***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Life stress and coping responses jointly contribute to psychological adjustment in many chronic illness population s , but their significance in multiple sclerosis ( MS ) has not been extensively investigated . Physical disability , cognitive status , negative life stress  ,  coping strategies  , and depressive symptoms were prospect ively assessed in 27 adults with definite or probable MS . Of the original subjects , 22 provided two additional assessment s at 6-month intervals . After accounting for cognitive status and physical disability , life stress was positively correlated with current as well as future depressive symptoms ; the prospect i ve relationship was replicated within the second pair of prospect i ve data waves . Escape avoidance was the only coping strategy that added to the prediction of future mood symptoms , but this was not replicated . Results suggest that MS-related depressive symptoms are a function of prior disease-related impairment , life stress , and possibly escape avoidance coping Anxiety and phobia frequently prevent patients with multiple sclerosis ( MS ) from self-injecting their injectable disease-modifying medications . This small , r and omized , controlled trial tested the efficacy of a six-session nurse-administered programme to teach self-injection to patients with MS , who , due to anxiety or phobia , were unable to self-inject their injectable medications . Participants were 30 patients with MS who were prescribed interferon beta-1a ( IFNβ-1a ) administered via weekly intramuscular injection . All patients were unable to self-inject due to anxiety or phobia . Patients were r and omized to either the six-session Self-Injection Anxiety Therapy ( SIAT ) or a control telephone support condition modelled on the support programme offered by the manufacturer of IFNβ-1a . Four patients dropped out of SIATwhile three dropped out of the control condition . Eight patients receiving SIAT , compared to three control patients , were able to self-inject after six weeks of treatment . SIAT patients were significantly more likely to achieve self-injection at treatment cessation , compared to telephone control patients , in completer analyses ( p=0.022 ) , however , this only reached a trend in intent-to-treat analyses ( p=0.058 ) . These findings suggest that SIAT is a potentially valuable intervention to teach self-injection skills to injection phobic and anxious patients , and should be investigated more thoroughly in a larger clinical trial The research ers studied the effectiveness of a nursing intervention in promoting adjustment and symptom management in individuals with multiple sclerosis ( MS ) . This was a 4-year longitudinal study to determine whether the 4-week intensive outpatient program was effective in increasing adjustment to MS and if the treatment effect would last over time . A sample of 27 individuals with MS participated in the study . Treatment participants had significant improvements in symptom management at the 4-year follow up . This improvement was attributable to significant improvements in sleep and fatigue levels . Although adjustment and self-efficacy scores improved in the treatment group over time , this improvement was not superior to the control group . This was anticipated because the behavioral changes would precede improvement in adjustment to life following the diagnosis of MS Objective : There has long been a belief that depression contributes to fatigue in multiple sclerosis ( MS ) although supporting data are minimal at best . Clinical guidelines for the treatment of fatigue include recommendations for the treatment of depression in the absence of clear empirical support . The goal of this study was to examine the effects of treatment for depression on fatigue in MS . Methods : Sixty patients with a relapsing form of MS and moderate to severe depression were r and omly assigned to one of three vali date d 16‐week treatments for depression : individual cognitive behavioral therapy , group psychotherapy , or sertraline . Assessment s at baseline and treatment cessation included the primary outcome measure , fatigue assessment instrument ( FAI ) , and Beck depression inventory ( BDI ) . Results : The total FAI and the global fatigue severity subscale were significantly reduced over the course of treatment ( p values < .02 ) . Other subscales did not change significantly . Secondary analyses showed change in global fatigue severity was associated with change in BDI ( p = .03 ) but change in total FAI was only marginally related to change in BDI ( p = .05 ) . These relationships were due entirely to change in mood ( p values < .02 ) and not to change in cognitive or vegetative symptoms ( p values > .17 ) . Conclusions : These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms , and that this relationship is due primarily to treatment related changes in mood Twenty multiple sclerosis patients ( 14 female , 6 male ) were involved in the study , their ages ranging rom 29 to 47 years . Ten participants formed the therapy group , and 10 the control group .  The groups were comparable on the st and ard neurological classification scheme Exp and ed Disability Status Scale ( EDSS ) . Exclusion criteria were pregnancy and mental disorders requiring medication . Measurements were taken before therapy began ( T1 ) , and subsequently every 3 months ( T2-T4 ) . This battery included indicators of clinical depression and anxiety ( Beck Depression Inventory and Hospital Anxiety and Depression Scale ) , a self-acceptance scale ( SESA ) and a life quality assessment ( Hamburg Quality of Life Question naire in Multiple Sclerosis ) . In addition , data were collected on cognitive ( MSFC ) and functional ( EDSS ) parameters . Patients in the therapy group received 3 blocks of music therapy in single sessions over the course of the one year project ( 8 to 10 sessions respectively ) . The music therapy approach used for this study is based on the Nordoff Robbins approach ( Nordoff & Robbins , 1977 ) . There was no significant difference between the music therapy treatment group and the control group . However , the effect size statistics comparing both groups show a medium effect size on the scales measuring self esteem ( d = 0.5423 , r = .026 ) , depression HAD-D ( d = 0.63 , r = 0.310 ) and anxiety HAD-A ( d = 0.63 , r = 0.310 ) . Significant improvements were found for the therapy group over time ( T1-T4 ) in the scale values of self esteem , depression , and anxiety . Given the stigmatizing effect of a chronic degenerative disease , the positive benefits of music therapy point to a realm of aesthetic considerations in assessing clinical improvement Objectives : Cognitive problems in multiple sclerosis are common but any possible benefits of treatment remain uncertain . The aim of the study was to evaluate the benefits of providing a psychology service , including cognitive assessment and intervention , to patients with multiple sclerosis . Method : The study was a single blind r and omised controlled trial . A total of 240 patients with clinical ly definite , laboratory supported , or clinical ly probable multiple sclerosis were recruited from an multiple sclerosis management clinic and assessed on a brief screening battery . They were r and omised into three groups . The control group received no further intervention . The assessment group received a  detailed cognitive assessment  , the result of which was fed back to staff involved in the patients ' care . The treatment group received the same detailed cognitive assessment and a treatment programme design ed to help reduce the impact of their cognitive problems . Patients were followed up 4 and 8 months later on the general health question naire ( GHQ-28 ) , extended activities of daily living scale , SF-36 , everyday memory question naire , dysexecutive syndrome question naire , and memory aids question naire . Results : The three groups were compared on the outcome measures at 4 and 8 months after recruitment . There were few significant differences between the groups and those that occurred favoured the control group . Overall , the results showed no effect of the interventions on mood , quality of life , subjective cognitive impairment or independence . Conclusions : The study failed to detect any significant effects of cognitive assessment or cognitive intervention in this cohort of people with multiple sclerosis This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy ( CBT ) for the treatment of depressive symptomatology in multiple sclerosis ( MS ) patients . The treatment , Coping with MS ( CMS ) , included a patient workbook design ed to structure the treatment , provide visual aids , and help with homework assignments .  Thirty-two patients with MS , who scored at least 15 on the Profile of Mood States Depression-Dejection scale , were r and omly assigned to either the telephone CMS or to a usual-care control ( UCC ) condition . Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition . Furthermore , adherence to interferon beta-1a , a disease-modifying medication for the treatment of MS , was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition This r and omized clinincal trial utilized established techniques to improve new learning and memory performance in multiple sclerosis ( MS ) participants with learning impairment . Participants were 29 individuals with clinincally definite MS with documented learning deficits , r and omly assigned to the experimental or control group . The experimental group underwent eight sessions of the Story Memory Technique ( SMT ) , while the control group participated in eight sessions of memory exercises .  Neuropsychological assessment was conducted at baseline , immediately following treatment and 5 weeks later to assess outcome . When stratifying participants by degree of learning deficits , a significant treatment effect was noted . MS participants with moderate-severe impairment in learning  showed a significant improvement in learning abilities when compared to controls , ( t(19)-3.32 , P<0.01 ) evident in 88 % of participants in the experimental group . Little improvement was noted in MS participants with mild learning impairments . Significant self-reported improvements in memory were noted in MS participants that underwent treatment , but not those that did not undergo treatment ( t(26)-2.55 , P<0.01 ) . Results indicate that learning and memory deficits in MS can be effectively treated through a memory rehabilitation program utilizing context and imagery to improve new learning . Appropriate patient selection is important , with moderately-severely impaired individuals showing significantly greater benefit from treatment BACKGROUND Studies have been fairly consistent in finding a relationship between social support and depression . However , little is known about the relationship between depression and social support in the context of treatment for depression . This study examined the effects of treatment for depression on social support among patients with multiple sclerosis ( MS ) . METHOD Sixty-three moderately depressed MS patients received 16 weeks of cognitive behaviour therapy ( CBT ) , supportive expressive group psychotherapy ( SEGP ) or sertraline . Depression was measured using the Beck Depression Inventory and social support was measured using Arizona Social Support Interview Schedule . RESULTS Treatment for depression was associated with significant increases in perceived social support , utilized social support and satisfaction with support , as well as reduction in need for emotional support . There were no significant changes in structural support or need for physical support . There were also no differences in change in social support across treatments . All changes in social support were fully explained by depression . Improvements in utilized social support and satisfaction with social support were fully mediated by improvements in depression . Baseline depression predicted improvements in perceived support and need for emotional support . CONCLUSIONS These findings suggest that improvements in social support among MS patients during treatment for depression can be explained by depression . However , different domains of social support may be differentially sensitive to changes in depression OBJECTIVE To examine the effects of a wellness intervention program for women with multiple sclerosis ( MS ) on health behaviors and quality of life ( QOL ) . DESIGN R and omized clinical trial . SETTING Community setting in the southwestern United States . PARTICIPANTS Convenience sample of 113 women with physician-confirmed MS ( mean age , 45.79y ) . INTERVENTIONS The 2-phase intervention program included lifestyle-change classes for 8 weeks , then telephone follow-up for 3 months . Participants were followed over an 8-month period . MAIN OUTCOME MEASURES A series of self-report instruments to measure barriers , re sources , self-efficacy for health behaviors , health promotion behaviors , and health-related QOL were completed at baseline , 2 months ( after the classes ) , 5 months ( after telephone follow-up ) , and at 8 months . Principal outcomes measures were health-promoting behaviors ( scores on the Health Promoting Lifestyle Profile II ) and QOL ( scores on the Medical Outcomes Study 36-Item Short-Form Health Survey [ SF-36 ] scales ) . RESULTS Hierarchical linear modeling techniques revealed a statistically significant group by time effect for self-efficacy for health behaviors , health-promoting behaviors , and the mental health and pain scales of the SF-36 . CONCLUSION These data provide initial support for the positive effects of wellness interventions to improve health behaviors and selected dimensions of QOL for women with MS We studied the effectiveness of a newly-developed cognitive-behavioral intervention in 15 patients with marked cognitive impairment and behavior disorder . The design was a single-blind test of a neuropsychological intervention , with pre- and post-treatment assessment s of personality and social behavior . MS patients underwent neurological examination and neuropsychological testing at baseline . The patients were then r and omly assigned to neuropsychological counseling or st and ard , non-specific supportive psychotherapy . The active 12-week treatment emphasized enhancement of insight through education , social skills training , and behavior modification . All patients were re-examined within 2 weeks of the termination of treatment . Neuropsychological technicians were blind to treatment condition . Both groups showed evidence of cognitive impairment and personality/behavior disorder prior to treatment and were well matched on demographic , disability , and cognitive measures . Patients who underwent neuropsychological counseling showed significant positive response on measures of social behavior ( e.g. excessive ego-centric speech ) compared to those who underwent st and ard counseling . We conclude that these data support the use of non-pharmacological , neuropsychological counseling in patients with acquired , MS-associ 
    Output:
    
Some evidence of effectiveness of cognitive rehabilitation  on cognitive outcomes , although this was difficult to interpret because of the large number of outcome measures used .
AUTHORS ' CONCLUSIONS The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS .
However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression , and in helping people adjust to , and cope with , having MS