Thoughts on Cognitive Behavioral Psychotherapy (CBP) for Multiple Sclerosis

Here is My Question:
What are your thoughts on CBP? Does your center offer cognitive therapy? Do you think medications are more effective than the physical therapy for cognitive function?


Answer:
Cognitive Behavioral Psychotherapy (CBT) can be helpful in the setting of depression and significant adjustment reaction to the diagnosis of MS.  I have used this with good results in some patients.  The evidence supports an emphasis on CBT offering coping strategies (which is what some of my patients have found helpful).  As with any form of this type of therapy, success is determined--to a degree--on the patient-therapist interaction.  On rare occasion, it may be more difficult to find the right personality match between therapist and patient.  At our center, we have neuropsychologists who can engage in this type of therapy, and I suspect most comprehensive MS centers have this resource or, at a minimum, a list of good therapists in the community.

For cognitive rehabilitation, we use the speech language pathologist in this role but some centers use neuropsychologists, psychologists or social workers for this role.  In order to make this effective, we first obtain neuropsychological testing (in the appropriate individual) which is a battery of tests that determine an individual's strengths and weaknesses in respect to their cognitive function.  Once the pattern of deficits is understood, a tailored rehab program can be created and implemented.  This is also a helpful modality of treatment.
 
MS research has evaluated various medications that are used in other cognitive diseases (such as Alzheimer's and other cognitive impairment/memory diseases).  Unfortunately, the results have been mixed at best, but typically disappointing.  When I think of medicine and cognitive problems in MS, I first think about medication I can remove from a patient's medicine cabinet.  Many of the symptomatic medications we use in MS can have the side effect of cognitive dysfunction.
 
For more information on cognition and MS, please see Dr. Kinkel's blog.
 
Hope this helps,
A. Scott Nielsen MD, MMSc
Virginia Mason Multiple Sclerosis Center
Seattle, WA