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Komar A, Dickson K, Alavinia M, Bruno T, Bayley M, Feinstein A, Scandiffio J, Simpson R. Effects of mindfulness-based interventions on cognition in people with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2024; 15:1339851. [PMID: 39071226 PMCID: PMC11272459 DOI: 10.3389/fpsyt.2024.1339851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Cognitive impairment affects up to 65% of people with multiple sclerosis (PwMS), undermining functional independence and quality of life. The objective of this study is to synthesize existing randomized controlled trial (RCT) evidence on the effects of Mindfulness-based interventions (MBIs) on cognitive function in PwMS. Methods A systematic literature search was conducted to identify RCTs assessing MBIs effects on cognitive functioning in PwMS. Using pre-defined criteria, two independent reviewers screened titles, abstracts, and extracted data from included studies. Meta-analysis was performed, where possible, using a random effects model. Narrative synthesis was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidance was followed. PROSPERO_ID:(CRD42021286429). Results Twelve eligible RCTs were identified, n=700 PwMS. MBIs included both standardized and tailored interventions, in-person and virtually. A variety of measures of cognitive functioning were reported. Five studies (n=254 PwMS) were included in meta-analysis; pooled results suggested MBIs effectively improved scores on the Paced Auditory Serial Addition Test (PASAT)-2 (SMD=0.38; 95% CI 0.06-0.71; I2 63%; p=0.02), whereas improvements were of borderline significance on the PASAT-3 (SMD=0.32; 95% CI -0.01-0.64; I2 65%; p=0.06), and, although trending to positive, were statistically insignificant on the Perceived Deficits Questionnaire (SMD=0.34; 95 CI -0.05-0.74; I2 0%; p=0.09) and Symbol Digits Modality Test (SMD=0.25; 95% CI -0.15-0.66; I2 0%; p=0.21). Conclusion Preliminary findings in meta-analysis are inconsistent but suggest potential benefits from MBI training on cognitive functioning in PwMS. High quality RCTs are necessary to test more definitively the impact of MBIs on cognitive functioning in PwMS. Systematic review registration PROSPERO, identifier CRD42021286429.
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Affiliation(s)
- Alyssa Komar
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | | | - Mohammad Alavinia
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Tania Bruno
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Mark Bayley
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Anthony Feinstein
- Department of Medicine, Division of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Robert Simpson
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- University of Glasgow, Glasgow, Scotland, United Kingdom
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Campese S, Lyons J, Learmonth YC, Metse A, Kermode AG, Marck CH, Karahalios A. Comparing the effectiveness, safety and tolerability of interventions for depressive symptoms in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2024; 89:105763. [PMID: 39032399 DOI: 10.1016/j.msard.2024.105763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/06/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Depression is more common in people with multiple sclerosis (MS) compared to the general population. While many interventions are available for treating depressive symptoms in people with MS, it is unclear how different intervention modalities compare. This systematic review aimed to compare the reported effectiveness, safety, and tolerability of interventions for treating depressive symptoms in people with MS. METHODS We systematically searched 7 databases for randomised controlled trials (RCTs) of pharmaceutical, psychological, physical, and electromagnetic stimulation interventions which aimed to reduce depressive symptoms amongst adults with MS. Screening, data extraction and risk of bias assessment were completed by at least two independent researchers. We planned to synthesise the data using network meta-analysis, however the high risk of bias of the included trials resulted in synthesis without meta-analysis. RESULTS Of 1,949 citations, 31 trials (21 psychological, seven physical activity, two pharmaceutical, and one combination) were included, comprising 2,289 participants. Of the 31 eligible trials 24 were at high and six at moderate risk of bias, which precluded meta-analysis. Twenty-six trials reported on efficacy and only 16/31 reported safety and/or tolerability, using inconsistent methods. CONCLUSIONS The current strength of the evidence for treating depressive symptoms in MS is low, therefore, we are not able to summarise or make comparisons between the treatment modalities. There is an urgent need for high-quality and diverse trials investigating treatment options for depression in people with MS. This can only be achieved if the conduct and reporting of RCTs are improved.
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Affiliation(s)
- Stephanie Campese
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Julia Lyons
- Population Mental Health Unit, Centre for Mental Health and Community Wellbeing, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Yvonne C Learmonth
- School of Allied Health (Exercise Science), Murdoch University, Murdoch, Western Australia, Australia; Perron Institute for Neurological and Translational Science, University of Western Australia, QEII Medical Centre, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Alexandra Metse
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia; School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Allan G Kermode
- Perron Institute for Neurological and Translational Science, University of Western Australia, QEII Medical Centre, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Claudia H Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, The Melbourne School of Population and Global Health, The University of Melbourne, Australia
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3
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Nauta IM, van Dam M, Bertens D, Kessels RPC, Fasotti L, Uitdehaag BMJ, Speckens AEM, de Jong BA. Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial. J Neurol 2024; 271:4361-4372. [PMID: 38653820 PMCID: PMC11233341 DOI: 10.1007/s00415-024-12327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently gives rise to depressive and anxiety symptoms, but these are often undertreated. This study investigated the effect of mindfulness-based cognitive therapy (MBCT) and cognitive rehabilitation therapy (CRT) on psychological outcomes and quality of life (QoL), and whether they mediate treatment effects on MS-related cognitive problems. METHODS This randomized controlled trial included MS patients with cognitive complaints (n = 99) and compared MBCT (n = 32) and CRT (n = 32) to enhanced treatment as usual (n = 35). Baseline, post-treatment and 6-months follow-up assessments included patient-reported outcome measures (PROMS) and cognitive outcomes (self-reported and neuropsychological assessment). PROMS concerned psychological symptoms, well-being, QoL, and daily life function. Linear mixed models indicated intervention effects on PROMS and mediation effects of PROMS on cognitive outcomes. RESULTS MBCT positively affected depressive symptoms (Cohen's d (d) = -0.46), fatigue (d = -0.39), brooding (d = -0.34), mindfulness skills (d = 0.49), and mental QoL (d = -0.73) at post-treatment. Effects on mindfulness skills remained significant 6 months later (d = 0.42). CRT positively affected depressive symptoms (d = -0.46), mindfulness skills (d = 0.37), and mental QoL (d = -0.45) at post-treatment, but not at 6-month follow-up. No effects on anxiety, well-being, self-compassion, physical QoL, and daily life function were found. Treatment effects on self-reported, but not objective, cognition were mediated by psychological symptoms and mindfulness skills. CONCLUSIONS MBCT and CRT reduced a wide array of psychological symptoms and improved mental QoL. These improvements seemed to impact self-reported cognitive problems after both treatments, whereas objective cognitive improvements after MBCT seemed independent of improvement in psychological symptoms. Future studies should investigate long-term sustainability of these beneficial effects. TRIAL REGISTRATION The trial was prospectively registered in the Dutch Trial registry on 31 May 2017 (NL6285; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6459 ).
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Affiliation(s)
- Ilse M Nauta
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Maureen van Dam
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands.
| | - Dirk Bertens
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luciano Fasotti
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Anne E M Speckens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigit A de Jong
- Department of Neurology, MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Jellinger KA. Depression and anxiety in multiple sclerosis. Review of a fatal combination. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02792-0. [PMID: 38869643 DOI: 10.1007/s00702-024-02792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Depression and anxiety are the most frequent neuropsychiatric symptoms of multiple sclerosis (MS), an autoimmune-mediated demyelinating neurodegenerative disease. Their prevalence is 25-65% and 20-54%, respectively, often associated with chronic fatigue and cognitive impairment, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. Both disorders often arise before MS diagnosis, lead to faster disability and impair the quality of life. Risk factors are (young) age, genetic and family history burden. While no specific neuropathological data for depression (and anxiety) in MS are available, modern neuroimaging studies showed bilateral fronto-temporal, subcortical and limbic atrophies, microstructural white matter lesions and disruption of frontoparietal, limbic and neuroendocrine networks. The pathogenesis of both depression and anxiety in MS is related to shared mechanisms including oxidative stress, mitochondrial dysfunction, neuroinflammation and neuroendocrine mechanisms inducing complex functional and structural brain lesions, but they are also influenced by social and other factors. Unfortunately, MS patients with anxiety, major depression or suicidal thoughts are often underassessed and undertreated. Current treatment, in addition to antidepressant therapy include transcranial magnetic stimulation, cognitive, relaxation, dietary and other healthcare measures that must be individualized. The present state-of- the-art review is based on systematic analysis of PubMed, Google Scholar and Cochrane Library until May 2024, with focus on the prevalence, clinical manifestation, neuroimaging data, immune mechanisms and treatment options. Depression and anxiety in MS, like in many other neuroimmune disorders, are related, among others, to multi-regional patterns of cerebral disturbances and complex pathogenic mechanisms that deserve further elucidation as a basis for early diagnosis and adequate management to improve the quality of life in this disabling disease.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
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Liu YL, Lee CH, Wu LM. A mindfulness-based intervention improves perceived stress and mindfulness in university nursing students: a quasi-experimental study. Sci Rep 2024; 14:13220. [PMID: 38851820 PMCID: PMC11162462 DOI: 10.1038/s41598-024-64183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
University nursing students have been shown to experience psychological stress. A mindfulness-based intervention (MBI) may be a helpful tool for stress management. The aim of this study was to examine the effects of a MBI on improving mindfulness and reducing perceived stress in nursing students. A quasi-experimental study was conducted between July 2021 and February 2022. The intervention group participated in an 8-week mindfulness awareness course, which included 50 min of training and practice in mindfulness meditation techniques each week. Over the same 8 weeks, the control group watched a 50-min film each week. The mindful attention awareness scale (MAAS) and perceived stress scale (PSS) were administered before the intervention, intervention completion, and 2 and 6 months after the intervention. Data were analyzed using t test and generalized estimating equation. Overall, that the MBI showed a substantial effect on felt stress in comparison to the control group. When compared to the control group, the MBI showed a substantial impact on trait mindfulness. The MBI was beneficial for nursing students and could be considered a viable approach in nursing education to enhance mental wellbeing. It could be an effective method of relieving stress in a high-stress population.
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Affiliation(s)
- Yi-Ling Liu
- School of Nursing, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Sanmin Dist, Kaohsiung, 807378, Taiwan (R.O.C.)
- Department of Nursing, Meiho University, Pingtung, Taiwan (R.O.C.)
| | - Chao-Hsien Lee
- Department of Nursing, Meiho University, Pingtung, Taiwan (R.O.C.)
- Department of Social Work, Meiho University, Pingtung, Taiwan
| | - Li-Min Wu
- School of Nursing, Kaohsiung Medical University, No. 100, Shin-Chuan 1st Road, Sanmin Dist, Kaohsiung, 807378, Taiwan (R.O.C.).
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
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Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Polick CS, Rubenstein D, Shah S, Beckham JC, Calhoun PS, Noonan D. Addressing Smoking in Persons With Multiple Sclerosis: State of the Science and Need for a Targeted Intervention. Nicotine Tob Res 2024; 26:250-252. [PMID: 37625016 DOI: 10.1093/ntr/ntad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- Durham VA Health Care System, Durham, NC, USA
| | | | - Suma Shah
- Neurology Department, Duke University School of Medicine, Durham, NC, USA
- MS Center of Excellence, Durham VA Medical Center, Durham VA, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA
| | - Devon Noonan
- School of Nursing, Duke University, Durham, NC, USA
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Giovannetti AM, Quintas R, Maggiolo S, Quartuccio ME. Online mindfulness program (COndiVIDere) for people with multiple sclerosis in the time of COVID-19: a pilot longitudinal study. Disabil Rehabil 2023:1-9. [PMID: 38042990 DOI: 10.1080/09638288.2023.2290690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE This study aims to evaluate the feasibility and effectiveness of a mindfulness-based group intervention (The COndiVIDere program) delivered online to people with MS (PwMS) in the time of COVID-19. MATERIALS AND METHODS This is a single-arm longitudinal study with a nested qualitative study. The COndiVIDere program is composed of five weekly sessions (1-h each) plus three booster monthly sessions. Data were collected immediately before the beginning of the program, after the five weekly sessions, and at 3- and 6-month follow-ups. RESULTS Fifty PwMS participated in the program. Participants improved in anxiety, stress, loneliness and mindfulness ("non-judgmental inner experience" component). Improvements on most outcomes occurred at post-intervention and reached the statistically significant threshold at 3-month follow-up. Mindfulness improvements keep increasing at each time point. Qualitative data confirmed the COndiVIDere program feasibility and the positive psychological impacts on participants. Mindfulness, compassion and the group setting were considered the most important active elements. CONCLUSIONS Study findings support COndiVIDere feasibility and effectiveness with PwMS and its broad applicability in this population.
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rui Quintas
- Unit of Clinical and Experimental Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Maggiolo
- Italian Multiple Sclerosis Society and Research Foundation (FISM), Genoa, Italy
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Motolese F, Stelitano D, Lanzone J, Albergo G, Cruciani A, Masciulli C, Musumeci G, Pilato F, Rossi M, Ribolsi M, Di Lazzaro V, Capone F. Feasibility and efficacy of an at-home, smart-device aided mindfulness program in people with Multiple Sclerosis. Mult Scler Relat Disord 2023; 78:104931. [PMID: 37603929 DOI: 10.1016/j.msard.2023.104931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/16/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic disease with a high prevalence of neuropsychiatric symptoms. Mindfulness is a practice that encourages individuals to cultivate a present-focused, acceptance-based approach for managing psychological distress. Its positive effect on MS has been demonstrated, but learning such technique is expensive and time-consuming. In this study, we investigated the feasibility and efficacy of an 8-week, at-home, smart-device aided mindfulness program in a cohort of MS patients. Specifically, we explored the role of a brain-sensing headband providing real-time auditory feedback as supportive tool for meditation exercises. METHODS The study included two visits, one at baseline and another after the mindfulness program. We measured adherence to the proposed mindfulness treatment and its effect on questionnaires investigating different psychological domains, cognition, fatigue, quality of life and quantitative EEG parameters. All participants received a smart biofeedback device to be used during the therapeutic program consisting of daily meditative exercises. RESULTS Twenty-nine patients were recruited for the present study. Among them, 27 (93%) completed the entire program and 17 (63%) completed more than 80% of the scheduled sessions. We observed a statistically significant reduction of the Ruminative Response Scale score and a significant increase of the Digit Span Backward. Regarding neurophysiological data, we found a significant reduction of the whole-scalp beta and parieto-occipital theta power post intervention. CONCLUSION Our results show that an at-home, smart-device aided mindfulness program is feasible for people with MS. The efficacy in terms of reappraisals of stress, cognitive and emotional coping responses is also supported by our neurophysiological data. Further studies are warranted to better explore the role of such approaches in managing the psychological impact of MS diagnosis.
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Affiliation(s)
- Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Domenica Stelitano
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Italy
| | - Giuliano Albergo
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | | | - Gabriella Musumeci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Mariagrazia Rossi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Michele Ribolsi
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.
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10
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Fragkiadaki E, Cotterill N, Rice C, Smith JA, Nizza IE. Evaluation of the feasibility and acceptability of an integrative group psychological intervention for people with Multiple Sclerosis: A study protocol. PLoS One 2023; 18:e0288295. [PMID: 37478122 PMCID: PMC10361468 DOI: 10.1371/journal.pone.0288295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
Multiple Sclerosis (MS) is characterised by significant symptom diversity and complexity. The unpredictability of the symptoms and the emotional and cognitive facets of the disease have a significant impact on the patients' quality of life, relationships and other significant areas of living. Psychological interventions have been found to have moderate effects on quality of life, depression, stress reduction, improvement of wellbeing, anxiety, fatigue, sleep disturbances and emotion regulation. Most interventions so far are based on generic models of therapy which cannot always cover the complexity and unpredictability of MS. The present research project follows from an exploratory mixed method study on the experience of psychological interventions and the impact on the management of MS. The results of that study generated themes that led to the development of an integrative group psychological intervention named MyMS-Ally. The current study aims to explore the feasibility and acceptability of MyMS-Ally intervention and obtain preliminary data on the effects on quality of life, emotion regulation, depression and anxiety through the application of a convergent mixed methods design. People with MS will be recruited at the Bristol and Avon Multiple Sclerosis centre, North Bristol NHS Trust. They will participate in MyMS-Ally group intervention for 8 weeks. Individual semi-structured interviews drawing on Interpretative Phenomenological methodology will be conducted before and after the intervention and at three months follow up. Participants will complete quantitative measures on quality of life, emotion regulation, depression and anxiety before and after the intervention and at one and three months follow up. The aim is to explore the relevance, sustainability and adherence to the intervention and study processes (feasibility) as well as the appropriateness of the intervention based on the emotional and cognitive responses, satisfaction and perceived effectiveness (acceptability). It is aspired that this patient-centred psychological intervention will address needs and preferences of people with MS. The results of the present study will provide data for further development of the intervention and will lead to a big scale evaluation study.
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Affiliation(s)
- Evangelia Fragkiadaki
- School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Nikki Cotterill
- School of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, United Kingdom
| | - Claire Rice
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan A Smith
- School of Science, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Isabella E Nizza
- School of Science, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
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Lawrence M, Davis B, De Amicis L, Booth J, Dickson S, Dougall N, Grealy M, Jani B, Maxwell M, Parkinson B, Pieri M, Mercer S. The HEADS: UP Development Study: Working with Key Stakeholders to Adapt a Mindfulness-Based Stress Reduction Course for People with Anxiety and Depression after Stroke. Healthcare (Basel) 2023; 11:healthcare11030355. [PMID: 36766930 PMCID: PMC9914141 DOI: 10.3390/healthcare11030355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Following stroke, rates of mood disorder are and remain high at five years (anxiety 34.4%; depression 23%). Structured mindfulness-based stress reduction (MBSR) courses are effective in a range of health conditions, but stroke survivors find adherence challenging. We aimed to adapt a standard MBSR course specifically for people affected by stroke. METHODS We recruited stroke survivors and family members with symptoms of anxiety and/or depression to take part in a co-development study comprising two rounds of MBSR 'taster' sessions, followed by focus groups in which views were sought on the practices sampled. Data were collected in October 2017 and May 2018 and were analysed using framework analysis, informed adaptations to mindfulness materials and delivery. RESULTS Twenty-eight stroke survivors and seven family members participated. Nineteen (76%) stroke survivors had anxiety; 15 (60%) had depression. Five (71.4%) family members reported anxiety; n = 4 (57.1%) depression. Thirty participants attended the first round of taster sessions and focus groups; twenty (66%) the second and three (10%) were unable to attend either round. Framework analysis informed adaptations to course delivery, practices, and materials, ultimately resulting in a stroke-specific MBSR course, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). CONCLUSIONS HEADS: UP may provide a feasible, appropriate, and meaningful self-management intervention to help alleviate symptoms of mood disorder.
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Affiliation(s)
- Maggie Lawrence
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
- Correspondence: ; Tel.: +44-(0)141-331-8863
| | - Bridget Davis
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Leyla De Amicis
- School of Education, University of Glasgow, Glasgow G3 6NH, UK
| | - Jo Booth
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Sylvia Dickson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Nadine Dougall
- Health and Social Care Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Madeleine Grealy
- Psychological Services and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Bhautesh Jani
- General Practice and Primary Care, School of Health and Wellbeing, MVLS, University of Glasgow, Glasgow G12 9LJ, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU), Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Ben Parkinson
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Matilde Pieri
- Research Centre for Health (ReaCH), Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK
| | - Stewart Mercer
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
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Cognitive rehabilitation and mindfulness reduce cognitive complaints in multiple sclerosis (REMIND-MS): A randomized controlled trial. Mult Scler Relat Disord 2023; 71:104529. [PMID: 36736039 DOI: 10.1016/j.msard.2023.104529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive problems, both complaints and objective impairments, are frequent and disabling in patients with multiple sclerosis (MS) and profoundly affect daily living. However, intervention studies that focus on cognitive problems that patients experience in their daily lives are limited. This study therefore aimed to investigate the effectiveness of cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT) on patient-reported cognitive complaints in MS. METHODS In this randomized-controlled trial, MS patients with cognitive complaints completed questionnaires and underwent neuropsychological assessments at baseline, post-treatment and 6-month follow-up. Patient-reported cognitive complaints were primarily investigated. Secondary outcomes included personalized cognitive goals and objective cognitive function. CRT and MBCT were compared to enhanced treatment as usual (ETAU) using linear mixed models. RESULTS Patients were randomized into CRT (n = 37), MBCT (n = 36) or ETAU (n = 37), of whom 100 completed the study. Both CRT and MBCT positively affected patient-reported cognitive complaints compared to ETAU at post-treatment (p<.05), but not 6 months later. At 6-month follow-up, CRT had a positive effect on personalized cognitive goals (p=.028) and MBCT on processing speed (p=.027). Patients with less cognitive complaints at baseline benefited more from CRT on the Cognitive Failures Questionnaire (i.e. primary outcome measuring cognitive complaints) at post-treatment (p=.012-.040), and those with better processing speed at baseline benefited more from MBCT (p=.016). CONCLUSION Both CRT and MBCT alleviated cognitive complaints in MS patients immediately after treatment completion, but these benefits did not persist. In the long term, CRT showed benefits on personalized cognitive goals and MBCT on processing speed. These results thereby provide insight in the specific contributions of available cognitive treatments for MS patients.
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Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review. J Neurol 2023; 270:1300-1322. [PMID: 36445508 PMCID: PMC9707147 DOI: 10.1007/s00415-022-11497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. METHODS Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings. RESULTS Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS. CONCLUSIONS A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.
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A systematic review and meta-analysis exploring the efficacy of mindfulness-based interventions on quality of life in people with multiple sclerosis. J Neurol 2023; 270:726-745. [PMID: 36348069 PMCID: PMC9643979 DOI: 10.1007/s00415-022-11451-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Quality of life (QoL) is commonly impaired among people with multiple sclerosis (PwMS). The aim of this study was to evaluate via meta-analysis the efficacy of Mindfulness-based interventions (MBIs) for improving QoL in PwMS. METHODS Eligible randomized controlled trials (RCTs) were identified via searching six major electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, AMED, and PsycINFO) in April 2022. The primary outcome was QoL. Study quality was determined using the Cochrane Collaboration risk of bias tool. Meta-analysis using a random effects model was undertaken. Effect sizes are reported as Standardized Mean Difference (SMD). Prospero ID: 139835. RESULTS From a total of 1312 individual studies, 14 RCTs were eligible for inclusion in the meta-analysis, total participant n = 937. Most studies included PwMS who remained ambulatory. Cognitively impaired PwMS were largely excluded. Comorbidities were inconsistently reported. Most MBIs were delivered face-to face in group format, but five were online. Eight studies (n = 8) measured MS-specific QoL. In meta-analysis, overall effect size (SMD) for any QoL measure (n = 14) was 0.40 (0.18-0.61), p = 0.0003, I2 = 52%. SMD for MS-specific QoL measures (n = 8) was 0.39 (0.21-0.57), p < 0.0001, I2 = 0%. MBI effect was largest on subscale measures of mental QoL (n = 8), SMD 0.70 (0.33-1.06), p = 0.0002, I2 = 63%. Adverse events were infrequently reported. CONCLUSIONS MBIs effectively improve QoL in PwMS. The greatest benefits are on mental health-related QoL. However, more research is needed to characterize optimal formatting, mechanisms of action, and effects in PwMS with more diverse social, educational, and clinical backgrounds.
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Korupolu R, Malik A, Ratcliff C, Robinson-Whelen S, Taylor HB. Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review. Arch Phys Med Rehabil 2022; 103:2410-2428. [PMID: 35760105 DOI: 10.1016/j.apmr.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas.
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Chelsea Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B Taylor
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas
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Montañés‐Masias B, Bort‐Roig J, Pascual JC, Soler J, Briones‐Buixassa L. Online psychological interventions to improve symptoms in multiple sclerosis: A systematic review: Online psychological interventions in Multiple Sclerosis. Acta Neurol Scand 2022; 146:448-464. [PMID: 36121184 PMCID: PMC9825977 DOI: 10.1111/ane.13709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
The aim of this systematic review was to assess the effectiveness of Internet-based psychological interventions in the treatment of physical, socio-affective and cognitive symptoms and quality of life (QoL) in people with multiple sclerosis (pwMS) to provide currently available evidence. Systematic searches for eligible studies were carried out in four databases (August 2021) using key words. Studies were screened, data extracted, quality appraised and analysed by three independent reviewers, using predefined criteria and following the PRISMA rules. Study quality was assessed using Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool. Physical, socio-affective and cognitive symptoms and QoL were the primary outcomes. Thirteen studies were included. Two principal approaches were reported: Cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI). Interventions varied from tailored versions to videoconference by a clinician, duration mean 8 weeks, delivered via individually and groups, all online. The review found that iCBT interventions were effective for improve depression, anxiety, fatigue and QoL, and slightly in cognitive functioning in pwMS, whereas MBI interventions reported benefits in depression, anxiety, stress and QoL, and less evidence in fatigue. Generally, study quality was acceptable in most studies; eleven of the studies scored a low risk of bias on all items in the Qualsyst Tool, whereas only two studies were considered unacceptable. Psychological online interventions may improve physical, socio-affective and cognitive symptoms as well as QoL in pwMS, overcoming the face-to-face barriers (i.e. disability). Contact with the therapist and groups sessions have been identified as enablers of the online interventions. Nevertheless, the limited number of studies and the heterogeneity of health outcomes reported made difficult to afford robust conclusions on psychological intervention effects in pwMS.
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Affiliation(s)
- Brenda Montañés‐Masias
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Judit Bort‐Roig
- Sport and Physical Activity Research Group, Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
| | - Juan Carlos Pascual
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Joaquim Soler
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Institut de Recerca Biomèdica Sant Pau (IIB‐Sant Pau)BarcelonaSpain,Department of Psychiatry and Forensic Medicine & Institute of NeurosciencesUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Laia Briones‐Buixassa
- Research group in Mental Health and Social Innovation (SaMIS), Centre for Health and Social Care ResearchUniversitat de Vic – Universitat Central de CatalunyaVicCataloniaSpain
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The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis). IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2022. [DOI: 10.5812/ijpbs-127590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Context: Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged and often occurs between the ages of 20 and 40. In addition to loss of motor, sensory, and cognitive function, patients with MS also experience related symptoms such as depression, anxiety, stress, fatigue, and pain. Objectives: The aim of this study was to systematically and meta-analyze the effectiveness of cognitive-behavioral, mindfulness and acceptance and commitment (CMAC) therapies to improving the psychological symptoms of patients with multiple sclerosis in Iran. Methods: The study was conducted using preferred reporting items for systematic reviews and meta-analysis. This study examined articles published from the beginning until November 20, 2021 in Persian and English on cognitive and behavioral interventions performed in Iran, in order to influence psychological symptoms for people with multiple sclerosis. Articles relevant to research were screened in external (Google Scholar, PubMed, Scopus, Science Direct, Web of Science) and internal databases (Sid, Magiran, Ganj, Irandoc, Civilica). The quality of the included RCTs was assessed using the Cochrane guideline risk of bias tool. The results were expressed in terms of mean difference (MD) and the corresponding 95% confidence interval. Data analyses were performed by RevMan5.4. Results: In the first stage of the search, 792 articles were obtained. After reviewing the titles of the articles, 701 articles were discarded due to irrelevance and duplication and 91 articles remained. Finally, 21 studies were selected by reviewing the abstracts and considering the inclusion criteria. Compared with the control group, the standardized mean difference (SMD) estimate depression was 1.60 (2.27, 0.93), for anxiety 0.49 (0.80, 0.19), for stress 0.97 (1.70, 0.23) and for fatigue 0.19 (2.75, 1.25) had a positive effect; But no significant effect on pain reduction equal to 0.49 (2.21, 1.23) was not found. Conclusions: The meta-analysis in the posttest showed that the effects of CMAC were considerable on reducing depression, anxiety, stress, and fatigue, but the effects were not notable for pain mitigation. Future high quality studies with follow-up evaluations are needed to support the effects of CMAC on reducing symptoms in people with multiple sclerosis and to evaluate the interventional features that enhance and maintain the effects.
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Online Mindfulness-Based Cognitive Therapy for People with Parkinson’s Disease and Their Caregivers: a Pilot Study. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:381-395. [PMID: 35527798 PMCID: PMC9059916 DOI: 10.1007/s41347-022-00261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
Anxiety and depression are common non-motor symptoms of Parkinson’s disease (PD). Caregivers of people with PD may experience severe caregiver burden. This study explored the feasibility and potential benefits of an online mindfulness-based cognitive therapy (MBCT) intervention for improving anxiety and depressive symptoms in people with PD and their caregivers (ClinicalTrials.gov NCT04469049, 7/8/2020). People with PD or parkinsonism and anxiety and/or depressive symptoms and caregivers of people with PD participated in one of three online MBCT groups. Demographic variables, pre- and post-MBCT behavioral measures (GAD-7, PHQ-9, Five Facet Mindfulness Questionnaire — FFMQ-15, Caregiver Self-Assessment Questionnaire — CSAQ), and satisfaction surveys were collected. Descriptive statistics were used to summarize data. Pre- and post-MBCT behavioral scores were compared using mixed-effect models. Fifty-six potential participants were assessed for eligibility. Twenty-eight entered MBCT groups; all but one completed the intervention. The overall sample analyzed (22 people with PD, 4 caregivers) showed significant GAD-7 and PHQ-9 score reductions and FFMQ-15 total and observing and non-reactivity subscale score increases (all p’s < 0.05). Participants with PD and anxiety symptoms (n = 14) had a significant GAD-7 score reduction; those with PD and depressive symptoms (n = 12) had a significant PHQ-9 score reduction (both p’s < 0.05). Participants with PD also had a significant FFMQ-15 observing subscale score increase (p < 0.05). The caregiver sample was too small to be analyzed separately. Online MBCT is feasible (as measured by high attendance, completion rate, and participant satisfaction) and may be effective in improving anxiety and depressive symptoms in people with PD.
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Sadeghi-Bahmani D, Esmaeili L, Mokhtari F, Sadeghi L, Afsharzadeh M, Shaygannejad V, Mirmosayyeb O, Goldstein-Piekarski AN, Gross JJ. Effects of Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR) on Symptoms and Emotional Competencies in Individuals with Multiple Sclerosis. Mult Scler Relat Disord 2022; 67:104029. [DOI: 10.1016/j.msard.2022.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/15/2022] [Accepted: 07/03/2022] [Indexed: 10/31/2022]
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Lyons J, Campese S, Learmonth YC, Metse A, Kermode AG, Karahalios A, Marck CH. Comparing the effectiveness, safety and tolerability of interventions for depressive symptoms in people with multiple sclerosis: a systematic review and network meta-analysis protocol. BMJ Open 2022; 12:e055796. [PMID: 35680262 PMCID: PMC9185417 DOI: 10.1136/bmjopen-2021-055796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Comorbid depression is prevalent in people with multiple sclerosis (MS). Depression is commonly untreated or undertreated, thus, there is a need for effective and safe interventions and current guidelines recommend psychological and pharmaceutical interventions for people with MS. However, research suggests that other interventions, such as exercise, could also be effective. The comparative efficacy and safety of intervention modalities have not been quantified.We plan to conduct a systematic review and network meta-analysis to compare efficacy and safety of psychological, pharmaceutical, physical and magnetic stimulation interventions for depression in people with MS. METHODS AND ANALYSIS We will search EMBASE, Medline, Cochrane CENTRAL, APA PsycINFO, Web of Science, CINAHL and PEDro from inception to 31 December 2021. Search terms will stem from three concepts: MS, depression and randomised controlled trials. Included studies will be randomised controlled trials, where participants are people with MS randomised to receive one of the aforementioned intervention types, and depression or depressive symptoms is the primary outcome, only outcome or secondary outcome with an a priori power calculation. Screening, data extraction and risk of bias assessment (using the Risk of Bias 2 tool) will be conducted independently by two reviewers. If possible, we will synthesise the evidence by fitting a frequentist network meta-analysis model with multivariate random effects, or a pairwise random-effects meta-analysis model. For each model, efficacy will be measured using a standardised mean difference, and safety using an OR. We plan to provide summary measures including forest plots, a geometry of the network, surface under the cumulative ranking curve, and a league table, and perform subgroup analyses. Otherwise, a narrative review will be provided. ETHICS AND DISSEMINATION Ethics is not required for a systematic review and network meta-analysis. Results will be published in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020209803.
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Affiliation(s)
- Julia Lyons
- Disability and Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Campese
- Disability and Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne C Learmonth
- Discipline of Exercise Science, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Alexandra Metse
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Allan G Kermode
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Claudia H Marck
- Disability and Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Poos JM, van den Berg E, Papma JM, van der Tholen FC, Seelaar H, Donker Kaat L, Kievit JA, Tibben A, van Swieten JC, Jiskoot LC. Mindfulness-Based Stress Reduction in Pre-symptomatic Genetic Frontotemporal Dementia: A Pilot Study. Front Psychiatry 2022; 13:864391. [PMID: 35573340 PMCID: PMC9091907 DOI: 10.3389/fpsyt.2022.864391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Pre-symptomatic frontotemporal dementia (FTD) mutation carriers and first-degree family members that are 50% at-risk for FTD may experience symptoms of anxiety and depression as a result of the ambiguity of when or if symptoms of the disease will manifest. We conducted a pilot study to investigate the use of an online mindfulness-based stress reduction (MBSR) course to reduce symptoms of anxiety and depression in presymptomatic frontotemporal dementia (FTD) mutation carriers and individuals 50% at-risk. Seven known mutation carriers and six individuals 50% at-risk completed a standardized 8-week MBSR course, and filled out pre- and post and two-month follow-up questionnaires. The primary outcome measure was the Hospital Anxiety and Depression Scale (HADS). Measures of psychological distress (SCL-90-R), coping style (UCL), quality of life (SF-36) and mindfulness skills (FFMQ) were administered as secondary outcome. Group effects were analyzed with repeated measures ANOVA or Friedman's test, and the individual reliability change index (RCI) was calculated per participant for each outcome measure. Semi-quantitative data included an evaluation and process measure post-intervention. Significant decline was found on the HADS-A post-intervention and after 2 months (p = 0.01), with 54% and 62% of participants demonstrating a clinically significant RCI, respectively. On the HADS-D, significant decline was found 2 months post-intervention (p = 0.04), which was driven by 23% of participants whom had a clinically significant RCI. Additional changes were found between baseline and post-intervention on the seeking distraction and reassuring thoughts subscales of the UCL, the depression and interpersonal sensitivity subscales of the SCL, the observe subscale of the FFMQ, and on physical role limitations of the SF-36 (all p < 0.05). The process evaluation form indicated that the course was found beneficial by participants, and that they applied it in a wide range of everyday situations. This exploratory pilot study indicates the feasibility of MBSR in reducing anxiety and depression in presymptomatic FTD mutation carriers and 50% at-risk individuals. A randomized controlled trial is necessary to replicate these results.
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Affiliation(s)
- Jackie M. Poos
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Janne M. Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Fleur C. van der Tholen
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Harro Seelaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Laura Donker Kaat
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - J Anneke Kievit
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - John C. van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Lize C. Jiskoot
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Dementia Research Centre, University College London, London, United Kingdom
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22
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Liu Z, Jia Y, Li M, Meng X, Shang B, Wang C, Chen L. Effectiveness of online mindfulness-based interventions for improving mental health in patients with physical health conditions: Systematic review and meta-analysis. Arch Psychiatr Nurs 2022; 37:52-60. [PMID: 35337439 DOI: 10.1016/j.apnu.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/19/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022]
Abstract
We aimed to determine the effectiveness of online mindfulness-based interventions (MBIs) for improving mental health in patients with physical health conditions. Randomized controlled trials (RCTs) in PubMed, Cochrane Library, Web of Science, Elsevier, and CINAHL published through September 2019 were searched. Two reviewers selected trials, conducted a critical appraisal, and extracted the data. Meta-analyses were performed. A total of nine RCTs were included. Analyses revealed that online MBIs was effective in improving depression [standardized mean difference (SMD) = -0.22, 95% confidence interval (CI) (-0.37, -0.07), p = 0.004], anxiety [SMD = -0.19, 95% CI (-0.33, -0.04), p = 0.01], and stress [SMD = -0.32, 95% CI (-0.52, -0.13), p = 0.001], and mindfulness [SMD = 1.67, 95% CI (0.14, 3.20), p = 0.03] in patients with physical conditions. We did not find any obvious effects on well-being [SMD = 1.12, 95% CI (-0.11, 2.36), p = 0.08]. Nevertheless, additional well-designed randomized clinical trials are further needed.
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Affiliation(s)
- Zengxia Liu
- School of Nursing, Jilin University, Changchun, China; School of Nursing, Changchun University of Chinese Medicine, Changchun, China
| | - Yong Jia
- School of Nursing, Jilin University, Changchun, China
| | - Min Li
- Invasive Technology Department, First Hospital of Jilin University, Changchun, China
| | - Xiangfei Meng
- School of Nursing, Jilin University, Changchun, China
| | - Binghan Shang
- School of Nursing, Jilin University, Changchun, China
| | - Chunyan Wang
- Senior Officials Inpatient Ward, First Hospital of Jilin University, Changchun, China.
| | - Li Chen
- School of Nursing, Jilin University, Changchun, China.
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23
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Kraemer KM, Jain FA, Mehta DH, Fricchione GL. Meditative and Mindfulness-Focused Interventions in Neurology: Principles, Science, and Patient Selection. Semin Neurol 2022; 42:123-135. [PMID: 35139550 PMCID: PMC9177528 DOI: 10.1055/s-0042-1742287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A growing body of research suggests that meditative- and mindfulness-focused interventions may improve neuropsychiatric symptoms that commonly occur in a range of neurological disorders. In this article, the principles of meditation and mindfulness are first defined, as well as briefly describing the neurobiological mechanisms implicated in these interventions. Thereafter, a range of meditative- and mindfulness-focused interventions are detailed, along with their supporting evidence to treat neuropsychiatric symptoms in neurological conditions (e.g., headache, movement disorders, chronic pain, etc.). Overall, these interventions warrant further investigation among individuals with neurological conditions. When recommending these interventions, health care professionals must consider a combination of structural (e.g., insurance reimbursement) and patient factors (e.g., ability to tolerate a group setting).
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Affiliation(s)
- Kristen M. Kraemer
- Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA 02215
| | - Felipe A. Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, One Bowdoin Square, 6th Floor, Boston MA 02114
| | - Darshan H. Mehta
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, 151 Merrimac Street, 4th Floor, Boston, MA 02114
- Osher Center for Integrative Medicine, Brigham & Women’s Hospital, 900 Commonwealth Avenue East, 3rd Floor, Boston, MA 02215
| | - Gregory L. Fricchione
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, 151 Merrimac Street, 4th Floor, Boston, MA 02114
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24
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Undertaking specific stress-reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis. Mult Scler Relat Disord 2022; 62:103804. [DOI: 10.1016/j.msard.2022.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/28/2022] [Accepted: 04/10/2022] [Indexed: 11/21/2022]
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25
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Exploring the enablers and barriers to social prescribing for people living with long-term neurological conditions: a focus group investigation. BMC Health Serv Res 2021; 21:1230. [PMID: 34774034 PMCID: PMC8590354 DOI: 10.1186/s12913-021-07213-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with Long Term Neurological Conditions (LTNCs) value peer support and social activities. Psychological support and wellbeing enables them to manage their condition. Social prescribing is a formal process of referring patients to a link worker to co-design a plan to improve their health and wellbeing. Intervention involves supporting participation in activities based within the individual’s local community. This study aimed to explore the barriers and enablers to accessing social prescribing for people living with LTNCs (plwLTNCs). Methods A total of four focus groups were carried out with 17 participants, including different neurological conditions such as multiple sclerosis, Fragile X Syndrome, epilepsy, and traumatic brain injury. Two participants were family carers and supported people living with epilepsy and motor neurone disease. Findings were analysed using thematic analysis. Results Five themes were identified: (1) Lack of knowledge; (2) Service provision difficulties; (3) Benefits of social prescribing activities; (4) Physical barriers and (5) Psychological barriers. There was a lack of knowledge about social prescribing and what it actually was. Participants anticipated service provision difficulties relating to funding, link workers need for knowledge of LTNC’s and for activities to be varied and individualised. The potential benefits of social prescribing activities were recognised across the groups especially its potential to tackle loneliness and to offer plwLTNC’s purpose. Participants highlighted a number of physical barriers such as transport and accessibility; and psychological barriers such as anxiety and stigma. Conclusion Social prescribing aims to address the health inequalities of those living with long-term conditions, however currently it is likely to exclude plwLTNCs. Recommendations for practice and future research are made. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07213-6.
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26
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Sauder T, Hansen S, Bauswein C, Müller R, Jaruszowic S, Keune J, Schenk T, Oschmann P, Keune PM. Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression. BMC Neurol 2021; 21:390. [PMID: 34625058 PMCID: PMC8499486 DOI: 10.1186/s12883-021-02390-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention. METHODS A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training. RESULTS Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance. CONCLUSION Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.
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Affiliation(s)
- Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Carina Bauswein
- Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sonja Jaruszowic
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Jana Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Thomas Schenk
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany. .,Department of Physiological Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany.
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27
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Simpson R, Simpson S, Wasilewski M, Mercer S, Lawrence M. Mindfulness-based interventions for people with multiple sclerosis: a systematic review and meta-aggregation of qualitative research studies. Disabil Rehabil 2021; 44:6179-6193. [PMID: 34498997 DOI: 10.1080/09638288.2021.1964622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Mindfulness-based interventions (MBIs) are effective treatments for stress, anxiety, and depression in PwMS. However, low adherence and high attrition may limit effectiveness. Qualitative research can provide important insights into MBI acceptability, accessibility, and implementation. This systematic review and meta-aggregation evaluated qualitative research findings on the use of MBIs for PwMS. METHODS Systematic searches were undertaken in six major electronic databases. Studies using qualitative or mixed methods were included. Two reviewers screened, data extracted, and critically appraised studies. Meta-aggregation was performed following the Joanna Briggs Institute approach, extracting findings, developing categories, and synthesizing findings. RESULTS Six eligible papers, including 136 PwMS were included in meta-aggregation. 136 findings were extracted, grouped into 17 categories, with four synthesized findings: (1) "accessing mindfulness," (2) "a sense of belonging," (3) "experiencing mindfulness," and (4) "making mindfulness more relevant and sustainable for PwMS." CONCLUSIONS MBIs for PwMS need to take into consideration disability which can limit accessibility. Online MBIs (synchronous and asynchronous) appear acceptable alternatives to traditional face-to-face courses. However, PwMS benefit from shared (mindful) experiencing and highlight MBI instructors as crucial in helping them understand and practice mindfulness. Involving PwMS in design, delivery, and iterative refinement would make MBIs more relevant to those taking part.IMPLICATIONS FOR REHABILITATIONBoth face-to-face and online Mindfulness-based interventions (MBIs) appear acceptable to PwMS and, ideally, people should be offered a choice in training modality.PwMS derive benefit from undertaking MBIs with their peers, where a sense of camaraderie and belonging develop through shared (mindful) experiences.Instructors delivering MBIs for PwMS should be knowledgeable about the condition; participants describe how the instructor has a key role in helping them practice mindfulness effectively in the context of unpleasant experiences associated with MS.MBIs tailored for PwMS should include a pre-course orientation session, clearly articulate how mindfulness practices can help with MS, provide well-organized course materials in large font size, and deliver individual mindfulness practices flexibly depending on participant need.
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Affiliation(s)
- Robert Simpson
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada.,Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Sharon Simpson
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Marina Wasilewski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Canada
| | | | - Maggie Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK
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28
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Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Psychosom Med 2021; 82:600-613. [PMID: 32541543 DOI: 10.1097/psy.0000000000000819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS). METHODS Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted. RESULTS Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively). CONCLUSIONS MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS. PROSPERO REGISTRATION CRD42018099704.
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29
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Panagopoulou Z, Artemiadis AK, Chrousos GP, Darviri C, Anagnostouli MC. Pythagorean Self-Awareness Intervention for Multiple Sclerosis Patients: A Quasi-Experimental Pragmatic Trial. Arch Clin Neuropsychol 2021; 37:125-132. [PMID: 34128954 DOI: 10.1093/arclin/acab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system affecting patients' well-being and quality of life. Pythagorean Self-Awareness Intervention (PSAI) is a novel non-pharmaceutical intervention with significant benefits both in MS and other chronic diseases. In this study, the longstanding effectiveness of PSAI was investigated. METHOD This was a two-arm quasi-experimental pragmatic trial in relapsing-remitting MS patients (23 in the PSAI and 21 in the control group). PSAI patients received an 8-week training period and then they performed PSAI at home for another 16 weeks. Assessments took place at baseline, 8 weeks, and 24 weeks. These included cognition, fatigue, perceived stress, and hair cortisol. RESULTS Significant group × time interactions favoring PSAI were found during the first 8-week period for information processing speed, fatigue, and perceived stress. However, only verbal memory was found to be significantly improved in the PSAI group during the 24-week follow-up period. There were no significant group × time differences with respect to hair cortisol. No side effects were noted and compliance was excellent. CONCLUSIONS PSAI was mostly effective during the first 8-week training period. Its benefits worn out during the non-training period, albeit we observed a delayed significant improvement of verbal memory. Our findings will help to further refine the technique, either by extending the training period and/or by including booster sessions, throughout the PSAI treatment. This study provided Class III evidence for PSAI.
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Affiliation(s)
- Zacharo Panagopoulou
- Postgraduate Program "The Science of Stress and Health Promotion," Medical School, National Kapodistrian University of Athens, Athens, Greece
| | | | - George P Chrousos
- 1st Department of Pediatrics, Aghia Sophia Children's Hospital, Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - Christina Darviri
- Postgraduate Program "The Science of Stress and Health Promotion," Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - Maria C Anagnostouli
- 1st Department of Neurology, Aeginition Hospital, Medical School, National Kapodistrian University of Athens, Athens, Greece
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30
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Davis BE, Lakin L, Binns CC, Currie KM, Rensel MR. Patient and Provider Insights into the Impact of Multiple Sclerosis on Mental Health: A Narrative Review. Neurol Ther 2021; 10:99-119. [PMID: 33877584 PMCID: PMC8056993 DOI: 10.1007/s40120-021-00240-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic disease in which the immune system attacks the central nervous system, causing inflammation and neurodegeneration. People living with MS may experience a variety of symptoms as a consequence of this process, including many “invisible” symptoms that are internally manifested and not seen by others. Of the invisible symptoms of MS, which we have reviewed in a companion article, mood and mental health disorders are of particular concern due to their high prevalence and significant impact on patient quality of life. In this review, we showcase the experiences of patient authors alongside perspectives from healthcare provider authors as we promote awareness of the common mental health conditions faced by those living with MS, such as depression, anxiety, adjustment disorder, bipolar disorder, psychosis, and suicidal ideation. Many of these conditions stem in part from the increased stress levels and the many uncertainties that come with managing life with MS, which have been exacerbated by the environment created by the coronavirus disease 2019 (COVID-19) pandemic. A patient-centered interdisciplinary approach, routine screening for mental health changes, and referral to specialists when needed can normalize discussions of mental health and increase the likelihood that people living with MS will receive the support and care they need. Management techniques such as robust social support, cognitive behavioral therapy, mindfulness-based interventions, and/or pharmacotherapy may be implemented to build resilience and promote healthy coping strategies. Increasingly, patients have access to telehealth options as well as digital apps for mental health management. Taken together, these approaches form an integrative care model in which people living with MS benefit from the care of medical professionals, a variety of support networks/resources, and self-management techniques for optimal mental health care. ![]()
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Affiliation(s)
- Bryan E Davis
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA.,The University of California Riverside, Comprehensive MS Center, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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31
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Han A. Mindfulness- and Acceptance-Based Interventions for Symptom Reduction in Individuals With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2021; 102:2022-2031.e4. [PMID: 33812883 DOI: 10.1016/j.apmr.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effects of mindfulness- and acceptance-based interventions (MABIs) on reducing symptoms in individuals with multiple sclerosis (MS). DATA SOURCES A comprehensive search was conducted within the PubMed, CINAHL, PsycINFO, and SCOPUS databases for articles published from inception to July 3, 2020. STUDY SELECTION Randomized controlled trials (RCTs) were included if MABIs were provided to individuals with MS exclusively, with reported pre-and posttest results in symptoms of depression, anxiety, stress, fatigue, or pain. DATA EXTRACTION Characteristics of the included RCTs and data for meta-analysis were extracted. The quality of the included RCTs was assessed using the Cochrane Collaboration risk of bias tool. DATA SYNTHESIS A random effects model with the inverse variance method was used with effect size reported as standardized mean difference. Heterogeneity was assessed using the I2 statistic. RESULTS Twenty-three RCTs met the eligibility criteria. Meta-analyses found large effects of MABIs on reducing depressive symptoms, anxiety, stress, and pain, as well as a moderate effect of MABIs on reducing fatigue at the immediate posttest. Large effects of MABIs on reducing depressive symptoms, anxiety, and stress at follow-up were also found, whereas a moderate effect on reducing fatigue was found at follow-up. There was no significant effect of MABIs on reducing pain at follow-up. CONCLUSIONS Fewer studies were included in meta-analyses for pain at the immediate posttest and follow-up and stress and fatigue at follow-up. The overall risk of bias was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on reducing symptoms in individuals with MS and examine intervention features that increase and maintain effects.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL.
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32
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Sauder T, Keune PM, Müller R, Schenk T, Oschmann P, Hansen S. Trait mindfulness is primarily associated with depression and not with fatigue in multiple sclerosis (MS): implications for mindfulness-based interventions. BMC Neurol 2021; 21:115. [PMID: 33726702 PMCID: PMC7962308 DOI: 10.1186/s12883-021-02120-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Persons with MS (PwMS) often display symptoms of depression and fatigue. Mindfulness-based interventions are known to counteract these symptoms. However, to-date the exact relations between trait mindfulness, depression and fatigue remain to be examined. Fatigue is generally regarded as a symptom immanent to the disease and as a direct neurobiological consequence of increased cytokine levels and cortical atrophy. In depression on the other hand, psychosocial factors in the context of adaptation difficulties are probably of higher relevance. Hence, one may argue that mindfulness, as a trait that promotes successful adaption, may show a strong negative association with depression and a relatively minor negative association with fatigue in PwMS. Methods In the current study, the association between self-reported trait mindfulness, fatigue and depression was examined in a sample of 69 PwMS. Results Trait mindfulness showed highly significant negative correlations with both, depression and fatigue. Mediation analyses however, revealed that depression mediated the relation between mindfulness and fatigue. Conclusion It may be concluded that in PwMS, trait mindfulness shows a genuine negative association with depression, but that it is only secondarily associated with fatigue. Implications for mindfulness-based interventions in MS are discussed. Based on the results of the current study, it may be feasible to promote the acceptance of default fatigue symptoms, instead of an actual reduction of fatigue symptoms.
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Affiliation(s)
- Torsten Sauder
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany. .,Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Philipp M Keune
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Roy Müller
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Thomas Schenk
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Patrick Oschmann
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Sascha Hansen
- Department of Neurology, Klinikum Bayreuth GmbH, Bayreuth, Germany.,Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
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Eccles FJR, Craufurd D, Smith A, Davies R, Glenny K, Homberger M, Rose L, Theed R, Peeren S, Rogers D, Skitt Z, Zarotti N, Simpson J. Experiences of Mindfulness-Based Cognitive Therapy for Premanifest Huntington's Disease. J Huntingtons Dis 2021; 10:277-291. [PMID: 33646170 DOI: 10.3233/jhd-210471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological difficulties such as anxiety, depression, and irritability are common in Huntington's disease, even for premanifest individuals. However, very little evidence exists of psychological approaches to manage this distress. We have conducted a feasibility study with an embedded qualitative component to investigate the possibility of using mindfulness-based cognitive therapy (MBCT) and present here the findings from the qualitative data. OBJECTIVE To investigate the experience of premanifest individuals learning and practising mindfulness through completing a course of MBCT. METHODS Twelve premanifest individuals completed a course of MBCT and attended three follow up reunion meetings over the following year. Eleven participants agreed to be interviewed post-course and ten participants one year post-course about their experience of the course and any impact on their lives. Seven participants nominated a friend or relative (supporter) to be involved in the research, of whom six agreed to be interviewed post-course and two at one year about the impact of the course on the participants. Data were analysed using reflexive thematic analysis. RESULTS Four themes were constructed from the data: 1) A meeting of minds: the group facilitating learning and support; 2) Mindfulness is hard, but enables more effective emotional management; 3) Mindfulness can change the relationship with self and others; and 4) Benefiting from mindfulness: the importance of persistence. CONCLUSION The participants who completed the course found it beneficial. Some participants reported reductions in psychological distress, a greater sense of calm and better emotion regulation, with some of these positive changes also noticed by supporters. MBCT is worthy of further investigation for this population.
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Affiliation(s)
- Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - David Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alistair Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kristian Glenny
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Max Homberger
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Leona Rose
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rachael Theed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Siofra Peeren
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dawn Rogers
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Zara Skitt
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Han A. Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:1514-1531. [PMID: 33629885 DOI: 10.1080/13548506.2021.1894345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) examined effects of mindfulness- and acceptance-based interventions (MABIs) on quality of life (QoL), coping, cognition, and mindfulness among people with multiple sclerosis (MS). Four electronic databases were searched to 3 July 2020. Data was combined in a random-effects meta-analysis model. Eighteen RCTs met the eligibility criteria. Meta-analyses at the immediate posttest found: moderate effects of MABIs on QoL, coping, and attention; and a large effect on memory. A large effect of MABIs on QoL was found at follow-up. There was no significant effect of MABIs on mindfulness. Relatively fewer studies in outcomes other than QoL were found, and the overall risk of bias across the included 18 RCTs was unclear. Future high-quality studies with follow-up evaluations are needed to support effects of MABIs on QoL, coping, cognition, and mindfulness in people with MS and examine intervention features that increase and maintain effects.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Dunne J, Chih HJ, Begley A, Daly A, Gerlach R, Schütze R, Castell E, Byrne J, Black LJ. A randomised controlled trial to test the feasibility of online mindfulness programs for people with multiple sclerosis. Mult Scler Relat Disord 2020; 48:102728. [PMID: 33477003 DOI: 10.1016/j.msard.2020.102728] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/23/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Practicing mindfulness may improve mental health and reduce pain in people with multiple sclerosis (MS). Since participating in face-to-face mindfulness programs can be challenging for people with MS, exploring alternative ways of delivering these programs is necessary. The objective of this trial was to assess feasibility of two different eight-week online mindfulness programs across five domains: recruitment, practicality, acceptability, integration of mindfulness practice, and limited efficacy testing on mental health, quality of life and pain. METHODS In a three-arm randomised controlled mixed-method trial, participants were assigned to: 1) Mindfulness for Multiple Sclerosis (M4MS) (n=18); 2) Chair Yoga (n=18); or 3) wait-list control group (n=19) for eight weeks. Daily home practice diaries and weekly reflective journals were collected along with online questionnaires at baseline and post-intervention. Feasibility was assessed using descriptive statistics, multilevel mixed-effects regression, and content analysis. RESULTS Online recruitment, online program delivery and online data collection were all found to be feasible. The sign up rate was 65% and overall, 87% of the participant completed the eight-week online programs. The programs were perceived as practical and acceptable by the participants. Integration of mindfulness practice into daily life varied, with time and fatigue reported as common barriers to practice. No statistically significant differences in efficacy measures were found among groups (p>0.05). CONCLUSION Online mindfulness programs are feasible and acceptable for people with MS. This study provides useful insights for future trials when designing online mindfulness programs for people with MS.
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Affiliation(s)
- Jennifer Dunne
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Hui Jun Chih
- School of Public Health, Curtin University, Perth, Western Australia, Australia.
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Alison Daly
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Robert Schütze
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Emily Castell
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Jean Byrne
- Wisdom Yoga Institute, Western Australia, Australia
| | - Lucinda J Black
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Simpson S, Smith S, Furlong M, Ireland J, Giebel C. Supporting access to activities to enhance well-being and reduce social isolation in people living with motor neurone disease. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2282-2289. [PMID: 32483867 DOI: 10.1111/hsc.13049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE People living with Motor Neurone Disease (plwMND) have emphasised the importance of psychological support and well-being in helping them manage their condition. Social prescribing is a formal process of referring patients with largely socioeconomic and psychosocial issues to a link worker to co-design a plan to improve their health and well-being. Intervention involves supporting engagement in meaningful activities based within the individual's local community. This pilot project aimed to explore the application of social prescribing with plwMND. METHODS A cohort of plwMND were supported by an occupational therapist and link worker to identify and access community-based activities. Qualitative interviews were completed post-intervention with the plwMND and the link workers. Findings were analysed using thematic analysis. RESULTS A total of nine plwMND took part in this pilot service, and five plwMND and four link workers were interviewed. PlwMND valued participation and wanted to engage in community-based activities. Those with mild symptomatology were able to access activities and reported a positive impact on their well-being. Those with more complex needs, particularly reduced mobility, experienced significant barriers to participation. Barriers included transport, equipment provision, lack of company to support participation and lack of confidence using mobility aids in a community environment. Link workers valued joint working with an occupational therapist. CONCLUSION Social prescribing aims to address the health inequalities of those living with long-term conditions, although currently it likely excludes plwMND. Future work needs to quantitatively evaluate the effects of the service on the well-being of plwMND.
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Affiliation(s)
- Suzanne Simpson
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Moira Furlong
- NIHR ARC NWC, Liverpool, UK
- MND Association, Liverpool, UK
| | - Janet Ireland
- NIHR ARC NWC, Liverpool, UK
- The Brain Charity, Liverpool, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
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Hearn JH, Finlay KA, Sheffield D. ‘Trying to bring attention to your body when you’re not sure where it is’: An interpretative phenomenological analysis of drivers and barriers to mindfulness for people with spinal cord injury. Br J Health Psychol 2020; 26:161-178. [DOI: 10.1111/bjhp.12462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/01/2020] [Indexed: 01/12/2023]
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Kiernan MC. The Journal of Neurology, Neurosurgery and Psychiatry centenary milestone award 2020. J Neurol Neurosurg Psychiatry 2020; 91:677. [PMID: 32123039 DOI: 10.1136/jnnp-2020-322976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew C Kiernan
- Bushell Chair of Neurology, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia .,Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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39
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Eccles FJR, Craufurd D, Smith A, Davies R, Glenny K, Homberger M, Peeren S, Rogers D, Rose L, Skitt Z, Theed R, Simpson J. A feasibility investigation of mindfulness-based cognitive therapy for people with Huntington's disease. Pilot Feasibility Stud 2020; 6:90. [PMID: 32595978 PMCID: PMC7315515 DOI: 10.1186/s40814-020-00631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative condition which affects movement, coordination and cognitive functioning. Psychological difficulties are commonly experienced; however, psychological interventions have been little researched with this population. We investigated the feasibility of conducting a randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) with people with the HD genetic mutation, either pre-manifest (before onset of movement symptoms) or at an early disease stage. Specifically, we evaluated the willingness of participants to be recruited into and complete the intervention; the acceptability of the study measures in relation to completion; the feasibility of offering the standard MBCT course to people with HD; the acceptability of the intervention and the estimated effect sizes. METHODS Participants were recruited from two UK HD centres and took part in an 8-week course of MBCT, with three reunions throughout the following year. Stress, depression, anxiety, and mindfulness were measured pre-, mid-, and post-course, at 3 months and at 1 year. Sleep, quality of life, positive affect and coping were measured pre- and post-course, at 3 months and at 1 year. Descriptive data and approximate effect sizes were calculated. Interviews were conducted post-course and at 1 year and data pertaining to the acceptability of the course were extracted. RESULTS Twelve participants took part in two groups; all were pre-manifest. Levels of depression and anxiety were low pre-course leaving little room for improvement. Changes in stress and in some aspects of mindfulness were medium to large. The qualitative data suggested participants rated the course highly and found it helpful and no changes to the standard course were needed. Recruitment levels were below those anticipated. Most measures were found to be acceptable. CONCLUSIONS Although the course was acceptable to those who took part, given the difficulties in recruiting and the rarity of HD, conducting an RCT of MBCT teaching groups in person does not seem feasible. However, alternative modes of course delivery (e.g. online) would allow the recruitment of people from a greater geographical area and may make an RCT feasible; this revised focus would be suitable for future feasibility studies. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02464293, registered 8 June 2015.
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Affiliation(s)
- Fiona J. R. Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - David Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Alistair Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ UK
| | - Kristian Glenny
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Max Homberger
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Siofra Peeren
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Dawn Rogers
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Leona Rose
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Zara Skitt
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
- Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UK
| | - Rachael Theed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YT UK
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Russell RD, Black LJ, Pham NM, Begley A. The effectiveness of emotional wellness programs on mental health outcomes for adults with multiple sclerosis: a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 44:102171. [PMID: 32554283 DOI: 10.1016/j.msard.2020.102171] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND People with multiple sclerosis (MS) have a greater prevalence of depression and anxiety than the general population. Emotional wellness programs (any psychological or psychosocial interventions that focus on awareness, acceptance, managing, or challenging thoughts and feelings) could be important for people with MS. However, there have been no reviews on the effectiveness of emotional wellness programs for people with MS. The objective of this review was to determine the effectiveness of emotional wellness programs on mental health outcomes for adults with MS. INCLUSION CRITERIA Randomised controlled trials (RCTs) and quasi-experimental trials evaluating emotional wellness programs for adults with any form of MS were included. Mental health outcomes included were depression, anxiety, quality of life, and stress. The comparator groups were waitlist controls, usual care, or another intervention. METHODS This review was registered with PROSPERO (registration number CRD42019131082) and conducted in accordance with PRISMA guidelines. CINAHL, Cochrane, MEDLINE, PsycInfo, Web of Science, ProQuest Dissertations and Theses, Cochrane register of Controlled Trials, and Google Scholar were searched for English- language publications. Titles and abstracts were initially screened, followed by a screen of full text articles. Studies were critically appraised for methodological quality using the JBI standardised critical appraisal checklists. Data were extracted on intervention details, study outcome measures, behaviour change techniques, and results. Random effects meta-analyses were performed for outcomes assessed in at least five studies, with results reported as the standardised mean difference (SMD). RESULTS This review comprised 25 RCTs and four quasi-experimental studies (n participants=2323); 21 were included in meta-analyses. Meta-analyses produced statistically significant results favouring the interventions (SMD (95% CI) for depression -0.55 (-0.87, -0.24); anxiety -0.42 (-0.70, -0.14); quality of life 0.28 (0.14, 0.43); and stress -1.00 (-1.58, -0.43)). The most commonly used behaviour change techniques were behaviour practice/rehearsal, social comparison, and social support. CONCLUSIONS This review provides evidence to support the effectiveness of emotional wellness programs for improving mental health outcomes in adults with MS. However, these findings should be interpreted with caution given the high degree of heterogeneity between the studies, and potential for biases in analysis due to missing data and/or incomplete reporting.
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Affiliation(s)
- R D Russell
- School of Public Health, Curtin University, Perth, Australia
| | - L J Black
- School of Public Health, Curtin University, Perth, Australia
| | - N M Pham
- School of Public Health, Curtin University, Perth, Australia; Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - A Begley
- School of Public Health, Curtin University, Perth, Australia.
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Vorobeychik G, Black D, Cooper P, Cox A. Multiple sclerosis and related challenges to young women's health: Canadian expert review. Neurodegener Dis Manag 2020; 10:1-13. [PMID: 32372725 DOI: 10.2217/nmt-2020-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is among the most common chronic neurological diseases, with a highly variable degree of disability during its long-term course. The majority of patients develop significant permanent disability later in life. MS is often diagnosed in women of childbearing age, with a 3:1 ratio of young women to young men with MS. Comorbidities such as depression, anxiety, migraines and reproductive, urological and bowel issues are common and negatively impact patients' quality of life. The objective of this supplement is to review the most common comorbidities occurring in young women with MS, and to propose a multidisciplinary, holistic approach to management.
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Affiliation(s)
- Galina Vorobeychik
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9.,Fraser Health Multiple Sclerosis Clinic, Burnaby Hospital, Burnaby, BC V5G 2X6
| | - Denise Black
- Seine River Medical Centre, Winnipeg, MB R2N 0A5
| | - Paul Cooper
- Department of Clinical Neurological Sciences, Western University, London, ON N6A 3K7.,Schulich School of Medicine & Dentistry, London, ON N6A 5C1
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS B3H 1Y6
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Conroy SK, Brownlowe KB, McAllister TW. Depression Comorbid With Stroke, Traumatic Brain Injury, Parkinson's Disease, and Multiple Sclerosis: Diagnosis and Treatment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:150-161. [PMID: 33162852 DOI: 10.1176/appi.focus.20200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
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Affiliation(s)
- Susan K Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Katherine B Brownlowe
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
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Simpson R, Simpson S, Ramparsad N, Lawrence M, Booth J, Mercer SW. Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis – a systematic review and meta-analysis. Mult Scler Relat Disord 2020; 38:101493. [DOI: 10.1016/j.msard.2019.101493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
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Hearn JH, Cross A. Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review. BMC Neurol 2020; 20:32. [PMID: 31964353 PMCID: PMC6971852 DOI: 10.1186/s12883-020-1619-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. METHODS Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). RESULTS Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. CONCLUSIONS The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.
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Affiliation(s)
- Jasmine Heath Hearn
- Department of Psychology, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Ainslea Cross
- Department of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB UK
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