Mindfulness-based Stress Reduction for MS: Feasibility, Durability, and Clinical Outcomes

Principal Investigator: Angela Senders, ND

Abstract: Multiple sclerosis (MS) is the most common neurological condition affecting young adults in the United States. MS symptoms are diverse and unpredictable and include impaired mobility, chronic pain, fatigue, depression, anxiety, and cognitive impairment. People with MS have long reported that psychological stress can worsen their symptoms, and studies show that chronic exposure to a wide range of challenging life events is correlated with worsening neurological symptoms (1) and increased lesion burden on brain MRI (2,3). A recent study found that participation in an 8-week stress-reduction trial reduced new lesion development on MRI in MS (4), suggesting that stress-management might not only improve symptoms but could potentially modify disease progression (5). Unfortunately, benefits only lasted as long as patients were engaged in program. Thus, identifying effective stress-management therapies that foster long-term behavior change and clinical improvement in MS is essential.

Mindfulness-based stress reduction (MBSR) is an eight-week program that consists of weekly two-hour classes where participants are instructed in mindfulness meditation, breath work, yoga postures, self-reflection and awareness. Clinical trials of MBSR have demonstrated improved health outcomes across a variety of patient populations (6), but before adopting MBSR for MS, several uncertainties need to be addressed. First, very few trials have applied MBSR to people with neurological impairments. Only one trial has conducted MBSR for people with MS and it excluded people with more advanced disabilities (7). Little is known about the feasibility of MBSR for people with neurological challenges, and others have suggested that the protocol should be modified in consideration of the complexities of neurological disease (8). Second, once the intervention is complete there is conflicting evidence as to the sustainability of MBSR effects over time. Some studies show maintenance of effects (9–11), while others find attenuation over 12 months (7,12,13). In order to fully translate the use of MBSR to clinical practice desired effects must be maintained long-term, yet very little is known about what factors lead to lasting health outcomes.

The goal of this research is to understand the feasibility of MBSR for MS, explore preliminary clinical outcomes of MBSR compared to MS Education Control, assess the sustainability of outcomes over time, and appreciate what post-intervention activities and behaviors might support or inhibit sustainability.