title: Managing Neuropsychological Impairment in Multiple Sclerosis: Pilot Study on a Standardized Metacognitive Intervention.
abstract: BACKGROUND
  Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of potential autoimmune origin that is frequently associated with psychological disorders and cognitive deficits, as well as with fatigue, stress, and psychosocial burden. These factors often cause decreased quality of life, social withdrawal, and unemployment. We describe the development of a cognitive-behavioral group intervention based on the concept of metacognition and evaluation of the feasibility and acceptance of the program as a rehabilitation tool.
  
  
  METHODS
  Metacognitive Training in MS (MaTiMS) consists of six modules, each 90 minutes in duration. We tested acceptance and design of the program in six focus groups (entire sample, n = 27). Framework analysis of transcripts was used to identify key topics and categories. Program modules were revised in accordance with appropriate recommendations of focus group members. We subsequently evaluated MaTiMS in two groups (n = 5, n = 6) in a rehabilitation center. Neuropsychological functioning as well as coping self-efficacy, depression, stress, perceived cognitive deficit, fatigue, and quality of life were assessed. Acceptance of MaTiMS from the patient perspective was also studied.
  
  
  RESULTS
  The modules were highly accepted by patients. Pre-post assessments showed significant improvements in the Coping Self Efficacy Scale (P = .007), the Würzburger Fatigue Inventory for MS Score (P = .028), and the Hamburg Quality of Life Questionnaire in Multiple Sclerosis Mood subscale (P = .046).
  
  
  CONCLUSIONS
  These preliminary results suggest that MaTiMS represents a feasible psychological group training program that may foster improvements in self-efficacy, fatigue, and mood. The next step will be an evaluation of the program in a randomized controlled trial.
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology (JP, SL, CH) and Department of Psychiatry and Psychotherapy (SM), University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; and Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland (IP).
authors.forename: Jana
authors.initials: J
authors.lastname: Pöttgen
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology (JP, SL, CH) and Department of Psychiatry and Psychotherapy (SM), University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; and Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland (IP).
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lau
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology (JP, SL, CH) and Department of Psychiatry and Psychotherapy (SM), University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; and Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland (IP).
authors.forename: Iris
authors.initials: I
authors.lastname: Penner
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology (JP, SL, CH) and Department of Psychiatry and Psychotherapy (SM), University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; and Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland (IP).
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
authors.affiliation: Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology (JP, SL, CH) and Department of Psychiatry and Psychotherapy (SM), University Medical Center, Hamburg-Eppendorf, Hamburg, Germany; and Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland (IP).
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz