Table 3 Summary of the content of the CBT manual for adjustment to MS

Chapter 1:

Introduction to adjusting to MS

What is MS and what does adjusting to MS mean?

Factors which have been shown to affect adjustment in MS.

A CBT model of adjusting to MS which includes interactions between thoughts, behavior, biology and emotions.

Assessment of current strengths and difficulties.

Chapter 2:

Adapting to living with MS

What do we mean by acceptance?

Strategies for becoming accepting.

Dealing with negative emotions such as sadness, grief, loss, frustration, anger, anxiety, depression, shame and embarrassment.

Chapter 3.

Setting goals and problem solving

Exploring values and setting treatment goals where change may be needed across different areas of life.

Once problems are identified, developing a stepped approach to problem solving drawing on the patient's strengths and support network.

Chapter 4.

Managing symptoms

Helping make the link between symptoms, thoughts and behaviors. May involve a discussion on accepting limitations.

The pitfalls of becoming overly symptom focused and avoidant and strategies for managing these.

Understanding MS symptoms, and which symptoms are likely to be a sign of relapse, medication side effects, or stress/distress.

Diaries of patterns of rest and activity to see how these may influence symptom experience.

Chapter 5.

How to tackle negative and unhelpful thoughts

Demonstrations of how perceptions of events can influence coping with illness.

Identifying traps or 'errors' in thinking and finding alternatives can help with adjustment and levels of distress.

Examples of unhelpful thoughts are covered such as fears about the illness and future, and high personal expectations.

Using daily thought records of unhelpful thoughts, challenging these thoughts and coming up with alternative thoughts.

Chapter 6.

Improving the quality of your sleep

Basic sleep hygiene including establishing a good sleep/wake routine which encourages natural sleep and addressing factors which interrupt sleep.

Goal setting to improve sleep.

Chapter 7.

Managing stress

Exploring skills to call on in times of stress such as distraction, problem solving, relaxation, prioritising, saying no and planning.

Goal setting to improve stress management.

Chapter 8.

Managing social relationships

Becoming more assertive.

Managing relationships with care providers.

Getting the right type of support for one's needs and sharing emotions.

Chapter 9.

Preparing for the future

Identifying physical and emotional warning signs of relapse and normalising these.

Developing a future management plan using personal strengths, newly learnt skills and support from others in difficult times.