ACT with NMOSD: A Targeted Mental Health Intervention for NMOSD Patients and Caregivers
darcy esiason1, patrick smith2, wakschal emily3, charles peppers3, leigh andrews3, hallie kushner3, chelsi nurse3, wendy erler5, tom hattrich5, ankita deshpande5, michael levy6, thomas leist3, c virginia O'HAYER4
1Esiason OHayer Institute for Behavioral Medicine, 2university of north carolina chapel hill, 3thomas jefferson university, 4psychiatry and human behavior, thomas jefferson university, 5Alexion Astra Zeneca, 6harvard
Objective:
Determining effectiveness of a 6-session, telehealth-delivered mental health intervention targeting the psychological burden of NMOSD.
Background:
Our team previously defined the extent and nature of the psychological burden of NMOSD for patients and their caregivers (Esiason et al., 2024). With emphasis on improving psychological flexibility, Acceptance and Commitment Therapy (ACT) was predicted to improve depression, anxiety, value-based living, and cognitive fusion/rigidity.
Design/Methods:
Forty-three adults with NMOSD (76% AQP4+) enrolled in the 6-week ACT w NMOSD trial delivered via HIPAA-compliant Zoom. Caregivers were invited to participate to any extent. All completed self-report measures of anxiety (BAI, GAD-7), depression (BDI-II, PHQ-9), cognitive fusion (CFQ-13), psychological flexibility (AAQ-II), valued living (VLQ), disability status (self-report EDSS), sleep quality (PSQI), fatigue (BFI), and pain (Iowa Pain Thermometer). Repeated measures, linear mixed effect models examined changes in each measure, controlling for age, sex, disability, AQP4.
Results:
Participants were mostly female (84%) and Caucasian (56%), with baseline mild depression (mean BDI-II = 16.2 [SD = 8.7]) and moderate anxiety (mean BAI = 14.3 [SD = 9.3]). Pre-to-post treatment analysis evidenced reduction in depression (BDI-II: 16.2 (13.5, 19.0) to 11.7 (8.9, 14.5) P<.001; PHQ-9: 9.1 (7.5, 10.6) to 6.1 (4.6, 7.7) P<.001) and anxiety (BAI = 14.3 (11.8, 16.9) to 11.8 (9.2, 14.4) P =.043; GAD-7 (7.2 (5.8, 8.7) to 5.2 (3.8, 6.7) P<.009). Parallel improvements in cognitive fusion (CFQ: 39.8 (35.8, 43.9) to 34.1 (30.0, 38.2) P<.001), psychological acceptance (AAQ-II: 20.1 (17.3, 22.9) to 17.2 (14.4, 20.0) P <.004), valued living (VLQ: 49.8 (43.7, 55.8) to 59.2 (53.2, 65.3) P<.001), and sleep quality (PSQI: 10.6 (9.4, 11.8) to 8.7 (7.5, 9.9), P<.001). Disability status, pain, fatigue were unchanged. Improvements remained at 3-month follow-up.
Conclusions:
ACT w NMOSD is a promising innovative mental health intervention demonstrating improvements in depression, anxiety, cognitive fusion, psychological flexibility, valued living, and sleep quality, including 3-months post-treatment.
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