Tuesday, 2 August 2016

Mind over matter - "can do treatment in MS"

BMC Res Notes. 2016 Jul 29;9(1):375.

Intensive social cognitive treatment (can do treatment) with participation of support partners in persons with relapsing remitting multiple sclerosis: observation of improved self-efficacy, quality of life, anxiety and depression 1 year later.

Jongen PJ, Heerings M, Ruimschotel R, Hussaarts A, Duyverman L, van der Zande A, Valkenburg-Vissers J, van Droffelaar M, Lemmens W, Donders R, Visser LH.

Abstract

BACKGROUND:

In persons with multiple sclerosis (MS) self-efficacy positively affects health-related quality of life (HRQoL) and physical activity. In a previous study we observed that 6 months after an intensive 3-day social cognitive treatment (Can Do treatment) with the participation of support partners, self-efficacy and HRQoL had improved in persons with relapsing remitting MS (RRMS). Given the chronic nature of the disease, it is important to know whether these beneficial changes may last.

METHODS:

Can Do treatment was given to 60 persons with MS and their support partners. At baseline and 12 months after treatment self-efficacy control, self-efficacy function, physical and mental HRQoL, anxiety, depression and fatigue were assessed via self-report questionnaires. Differences were tested via a paired t test.

RESULTS:

Of the 57 persons with MS that completed the baseline assessment and the 3-day treatment, 38 filled in the 12th month questionnaires (response rate 66.7 %), 22 with RRMS and 14 with progressive MS. In the RR group self-efficacy control had increased by 20.2 % and physical HRQoL by 15.0 %, and depression and anxiety had decreased by 29.8 and 25.9 %, respectively (all P < 0.05); the changes in mental HRQoL (+17 %) and fatigue (-20 %) failed to be statistically significant (P = 0.087, P = 0.080, respectively). In the progressive group no changes suggestive of improvement were seen.

CONCLUSIONS:

The findings suggest that a 3-day intensive social cognitive treatment (Can Do treatment) with the participation of support partners may have long lasting beneficial effects on the self-efficacy and HRQoL in persons with RRMS; and that improvements in anxiety and depression, not seen in the 6-month study, may yet develop at 12 months.

 Tony Robbins - a well known self-help guru/motivational speaker

The saying that you cannot have a positive life and a negative mind is never truer than when you become unwell. But as truisms go advice is cheap and available in abundance, but you have to be prepared to listen and to a certain degree truly believe.

Participation is therefore critical to the success of social programs. People affected by MS vary in the level of support needed and it is difficult to standardize such a treatment or to tailor to suit a wider audience. What may not be counterintuitive is to use this in the clinic setting where you have the freedom of tailoring the program.

Jongen et al, talk of "self-efficacy" - how confident are you in completing tasks and reaching goals in specific situations? They further elaborate and state that one's ability to produce a desirable effect or outcome is crucial to success, and is influenced by experience, social persuasion and psychological factors. In chronic conditions, they note that self-efficacy and psychosocial well being are related, and that self-efficacy is the single most consistent determinant of physical activity. Critical to their way of thinking is illness behaviour - where medical help seeking behaviour is a reaction to underlying life stressors (e.g. unemployment or marital problems). Identification of individual stressors and their elimination can improve self-efficacy. This is not a novel concept, and is well known in mindfulness programs.

Using a social cognitive "Can Do" treatment program with the support of partners, the authors demonstrate that you may be able to have long-lasting effects on self-efficacy, at least in RRMS. Simply put, believing that you can, means that you can. However, this type of program may not work in progressive patients. A special type of resilience is needed in progressive disease with regular reinforcement, where a short program, such as this, may not be successful. This is where partners are critical, and speaking from experience partners appreciate being involved, even if it's medically sanctioned!

7 comments:

  1. "Simply put, believing that you can, means that you can. However, this type of program may not work in progressive patients."

    Oh yes - I believed that I could have a shower, do the laundry, do the gardening, do the cooking then clean the floor. I really did. I had a good breakfast, plenty of fluids and energy-boosting snacks and I did deep breathing...

    I had my shower. I did the laundry. I did the vegetable preparation for the cooking. I did some weeding, then sat in the sun in the garden barely able to walk any more. No matter how hard I pushed. I'll do the floor another day.

    Just believing doesn't work all the time.

    ReplyDelete
  2. "Simply put, believing that you can, means that you can. However, this type of program may not work in progressive patients."

    Achievable goals. Aka: Spoon theory. However, spoon theory for the home brew hypertext medical journals and journalists is only one part of the place setting.

    Fork theory. Keep stabbing away at MS, education, self, seek professional assistance, act upon it, do not give up.

    Salad Fork theory - Eat right

    Knife theory - Cut out the crap in favor of wellness regimen.

    Noodle theory - Use your mind as much as possible. Cognition and memory.

    Vegetable theory - Do not ignore clinical advice.

    Potato theory - If one chooses sedentary the couch becomes one's cruiseliner.

    Glass theory - Half empty or half full seems to be the same thing. A full soul finds life even in adversity.

    Chair theory - Get up, sit down... exercise.

    There is also plate theory and table theory which I will leave to the imagination.

    ReplyDelete
  3. I would have agreed with both comments several years ago, but now I'm more open to the possibilities, as several of my patients have proven to me.

    ReplyDelete
    Replies
    1. So I can do all the housework the gardening and then maybe also entertain some visitors, even if it's my time of the month, even with my spinal lesions? Get real. No one can teach me anything about determination, but I am not going to give you my life history to prove that.

      Delete
    2. Jaded, the purpose of the blog is to inform MS patients, families, and MS professionals about the latest MS research. We interpret these findings; some are useful for some, others not so.

      Delete
    3. Sorry, I just don't understand your disagreement with my original post.

      Delete
  4. I've done pretty much all of the above. Positivity towards self has never been a long term issue with me. Sure, I have some bouts.

    I managed my own MS for near 8 years with no DMT's, probably not my smartest move.

    Ive fought back quite a ways over this past year. I try hit upon every area. Physical, mental, cognitive etc. I've not done it alone, not sure I could do it alone.

    In the same sentence I cannot begin to tell you how much many in clinical and research have inspired me. I've never met Prof G or B yet both have been important as they show me, "I can!"

    They have shown me that I may not always get my hopeful expected results but that if I do not try I am more certain of the results. They are a world away yet in numerous ways are fundamental towards MY personal MS awareness and work to make progress.

    I simply cannot thank them enough.

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.