Meditation May Relieve Fatigue and Depression in Multiple Sclerosis

MS quality of life, depression, and fatigue improve after mindfulness training. A randomized trial. Objective: Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS. Methods: A total of 150 patients were randomly

assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes. Results: Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4–0.9 posttreatment and 0.3–0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample. Conclusions: In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL. Classification of evidence: This trial provides Class III evidence that MBI compared with UC improved HRQOL,

fatigue, and depression up to 6 months postintervention. Abbreviations: ANCOVA = analysis of covariance; CES-D = Center for Epidemiologic Studies Depression Scale; CI = confidence interval; EDSS = Expanded Disability Status Scale; ES = effect size; HAQUAMS = Hamburg Quality of Life Questionnaire in Multiple Sclerosis; HRQOL = health-related quality of life; MBI = mindfulness-based intervention; MFIS = Modified Fatigue Impact Scale; MS = multiple sclerosis; NNT = number needed to treat; PQOLC = Profile of Health-Related Quality of Life in Chronic Disorders; PRO = patient-reported outcome; STAI = Spielberger Trait Anxiety Inventory; UC = usual care. From the Department of Psychosomatic Medicine (P.G., C.S.), Division of Internal Medicine, University Hospital Basel, Basel; Department of Neurology (L.K., H.G., M.D.), University Hospital Basel, Basel; Department of Preventive Medicine (D.C.M.), Feinberg School of Medicine, Northwestern University, Evanston, IL; and Department of Psychology (I.K.P.), University of Basel, Basel, Switzerland. Authors: P. Grossman, PhD, L. Kappos, MD, H. Gensicke, MD, M. D’Souza, MD, D.C. Mohr, PhD, I.K. Penner, PhD and C. Steiner, MS. Address correspondence and reprint requests to Dr. Paul Grossman, Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-3041 Basel, Switzerland .Paul Grossman is Director of the

Psychophysiology Research Laboratory, Department of Psychosomatic and Internal Medicine, University of Basel Hospital, Basel, Switzerland, and the Freiburg Institute for Mindfulness Research, Freiburg, Germany. He studied philosophy and psychology, and received his Ph.D. in psychology from the University of Florida. Previously Director of the Lown Cardiovascular Research Laboratory, Harvard School of Public Health, he has held positions at the Free University of Amsterdam, the Netherlands and the University of Freiburg, Germany. He is President-Elect and Executive Board Member of the International Society for the Advancement of Respiratory Psychophysiology. His empirical research interests have aimed toward the expansion of autonomic, respiratory and cardiovascular physiology into psychological and behavioral domains. He has published many journal articles and chapters that examine how breathing and cardiovascular activity are modified, in health and disease, by emotion, mental activity and psychological state. For the past several years, Dr. Grossman has also investigated the benefits of mindfulness meditation for health-related disorders, and he is currently Principal Investigator of a large randomized controlled trial that evaluates the efficacy of mindfulness-based stress reduction (MBSR) among individuals suffering from fibromyalgia. He is

additionally interested in issues regarding the transfer and translation of Buddhist psychological principles and concepts to Western psychological paradigms. Dr. Grossman is a longtime student of insight meditation and completed the MBSR Internship at the UMass Center for Mindfulness in 1998. For the last six years he has taught a seminar on Buddhist psychology and mindfulness at the University of Freiburg Department of Psychology. Sources: &  ~ Meditation is a holistic discipline during which time the practitioner trains his or her mind in order to realize some benefit. Meditation is generally a subjective, personal experience and most often done without any external involvement, except perhaps prayer beads to count prayers. Meditation often involves invoking and cultivating a feeling or internal state, such as compassion, or attending to some focal point, etc. The term can refer to the process of reaching this state, as well as to the state itself. There are hundreds of specific types of meditation.The word, ‘meditation,’ means many things dependent upon the context of its use. People practice meditation for many reasons within the context of their culture. Meditation is a component of many religions, and has been practiced since antiquity, especially by monastics. To date, the exact mechanism at work in meditation remains unclear.  ~  GoodNews International

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