Reduce Fatigue and Depression in Patients with Multiple Sclerosis with Mindfulness
By John M. de Castro, Ph.D.
“the pragmatic resiliency skills of mindfulness training may be beneficial in helping to mitigate unpleasant and unpredictable mental and physical symptoms that are associated with an MS diagnosis.” – Rachel M. Gilbertson
Multiple Sclerosis (MS) is a progressive demyelinating disease which attacks the coating on the neural axons which send messages throughout the body and nervous system. It affects about 2 million people worldwide and about 400,000 in the U.S. It is most commonly diagnosed in people between the ages of 20 and 50 years. Unfortunately, there is no cure for multiple sclerosis. There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms. But MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. Mindfulness practices have been shown to improve the symptoms of multiple sclerosis.
In today’s Research News article “Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499486/ ) Sauder and colleagues recruited patients diagnosed with Multiple Sclerosis (MS) who also had symptoms of fatigue and depression during a brief (>5-day) hospital stay. During their hospital stay the patients were administered daily 45-minute mindfulness training based upon Mindfulness-Based Cognitive Therapy (MBCT). They were measured before and after the hospital stay for depression, fatigue, rumination, mindfulness, cognition, and attention.
They found that in comparison to baseline after training there were significant increases in mindfulness and distraction techniques to cope with a negative mood and significant decreases in depression, general fatigue, and physical fatigue. Further, they found that the greater the increases in mindfulness the greater the reductions in fatigue and depression. A mediation analysis revealed that mindfulness decreased fatigue indirectly by reducing depression that in turn reduced fatigue.
The study lacked a control, comparison, condition and as such caution must be exercised in interpreting the results. But mindfulness has been previously demonstrated in controlled studies to reduce fatigue and depression in a wide variety of people. So, the effects of mindfulness reported here were probably due to mindfulness causing the improvements. What is new here is that mindfulness reduces depression and in turn fatigue in patients with Multiple Sclerosis (MS). The patients also had a significant increase in the coping strategy of using distraction during negative mood states. This suggests that mindfulness training helps them to learn to distract themselves from depression and this may be the mechanism whereby mindfulness reduces depression.
Depression and fatigue greatly reduce the patients’ ability to conduct their lives, reducing their quality of life, So, improving depression and fatigue can be very beneficial to these patients. This suggests that mindfulness training should be recommended for patients with Multiple Sclerosis (MS).
So, reduce fatigue and depression in patients with multiple sclerosis with mindfulness.
“Mindfulness practice appears to be a safe, drug-free approach to coping with stress and anxiety, which may in turn help reduce your MS symptoms.” – Amit Sood
CMCS – Center for Mindfulness and Contemplative Studies
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Sauder, T., Hansen, S., Bauswein, C., Müller, R., Jaruszowic, S., Keune, J., Schenk, T., Oschmann, P., & Keune, P. M. (2021). Mindfulness training during brief periods of hospitalization in multiple sclerosis (MS): beneficial alterations in fatigue and the mediating role of depression. BMC neurology, 21(1), 390. https://doi.org/10.1186/s12883-021-02390-7
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.
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.
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.
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.