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A remote-access internet-delivered cognitive behavioral therapy program was found to be safe and effective for alleviating the symptoms of depression in multiple sclerosis patients in a new study.

Compared to healthy individuals, people with inflammatory and neurological conditions have a higher prevalence of depression. The onset of depression in multiple sclerosis (MS) patients is associated with impairment of quality of life, higher rates of morbidity and mortality, and more rapid progression of the disease. Among the pharmacological and non-pharmacological therapeutic approaches for countering depression, there is increasing evidence to indicate the advantages of cognitive behavioral therapy (CBT). 

This study employed a multicenter phase 3 trial design to explore the efficacy and safety of internet-delivered CBT for treating depressive symptoms in MS patients. The findings are published in The Lancet, Digital Health.

Baseline Characteristics

The trial included a total of 279 participants, who were randomized to guided internet-based CBT, stand-alone internet-delivered CBT, or a control group. At baseline, 44% of the study participants had received antidepressants. The mean age of the participants in the control, stand-alone internet-delivered CBT, and guided internet-based CBT was 47.3 ± 11.1 years, 46.5 ± 11.9 years, and 47.1 ± 12.1 years, respectively.

Improvement in Depressive Symptoms

Compared to the stand-alone internet-delivered CBT, the guided internet-based CBT group had a higher number of hours worked with the program and a higher number of modules completed. Compared to the control groups, both CBT groups reported a significant reduction in depressive symptoms; however, there were no significant differences between the two intervention groups.

Improvement in Quality of Life

Both internet-delivered CBT groups reported a significant improvement in the quality of life of MS patients, as indicated by the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) environmental, physical, and psychological domains. Improvement was also reported in the psychological quality-of-life assessment using the Multiple Sclerosis Impact Scale (MSIS). The CBT groups, however, demonstrated no significant improvement in the fatigue measures or MS-specific quality of life.

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The study reported no concerns for suicidality or new occurrences of suicidality in the participants. During the study period, there were no hospitalizations, suicidal thoughts, or indications of suicidality during the interview. Three patients in the control group and one patient in the stand-alone internet-delivered CBT group had worsening depressive symptoms.


Gold, S. M., Friede, T., Meyer, B., Moss‐Morris, R., Hudson, J., Asseyer, S., Bellmann‐Strobl, J., Leisdon, A., Ißels, L., Ritter, K., Schymainski, D., Pomeroy, H., Lynch, S. G., Cozart, J., Thelen, J., Román, C. a. F., Cadden, M., Guty, E., Lau, S., . . . Heesen, C. (2023). Internet-delivered cognitive behavioural therapy programme to reduce depressive symptoms in patients with multiple sclerosis: a multicentre, randomised, controlled, phase 3 trial. The Lancet Digital Health, 5(10), e668–e678. https://doi.org/10.1016/s2589-7500(23)00109-7