Journal Article Ahead of print
PubMed: 42431140 DOI: 10.1016/j.msard.2026.107375
Effectiveness of the adapted Unified Protocol (UP-MSo) in relapsing-remitting multiple sclerosis with overweight/obesity: A pre-registered randomized controlled trial on emotion regulation, eating behavior, and neurological outcomes.
Mult Scler Relat Disord 113:107375
Authors: Maria Consuelo San Martín, Marcos Domic-Siede, Marcela Soto, Paulina Pino-Ruy-Perez, Luis Pardo-Garrido, Rodrigo Beltran, Vanetza E Quezada-Scholz, Candelaria Zegers, Nicolas Zuñiga, Jorge Osma, Carlos Guevara
Affiliations
- Escuela de Psicología, Universidad de los Andes, Av. Mons. Alvaro del Portillo 12455, Las Condes, Santiago, 7620001, Chile.
- Escuela de Psicología, Universidad Católica del Norte, Av. Angamos 0610, Antofagasta, 1270709, Chile.
- Departamento de Psicología, Universidad de Chile, Av. Capitan Ignacio Carrera Pinto 1045, Ñuñoa, Santiago, 7800284, Chile.
- Departamento de Psicología, Universidad de Chile, Av. Capitan Ignacio Carrera Pinto 1045, Ñuñoa, Santiago, 7800284, Chile; Escuela de Psicología, Pontificia Universidad Católica de Chile, Av. Vicuna Mackenna 4860, Macul, Santiago, 7820436, Chile.
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Calle Juan del Rosal 10, Madrid, 28040, Spain.
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Calle Atarazanas 4, Teruel, 44003, Spain.
- Facultad de Medicina, Hospital Clínico José Joaquin Aguirre, Universidad de Chile, Av. Santos Dumont 999, Independencia, Santiago, 8380453, Chile; Servicio de Neurología, Hospital San Juan de Dios, Santiago, Chile.
Abstract
BACKGROUND
Relapsing-remitting multiple sclerosis (RRMS) is frequently associated with anxiety, depression, and emotion regulation difficulties, which may foster maladaptive coping strategies such as emotional eating and contribute to comorbid overweight/obesity. Transdiagnostic, emotion-focused interventions may be especially relevant for this population.
OBJECTIVE
To evaluate the effectiveness of an adapted group-based Unified Protocol (UP) on emotion regulation, eating behaviors, and medical outcomes in adults with RRMS and overweight/obesity.
METHODS
A pre-registered single-blind randomized controlled trial (OSF: https://osf.io/sr4bx) compared a 14-session group-based adapted UP (n = 47) against standard medical care (n = 33). Complete pre-post medical data (body mass index (BMI), weight, Expanded Disability Status Scale (EDSS), Symbol Digit Modalities Test (SDMT), magnetic resonance imaging (MRI) brain metrics, T2 lesions) were available for both arms; complete psychological self-report data were available only for the intervention arm. Medical outcomes were analyzed with two-way mixed ANOVAs (Group × Time); psychological outcomes were analyzed within-arm with linear mixed-effects models.
RESULTS
Within the intervention arm, significant pre-post improvements were observed in emotion regulation difficulties, emotional eating, and psychosocial impairment, with longitudinal reductions in anxiety and depressive symptoms. Between-group analyses revealed significant Group × Time interactions for BMI (p=.030, ηp²=.07), weight (p=.024, ηp²=.07), and EDSS (p<.001, ηp²=.31), favoring the intervention. No interactions emerged for SDMT, MRI brain volumes, or T2 lesions.
CONCLUSIONS
Within the intervention arm, the group-based UP was associated with within-group improvements in emotion regulation and disordered eating, and with between-group anthropometric and EDSS outcomes relative to standard care. Because the psychological outcomes were assessed within the intervention arm only, these within-group changes should not be interpreted as treatment effects relative to standard care. EDSS findings should be interpreted as preliminary, as they were not corroborated by confirmed disability improvement criteria or concurrent MRI changes.
MeSH
Sclerosis, Multiple Sclerosis, Eating, Emotions, Brain, Feeding Behavior, Obesity, Overweight, Wounds And Injuries, Multiple Sclerosis, Relapsing-Remitting, Emotional Regulation, Emotional Eating