In Multiple Sclerosis, Anxiety May Signal Depression
People with MS had emotional balance perturbations in keeping with the Watson-Clark model.
Anxiety is a strong predictor of depression in people with multiple sclerosis (MS), according to a study published in BMC Neurology. In addition, it predicts via both direct and indirect pathways.
While there is a high comorbidity of anxiety and depression in people with MS, the association between the two remains ambiguous. Drawing on Watson and Clark's model of anxiety and depression as well as Rachman's proposal of emotional processing, researchers from the psychology department at the University of Paris West in Nanterre, France, set out to clarify both the relationship between anxiety and depression and the relevance of emotional processing, emotional balance, and coping to depression.
“A key issue is how emotional perturbations (imbalances in positive and negative emotions and emotional processing deficits) lead to depression and whether anxiety exerts an impact directly on depression in MS or whether it influences depression via factors related to emotional processing,” lead Marie-Claire Gay, PhD, said.1
Researchers relied on 189 participants (121 women and 68 men; mean age, 47.2), recruited from 3 French hospitals, who were diagnosed with MS to complete a series of questionnaires to test the following areas:
- anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS)
- emotional processing, measured by the Emotional Processing Scale (EPS-25)
- emotional balance, measured by the Positive and Negative Emotionality Scale (EPN-31)
- alexithymia, measured by Bermond-Vorst Alexithymia Questionnaire (BVAQ)
- coping, measured by the Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) Questionnaire
Based on the results from these self-reported answers, researchers deemed depression to be prevalent in people with MS and that people with MS had emotional balance perturbations in keeping with the Watson-Clark model.2,3
However, the study also presented distinctions from the Watson-Clark study: people with MS and probable anxiety disorder also demonstrated perturbation of positive emotions, while populations of non-depressed people with MS reported high levels of negative emotions but low levels of positive emotions, suggesting that having negative emotions alone is not enough to warrant a diagnosis of depression. Anxiety and dysfunctional emotional processing strongly suggest the existence of negative emotions in depression.
Anxiety not only directly predicted depression but is also an indirect predictor of depression, as measured by the “Unregulated Emotions” subscale of the Emotional Processing Scale and through negative emotions, which can lead to depressive symptoms.
The study's findings suggest the importance of early intervention, and the research team suggests cognitive behavior therapy for patients with MS who exhibit signs of anxiety.
“Interventions should address both individual and social factors that support resilience such as promoting thinking and planning and engagement in meaningful activities,” Dr Gay said. “Positive psychological approaches that focus on eliciting positive emotions may provide a means of reducing or even neutralizing the impact of aversive events on emotional experiences.”4-6
- Gay MC, Bungener C, Thomas S, et al. Anxiety, emotional processing and depression in people with multiple sclerosis [published online February 23, 2017]. BMC Neurol. doi:10.1186/s12883-017-0803-8
- Watson D, Clark LA, Carey G. Positive and negative affectivity and their relation to anxiety and depressive disorders. J Abnorm Psychol. 1988;97:346-353.
- Watson D, Clark LA, Harkness AR. Structures of personality and their relevance to psychopathology. J Abnorm Psychol. 1994;103:18-31.
- Fredrickson BL. The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. Am Psychol. 2001;56:218-226.
- Silverman AM, Am V, Alschuler KN, Smith AE, Ehde DM. Bouncing back again, and again: a qualitative study of resilience in people with multiple sclerosis [published online February 15, 2016.]. Disabil Rehabil. 15:1-9.
- Csillik A. Understanding motivational interviewing effectiveness: contributions from Rogers' client-centered approach. Humanist Psychol. 2013;41:350-363.