Combined behavioral, cognitive training aids memory, coping skills
10-week COMBAT-MS program saw results that lasted up to a year
A 10-week program that combines cognitive behavioral therapy — a technique focused on understanding the connection between thoughts, feelings, and behaviors — with cognitive training to improve memory, attention, and problem-solving skills may enhance memory, boost vitality, and help people with multiple sclerosis (MS) develop effective coping strategies.
“These findings align with clinical guidelines and professional recommendations suggesting that integrated approaches addressing both cognitive and psychological domains are important for enabling [people with MS] to live well,” wrote the researchers about their study.
The effects of this program lasted up to a year, particularly when delivered in person. However, the “effects took time to accumulate,” suggesting that adding booster sessions along the way could make the program even more effective. The study, “COMBAT-MS (group-based cognitive remediation and behavioural approaches to intervention in multiple sclerosis),” was led by the University of Sydney’s Brain and Mind Center in Australia and published in Multiple Sclerosis and Related Disorders.
People with MS often experience cognitive impairment, including problems with memory and difficulty concentrating and solving problems, and mental health problems such as anxiety and depression. These challenges can take a toll on their well-being and make it more difficult to adjust to life with MS.
Cognitive training, therapy for MS
The researchers tested a program called COMBAT-MS that combined cognitive behavioral therapy and cognitive training to address both cognitive impairment and mental health problems in patients receiving care at the MS clinic of the Brain and Mind Center.
The study included 105 adults diagnosed with MS. Most (74%) had relapsing-remitting disease, where periods of new or worsening symptoms are followed by periods of recovery. The others had progressive types of MS, where symptoms get steadily worse over time from the onset or after a relapsing-remitting course.
The patients were randomly assigned to either COMBAT-MS (45) or a control group (60) and continued to receive their usual care. On average, both groups had the same age and level of disability, but those in the intervention were older at the onset of their symptoms (33.8 vs. 29.5).
Weekly two-hour group sessions were led by one of two neuropsychologists. Due to the COVID-19 pandemic, some sessions had to be delivered online, allowing the researchers to compare in-person and online versions.
The first five weeks focused on understanding MS and how it affects people physically, emotionally, and socially. Patients set goals, reviewed their support systems, and began cognitive behavioral therapy by exploring how thoughts, feelings, and actions are connected. They also learned how to manage stress by relaxing and how to plan activities.
For the next five weeks, the program shifted toward cognitive training. Patients learned about their memory, attention, and problem-solving skills, and developed personalized strategies to stay organized, manage tasks, and continue adjusting beyond the program.
A year after the face-to-face intervention, the patients reported significantly better overall health and vitality on the 36-item Short Form Health Survey (SF-36) than the control group. In the online intervention and control groups, these scores didn’t change significantly.
The ones who attended the in-person sessions also developed strategies to cope positively, reported more social support, and had improved memory. Unlike those who attended the online sessions, however, they didn’t see significant improvements in fatigue, a common symptom of MS.
“The COMBAT-MS program, integrating [cognitive behavioral therapy] and [cognitive training], demonstrates feasibility and potential efficacy in improving cognitive and psychosocial health in [people with MS], with outcome variability influenced by the mode of delivery,” the researchers wrote.
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