The application of cognitive behavioral therapy on Leventhals’ model for improving quality of life in multiple-sclerosis patients

Farhad Hazhir, Hasan Ahadi, Abas Pourshahbaz, Mansour Rezaei


Background: Multiple sclerosis is a common disorder between neural and immune systems whose main psychological consequence is dropping the quality of life. The lack of a basic targeted theoretical model is the most common flaw of few pre trails. It has been shown; the components of Leventhals’ model (illness representations) are associated with chronic illness outcomes. The aim of this study was to determine the effectiveness of cognitive-behavior therapy on altering illness representations and improving the Quality of Life of the patients.

Methods: In a randomized controlled trial design, based on the inclusion criteria, 35 volunteer patients allocated to intervention and control groups. An extensive interventional Cognitive behavior therapy based package was conducted to intervention group in 10 weekly sessions. The control group stayed in waiting list and participated in 5 biweekly group meeting sessions. (IPQ-R) and (SF-36) scales were used to assess illness representations and quality of life.

Results: The results showed positive changes in 4 illness representation components of the patients including illness (identity, Consequences, coherence) and personal control. Associated positive changes emerged in emotional representations, physical and psychological domains of quality of life, too (P<0.01).

Conclusion: Mooney and Padeskeys’ theoretically based Cognitive- Behavior Therapy, is effective on improving patient’s quality of life via modulating emotional and illness representations. The findings of this study have some similarities with that of Goodman’s’ trial on systemic lupus erythematosus patients and Petries’ trail on cardiac patients.


Sage N, Sowden M, Chorlton E, Edeleaun A. CBT for chronic Illness and palliative care; A workbook and Toolkit. Sussex: John Wiley & Sons. 2008.

Thomas PW, Thomas S, Hillier C, Galvin K, Baker R. Psychological intervention for multiple sclerosis. Cochrane Database of Systematic Reviews. 2009.

Siegert RJ, Abernethy DA. Depression in multiple sclerosis: a review. J Neurol Neurosurg Psychiatry. 2005;76(4):469-75.

Falvo D. Medical and psychological aspects of chronic illness and disability. 3rd ed. Canada: Jones and Bartlett Publishers. 2005;16-17.

Sadeghi Kh. [The effectiveness of cognitive- Behavioural therapy in treating patients with obesity (Persian)]. PhD thesis in clinical psychology. Tehran: Tehran psychiatric Institute, Iran University of Medical Sciences. 2007; 92-4.

Diner E, Seligman MEP. Beyond money: toward an economy of well being. Psychological Science in the public interest. 2004; 5(1): 1-31.

Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. J Rehabil Res Dev. 2005;42(3 Suppl 1):87-110.

Leventhal H, Brissette I, Leventhal EA. The common-sense model of self- regulation of health and illness. In: Comeron LD, Leventhal H. The self- regulation of health and illness behaviour. London: Routledge. 2003; 42-65.

Pimm TJ, Byron MA, Curson D, Weinman J. Personal illness models and the self-management of arthritis. Arthritis and Rheumatism.1994; 37(9 Suppl): S358.

Hazhir F. [The application of cognitive- Behaviour therapy for altering illness representations of (M.S) patients and improving their quality of life (Persian)]. PhD thesis in health psychology. Karaj: Islamic Azad University. 2011.

Hazhir F, Ahadi H, Pourshahbaz A, Rezaei M. [The effectiveness of cognitive- behavior therapy on illness representations of multiple-sclerosis patients and improving their emotional states(Persian)]. Journal of Kermanshah University of Medical Sciences. 2012; 15(6): 414-27.

Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. [The revised illness perception questionnaire (IPQ-R)]. Psychology and Health. 2002: 17(1):1-16.

Clark DM, Faibairn CG. Science and practice of cognitive therapy. Oxford: Oxford University Press. 1996.

Goodman D, Morrissey S, Graham D, Bossingham D. The application of cognitive- behavior therapy in altering illness representations of systemic lupus erythematous. Behav Change. 2005; 22: 156-71.

Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med. 2002;64(4):580-6.

Padesky CA, Mooney KA. Clinical tip: Presenting the cognitive model to clients. International Cognitive Therapy Newsletter. 1990; 6: 13-4.

Masoudnia E. Illness perception and delay in seeking help in women with breast cancer symptoms. An appraisal of self-regulation model. Journal of Behavioral Sciences. 2008; 2(3): 271-82.

Sadeghi Kh, Gharaee B, Mazhari SZ. [Effectiveness of cognitive- bbehavioral treatment in treating of patients with obesity(Persian)]. Andeeshe va Raftar. 2010;16(2): 107-17.

Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875-82.

Bryant RA, Harvey AG. Acute stress disorder: A handbook of theory, assessment and treatment. American Psychological Association (APA). 2000: 87-134.

Taylor RR. Cognitive Behavioral Therapy for chronic Illness and disability. Chicago: University of Illinois. Department of occupational therapy. 2000; MC 811.

Greenberger D, Padesky CA. Mind over mood: change how you feel by changing the way you think. Guilford press. 1995; 63-89.

Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press. 1976.

Beck A, Rush A, Shaw B, Emery G. Cognitive therapy for depression. New York: Guilford Press, (1979).

Sanderson, C. A. [Health psychology]. New York: Willey. 2004; 260-61.

Sarafino EP. Health psychology. Translated by a group of translators under supervision of Mirzaei E, 1st ed. Tehran: Roshd Publisher. 2005; 188-92, 252-62.

Seligman MEP. Helplessness: on depression, development and death. San Francisco: Freeman. 1975.

Guthrie E. Emotional disorder in chronic illness: psychotherapeutic interventions. Br J Psychiatry. 1996;168(3):265-73.

Bruggimann L, Annoni JM. Management of Anxiety disorders in neurological disease. Schweitzer Archive for Neurology and psychiatry. 2004; 155: 407-13.

Ropper AH, Brown RH. Adams and victor's principles of Neurology. 8th ed. MCGraw Hill. 2005;776.

Ghasemzadeh H, Arjmand M, Mohsenifar S, Hamidpour H. [The revised Illness Perception Questionnaire(Persian)]. available at IPQ-RWebsite.



  • There are currently no refbacks.

Copyright (c)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.