Temporal perception, attentional bias, and moral reasoning in multiple sclerosis: a moderated mediation analysis

Abstract Objective This study examines the relationships between future time perspective, attentional biases, and moral judgment in people with multiple sclerosis (pwMS) compared to healthy controls, testing a preregistered moderated mediation model derived from Socioemotional Selectivity Theory. Method Ninety participants (45 relapsing–remitting pwMS, EDSS ≤4; 45 matched controls) completed neuropsychological assessments, a moral judgment task based on 20 validated dilemmas, two measures of future time perspective (the Future Time Perspective Scale and an implicit word-completion task), and a dot-probe task measuring attentional biases toward positive and negative stimuli. Logistic mixed-effects models and moderated mediation analyses were conducted. Results pwMS exhibited a significantly lower probability of utilitarian responses compared to controls (OR = 0.42, 95% CI 0.27, 0.67, p .001), consistent with a stronger deontological preference. They also displayed a more limited future time perspective on both the explicit scale (p = .038) and the implicit task (p = .049), as well as reduced attentional engagement with negative stimuli (p = .024). In this sample, the associations between future time perspective, attentional biases, and moral judgment did not follow the hypothesized SST-derived pathway. Conclusions The findings highlight novel affective–motivational differences in pwMS, including a reduced future time perspective and diminished attention to negative cues. These results encourage further exploration of the cognitive–affective processes shaping moral reasoning in chronic neurological conditions.