Alexandra E.W. Hoogerwerf, Yvonne Bol, Jill Lobbestael, Raymond Hupperts, Caroline M. van Heugten
Medical Psychology, Zuyderland Medical Centre, 6130 MB Sittard/Geleen, The Netherlands. E-mail: s.hoogerwerf@zuyderland.nl
DOI: 10.2340/16501977-2237

Background: Fatigue is the most common symptom in multiple sclerosis. Evidence-based treatment options are scarce.
Objective: To study the feasibility and potential effectiveness of mindfulness-based cognitive therapy in severely fatigued multiple sclerosis patients.
Methods: Non-randomized pilot study with a wai-ting list control period including 59 multiple sclerosis patients with severe fatigue. Primary outcome measure: fatigue severity subscale of the Checklist Individual Strength-20. Secondary measures: Hospital Anxiety and Depression Scale, Life Satisfaction Questionnaire, subscale sleep of the Symptom Checklist-90, Cognitive Failure Questionnaire, Fatigue Catastrophizing Scale, Coping Inventory of Stressful Situations, and Five Facet Mindfulness Questionnaire-Short Form. Measurements were taken before treatment (double baseline), after treatment, and at follow-up (3 months).
Results: Adherence rate was 71%. Eight out of 10 participants who completed the intervention were satisfied with the intervention. Significant time effects were found for 7 out of 11 outcome measures (p = 0. 006 to < 0. 001). The effect size was moderate for all outcome measures that were significant post-treatment and/or at follow-up (Ƞ² = 0. 10–0. 17). Improvements were maintained at follow-up. Of the completers, 46% showed a clinically relevant change regarding fatigue.
Conclusion: Mindfulness-based cognitive therapy is feasible in severely fatigued multiple sclerosis patients and has positive results in the reduction of severe fatigue and several psychological factors.

Although fatigue is the most common symptom of patients with multiple sclerosis (MS), treatment options are limited. Mindfulness based cognitive therapy is a relatively new, but promising cognitive behavioral therapy. It is an attention training with the purpose to become aware of all incoming thoughts and feelings and accept them without judgment. We studied the feasibility and the possible effectiveness of an eight week mindfulness group training in 55 severely fatigued MS patients. We found that the training was feasible for most of the patients and that up to three months after the training, there was a reduction of the fatigue. Patients also experienced less depression, anxiety, and cognitive complaints. Furthermore, patients had less negative thoughts about fatigue and they coped less emotional with their problems. Even though future studies are necessary, mindfulness training seems to be a valuable treatment in MS.

Appendix S1A-B