The Effectiveness of a Body-Affective Mindfulness Intervention for Multiple Sclerosis Patients with Depressive Symptoms: A Randomized Controlled Clinical Trial.

Sara Carletto,Francesco Oliva,Simona Malucchi,Antonio Bertolotto,Riccardo Torta,Luca Ostacoli,Gabriella Bertino,Diana Francone,Francesco Scavelli,Martina Borghi,Valentina Tesio

doi:10.3389/fpsyg.2017.02083

Abstract

Purpose: Mindfulness interventions have been shown to treat depressive symptoms and improve quality of life in patients with several chronic diseases, including multiple sclerosis, but to date most evaluation of the effectiveness of mindfulness interventions in multiple sclerosis have used patients receiving standard care as the control group. Hence we decided to evaluate the effectiveness of a group-based body-affective mindfulness intervention by comparing it with a psycho-educational intervention, by means of a randomized controlled clinical trial. The outcome variables (i.e., depression, anxiety, perceived stress, illness perception, fatigue and quality of life) were evaluated at the end of the interventions (T1) and after a further 6 months (T2).Methods: Of 90 multiple sclerosis patients with depressive symptoms (Beck Depression Inventory-II score greater than 13) who were randomized, 71 completed the intervention (mindfulness group n = 36; psycho-educational group n = 35). The data were analyzed with GLM repeated-measures ANOVA followed by pairwise comparisons.Results: Per-protocol analysis revealed a time by group interaction on Beck Depression Inventory-II score, with the mindfulness intervention producing a greater reduction in score than the psycho-educational intervention, both at T1 and at T2. Furthermore, the mindfulness intervention improved patients’ quality of life and illness perception at T1 relative to the baseline and these improvements were maintained at the follow-up assessment (T2). Lastly, both interventions were similarly effective in reducing anxiety and perceived stress; these reductions were maintained at T2. A whole-sample intention-to-treat (ITT) analysis broadly confirmed the effectiveness of the mindfulness intervention.Conclusion: In conclusion, these results provide methodologically robust evidence that in multiple sclerosis patients with depressive symptoms mindfulness interventions improve symptoms of depression and anxiety and perceived stress, modulate illness representation and enhance quality of life and that the benefits are maintained for at least 6 months.Trial registration: the study was registered in the ClinicalTrials.gov registry (NCT02611401).

Highlights

Multiple sclerosis (MS) is a chronic, demyelinating disease and onset usually occurs at a young age
We evaluated the effects of a group-based body-affective mindfulness (BAM) intervention on depressive symptoms in patients with MS at the end of the intervention and 6 months later
We evaluated the effects of the BAM intervention on quality of life, illness perception, symptoms of anxiety, perceived stress and fatigue

Summary

Introduction

Multiple sclerosis (MS) is a chronic, demyelinating disease and onset usually occurs at a young age. People with MS have to deal with many debilitating and unpredictable symptoms and with the loss of function and the consequent disability, and with the unpredictability of the disease and the uncertain prognosis This imposes a significant emotional burden and has a severe impact on psychosocial functioning. Affective disorders in MS are still under-recognized and under-treated by clinicians (Goldman Consensus Group, 2005) For these reasons the American Academy of Neurology formulated evidence-based recommendations for screening, diagnosis and treatment of psychiatric disorders in MS (Minden et al, 2014), recommending further research on the utility of treatments shown to be effective in other clinical populations

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