Mindfulness-Based Stress Reduction Intervention Shows Potential to Treat Silent Symptoms of Multiple Sclerosis

Christopher C. Hemond, MD

In a recently concluded small-scale study of individuals with multiple sclerosis (MS), implementation of a mindfulness-based stress reduction (MBSR) intervention resulted in several positive benefits on patient-reported outcomes (PROs).

Led by Christopher C. Hemond, MD, neurologist, UMass Memorial Health, the study featured 23 females with relapsing-remitting MS who were offered 8 weeks of MBSR free of charge. After a 12-week observation period, treatment with MBSR was associated with robust (d >.08) improvements across a range of unadjusted PROs, including stress, anxiety, depression, fatigue, loneliness, well-being, and interoceptive awareness (all P <.01).

Presented at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 to June 3, in Aurora Colorado, the cohort of individuals assessed had a median Expanded Disability Status Scale score of 2.0 (±1.2) and showed no new clinical/MRI disease activity during the 12-week observation period. More than half (57%) were on a B-cell depleting agent, and 91% completed the course.

READ MORE: Low-Fat Diet Intervention Demonstrates Significant Impacts on Multiple Sclerosis Fatigue

The conserved transcriptional response to adversity (CTRA) score was determined using well-established methods from 53 prespecified blood gene expression markers representing a composite of inflammation, interferon response, and immunoglobulin expression. Coming into the study, investigators hypothesized that MBSR would modulate systemic and central nervous system inflammation through top-down neurocognitive control over forebrain limbic areas responsible for the neurobiological stress response.

Prior to adjustment, no pre-post changes were noted in average hair cortisol, structural MRI, or CTRA as related to completion of MBSR. In mixed-effect analyses adjusting for age, race, body mass index, medical therapy, and time, changes in inflammatory gene expression (CTRA; n = 12) correlated inversely with changes in patient-reported stress (P <.0001), loneliness (P = .002), hair cortisol (P = .01), and aspects of interoceptive awareness. In similar exploratory mixed-effect regression with parcellated MRI data, a higher CTRA was associated with larger left (P = .02) and smaller right (P = .02) anterior insula cortical thickness.

Although there are few studies in MS, MBSR has shown potential to help alleviate silent symptoms of the disease. In 2017, a feasibility, randomized controlled trial of 50 individuals with MS assessed an MBSR intervention over a 3-month period, with primary outcomes of perceived stress and quality of life (QOL). Immediately post-MBSR, perceived stress improved with a large effect size (0.93; P <.01) compared with very small beneficial effects on QOL (0.17; P = .48). Depression (1.35; P <.05), positive affect (0.87; P = .13), anxiety (0.85; P = .05), and self-compassion (0.80; P <.01) also improved with large effect sizes.

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REFERENCES
1. Hemond CC, Deshpande M, Morales IB, Slavich GM, Cole SW. An unblinded observational study of mildfulness-based stress reduction in MS: MRI and biological inflammatory correlates of patient-reported outcomes. Presented at: 2023 CMSC Annual Meeting; May 31-June 3; Aurora, CO. Abstract IMG06.
2. Simpson R, Mair FS, Mercer SW. Mindfulness-based stress reduction for people with multiple sclerosis – a feasibility randomized controlled trial. BMC Neurol. 2017;17(1):94. doi:10.1186/s12883-017-0880-8