Abstract

Purpose: People with secondary progressive multiple sclerosis (MS) experience high rates of depression. Behavioural activation may represent an accessible therapeutic intervention for this group. We aimed to: (a) examine preliminary evidence of efficacy of a behavioural activation intervention, for people with secondary progressive MS experiencing low mood; (b) understand the feasibility of recruiting, retaining, and delivering the intervention; (c) explore whether/how the intervention has a positive impact on mood, fatigue, and quality of life (QoL) using process measures; and (d) understand participants’ experience of the intervention.

Research method/design: A mixed-method multiple single-case experimental design was used to investigate the effectiveness of a five-session behavioural activation intervention on depression for people with secondary progressive MS. An AB design was used, and intervention was delivered after establishing a stable baseline for depression on the Patient Health Questionnaire 2. Depression was measured using the Hospital Anxiety and Depression Scale – depression subscale and activation was measured using the Behavioural Activation for Depression Scale – Short Form. The intervention was delivered using an initial face-to-face session followed by telephone or Skype-delivered sessions. Data were analysed using visual analysis (conservative dual-criterion and percentage exceeding the median) and reliable and clinically significant change analysis. Postintervention change interviews were completed and analysed using framework analysis.

Results: Eight people were recruited, of which six established a stable baseline and proceeded to intervention. Five participants completed the intervention and one participant withdrew. Five participants, including the participant who withdrew, completed change interviews. Systematic reduction in depression was observed in three of five completers and reliable and clinically significant reduction was observed in two of these three participants. Three of five participants demonstrated highly effective treatment (≥.9) and two participants demonstrated moderately effective treatment (0.7-0.9). Systematic increase in activation was observed in two of five completers and reliable change was observed in one participant. In most cases, in change interviews, participants reported benefits from the intervention and that it was acceptable, even in the face of competing demands. No changes were observed in fatigue or physical components of health related QoL. Reliable change was observed in two participants for mental health related QoL.

Conclusion: There was some evidence to suggest that behavioural activation for people with secondary progressive MS led to a reduction in depressive symptoms when engagement in positively reinforcing behaviour increased. Changes in fatigue or physical health QoL were not observed suggesting that engaging in behavioural activation does not worsen fatigue.