Intensive social cognitive treatment (can do treatment) with participation of support partners in persons with relapsing remitting multiple sclerosis: observation of improved self-efficacy, quality of life, anxiety and depression 1 year later.Jongen PJ, Heerings M, Ruimschotel R, Hussaarts A, Duyverman L, van der Zande A, Valkenburg-Vissers J, van Droffelaar M, Lemmens W, Donders R, Visser LH.
In persons with multiple sclerosis (MS) self-efficacy positively affects health-related quality of life (HRQoL) and physical activity. In a previous study we observed that 6 months after an intensive 3-day social cognitive treatment (Can Do treatment) with the participation of support partners, self-efficacy and HRQoL had improved in persons with relapsing remitting MS (RRMS). Given the chronic nature of the disease, it is important to know whether these beneficial changes may last.
Can Do treatment was given to 60 persons with MS and their support partners. At baseline and 12 months after treatment self-efficacy control, self-efficacy function, physical and mental HRQoL, anxiety, depression and fatigue were assessed via self-report questionnaires. Differences were tested via a paired t test.
Of the 57 persons with MS that completed the baseline assessment and the 3-day treatment, 38 filled in the 12th month questionnaires (response rate 66.7 %), 22 with RRMS and 14 with progressive MS. In the RR group self-efficacy control had increased by 20.2 % and physical HRQoL by 15.0 %, and depression and anxiety had decreased by 29.8 and 25.9 %, respectively (all P < 0.05); the changes in mental HRQoL (+17 %) and fatigue (-20 %) failed to be statistically significant (P = 0.087, P = 0.080, respectively). In the progressive group no changes suggestive of improvement were seen.
The findings suggest that a 3-day intensive social cognitive treatment (Can Do treatment) with the participation of support partners may have long lasting beneficial effects on the self-efficacy and HRQoL in persons with RRMS; and that improvements in anxiety and depression, not seen in the 6-month study, may yet develop at 12 months.
Tony Robbins - a well known self-help guru/motivational speaker
The saying that you cannot have a positive life and a negative mind is never truer than when you become unwell. But as truisms go advice is cheap and available in abundance, but you have to be prepared to listen and to a certain degree truly believe.
Participation is therefore critical to the success of social programs. People affected by MS vary in the level of support needed and it is difficult to standardize such a treatment or to tailor to suit a wider audience. What may not be counterintuitive is to use this in the clinic setting where you have the freedom of tailoring the program.
Jongen et al, talk of "self-efficacy" - how confident are you in completing tasks and reaching goals in specific situations? They further elaborate and state that one's ability to produce a desirable effect or outcome is crucial to success, and is influenced by experience, social persuasion and psychological factors. In chronic conditions, they note that self-efficacy and psychosocial well being are related, and that self-efficacy is the single most consistent determinant of physical activity. Critical to their way of thinking is illness behaviour - where medical help seeking behaviour is a reaction to underlying life stressors (e.g. unemployment or marital problems). Identification of individual stressors and their elimination can improve self-efficacy. This is not a novel concept, and is well known in mindfulness programs.
Using a social cognitive "Can Do" treatment program with the support of partners, the authors demonstrate that you may be able to have long-lasting effects on self-efficacy, at least in RRMS. Simply put, believing that you can, means that you can. However, this type of program may not work in progressive patients. A special type of resilience is needed in progressive disease with regular reinforcement, where a short program, such as this, may not be successful. This is where partners are critical, and speaking from experience partners appreciate being involved, even if it's medically sanctioned!