Response to treatment and patient reported outcome in Multiple Sclerosis’ patients in an innovative patient support program
INVESTIGATORS
OBJECTIVES
According to the evolution of neuroscience, medicine and psychology has also been taking up the study of brain changes consequent to the psychotherapeutic processes, as in an integrative study of Mind-Matter Interaction.
Regarding Clinical Hypnosis, research has shown a significant level of therapeutic efficacy, seeming to prove the usefulness of such techniques in the psychotherapeutic process and in the somatic manifestation of disease.
Therefore, in order to gain a better understanding of brain processes in the context of psychotherapy under a non-ordinary state of consciousness, using techniques of Clinical Hypnosis, in this case the Cognitive and Experiential Restructuring Therapy (CERT), we aim to conduct a doubled-centered, randomized, controlled clinical trial.
Moreover, the aim of the present study is to understand and intervene on the issues associated with the psychological, experiential and psychosomatic dimensions around Multiple Sclerosis.
In this sense, we will recruit patients from CHLN (Centro HospitalarLisboa Norte) neurology/psychiatry departments and SPEM and then address participants to the program.
We differentiate three distinct groups based on the therapeutic intervention: without intervention; with individual psychotherapeutic intervention; and with group psychotherapeutic intervention.
All patients will be submitted also to a series of psychological (Expanded Disability Status Scale, Multiple Sclerosis Impact Scale), and physiological tests in order to measure the therapeutic efficacy and the results produced by the various sessions. As described in “Biomarkers in Multiple Sclerosis: An Up-to-Date Overview” (Katsavos et al. Multiple Sclerosis International, 2013) we will be using the necessary diagnostic and follow-up tools depending on gathered funding and collaborations with both hospital CHLN and academical/research (IFA –Instituto de Formação Avançada) units.
This investigation aims to reveal the clinical purpose dealing with the somatic manifestation of the MS disease but also with the Psychological and Social dimensions of the patient reported clinical outcome.
OUTCOMES ACHIEVED TO DATE
So far we have conducted experimental individual and group sessions with patients with MS, which sought to assess the feasibility of the project and the degree of patient adherence to this type of psychotherapy. However, the obtained results have not yet been measured using the fMRIs. Preliminary results indicate a good level of adherence to individual sessions as well as to the group sessions. Specifically in the context of individual sessions, the results tend to show the need to adjust the thematic list of the sessions in order for the patient participate in the decision making process of these subjects, and therefore, show greater adherence to the session as well as better results. Preliminary results of these sessions reveal the development of a reflective capacity about the self as well as regarding the pathology development and evolution, creating bridges that link emotional and somatic experiences associated with MS. In addition, these patients seem to develop a growing understanding of the impact of past traumatic experiences in their day-to-day life, allowing a restructuring of the patient´s expectations in terms of his/hers perception of control over the disease.
According to the available literature, we expect these results have a measurable correlate through fMRIs, since the results that have been published are consistent with each other, saying that psychotherapeutic approaches conditioned changes in dysfunctional neural circuitry associated with the disturbances in question (Peres & Nasello, 2007). In fact, changes conditioned by psychotherapy, are coincident with the registration of changes in blood flow as well as the normalization of neuronal dynamics of patients (Gabbard, 2000).
In the context of the group sessions performed, the preliminary results involve the developing of a greater awareness of the "other ", with clear benefits in the patient’s interaction in social and professional contexts. Moreover, we found as well the development of a “thinking ability” regarding the self (although with limitations in some cases) as well as the development of a growing understanding of and the impact of past traumatic experiences in day- to-day life, with repercussions in the development of MS symptoms.
Also as published: “Mindfulness based interventions (MBIs) in multiple sclerosis - a systematic review” (Simpson et al. BMC Neurology 2014), MBIs may benefit some MS patients in terms of QOL (Quality of Life), mental health, and some physical health measures. Further studies are needed to clarify how MBIs might best serve the MS population.
However as published: “Effect of dronabinol on progression in progressive multiple sclerosis (CUPID): a randomised, placebo-controlled trial” (Zajicek et al. Lancet Neurology 2013), CUPID has no overall effect on the progression of multiple sclerosis in the progressive phase. The findings have implications for the design of future studies of progressive multiple sclerosis, because lower than expected progression rates might have affected our ability to detect clinical change.
To help us conducting this study, there is also a major overcome in this Medical interest in Mind-Matter interaction that is the creation of a Research Unit, in the setting of the Lisbon Medical School, having as main objective the study of the effect of a patients‘ mind on the matter of Clinical Immunology, Oncology and Neuroscience.
This study will be included in a series of studies comprising Mind-Matter interaction with Therapeutic Intention, conducted by this Laboratory.
- Mário Simões, MD, PhD, Aggregate Professor of Mental Health, Psychiatry and Consciousness Sciences, Director of the post-Graduation Course on Clinical and Experimental Hypnosis of Faculty of Medicine of Lisbon and Director of LIMMIT
- Alexandra Duque, Master in Psychology, PhD Student of Psychology Program of University of Lisbon, Resident Investigator of LIMMIT
- Jorge Emanuel Martins, MD, PhD Student of Neuroscience Program of Faculty of Medicine of Lisbon, Chief and Resident Investigator of LIMMIT
OBJECTIVES
According to the evolution of neuroscience, medicine and psychology has also been taking up the study of brain changes consequent to the psychotherapeutic processes, as in an integrative study of Mind-Matter Interaction.
Regarding Clinical Hypnosis, research has shown a significant level of therapeutic efficacy, seeming to prove the usefulness of such techniques in the psychotherapeutic process and in the somatic manifestation of disease.
Therefore, in order to gain a better understanding of brain processes in the context of psychotherapy under a non-ordinary state of consciousness, using techniques of Clinical Hypnosis, in this case the Cognitive and Experiential Restructuring Therapy (CERT), we aim to conduct a doubled-centered, randomized, controlled clinical trial.
Moreover, the aim of the present study is to understand and intervene on the issues associated with the psychological, experiential and psychosomatic dimensions around Multiple Sclerosis.
In this sense, we will recruit patients from CHLN (Centro HospitalarLisboa Norte) neurology/psychiatry departments and SPEM and then address participants to the program.
We differentiate three distinct groups based on the therapeutic intervention: without intervention; with individual psychotherapeutic intervention; and with group psychotherapeutic intervention.
All patients will be submitted also to a series of psychological (Expanded Disability Status Scale, Multiple Sclerosis Impact Scale), and physiological tests in order to measure the therapeutic efficacy and the results produced by the various sessions. As described in “Biomarkers in Multiple Sclerosis: An Up-to-Date Overview” (Katsavos et al. Multiple Sclerosis International, 2013) we will be using the necessary diagnostic and follow-up tools depending on gathered funding and collaborations with both hospital CHLN and academical/research (IFA –Instituto de Formação Avançada) units.
This investigation aims to reveal the clinical purpose dealing with the somatic manifestation of the MS disease but also with the Psychological and Social dimensions of the patient reported clinical outcome.
OUTCOMES ACHIEVED TO DATE
So far we have conducted experimental individual and group sessions with patients with MS, which sought to assess the feasibility of the project and the degree of patient adherence to this type of psychotherapy. However, the obtained results have not yet been measured using the fMRIs. Preliminary results indicate a good level of adherence to individual sessions as well as to the group sessions. Specifically in the context of individual sessions, the results tend to show the need to adjust the thematic list of the sessions in order for the patient participate in the decision making process of these subjects, and therefore, show greater adherence to the session as well as better results. Preliminary results of these sessions reveal the development of a reflective capacity about the self as well as regarding the pathology development and evolution, creating bridges that link emotional and somatic experiences associated with MS. In addition, these patients seem to develop a growing understanding of the impact of past traumatic experiences in their day-to-day life, allowing a restructuring of the patient´s expectations in terms of his/hers perception of control over the disease.
According to the available literature, we expect these results have a measurable correlate through fMRIs, since the results that have been published are consistent with each other, saying that psychotherapeutic approaches conditioned changes in dysfunctional neural circuitry associated with the disturbances in question (Peres & Nasello, 2007). In fact, changes conditioned by psychotherapy, are coincident with the registration of changes in blood flow as well as the normalization of neuronal dynamics of patients (Gabbard, 2000).
In the context of the group sessions performed, the preliminary results involve the developing of a greater awareness of the "other ", with clear benefits in the patient’s interaction in social and professional contexts. Moreover, we found as well the development of a “thinking ability” regarding the self (although with limitations in some cases) as well as the development of a growing understanding of and the impact of past traumatic experiences in day- to-day life, with repercussions in the development of MS symptoms.
Also as published: “Mindfulness based interventions (MBIs) in multiple sclerosis - a systematic review” (Simpson et al. BMC Neurology 2014), MBIs may benefit some MS patients in terms of QOL (Quality of Life), mental health, and some physical health measures. Further studies are needed to clarify how MBIs might best serve the MS population.
However as published: “Effect of dronabinol on progression in progressive multiple sclerosis (CUPID): a randomised, placebo-controlled trial” (Zajicek et al. Lancet Neurology 2013), CUPID has no overall effect on the progression of multiple sclerosis in the progressive phase. The findings have implications for the design of future studies of progressive multiple sclerosis, because lower than expected progression rates might have affected our ability to detect clinical change.
To help us conducting this study, there is also a major overcome in this Medical interest in Mind-Matter interaction that is the creation of a Research Unit, in the setting of the Lisbon Medical School, having as main objective the study of the effect of a patients‘ mind on the matter of Clinical Immunology, Oncology and Neuroscience.
This study will be included in a series of studies comprising Mind-Matter interaction with Therapeutic Intention, conducted by this Laboratory.