Abstract

Background: Conscientiousness, or the proclivity for deliberation, achievement, and order, declines in many people with multiple sclerosis (MS). Decreased Conscientiousness predicts future cognitive deterioration, brain atrophy, and employment loss in people with MS. As a psychological trait, it may be an actionable antecedent to these important outcomes. We pilot tested an application (app)-facilitated behavioral intervention to help adaptation to low Conscientiousness and, in turn, improve employment.

Methods: Eleven people with MS (five treatment, six control) with low Conscientiousness were recruited for a 12-week randomized controlled trial. The treatment group received a newly developed behavioral treatment and smartphone app designed to help people behave more conscientiously, two teleconference booster sessions, and weekly telephone calls to monitor progress. Employment changes were recorded at baseline and follow-up. Patients provided detailed posttreatment interviews.

Results: Participant groups were matched on baseline age, sex, education, disease duration, hours worked, and Conscientiousness. All participants in the treatment arm reported benefits, found the app easy to use, and would recommend it to others. The treatment group reported significantly more positive work outcomes relative to controls at follow-up (P = .028). Other positive life changes were described by treatment participants during posttreatment interviews.

Conclusions: These results support the hypothesis that behaviors typically associated with low Conscientiousness may be addressed by behavioral therapy in the MS population. In addition to the positive employment changes in the treatment group, several other quality of life changes were described by study participants. Additional research is needed.

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