The Power of Positive Thinking
A recent meta-analysis suggests that treating some of the psychological complications of multiple sclerosis may have a positive effect on physical symptoms as well
Multiple sclerosis is a disease that eats away not only at a person’s physical capabilities, but also at their emotional well-being. People with MS have roughly three times the lifetime prevalence of major depressive disorder compared to the general population. Just as with the physical aspects of the disease, emotional issues vary from person to person.
People with MS may become depressed because they feel bad about having the disease, or the disease itself may beget depression. Regardless of the reason, psychological interventions aimed at improving mood, behavior, and thinking can help alleviate emotional symptoms. But the effects of these interventions may extend beyond mood, according to a recent meta-analysis published in the journal BMC Neurology. Treatments that aim to improve patients’ mood, thinking, and behavior may also improve physical symptoms like fatigue, disturbed sleeping, and pain (Pagnini et al., 2014).
Researchers aggregated 22 randomized controlled trials that examined psychological interventions and also recorded physical outcome measures. Their results included a total of 5705 MSers with an average disease duration of 8 years and a mean age over 40. Most of the patients scored less than 5.5 on the Expanded Disability Status Scale.
Psychological interventions generally helped improve mood and were also associated with positive changes in fatigue, sleep disturbances, pain, physical vitality, and overall quality of life. These measures were all self-reported. But some studies did examine more objective outcome measures. One found that stress-management interventions were associated with reduced brain lesions in patients with relapsing-remitting MS. Another found that successfully treating depression—with psychological therapies or medication—was associated with reduced antigen-specific and nonspecific interferon production.
The authors of the meta-analysis acknowledged that since most of the outcome measures such as fatigue and pain were self-reported, the changes may merely be in the patient’s perception. But the fact that they saw a strong trend as well as the apparent effect of psychological treatments on biological measures suggests, to the authors, that the mind affects the body. They called for more research to be done in this area and stressed the importance of psychological well-being in patients with MS.
Key open questions
- How can symptoms like fatigue and pain be more objectively measured in people with MS?
- How might treatments like stress management eventually lead to fewer lesions and relapses? Are the effects direct, indirect, or both?
Disclosures and sources of funding
The authors reported no conflicts of interest. Their analysis was funded by Università Cattolica del Sacro Cuore (D3.1 line) and from Fondazione Italiana Sclerosi Multipla, with the FISM 2013 Research Grant “Migliorare la Qualità di Vita di persone con Sclerosi Multipla e dei loro familiari tramite un intervento di Mindfulness e Telemedicina.”
There’s a lot to depression and MS. One obvious reason someone with MS may become depressed is due to the chronic, progressive nature of the disease. Certainly a portion of MS patients are depressed because they are reacting to either the disease itself or the challenges posed by the symptoms. But there also appears to be a disease-related impact on patients that can cause depression. One line of thinking is that lesions in the brain may disrupt areas of the brain that impact mood. There are multiple ways to treat depression in people with MS. Medication is one option, but psychological interventions such as cognitive-behavioral therapy and acceptance and commitment therapy are also effective. These therapies help patients approach their situation in different ways so that they can improve their mood and quality of life. It’s exciting to see that the positive effect of psychological interventions on physical symptoms, in addition to mood, is gaining wider acceptance in the medical community through this article. It’s long been known that mood and how one feels physically have a reciprocal relationship, and this paper shows that psychological interventions may augment the effect of physical interventions.