Two Sides of the Same Coin: A Randomized Clinical Trial of the Unified Protocol for Addressing Depression and Anxiety in People With Multiple Sclerosis

Background: Depression and anxiety are common in people with multiple sclerosis (MS) and significantly impact disease symptomatology, coping, quality of life (QOL), and psychological well-being (PWB). Effective treatment of both is warranted and may be accomplished using a transdiagnostic intervention such as the Unified Protocol (UP). The purpose of this study was to conduct a pilot randomized controlled trial (Clinical Trials # NCT05953519) to determine the effectiveness of the UP in reducing depression and anxiety and the subsequent impact on MS symptomatology, coping, QOL, and PWB. Methods: Thirty people with MS and depression and/or anxiety were randomly assigned to a UP intervention (n = 12) or a control group (n = 18). Individuals in the intervention group completed a 12-week group virtual intervention. All completed baseline, posttreatment, and 3-month follow-up assessments. All study procedures were approved by the Kessler Foundation Institutional Review Board. Results: Following the intervention, significant reductions in depression, experiential avoidance, and fatigue were observed. Participants also demonstrated improvements in self-efficacy, coping (eg, benefit finding, social support), QOL (eg, flourishing), and PWB (eg, acceptance). These effects were maintained at the 3-month follow-up. Conclusions: The UP intervention holds great promise in reducing mood symptoms in people with MS, as well as fatigue, one of the most detrimental symptoms associated with MS. The impact on coping, QOL, and PWB also suggests greater, long-standing effects on perspective, reframing, and coping, which are likely to have a greater impact overall for individuals with MS.