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Published in: BMC Neurology 1/2017

Open Access 01-12-2017 | Research article

Mindfulness-based stress reduction for people with multiple sclerosis – a feasibility randomised controlled trial

Authors: Robert Simpson, Frances S. Mair, Stewart W. Mercer

Published in: BMC Neurology | Issue 1/2017

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Abstract

Background

Multiple sclerosis (MS) is a stressful condition. Mental health comorbidity is common. Stress can increase the risk of depression, reduce quality of life (QOL), and possibly exacerbate disease activity in MS. Mindfulness-Based Stress Reduction (MBSR) may help, but has been little studied in MS, particularly among more disabled individuals.

Methods

The objective of this study was to test the feasibility and likely effectiveness of a standard MBSR course for people with MS. Participant eligibility included: age > 18, any type of MS, an Expanded Disability Status Scale (EDSS) </= 7.0. Participants received either MBSR or wait-list control. Outcome measures were collected at baseline, post-intervention, and three-months later. Primary outcomes were perceived stress and QOL. Secondary outcomes were common MS symptoms, mindfulness, and self-compassion.

Results

Fifty participants were recruited and randomised (25 per group). Trial retention and outcome measure completion rates were 90% at post-intervention, and 88% at 3 months. Sixty percent of participants completed the course. Immediately post-MBSR, perceived stress improved with a large effect size (ES 0.93; p < 0.01), compared to very small beneficial effects on QOL (ES 0.17; p = 0.48). Depression (ES 1.35; p < 0.05), positive affect (ES 0.87; p = 0.13), anxiety (ES 0.85; p = 0.05), and self-compassion (ES 0.80; p < 0.01) also improved with large effect sizes. At three-months post-MBSR (study endpoint) improvements in perceived stress were diminished to a small effect size (ES 0.26; p = 0.39), were negligible for QOL (ES 0.08; p = 0.71), but were large for mindfulness (ES 1.13; p < 0.001), positive affect (ES 0.90; p = 0.54), self-compassion (ES 0.83; p < 0.05), anxiety (ES 0.82; p = 0.15), and prospective memory (ES 0.81; p < 0.05).

Conclusions

Recruitment, retention, and data collection demonstrate that a RCT of MBSR is feasible for people with MS. Trends towards improved outcomes suggest that a larger definitive RCT may be warranted. However, optimisation changes may be required to render more stable the beneficial treatment effects on stress and depression.

Trial registration

ClinicalTrials.gov Identifier NCT02136485; trial registered 1st May 2014.
Appendix
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Literature
1.
go back to reference Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141–53.CrossRefPubMed Dennison L, Moss-Morris R, Chalder T. A review of psychological correlates of adjustment in patients with multiple sclerosis. Clin Psychol Rev. 2009;29(2):141–53.CrossRefPubMed
2.
go back to reference Marrie RA, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler J. 2015;21(3):305–17. Marrie RA, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler J. 2015;21(3):305–17.
5.
go back to reference Artemiadis AK, Anagnostouli MC, Alexopoulos EC. Stress as a risk factor for multiple sclerosis onset or relapse: a systematic review. Neuroepidemiology. 2011;36(2):109–20.CrossRefPubMed Artemiadis AK, Anagnostouli MC, Alexopoulos EC. Stress as a risk factor for multiple sclerosis onset or relapse: a systematic review. Neuroepidemiology. 2011;36(2):109–20.CrossRefPubMed
6.
go back to reference McEwen BS, Getz L. Lifetime experiences, the brain and personalized medicine: An integrative perspective. Metabolism. 2013;62:S20–6.CrossRefPubMed McEwen BS, Getz L. Lifetime experiences, the brain and personalized medicine: An integrative perspective. Metabolism. 2013;62:S20–6.CrossRefPubMed
7.
go back to reference McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2):174–85.CrossRefPubMedPubMedCentral McEwen BS. Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2):174–85.CrossRefPubMedPubMedCentral
8.
go back to reference Salehpoor G, Rezaei S, Hosseininezhad M. Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran. Iranian journal of nursing and midwifery research. 2014;19(6):593.PubMedPubMedCentral Salehpoor G, Rezaei S, Hosseininezhad M. Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran. Iranian journal of nursing and midwifery research. 2014;19(6):593.PubMedPubMedCentral
10.
go back to reference Fiest K, et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2016;5:12–26.CrossRefPubMed Fiest K, et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2016;5:12–26.CrossRefPubMed
11.
go back to reference Reynard AK, Sullivan AB, Rae-Grant A. A Systematic Review of Stress-Management Interventions for Multiple Sclerosis Patients. International journal of MS care. 2014;16(3):140–4.CrossRefPubMedPubMedCentral Reynard AK, Sullivan AB, Rae-Grant A. A Systematic Review of Stress-Management Interventions for Multiple Sclerosis Patients. International journal of MS care. 2014;16(3):140–4.CrossRefPubMedPubMedCentral
12.
go back to reference Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–68.CrossRefPubMedPubMedCentral Goyal M, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–68.CrossRefPubMedPubMedCentral
13.
go back to reference MRC U. Developing and evaluating complex interventions: new guidance. London: Medical Research Council; 2008. MRC U. Developing and evaluating complex interventions: new guidance. London: Medical Research Council; 2008.
14.
go back to reference Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion. 1994;4. Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion. 1994;4.
15.
go back to reference Tang Y-Y, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. 2015;16(4):213–25.CrossRefPubMed Tang Y-Y, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci. 2015;16(4):213–25.CrossRefPubMed
16.
go back to reference Hölzel BK, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6(6):537–59.CrossRefPubMed Hölzel BK, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6(6):537–59.CrossRefPubMed
17.
go back to reference Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47.CrossRefPubMed Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33–47.CrossRefPubMed
18.
go back to reference Fjorback L, et al. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy–a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011;124(2):102–19.CrossRefPubMed Fjorback L, et al. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy–a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011;124(2):102–19.CrossRefPubMed
19.
go back to reference Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013;8(8):e71834.CrossRefPubMedPubMedCentral Lakhan SE, Schofield KL. Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PLoS One. 2013;8(8):e71834.CrossRefPubMedPubMedCentral
21.
go back to reference Bogosian A, et al. Distress improves after mindfulness training for progressive MS: A pilot randomised trial. Mult Scler J. 2015;21(9):1184–94. Bogosian A, et al. Distress improves after mindfulness training for progressive MS: A pilot randomised trial. Mult Scler J. 2015;21(9):1184–94.
22.
go back to reference Bogosian A, et al. Potential treatment mechanisms in a mindfulness based intervention for people with progressive multiple sclerosis. Br J Health Psychol. 2016;21(4):859–80. Bogosian A, et al. Potential treatment mechanisms in a mindfulness based intervention for people with progressive multiple sclerosis. Br J Health Psychol. 2016;21(4):859–80.
23.
go back to reference Burschka JM, et al. Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol. 2014;14(1):165.CrossRefPubMedPubMedCentral Burschka JM, et al. Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression. BMC Neurol. 2014;14(1):165.CrossRefPubMedPubMedCentral
24.
25.
go back to reference Kolahkaj B, Zargar F. Effect of Mindfulness-Based Stress Reduction on Anxiety, Depression and Stress in Women With Multiple Sclerosis. Nursing and Midwifery Studies. 2015:4(4). Kolahkaj B, Zargar F. Effect of Mindfulness-Based Stress Reduction on Anxiety, Depression and Stress in Women With Multiple Sclerosis. Nursing and Midwifery Studies. 2015:4(4).
26.
go back to reference Mills N, Allen J. Mindfulness of movement as a coping strategy in multiple sclerosis: a pilot study. Gen Hosp Psychiatry. 2000;22(6):425–31.CrossRefPubMed Mills N, Allen J. Mindfulness of movement as a coping strategy in multiple sclerosis: a pilot study. Gen Hosp Psychiatry. 2000;22(6):425–31.CrossRefPubMed
27.
go back to reference Tavee J, et al. Effects of meditation on pain and quality of life in multiple sclerosis and peripheral neuropathy: A pilot study. International journal of MS care. 2011;13(4):163–8.CrossRefPubMedPubMedCentral Tavee J, et al. Effects of meditation on pain and quality of life in multiple sclerosis and peripheral neuropathy: A pilot study. International journal of MS care. 2011;13(4):163–8.CrossRefPubMedPubMedCentral
28.
go back to reference Carmody J, Baer RA. How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. J Clin Psychol. 2009;65(6):627–38.CrossRefPubMed Carmody J, Baer RA. How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. J Clin Psychol. 2009;65(6):627–38.CrossRefPubMed
29.
go back to reference Bellg AJ, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23(5):443.CrossRefPubMed Bellg AJ, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23(5):443.CrossRefPubMed
30.
go back to reference Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385–96. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385–96.
31.
go back to reference Janssen M, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–27.CrossRefPubMed Janssen M, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–27.CrossRefPubMed
32.
go back to reference Ritvo P, et al. MSQLI—Multiple Sclerosis Quality of Life Inventory, A user’s manual. New York: National MS Society; 1997. Ritvo P, et al. MSQLI—Multiple Sclerosis Quality of Life Inventory, A user’s manual. New York: National MS Society; 1997.
33.
go back to reference Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822.CrossRefPubMed Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822.CrossRefPubMed
34.
go back to reference Raes F, et al. Construction and factorial validation of a short form of the self-compassion scale. Clinical psychology & psychotherapy. 2011;18(3):250–5.CrossRef Raes F, et al. Construction and factorial validation of a short form of the self-compassion scale. Clinical psychology & psychotherapy. 2011;18(3):250–5.CrossRef
35.
go back to reference Newsom-Davis I, et al. The emotional lability questionnaire: a new measure of emotional lability in amyotrophic lateral sclerosis. J Neurol Sci. 1999;169(1):22–5.CrossRefPubMed Newsom-Davis I, et al. The emotional lability questionnaire: a new measure of emotional lability in amyotrophic lateral sclerosis. J Neurol Sci. 1999;169(1):22–5.CrossRefPubMed
36.
go back to reference Carstairs V, Morris R. Deprivation and health in Scotland. Health Bull. 1990;48(4):162–75. Carstairs V, Morris R. Deprivation and health in Scotland. Health Bull. 1990;48(4):162–75.
37.
go back to reference Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933–40.CrossRefPubMed Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933–40.CrossRefPubMed
38.
go back to reference Mathew KL, et al. The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder. Behav Cogn Psychother. 2010;38(5):561–76.CrossRefPubMed Mathew KL, et al. The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder. Behav Cogn Psychother. 2010;38(5):561–76.CrossRefPubMed
39.
go back to reference Gu J, et al. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12.CrossRefPubMed Gu J, et al. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12.CrossRefPubMed
40.
go back to reference Schirda, B., J.A. Nicholas, and R.S. Prakash, Examining Trait Mindfulness, Emotion Dysregulation, and Quality of Life in Multiple Sclerosis. 2015. Schirda, B., J.A. Nicholas, and R.S. Prakash, Examining Trait Mindfulness, Emotion Dysregulation, and Quality of Life in Multiple Sclerosis. 2015.
41.
go back to reference Senders A, et al. Perceived Stress in Multiple Sclerosis The Potential Role of Mindfulness in Health and Well-Being. Journal of evidence-based complementary & alternative medicine. 2014;19(2):104–11.CrossRef Senders A, et al. Perceived Stress in Multiple Sclerosis The Potential Role of Mindfulness in Health and Well-Being. Journal of evidence-based complementary & alternative medicine. 2014;19(2):104–11.CrossRef
42.
go back to reference Pakenham KI, Samios C. Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance. J Behav Med. 2013;36(4):389–400.CrossRefPubMed Pakenham KI, Samios C. Couples coping with multiple sclerosis: A dyadic perspective on the roles of mindfulness and acceptance. J Behav Med. 2013;36(4):389–400.CrossRefPubMed
43.
go back to reference Sirois FM, Molnar DS, Hirsch JK. Self-Compassion, Stress, and Coping in the Context of Chronic Illness. Self Identity. 2015;14(3):334–47.CrossRef Sirois FM, Molnar DS, Hirsch JK. Self-Compassion, Stress, and Coping in the Context of Chronic Illness. Self Identity. 2015;14(3):334–47.CrossRef
44.
go back to reference Simpson RJ, et al. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014;14(1):128.CrossRefPubMedPubMedCentral Simpson RJ, et al. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014;14(1):128.CrossRefPubMedPubMedCentral
45.
go back to reference Mackenzie C, Gekoski W, Knox V. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging and Mental Health. 2006;10(6):574–82.CrossRefPubMed Mackenzie C, Gekoski W, Knox V. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging and Mental Health. 2006;10(6):574–82.CrossRefPubMed
46.
47.
go back to reference Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology. 2008;7(12):1139–51.CrossRefPubMed Chiaravalloti ND, DeLuca J. Cognitive impairment in multiple sclerosis. The Lancet Neurology. 2008;7(12):1139–51.CrossRefPubMed
48.
49.
go back to reference Kurtzke, J.F., Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology, 1983. 33(11): p. 1444–4. Kurtzke, J.F., Rating neurologic impairment in multiple sclerosis an expanded disability status scale (EDSS). Neurology, 1983. 33(11): p. 1444–4.
Metadata
Title
Mindfulness-based stress reduction for people with multiple sclerosis – a feasibility randomised controlled trial
Authors
Robert Simpson
Frances S. Mair
Stewart W. Mercer
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2017
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0880-8

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