Mixed Improvements Seen Among Patients With MS Practicing Mindfulness

A systematic review and meta-analysis of studies of patients with multiple sclerosis (MS) found that mindfulness- and acceptance-based interventions (MABIs) did not have a significant effect on mindfulness among these patients. Quality of life (QOL), coping skills, cognition, and mindfulness were shown to have just moderate gains.

The author searched PubMed (1966-2020), CINAHL (1981-2020), PsycINFO (1935-2000), and SCOPUS (1966-2020) from their inception through July 3, 2020, including 18 randomized controlled trials in her final analysis. Search terms used included mindfulness, acceptance, meditation, acceptance and commitment therapy, and multiple sclerosis. Among qualifying criteria, the 18 trials had to be written in English, provide a comparison of before and after results, and test sole or multicomponent interventions “involving MABIs at least 50% of the whole intervention time.”

Of the 18 studies included, in-person interventions were tested in 15 and web- or phone-based interventions in 3, among a mean (SD) cohort size of 61.2 (37.5) patients, with the smallest trial including 24 individuals and the largest, 150. The mean (SD) patient age was 42.4 (8.6) years, and 78.7% of patients were female.

The findings were published recently in Psychology, Health & Medicine.

“Interventions involving mindfulness training have shown growing evidence for improving cognitive functions, including attention and memory,” said Areum Han, PhD, the study’s author. “But the scientific investigation regarding effects of mindfulness training on cognition is still relatively new with a limited number of studies.”

Her analysis revealed these findings of the MABIs tested:

• They had a moderate effect on QOL in 12 of the trials, which covered 547 participants (standardized mean difference [SMD], 0.56; 95% CI, 0.15-0.97). This was seen immediately following the interventions.
• QOL improved more with follow-up in 7 of the trials, which covered 390 participants (SMD, 0.81; 95% CI, 0.21-1.40).
• Coping skills had slight improvements in 4 of the trials, of 214 participants (SMD, 0.45; 95% CI, 0.02-0.87), immediately following the interventions.
• Coping skills did not have statistically significant increases in 3 of the trials, among 170 participants (SMD, 0.63; 95% CI, –0.15 to 1.42), at follow-up.
• Cognition (memory) moderately improved in just 4 trials, covering 170 participants (SMD, 0.49; 95% CI, 0.19-0.80), a finding seen right after the MABIs concluded.
• Memory was shown to greatly improve in 3 of the trials, covering 137 participants (SMD, 1.12; 95% CI, 0.06-2.17), but this was only seen at follow-up.
• No statistically significant improvements from MABIs were noticed for mindfulness, both immediately following interventions (SMD, 0.22; 95% CI, –0.34 to 0.77) and at a more distanced follow-up (SMD, 0.59; 95% CI, –0.26 to 1.44).

“The present meta-analysis paper found new information by conducting meta-analyses regarding effects on coping, attention, memory, and mindfulness,” Han noted. “Previous meta-analyses for people with MS were not conducted in these outcomes.”

These previous studies, she added, have primarily focused on symptom reduction for depression, anxiety, stress, fatigue, and pain.

Because the present meta-analysis did not include subgroup analyses on individual MABI features and only studies written in English were included, these findings may be limited in their generalizability.

Future studies on the effects of MABIs on QOL, coping, cognition, and mindfulness should include subgroup analyses for contributions of mindfulness-based cognitive therapy, acceptance and commitment therapy, and dialectical behavior therapy among patients with MS, Han concluded.

“High-quality studies with follow-up evaluations are needed to support effects of MABIs on QOL, coping, cognition, and mindfulness in people with MS and examine intervention features that increase and maintain effects,” she emphasized.

Reference

Han A. Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: a systematic review and meta-analysis. Psychol Health Med. 2021;1-18. doi:10.1080/13548506.2021.1894345