Telehealth offers a new path for improving mental health in NMOSD
6-week intervention program seen to ease anxiety, depression in adults
A six-week psychotherapy program, tailored specifically for people with neuromyelitis optica spectrum disorder (NMOSD) and delivered via telehealth, helped to ease anxiety and depression in adults with these conditions — with benefits lasting up to three months after treatment.
These are the findings of a U.S. pilot clinical trial (NCT05840055) that tested ACT with NMOSD, an acceptance and commitment therapy (ACT) program, in 43 adults with both the autoimmune disease and elevated anxiety and/or depression.
According to the researchers, those participants showing greater gains in psychological flexibility, or the capacity to navigate difficult emotions while continuing to engage in meaningful activities, were more likely to experience reductions in mental health issues.
Overall, by the program’s end, participants tended to have reduced cognitive fusion, defined as the tendency to get stuck in negative thoughts and let them guide action, and to see improvements in valued living — when people align their actions with their personal values.
“ACT with NMOSD is a promising innovative targeted mental health intervention for adults with NMOSD with lasting benefits,” the researchers wrote.
The study, “ACT with NMOSD: A targeted, telehealth-delivered mental health intervention for patients & caregivers,” was published in Multiple Sclerosis and Related Disorders. It was supported by Alexion Pharmaceuticals, which developed certain NMOSD-approved therapies and is now known as Alexion, AstraZeneca Rare Disease after its acquisition by AstraZeneca.
NMSOD is an autoimmune disease marked by sudden episodes of damaging inflammation that primarily affects the spinal cord and optic nerves, which relay signals between the eyes and the brain. This can result in symptoms such as vision loss, muscle weakness, and pain.
Because these inflammatory attacks are unpredictable and can cause permanent disability, people with NMOSD often live with constant uncertainty that can significantly affect their mental health.
Many NMOSD patients worry about future relapses, deal with isolation
Indeed, many patients experience anxiety about future relapses and disease progression. Depression is also common, often linked to physical limitations, social isolation, or loss of function.
According to the researchers, cognitive fusion is “a previously unknown aspect of the psychological burden of NMOSD.” However, the team noted that nearly two-thirds of patients and half of caregivers “endorsed clinically-relevant cognitive fusion.”
This mental rigidity can limit psychological flexibility, making it more difficult for individuals to adapt to changes or to engage in meaningful activities despite their health challenges. For people with NMOSD, it can further contribute to psychological distress.
Caregivers also often experience similar emotional strain while supporting loved ones through the ups and downs of the disease.
ACT, a form of psychotherapy that aims to enhance psychological flexibility and improve overall well-being, has been shown to be effective in people with chronic diseases.
Now, a team of researchers in the U.S. sought to evaluate its potential in NMSOD. To that end, the team conducted a pilot study using a six-week telehealth version of ACT, specifically adapted for people with NMOSD and their caregivers.
A total of 43 patients with elevated anxiety and/or depression, as well as 22 caregivers, were recruited at two U.S. sites — one in Virginia and one in Georgia. Most patients were women (86%), and slightly more than half were Caucasian individuals. About three-quarters were positive for the most common NMOSD-driving self-reactive antibodies. Among caregivers, about two-thirds were Caucasian individuals, and 55% were spouses or partners.
The program involved weekly 50-minute Zoom sessions led by trained therapists. Each session included experiential interventions, such as mindfulness practices, acceptance, and values clarification, along with home practices.
Gains in mental health still seen 3 months after telehealth program ended
At the start of the program, the NMSOD patients had moderate to high levels of anxiety and depression, clinically significant cognitive fusion, and psychological flexibility that tended toward lower than normal. Caregivers tended to report clinically relevant depressive and anxiety symptoms.
All but three patients completed all six sessions. Immediately after the program, patients showed significant reductions in anxiety, depression, and cognitive fusion, along with significant improvements in psychological flexibility and valued living. These benefits were sustained at three months after the intervention was completed, according to the researchers.
There also was a trend toward improved self-reported adherence to NMOSD medication immediately after the program, though this effect was not sustained at the three-month follow-up, per the study data.
Caregivers also experienced some improvements, though to a lesser degree. There was a trend toward reduced depressive symptoms over time, and cognitive fusion was significantly reduced by the three-month follow-up.
[The results] suggest that ACT with NMOSD is an effective and enjoyable talk therapy for adults with NMOSD, with positive treatment effects persisting at [three] months after the end of treatment.
Further analyses showed that the strongest predictors of depression and anxiety reductions after the intervention, as well as greater flexibility improvements, were higher levels of depression and/or anxiety at the study’s start, as well as lower psychological flexibility at the study’s start.
“The ACT with NMOSD intervention effectively improved psychological flexibility, and the more flexibility improved, the more depression and anxiety reduced,” the researchers wrote.
Among the study’s limitations, as noted by the team, was that intervention adherence was based on self-reports. Importantly, also, the patient sample was mostly Caucasian people, when the disease is more frequent among nonwhite populations.
Still, the results “suggest that ACT with NMOSD is an effective and enjoyable talk therapy for adults with NMOSD, with positive treatment effects persisting at [three] months after the end of treatment,” the researchers concluded.
The team also noted that the program would be fairly easy to implement.
“The trainability of the protocol, with high treatment fidelity is encouraging of ACT with NMOSD as an intervention that can feasibly be taught to providers and delivered widely to people with NMOSD and their loved ones,” the researchers wrote.
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