Anxiety, Coping, Depression Anxiety Disorder, Multiple Sclerosis, Problem Solving
Conditions
Keywords
multiple sclerosis, anxiety, problem -solving coping strategies, depression
Brief summary
Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the brain and spinal cord, often leading to unpredictable symptoms and significant emotional distress. Many people with MS experience anxiety, depression, and difficulties in coping with the challenges of the disease. Research has shown that effective coping-especially problem-focused coping-can reduce psychological distress and improve quality of life. However, access to psychological care can be limited, particularly in low-resource or mobility-restricted settings.This study, conducted at the Nehme and Therese Tohme Multiple Sclerosis Center at the American University of Beirut Medical Center (AUBMC), evaluated the feasibility and preliminary effectiveness of an eight-week, online psychological intervention designed to enhance problem-solving and coping strategies in adults with MS living in Lebanon.The primary objective was to determine whether an online problem-solving coping strategies (PCS) intervention is feasible, acceptable, and well-tolerated for people with MS. The secondary objective was to assess the intervention's preliminary effects on problem-focused coping, depression, and anxiety.
Detailed description
Design and Methods:This was a pilot randomized controlled trial (RCT) including 30 adults diagnosed with MS for at least one year. Participants were randomly assigned in equal numbers (1:1 ratio) to one of two groups:1. PCS Intervention group: 15 participants received eight weekly, 60-minute individual online sessions with a licensed clinical psychologist using WhatsApp video calls.2. Treatment-as-Usual (TAU) group: 15 participants continued their regular neurological and nursing care without additional psychological intervention.All participants completed questionnaires at baseline and at the end of the 8-week study to measure coping strategies, anxiety, and depression using validated Arabic versions of the Brief-COPE Scale and the Hopkins Symptom Checklist (HSCL-25). The PCS group also completed a self-developed Feasibility Questionnaire to assess the acceptability and practicality of the online sessions.Intervention Details:The PCS program was developed in Arabic by a multidisciplinary team including psychologists, nurses, and physicians. It was based on Lazarus and Folkman's Transactional Model of Stress and Coping (1984) and Problem-Solving Therapy principles. Each session included psychoeducation about healthy versus maladaptive coping, guided problem-solving exercises, and real-life applications through weekly homework. The sessions emphasized identifying challenges, generating solutions, weighing pros and cons, and implementing action plans
Interventions
BEHAVIORALProblem-Solving Coping Strategies (PCS) Intervention
This intervention is unique in that it delivers a structured, psychologist-guided problem-solving and coping program entirely via WhatsApp video calls, a widely accessible and low-cost platform in Lebanon and the MENA region. Unlike most telehealth or cognitive-behavioral interventions that rely on specialized software, this program was developed in Arabic and culturally adapted for adults with multiple sclerosis (MS) to address psychosocial stress, depression, and anxiety within local contexts. The content integrates Lazarus and Folkman's Transactional Model of Stress and Coping with Problem-Solving Therapy (PST) principles, emphasizing practical, real-life coping skills rather than symptom education alone. Delivered individually by a licensed clinical psychologist trained in MS-specific behavioral care, the program also includes weekly skill practice, personalized feedback, and a coping diary, making it a tailored, behaviorally focused, and patient-centered telepsychology model disti
OTHERTreatment as usual (TAU)
Standard neurological and nursing care, including regular medical follow-up, medication management, and rehabilitation or physical therapy as clinically indicated. No structured psychotherapy provided.
Sponsors
American University of Beirut Medical Center
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This study used a randomized, parallel assignment model in which participants were randomly allocated (1:1) to one of two arms: Intervention Arm: Participants received an 8-week, online Problem-Solving Coping Strategies (PCS) intervention delivered individually by a licensed clinical psychologist via WhatsApp video calls. Control Arm: Participants received treatment as usual (TAU), consisting of standard neurological and nursing care provided at the AUBMC Multiple Sclerosis Center. Each participant was assigned to only one study arm and followed for 8 weeks. No crossover occurred between groups. The model was chosen to compare the feasibility and preliminary effectiveness of the PCS intervention versus routine care in improving coping, anxiety, and depression among adults with multiple sclerosis.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older * Diagnosis of Multiple Sclerosis ≥ 1 year (McDonald criteria 2017) * Access to a stable internet connection and smartphone/laptop * Able to provide informed consent
Exclusion criteria
* Active suicidal ideation at screening * Cognitive impairment or psychiatric instability precluding participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility and Acceptability of the Online Problem-Solving Coping Strategies (PCS) Intervention | • Recruitment rate (% of eligible patients enrolled) - 4 months • Retention and session adherence (completion of ≥6/8 sessions) - 8 weeks • Participant satisfaction using the Feasibility Questionnaire (score range: 13-65; 8weeks) | Feasibility and acceptability were evaluated using a self-developed Feasibility Questionnaire (score range: 13-65; higher scores indicate greater satisfaction and tolerance). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Preliminary Effectiveness of the Online Problem-Solving Coping Strategies (PCS) Intervention | Assessments were completed at baseline and at 8 weeks following the intervention. • Change in Problem-Focused Coping (Brief-COPE subscale) baseline to 8 weeks | Preliminary Effectiveness of the Online Problem-Solving Coping Strategies (PCS) Intervention Effectiveness was assessed by comparing pre- and post-intervention coping changes between PCS and Treatment-as-Usual (TAU) groups. Problem-focused coping was measured using the Brief COPE Scale (scores 8-32; higher scores indicate greater use of problem-focused strategies). |
Countries
Lebanon
Outcome results
None listed