In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked psychologist Amy MB Sullivan to answer some of your questions related to implementing integrative medicine in multiple sclerosis care. Sullivan is a board-certified staff clinical health psychologist and the director of behavioral medicine at the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic. Sullivan received her doctorate from Argosy University-Atlanta, worked her internship at the University of Cincinnati, and had a fellowship at the Cleveland Clinic in pain medicine. She specializes in multiple sclerosis mental health care and is concerned about physician and caregiver self-care, burnout, and psychological health. What mental health challenges are unique to life with a progressive disease? I strongly utilize the grief and acceptance work that has been adapted from Elisabeth Kübler-Ross with my patients, as these are patients who are faced with a functionally, cognitively, socially, financially, and emotionally debilitating disease, sometimes at a very young age. This model theorizes that people move, in no particular order, through and in between different stages of grief (anger, denial, depression, bargaining, and acceptance/adaptation). Life without a chronic disease is difficult; life with a chronic illness adds another layer of complexity. What do you wish more doctors would realize about the mental health challenges of living with multiple sclerosis? The high prevalence of mental health disorders in people with chronic disease, especially as it relates to people with multiple sclerosis, as they have three to four times higher rates of depression than the general population. This means that there are likely many contributing factors, one being the adjustment to disease and functional changes. Another could be medication-induced mood disorders, and another is likely changes in the brain from a structural perspective. I wish they would screen for mental health conditions. Prior to all appointments at Mellen Center, our patients are screened using the PHQ-9 [questionnaire]. This is then prepopulated into the note in their electronic health record, and we can assess mood over time. The providers are able to assess their mood, and they can choose to treat the patient or send the person to our behavioral medicine team. How can caregivers help a loved one who’s experiencing loneliness from social avoidance related to their diagnosis or symptoms? Listen and empathize. Don't judge. Communication skills are important to all relationships, and even more so with a relationship which now has the uninvited guest of a chronic illness. Caregivers have to remember to take care of themselves and be able to communicate effectively with the person they’re caring for. Multiple sclerosis can make a person feel like a burden. What tips do you have for a patient who fears expressing new limitations, such as those caused by fatigue, to their loved ones? If one is in a trusting, safe relationship, expressing their thoughts or feelings is healthy. They also have to realize that the caregiver/loved one is likely experiencing their own changes, and it’s equally important to listen to them. Role reversal is frequent: where a person who was a stay-at-home partner is now back at work, and a person who was in the work force is now in the stay-at-home role. All of this is difficult, and it is important for each side to listen and share their feelings. What advice do you have for someone who feels they must be "tough" for their family and not show the toll of the disease on their psyche? I think it’s really tough. I always encourage patients to be comfortable sharing their emotions, but it also depends on having the right support system in place. Having that communication between patients and caregivers is critical. Many who experience suicidal thoughts feel that realistically they won’t be able to overcome such thoughts. How do you respond to that? Get help immediately. We do not mess around with suicide. Sometimes it's important to get space between stimulus and response. Thoughts can be fleeting, and we need to take a minute to get that space. It’s often said that we must process things like diagnosis and medical disappointments. But what does processing actually look like, practically? It looks like the flow of experience, thoughts, behaviors, and feelings, and how these experiences may change as information is accessed from different channels. The process is going to look different for each patient, and we have to recognize each individual’s needs and the ways they process the stages of their disease. Expert Voices is a monthly series involving a Q&A with an expert in the multiple sclerosis space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.