Behavioral interventions in multiple sclerosis: a biopsychosocial perspective

Abstract

Managing uncertainty is a major challenge associated with the diagnosis of multiple sclerosis (MS). In addition to physical symptoms, neuropsychiatric symptoms are highly prevalent in this disease. Depression in particular is more common in MS than in other chronic diseases. While substantial achievements have been made in the therapy of MS and an increasing number of immunomodulatory treatments are now available, the long-term benefits of these are still a matter of debate. Importantly, while the approved therapies show good efficacy on inflammatory lesions and relapse rate, and may slow certain aspects of disease progression, improvements in function have rarely been reported. On the other hand, behavioral interventions have recently been shown to significantly improve fatigue and depression as well as motor function. In addition, recent evidence suggests that group education or face-to-face behavioral interventions may decrease inflammatory disease activity (such as relapse rate or lesion formation measured by MRI). Therefore, behavioral interventions not only ameliorate symptoms but may have the potential to modify the disease process itself.

The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial

“…We argue that, consistent with other studies, the behavioral approach provided here may also benefit depression, irrespective of the origin, and therefore we did not wish to exclude depressed patients (Heesen et al, 2012). To explore the net effects of the intervention(s) on primary fatigue, all potential causes of secondary fatigue should be excluded.…”

Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis

“…The prevalence of depression for people with MS is considerably higher than that of the general population [40] and higher than with other chronic illnesses [41,42] probably because of the multifactorial nature of depression in MS. While it may be reactive to the diagnosis of a chronic illness, depression in MS is also likely to be endogenous, partly based on the link with sclerotic pathology in specific neurological territories [43].…”

Multiple Sclerosis/Chronic Fatigue Syndrome overlap: When two common disorders collide

“…Despite the fact that generic fatigue management rehabilitation programmes routinely offered to MS patients encompass most of the management strategies used for CFS/ME patients (Heesen, 2012), CFS/ME management plans focus on addressing the perpetuating factors for the fatigue such as a perfectionist personality or boom and bust behaviour (Smith, 2012). Cognitive Behavioural Therapy (CBT) is more focused (Stahl, 2013).…”