Navigating Behavioral Health Challenges in Patients With Multiple Sclerosis (Podcast)

The invisible symptoms of multiple sclerosis (MS) – including overwhelming fatigue, painful neurological disruptions and unpredictable cognitive difficulties – are not only physically taxing, but can also take a significant toll on a patient’s mental health.

“As many as 50% of folks diagnosed with MS report depression, and about 40% experience anxiety at some point in their journey – rates that are roughly four times higher than in those diagnosed with other neurological conditions,” says Grace Tworek, PsyD, a clinical health psychologist at the Mellen Center for Multiple Sclerosis Treatment and Research in Cleveland Clinic's Neurological Institute. “Stress, in particular, can have significant, long-term effects on mood, cognitive functioning and how patients experience their MS symptoms and cope with challenges in their everyday lives.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Tworek discusses how to best meet the complex mental health needs of individuals with MS. She covers:

• Common behavioral concerns
• Screening for the presence of anxiety and depression
• Addressing symptoms with multidisciplinary care
• Using cognitive therapy techniques to reframe negative thought patterns and manage stressors
• Connecting patients and their families with appropriate support networks

Click the podcast player above to listen to the 20-minute episode now, or read on for a short, edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

This activity has been approved for AMA PRA Category 1 Credit™ and ANCC contact hours. After listening to the podcast, you can claim your credit here.

Podcast excerpt

Podcast host Glen Stevens, DO, PhD: [Let’s say] I'm a patient who’s been diagnosed with MS. It looks like I've got some behavioral health issues, and my physician says I should come see you. Take me through that appointment.

Dr. Tworek: We really try to make our initial treatment plans as individualized as possible. We want to spend some time getting to know you as a person and understanding your MS journey. What did your first symptoms look like? Did you have any mood concerns prior to receiving your MS diagnosis? What [are your] day-to-day life stressors? How does MS play a role in all of this? At the end of that visit, we create a realistic plan that includes how often we should see one another. From there, we start to build what I call the patient’s “tool belt.” One of our main treatment goals is to give folks the skills and tools they need to make the daily stressors in their life feel more manageable, including realistic [techniques] like deep breathing and meditation. We want to…help them get back to doing the things they love with the people they love.

Dr. Stevens: How do behavioral changes [manifest] over time as the disease burden progresses?

Dr. Tworek: We can never know what the future may hold for each individual, but we do have increasing confidence in the ability of [disease-modifying] therapies to provide patients with a level of stability. This means that our goals focus on promoting what matters most to that person. For example, if I'm meeting with somebody who really enjoyed hiking in the past but is no longer able to because of physical limitations, we take a deeper look at that activity. What was it about hiking that they enjoyed the most? Was it the activity itself? Was it the environment? Was it [the companionship] of their hiking partner? Once we can identify the components that promote joy within that activity, we can find some ways to adapt and adjust to [any new barriers]. So maybe it was being outside, hearing the birds and being with a loved one that made the patient feel so good. Can we find other activities that promote that same feeling, even if they look a little bit different than they did previously?