Effects of psychological therapies in people with multiple sclerosis: a systematic review and network meta-analysis of randomized controlled trials

Abstract

Background: People with MS (PwMS) often experience high levels of emotional distress. Interventions to improve emotional wellbeing in PwMS are needed; however, the effectiveness of diverse psychological therapies in PwMS on cumulative outcomes is not well understood. This systematic review and network meta-analysis (NMA) aims to evaluate the effectiveness of psychological therapies in PwMS. Methods: Five databases were searched (CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE ALL, APA PsycINFO) from 1984 to April 2025. Randomized controlled trials that compared a psychological intervention with any comparator in PwMS were included. Two independent reviewers performed data extraction and risk of bias analysis. A standard random-effects Bayesian consistency NMA was fitted. Outcome domains included mental health, cognition, physical health, quality of life (QoL), and health economics. Results: After screening, 111 studies were included in the review, 89 included in the meta-analysis, and 77 included in the NMA (n = 3911 participants). Cognitive behavioural therapy was found to be most effective in improving outcomes overall, with the greatest changes in mean difference (MD 11.0, 95% CI 5.72–16.2) when compared with control conditions. Psychological therapies significantly improved mental health outcomes (SMD 1.41; 95% CI 1.00–1.83; p < 0.00001), physical health outcomes (SMD 1.08; 95% CI 0.41–1.74; p < 0.00001), QoL (SMD 0.77; 95% CI 0.21–1.34), and cognition (SMD 0.66, 95% CI 0.24–1.07) in PwMS. Conclusions: This systematic review and NMA found that psychological interventions are broadly effective in PwMS across mental health, cognitive, physical and QoL outcome domains, and provides strong support for their use in the care of PwMS.