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Does Stress Management Slow MS?
Date:7/11/2012

By Barbara Bronson Gray
HealthDay Reporter

WEDNESDAY, July 11 (HealthDay News) -- When researcher David Mohr began working with people with multiple sclerosis about 20 years ago, patients would tell him that stress made their disease worse. At the time, most physicians didn't believe there was a connection, he said.

But a study published online July 11 in Neurology adds to growing evidence that suggests a link between stress and flare-ups of the neurological disease. The research shows that participating in weekly stress management therapy prevented the development of new brain lesions, indicators of the impact of the disease in the brain. But not long after the treatment stopped, new brain lesions appeared.

"It's clear that stress plays an important role in multiple sclerosis, and therapy may be a useful additional treatment, along with drug therapy," said Mohr, author of the study and professor of preventive medicine at Northwestern University in Chicago.

Multiple sclerosis (MS), an autoimmune disease that affects the brain and spinal cord, is caused by damage to the protective covering that surrounds nerve cells. According to the U.S. National Institute of Neurological Disorders and Stroke, 250,000 to 350,000 people in the United States have the disease.

The research involved 121 people with MS who were randomly assigned to either receive stress management therapy or no such therapy. Those in the treatment group participated in 16 sessions of 50 minutes each over 24 weeks, with follow-up six months later.

More than three-quarters of the participants were women, who have a higher incidence of MS, and their average age was 43.

Those in the therapy group were taught by licensed psychologists in private sessions how to better anticipate stressful events that could come up in the course of daily life, such as hectic times at work, or a visit from an unwelcome family member, said Mohr.

The participants also learned that for an event or a situation to be stressful, it must present two factors: it has to feel like a threat to something they highly value, and they must believe they don't have any control over the situation, Mohr noted.

Mohr explained that the therapy helped people better estimate the potential impact of a perceived threat and gave them ways to better manage the stress. "Most people overestimate the threat and underestimate their ability to manage it," he said.

For those situations when stress couldn't be avoided, participants were taught meditation and relaxation strategies to calm their physical responses.

To assess the potential impact of the therapy on the individuals' physiological response to MS, the researchers performed a series of MRI scans of the brains of both groups of participants (those receiving therapy and those who didn't), using two types of scanning. Assessments were done before the therapy and at regular intervals during and after the treatment period.

Some patients were injected with gadolinium, which helps detect a type of brain lesion that allows the immune system to attack and damage brain cells. Others were scanned to find what is known as T2 brain lesions, commonly assessed when drugs for MS are evaluated for their effectiveness in controlling the disease.

Overall, MRIs showed that the stress management therapy reduced both kinds of new brain lesions common in people with MS. For instance, 77 percent of the therapy group was free of new gadolinium-enhancing lesions during treatment compared to 55 percent of the "no-therapy" group. In addition, 70 percent of the therapy group remained free of new T2 lesions during treatment versus 43 percent of the other group.

However, new brain lesions were detected after the therapy stopped.

Nicholas La Rocca, vice president for health care delivery and policy research for the National Multiple Sclerosis Society in New York City, said therapy often has only a short-term impact on patients.

"As psychologists, we always hope that when people are in treatment they are learning life skills that they'll continue to use for their benefit. Maybe that's a little naive," he said. He pointed out that some people may need to carry on with the treatment for a longer period of time, or may benefit from ongoing intervention.

"Therapy isn't too different from taking disease-modifying drugs. You may not be able to just drop the treatment," La Rocca said.

Was stress shown to cause the brain lesions directly? Mohr said he didn't think so. "Stress is one factor among many," Mohr said. "But stress makes it more difficult for the body to regulate inflammatory processes."

While the study didn't find that stress management treatment helps control MS-related symptoms, Mohr said he believes stress management is beneficial for MS patients and improves their quality of life. "But it's premature to say it improves the disease itself," he said.

More information

For more about multiple sclerosis, visit the U.S. National Library of Medicine.

SOURCES: David Mohr, professor of preventive medicine, Northwestern University, Chicago; Nicholas La Rocca, vice president for health care delivery and policy research, National Multiple Sclerosis Society, New York City; July 11, 2012, Neurology, online


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