Ires Ghielen

99 Meta-analyses on psychotherapies in MS and PD Introduction Progressive neurological disorders, such as Multiple Sclerosis (MS), Parkinson’s disease (PD) and Huntington’s disease (HD), are often accompanied by psychological distress [1-3]. Psychological distress can be defined as negative mental health states and includes anxiety and depressive symptoms. Psychological distress has a higher impact on the quality of life of both the patients and their caregivers as compared to the physical symptoms that accompany the diseases [4, 5]. The resemblance between MS, PD and HD includes the progressive nature of the disease, uncertainty on disease course, and incurability (only symptom reduction is possible), which contribute to psychological distress. In addition to these factors, psychological distress can arise from physical symptoms such as spasms, rigidity, and autonomic dysregulation, resulting in a vicious circle where physical and psychological symptoms reinforce one another. On the neurobiological level, frontostriatal circuits are affected by the disease, causing disruptions in cognition, affect, motivation, behavior, and stress regulation [6, 7]. Because of these similarities, it is likely that these three patient populations can equally benefit from psychological treatments. This hypothesis is supported by the finding that a standardized psychosocial self-management program proved to be effective in a variety of chronic diseases, including MS, PD, and HD [8]. A considerable number of studies has investigated potential effective treatments for psychological distress reduction. These treatments are cognitive behavioral and mindfulness-based. In an extensive review and meta-analysis, Hofmann and colleagues [9], showed that cognitive behavioral therapy (CBT) is an effective treatment for psychological distress and, more specifically, anxiety symptoms in patients with psychiatric and medical conditions. Besides classical CBT, problem solving and self-management therapies are also considered CBT-based since these interventions are based on the same principles. In PD patients, CBT also showed positive effects in treating anxiety and depressive symptoms [10-12]. In MS, Dennison and colleagues [13] concluded that CBT is effective in improving the management of somatic symptoms and psychological distress. According to Novak and Tabrizi [14], depression and anxiety are usually treated with medication in HD patients, but CBT is also effective in well-selected patients that experience mild symptoms and who have insight in their psychological problems. However, no controlled studies have been performed in this patient group. 6