Integrating Behavioral Medicine into Effective Treatment of Multiple Sclerosis

At the 2013 Annual Meeting of the Consortium of Multiple Sclerosis Centers, Amy Burleson Sullivan, PsyD, a psychiatrist with the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic Foundation, began her behavioral medicine session talk by emphasizing that a variety of clinicians and support staff is needed to provide effective care due to the unpredictable nature of multiple sclerosis (MS). This includes neurologists, psychologists, physical therapists, social workers, and clinical researchers.

Many patients experience increased anxiety and depression following a multiple sclerosis diagnosis and this can exacerbate their symptoms. Sullivan referred to one clinical study authored by Mohr et al. in 2013 that focused on the effects of stress management therapies on MS outcomes. One group received 16 stress management therapies over 24 weeks. After 16 weeks, this group experienced a 70% reduction in T2 lesions as compared to just a 43% reduction for the control patients. This study actually showed that stress management therapies could reduce lesion rates in MS patients in the short term.

Sullivan also highlighted the unique challenges that come with multiple sclerosis, pointing out that patients often appear on the surface to be completely healthy, prompting peers and family members to sometimes ask questions such as “What could be wrong with you?” There are also disclosure issues associated with MS; the patient must decide whether to tell family members, his or her employer, and other personal relationships about a diagnosis. Other challenges faced by patients with MS include impaired or degraded motor skills and other basic physical functions that can impact their occupation and social life.

Sullivan pointed out that behavioral medicine is needed to help patients with MS focus on the positives, adjust their goals and expectations, and create a new sense of purpose. One observer of Sullivan’s practice commented on how happy her patients were after they had visited her and asked her what she was doing. Sullivan just said that she “just gives patients love.” She said that this tender approach to empathetic understanding of MS can be therapeutic to the transition to healthy management of MS.

However, according to Adrienne Boissy, MD, neurologist with the Cleveland Clinic Foundation, in some cases empathy is not enough and psychology is necessary. She told the story of a patient with MS for whom the staff of interdisciplinary healthcare workers at her facility had very little sympathy. This particular patient had chronic headaches and had been to the hospital numerous times without achieving any relief. This patient lived with her parents who did not believe that anything was wrong with her. Boissy had been a bartender in a previous life and casually engaged the patient with a “tell me about yourself” listening approach. Ultimately the conversation led to new discoveries about this individual’s personal story. It included a rape and a self-inflicted wound. Profound psychological trauma had been involved here and it needed to be addressed.

Later, Boissy described somatoform patients who presented with symptoms resembling MS but in whom no physical abnormalities could be detected. She said such cases should be considered as psychiatric disorders and that clinicians must handle these patients with a great deal of tact, as they are often especially sensitive to information regarding their disease.