Evaluating the Feasibility and Effectiveness of an Online Psychological Intervention Targeting Problem-Solving and Coping Strategies in People With Multiple Sclerosis
Phase: NA
Conditions: Multiple Sclerosis, Anxiety, Problem Solving, Depression Anxiety Disorder, Coping
Sponsor: American University of Beirut Medical Center

Evaluating the Feasibility and Effectiveness of an Online Psychological 
Intervention Targeting Problem-Solving and Coping Strategies in People With 
Multiple Sclerosis 
 
NCT Number: Not assigned yet 
SBS-2023-0043 
 
March 16, 2026 
 
 

Brief Summary (for ClinicalTrials.gov submission) 
Overview: 
Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the brain and spinal cord, 
often leading to unpredictable symptoms and significant emotional distress. Many people with 
MS experience anxiety, depression, and difficulties in coping with the challenges of the disease. 
Research has shown that effective coping—especially problem-focused coping—can reduce 
psychological distress and improve quality of life. However, access to psychological care can be 
limited, particularly in low-resource or mobility-restricted settings. 
This study, conducted at the Nehme and Therese Tohme Multiple Sclerosis Center at the 
American University of Beirut Medical Center (AUBMC), evaluated the feasibility and 
preliminary effectiveness of an eight-week, online psychological intervention designed to 
enhance problem-solving and coping strategies in adults with MS living in Lebanon. 
Study Objectives: 
The primary objective was to determine whether an online problem-solving coping strategies 
(PCS) intervention is feasible, acceptable, and well-tolerated for people with MS. The secondary 
objective was to assess the intervention’s preliminary effects on problem-focused coping, 
depression, and anxiety. 
Design and Methods: 
This was a pilot randomized controlled trial (RCT) including 30 adults diagnosed with MS for 
at least one year. Participants were randomly assigned in equal numbers (1:1 ratio) to one of two 
groups: 
1. PCS Intervention group: 15 participants received eight weekly, 60-minute individual 
online sessions with a licensed clinical psychologist using WhatsApp video calls. 
2. Treatment-as-Usual (TAU) group: 15 participants continued their regular neurological 
and nursing care without additional psychological intervention. 
All participants completed questionnaires at baseline and at the end of the 8-week study to 
measure coping strategies, anxiety, and depression using validated Arabic versions of the Brief-
COPE Scale and the Hopkins Symptom Checklist (HSCL-25). The PCS group also completed 
a self-developed Feasibility Questionnaire to assess the acceptability and practicality of the 
online sessions. 
Intervention Details: 
The PCS program was developed in Arabic by a multidisciplinary team including psychologists, 
nurses, and physicians. It was based on Lazarus and Folkman’s Transactional Model of 
Stress and Coping (1984) and Problem-Solving Therapy principles. Each session included 
psychoeducation about healthy versus maladaptive coping, guided problem-solving exercises, 
and real-life applications through weekly homework. The sessions emphasized identifying 
challenges, generating solutions, weighing pros and cons, and implementing action plans. 

Feasibility Results: 
All 30 participants completed the study (100% retention). All PCS participants attended at least 
six of the eight sessions, meeting the feasibility benchmark for adherence. The average 
feasibility score was 60.5 out of 65, indicating high satisfaction and tolerance for the online 
format. Participants reported that WhatsApp was practical, accessible, and easy to use, especially 
for those with limited mobility or lower technological literacy. 
Qualitative feedback showed four main positive themes: 
1. Improved problem-solving and active coping skills. 
2. Greater self-awareness and confidence. 
3. Emotional expression and sense of safety during sessions. 
4. Altruism, with participants sharing learned coping skills with others. 
Minor challenges included unstable internet connections and limited privacy at home. 
Preliminary Effectiveness Findings: 
Both groups showed improvements in coping, depression, and anxiety after 8 weeks. Participants 
in the PCS group demonstrated a significant increase in problem-focused coping and a 
significant reduction in depression and anxiety scores, although differences between the PCS and 
TAU groups were not statistically significant due to the small sample size. The results indicate 
promising trends suggesting that online coping interventions can complement standard medical 
care and improve emotional well-being. 
 
Conclusions and Future Directions: 
This pilot study demonstrates that an online, problem-solving coping intervention is feasible, 
acceptable, and safe for people with MS in Lebanon. Delivering psychological care through 
accessible platforms like WhatsApp may reduce barriers to mental health support for individuals 
facing mobility, geographic, or resource limitations. 
The findings encourage larger, multi-site studies to confirm these results and explore group-
based or hybrid models that combine psychological support, coping skills training, and peer 
interaction. Future studies could also assess long-term outcomes and integration of such 
interventions into national MS care pathways through the Ministry of Public Health. 
 
Trial Information: 
• 
Sponsor / Site: American University of Beirut Medical Center (AUBMC), Nehme and 
Therese Tohme MS Center 
• 
Principal Investigator: Prof. Samia J. Khoury, MD 
• 
Study Design: Randomized, open-label, two-arm pilot RCT 
• 
Sample Size: 30 participants (15 PCS intervention; 15 control) 
• 
Intervention Name: PCS (Problem-Solving Coping Strategies) 

• 
Duration: 8 weeks per participant 
• 
Delivery Platform: WhatsApp video sessions 
• 
Outcome Measures: Feasibility, problem-focused coping (Brief-COPE), depression and 
anxiety (HSCL-25) 
• 
IRB Approval: AUB IRB Protocol SBS-2023-0043 
• 
ClinicalTrials.gov registration: Pending (Retrospective registration underway)