Trial to target MS cognitive symptoms with mindset coaching

An international trial will test a combined approach to targeting underrecognized cognitive symptoms of multiple sclerosis (MS), coaching patients on becoming more conscientious with the aim of making them more likely to stick with treatment plans.

Difficulties with learning, memory, and related functions are among the symptoms of MS, affecting about half of patients. Though often overlooked, they can have profound effects on everyday life.

Greater conscientiousness — the ability to be orderly and dependable so that goals can be achieved more easily  — can help patients adhere to treatment plans. Those who are more motivated to take an active role in their treatment can see their quality of life improve, and research has shown it may also influence disease progression.

“It is important to focus on what can be controlled,” said Ralph Benedict, a University of Buffalo professor involved in the trial, said in a university news story. “This includes maintaining a healthy lifestyle — regular exercise, cognitive engagement in daily activities, and practices such as mindfulness meditation — which can help support brain health and reduce depression and anxiety.”

Benedict and his team have developed an app, Conscientiousness Coach, designed to help users identify core values and set meaningful goals for themselves.

Recommended Reading

Sept. 18, 2025 Columns by Benjamin Hofmeister

MS cognitive symptoms frighten me more than the physical ones

‘Hidden deficit’ in the workplace

MS, a neurodegenerative condition, has autoimmune origins, arising when the immune system mistakenly attacks myelin, the fatty sheath that protects nerve cells. As the cells lose myelin, neurodegeneration and inflammation can lead to a variety of symptoms.

Some of these symptoms — such as difficulty walking or loss of balance — are relatively visible. Others, including pain, mental health challenges, and cognitive changes, are less overt. It can be difficult for people with these symptoms to acknowledge them and explain them to others. However, they can still affect everyday activities, such as work.

“Because it is often a ‘hidden’ deficit, patients and employers may not recognize that difficulties in the workplace are symptoms of the disease and may warrant accommodations,” Benedict said.

Studies have shown that cognitive impairment is a primary reason for job loss among MS patients, and acknowledging the less visible aspects of living with MS may help people feel less isolated.

The Conscientiousness Coach app was meant to improve conscientiousness. Conscientious individuals “tend to be more organized, goal-directed, and consistent in their health behaviors,” Benedict said.

Increasing conscientiousness could help people dealing with chronic conditions like MS adopt lifestyle strategies that might ultimately support their overall health.

In a previous study, the researchers found that adults with MS who used the app and participated in telehealth coaching sessions saw significant increases in conscientiousness.

Scores for orderliness and dependability, sub-facets of conscientiousness on the scoring system, also improved significantly. However, other behavioral traits, such as neuroticism, anxiety, and depression, remained unchanged throughout the intervention. Neuroticism is marked by emotional instability, increased reactivity to stress, and a tendency to experience negative emotions.

The clinical trial will assess whether this type of conscientiousness coaching can help improve outcomes of formal cognitive rehabilitation. Structured MS cognitive rehabilitation programs focus on improving memory and enhancing processing speed, and have shown some success in the past.

In the first part of the trial, participants will undergo conscientiousness coaching focused on mindset, organization, and setting goals. They will then undergo a targeted cognitive rehabilitation program. The researchers hypothesize that entering the training with a more conscientious outlook could make the program more successful.