Stress management therapy effectively prevents MS brain lesions

For those suffering from the autoimmune disorder multiple sclerosis, life alternates between almost symptomless periods of time and episodes of intense neurological problems that can result in anything from painful muscle spasms, loss of vision or problems moving arms and legs.

These “flare-ups” are often preceded by brain lesions, scars that form in the nervous system and destroy myelin sheath – material that surrounds neurons responsible for carrying electrical signals.  By managing the development of these scars, patients with MS can keep better control their episodes.

And now, new research has shown that a weekly stress management program was very effective in preventing the development of new lesions, pointing toward possibly supplemental therapy that could be used with existing MS treatments.

The study, published in an issue of Neurology, the medical journal of the American Academy of Neurology, is part of ongoing research from principal investigator David Mohr, professor of preventive medicine at Northwestern University Feinberg.  A previous study of Mohr’s involved following MS patients receiving MRIs and the stressful events in their lives; stress was found to be a good predictor of the development of brain lesions.

MRIs track development of lesions

“We’ve been able to show [with previous research] that stress is related to the development of new lesions and exacerbations of MS,” Mohr told  “We ended up getting funded by the NIH (National Institutes of Health) to conduct a trial for the stress management program.  It’s important to mention this trial was designed very much like a Phase II pharmaceutical trial.  So we used the same kind of imaging markers commonly used by pharmaceutical companies and by the FDA, and a lot of the methodology was similar.”

According to Mohr, these most recent findings are the first to show that counseling and psychotherapy affect brain lesion development.  The study, conducted over a 24-week period, randomly assigned 121 MS patients to one of two groups – half receiving stress management therapy in 16 sessions and the others assigned to a control group.

The stress management involved helping patients to identify stressors and what they can do to address stressful situations.

“When people get stressed, they overestimate the stress and underestimate the ability to manage it,” Mohr said.  “So we help them with the appraisal – is it that bad, and are they that helpless?  If they are having a problem, rather than become completely stressed out, we see if there’s a way to manage the problems they’re having.  We also show them how to manage the physiological response, developing ways of using breath and breathing to reduce the physiological stress response.  Teaching them how to apply that to various situations in their lives.”

The researchers tracked the development of the patients’ lesions by giving them MRIs every two months.  The imaging helped to show if inflammation in the brain had occurred.

“When people have exacerbations, it’s basically an autoimmune reaction in which the immune system attacks the myelin sheath on the neuron – it identifies them as foreign,” Mohr said.  “For that process to start, the immune system has to open the blood-brain barrier to get through to the brain.  One of the neuro-imaging markers we used was a gadolinium enhancing MRI, in which gadolinium is injected in blood stream during MRI and passes through blood brain area, so you get an image of active inflammation.”

These kinds of lesions highlighted through gadolinium can disappear over time.  The second type of lesion the team tested – a T2 brain lesion – is more permanent, and these markers are more commonly used to evaluate MS medications in Phase II trials.

“With the stress management group, we saw significant reductions in both [kinds of lesions],” Mohr said.  “With the gadolinium enhancing MRI, 77 percent of the patients remained disease-free during the treatment compared to 55 percent in control.  For T2 lesion, 70 percent remained free compared to 43 percent in the control.  Those are effects sizes that are seen in pharmaceutical treatment of MS.”

Stress less, reduce depression

While the results are comparable to results seen from current MS treatments, Mohr cautioned against stress management replacing prescribed medications.

“I would not want to see patients go off medications,” Mohr urged.  “Some of the patients we had in trial were on active medication, and we looked at whether there were differences in effects between those on medication and those who weren’t, and there were no differences.  What that means is that the underlying processes of how stress management works is independent of the medications, so this is not a substitute.”

In order to better understand just how effective stress management can be, Mohr hopes for a much longer, more extensive clinical trial.  Even if the results are consistent with these findings, Mohr noted that stress management therapy is already very beneficial for MS patients.

“This stress management program…is highly effective for treatment of depression, reducing fatigue and improving quality of life,” Mohr said.  There are a lot of reasons that people with MS would want to use this kind of treatment.  If we do a larger trial and see it is in fact useful for reducing the number of new exacerbations, it would be a potentially useful adjunct treatment for people experiencing a lot of stress.”