Effectiveness of a group resilience intervention for people with multiple sclerosis delivered via frontline services

Abstract

Purpose

This study aims to evaluate the effectiveness of an Acceptance and Commitment Therapy-based group resilience intervention (The REsilience and Activities for every DaY program, READY) delivered to people with MS (PwMS) via frontline Italian services.

Materials and methods

This is a single-arm longitudinal study (with a nested qualitative study). READY is composed of seven weekly in-person sessions (2.5-h each) plus a booster session five weeks later. Data were collected immediately before the program, after the booster session, and at 3-months follow-up.

Results

Thirty-three READY groups (237 participants) were run by thirty-three trained psychologists. Participants improved in resilience (primary outcome), anxiety, depression, stress, health-related quality of life (HRQoL), and psychological flexibility and associated processes (acceptance, defusion, and values). Improvements on most outcomes occurred post-intervention and were maintained at a 3-month follow-up. No demographic or illness variables predicted these improvements. Psychological flexibility mediated improvements in resilience, anxiety, depression, stress, and HRQoL. Qualitative data confirmed READY feasibility and the positive psychological impacts on participants.

Conclusions

Study findings support READY effectiveness with PwMS, its broad applicability in this population, and its delivery through frontline services.

IMPLICATIONS FOR REHABILITATION

• READY for MS is a highly structured, brief manualized group intervention.

• It is effective in improving participants’ psychological functioning (resilience, anxiety, depression, stress, HRQoL, psychological flexibility, and related ACT processes).

• Psychological flexibility mediated the improvements in resilience, anxiety, depression, stress, HRQoL.

• READY can be effectively delivered through frontline services for PwMS without limitation in terms of participants’ demographic and illness characteristics.

Keywords:

• Resilience training
• multiple sclerosis
• acceptance and commitment therapy
• mindfulness
• quality of life

Acknowledgements

We thank the “RETE PSICOLOGI AISM” for providing access to the AISM Psychologist Network and many other forms of support in conducting the project. We also thank the PwMS who participated in the project.

Special thanks to the READY Facilitator Team. Members of the Facilitator Team were (alphabetical order): Annamaria Barbarulo, Fabio Bellomi, Miriam Benin, Sarah Bertagnoli, Francesca Bonorino, Martina Borghi, Daniela Buonanno, Maria Marica Carrillo, Cinzia Caruso, Laura Compagnucci, Giuliana Costantini, Lucia Desantis, Diana Di Lorenzo, Francesca Di Tante, Monica Falautano, Vincenzina Gentile, Miranda Giuntoli, Silvia Gregori, Monica Grobberio, Paola Grossi, Laura Mambelli, Alessandra Martelli, Mary Micheli, Anna Maria Perillo, Erika Pietrolongo, Maria Francesca Possa, Maria Esmeralda Quartuccio, Rui Quintas, Vanessa Raimondi, Ambrogia Riolo, Paola Rizzi, Elisabetta Romagnolo, and Angella Tilli.

Author contributions

AMG, AS, and KP conceived and developed the study protocol. AMG and KP conceived and developed The ACT and be READY for MS Training Program. AMG ran the training. The trainee facilitators of the READY Facilitator Team ran the READY group with PwMS and collected all the data. AMG performed the data analysis. AMG, AS, and KP drafted the manuscript. All authors approved the final manuscript.

Disclosure statement

AMG received a research grant from Rehabilitation In Multiple Sclerosis (RIMS) European network for best practice and resources. AS received a research grant from Fondazione Italiana Sclerosi Multipla (FISM) during the study implementation and personal fees from Biogen Idec, Merck Serono, Novartis, Almirall, and Excemed. As a staff member of the University of Queensland and co-Author of the READY program, KP receives royalties from UniQuest for commercial (not research) licensing arrangements entered into by third parties who want to deliver the program.

Data availability statement

Data are available upon request to the corresponding author.

Additional information

Funding

This work was supported by Fondazione Italiana Sclerosi Multipla (FISM) – cod. 2016/B/3 and financed or co-financed with the “5 per mille” public funding. The funding source had no role in study design, data collection, data analysis, data interpretation, or report writing.