Psychodrama for Adults With Relapsing-Remitting Multiple Sclerosis: A Mixed-Methods Study

Background: People with MS frequently experience fatigue, cognitive difficulties, depressive and anxiety symptoms, sleep problems and loneliness. Psychodrama is an action-based group psychotherapy method that may support emotional expression, role flexibility and interpersonal connection, but evidence in MS is limited.

Design: Exploratory convergent mixed-methods study combining a one-group pretest-posttest-follow-up quantitative component with a descriptive phenomenological qualitative component. Both components were given equal priority, analysed separately and then integrated using a joint display.

Intervention: A closed psychodrama group met once weekly for 13 sessions (12 December 2024 to 6 March 2025). Each session lasted approximately 180 minutes and followed the classical structure of warm-up, action and sharing, using techniques such as doubling, role reversal, mirroring, soliloquy, chorus and sociometry. Sessions were facilitated by a psychiatric nurse (PhD) with psychodrama assistant certification and a clinical psychologist with psychodrama training. Two trainer psychodramatists provided supervision before and after each session. Neurology clinicians supported medical follow-up, and a referral pathway to neurology and psychiatric services was in place.

Assessments: Loneliness (UCLA Loneliness Scale short form, ULS-6), fatigue (Modified Fatigue Impact Scale, MFIS), cognitive performance (Symbol Digit Modalities Test, SDMT; California Verbal Learning Test-II, CVLT-II), depressive symptoms (Hamilton Depression Rating Scale, HAM-D), anxiety symptoms (Hamilton Anxiety Rating Scale, HAM-A) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were assessed at baseline, post-intervention and 6-month follow-up. Individual online semi-structured interviews were conducted at post-intervention and follow-up.

Analysis: Quantitative data were analysed with the Friedman test and pairwise Wilcoxon signed-rank tests in IBM SPSS Statistics. Qualitative data were analysed with Colaizzi's descriptive phenomenological method in MAXQDA by two independent coders. This study was registered retrospectively.

Adults with relapsing-remitting MS attended 13 weekly group psychodrama sessions (approximately 180 minutes each) in addition to standard medical treatment.

Behavioral: Group psychodrama

Closed-group psychodrama delivered once weekly for 13 sessions of approximately 180 minutes. Each session followed the warm-up, action and sharing structure and included group-centred exercises, protagonist work and vignettes using doubling, role reversal, mirroring, soliloquy, chorus and sociometry. The programme was shaped flexibly according to needs emerging in the group process rather than a symptom-focused protocol.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

Six-item UCLA Loneliness Scale short form (ULS-6); higher scores indicate greater loneliness.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

21-item Modified Fatigue Impact Scale (MFIS), total and physical, cognitive and psychosocial subscale scores; higher scores indicate greater fatigue impact.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

Symbol Digit Modalities Test (SDMT); higher scores indicate better performance.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

California Verbal Learning Test-Second Edition (CVLT-II); higher scores indicate better performance.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

17-item clinician-rated Hamilton Depression Rating Scale (HAM-D); higher scores indicate more severe depressive symptoms.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

14-item clinician-rated Hamilton Anxiety Rating Scale (HAM-A); higher scores indicate more severe anxiety.

Plazo: Baseline, post-intervention (week 13) and 6-month follow-up

Pittsburgh Sleep Quality Index (PSQI) global score; higher scores indicate poorer sleep quality.

Plazo: Post-intervention (week 13) and 6-month follow-up

Individual semi-structured interviews exploring physical, cognitive, psychological and social changes, analysed with Colaizzi's descriptive phenomenological method.

Exploring Therapeutic Change Following Psychodrama in Multiple Sclerosis: A Mixed-Methods Study With 6-Month Follow-Up