Monday, 17 October 2016

#ClinicSpeak: Are you a ruminator or worrier?

Are you using mindfulness to manage your MS symptoms? #ClinicSpeak #MSBlog

What is mindfulness? It is a psychological process that brings one's attention to the internal and external experiences occurring in the present moment, which can be developed through the practice of meditation. Mindfulness is a significant element of Buddhist traditions. The practice of mindfulness is strongly correlated with well-being and perceived health. Mindfulness is an anecdote to rumination and worry, which both contribute to mental illness, in particular depression and anxiety. Mindfulness-based interventions are effective in the reduction of both rumination and worry. The systematic review below summarises that mindfulness also helps with MS-related fatigue. 

If any of you have had positive experiences with mindfulness can you please share them with us? Thanks


Ulrichsen et al. Clinical Utility of Mindfulness Training in the Treatment of Fatigue After Stroke, Traumatic Brain Injury and Multiple Sclerosis: A Systematic Literature Review and Meta-analysis. Front Psychol. 2016 Jun 23;7:912. doi: 10.3389/fpsyg.2016.00912. eCollection 2016.

BACKGROUND: Fatigue is a common symptom following neurological illnesses and injuries, and is rated as one of the most debilitating sequela in conditions such as stroke, traumatic brain injury (TBI), and multiple sclerosis (MS). Yet effective treatments are lacking, suggesting a pressing need for a better understanding of its etiology and mechanisms that may alleviate the symptoms. Recently mindfulness-based interventions have demonstrated promising results for fatigue symptom relief.


OBJECTIVE: Investigate the efficacy of mindfulness-based interventions for fatigue across neurological conditions and acquired brain injuries.

MATERIALS AND METHODS: Systematic literature searches were conducted in PubMed, Medline, Web of Science, and PsycINFO. We included randomized controlled trials applying mindfulness-based interventions in patients with neurological conditions or acquired brain injuries. Four studies (N = 257) were retained for meta-analysis. The studies included patients diagnosed with MS, TBI, and stroke.

RESULTS: The estimated effect size for the total sample was -0.37 (95% CI: -0.58, -0.17).


CONCLUSION: The results indicate that mindfulness-based interventions may relieve fatigue in neurological conditions such as stroke, TBI, and MS. However, the effect size is moderate, and further research is needed in order to determine the effect and improve our understanding of how mindfulness-based interventions affect fatigue symptom perception in patients with neurological conditions.

9 comments:

  1. I went on a NHS (MBSR) mindfulness based stress reduction 8 week course. It was useful, the drop out rate of people on the course was fairly high (around 50%).
    As I suffer from aches and pains in my legs and back, more so by the end of the day (fatigue?), the course helped me.
    Mindfulness based activities I use most days now. When I stand and cook food or wash up dishes the mindfulness focused attention helps. I focus on how the sensations feel such as chopping the food, how it looks, textures of food. The warmth of the washing up water, the soap suds. All things that I didn't overly notice before but now help distract me from the pain and rumination.

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    1. Thanks for responding. When I first heard of mindfulness helping MSers I was sceptical. But almost every patient of mine who goes on a course and adopts feels it helps. The response has been so positive that I now recommend it as part of routine care. May be we should make it a life skill?

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    2. It is indeed an invaluable lifeskill and is being introduced in some schools in the US at a young age. The resistance in such settings though is the mistaken belief that it needs to involve religion. Mindfulness and meditation are used by both the US and British armies in the treatment of PTSD and is used to reduce violence in prisons.

      I do not hold any religious beliefs, and many religions do feature meditation, but I have been reading Buddhist philosophy for a few years and it is pretty amazing stuff.




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  2. When I was in my twenties, I read "The Wisdom of Insecurity" by Alan Watts. This is the original mindfulness book. When I read it again recently, I realised that I had absorbed the principles in it when I read it decades ago and that I live in the moment, in a way that has (mostly) led to a very happy life. It did have its downsides - I might have gone on one of the early DMTs at diagnosis, if I had been more worried about the future, and I might not be in such a sorry state physically now. Alan Watts recommended being in the moment, every moment. Probably not the best or most practical idea, but a long way from rumination or worry. I still don't do much of either of these and I am still a happy person.

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  3. Please research before you try meditation, it is a good idea to read a variety of methods, there are many traditions and they won't all suit you.

    Meditation is not about emptying your mind, you won't be able to, thoughts will come and go, just sit and observe them without judging them. You may find that the gaps between them grow, but it is unrealistic to expect that thoughts of what's for dinner later or what to wear tomorrow won't appear, they will. Just don't react to them.

    I won't attempt to recommend books/teachers/traditons on here but you could try looking on youtube. There is a vast array of people and traditions, listen to a few, some will gel with you some won't.

    The Dalai Lama is keen on science and this is a quote from an article written by him based on his talk given at the Society for Neuroscience AGM, 2005:

    'Recent discoveries in neuroscience have demonstrated the innate plasticity of the brain, both in terms of synaptic connections and birth of new neurons, as a result of exposure to external stimuli, such as voluntary physical exercise and an enriched environment. The Buddhist contemplative tradition may help to expand this field of scientific inquiry by proposing types of mental training that may also pertain to neuroplasticity. If it turns out, as the Buddhist tradition implies, that mental practice can effect observable synaptic and neural changes in the brain, this could have far-reaching implications.'

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  4. I was already using Mindfulness before my diagnosis last year. However, after 2 relapses in seven months my body was so uncomfortable that being asked to sit in a certain way or breathe to a particular timeframe was stressful and often not achievable. I started hunting on You Tube and discovered Mindfulpeace. The oral instructions are flexible: for example: to sit or lie in a way that's comfortable for you. Find it SO beneficial in the impact on the emotional and psychological level. Helps me to maintain a positive, balanced perspective, is calming and offers excellent strategies in the form of repeatable phrases. Have others such as my sister with Sarcoidosis doing the one on managing pain and another on feeling the joy in life. That such things are freely accessible online and don't require anything such as specific venue, time or training is great for MSers - have even done the Mindfulpeace on starting the day after 3pm because that particular day, it felt my day was beginning that late in the afternoon!

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  5. I have found mindulness based techniques really helpful at times too - finally got on the band wagon when a physio at the pain clinic went through the evidence of how we need to rewire to change chronic pain signals. Some favourites of mine are 10% Happier (for fidgeting skeptics) (a lot for free) and Smiling Mind apps (dulcet Australian tones and programmes for teenagers too) - free always. There are many around for free. A lot of people recommend Headspace and I guess the guy is now a millionaire for a reason, but I think it's rather expensive after free trial. There's a lot out on there on youtube too. Give it a go and try and stick with it, it's not silver bullet but with time it's a really good skill to develop.

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  6. I feel the spasticity in my left foot is reduced for a time immediately after meditation, even just a 15 min, eyes closed meditation make as difference. My PT tells me that spasticity is caused by nerves that are firing too much, and so meditation might help. Can't find any research.

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  7. I took a six week mindfulness training course in Victoria, BC, Canada. Paid for by BC Health. There's always a big waiting list to get into these courses which are very popular here.

    Our course was run by two medical doctors who use mindfulness practice in their personal lives and mindfulness training with their patients. It's a private enterprise not for profit.

    I learned that mindfulness is different from meditation.

    I have MS fatigue and cog fog. So I have difficulty implementing mindfulness, physio exercises, and general fitness recommendations.

    However, I have used mindfulness to empty my mind when I get over stimulated. It's a very useful tool to have in your toolbox.

    You can learn it at home but it's easier to learn if you go to a group and your more likely to follow the practice.

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