The Development and Evaluation of an Online Mindfulness Program for People with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system, which has a significant impact on physical and mental health. The aim of this thesis was to develop and evaluate an online psychological intervention for people with MS (PwMS). A meta-analysis of 13 randomized controlled trials (RCTs) found that psychosocial interventions are effective for PwMS (n = 1617, Sesel, Sharpe, & Naismith, 2018, Chapter 2). Yet cognitive-behavioural therapy, the most commonly evaluated intervention, was not efficacious for a range of outcomes, whilst other interventions were. Thus, an online mindfulness program was developed (Chapter 3). Nineteen face-to-face interviews with PwMS yielded three major themes: uncertainty, grief and loss, and social isolation, which were incorporated into program. A subsample of PwMS (n = 11) and a number of experts (n = 8) provided iterative feedback on the program. The online mindfulness program was evaluated according to a study protocol (Sesel et al., 2019, Chapter 4). An RCT was conducted (n = 132), and at three-months follow-up, the program was found to be effective for depressive symptoms and health-related quality of life (HRQoL) in PwMS (Chapter 5). PwMS with a history of recurrent depression benefitted more from the program that those without on measures of depressive symptoms, mental HRQoL and pain interference. There were no effects for anxiety, fatigue, or pain intensity. The online mindfulness programs such as the one described in this thesis have the potential to increase accessibility to psychological support, which is an important unmet need for PwMS and may help to ease the personal and economic burden of disease. Future research should focus on improving the efficacy and availability of psychological interventions for PwMS, who are often faced with a plethora of psychosocial symptoms and consequences in the prime of their lives