A 24-week stress management program reduced disease activity on MRI scans significantly more than in a control group, in a study of 121 people with relapsing MS. However, the benefits appeared to disappear after the weekly in-person stress management sessions were completed. David C. Mohr, PhD (Northwestern University Feinberg School of Medicine, Chicago) and colleagues report their findings in Neurology (2012;79:412–419
). Future studies should provide more clarity for optimizing the potential benefits of stress management in people with multiple sclerosis.
Many people with MS say they experience more symptoms during stressful times. When the stress abates, their symptoms seem less troubling or less severe. Research has shown a relationship between stress and the onset of MS, MS relapses and the development of new brain lesions, but a causal relationship has not been demonstrated.
A total of 121 people were randomly assigned to a stress management program, or to a control group. The stress management program consisted of 16, 50-minute individual sessions with a licensed psychologist over 24 weeks, and included teaching problem-solving skills, relaxation, and enhancement of social support. The treatment was supported by a workbook for participants and therapists were guided by a treatment manual, both of which have been published. Participants were then followed for up to six months post-treatment. The control group was wait-listed for 10 months, and then participated in a five-hour workshop on stress management.
The primary goal of the study was to determine the effects of the stress management program on reducing disease activity as observed on MRI scans. The study was not designed to detect impacts on actual clinical symptoms or relapses. Secondary goals included determining the effects on reducing stress, reducing relapses, improving disease symptoms, and safety. The study was funded by the National Institute of Child Health & Human Development.
Disease activity on MRI scans was reduced significantly among people receiving the stress management program compared to those in the control group: 77% remained free of active brain lesions (gadolinium-enhancing lesions, indicating areas of active disease) versus 55% of those in the control group; and 70% remained free of new areas of damage, versus 43% of the control group. These differences were not apparent at follow-up, once the stress management program stopped. Measures of stress reduced significantly in the treatment group, but not in the control group. There were no serious adverse events.
The authors speculate about why the benefits of the stress management treatment did not last beyond the 24-week treatment period. One possibility they point out is that participants may require longer treatment to learn to maintain the stress-reducing behaviors on their own. Another possibility is that the benefits of the stress management program were derived less from the stress management techniques and more from the positive attention they received from in-person sessions with a psychologist.
The authors are continuing to examine these results, and note that future studies in this area should include a larger trial capable of evaluating clinical outcomes. They also suggest that the use of telephone, internet, and mobile phone interventions may help sustain the results of stress management programs after the program stops, since “…long-term standard behavioral intervention can be burdensome for patients who must make weekly office visits,” they write.
In an accompanying editorial, Christoph Heesen, MD, and Stefan Gold, PhD (University Medical Center Eppendorf, Hamburg, Germany) note that this study may provide the first direct evidence “for a causal link between stress and inflammatory activity in these patients.” They also suggest that the study shows that science needs to be more mindful of “a biopsychosocial model of disease.” This model acknowledges that biological and psychological factors contribute to diseases such as MS. “…the evidence for the relevance of experiences, expectations, and behavior on brain functioning is growing,” they write.
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