September 20, 2023

3 min read

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Carlson reports no relevant financial disclosures.

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ASCO and Society for Integrative Oncology published a guideline that recommends mindfulness-based interventions and other integrative approaches for management of cancer-related anxiety and depression.

The guideline — published in Journal of Clinical Oncology — outlines the effectiveness of strategies such as yoga, relaxation, hypnosis, acupuncture and music therapy for relieving symptoms of anxiety and depression during cancer treatment and survivorship.

This is the first guideline ASCO has produced specifically addressing integrative therapies for anxiety and depression. Society for Integrative Oncology (SIO) had produced prior guidelines on its own.

“Having these types of integrative therapies endorsed by ASCO, which is the largest mainstream cancer organization in the world, sets the stage for integrating these therapies as standard of care,” guideline lead author Linda E. Carlson, RPsych, PhD, president of SIO and professor in the department of oncology, Cumming School of Medicine at University of Calgary, told Healio. “This recommendation gives mindfulness interventions a legitimacy that might lead to support from insurance companies, administrators and policymakers.”

Carlson and colleagues assembled a panel of experts in the fields of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology and patient advocacy.

Panelists conducted a systematic literature search of reviews, meta-analyses and randomized controlled trials published between 1990 and 2023. The search yielded 110 relevant studies — encompassing more than 400 individual clinical trials — to serve as the evidence base for the guideline.

Healio spoke with Carlson about the importance of the new guideline, the increased openness to integrative medicine in cancer care, and the next steps needed to further incorporate integrative therapies into oncology.

Healio: Can you describe the recommendations in this guideline?

Carlson: There are several, but the strongest pertains to mindfulness-based interventions for people with cancer — both during and after treatment — for anxiety and depression. Other mind-body therapies like yoga also are recommended, as are things like relaxation therapies, hypnosis, music therapy and imagery, which are useful specifically for anxiety during treatment.

There also are recommendations for post-treatment tai chi, acupuncture, qigong or reflexology for treating anxiety after treatment. In terms of depression symptoms, mindfulness-based interventions, yoga, music therapy, relaxation and reflexology are recommended during active treatment, and mind-body interventions, yoga, acupuncture, tai chi or qigong, and reflexology are recommended after treatment.

Healio: What can oncologists do to help promote and optimize this guideline?

Carlson: If you look through the treatment trajectory, we have some recommendations — such as music therapy or hypnosis — to reduce anxiety as people are going through diagnosis and treatment. Those are fairly simple things that can be offered within a treatment setting by an integrative therapist. There are even some apps and online interventions that can be delivered fairly inexpensively. It’s not really difficult to gain access to some of these services. The more intensive interventions, like the mindfulness-based interventions and the yoga programs, tend to be multiweek programs. They often have been done in person in group settings. Many cancer centers and cancer support organizations are offering these more frequently. So, I think clinicians should know what resources are available in their area and be able to refer patients to theme. Cancer centers also should be investing in developing these resources for their patients if they are not already available and accessible.

Healio: What are the next steps in terms of integrative medicine guidelines in the cancer setting?

Carlson: This is part of a partnership between ASCO and SIO to develop these guidelines. We released the pain management guideline last fall, and this is the anxiety/depression guideline. We have a fatigue guideline in the works, and we’re doing a sleep guideline after that.

Healio: Is there anything else you would like to mention?

Carlson: There are other therapies people are interested in and are using that aren’t in the guideline. It’s not because they don’t work, but because there hasn’t been enough research conducted in those areas yet. So, just because something is not on the guideline doesn’t mean it doesn’t work. It just means we don’t know enough about it. This was based on only randomized controlled trials with fairly large sample sizes. It’s a very conservative guideline.

For more information:

Linda E. Carlson, RPsych, PhD, can be reached at University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4; email: l.carlson@ucalgary.ca.

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Every major athletic team in the world has a sports psychologist or mental performance consultant on deck for its athletes. We know the role that psychology plays in athletic performance, and this is why this area is so heavily prioritized for professional athletes. But what about the amateur athlete? How can the amateur athlete spot early signs of burnout and effectively right the ship?

A landmark study from 1997, conducted on 236 age-group swimmers, defined burnout in athletes as a multidimensional mental health disorder consisting of: emotional and physical exhaustion, reduced level of accomplishments, and sport devaluation (losing interest or resentment towards sports) – all of which are in alignment with the accepted definition of occupational burnout as well. Athletes with burnout syndrome may experience any of these dimensions at different levels.

For as much good that comes from participating in sports, factors such as early specialization in adolescent athletes (year-round training and competition in a single sport) as well as the nature of competition and professional level contracts can lead to increased risk for burnout and potential dropout from sport. A consensus statement from The British Journal of Sports Medicine in 2020 underscored that while certain personality traits can aid in athletic success, these same traits can also be associated with mental health disorders, with athletic culture piling onto this.

Early Signs of Burnout

How can we spot burnout? A study from the International Journal of Environmental Research and Public Health outlines affective problems such as low mood and hostility toward the athlete’s training environment, coupled with distracted focus, memory, and feelings of helplessness. Physical symptoms start to present, such as fatigue, increased chance of injury, and for some, this is often the stage when doping is considered. The study describes the final stage as behavioral issues, with absenteeism and poor sports performance, leading to a final dropout from the sport.

This is an unfortunately common pattern in adolescent athletes who have demonstrated extraordinary athletic talent, making parents and coaches more likely to encourage early specialization. But what about adult, amateur athletes?

As a coach, I often observe athletes teetering on a thin line—their stress levels at work and in their personal lives climb while they try to maintain the same volume and intensity in their training. We know that stress is stress and the body struggles to discern between the different types. These athletes can keep it together for a bit, but oftentimes doing so culminates with emotional, psychological, and physical exhaustion. This trifecta either leads to injury, illness, or withdrawal from something that once brought the athlete joy.

Other times, I notice athletes become so heavily dedicated to a goal (typically, a very results-oriented goal with specific paces and finishing times in mind), that they begin to develop anxiety around workouts and an even greater degree of performance anxiety with races. It’s easy to say “just focus on the process and the results will come!” and while this often proves to be true, it’s difficult to make the shift and shed the fear-driven response when the athlete is deeply steeped within it. What was once a positive, exciting goal for an athlete turns into the very thing that begins to drive them away from the sport.

What Does The Science Say?

A common misconception with athletic burnout is to pull the plug entirely on the sport. However, numerous studies demonstrate that leaving the sport does not relieve the symptoms of burnout, but actually worsens the athlete’s mental and moral states. So what does work to treat burnout?

A meta-analysis from 2022 found that cognitive behavioral therapy (most commonly used in athletics and includes things like journaling, setting attainable goals, practicing cognitive relabeling, and undergoing situational exposure) and mindfulness-based interventions (meditation, bringing the focus to the present moment, shifting awareness to bodily sensations: otherwise known as body scanning) were effective forms of reducing most burnout dimensions. Cognitive behavioral therapy interventions were more effective at reducing emotional and physical exhaustion, but mindfulness-based interventions were still found to be beneficial when compared to no psychological intervention.

The meta-analysis also found that the positive effects of intervention were significantly higher in female-identifying athletes, demonstrating the gender gap that still exists in sports when it comes to being open to mental health consultation and with less stigma compared to male-identifying athletes.

Perhaps the most interesting finding was that online interventions were more effective in reducing emotional and physical exhaustion and the devaluation of sports dimensions compared to offline, traditional face-to-face interventions. The authors attribute an increase in openness to online assistance due to the COVID-19 pandemic, and underscore the efficacy of such online mental-health interventions in better coping with psychological stressors wherever the athletes are located.

A recent study from 2023 tested a mindfulness-based stress reduction program on higher level athletes and recreationally active adults, testing both dynamic (mindful yoga) and static (body scanning) strategies. The analysis showed that both intervention strategies improved functional psychobiosocial states, reduced perceived stress, and enhanced mindfulness levels in both athletes and recreationally active individuals. Interestingly though, the interventions had longer lasting effects on the higher level athletes. The authors recommended longer-term programs in recreationally active people, stating the effects of mindfulness strategies seem to be less impactful and enduring in this specific population.

A Coach’s Insight

It’s important for coaches (and loved ones) to keep a pulse on the athlete’s overall stress levels and mental health. A dynamic training program is always going to reign over a static training program that leaves no room for adjustments based on the athlete’s physical and emotional states. While not every athlete is “Type A,” most athletes are hardworking, intrinsically motivated individuals who like to check boxes. When flexibility isn’t encouraged and celebrated, this can precipitate a path towards high levels of stress and diminished physical and mental health.

I often find that having clear expectations on what the framework to achieve the athlete’s goals looks like is a helpful, even preventative tool to prevent burnout. If there is clarity surrounding the workload ahead, the athlete is less likely to be surprised about the time commitment and “normal” levels of physical and mental fatigue that will, at some point, set in as the athlete peaks for their goal event. Having an understanding of the training and periodization can help keep the benefits of engaging in the sport higher than the stress-related costs.

For athletes who feel they may be experiencing tenants of burnout syndrome, whether that’s feelings of frustration toward sport, mental exhaustion, or feelings of helplessness — I recommend asking yourself where your heart strings are pulling you. If UltraSignup or social media channels were null and no one would ever know what you were training for or what you decided to race (or not race), what would you do? What would make you genuinely happy? What excites you? Why did you initially embark on this journey? Having clear answers to these questions can help curb the frustration element of burnout that leads the athlete to exasperation towards “better” alternatives rather than sport.

Your path can always wind or change course. Nothing is ever set in stone, even if you signed up for the race. Training should be something that’s additive to your life and something that you look forward to, 95 percent of the time (with the remaining five percent accounting for normal lack of motivation that happens to every athlete, regardless of fitness level). If it’s not feeling that way, it’s worth taking a step back to reevaluate your core values and long term goals for yourself.

Learning how to relabel challenging workouts or races into opportunities for growth can be pivotal in getting a hold on early signs of burnout. Employing science-backed methods such as journaling (for example, journaling three positives that went well within each run), more frequently lining up for shorter, local races that don’t hold a lot of pressure in a lead-up to an A goal race (situational exposure), or implementing a mindfulness practice on a daily basis in order to lower perceived stress are all very accessible places to start for any athlete.

What A Sports Psychologist Has to Say about Burnout

If you reach a point where the aforementioned interventions still aren’t helping your symptoms of burnout, consider reaching out to a sports psychologist. Emily Saul, Ed.M, LMHC, a Boston-based sports psychologist, underscores that burnout is absolutely an experience about which any runner should feel comfortable reaching out to a sport psychologist.

“Much like our physical bodies need preventative care and also responsive attention through common practices like sleep, body work, strength training, physical therapy, etc., our minds and mental health deserve the same kind of attention and care,” says Saul. “Each and every runner deserves to have a healthy and generative relationship with running, so if that relationship is starting to feel depleting or is diminishing in quality and satisfaction, addressing it with the support of sport psychology makes the same kind of sense as seeing a PT when your body is experiencing some pain or “niggles” start making noise.”

Saul also argues that maintaining and strengthening the quality of amateur athletes’ relationship with running may be even more important compared to elite athletes, because they are less likely to have structured support systems and teams in place to help them navigate challenges and nurture their success.

“Sport psychology is not only responsive to challenges or disruptions to a sport practice, but is also specifically focused on enhancing and optimizing the athlete’s ability to grow, develop, and thrive in their sport. Every person with a movement practice, running or other sports, elite or not, can benefit from the opportunity to overcome mental challenges in sport and to grow, develop, and thrive,” says Saul.

Each athlete is on a unique trajectory. Some at a very high level, some simply looking to keep moving and maintain health. But what Saul states holds true for all. Every athlete is in search of growth, in some form, at their core. Regardless of fitness level, every athlete has the opportunity to develop an elite mindset and approach to their training, whether that’s enacting a self-guided mindfulness practice or seeking guidance from a sports psychologist. Every athlete benefits from placing an emphasis on mental health and taking burnout in sport seriously. The knee-jerk reaction is to walk away from the sport altogether, but the implementation of positive psychology tools, whether online or face-to-face, greatly benefits the athlete’s relationship with sport – and every aspect of an athlete’s life outside of sport.

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As WHO celebrates
Self-Care Month (24 June – 24 July), we shine a spotlight on how self-care
interventions are making a difference to the lives of people in Timor-Leste.

“Timor-Leste is on the verge of a self-care revolution,” said Dr Arvind Mathur, WHO Representative to the island nation. “A lot has changed in terms of the way people approach their health and well-being due to improved access to healthcare in the country.”

An estimated 3.6 billion people – half of the world – lack access to essential health services. WHO recommends self-care interventions for every country as a critical path to reach universal health coverage, promote health, keep the world safe, and serve the vulnerable. This is especially true in a county like Timor-Leste where health infrastructure and access to specialized care can be limited. 

Working with the World
Health Organization (WHO), Timor-Leste’s Ministry of Health is advancing the highest standard of
health for its people with the help of self-care interventions that screen for
diseases, expand options for health service delivery, and prevent illness,
while improving access to health services.   

Detection of diseases through self-testing and self-sampling

In
January 2023, the Government of Timor-Leste launched two pilots for HIV
self-testing, and pre-exposure prophylaxis (PrEP) medication, which helps to protect
against getting HIV. The pilots are in the capital, Dili, and target key
populations such as men who have sex with men and female sex workers.

At
designated drop-in centres 4,000 HIV self-tests have been made available and WHO
has been training outreach workers from those key populations to raise
awareness of HIV and self-testing; demonstrate how to use a self-test kit; and
encourage people to visit the centres to find out their status. Since the pilot
launch, over 700 people have taken a test. For those who test negative,
information is available about how to protect themselves in the future, while
those that test positive are referred for treatment.  To support
these efforts, WHO has also produced targeted information
leaflets, as well as materials aimed specifically at health workers and
counsellors. 

“I
was surprised to find out there was no needle prick involved in this test,”
said a student from the national university in Dili. “I was nervous about
taking the test but the counsellor and health worker at the drop-in centre were
very helpful. They explained the entire process and also there was no pressure
to share the results unless I wanted to.”

Another important
step in expanding self-care health options within the country will be the
introduction of self-sampling for human papillomavirus (HPV) as part of the
national cervical cancer screening programme. In
Timor-Leste, cervical cancer is the second most common cancer among women. Almost
all (99%) cervical cancers are linked to HPV infections, an extremely common
virus transmitted through sexual contact.

Self-sampling
– where women are given a simple kit to take their own sample – is one of the
ways to test for the virus. Women can take the sample alone at home, in a
health clinic or another location typically using a swab (like a cotton bud) or
a soft brush.  The sample is then sent to
be checked at a laboratory and if positive, the woman is invited back for
further care.

“We are committed to promoting self-care interventions in
all areas, including sexual and reproductive health, and our advocacy and
information, education and communication initiatives are strategically and
thoughtfully concentrated in this direction,” Dr Mathur said.  

Self-care and family planning

Timor-Leste has a high unmet need for family planning and increasing access to contraceptive self-care interventions, like condoms and contraceptive pills, is one of the ways to help meet that demand. Timor-Leste also has a very young population: nearly half of Timor-Leste’s population is under 18 and according to a 2018 UNDP report, the country has one of the youngest populations in the Asia and Pacific region with a median age of 17.4 years. An estimated 19% of women 20-24 are married before they are 18, and almost a quarter are pregnant by the time they turn 20.

Through an outreach initiative involving WHO, the Ministry of Health and agencies like Marie Stopes International, condoms and contraceptive pills are now available in every health outpost in the country. Awareness of these self-care options has been raised through focus group discussions and youth and parent corners and this, combined with their wider accessibility, is empowering people to take control of their reproductive health.

“One visible change that I have seen is that women are seeking contraception more openly, and they are now often taking their own decisions in this area,” said Ms Fransisca Rosalina, a midwife for 28 years who works at the national hospital in Dili. “Previously, we had to speak to the husbands or other family members about family planning services. But now, women seek the information on their own. Many of them ask about it [contraception] when they are about to be discharged after childbirth.”  

“Self-care interventions are a crucial aspect of healthcare,” said Dr Odete Maria Freitas Belo, Minister of Health of Timor-Leste. “When self-care interventions are promoted, one promotes prevention of diseases as well as early diagnosis of diseases. In addition, self-care interventions also have the potential to reduce the financial burden on health systems and on individuals and communities, thus paving the way for Universal Health Coverage.” 

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Nature-based interventions can take many different forms, including outdoor activities such as hiking, gardening, and camping, as well as exposure to natural environments like forests, lakes, and beaches. These interventions have been shown to have a range of mental health benefits, including reduced levels of stress and anxiety, improved mood, and increased feelings of well-being.

One of the main reasons why nature-based interventions are effective in supporting mental health recovery is that they provide a break from the stresses and pressures of modern life. Spending time in nature allows individuals to disconnect from technology and the constant barrage of information that can contribute to feelings of overwhelm and anxiety. Additionally, natural environments are inherently calming and soothing, which can help to alleviate symptoms of stress and anxiety.

Another key benefit of nature-based interventions is that they provide individuals with a sense of purpose and connection. Engaging in outdoor activities like gardening or hiking can give individuals a sense of accomplishment and help them feel more connected to the natural world. This can be particularly beneficial for individuals who are struggling with feelings of isolation or disconnection.

Finally, nature-based interventions can be an effective tool for building resilience and coping skills. Spending time in nature can help individuals develop a greater sense of inner strength and resourcefulness, which can be invaluable when facing challenges in other areas of life.

In conclusion, nature-based interventions can play an important role in supporting mental health recovery. By providing a break from the stresses of modern life, fostering a sense of connection and purpose, and building resilience and coping skills, these interventions can help individuals overcome mental health challenges and improve their overall well-being. If you or someone you know is struggling with mental health issues, consider incorporating nature-based interventions into your treatment plan.

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Findings Indicate Improvements in Mental and Physical Health as well as a Reduction in Healthcare Costs For People Living with Type 1 Diabetes 

SAN DIEGO, June 24, 2023 /PRNewswire/ — Results from two studies evaluating the impact of mental health support for diabetes patients found significant benefits in patient outcomes were presented today at the 83rd Scientific Sessions of the American Diabetes Association® (ADA) in San Diego, CA.

American Diabetes Association 83rd Scientific Sessions (PRNewsfoto/American Diabetes Association)

As the number of diabetes cases continues to rise, addressing mental health challenges is a critical element in helping individuals with diabetes manage their care plan. Diabetes distress (DD) for example includes the fears, worries, and burdens associated with the diabetes experience. DD, which is distinct from depression, is common among adults with type 1 diabetes (T1D). In fact, in any 18-month period, 33% to 50% of people with diabetes experience heightened levels of DD. Individuals living with diabetes are also 2 to 3 times more likely to have depression than people without diabetes. Furthermore, only 25% to 50% of people with diabetes who have depression get diagnosed and treated. This points to a need to provide proactive behavioral health support as part of the overall care plan.

“People with type 1 diabetes are at a heightened risk for mental health issues, including diabetes distress, depression, anxiety, and disordered eating. However, these are all treatable disorders that can be addressed with personalized treatment plans that go beyond the physical symptoms,” said Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA. “I’m encouraged by the findings from the studies presented during this year’s Scientific Sessions as we continue to seek out innovative, evidence-based solutions that support people living with diabetes when they need it the most.”

EMBARK Clinical Trial: Reducing the Emotional Burdens of Living with Diabetes
Results from the randomized, controlled EMBARK clinical trial revealed significant reductions in DD, among adults with T1D through three intervention programs.

Story continues

The EMBARK trial included 300 adults with T1D and elevated distress. Individuals were randomly assigned to receive one of three intervention programs: (1) Streamline, an educator-led education and management program; (2) TunedIn, a psychologist-led program focused exclusively on reducing diabetes distress; or (3) FixIt, an integration of the StreamLine and TunedIn programs. Each intervention was delivered in a group-based, virtual format over a three-to-four-month period, including initial workshops, one-to-one phone calls and follow-up meetings.

The results demonstrated a large and clinically meaningful reduction in DD across all three study arms at the follow-up assessment with 35% of participants no longer reporting elevated levels of distress at follow-up and 74% of participants reported a clinically important reduction in distress. The FixIt intervention, which integrated education and emotional DD-targeted approaches, resulted in the greatest reduction in DD, followed by TunedIn and Streamline. The reductions in DD were significantly greater in the FixIt intervention compared to Streamline.

“The preliminary results of the EMBARK trial are promising for people living with T1D who suffer from diabetes distress,” said Danielle Hessler Jones, PhD, Professor and Vice Chair for Research in the Department of Family and Community Medicine at the University of California, San Francisco, and lead investigator. “These findings emphasize the significance of providing comprehensive support that addresses both the educational and emotional needs of individuals living with diabetes.”

The authors of this study will be reporting on 12-month follow up findings later this year to understand if these improvements were maintained alongside glycemic outcomes. Additionally, there are plans to expand on this work in DD-ASSIST, a new study in which researchers will train clinical teams from 18 diabetes clinics on how to assess and address DD as part of their care delivery.

Late-Breaking Poster: Do The Right Thing: Behavioral Intervention for At-Risk T1D Youth 
Findings from the study evaluating home and community-based behavioral health intervention for youths with diabetes, Novel Interventions in Children’s Healthcare (NICH), revealed that in addition to improved health, patients had lower healthcare costs in the years after starting NICH.

The study evaluated direct cost data from three healthcare systems provided for youth with avoidable health concerns who received an intensive behavioral health intervention NICH. Youths were included in analyses if they had T1D and at least one year of cost data prior to and following NICH enrollment. Outpatient, emergency department, and inpatient costs were combined, with variability in the amount and type of cost data present across sites.

The analysis included 53 youth: mean age 14.2±2.4 years; 87% Medicaid; 58% Female, 42% Male; 32% Black, 29% Non-Hispanic White, 28% Hispanic/Latinx, 7% Pacific Islander, 2% Asian and 2% other racial and ethnic groups. Mean yearly direct costs were $58.1k and $21.8k, prior to and following NICH enrollment, respectively, but not significantly different. After removing three outliers (> 3 SD from the mean), average yearly costs significantly decreased from $20.4k to $9.5k per youth, largely due to inpatient charges.

“These results highlight the benefits of providing access to intensive interventions to pediatric populations experiencing health disparities,” said David V. Wagner, PhD and senior author. “Investing early in the lives of youth experiencing health disparities is not only the right thing to do to improve patients’ health but it could also positive economic impact down the road.”

Researchers are designing follow-up studies and related efforts to further expand access to this intervention nationwide and determine the impact on the lived experience of people with diabetes.

Research presentation details:
Dr. Hessler will present the findings at the following oral presentation session:

• ADA Presidents’ Select Abstract: EMBARK—A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress in Adults with Type 1 Diabetes

• Presented on Saturday, June 24, 2023 at 4:30 PM PST

Dr. Wagner will present the findings at the following general poster session:

• Do the Right Thing—Intensive Intervention and Resulting Costs for Youth with High Social Risk and Type 1 Diabetes (T1D)

• Presented on Saturday, June 24, 2023 at 11:30 am PST

About the ADA’s Scientific Sessions
The ADA’s 83rd Scientific Sessions, the world’s largest scientific meeting focused on diabetes research, prevention, and care, will be held in San Diego, CA on June 23–26. More than 12,000 leading physicians, scientists, and health care professionals from around the world are expected to convene both in person and virtually to unveil cutting-edge research, treatment recommendations, and advances toward a cure for diabetes. Attendees will receive exclusive access to thousands of original research presentations and take part in provocative and engaging exchanges with leading diabetes experts. Join the Scientific Sessions conversation on social media using #ADA2023.

About the American Diabetes Association
The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For 82 years, the ADA has driven discovery and research to treat, manage, and prevent diabetes while working relentlessly for a cure. Through advocacy, program development, and education we aim to improve the quality of life for the over 133 million Americans living with diabetes or prediabetes. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Spanish Facebook (Asociación Americana de la Diabetes), LinkedIn (American Diabetes Association), Twitter (@AmDiabetesAssn), and Instagram (@AmDiabetesAssn).

Contact:  Rebecca Fisher, 703-253-4918
SciSessionsPress@diabetes.org

Cision

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SOURCE American Diabetes Association

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Christopher C. Hemond, MD

In research performed through MRI, reduction in levels of stress have been associated with reduced inflammation. One intervention that shows promise for patients with multiple sclerosis (MS) is mindfulness-based stress reduction (MBSR). The therapy is a low-risk intervention that may be salubrious for systemic inflammation as well as for the debilitating “silent symptoms” of MS.

A recent study showed MBSR was associated with improvements in MS among patient-reported outcomes (PROs) for the silent symptoms in MS. The findings were presented in an abstract presentation in a platform session by lead author Christopher C. Hemond, MD, assistant professor of neurology, UMass Chan Medical School, at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 to June 3, in Aurora, Colorado.1

In the study, 23 patients with relapsing-remitting MS were offered 8 weeks of free MBSR (median age = 45 ± 11; 100% female; Expanded Disability Status Scale score = 2.0 [±1.2]). Volunteers were enrolled for pre- and post-course assessments of PROs, hair cortisol, blood-based inflammatory gene expression markers, and structural MRI. There were no reports of patients with new clinical/MRI disease activity during the 12-week observation period and 57% were on a B-cell-depleting agent. Only 91% of the patients completed the MBSR course.

During the meeting, Hemond sat down in an interview with NeurologyLive to discuss more about the findings from the study. He provided an overview of the design of the study, as well as the notable results observed. Hemond also talked about the implications of the findings regarding the management of MS and the use of mindfulness-based interventions. In addition, he spoke about the study’s limitations and what the next steps in research are in this area.

NeurologyLive: Can you provide an overview of the study design and main findings?

Christopher C. Hemond, MD: This is an unblinded, observational study of pre-post effects of mindfulness-based stress reduction on patient-reported outcome measures, structural MRI changes, and peripheral blood inflammatory markers. We found significant improvements across a wide range of patient-reported outcome measures including stress, fatigue, anxiety, depression, loneliness, and well-being. MBSR was also associated with large increases in interoceptive awareness (a perception of one’s own bodily/internal state).

Secondly, most of these self-reported measures correlated highly with the Conserved Transcriptional Response to Adversity (CTRA), which is a 53-gene panel readout of peripheral white blood cell inflammation and antiviral potency. The CTRA is typically increased in conditions of environmental and social adversity.

Were there any other noteworthy findings from the study?

In preliminary structural MRI analyses limited to prespecified regions-of-interest in limbic structures, we found that MBSR is associated with a ~1% volumetric enlargement of the right hippocampus, similar to results from several other prior studies. We did not find any changes in the volume of the amygdala or its sub-structures.

What are the potential implications of these findings for the management of MS and the use of mindfulness-based interventions?

These findings further support the existing literature on the potential for MBSR to improve the challenging “silent symptoms” of MS without potential adverse effects from pharmacological intervention. Also, the Conserved Transcriptional Response to Adversity appears to be valid as a biological readout in MS, as it was highly positively correlated with multiple patient-reported measures of worsening social adversity such as loneliness, stress and anxiety.

Were there any limitations or challenges encountered during the study that may have influenced the results or interpretation?

Yes, the trial was both small with a total of 23 patients with MS as well as unblinded and observational. This trial design is susceptible to various forms of bias which reduce the generalizability of results, and increase the risk of type I statistical errors.

Based on the results of this study, what are the next steps for further research in this area? Are there any plans for conducting additional studies or investigations?

Some of the imaging data are still being processed, with the next steps including additional region-of-interest analyses including the hypothalamus and its sub-structures. Additionally, we will be assessing resting-state functional MRI connectivity measures and any changes related to MBSR. Since this is a small study, future studies will focus on both a larger sample size as well as a randomized, controlled design to reduce bias.

Click here for more coverage of CMSC 2023.

Transcript edited for clarity.

Editor’s Note: Christopher C. Hemond disclosed a consulting fee with VIVIO.

REFERENCES
1. Hemond CC, Deshpande M, Morales IB, et al. An Unblinded Observational Study of Mindfulness-Based Stress Reduction in MS: MRI and Biological Inflammatory Correlates of Patient-Reported Outcomes. Presented at CMSC 2023. IMG06.

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Chronic health conditions are defined as illnesses or conditions that last for an extended period of time, typically longer than three months. These conditions can include diabetes, heart disease, cancer, chronic pain, autoimmune diseases, and more. Chronic health conditions can cause physical and emotional stress, leading to decreased quality of life and increased healthcare costs.

MBIs can help individuals with chronic health conditions manage their symptoms and improve their quality of life. Mindfulness practices can help individuals cope with the emotional and physical stress associated with chronic health conditions. The practice of mindfulness can improve patients’ pain management, reduce symptoms of anxiety and depression, and increase overall well-being.

One common MBI is Mindfulness-Based Stress Reduction (MBSR). MBSR is an eight-week program that teaches mindfulness practices such as meditation, body scan, and gentle yoga. The program is designed to help individuals manage stress and reduce symptoms of anxiety and depression. MBSR has been shown to be effective in reducing symptoms of chronic pain, improving sleep quality, and reducing symptoms of anxiety and depression.

Another MBI is Mindfulness-Based Cognitive Therapy (MBCT). MBCT combines mindfulness practices with cognitive therapy techniques. MBCT is typically used to treat individuals with depression, but it has also been shown to be effective in reducing symptoms of anxiety and improving overall well-being.

MBIs can be conducted in a group setting or individually with a trained therapist. These interventions can be used alone or in combination with other treatments, such as medication or psychotherapy.

MBIs are relatively inexpensive and have few side effects. The practice of mindfulness can be easily incorporated into daily life, making it a convenient and accessible form of treatment for individuals with chronic health conditions.

In conclusion, MBIs are a promising form of complementary therapy for individuals with chronic health conditions. These interventions can help improve symptoms of anxiety, depression, and stress, as well as improve overall well-being and quality of life. MBIs can be easily incorporated into daily life and can be used alone or in combination with other treatments. More research is needed to fully understand the effectiveness of MBIs for chronic health conditions, but the current evidence suggests that these interventions can have a positive impact on patients’ lives.

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