topics will be covered in different sessions. The manual consists of 9 chapters which can be used as appropriate to the individual's needs:
1. Introduction to adjusting to MS
2. Adapting to living with MS
3. Setting goals and problem solving
4. Symptom management
5. How to tackle negative and unhelpful thoughts
6. Improving the quality of your sleep
7. Managing stress
8. Managing social relationships
9. Preparing for the future
Participants will work with their nurse-therapist in setting tasks or homework to do in between the sessions. Participants have 8 sessions of CBT over 10 weeks. This is delivered by general nurses specially trained as nurse-therapists. 2 sessions are face-to-face, 6 are by telephone.

Supportive Listening arm:
Participants in the Supportive Listening arm will have the opportunity to talk freely, extensively and confidentially about their experiences, thoughts and feeling about MS and its effect on their lives. The listening skills we will use in this trial are based on the theories and counselling techniques of Carl Rogers. These core skills include asking open questions, active listening skills such as minimal encouragers and paraphrasing, empathising, reflecting and summarising. The purpose is to provide the participant the opportunity to talk and express themselves in a non-judgmental, safe environment. The person should experience empathy from the therapist and feel listened to. Participants have 8 sessions of Supportive Listening over 10 weeks. This is delivered by general nurses specially trained as nurse therapists. 2 sessions are face-to-face, 6 are by telephone.

Questionnaire assessments will be carried out at baseline, mid-therapy, post-therapy and at 6 and 12 months.
Primary outcome measure(s) The following will be assessed at baseline, mid-therapy, post-therapy and at 6 and 12 months:
1. Distress, assessed by the General Health Questionnaire (Goldberg, 1978)
2. Work and Social Adjustment, assessed by the Work and Social Adjustment Scale (Mundt et al., 2002)
Secondary outcome measure(s) The following will be assessed at baseline, post-therapy and at 6 and 12 months, unless specified otherwise:
1. Social support, assessed using the Significant Others Scale (SOS; Power et al., 1988) at baseline, post-therapy and at 6 and 12 months
2. Beliefs About Emotions (BAE-6; Rimes & Chalder, publication in preparation)
3. Illness perceptions, assessed using the Brief Illness Perception Questionnaire (B-IPQ; Broadbent et al., 2006)
4. Cognitive and Behavioural responses to symptoms (CBSRQ; Moss-Morris et al., publication in preperation)
5. Acceptance, assessed by the Acceptance of Chronic Health Conditions (ACHC) Scale (Stuifbergen et al., in press)
6. Dyadic adjustment, assessed by the Dyadic Adjustment Scale (DAS-4; Sabourin et al., 2005) at baseline and post-therapy
7. Dysfunctional beliefs, assessed by the Psychological Vulnerability Scale (PVS; Sinclair & Wallston, 1999)
8. Health status, assessed by Euroqol (Curtis & Netten, 2006) at baseline, 6 and 12 months
9. Health service usage/costs, assessed using the Client Service Receipt Inventory (CSRI, Beecham & Knapp, 2001) at baseline, 6 and 12 months
Sources of funding Multiple Sclerosis Society (refs: 839/06 and 072/07)
Trial website http://www.soton.ac.uk/samstrial
Publications 1. 2009 protocol in http://www.ncbi.nlm.nih.gov/pubmed/19698171
2. 2012 results in http://www.ncbi.nlm.nih.gov/pubmed/22730954
Contact name Prof  Rona  Moss-Morris
  Address School of Psychology
University of Southampton
Highfield Campus
  City/town Southampton
  Zip/Postcode SO17 1BJ
  Country United Kingdom
Sponsor University of Southampton and Southampton University Hospitals Trust (UK)
  Address c/o Dr Martina Dorward
Research Governance Manager
Legal Services
Room 4033
Building 37
University Road
  City/town Southampton
  Zip/Postcode SO17 1BJ
  Country United Kingdom
  Sponsor website: http://www.soton.ac.uk
Date applied 07/01/2008
Last edited 22/10/2012
Date ISRCTN assigned 11/04/2008
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