ACT with NMOSD: A targeted, telehealth-delivered mental health intervention for patients & caregivers.

PURPOSE: The rare, unpredictable, debilitating nature of neuromyelitis optica spectrum disorder (NMOSD) constitutes a unique psychological burden. This single-arm, pilot clinical trial examined the effectiveness of Acceptance and Commitment Therapy (ACT) tailored to meet the psychological burden of NMOSD, a brief telehealth-delivered intervention, targeting this burden.

METHODS

Forty-three adults with NMOSD (76 % aquaporin-4 seropositive (AQP4+)) in USA, with elevated anxiety and/or depression completed 6-weeks of an experiential talk therapy designed to increase psychological flexibility and valued action, specifically tailored to address the psychological burden of NMOSD: Acceptance and Commitment Therapy (ACT) w NMOSD. Patients attended via Zoom, along with 22 caregivers, providing baseline, posttreatment, and follow-up measures of depression, anxiety, cognitive fusion, psychological flexibility, valued living, disability, sleep, fatigue, and pain. Linear mixed effect models examined changes in repeated measures of all outcomes, controlling for age, sex, disability, AQP4 serostatus.

RESULTS

Participants were mostly female (84 %) and Caucasian (56 %), with baseline mild depression (mean 15.4 [SD = 8.7]) and moderate anxiety (mean = 13.5 [SD = 9.3]). Most participants (93 %) completed all treatment sessions and study assessments. Pre-to-post treatment analysis showed clinically meaningful reductions in depression (15.4 (12.8, 19.0) to 11.1 (8.3, 13.8) P<.001;) and anxiety (13.5 (11.2, 15.7) to 10.0 (7.5, 12.4) P ≤.005). Parallel improvements in cognitive fusion (39.6 (35.6, 43.6) to 33.7 (29.6, 37.7) P<.001), psychological acceptance (20.0 (17.3, 22.8) to 17.0 (14.2, 19.8) P < 0.002), valued living (49.2 (43.2, 55.3) to 60.5 (54.4, 66.6) P<.001), and sleep quality (10.1 (9.0, 11.2) to 8.3 (7.1, 9.5), P<.001) support the overall benefit of ACT to mental health. Improvements remained at 3-month follow-up. Disability status, pain, fatigue, were unchanged, as expected.

CONCLUSIONS

ACT with NMOSD is a promising innovative targeted mental health intervention for adults with NMOSD with lasting benefits.

CLINICALTRIALS: gov ID # NCT05840055 Supported by Alexion Pharmaceuticals.