Psychotherapy and pharmacotherapy interventions to reduce distress or improve well-being in people with amyotrophic lateral sclerosis: A systematic review

Abstract

Our objective was to systematically review and critically evaluate the evidence for psychotherapy and pharmacotherapy interventions for reducing distress or improving well-being in people with amyotrophic lateral sclerosis (pwALS). Online bibliographic databases and clinical trial registers were searched and an assessment of study quality was conducted. Seven thousand two hundred and twenty-three studies were identified, of which five met inclusion criteria (four completed and one in progress). All studies examined psychotherapeutic interventions, and no studies investigated pharmacotherapy. Two studies adopted a randomized controlled trial design, one a controlled trial design and two a cohort design. Sample sizes were small in all studies (overall n = 145). The quality of completed studies was generally poor, with evidence that all were at potential risk of bias in numerous areas. Improvements in well-being were found with expressive disclosure (compared to no disclosure), cognitive behavioural therapy/counselling (compared to non-randomized pharmacotherapy) and hypnosis in the short term only, while no improvements were seen with a life review intervention. In conclusion, there is currently insufficient evidence to recommend the use of specific psychotherapy interventions for reducing distress or improving well-being in pwALS, and no evidence to support pharmacotherapy interventions. Research is urgently needed to address these significant gaps in the literature.

Key words::

• Amyotrophic lateral sclerosis
• psychotherapy
• pharmacotherapy
• distress
• well-being

This article is referred to by:

Can pharmacotherapy improve depressive symptoms in patients with amyotrophic lateral sclerosis? A systematic review of the literature

Acknowledgements

RLG and RJH receive salary support from King's College London and the South London and Maudsley NHS Foundation Trust. MCC receives salary support from Middlesex University. RLG, RJH, RGB, LHG and AAC receive salary support from the NIHR Dementia Biomedical Research Unit and/or the NIHR Biomedical Research Centre for Mental Health, both at King’s College London and the South London and Maudsley NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would like to express their gratitude and thanks to all those authors who responded to queries about their studies, and to two anonymous reviewers for their helpful comments.

Declaration of interest: The authors declare no conflicts of interest in this study.

Supplementary material available online

Supplementary Table I to be found online at http://informahealthcare.com/doi/abs/10.3109/21678421.2015.1062515.