Telephone-supported Acceptance and Commitment Bibliotherapy for people with Multiple Sclerosis and psychological distress: a randomised controlled feasibility trial

Background: Telephone-supported self-help Acceptance and Commitment Therapy (ACT) may be a way of providing accessible and effective psychotherapy to people with Multiple Sclerosis (MS). The aim of this trial was to determine the feasibility of a randomised controlled trial (RCT) of telephone-supported ACT bibliotherapy compared to treatment-as-usual (TAU), and explore the effectiveness of the intervention. Methods: The study was a randomised control feasibility trial. The intervention was eight weekly support calls guiding participants through the ACT self-help text “Get Out Of Your Mind and Into Your Life†(Hayes, 2005). Participants were assessed at baseline and post-intervention using the Generalised Anxiety and Depression Measure (GAD) and the Patient Health Questionnaire (PHQ) as primary outcome measures. The EuroQol (EQ-5D-5L) and Multiple Sclerosis Impact Scale (MSIS-29) were secondary outcome measures, and the Acceptance and Action Questionnaire (AAQ-II) was a process measure. A sample of participants were interviewed to assess RCT feasibility. Results: 27 participants with MS with anxiety and/or depression were recruited from an outpatient MS clinic and an MS charity. The majority of participants found the different elements of the RCT acceptable. Overall attrition was 66%, and 64% in the intervention group. Linear mixed model analysis and effect size calculation found a significant effect (p=0.004) and large effect size (0.84 (95% confidence intervals 0.02-1.66)) at post-intervention in favour of the intervention on anxiety in intention-to-treat analysis. Smaller non-significant positive effects were found on other measures. Intervention completers had significantly lower scores on the MSIS and the AAQ-II at baseline. Discussion: Telephone-supported ACT bibliotherapy delivered in a RCT format may be a feasible research method for people with MS, and the intervention has the potential to be effective in reducing psychological distress. However, attrition rates must be addressed: practical changes to the method of delivery to increase participant retention are suggested.