Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis

  • Marzieh Hajibabaei ORCID Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran. AND Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Mohammad Bagher Kajbaf ORCID Mail Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
  • Maryam Esmaeili ORCID Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
  • Mohammad Hossein Harirchian ORCID Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
  • Ali Montazeri ORCID Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran. AND School of Humanity Sciences, University of Science and Culture, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran.
Cognitive-Behavioral Therapy, Existential-Spiritual Intervention, Meaning in Life, Multiple Sclerosis, Quality of Life


Objective: Multiple sclerosis (MS) is a chronic neurological disease that could aggressively affect patients’ quality of life in most instances. This study aimed to compare the effectiveness of an existential-spiritual psychotherapy with a cognitive-behavioral therapy on quality of life and meaning in life in women with multiple sclerosis.
Method: A convenience sample of 43 women with multiple sclerosis participated in this quasi-experimental study. They were randomly assigned into 3 groups: an existential-spiritual intervention, a cognitive-behavioral intervention, and the control group. Participants were assessed for outcome measures (quality of life and meaning in life) at 3 points in time: pretest, posttest, and 5-months follow-up. The Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Meaning in Life Questionnaires (MLQ) were used as outcome measures. To compare outcomes among the study groups, repeated measures analysis of variance was performed.
Results: The results showed that while no difference was observed for the control group, scores for meaning in life improved significantly for existential-spiritual intervention and cognitive-behavioral therapy (p = 0.027, p = 0.039). Also, both mental (p < 0.001, p = 0.014) and physical (p = 0.001, p = 0.013) health dimensions of quality of life increased significantly in the 2 intervention groups. However, the results indicated that women in the existential-spiritual intervention group showed greater improvement in some aspects of meaning in life (search for meaning) and quality of life (role physical and role emotional, pain and energy) compared to women in the cognitive-behavioral intervention group. However, the latter group showed better improvements on 2 subscales (physical function and health distress).
Conclusion: Both existential-spiritual and cognitive-behavioral interventions can improve quality of life and meaning in life among women with multiple sclerosis. However, the findings suggest that although both interventions were effective, the existential-spiritual intervention resulted in more positive improvements in some aspects of meaning in life and quality of life.


1. Young L, Healey K, Charlton M, Schmid K, Zabad R, Wester R. A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol. F1000Res. 2015;4:872.
2. Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol 2016;172(1):3-13.
3. Milo R, Kahana E. Multiple sclerosis: geoepidemiology, genetics and the environment. Autoimmun Rev. 2010;9(5):A387-A94.
4. Wallin MT, Culpepper WJ, Nichols E, Bhutta ZA, Gebrehiwot TT, Hay SI, et al. Global, regional, and national burden of multiple sclerosis 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18(3):269-85.
5. Eskandarieh S, Heydarpour P, Elhami SR, & Sahraian MA. Prevalence and incidence of multiple sclerosis in Tehran, Iran. Iran J Public Health. 2017;46(5), 699-704.‏
6. Eskandarieh S, Allahabadi NS, Sadeghi M, Sahraian MA. Increasing prevalence of familial recurrence of multiple sclerosis in Iran: a population based study of Tehran registry 1999-2015. BMC Neurol. 2018;18(1):15.
7. Adelman G, Rane SG, Villa KF. The cost burden of multiple sclerosis in the United States: a systematic review of the literature. J Med Econ. 2013;16(5):639-47.
8. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000;343(13):938-52.
9. Chalah MA, Ayache SS. Psychiatric event in multiple sclerosis: could it be the tip of the iceberg? Braz J Psychiatry. 2017;39(4):365-8.
10. McKeown LP, Porter-Armstrong AP, Baxter GD. Caregivers of people with multiple sclerosis: experiences of support. Mult Scler. 2004;10(2):219-30.
11. Solari A. Role of health-related quality of life measures in the routine care of people with multiple sclerosis. Health Qual Life Outcomes. 2005;3:16.
12. Ford HL, Gerry E, Johnson MH, Tennant A. Health status and quality of life of people with multiple sclerosis. Disabil Rehabil. 2001;23(12):516-21.
13. Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D, et al. ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24(2):96-120.
14. Kang KA, Shim JS, Jeon DG, Koh MS. [The effects of logotherapy on meaning in life and quality of life of late adolescents with terminal cancer]. J Korean Acad Nurs. 2009;39(6):759-68.
15. Frankl VE. Man's Search for Meaning, New York: Touchstone. Simon & Schuster; 1984.
16. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: a review of manualized interventions. Clin Psychol Rev. 2008;28(3):472-93.
17. Tang PL, Chen WL, Cheng SF. [Using logotherapy to relieve death anxiety in a patient with recurrent cancer: a nursing experience]. Hu Li Za Zhi. 2013;60(4):105-10.
18. Sun FK, Hung CM, Yao Y, Fu CF, Tsai PJ, Chiang CY. The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients: A Preliminary Study. Cancer Nurs. 2019.
19. Rahnama P, Javidan AN, Saberi H, Montazeri A, Tavakkoli S, Pakpour AH, et al. Does religious coping and spirituality have a moderating role on depression and anxiety in patients with spinal cord injury? A study from Iran. Spinal Cord. 2015;53(12):870-4.
20. Irvine H, Davidson C, Hoy K, Lowe-Strong A. Psychosocial adjustment to multiple sclerosis: exploration of identity redefinition. Disabil Rehabil. 2009;31(8):599-606.
21. Hajiaghababaei M, Saberi H, Rahnama P, Montazeri A. Spiritual well-being and quality of life in patients with spinal cord injury: A study from Iran. J Spinal Cord Med. 2018;41(6):653-8.
22. Mauk KL, Schmidt NA. Spiritual care in nursing practice: Lippincott Williams & Wilkins; 2004.
23. Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med. 2009;12(10):885-904.
24. McNulty K, Livneh H, Wilson LM. Perceived uncertainty, spiritual well-being, and psychosocial adaptation in individuals with multiple sclerosis. Rehabil. Psychol. 2004;49(2):91-9.
25. White CA. Cognitive behaviour therapy for chronic medical problems: A guide to assessment and treatment in practice: John Wiley & Sons Ltd; 2001.
26. Dennison L, Moss-Morris R. Cognitive-behavioral therapy: what benefits can it offer people with multiple sclerosis? Expert Rev Neurother. 2010;10(9):1383-90.
27. Moorey S, Cort E, Kapari M, Monroe B, Hansford P, Mannix K, et al. A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Psychol Med. 2009;39(5):713-23.
28. Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141-53.
29. Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological interventions for multiple sclerosis. Cochrane Database Syst Rev. 2006(1):Cd004431.
30. Malcomson KS, Dunwoody L, Lowe-Strong AS. Psychosocial interventions in people with multiple sclerosis: a review. J Neurol. 2007;254(1):1-13.
31. Pakniya N, Bahmani B, Dadkhah A, Azimian M, Naghiyaee M, MASUDI SR. Effectiveness of cognitive existential approach on decreasing demoralization in women with multiple sclerosis. IRANIAN REHABILITATION JOURNAL. 2015; 13(4):28-33.
32. Ghazavi Z, Rahimi E, Yazdani M, Afshar H. Effect of cognitive behavioral stress management program on psychosomatic patients' quality of life. Iran J Nurs Midwifery Res. 2016;21(5):510-5.
33. Frankl VE. The doctor and the soul: From psychotherapy to logotherapy: Vintage; 1986.
34. Alavi MS, Jabal Ameli S. The Effectiveness of Cognitive-Behavioral Therapy on Emotional Control of MS Patients in the City of Isfahan. Jorjani Biomed J. 2018;6(1):44-54.
35. Vickrey BG, Hays RD, Harooni R, Myers LW, Ellison GW. A health-related quality of life measure for multiple sclerosis. Qual Life Res. 1995;4(3):187-206.
36. Ghaem H, Borhani Haghighi A, Jafari P, Nikseresht AR. Validity and reliability of the Persian version of the multiple sclerosis quality of life questionnaire. Neurol India. 2007;55(4):369-75.
37. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. J. Couns. Psychol. 2006;53(1):80-93.
38. Mesrabadi J, Jafariyan S, Ostovar N. Discriminative and construct validity of meaning in life questionnaire for Iranian students. J Behavi Scie. 2013;7(1):83-90.
39. Haresabadi M, Karimi Monaghi H, Froghipor M, Mazlom S. Quality of life in patients with multiple sclerosis referring to Ghaem hospital, Mashhad in 2009. JNKUMS. 2011;2(4):7-12.
41. Delaney C, Barrere C, Helming M. The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study. J Holist Nurs. 2011;29(1):21-32.
42. Moss-Morris R, Dennison L, Landau S, Yardley L, Silber E, Chalder T. A randomized controlled trial of cognitive behavioral therapy (CBT) for adjusting to multiple sclerosis (the saMS trial): does CBT work and for whom does it work? J Consult Clin Psychol. 2013;81(2):251-62.
43. van Kessel K, Moss-Morris R, Willoughby E, Chalder T, Johnson MH, Robinson E. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med. 2008;70(2):205-13.
44. Breitbart W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer. 2002;10(4):272-80.
45. Nsamenang SA, Hirsch JK, Topciu R, Goodman AD, Duberstein PR. Erratum to: The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis. J Behav Med. 2016;39(2):364.
46. Puchalski C, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3(1):129-37.
47. Kang K, Im J, Kim H, Kim S, Song M, Sim S. The effect of logotherapy on the suffering, finding meaning, and spiritual well-being of adolescents with terminal cancer. Curr Dir Psychol Sci. 2009;15(2):136-44.
48. Solaimani Khashab A, Ghamari Kivi H, Fathi D. Effectiveness of Cognitive Behavioral Therapy on Spiritual Well-Being and Emotional Intelligence of the Elderly Mourners. Iran J Psychiatry. 2017;12(2):93-9.
How to Cite
Hajibabaei M, Kajbaf MB, Esmaeili M, Harirchian MH, Montazeri A. Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis. Iran J Psychiatry. 15(4):322-330.
Original Article(s)