title: Psychotherapy and pharmacotherapy interventions to reduce distress or improve well-being in people with amyotrophic lateral sclerosis: A systematic review.
abstract: Our objective was to systematically review and critically evaluate the evidence for psychotherapy and pharmacotherapy interventions for reducing distress or improving well-being in people with amyotrophic lateral sclerosis (pwALS). Online bibliographic databases and clinical trial registers were searched and an assessment of study quality was conducted. Seven thousand two hundred and twenty-three studies were identified, of which five met inclusion criteria (four completed and one in progress). All studies examined psychotherapeutic interventions, and no studies investigated pharmacotherapy. Two studies adopted a randomized controlled trial design, one a controlled trial design and two a cohort design. Sample sizes were small in all studies (overall n = 145). The quality of completed studies was generally poor, with evidence that all were at potential risk of bias in numerous areas. Improvements in well-being were found with expressive disclosure (compared to no disclosure), cognitive behavioural therapy/counselling (compared to non-randomized pharmacotherapy) and hypnosis in the short term only, while no improvements were seen with a life review intervention. In conclusion, there is currently insufficient evidence to recommend the use of specific psychotherapy interventions for reducing distress or improving well-being in pwALS, and no evidence to support pharmacotherapy interventions. Research is urgently needed to address these significant gaps in the literature.
authors.affiliation: a Department of Old Age Psychiatry , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Gould
authors.affiliation: b Department of Psychology , School of Science and Technology, Middlesex University , London , UK.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Coulson
authors.affiliation: c Department of Psychology , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
authors.affiliation: c Department of Psychology , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Goldstein
authors.affiliation: d Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK.
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Chalabi
authors.affiliation: a Department of Old Age Psychiatry , Institute of Psychiatry, King's College London , London , UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Howard
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000188:drug therapy / Q000534:rehabilitation; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation
keywords: Amyotrophic lateral sclerosis; distress; pharmacotherapy; psychotherapy; well-being