Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community

Abstract

Background: Multiple sclerosis is an inflammatory demyelinating neurological condition affecting the central nervous system (CNS) that causes degeneration within the brain and spinal cord. The neuropathology of MS results in decline of motor, sensory and cognitive functioning that is varied in presentation and severity, based on the location and progression of demyelination. Psychological distress is also high in people with MS (PwMS) and reduced quality of life (QoL) is common. Mindfulness-based interventions (MBIs) are effective in improving psychological distress, fatigue, and health-related QoL in PwMS. However, there are often time, mobility and travel restrictions for PwMS that may impact the accessibility of standard programs, which means continued research is needed into the acceptability and feasibility of modified MBIs for this population. Previous studies have not examined mechanisms of change of MBIs in an MS sample.Objective: Mindfulness for MS (Spizter & Pakenham, 2018) is a 5-week MBI for PwMS, delivered in community locations. This study examined the effectiveness, perceived helpfulness and sustained feasibility of the Mindfulness for MS program. The aim was to explore mechanisms of change in intervention outcomes and whether socio-demographic factors, illness variables, or amount of home practice predicted intervention outcomes.Methods: Participants were 126 PwMS, recruited though Multiple Sclerosis Queensland, Australia. A single intervention condition design was used, with assessment at pre-intervention, post-intervention and 2-month follow-up. Primary outcomes were psychological distress, perceived stress, quality of life (QoL) and fatigue. Secondary outcomes were mindfulness, self-compassion and psychological flexibility, the proposed mediators of intervention related change. Qualitative feedback was collected at post-intervention and examined using thematic analysis.Results: A whole sample intention-to-treat (ITT) analysis revealed overall improvement from pre-intervention to follow-up in all primary and secondary outcomes except anxiety. Mindfulness was the only secondary outcome to increase from pre- to post-intervention, and this mediated ongoing decreases in perceived stress. From post-intervention to follow-up self-compassion and psychological flexibility increased. Self-compassion mediated concurrent reductions in psychological distress, perceived stress, fatigue, and increased QoL, while psychological flexibility only mediated concurrent reductions in psychological distress. Increased home practice was not predictive of improved outcomes at post-intervention. However, participants’ education level predicted changes in fatigue, and lower disease severity predicted greater improvements in global QoL and physical functioning component of QoL. Improvements in outcomes were supported by qualitative feedback and participant ratings indicated the program was helpful, enjoyable, and increased participant attention to the present moment, with most participants indicating they would suggest it to others with MS. A total of 21 groups were offered with good participant and facilitator engagement, wide geographical reach, and positive participant feedback, suggesting sustained feasibility of the Mindfulness for MS program over five years.Conclusions: The Mindfulness for MS Program, a brief (5-week) MBI for PwMS, delivered in community-based locations, is effective in reducing psychological distress, perceived stress, fatigue, and improving QoL in PwMS from pre-intervention to 2-months follow-up, consistent with previous research of standard MBI programs for PwMS. Increased mindfulness, self-compassion and psychological flexibility were found to be mediators of intervention related changes in outcomes for PwMS, suggesting these are mechanisms of change in MBIs for this population. Sustained program feasibility was supported by recruitment, attendance, home practice completion, facilitator engagement, participant feedback and the program’s geographical reach.