Using Trait Mindfulness Techniques May Help Reduce Depression in MS

Multiple sclerosis (MS) patients reported fewer difficulties regulating their emotions, and reduced depressive symptoms when they applied trait mindfulness techniques, a study showed.

Trait mindfulness refers to an innate ability to pay and maintain attention to moments in the present with an open, non-judgmental attitude.

Notably, the use of acceptance as a strategy to regulate emotions played a role in the relationship between trait mindfulness and depression.

“These findings suggest that increasing levels of mindfulness through clinical interventions may present a path toward improving emotion regulation, and by extension, reducing the symptoms of depression in [people with MS],” the researchers wrote.

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The study, “Trait mindfulness, emotion dysregulation, and depression in individuals with multiple sclerosis,” was published in the journal Multiple Sclerosis and Related Disorders.

Depression and other emotional challenges are more prevalent among people with MS than in the general population, leading to a lower overall quality of life and often, worse disease symptoms. MS patients with depression are less likely to take their disease-modifying therapies, have an increased risk of disability worsening, and also report less exercise and a poorer diet. As a result, there is a need to understand factors that contribute to depression in MS.

Studies suggest that MS patients find it more difficult to regulate emotions compared with healthy people — which has been found to increase depressive symptoms and reduce quality of life.

Trait mindfulness is a self-regulating technique that correlates with improved psychological health in numerous patient populations. Higher degrees of trait mindfulness have been linked to positive outcomes in people with MS, such as less psychological stress, better coping skills, and better quality of life.

Now, researchers based at Ohio State University designed a study, dubbed Cognitive and Emotion Regulation Training in MS or CERT–MS (NCT02717429), to examine the impact of trait mindfulness on emotional regulation in MS patients. The study was conducted in a laboratory setting, in which worry and rumination were induced.

A total of 61 adults with MS were involved in the study. They had a mean age of 45.7, were relapse-free, and had not taken immune-suppressing corticosteroids for at least 30 days prior to the trial’s start. The majority of participants were white (72%) and female (77%), and most had relapsing-remitting MS (96.7%). The average disease duration was 11.2 years.

Trait mindfulness was evaluated using the five facet mindfulness questionnaire, which assessed the following factors of paying and maintaining attention to moments in the present: observing, describing, acting with awareness, nonjudgment, and nonreactivity. Higher scores reflected more trait mindfulness. Depressive symptoms also were measured using the Beck Depression Inventory-II.

The emotion regulation scale measured six facets of emotion dysregulation, or the inability to regulate emotions: non-acceptance of emotional responses, difficulties engaging in goal-directed behavior, difficulties controlling impulses, lack of emotional awareness, limited access to emotional regulating strategies, and lack of emotional clarity.

Patients with more severe disability, as measured by the expanded disability status scale (EDSS), were more likely to report more symptoms of depression. No other clinical factors were related to depressive symptoms, including disease duration.

The trial was launched with a seven-day dairy period, in which participants collected information on their worries and ruminations; the two most intense worries and ruminations were selected. They were asked to engage with these worries, such as “I worried about what my husband would think when I told him about my fall,” and ruminations, including “I’ve been ruminating about the different paths my life could have taken and the choices I’ve made over the years.”

Participants then followed a series of 12 auditory prompts to increase their engagement with the worries and ruminations. For example, for worries, one prompt said: “Think about how keyed up or on edge you feel.” For rumination, one example prompt was “Think about how you wish this situation had gone better.”

Before and after each task, participants responded to questions that measured, on a scale of 1–100, their use of two maladaptive strategies to regulate emotions, such as avoidance and suppression, and two adaptive methods, including acceptance and cognitive reappraisal (recognizing and changing negative thought patterns).

The results revealed that those with higher trait mindfulness scores reported fewer difficulties with emotion regulation and less depression.

The worry and rumination task found a significant interaction between trait mindfulness and strategy type. Higher levels of mindfulness were associated with greater acceptance than avoidance and suppression.

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A second model also showed a relationship between trait mindfulness and acceptance as a strategy to regulate emotions. Further, there was a significant negative association between acceptance and depression, such that “increased acceptance use was related with decreased symptoms of depression,” the researchers wrote.

Finally, the team demonstrated that trait mindfulness had an indirect effect on depression, which was mediated by the use of acceptance. In general terms, people with higher trait mindfulness scores were more likely to use acceptance to regulate their emotions, which had a direct impact on depression.

However, a direct effect, which measured the impact of trait mindfulness on depression after statistically controlling for acceptance use, remained significant, indicating that “this relationship was only partially mediated by acceptance use,” the team wrote.

The total effect, the sum of the indirect and direct effects, showed a significant relationship between trait mindfulness and reduced depression.

“Our results suggest that the association between trait mindfulness and emotion dysregulation extends to the use of emotion regulation strategies during an emotionally evocative task,” the researchers concluded. “Additionally, emotion regulation strategy use, and acceptance in particular, may play a role in the relationship between acceptance and trait mindfulness and depression.”

This study was supported, in part, by a grant from the National Multiple Sclerosis Society.