Abstract
Self-management (SM) interventions improve pain, fatigue, and depression in individuals with chronic health conditions. However, little is known about the psychological mechanisms underlying symptom improvement. The current study sought to identify potential mechanisms that mediate the effect of participation in a cognitive-behavioral SM intervention on symptom improvement in multiple sclerosis (MS). Participants were 163 adults with MS reporting chronic pain, fatigue, and/or moderate depression who participated in one of two 8-week, 1:1 telephone-delivered interventions [SM, education]. Measures of affect, cognitive appraisal (e.g., pain catastrophizing, self-efficacy), behavior (e.g., behavioral activation, distraction), and outcome (pain interference, fatigue impact, depression) were administered at pre-, mid-, and post-intervention. Path analysis was used to test the indirect effects of each mediator with each outcome. Significant and marginally significant (p
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