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17 June 2022

Stress reduction techniques in MS – evidence shows how they help

Dr Jonathan White writes about the latest research from NEU on the link between stress-reducing activities and levels of fatigue, depression and mastery in people with MS.

Stress and MS

We all know that too much stress isn’t good for us.  The associations between chronic stress states and a wide range of illnesses are well documented, including hypertension and cardiovascular disease, mental illness, some cancers, and of course auto-immune conditions such as MS.

In MS specifically, it is commonly reported that the first symptoms often present 4 – 6 weeks after a stressful event, relapses can be triggered by acute stress, and that old symptoms often worsen during episodes of increased strain and anxiety.  I can personally attest to all of them!  

Professor Craig Hassed eloquently describes the underlying mechanisms behind the mind-body connection and the role of stress reduction in MS in Chapter 6 of the ‘Overcoming Multiple Sclerosis Handbook’.  I wholeheartedly recommend it to both new and experienced OMSers alike, especially for those “fidgety sceptics” amongst us, as Dan Harris of ‘Ten Percent Happier’ describes many would-be meditators.

The importance of stress reduction practice

So, whilst we may know that a regular stress reduction practice such as meditation is an important part of keeping us as well as possible, many obstacles get in the way of incorporating it into our daily routine; time pressures, fatigue, depression, or a lack of resources to name but a few. I have personally struggled at times with the motivation to meditate, and initially became rather impatient and even frustrated with the process.  Nearly 7 years later, and now I know it is enough to simply “turn up” each day, put my earphones in and sit with whatever arises.  I am certainly no Buddhist monk, but I know that I am a better and healthier person for it.

NEU study linking stress-reducing activities and fatigue, depression and mastery.

Whilst the evidence-base for stress reduction techniques such as mindfulness is increasing rapidly, it is vitally important to demonstrate their usefulness and benefits in the real world for those of us living with MS. To this end, the team at the Neuroepidemiology Unit at the University of Melbourne have just published their latest paper, entitled Undertaking specific stress reducing activities are associated with reduced fatigue and depression, and increased mastery, in people with multiple sclerosis‘ in the journal ‘Multiple Sclerosis and Related Disorders’.

In it, they took data from the ‘HOLISM Study’ to examine the associations between stress-reducing activities and levels of fatigue, depression and mastery, all of which are known to impact quality of life in people with MS. Mastery can be defined as “the extent of which people see life chances as being under one’s control”, something I think we can all agree is incredibly important when living with an unpredictable life-long condition such as MS.

Collecting information for the study

Information was collected on the participants at 2.5 years and 7.5 years into the HOLISM Study, and prospective analyses were performed to see what benefits, if any, the participants experienced during the follow-up period.   

Stress reduction practices were grouped into:
•    Relaxation – artistic/other creative, playing/ listening to music, hobbies, and massage/reiki/reflexology.
•    Physical – exercise/sport, and dance.
•    Mind-body – Pilates/yoga, and Qigong/Tai Chi.
•    Spiritual – faith/prayer/spirituality.

The 774 participants were asked if they practiced meditation in the following categories:  never, less than once a week, more than once a week; and duration:  none, 0-10 minutes, 10-20 minutes, and more than 20 minutes.

Depression was assessed using the Patient Health Questionnaire-9 (PHQ), comprising nine questions, each scored from 0 (not at all) to 3 (nearly every day). Individual scores were tallied and a PHQ of more than 9 was defined as depression.

Fatigue was assessed via the Fatigue Severity Scale (FSS), comprising nine questions, each scored from 1 (strongly disagree) to 7 (strongly agree). Scores were averaged and a mean FSS of more than 5 was defined as clinically significant fatigue.

Mastery was assessed via the Pearlin Mastery Scale (PMS), comprising seven questions each scored from 1 (strongly disagree) to 4 (strongly agree). Individual scores were totalled and PMS of 20 or more was defined as high mastery.

The results of the study

The results were striking. Depression was 30% less frequent in those who practiced meditation in the preceding 12 months, with benefits found in those meditating less than once a week, more than once a week, and for sessions lasting up to 20 minutes.  There was no additional benefit found in sessions lasting more than 20 minutes.  Depression rates were also lower in those undertaking relaxation (33% reduction) or physical stress-reducing activities (40% reduction).

Clinically significant fatigue was 19% less frequent in those who undertook physical stress-reducing techniques but interestingly was not associated with meditation or other techniques.

A high sense of mastery was 17% more likely in pwMS who practiced meditation in the previous 12 months, and 16% and 21% more likely for sessions lasting less than 10 minutes and for those lasting 11 – 20 minutes, respectively. No significant associations were observed for sessions greater than 20 minutes and mastery was not associated with other stress-reducing activities.

In terms of predicting longer-term outcomes, meditation practice at 2.5 years was associated with 31% less likelihood of depression at 7.5 years.  Meditating less than once a week or more than once a week were both protective, but only for sessions lasting more than 10 minutes.  No such associations were found prospectively between meditation practice and fatigue levels or mastery.

Study limitations

There were of course some limitations, not least of which was the greater than 40% attrition rate of participants from the start of the study, a common finding in long-term, self-reported observational studies.  There was also a noticeable healthy participant bias, as there was a high baseline rate of regular meditation and a high sense of mastery when the study began.  This can muddy the waters somewhat, as it doesn’t always reflect the general population of people with MS.  It does however closely reflect many within the OMS community, who are well known to be highly motivated with regards to healthy behaviours and often have a well-developed sense of mastery towards their health.  Does that mastery come from following the OMS program, or do these people follow OMS because of that same sense of mastery led them to it?  I will let you decide for yourself.

Final thoughts

The take-home message then is that even a little meditation can go a very long way.  Depression affects 1 in 4 of the general population, and more than 1 in 2 people living with MS.  Living with depression in turn increases the chances of developing other illnesses and of worsening MS, not to mention the terrible effects it has on our quality of life, and on those we care about.

But if you were to meditate for as little as 10 – 20 minutes, and even less than once a week, this would help to protect against it.  That is certainly one pill I am very happy to take and hopefully gives you that little extra motivation to simply turn up too.