Federica Graziano

The effects of a group-based cognitive behavioral therapy on people with multiple sclerosis: a randomized controlled trial

Objective: To evaluate the effectiveness of a cognitive behavioral group-based intervention aimed at reducing depression and fostering quality of life and psychological well-being of multiple sclerosis patients through the promotion of identity redefinition, sense of coherence, and self-efficacy. Design: A randomized controlled trial. Setting: Non-medical setting, external to the Multiple Sclerosis Clinic Centre. Subjects Eighty-two patients: 64% women; mean age 40.5, SD = 9.4; 95% with relapsing-remitting multiple sclerosis; Expanded Disability Status Scale (EDSS) between 1 and 5.5 were included in the study. Interventions: Patients were randomly assigned to an intervention group (five cognitive behavioral group-based sessions, n = 41) or to a control group (three informative sessions, n = 41). Main measures Depression (CES-D), Quality of life (MSQOL revised), Psychological well-being (PANAS), Identity Motives Scale, Sense of Coherence (SOC), and Self Efficacy in Multiple Sclerosis. Results Quality of life increased in the intervention group compared with the control at 6-months follow-up (mean change 0.72 vs. −1.76, p < 0.05). Well-being in the intervention group increased for males and slightly decreased for females at 6-months follow-up (mean change 6.58 vs. −0.82, p < 0.05). Contrasts revealed an increase in self-efficacy in the intervention group at posttreatment compared with the control (mean change 2.95 vs. −0.11, p < 0.05). Depression tended to lower, while identity and coherence increased in the intervention group compared with the control, though the differences were not significant. Conclusions: Preliminary evidence suggests that intervention promotes patients’ quality of life and has an effect on psychological well-being and self-efficacy.

Links between maternal and paternal support, depressive feelings and social and academic self-efficacy in adolescence

This study focused on the role of paternal and maternal support on various indicators of adolescent adjustment. Similar patterns of support in the parental couple (father and mother both high or both low) and mixed patterns (father high and mother low or vice versa) as perceived by adolescents were considered. The specific purpose was to examine the role of both similar (parental consistency) and mixed (parental inconsistency) patterns of parental support on depressive feelings and social and academic self-efficacy. For parental inconsistency, differences between the maternal and paternal role were investigated. Gender and age differences were also examined. Data were collected from a sample of 1118 Italian students, aged 14 to 18 years, living in intact families, using a self-report questionnaire and ANOVAs were performed. Results indicated that high levels of perceived support from both parents were related to lower levels of depressive feelings and higher levels of social and academic self-efficacy. Mixed patterns of support in the parental couple did not differ from each other for any of the indicators considered. No interactions between typology of support, gender and age were observed. Findings confirmed the importance of studying paternal and maternal support interactions rather than focusing on their independent role.

Improving the quality of life and psychological well-being of recently diagnosed multiple sclerosis patients: preliminary evaluation of a group-based cognitive behavioral intervention

Abstract Purpose: The study evaluated a group-based cognitive behavioral intervention aimed at promoting the quality of life and the psychological well-being of recently diagnosed multiple sclerosis (MS) patients (up to 3 years since the diagnosis). Method: The study involved 85 patients [59% women; mean age 37, SD = 12.3; 94% with relapsing-remitting MS; Expanded Disability Status Scale (EDSS) between 1 and 4]. A quasi-experimental study design was applied; 54 patients (intervention group) participated in five group sessions, a 6-month post-intervention and a 1-year follow-up; 31 patients (comparison group) participated in activities routinely provided to recently diagnosed MS patients. Measures of Quality of Life (SF-12), Depression (CESD-10), Affective well-being (PANAS) and Optimism (LOT-R) were assessed. Results: At the 6-month post-intervention, mental health increased in the intervention group and decreased in the comparison group, whereas negative affect decreased in the intervention group and increased in the comparison group. At the 1-year follow-up, mental health and optimism increased in the intervention group and decreased in the comparison group. Conclusions: Preliminary evidence suggests that the proposed intervention fosters the quality of life and the psychological well-being of recently diagnosed MS patients by reducing negative affect and promoting mental health and optimism, particularly in the long term. Implications for Rehabilitation Preliminary evidence suggests that a group-based cognitive behavioral intervention focused on identity redefinition, sense of coherence and self-efficacy promotes the quality of life (increased mental health) and psychological well-being (decreased negative affect and increased optimism) of recently diagnosed MS patients (up to 3 years since the diagnosis). The first years following the MS diagnosis should be considered a good time for a psychological intervention aimed at promoting the patient’s adjustment to the illness. Strategies should be found to increase the participation of recently diagnosed MS patients in psychological interventions.

Le funzioni del consumo di tabacco e alcolici percepite dagli adolescenti: una ricerca con il focus group

Il fumo di sigarette ed il consumo di alcolici, come altri comportamenti a rischio, rappresentano per gli adolescenti condotte dotate di significato e dirette ad uno scopo: esse svolgono infatti delle specifiche funzioni in rapporto agli obiettivi di crescita. Il presente studio si e proposto di indagare quali sono tali funzioni nella percezione degli adolescenti attraverso sei focus group che hanno coinvolto un totale di 46 adolescenti di entrambi i generi frequentanti scuole medie superiori di diverso indirizzo della citta di Torino. Il materiale testuale ricavato dalle interviste e stato sottoposto ad analisi del contenuto, individuando una serie di categorie corrispondenti alle varie funzioni. I risultati hanno evidenziato che le principali funzioni attribuite al fumo di sigarette possono essere ricondotte alla trasgressione, alla sperimentazione, all’emulazione e alla visibilita, mentre le principali funzioni del consumo di alcolici si riferiscono alla comunicazione e al coping. Una motivazione che accomuna entrambi i comportamenti e riconducibile al piacere. I risultati, oltre a confermare quanto evidenziato dalla letteratura, offrono rilevanti spunti per la prevenzione.

Depressione e benessere psicologico in persone con sclerosi multipla: il ruolo dell’identità, del senso di coerenza e dell’autoefficacia

Lo studio si pone l’obiettivo di indagare il ruolo dell’identita, del senso di coerenza e dell’autoefficacia nella gestione della sclerosi multipla (SM) rispetto alla depressione e al benessere psicologico, in un gruppo di pazienti italiani affetti da SM, con disabilita lieve o moderata, tenendo conto delle differenze legate al genere, all’eta, agli anni dalla diagnosi, alla composizione del nucleo familiare e alla condizione lavorativa. Lo studio ha coinvolto un gruppo di 182 pazienti (64% donne; eta media = 40 anni, ds = 10.7; anni in media dalla diagnosi = 6, ds = 6) e le variabili oggetto dello studio sono state rilevate attraverso un questionario anonimo self-report. Le analisi di regressione evidenziano come i predittori significativi della depressione siano la diagnosi recente e punteggi bassi alle scale dell’identita e del senso di coerenza. Predittori significativi del benessere psicologico sono risultati punteggi elevati alle scale dell’identita, del senso di coerenza e dell’autoefficacia nella gestione della SM. I risultati dello studio suggeriscono l’utilita di interventi di sostegno psicologico per i pazienti affetti da SM per supportarli nel processo di ridefinizione dell’identita, costruzione di senso di coerenza e ridefinizione di obiettivi e strategie di azione, con il fine ultimo di promuovere un migliore adattamento alla malattia, in termini non solo di riduzione della depressione, ma anche di aumentato benessere.

Coping strategies and adjustment to multiple sclerosis among recently diagnosed patients: the mediating role of sense of coherence:

Objective: To examine the relationship between coping strategies (problem solving, emotional release, and avoidance) and adjustment (health-related quality of life, depression, and affective well-being) in a group of recently diagnosed multiple sclerosis patients (up to three years since diagnosis), and to explore the mediating role of sense of coherence between coping strategies and adjustment. Design: Cross-sectional. Setting: Multiple Sclerosis Clinic Centre. Subjects: A total of 102 patients (61.8% women; age (years): M = 35.8, SD = 11.9; 95% with a relapsing–remitting form of multiple sclerosis; Expanded Disability Status Scale score, between 1 and 4). Interventions: Not applicable. Main measures: Coping with multiple sclerosis (problem solving, emotional release, and avoidance), sense of coherence, health-related quality of life (SF-12), depression (CES-D), and affective well-being (PANAS). Results: Problem solving was linked to higher mental health (β = 0.28) and higher affective well-being (β = 0.36), emotional release was related to lower depression (β = −0.22); avoidance was associated to higher mental health (β = 0.25), higher affective well-being (β = 0.24), and lower depression (β = −0.29) (all betas were significant at p < 0.05). Sense of coherence mediated the relationship between emotional release and depression (Sobel z-value = −2.00; p < 0.05) and the relationship between avoidance and all the indicators of adjustment (mental health: Sobel z-value = 1.97; depression: Sobel z-value = −2.02; affective well-being: Sobel z-value= 2.05; p < 0.05). Conclusions: Emotional and avoidant coping strategies seem to be adaptive among recently diagnosed multiple sclerosis patients. A mediating role between coping strategies and adjustment is played by sense of coherence.

The Self-Efficacy in Multiple Sclerosis (SEMS) Scale

This research developed a new scale to evaluate Self-Efficacy in Multiple Sclerosis (SEMS). The aim of this study was to investigate dimensionality, item functioning, measurement invariance, and concurrent validity of the SEMS scale. Data were collected from 203 multiple sclerosis (MS) patients (mean age, 39.5 years; 66% women; 95% having a relapsing remitting form of MS). Fifteen items of the SEMS scale were submitted to patients along with measures of psychological well-being, sense of coherence, depression, and coping strategies. Data underwent Rasch analysis and correlation analysis. Rasch analysis indicates the SEMS as a multidimensional construct characterized by two correlated dimensions: goal setting and symptom management, with satisfactory reliability coefficients. Overall, the 15 items reported acceptable fit statistics; the scale demonstrated measurement invariance (with respect to gender and disease duration) and good concurrent validity (positive correlations with psychological well-being, sense of coherence, and coping strategies and negative correlations with depression). Preliminary evidence suggests that SEMS is a psychometrically sound measure to evaluate perceived self-efficacy of MS patients with moderate disability, and it would be a valuable instrument for both research and clinical applications.

Exploring change in a group-based psychological intervention for multiple sclerosis patients

Abstract Purpose: The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. Materials and methods: The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. Results: Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. Conclusions: The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients’ adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness to change and follow-up sessions should be implemented to maintain positive changes among participants. The use of qualitative instruments to evaluate group interventions captures the complexity of processes and gives useful indications to health professionals to improve rehabilitation programs.