A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): Does CBT work and for whom does it work?

Moss-Morris, Rona; Dennison, Laura; Landau, Sabine; Yardley, Lucy; Silber, Eli; Chalder, Trudie

doi:10.1037/a0029132

Cited by 97Multiple Sclerosis Research StudiesMindfulness and Compassion InterventionsCancer survivorship and care

A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): Does CBT work and for whom does it work?

Moss-Morris, Rona, Dennison, Laura, Landau, Sabine, Yardley, Lucy, Silber, Eli, Chalder, Trudie·2013·Journal of Consulting and Clinical Psychology

DOI 10.1037/a0029132

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Abstract

OBJECTIVE: The aims were (a) to test the effectiveness of a nurse-led cognitive behavioral therapy (CBT) program to assist adjustment in the early stages of multiple sclerosis (MS) and (b) to determine moderators of treatment including baseline distress, social support (SS), and treatment preference. METHOD: Ninety-four ambulatory people with MS within 10 years of diagnosis were randomized to receive 8 individual sessions of CBT (n = 48) or supportive listening (n = 46), most delivered on the telephone, in a multicenter randomized controlled trial. The primary outcomes were distress and functional impairment. Secondary outcomes included global improvement, acceptance of illness, and dysfunctional cognitions. Assessments were completed at home and were coordinated by a blind assessor. Data were analyzed by intention-to-treat using multilevel models. RESULTS: The CBT group was significantly less distressed at the end of treatment (estimated General Health Questionnaire group difference = 3.2 points, 95\% CI 1.1 to 5.4 points) and at the 12-month follow-up (estimated group difference = 2.2 points, 95\% CI 0.01 to 4.4 points). There were no differences between the groups on functional impairment. The CBT group also demonstrated significantly greater improvements on secondary outcomes at the end of treatment but not at the 12-month follow-up. CBT participants with poor SS and/or clinically defined levels of distress at baseline showed significantly greater gains on both primary outcomes. Treatment preference did not moderate treatment effects. CONCLUSION: CBT is more effective than supportive listening in reducing distress in people with MS. CBT appears most effective for patients with poor SS and high levels of distress. The loss of gains in the secondary outcomes by 12 months suggests further follow-up sessions may be warranted.

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CBT may be useful in mitigating depression, anxiety, fatigue, disability, cognitive problems, and improving quality of life in patients with multiple sclerosis.
“There is evidence suggesting that CBT may be useful in mitigating depression, anxiety, fatigue, disability, problems related to cognition, in addition to improving the quality of life of PwMS (13, 16).”
From The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis) (2022) · cites this paper as [13]

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Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses
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“6 MS nurses are often the main point of contact between patients and their care team on a day-to-day basis and therefore they play a pivotal role in producing positive outcomes in MS. 6 The success of the pharmaceutical industry-sponsored patient support programs is indicative of the impact that properly trained nurse…”
BackgroundInfluential
Activity patterns in response to symptoms in patients being treated for chronic fatigue syndrome: An experience sampling methodology study.
Band, R. J., Barrowclough, C., Caldwell, K., Emsley, R., & Wearden, A. J. (2016) · Health Psychology · doi:10.1037/hea0000422 · Cited by 19 · see citing works
“Both of these therapies involve a gradual and programmed increases in activity and may result in breaking the link between experiencing symptoms and activity levels, thus modifying patient beliefs and behavioral responses that are thought to perpetuate CFS (Moss-Morris et al., 2013).”
Background
Communication between persons with multiple sclerosis and their health care providers: A scoping review
Thompson, C. M., Pulido, M. D., Babu, S., Zenzola, N., & Chiu, C. (2022) · Patient Education and Counseling · doi:10.1016/j.pec.2022.07.013 · Cited by 19 · see citing works
The relation between goal adjustment, goal disturbance, and mental well-being among persons with multiple sclerosis
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Exploring meanings of illness causation among those severely affected by multiple sclerosis: a comparative qualitative study of Black Caribbean and White British people
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“Interventions to support this approach include nurseled and cognitive behavioural therapy (CBT), which appears to be successful in the early stages of MS [44,45], but has not been tested in more advanced illness or across ethnically diverse populations.”
BackgroundSelf-citation
Supporting brain health in multiple sclerosis: exploring the potential of neuroeducation combined with practical mindfulness exercises in the management of neuropsychological symptoms
Baetge, S. J., Filser, M., Renner, A., Raithel, L. M., Lau, S., Pöttgen, J., & Penner, I. (2023) · Journal of Neurology · doi:10.1007/s00415-023-11616-2 · Cited by 16 · see citing works
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“…and activities in everyday life because of the illness and this can lead to a worse adjustment, while patients’ engagement in goals in accordance with their present resources is linked to higher well-being, as also stressed by literature (Moss-Morris et al., 2013; Neter, Litvak, & Miller, 2009).”
BackgroundResultInfluential
A group memory rehabilitation programme for people with traumatic brain injuries: the ReMemBrIn RCT
das Nair, R., Bradshaw, L. E., Carpenter, H., Clarke, S., Day, F., Drummond, A. E., Fitzsimmons, D. F., Harris, S. R. S., Montgomery, A. A., Newby, G., et al. (2019) · Health Technology Assessment · doi:10.3310/hta23160 · Cited by 16 · see citing works
“5) 68 (23) Median (25th, 75th centile) 72 (56, 87) 69 (51, 83) 70.”
Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis
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Comparing individual and group intervention for psychological adjustment in people with multiple sclerosis: a feasibility randomised controlled trial
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A case-control study of psychosocial factors and their relationship to impairment and functionality in multiple sclerosis
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Self-citation
Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain: A mixed‐methods treatment fidelity evaluation
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“The 5-item alliance subscale of the adapted Primary Care Therapy Rating Scale (Godfrey, Chalder, Ridsdale, Seed, & Ogden, 2007; Moss-Morris et al., 2013) assesses therapist and patient contributions to alliance during psychological interventions (Table 3).”
Method
A systematic review of economic analyses of psychological interventions and therapies in health-related settings
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Cost-effectiveness of nurse-delivered cognitive behavioural therapy (CBT) compared to supportive listening (SL) for adjustment to multiple sclerosis
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“Providing booster sessions at follow up may improve quality of life gains as the treatment effect for CBT at the end of treatment was greater than at follow-up [17].”
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‘I can do this’: a qualitative exploration of acceptability and experiences of a physical activity behaviour change intervention in people with multiple sclerosis in the UK
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“based on materials used in the Supportive Adjustment for Multiple Sclerosis programme.(17) Self- reflection exercises”
Method
Chronic illness and mental health
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Psychotherapy and professional psychological support in multiple sclerosis: Uncovering patients’ patterns of access and preferences
Morris-Bankole, H., & Ho, A. K. (2023) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2023.104562 · Cited by 8 · see citing works
An acceptance and commitment therapy intervention for a woman with secondary progressive multiple sclerosis and a history of childhood trauma *
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The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support
Briones‐Buixassa, L., Montañés‐Masias, B., Milà, R., Arrufat, F., Aragonès, J. M., Norton, S., Roig, J. B., & Moss-Morris, R. E. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111375 · Cited by 7 · see citing works
Self-citation
Acceptance-based telephone support around the time of transition to secondary progressive multiple sclerosis: A feasibility randomised controlled trial
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Palliative Care Aspects in Multiple Sclerosis
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Beyond supervised therapy: Promoting behavioral changes in people with MS
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The nature of anger in people with multiple sclerosis: a qualitative study
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“As with other qualitative studies into MS, the involvement of another coder (LL) was welcomed (Dennison, Moss-Morris, Yardley, Kirby, & Chalder, 2013; Dennison, Yardley, Devereux, & Moss-Morris, 2011; Isaksson & Ahlstr€om, 2006; Moss-Morris et al., 2013).”
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Managing the Symptoms of Multiple Sclerosis
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“30 Promotion of spiritual wellbeing as well as discussions with the health care team about future planning may help patients adapt to their ‘‘new’’ normal and cope with prognostic uncertainty.”
Symptom Management in Multiple Sclerosis
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The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis)
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How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated moderation analysis
Goldsmith, K., Hudson, J. L., Chalder, T., Dennison, L., & Moss-Morris, R. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103594 · Cited by 2 · see citing works
Self-citation
Psychotherapy in treatment and rehabilitation of patients with multiple sclerosis
Nikolaev, E., Poluektov, M. G., Васильева, Н. В., & Голенков, А. В. (2017) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2017117121132-140 · Cited by 2 · see citing works
Feasibility, acceptability, and exploratory outcomes of a virtual cognitive behavioural therapy‐based group intervention for persistent fatigue in endometriosis: The Managing Fatigue in Endometriosis (MEND) programme
Spyrelis, A., Loades, M. E., & Roomaney, R. (2025) · British Journal of Health Psychology · doi:10.1111/bjhp.70014 · Cited by 2 · see citing works
“Third, publications by well-known experts in fatigue and CBT were considered (Burgess & Chalder, 2009; Moss-Morris et al., 2013).”
Behavioral medicine and clinical health psychology: Introduction to the special issue.
Christensen, A. J., & Nezu, A. M. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0031685 · Cited by 2 · see citing works
COMBAT-MS (group-based cognitive remediation and behavioural approaches to intervention in multiple sclerosis)
Diamond, K., Ruane, R., Dawes, C., Byrne, S., Taha, M., Foo, A. C. M., Mowszowski, L., Beadnall, H. N., Garber, J., Po, K., et al. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106464 · Cited by 1 · see citing works
Systematic review of therapeutic interventions for psychological adjustment to physical health diagnoses in adults
Stoner, C. R., Perkins, A., Durgante, H. B., Birt, L., & Spector, A. E. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2573835 · Cited by 1 · see citing works
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“Current approaches to student mental health management typically include pharmacotherapy, psychological therapies such as cognitive behavioral therapy (CBT), counselling services, and digital or campus-based support programmes (5, 6).”
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“…im Vergleich zu emotionsfokussierten und supportiven Interventionen sowie Entspannungsübungen, da die CBT vor allem über die Reduktion des Vermeidungsverhaltens sowie die Veränderung dysfunktionaler Einstellungen zur Fatigue wirkt [Hind et al., 2014; Moss-Morris et al., 2013; Knoop et al., 2012].”
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Galtrey, C. M., & Cock, H. R. (2015) · Neuropsychiatric symptoms of neurological disease · doi:10.1007/978-3-319-22159-5_15 · Cited by 1 · see citing works
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Comparison of the effectiveness of acceptance and commitment therapy and cognitive behavior therapy on fatigue in multiple sclerosis (MS) patients
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STATISTICAL AND GRAPHICAL EVIDENCE SYNTHESIS METHODS IN HEALTH TECHNOLOGY ASSESSMENT
Tan, S. H. (2016) · Leicester Research Archive (University of Leicester)
Support for practitioners working with people with neurodegenerative disorders
Barcroft, R., Simpson, J., & Butchard, S. (2016) · FPOP Bulletin Psychology of Older People · doi:10.53841/bpsfpop.2016.1.136.21
Multiple Sclerosis
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Implementing Cognitive Behavioral Therapy into Post Cerebral Vascular Accident Rehabilitation: An Occupational Therapy Guideline
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A Group Cognitive Behavioural Therapy Improves Quality of Life of Multiple Sclerosis Patients and Delays Disease Progression: A Multi-Centre Controlled Trial
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Effect of risk propensity on treatment understanding and decisions in MS patients
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Exploring the fear-avoidance model after brain injury
Wijenberg, M. (2021) · doi:10.26481/dis.20210705mw
Chapter 22. Individual and Group Psychotherapy
Smoski, M. J., & Kiosses, D. N. (2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615375196.ds22
Neuropsychiatric Manifestations in Multiple Sclerosis and Other Demyelinating Diseases
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How adults with chronic health conditions made self-administered music interventions (SAMIs) work: thematic synthesis from a mixed-studies systematic review
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Additional file 2 of Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial
Norton, C. S., Syred, J., Kerry, S., Artom, M., Sweeney, L., Hart, A., Czuber‐Dochan, W., Taylor, S. J., Mihaylova, B., Roukas, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15103024
Self-citation
Additional file 3 of Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial
Norton, C. S., Syred, J., Kerry, S., Artom, M., Sweeney, L., Hart, A., Czuber‐Dochan, W., Taylor, S. J., Mihaylova, B., Roukas, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15103027
Self-citation
Additional file 5 of Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial
Norton, C. S., Syred, J., Kerry, S., Artom, M., Sweeney, L., Hart, A., Czuber‐Dochan, W., Taylor, S. J., Mihaylova, B., Roukas, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15103033
Self-citation
Additional file 1 of Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial
Norton, C. S., Syred, J., Kerry, S., Artom, M., Sweeney, L., Hart, A., Czuber‐Dochan, W., Taylor, S. J. C., Mihaylova, B., Roukas, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15103021
Self-citation
Additional file 4 of Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial
Norton, C. S., Syred, J., Kerry, S., Artom, M., Sweeney, L., Hart, A., Czuber‐Dochan, W., Taylor, S. J. C., Mihaylova, B., Roukas, C., et al. (2021) · Figshare · doi:10.6084/m9.figshare.15103030
Self-citation
The COMPASS-MS Study on Implementing Digital Assessment and Treatment for Psychological Distress in Patients With Multiple Sclerosis: Protocol for a Real-World Longitudinal Study
Jenkinson, E., Moss-Morris, R. E., Seaton, N., Silber, E., Okai, D., Wroe, A. L., Brodie, S., Norton, S., & Hudson, J. L. (2026) · JMIR Research Protocols · doi:10.2196/83416
“CBT treatment protocols that are tailored to the challenges of living with MS appear to demonstrate larger treatment effects than traditional CBT [21], which reflects findings in other LTC populations, showing that LTC-tailored CBT increases treatment effect sizes for psychological distress…”
Self-citation
Evaluation de la personnalité, du coping et de la régulation émotionnelle de patients atteints de Dystrophie Myotonique de type 1 (DM1)
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A tailored cognitive behavioural therapy intervention for depression in those newly diagnosed with multiple sclerosis (ACTION-MS): A randomised, assessor-blinded, active comparator trial
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Improving work outcomes in people with multiple sclerosis: A scoping review of non-pharmacological interventions
Saddal, S. R. D., Perez, B. D. D., Machado, A., Friberg, E., das Nair, R., Radford, K., Daams, J. G., Hulst, H. E., de Groot, V., van der Hiele, K., et al. (2026) · Clinical Rehabilitation · doi:10.1177/02692155261454943
Reframing multiple sclerosis care: Integrating psychological, somatic, and spiritual dimensions
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Psychotherapeutic care for patients with multiple sclerosis
Zarubina, N. V., Tsygankov, B. D., & Artemyeva, M. S. (2026) · Vestnik nevrologii psihiatrii i nejrohirurgii (Bulletin of Neurology Psychiatry and Neurosurgery) · doi:10.33920/med-01-2605-05
Space to grieve and grow: A systematic review of psychosocial interventions for people newly diagnosed with multiple sclerosis
Phillips, C. S., Ha, R., Dhillon, S., & Stuifbergen, A. M. (2026) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2026.107883

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis
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How and for whom does supportive adjustment to multiple sclerosis cognitive-behavioural therapy work? A mediated moderation analysis
Goldsmith, K., Hudson, J. L., Chalder, T., Dennison, L., & Moss-Morris, R. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103594 · Cited by 2 · see citing works
Self-citation
Cognitive–behavioral therapy: what benefits can it offer people with multiple sclerosis?
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A randomized trial of cognitive behavioural therapy for improving psychological distress and cognitive impairments in multiple sclerosis
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Evaluating the effects of cognitive-behavioral group for chronic pain management in individuals with multiple sclerosis
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Authors: Moss-Morris, R., Dennison, L., Landau, S., Yardley, L., Silber, E., & Chalder, T.
Affiliations: King's College London (GB)
University of Southampton (GB)
King's College Hospital NHS Foundation Trust (GB)
ORCID: Moss-Morris, Rona
Landau, Sabine
Yardley, Lucy
Silber, Eli
Chalder, Trudie
Venue: Journal of Consulting and Clinical Psychology
Publisher: American Psychological Association (APA)
Published: 2013
Volume: 81
Issue: 2
Pages: 251-262
ISSN: 0022-006X (ISSN-L)
1939-2117
DOI: 10.1037/a0029132
OpenAlex: W2053281833
Cited by: 97
References: 46
Citations by year: 2026: 7 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 9 · 2021: 11 · 2020: 6 · 2019: 9 · 2018: 6 · 2017: 8 · 2016: 9 · 2015: 7 · 2014: 4 · 2013: 7
FWCI: 4.15
Type: journal article
Language: en
Open access: closed
Locations: Journal of Consulting and Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Funders: Multiple Sclerosis Society
Topics: Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: multiple sclerosis, cognitive behavioral therapy, adaptation to chronic illness, nurse-led intervention, telephone-delivered therapy, distress, social support, treatment moderators, functional disability, acceptance of illness, dysfunctional cognitions, early diagnosis
MeSH terms: Adaptation, Psychological, Adult, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Cognitive Behavioral Therapy, Treatment Outcome

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A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): Does CBT work and for whom does it work?

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