Enhancing Self-Esteem in Patients With Multiple Sclerosis: A Randomised Controlled Trial of the Lexical Association Technique
NCT ID: NCT07064291
Last Updated: 2025-07-14
Study Results
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Basic Information
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NOT_YET_RECRUITING
NA
160 participants
INTERVENTIONAL
2025-09-30
2027-09-30
Brief Summary
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The main questions it aims to answer are:
* Does the LAT increase well-being more than a placebo technique ?
* Does this technique help reduce psychological distress and improve quality of life ?
Participants will:
* Be randomly assigned to either the LAT group or the active control group
* Complete short visualization exercises at home using a personal computer
* Fill out questionnaires about self-esteem, stress, anxiety, depression, quality of life, and adjustment to illness
* Take part in the study over several weeks, with assessments before, after, and 14 days after the intervention
Researchers will compare results between the two groups (LAT group vs. Control group) to test the immediate and lasting effects of the LAT.
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Detailed Description
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As with many chronic illnesses, self-esteem is significantly impacted by the diagnosis of multiple sclerosis. Patients tend to report markedly lower self-esteem compared to the general population (Sarısoy et al., 2013; M.-C. Gay et al., 2010; McCabe, 2005; Nosek et al., 2003; Walsh \& Walsh, 1989). Yet self-esteem has been identified as a resilience factor (Black \& Dorstyn, 2015) and has been associated with maintaining quality of life (Gil-González et al., 2020; Mikula et al., 2017), better treatment adherence (Wilski \& Tasiemski, 2016), and lower levels of perceived stress (Ifantopoulou et al., 2015). High self-esteem is also linked to various clinical benefits, such as reduced somatic symptoms, anxiety, insomnia, and social dysfunction (Mikula et al., 2021). Additionally, research has established links between low self-esteem and both anxiety and depressive symptoms (Sowislo \& Orth, 2013). Altogether, these findings support the relevance of incorporating therapeutic protocols that aim to enhance self-esteem into the care of people with MS.
The Lexical Association Technique (LAT), developed by Niveau, New, and Beaudoin in 2021, seeks to boost self-esteem by reinforcing associations between positive self-attributes and mental imagery that illustrate possession of those qualities. Its efficacy has already been demonstrated through three randomized clinical trials (Niveau et al., 2022; Niveau et al., 2023). Compared to other self-esteem enhancement techniques like CBT or reminiscence therapy, this protocol has several advantages: it requires minimal time and cognitive resources. Moreover, LAT exercises can be done at home on a personal computer, making it an accessible and low-cost tool for patients.
PRIMARY OBJECTIVE As this technique aims to enhance participants' self-esteem, we expect to replicate the findings of the two initial LAT studies, with higher self-esteem scores at the end of the therapeutic protocol in the experimental group compared to the active control group.
SECONDARY OBJECTIVES The secondary objective of this study is to assess potential clinical benefits that improved self-esteem may bring in terms of psychological well-being and prevention of psycho-social risks associated with the MS diagnosis. The protocol includes measures to evaluate how increased self-esteem might impact quality of life, perceived self-efficacy, adjustment to illness, perceived stress levels, and self-reported symptoms of anxiety and depression.
METHODOLOGY This is a therapeutic effectiveness study, monocentric, interventional, prospective, controlled, and randomized, conducted under double-blind conditions. The 160 participants will be allocated using a minimization protocol into one of two groups: an experimental group using LAT and an active control group performing similar visualizations with no direct connection to the self. Self-esteem will be measured at multiple time points (before, after, and up to 14 days after the intervention) to assess both immediate and lasting effects of the technique.
POPULATION The study will include two patient samples: one composed of patients recently diagnosed with RRMS, and another of patients recently diagnosed with SPMS. A total of 160 patients will be included in the study (80 with RRMS and 80 with SPMS).
EXPECTED OUTCOMES This project could help demonstrate the efficacy of a therapeutic tool that healthcare professionals could offer to patients in order to strengthen their psychological resources during critical periods when psycho-social disorders are likely to emerge and become entrenched.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
Note: At the end of the study, all participants - including those in the active control group - will receive access to the full version of the Lexical Association Technique, so that everyone can benefit from its maximum therapeutic effects.
SUPPORTIVE_CARE
QUADRUPLE
Study Groups
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Experimental Group (LAT)
Participants assigned to the experimental group will complete six LAT training sessions at home on a personal computer. Each session lasts approximately five minutes and involves episodic visualizations centered on the self. Repeated exposure across sessions is intended to strengthen memory associations between positive self-related traits and autobiographical experiences.
During each session, a series of positive self-referential statements will be displayed on screen. For each statement, participants will be asked to visualize a specific event from their own life that illustrates the quality described. This exercise is designed to generate vivid, self-relevant mental imagery linked to various personal strengths and attributes.
The Lexical Association Technique (LAT)
The Lexical Association Technique (LAT) was developed by Niveau, New, and Beaudoin in 2021 (Niveau et al., 2022). It is grounded in principles of memory functioning described in the cognitive psychology literature, particularly the theoretical framework of the Self-Memory System proposed by Conway (2000, 2005).
The technique aims to enhance self-esteem by strengthening associative links between the self and positively valenced concepts stored in memory. To achieve this, it relies on the repeated mental visualization of positive autobiographical episodes paired with positive self-referential linguistic statements.
The effectiveness of this technique in increasing self-esteem has been demonstrated and replicated across three studies, conducted with distinct samples: two involving healthy participants and one involving a clinical sample of individuals with a chronic illness (Niveau et al., 2022, 2023).
Active Control Group
Participants in the active control group will also complete six training sessions at home on a personal computer. The structure and timing of the sessions will be identical to those in the experimental condition. However, the statements presented will refer to others (e.g., pharmacists, teachers, animals...) rather than the self, while maintaining the same positive tone and format as the LAT items.
As in the experimental group, participants will be asked to visualize a positive event corresponding to each statement.
This control condition enables researchers to isolate the specific effect of self-referential content while preserving key task features such as episodic imagery, emotional valence, cognitive effort, duration, and computer-based delivery.
Placebo of the Lexical Association Technique
The active control condition is based on the same procedural structure as the Lexical Association Technique (LAT), but without the core therapeutic component - the self-referential content. Participants in the control group are exposed to a series of positive statements, similar in form and valence to those used in the LAT, but referring to others (e.g., generic social roles or entities such as teachers, pharmacists, or animals) rather than the self.
Like in the LAT condition, participants are asked to generate mental imagery based on each statement, visualizing a corresponding positive episodic event. This ensures that the control task involves the same cognitive mechanisms (episodic memory retrieval, positive visualization, and sustained attention), while excluding the specific associative link to the self that constitutes the active ingredient of the intervention.
This control condition was designed to match the LAT in terms of structure, cognitive demand, and duration, and has be
Interventions
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The Lexical Association Technique (LAT)
The Lexical Association Technique (LAT) was developed by Niveau, New, and Beaudoin in 2021 (Niveau et al., 2022). It is grounded in principles of memory functioning described in the cognitive psychology literature, particularly the theoretical framework of the Self-Memory System proposed by Conway (2000, 2005).
The technique aims to enhance self-esteem by strengthening associative links between the self and positively valenced concepts stored in memory. To achieve this, it relies on the repeated mental visualization of positive autobiographical episodes paired with positive self-referential linguistic statements.
The effectiveness of this technique in increasing self-esteem has been demonstrated and replicated across three studies, conducted with distinct samples: two involving healthy participants and one involving a clinical sample of individuals with a chronic illness (Niveau et al., 2022, 2023).
Placebo of the Lexical Association Technique
The active control condition is based on the same procedural structure as the Lexical Association Technique (LAT), but without the core therapeutic component - the self-referential content. Participants in the control group are exposed to a series of positive statements, similar in form and valence to those used in the LAT, but referring to others (e.g., generic social roles or entities such as teachers, pharmacists, or animals) rather than the self.
Like in the LAT condition, participants are asked to generate mental imagery based on each statement, visualizing a corresponding positive episodic event. This ensures that the control task involves the same cognitive mechanisms (episodic memory retrieval, positive visualization, and sustained attention), while excluding the specific associative link to the self that constitutes the active ingredient of the intervention.
This control condition was designed to match the LAT in terms of structure, cognitive demand, and duration, and has be
Eligibility Criteria
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Inclusion Criteria
* Access to a computer and internet connection at home
* Diagnosis of multiple sclerosis according to the revised criteria of Thompson et al. (2018), either relapsing-remitting or secondary progressive form, between 1 and 5 years since disease onset (RRMS or SPMS entry phase)
* Currently receiving first- or second-line oral treatment (e.g., Teriflunomide, Dimethylfumarate, Fingolimod, Cladribine)
* Adult participants (age ≥ 18)
* Participant currently excluded from another study
* Individuals covered by Articles L1121-5 to L1121-8 of the French Public Health Code (CSP), i.e., legally protected persons: pregnant women, women in labor, breastfeeding mothers, individuals deprived of liberty by judicial or administrative decision, individuals under psychiatric care under Articles L.3212-1 and L.3213-1 not falling under Article L.1121-8, individuals admitted to healthcare or social institutions for reasons other than research, minors, individuals under legal protection or unable to provide informed consent
* Staff members with a hierarchical link to the principal investigator
Exclusion Criteria
* Major life event significantly affecting well-being in the two weeks prior to study inclusion (e.g., bereavement, separation, childbirth, etc.)
* Initiation of psychological, psychiatric, or pharmacological treatment (anxiolytics, antidepressants) within one month prior to study start
18 Years
ALL
No
Sponsors
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Laboratoire interuniversitaire de psychologie : personnalité, cognition et changement social - LIP-PC2S
UNKNOWN
Laboratoire de Psychologie et NeuroCognition
OTHER
University Hospital, Grenoble
OTHER
Responsible Party
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Locations
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CHU Grenoble Alpes
Grenoble, Grenoble, France
Countries
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References
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Endler, N. S., Parker, J. D. A., & Summerfeldt, L. J. (1998). Coping with health problems: Developing a reliable and valid multidimensional measure. Psychological Assessment, 10(3), 195-205. https://doi.org/10.1037/1040-3590.10.3.195
Simeoni M, Auquier P, Fernandez O, Flachenecker P, Stecchi S, Constantinescu C, Idiman E, Boyko A, Beiske A, Vollmer T, Triantafyllou N, O'Connor P, Barak Y, Biermann L, Cristiano E, Atweh S, Patrick D, Robitail S, Ammoury N, Beresniak A, Pelletier J; MusiQol study group. Validation of the Multiple Sclerosis International Quality of Life questionnaire. Mult Scler. 2008 Mar;14(2):219-30. doi: 10.1177/1352458507080733. Epub 2007 Oct 17.
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Lesage FX, Berjot S, Deschamps F. Psychometric properties of the French versions of the Perceived Stress Scale. Int J Occup Med Environ Health. 2012 Jun;25(2):178-84. doi: 10.2478/S13382-012-0024-8. Epub 2012 Apr 19.
Spielberger, C. D. (1983). State-Trait Anxiety Inventory for Adults (STAI-AD). APA PsycTests. https://doi.org/10.1037/t06496-000
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Dumont M, Schwarzer R, Jerusalem M. French Adaptation of the General Self-Efficacy Scale: Auto-efficacité Généralisée. Berlin, Allemagne, 2000.
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Rosenberg, M. (1965). Rosenberg Self-Esteem Scale (RSES). APA PsycTests. https://doi.org/10.1037/t01038-000
Conway MA, Pleydell-Pearce CW. The construction of autobiographical memories in the self-memory system. Psychol Rev. 2000 Apr;107(2):261-88. doi: 10.1037/0033-295x.107.2.261.
Conway, M. A. (2005). Memory and the self. Journal of Memory and Language, 53(4), 594-628. https://doi.org/10.1016/j.jml.2005.08.005
Niveau N, Beaudoin M, De Cornulier J, New B. The Lexical Association Technique: A randomized controlled trial with breast cancer patients. Appl Psychol Health Well Being. 2023 Aug;15(3):846-864. doi: 10.1111/aphw.12412. Epub 2022 Nov 1.
Sowislo JF, Orth U. Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychol Bull. 2013 Jan;139(1):213-240. doi: 10.1037/a0028931. Epub 2012 Jun 25.
Mikula P, Timkova V, Fedicova M, Szilasiova J, Nagyova I. Self-management, self-esteem and their associations with psychological well-being in people with multiple sclerosis. Mult Scler Relat Disord. 2021 Aug;53:103069. doi: 10.1016/j.msard.2021.103069. Epub 2021 Jun 4.
N Ifantopoulou P, K Artemiadis A, Triantafyllou N, Chrousos G, Papanastasiou I, Darviri C. Self-esteem is associated with perceived stress in multiple sclerosis patients. Neurol Res. 2015 Jul;37(7):588-92. doi: 10.1179/1743132815Y.0000000016. Epub 2015 Mar 3.
Wilski M, Tasiemski T. Illness perception, treatment beliefs, self-esteem, and self-efficacy as correlates of self-management in multiple sclerosis. Acta Neurol Scand. 2016 May;133(5):338-45. doi: 10.1111/ane.12465. Epub 2015 Jul 20.
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Other Identifiers
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France SEP-24 (SHS-ESTIME)
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
2025-A00907-42
Identifier Type: OTHER
Identifier Source: secondary_id
38RC25.0147
Identifier Type: -
Identifier Source: org_study_id
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