Mindfulness-Based Stress Reduction Intervention Shows Potential to Treat Silent Symptoms of Multiple Sclerosis


In mixed-effect analyses adjusting for multiple cofounders, changes in inflammatory gene expression correlated inversely with changes in patient-reported stress, loneliness, hair cortisol, and aspects of interoceptive awareness.

Christopher C. Hemond, MD, neurologist, UMass Memorial Health

Christopher C. Hemond, MD

In a recently concluded small-scale study of individuals with multiple sclerosis (MS), implementation of a mindfulness-based stress reduction (MBSR) intervention resulted in several positive benefits on patient-reported outcomes (PROs).

Led by Christopher C. Hemond, MD, neurologist, UMass Memorial Health, the study featured 23 females with relapsing-remitting MS who were offered 8 weeks of MBSR free of charge. After a 12-week observation period, treatment with MBSR was associated with robust (d >.08) improvements across a range of unadjusted PROs, including stress, anxiety, depression, fatigue, loneliness, well-being, and interoceptive awareness (all P <.01).

Presented at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 to June 3, in Aurora Colorado, the cohort of individuals assessed had a median Expanded Disability Status Scale score of 2.0 (±1.2) and showed no new clinical/MRI disease activity during the 12-week observation period. More than half (57%) were on a B-cell depleting agent, and 91% completed the course.

READ MORE: Low-Fat Diet Intervention Demonstrates Significant Impacts on Multiple Sclerosis Fatigue

The conserved transcriptional response to adversity (CTRA) score was determined using well-established methods from 53 prespecified blood gene expression markers representing a composite of inflammation, interferon response, and immunoglobulin expression. Coming into the study, investigators hypothesized that MBSR would modulate systemic and central nervous system inflammation through top-down neurocognitive control over forebrain limbic areas responsible for the neurobiological stress response.

Prior to adjustment, no pre-post changes were noted in average hair cortisol, structural MRI, or CTRA as related to completion of MBSR. In mixed-effect analyses adjusting for age, race, body mass index, medical therapy, and time, changes in inflammatory gene expression (CTRA; n = 12) correlated inversely with changes in patient-reported stress (P <.0001), loneliness (P = .002), hair cortisol (P = .01), and aspects of interoceptive awareness. In similar exploratory mixed-effect regression with parcellated MRI data, a higher CTRA was associated with larger left (P = .02) and smaller right (P = .02) anterior insula cortical thickness.

Although there are few studies in MS, MBSR has shown potential to help alleviate silent symptoms of the disease. In 2017, a feasibility, randomized controlled trial of 50 individuals with MS assessed an MBSR intervention over a 3-month period, with primary outcomes of perceived stress and quality of life (QOL). Immediately post-MBSR, perceived stress improved with a large effect size (0.93; P <.01) compared with very small beneficial effects on QOL (0.17; P = .48). Depression (1.35; P <.05), positive affect (0.87; P = .13), anxiety (0.85; P = .05), and self-compassion (0.80; P <.01) also improved with large effect sizes.

Click here for more coverage of CMSC 2023.

1. Hemond CC, Deshpande M, Morales IB, Slavich GM, Cole SW. An unblinded observational study of mildfulness-based stress reduction in MS: MRI and biological inflammatory correlates of patient-reported outcomes. Presented at: 2023 CMSC Annual Meeting; May 31-June 3; Aurora, CO. Abstract IMG06.
2. Simpson R, Mair FS, Mercer SW. Mindfulness-based stress reduction for people with multiple sclerosis – a feasibility randomized controlled trial. BMC Neurol. 2017;17(1):94. doi:10.1186/s12883-017-0880-8
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