A Randomized Trial of Stress Management for the Prevention of New Brain Lesions in MS

Overview

Journal Neurology

Specialty Neurology

Date 2012 Jul 13

PMID 22786596

Citations 51

Authors

David C Mohr

Jesus Lovera

Ted Brown

Bruce Cohen

Thomas Neylan

Roland Henry

Juned Siddique

Ling Jin

David Daikh

Daniel Pelletier

Affiliations

Soon will be listed here.

Abstract

Objectives: This trial examined the efficacy of a stress management program in reducing neuroimaging markers of multiple sclerosis (MS) disease activity.

Methods: A total of 121 patients with relapsing forms of MS were randomized to receive stress management therapy for MS (SMT-MS) or a wait-list control condition. SMT-MS provided 16 individual treatment sessions over 24 weeks, followed by a 24-week post-treatment follow-up. The primary outcome was the cumulative number of new gadolinium-enhancing (Gd+) brain lesions on MRI at weeks 8, 16, and 24. Secondary outcomes included new or enlarging T2 MRI lesions, brain volume change, clinical exacerbation, and stress.

Results: SMT-MS resulted in a reduction in cumulative Gd+ lesions (p = 0.04) and greater numbers of participants remained free of Gd+ lesions during the treatment (76.8% vs 54.7%, p = 0.02), compared to participants receiving the control treatment. SMT-MS also resulted in significantly reduced numbers of cumulative new T2 lesions (p = 0.005) and a greater number of participants remaining free of new T2 lesions (69.5% vs 42.7%, p = 0.006). These effects were no longer detectable during the 24-week post-treatment follow-up period.

Conclusions: This trial indicates that SMT-MS may be useful in reducing the development of new MRI brain lesions while patients are in treatment.

Classification Of Evidence: This study provides Class I evidence that SMT-MS, a manualized stress management therapy program, reduced the number of Gd+ lesions in patients with MS during a 24-week treatment period. This benefit was not sustained beyond 24 weeks, and there were no clinical benefits.

Trial Registration: ClinicalTrials.gov, number NCT00147446.

Citing Articles

A single-arm, open-label pilot study of neuroimaging, behavioral, and peripheral inflammatory correlates of mindfulness-based stress reduction in multiple sclerosis.

Hemond C, Deshpande M, Berrios-Morales I, Zheng S, Meyer J, Slavich G Sci Rep. 2024; 14(1):14044.

PMID: 38890336 PMC: 11189512. DOI: 10.1038/s41598-024-62960-w.

Effects of Psychological Stress on Multiple Sclerosis HPA Axis-mediated Modulation of Natural Killer T Cell Activity.

Gao Y, Liu W, Liu P, Li M, Ni B CNS Neurol Disord Drug Targets. 2024; 23(12):1450-1462.

PMID: 38818912 DOI: 10.2174/0118715273315953240528075542.

Acceptability of a digital health application to empower persons with multiple sclerosis with moderate to severe disability: single-arm prospective pilot study.

Kutzinski M, Krause N, Riemann-Lorenz K, Meyer B, Heesen C BMC Neurol. 2023; 23(1):382.

PMID: 37872471 PMC: 10591383. DOI: 10.1186/s12883-023-03434-w.

Stressful life events and depression and fatigue in people with multiple sclerosis: a cross-sectional analysis of an international cohort.

Reece J, Neate S, Davenport R, Milanzi E, Nag N, Bevens W Acta Neurol Belg. 2023; 124(2):457-466.

PMID: 37770791 PMC: 10965589. DOI: 10.1007/s13760-023-02390-z.

Schulz M, Hetzer S, Eitel F, Asseyer S, Meyer-Arndt L, Schmitz-Hubsch T iScience. 2023; 26(9):107679.

PMID: 37680475 PMC: 10480681. DOI: 10.1016/j.isci.2023.107679.

References

Lehman K, Burns M, Gagen E, Mohr D . Development of the brief inventory of perceived stress. J Clin Psychol. 2012; 68(6):631-44. PMC: 3689206. DOI: 10.1002/jclp.21843. View

Sormani M, Bonzano L, Roccatagliata L, Cutter G, Mancardi G, Bruzzi P . Magnetic resonance imaging as a potential surrogate for relapses in multiple sclerosis: a meta-analytic approach. Ann Neurol. 2009; 65(3):268-75. DOI: 10.1002/ana.21606. View

Polman C, Reingold S, Edan G, Filippi M, Hartung H, Kappos L . Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol. 2005; 58(6):840-6. DOI: 10.1002/ana.20703. View

Mohr D, Goodkin D, Nelson S, Cox D, Weiner M . Moderating effects of coping on the relationship between stress and the development of new brain lesions in multiple sclerosis. Psychosom Med. 2002; 64(5):803-9. PMC: 1893006. DOI: 10.1097/01.psy.0000024238.11538.ec. View

Nilsen W, Haverkos L, Nebeling L, Taylor M . Maintenance of long-term behavior change. Am J Health Behav. 2010; 34(6):643-6. DOI: 10.5993/ajhb.34.6.1. View

Wynn D, Kaufman M, Montalban X, Vollmer T, Simon J, Elkins J . Daclizumab in active relapsing multiple sclerosis (CHOICE study): a phase 2, randomised, double-blind, placebo-controlled, add-on trial with interferon beta. Lancet Neurol. 2010; 9(4):381-90. DOI: 10.1016/S1474-4422(10)70033-8. View

Mohr D, Hart S, Vella L . Reduction in disability in a randomized controlled trial of telephone-administered cognitive-behavioral therapy. Health Psychol. 2007; 26(5):554-63. DOI: 10.1037/0278-6133.26.5.554. View

Vallis T, Shaw B, Dobson K . The Cognitive Therapy Scale: psychometric properties. J Consult Clin Psychol. 1986; 54(3):381-5. DOI: 10.1037//0022-006x.54.3.381. View

Siddique J, Belin T . Multiple imputation using an iterative hot-deck with distance-based donor selection. Stat Med. 2007; 27(1):83-102. DOI: 10.1002/sim.3001. View

10.

Somer E, Golan D, Dishon S, Cuzin-Disegni L, Lavi I, Miller A . Patients with multiple sclerosis in a war zone: coping strategies associated with reduced risk for relapse. Mult Scler. 2010; 16(4):463-71. DOI: 10.1177/1352458509358714. View

11.

Grossman P, Kappos L, Gensicke H, DSouza M, Mohr D, Penner I . MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology. 2010; 75(13):1141-9. PMC: 3463050. DOI: 10.1212/WNL.0b013e3181f4d80d. View

12.

Mohr D, Likosky W, Bertagnolli A, Goodkin D, Van Der Wende J, Dwyer P . Telephone-administered cognitive-behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J Consult Clin Psychol. 2000; 68(2):356-61. DOI: 10.1037//0022-006x.68.2.356. View

13.

Mohr D, Pelletier D . A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis. Brain Behav Immun. 2005; 20(1):27-36. DOI: 10.1016/j.bbi.2005.03.011. View

14.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

15.

Mohr D, Vella L, Hart S, Heckman T, Simon G . The Effect of Telephone-Administered Psychotherapy on Symptoms of Depression and Attrition: A Meta-Analysis. Clin Psychol (New York). 2011; 15(3):243-253. PMC: 3045729. DOI: 10.1111/j.1468-2850.2008.00134.x. View

16.

Kappos L, Gold R, Miller D, MacManus D, Havrdova E, Limmroth V . Efficacy and safety of oral fumarate in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, double-blind, placebo-controlled phase IIb study. Lancet. 2008; 372(9648):1463-72. DOI: 10.1016/S0140-6736(08)61619-0. View

17.

Mohr D, Hart S, Julian L, Catledge C, Honos-Webb L, Vella L . Telephone-administered psychotherapy for depression. Arch Gen Psychiatry. 2005; 62(9):1007-14. DOI: 10.1001/archpsyc.62.9.1007. View

18.

Cohen S, Tyrrell D, Smith A . Psychological stress and susceptibility to the common cold. N Engl J Med. 1991; 325(9):606-12. DOI: 10.1056/NEJM199108293250903. View

19.

Mohr D, Boudewyn A, Goodkin D, Bostrom A, Epstein L . Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol. 2002; 69(6):942-9. View

20.

Mohr D, Hart S, Julian L, Cox D, Pelletier D . Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis. BMJ. 2004; 328(7442):731. PMC: 381319. DOI: 10.1136/bmj.38041.724421.55. View