Lead investigator of the study, David Mohr, professor of preventive medicine at Northwestern University Feinberg School of Medicine declares:
"This is the first time counseling or psychotherapy has been shown to affect the development of new brain lesions. In M.S., the prevention of new brain lesions is an important marker used to judge how effective medications are. The new finding is an important step and the strongest evidence we have to date that stress is involved in M.S."
The study findings reveal that stress management therapy could be a beneficial treatment in addition to taking MS drugs. However, Mohr says that it will require a larger clinical trial to confirm these results.
According to Mohr's previous research, psychological distress and the development of new brain lesions are associated with one another. Mohr, who spent over 10 years researching this link, which includes a study on depression and MS explains that stress is one of many influencing factors of whether the underlying M.S. disease processes grow to such an extent that a new lesion or a relapse. He continues explaining that in order to feel an event as stressful, it needs to be threatening or something important to the person, which they feel they have no control over.
"We taught patients strategies to evaluate how much of a threat something truly is. When people overestimate the threat of an event or underestimate their ability to manage it, we teach them how to evaluate their own thinking about the stress and how to challenge and change that thinking to a more realistic and helpful appraisal of the actual threat. That often leads to improved ability to manage stressful events."
The researchers also taught the participants how to keep physically calm when they were exposed to stress by using relaxation and meditation to cope with unavoidable stressful events.
The national clinical trial included a total of 121 MS patients, of which two-thirds were female, who were randomized over 24-weeks to either receive 16 sessions of stress management therapy for M.S. or be in the control group. The incidence rate of MS is higher in females than in males. Participants in the therapy group were taught how to cope to improve their ability to prevent stressful events from occurring and their capacity to manage their responses to those stressful events that were unavoidable. The follow-up period was 24 weeks after treatment.
The researchers discovered through MRI neuroimaging that two types of new brain lesions that frequently occur in multiple sclerosis were reduced by stress management therapy; with gadolinium-enhancing brain lesions, i.e. the first type suggesting a breakdown of the blood-brain barrier, which gave the immune system access for attacking and damaging brain cells. MS patients receive a Gadolinium injection during the MRI scan, which allows researchers to visualize the passing through the blood-brain barrier if these types of lesions are present. Gadolinium lesions can either disappear with time, or they can leave behind more permanent damage in the brain.
A T2 brain lesion, i.e. the second type is a more permanent lesion and is a more common marker of the impact of M.S. on the brain. These markers are frequently used to evaluate M.S. medications in Phase II trials. If the lesions become fewer, it means the drug is working.
The researchers observed that 55% of patients in the stress management therapy group had a new gadolinium-enhancing brain lesion during the treatment period, whilst those in the control group had 77%. They observed a similar finding with regard to T2 brain lesions, with 43% of those in the stress management therapy group experiencing these types of lesions compared with 70% of those in the control group. The team discovered that the stress reduction prevented new lesions irrespective of whether or not patients were taking M.S. disease-modifying medications, such as beta-interferons or glatiramer acetate. However, they noted that the improvement in brain lesions did not continue once the stress management program terminated.
"This suggests that we will need to develop treatments that are more sustainable over longer periods of time. It's difficult for people to come in for treatment once a week over long periods of time, due both to cost and time constraints. We are looking at telemedicine programs that can be delivered via a computer or a smartphone to people in their environment at much lower costs than traditional therapy."
The findings did not show a statistical difference in the rate of clinical M.S. symptoms. However, according to Mohr this was not to be expected considering the small number of study participants. He explained that the study only wanted to determine whether stress reduction affected the brain lesions and although the results proved positive, he said that it would be too early to recommend using stress management therapy for MS patients, pointing out: "I don't want to see patients decide not to take their medication and use this instead."
Written by Petra Rattue