Comparison of the Effectiveness of Cognitive Behavioral Therapy and Repetitive Transcranial Magnetic Stimulation on Adaptive and Maladaptive Cognitive Emotion Regulation Strategies in Patients with Multiple Sclerosis

Atieh  Maddah; Nooshin Taghinezhad; Kobra Hajializadeh; Azita  Amirfakhraei

Authors

Atieh Maddah PhD. Student, Department of Psychology, BA.C., Islamic Azad University, Bandar Abbas, Iran Author https://orcid.org/0009-0002-9293-2755
Nooshin Taghinezhad Assistant Professor, Department of Psychology, BA.C., Islamic Azad University, Bandar Abbas, Iran Corresponding Author https://orcid.org/0000-0001-9088-9314
Kobra Hajializadeh Associate Professor, Department of Psychology, BA.C., Islamic Azad University, Bandar Abbas, Iran Author https://orcid.org/0000-0002-6931-0635
Azita Amirfakhraei Associate Professor, Department of Psychology, BA.C., Islamic Azad University, Bandar Abbas, Iran Author https://orcid.org/0000-0002-3753-0924

Keywords:

multiple sclerosis, cognitive behavioral therapy, repetitive transcranial magnetic stimulation, emotion regulation

Abstract

The present study aimed to compare the effectiveness of cognitive behavioral therapy (CBT) and repetitive transcranial magnetic stimulation (rTMS) on adaptive and maladaptive cognitive emotion regulation strategies in patients with multiple sclerosis (MS). This applied, quasi-experimental study employed a pretest–posttest design with a one-month follow-up and a control group. The statistical population consisted of all patients with multiple sclerosis who attended a specialized clinic in Kerman, Iran, during 2025–2026. Using convenience sampling, 45 eligible patients were selected and randomly assigned to three groups of 15 participants each: a cognitive behavioral therapy group, a cognitive behavioral therapy combined with repetitive transcranial magnetic stimulation group, and a control group. Data were collected using the Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski & Kraaij, 2006). The experimental groups received, respectively, a 12-session CBT protocol and CBT combined with 30 sessions of rTMS, whereas the control group received no intervention. Data were analyzed using mixed analysis of variance (ANOVA) with repeated measures in SPSS version 26. The findings indicated that the group × time interaction effect was statistically significant for both primary study variables, namely adaptive and maladaptive cognitive emotion regulation strategies (p < .001). Compared with the control group, both interventions significantly increased adaptive cognitive emotion regulation strategies and decreased maladaptive cognitive emotion regulation strategies (p < .001), and these effects were maintained at the one-month follow-up. A direct comparison of the two interventions indicated no substantial difference between the two approaches in terms of the overall scores. The results demonstrated that both interventions were effective in improving emotion regulation and that repetitive transcranial magnetic stimulation contributed to an increase in adaptive strategies and a reduction in maladaptive strategies. Given the maintenance of the observed effects, the combined application of these interventions is recommended in the treatment of patients with multiple sclerosis.

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