Cleveland Clinic program empowers MS patients to manage daily stress
Participants learn to regulate mood, heart rate with mindfulness and biofeedback
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- A Cleveland Clinic program helps people with multiple sclerosis reduce depression and anxiety.
- The 4-session program uses biofeedback and mindfulness to manage stress.
- Patients learn to regulate mood and heart rate, improving emotional and physical health.
A brief, four-session stress management program created by the Cleveland Clinic is helping people with multiple sclerosis (MS) significantly reduce their depression and anxiety.
By using real-time biofeedback and mindfulness, the streamlined protocol offers patients a practical way to reclaim some control over their emotional and physical health without spending time or energy on traditional, months-long therapy.
The Stress Management Protocol (SMP) uses a pulse oximeter — a small finger device — to show patients how their heart rate and oxygen levels respond to relaxation techniques. Researchers found that these mind-body skills not only improved emotional well-being but also provided a sense of “agency” over a disease that often feels unpredictable. Improvements were seen after one session and continued over time.
“Unlike traditional, lengthy interventions that often suffer from high attrition, this streamlined approach offers a feasible clinical model that can empower patients to regulate their autonomic responses in real-world settings,” Amy Sullivan, director of behavioral medicine and research in the Mellen Center, said in a Cleveland Clinic press release. “Our findings suggest that even brief, targeted behavioral interventions can yield measurable improvements.”
The study, “Impact of a short-term stress management protocol on physiologic biofeedback measures of stress and mood in people with multiple sclerosis,” was published in Multiple Sclerosis and Related Disorders.
Why stress management is vital for MS care
Stress can worsen symptoms of MS, a chronic disease that damages nerve cells in the brain and spinal cord. Stress can worsen depression and anxiety, reducing quality of life and making MS feel more severe and more difficult to control. For this reason, managing stress is considered an important part of care.
Stress management programs help patients learn skills to cope with stress, physical tension, and difficult emotions. These programs are evidence-based and may include techniques such as biofeedback, which uses electronic monitoring of bodily functions, like breathing or heart rate, to help patients gain control over them.
However, many stress management programs require sessions over several months, which can be difficult for patients due to work, family responsibilities, and fatigue caused by their MS. To address this, doctors at the Cleveland Clinic designed a shorter program called the Stress Management Protocol.
The study describes the researchers’ 10-year clinical experience with the program, which consists of four one-hour individual sessions, spaced four to six weeks apart. The spacing allows patients to practice skills in their daily lives, not just during sessions. For biofeedback, patients used a pulse oximeter, a small device placed on the finger that measures breathing rate, heart rate, and oxygen saturation.
The first session explains how stress affects MS and teaches diaphragmatic breathing, a technique that involves slow, deep breaths from the abdomen. The second introduces a structured breathing pattern to reduce rapid or shallow breathing. The third uses guided imagery, where patients imagine calming scenes to relax the body and mind. The fourth focuses on mindfulness, which involves paying attention to the present moment, along with skills to relax muscles.
The researchers analyzed data from 195 adults with MS who completed at least one SMP session between 2012 and 2022. Most were women (71.9%), and the average age was 44.4 years.
Improvements seen across mood and physical health
The results showed significant improvements after one session. Symptoms of depression and anxiety eased, breathing and heart rate slowed, and oxygen saturation increased. Improvements continued across sessions, with the largest gains in depression and biofeedback measures seen in patients who completed three sessions.
However, many patients chose to stop participating over time, leaving 49 to complete the four sessions.
“We encouraged patients to drop out of the sessions once they felt they mastered the material and their mood improved,” Sullivan said. “The real-world applicability and respect of their time was one of our greatest accomplishments in this dataset.”
“This may reflect a selection bias in a real-world study like this,” Sullivan added, “as patients who achieve rapid mastery of the skills may discontinue the program early while those with more complex or treatment-resistant symptoms may be more apt to continue through the final session.”
The program improved both emotional well-being and physical stress in MS patients, enabling them to use the techniques and biofeedback tools outside the clinic in real-world settings.
“This mastery of mind-body skills provides patients with a sense of agency over their symptoms, which is often lost,” Sullivan said.
For the researchers, “our study supports the development of SMPs to assist individuals in utilizing the mind-body stress management skills while they monitor real-time physiological data (biofeedback) to motivate their success in managing stress outside of the therapy room and in a real-life environment,” they concluded.
