Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings.

This study assessed the rate of a.) the total and b.) specific psychiatric comorbidities among the three severity ratings for Anorexia Nervosa (AN): DSM-5, ICD-11 and overvaluation of weight and shape (OWS). The sample comprised 312 treatment-seeking patients with AN (mean age = 26.9). Weight and height were taken at intake to calculate BMI, the foundation for the DSM-5 and ICD-11 severity indices. The EDE-Q was used to assess OWS, and the Mini International Neuropsychiatric Interview was conducted to assess psychiatric comorbidities. For the DSM-5, the mild severity group showed a higher total number of psychiatric comorbidities, especially for panic, social anxiety, generalised anxiety, and post-traumatic stress disorders compared to the severe and extremely severe groups. ICD-11 and OWS severity groups did not significantly differ in total comorbidities, except for major depressive disorder and obsessive-compulsive disorders being more prevalent in the "significantly low BMI" ICD-11 group. The high OWS group displayed a notably higher rate of major depressive disorder than the low OWS group. The study underscores inconsistent patterns across the three severity systems, emphasising the need to recognise the current limitations of the assessed severity classification systems in AN assessment and guiding treatment.

Do risk factors differentiate DSM-5 and drive for thinness severity groups for anorexia nervosa?

BACKGROUND: The current study examined whether risk factors for anorexia nervosa (AN) were related to different levels of severity based on (a) the DSM-5/body mass index (BMI) and (b) drive for thinness (DT) severity ratings. METHODS: The sample comprised 153 pairs of individuals with a lifetime diagnosis AN per DSM-IV criteria and their non-ED sisters (N = 306, mean age = 26.53; mean current BMI = 20.42 kg/m2). The Oxford risk factor interview was used to establish AN-related risk factors. Individuals were categorised into the DSM-5 severity groups based on their lowest BMI, while the DT subscale from the eating disorder inventory-2 was used to classify individuals with AN into low and high DT groups. RESULTS: Multinominal regression models showed similar risk factors (e.g., perfectionism, having a history of being teased about weight and shape) contributed to the development of AN using the DSM-5 and DT severity ratings. Follow-up analyses across the severity groups for both indices revealed that only childhood perfectionism was found to be more common in the extreme severe DSM-5 BMI severity group compared to the severe DSM-5 group. CONCLUSION: Overall, this study found little evidence for AN risk factors being related to the DSM-5 and DT severity ratings. However, given the novelty of this study, replication of the current results is warranted.

Several risk factors, such as childhood obesity, have been found to contribute to the development of Anorexia Nervosa (AN). Yet, we are unsure if there is a set of risk factors that influence different levels of AN severity. While the DSM-5 suggests using BMI to measure severity, recent support favour the usage of drive for thinness (DT) as an alternative severity measure. Therefore, this study aimed to explore risk factors specifically associated with the development of different AN severity levels using both the DSM-5 BMI and DT severity classification systems. We recruited 153 pairs of individuals with a lifetime diagnosis AN per DSM-IV criteria and their non-ED sisters. The Oxford risk factor interview was used to establish AN-related risk factors. We found childhood perfectionism, weight/shape teasing, childhood obesity, and breast-related embarrassment to be significant risk factors for AN. Additionally, childhood perfectionism was more common in the extreme severe DSM-5 group compared to the severe DSM-5 group. This suggests that adding perfectionism-related aspects to prevention and early intervention programs for AN may be beneficial. Considering the novelty of this study, replication of the current results is needed.

Validating and developing a shortened version of the detail and flexibility (DFlex) questionnaire for eating disorders, anxiety and depression.

OBJECTIVE: To validate the original and a shortened version of the Detail and Flexibility (DFlex) Questionnaire. METHOD: Confirmatory factor analyses, internal consistency, and discriminant validity estimates were conducted within individuals with a diagnosis of an eating disorder (ED) (n = 124), an anxiety disorder and/or depression (n = 219), and a community sample (n = 852) (Part 1). Convergent validity of the DFlex through comparisons with the Autism Spectrum Quotient, Wisconsin Card Sorting Task, and Group Embedded Figures Task was undertaken within a combined ED and community sample (N = 68). Test-retest reliability of the DFlex was also examined across 2 years in a community sample (N = 85) (Part 2). RESULTS: The original factor structure of the DFlex was not supported. Hence, a shortened version, the DFlex-Revised, was developed. Good discriminant validity was obtained for the DFlex and DFlex-Revised, however, support for convergent validity was mixed. Finally, the 2-year test-retest reliability for the two DFlex versions was found to be low, suggesting potential malleability in construct over this timeframe. CONCLUSIONS: Further research is needed to validate the DFlex in clinical and non-clinical populations using different neurocognitive tests. Test-retest, using varied time intervals, should also be assessed.

Australian elite sport coaches' mental health literacy of eating disorders, orthorexia, and muscle dysmorphia in athletes: A qualitative study.

Athletes have an increased risk of developing eating disorders (EDs) compared to non-athletes. Coaches are in a unique position to identify symptoms and promote timely support; however, research has not yet explored coaches' mental health literacy about DSM-5 EDs and related orthorexia and muscle dysmorphia conditions in elite athletes. Eighteen Australian elite sport coaches from aesthetic, weight-class, and endurance sports participated in individual semi-structured interviews to investigate their mental health literacy of EDs and related conditions. Four themes emerged from the data. Theme 1 (knowledge of EDs and related conditions) highlighted coaches' awareness of maladaptive perfectionism as a key risk factor, limited awareness of EDs without observable weight loss, and conceptualisation of EDs as a nutritional issue. Theme 2 (facilitators to managing EDs) highlighted the helpfulness of building trust with athletes, accessing support staff, emphasising body functionality, and lived experience. Theme 3 (barriers to managing EDs) highlighted coaches' challenges with communicating about body image, responding to denial, and funding constraints. Theme 4 (future ED education and training) highlighted coaches' desire for in-person, interactive training and to support junior-level coaches. These findings may assist in developing tailored educational resources to improve coaches' ability to identify and manage eating-related concerns in athletes.

Assessing severity in anorexia nervosa: Do the DSM-5 and an alternative severity rating based on overvaluation of weight and shape severity differ in psychological and biological correlates?

OBJECTIVE: This study evaluated the severity ratings for anorexia nervosa (AN) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and an alternative severity rating based on overvaluation of weight/shape, on a range of psychological and biological variables. METHOD: A sample of 312 treatment-seeking patients with AN (mean age = 25.3, SD = 7.6; mean BMI = 16.8 kg/m2 , SD = 2.4) were categorised using both DSM-5 severity levels (mild/moderate/severe/extreme) and weight/shape (low/high) overvaluation. The severity categories were compared on a range of psychological (e.g., eating psychopathology) and biological (e.g., sodium) variables. RESULTS: Results showed that the overvaluation of weight/shape appeared better at indexing the level of severity in psychological variables among patients with AN compared to the DSM-5 severity rating with moderate to large effect sizes. Moreover, the DSM-5 mild and moderate severity groups experienced significantly higher eating and general psychopathology than the severe and extreme groups. Finally, neither the DSM-5 nor the weight/shape severity groups differed on any of the biological variables. CONCLUSIONS: This study provided no support for the DSM-5 severity rating for AN, while initial support was found for the weight/shape overvaluation approach in indexing psychological but not biological correlates.

The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis.

BACKGROUND: Depression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS. METHOD: The current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes. RESULTS: Stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness-related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes. CONCLUSION: The significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.

The effects of mindfulness-based interventions on symptoms of depression, anxiety, and cancer-related fatigue in oncology patients: A systematic review and meta-analysis.

OBJECTIVE: Mindfulness-based interventions (MBIs) are increasingly being integrated into oncological treatment to mitigate psychological distress and promote emotional and physical well-being. This review aims to provide the most recent evaluation of Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Cancer Recovery (MBCR) treatments, in reducing symptoms of depression, anxiety and CRF in oncology populations. METHODS: A search using the following search terms was conducted: (mindful* OR mindfulness* OR mindfulness-based* OR MBI* OR MBCT OR MBSR OR MBCR) AND (Oncol* OR cancer OR neoplasm OR lymphoma OR carcinoma OR sarcoma) to obtain relevant publications from five databases: PsycINFO, PubMed, Embase, and MEDLINE by EC, and ProQuest Dissertations & Theses Global from January 2000 to February 2022. 36 independent studies (n = 1677) were evaluated for their overall effect sizes (using random-effects models), subgroup analyses, and quality appraisals. Evaluations were performed separately for non-randomized (K = 20, n = 784) and randomized controlled trials (K = 16, n = 893). RESULTS: The results showed that MBIs have significant medium effects in reducing symptoms of depression (Hedges' g = 0.43), anxiety (Hedges' g = 0.55) and CRF (Hedges' g = 0.43), which were maintained at least three months post-intervention. MBIs were also superior in reducing symptoms of anxiety (Hedges' g = 0.56), depression (Hedges' g = 0.43), and CRF (Hedges' g = 0.42) in oncology samples relative to control groups. The superiority of MBIs to control groups was also maintained at least three months post-intervention for anxiety and CRF symptoms, but not for depressive symptoms. The risk of bias of the included studies were low to moderate. CONCLUSIONS: This review found that MBIs reduced symptoms of depression, anxiety and CRF in oncology populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: International Prospective Register of Systematic Reviews: CRD42020143286.

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms.

OBJECTIVE: The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD: 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS: Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION: We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

Self-concept, illness acceptance and depressive and anxiety symptoms in people with multiple sclerosis.

Little research has examined the relationship between self-concept and depressive and anxiety symptoms and whether this is moderated by illness acceptance in individuals with multiple sclerosis. Results of an online self-report survey completed by 515 individuals with multiple sclerosis revealed that self-concept was negatively associated with depressive and anxiety symptoms with illness acceptance moderating the association such that individuals with highest self-concept and illness acceptance had the lowest levels of depressive and anxiety symptoms. Findings lend support to psychological interventions that focus on increasing illness acceptance and fostering positive self-concept in individuals with multiple sclerosis.

Correction to: Comparison of the effectiveness of a tailored cognitive behavioural therapy with a supportive listening intervention for depression in those newly diagnosed with multiple sclerosis (the ACTION-MS trial): protocol of an assessor-blinded, active comparator, randomised controlled trial.

After publication of our article [1] the authors have notified us that three of the names have been incorrectly spelled.

Comparison of the effectiveness of a tailored cognitive behavioural therapy with a supportive listening intervention for depression in those newly diagnosed with multiple sclerosis (the ACTION-MS trial): protocol of an assessor-blinded, active comparator, randomised controlled trial.

BACKGROUND: Multiple sclerosis (MS) is an unpredictable, chronic neurological disease accompanied with high rates of depression and anxiety, particularly in the early stages of diagnosis. There is evidence to suggest that cognitive behavioural therapy (CBT) is effective for the treatment of depression amongst individuals with MS; however, there is a paucity of tailored CBT interventions designed to be offered in the newly diagnosed period. This trial is the first to assess the effectiveness and cost-effectiveness of a tailored CBT intervention compared to a supportive listening (SL) intervention amongst individuals with MS who are depressed. METHODS: ACTION-MS is a two-arm parallel group, assessor-blinded, active comparator, randomised controlled trial which will test whether a tailored CBT-based intervention compared to an SL intervention can reduce depression and related factors such as anxiety, fatigue, pain and sleep problems in those newly diagnosed with MS. Sixty participants who are within 5 years of having received a diagnosis of MS and scored within the mild to moderate range of depression on the Beck Depression Inventory (BDI-II) will be recruited from MS clinics located across three hospital sites in Melbourne, Australia. The primary outcome is depression severity using the BDI-II at post-assessment. Intervention satisfaction and acceptability will be assessed. A cost-effectiveness analysis will also be conducted. Data will be analysed on an intention-to-treat basis. DISCUSSION: There is a scarcity of psychological interventions for depression targeting the newly diagnosed period. However, interventions during this time point have the potential to have a major impact on the mental and physical wellbeing of those newly diagnosed with MS. The current trial will provide data on the effectiveness of a tailored CBT intervention for the treatment of depression in those newly diagnosed with MS. Findings will also provide effect size estimates that can be used to power a later-stage multi-centre trial of treatment efficacy, and will provide information on the mechanisms underlying any treatment effects and cost-effectiveness data for delivering this intervention in outpatient MS clinics. TRIAL REGISTRATION: ISRCTN trials registry, ISRCTN63987586. Current controlled trials. Retrospectively registered on 20 October 2017.

Importance of Coping in the Relationship Between Executive Function and Quality of Life in People with Multiple Sclerosis.

BACKGROUND: Maximizing quality of life (QOL) for people with multiple sclerosis (MS) is a primary focus of health care management professionals. Research has shown a relationship between QOL and a person's coping style and that coping provides an indirect link between cognition and stress, depression, and anxiety in MS. This research assessed whether coping moderates or mediates the relationship between executive function and QOL in people with MS. METHODS: We assessed 107 people with relapsing-remitting (n = 83) or secondary progressive (n = 24) MS using executive function tasks and self-report coping and QOL inventories. RESULTS: Coping strategies that mediated the relationship between executive function and QOL in people with MS included behavioral disengagement, acceptance, growth, and religion, while moderating strategies were denial, active, religion, adaptive, and total coping indices. Less cognitively demanding coping strategies that were related to increased QOL in people with poorer executive function included acceptance, growth, and religion, and maladaptive strategies associated with poorer QOL were behavioral disengagement and denial. CONCLUSIONS: These results suggest that lessening avoidant coping strategies and strengthening use of less cognitively demanding adaptive coping strategies may improve QOL in people with MS who experience deficits in executive function. Consideration should be given to the development of psychoeducation and interventions with this focus.

Trauma and Mental Health in Resettled Refugees: Mediating Effect of Host Language Acquisition on Posttraumatic Stress Disorder, Depressive and Anxiety Symptoms.

This study examined the relationship between traumatic exposure, host language acquisition and mental health (posttraumatic stress, depressive and anxiety symptoms) in long-term resettled refugees. Participants included a community sample of Bosnian refugees ( N = 138, 55% male, mean age of 40 years old) that had resettled in Australia and Austria on average 18 years prior. Two mediation models were tested based on two competing theories. Model A examined whether language acquisition mediates the relationship between traumatic exposure and mental health problems experienced by refugees. Model B examined whether mental health symptoms mediate the relationship between exposure to traumatic events and the acquisition of host language. Model A fit the data well (CFI = 1.00, SRMR = .017, RMSEA < .001, χ2 p = .526), while Model B was rejected as an acceptable model for the data (CFI = .556, SRMR = .136, RMSEA = .352). In Model A, the indirect pathway from trauma to mental health via language acquisition was significant for PTSD ( ß = .067, p = .028) and anxiety symptoms ( ß = .063, p = .026) but not depression symptoms ( ß = .048, p = .071). Intervention strategies aimed at improving host language acquisition may be important not only in successful adaptation to daily living in the host country, but also to improve the mental health of traumatized refugees.

A qualitative study investigating bipolar patients' expectations of a lifestyle intervention: A self-management program.

BACKGROUND: There is some evidence supporting the efficacy of lifestyle interventions in changing unhealthy habits and reduce the risk of developing comorbid conditions in Bipolar Disorder (BD). AIMS: This qualitative study aimed to identify what an optimal lifestyle intervention would look like for individuals with BD. METHODS: The current findings are based on one focus group and two paired interviews including a total of 10 individuals with BD (44.20 ±â€¯11.11 years; 6 females). Groups' transcripts were analyzed using a narrative approach. Primary themes included facilitating factors and barriers, general content, outcomes, format of the intervention, and background factors. RESULTS: Participants were in favor of a group-based lifestyle intervention as part of their usual treatment. The optimal group format would include 4 to 10 individuals, and comprise of 12 to 18 sessions lasting 1 to 1.5 h each. Accountability, motivation, interaction, and group activities were identified as contributing to the success of a lifestyle intervention. CONCLUSIONS: This qualitative study provides important information regarding aspects of lifestyle intervention format and delivery for individuals with BD. We identified barriers and facilitating factors that should be addressed in health promotion interventions delivered within community mental health settings.

Online Health Seeking Behaviours: What Information Is Sought by Women Experiencing Miscarriage?

One in four pregnancies ends in miscarriage, a distressing event which can cause significant psychosocial impacts for many women, and yet often remains unseen and unspoken. Many would-be mothers turn to the internet for information and emotional support, and to share their experiences. In this paper, we present the results from 12 semi-structured interviews with women, investigating how and what online information they searched for at the time of miscarriage. We found that women are passive information seekers, searching for causes and preventive strategies to inform future pregnancies. Women want information presented in an easy to understand manner that is not overly clinical, and informed by credible sources. Women also seek psychological support and emotional relief through reading about others' experiences and sharing their stories online. The findings from this study provide a unique insight into the support and information needs of women, and will be used to guide the content, design and functionality of web-based technologies for women experiencing miscarriage.

Target Coping Strategies for Interventions Aimed at Maximizing Psychosocial Adjustment in People with Multiple Sclerosis.

BACKGROUND: The experience of psychological distress is prevalent in people with multiple sclerosis (MS), including high levels of stress, anxiety, and depression. It has been shown that people with MS use less adaptive coping compared with healthy individuals. This study examined the ability of coping strategies to predict maladaptive and adaptive psychosocial outcomes across areas of stress, depression, anxiety, and quality of life (QOL) in people with MS. METHODS: 107 people with MS completed measures of depression (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), QOL (Multiple Sclerosis Quality of Life-54), stress (Daily Hassles Scale), and coping (COPE inventory). RESULTS: Consistent with expectations, depression, frequency of stress, trait anxiety, and mental health QOL were predicted by adaptive and maladaptive coping styles. Severity of stressful events was predicted by maladaptive, but not adaptive, coping styles. Depression and mental health QOL were most prominently connected to coping use. Emotional preoccupation and venting showed the strongest relationship with poorer psychosocial outcomes, whereas positive reinterpretation and growth seemed to be most beneficial. CONCLUSIONS: The results of this study highlight the importance of intervention programs targeting specific coping strategies to enhance psychosocial adjustment for people with MS.

Executive function is an important consideration for coping strategy use in people with multiple sclerosis.

INTRODUCTION: Executive function deficits are prevalent in people with multiple sclerosis (PwMS), and PwMS use less adaptive coping than healthy controls. This cross-sectional study assessed whether there is a relationship between executive function and coping in PwMS. METHOD: One hundred and seven participants with relapsing remitting or secondary progressive MS (n = 83 and 24, respectively; age M = 48.8 ± 11.1 years) completed measures of coping and executive function. RESULTS: A positive relationship was found between verbal fluency and use of active, emotional, and instrumental social support coping, and total executive function and substance abuse coping. There was a negative relationship between coping strategies and core (social support, acceptance, religion, restraint, and total coping), higher order (denial and humor), and total executive function indices (acceptance, religion, behavioral disengagement, denial, and total coping). CONCLUSION: These directional differences provide support for the importance of specific executive functions in coping strategy utilization. Understanding these relationships will assist psychologists and neuropsychologists with patient psychoeducation, adaptive coping strategy intervention and management for PwMS with reduced executive function ability.

Intimate relationship quality, self-concept and illness acceptance in those with multiple sclerosis.

Lower levels of Intimate Relationship Quality (IRQ) have been found in those with Multiple Sclerosis (MS) compared to the general population. This study examined an MS sample to see whether IRQ was positively associated with self-concept, whether IRQ was positively associated with MS illness acceptance and whether IRQ was predicted by self-concept and illness acceptance. In this cross-sectional study, 115 participants with MS who were in an intimate relationship completed an online survey advertised on MS related websites. The survey assessed demographic variables, MS illness variables and levels of IRQ, self-concept and illness acceptance. Results revealed that IRQ was significantly positively associated with self-concept and with illness acceptance. Multiple hierarchical linear regression analysis revealed that, after controlling for illness duration and level of disability, self-concept significantly predicted IRQ but illness acceptance did not significantly predict IRQ. This study addressed several gaps and methodological flaws in the literature and was the first known to assess predictors of IRQ in those with MS. The results suggest that self-concept could be a potential target for individual and couple psychological interventions to improve IRQ and contribute to improved outcomes for those with MS.

A pilot randomized controlled trial of a tailored cognitive behavioural therapy based intervention for depressive symptoms in those newly diagnosed with multiple sclerosis.

BACKGROUND: To examine the effectiveness and acceptability of an 8-week individual tailored cognitive behavioural therapy (CBT) intervention for the treatment of depressive symptoms in those newly diagnosed with multiple sclerosis. METHODS: The current study presents a pilot, parallel group randomized controlled trial (RCT) with an allocation ratio of 1:1 conducted in a large research and teaching hospital in Melbourne, Australia. 30 individuals with a mean age of 36.93 years (SD = 9.63) who were newly diagnosed with multiple sclerosis (MS) (X = 24.87 months, SD = 15.61) were randomized to the CBT intervention (n = 15) or treatment as usual (TAU) (n = 15). The primary outcome was level of depressive symptoms using the Beck Depression Inventory-II (BDI-II). Secondary outcomes were level of anxiety, fatigue and pain impact, sleep quality, coping, acceptance of MS illness, MS related quality of life, social support, and resilience. Tertiary outcomes were acceptability and adherence to the intervention. RESULTS: Large between group treatment effects were found for level of depressive symptoms at post and at 20 weeks follow-up (d = 1.66-1.34). There were also small to large group treatment effects for level of anxiety, fatigue and pain impact, sleep quality, MS related quality of life, resilience, and social support at post and at 20 weeks follow-up (d = 0.17-1.63). There were no drop-outs and participants completed all treatment modules. All participants reported the treatment as 'very useful', and most (73.4%) reported that the intervention had addressed their problems 'completely'. CONCLUSIONS: These data suggest that the tailored early intervention is appropriate and clinically effective for the treatment of depressive symptoms in those newly diagnosed with MS. A larger RCT comparing the CBT intervention with an active comparative treatment with longer term follow-up and cost effectiveness analyses is warranted. The pilot trial has been retrospectively registered on 28/04/2016 with the ISRCTN registry (trial ID ISRCTN10423371).