Mindfulness, Meditation & MS

When exploring the benefits of yoga it’s easy to focus on the physical practice, and how it can help with strength, balance and proprioception. To do so is to overlook the best bits.

Mindfulness and meditation are at the heart of yoga. For thousands of years, meditation has been practised as part of yoga and Ayurvedic medicine to bring mental clarity and wellbeing to yogis. Over the last few decades, western medicine has also recognised the benefits of meditation, with hundreds of studies conducted to explore them.

This article assesses mindfulness studies with people with MS to discover whether – and how – meditation can help us to reduce disease activity and manage symptoms.

But first: what exactly is the difference between mindfulness and meditation?

Mindfulness vs Meditation

Mindfulness is a particular type of meditation – directed focus meditation. Jon Kabat-Zinn, the founder of Mindfulness Based Stress Reduction (MSBR) defines it as “paying attention in a particular way, on purpose, in the present moment and nonjudgmentally.”

The object of your attention can be anything that brings your focus to the present moment, for example, the sensation on your skin as you shower, or the sound of your breath. Is this sounding familiar? It should if you practice yoga! Mindfulness is directly analogous to dharana, the sixth limb of the Eight Limbs of Yoga. A dharana or mindfulness practice is often used at the start of a yoga class to welcome you to the mat and bring your focus to the practice.

Dharana, Dhyana and Samadhi take the yogi into the innermost recesses of his soul.

By profound meditation, the knower, the knowledge and the known become one.

The seer, the sight and the seen have no separate existence from each other.

It is like a great musician becoming one with his instrument and the music that comes from it.

B.K.S. Iyengar, Light on Yoga

Meditation can be thought of as the level after mindfulness, a deeper state where the mind is fully absorbed. Unsurprisingly, it takes time, practice and patience to reach this deeper state, so it’s difficult to assess its effects in a clinical study. Instead, scientists focus on studying mindfulness, particularly MSBR, as it is easier to learn in a short period of time.

Why should you care about meditation & MS?

The science is somewhat underdeveloped, so it’s too soon to claim that we can prove meditation can help MS. The problem is that there aren’t enough very large, very controlled studies that offer robust enough evidence, but there are so many small or imperfect studies that are consistently in favour of meditation that it seems daft to ignore them. And that evidence base is growing.

Back in 2014, a group of researchers conducted a review of studies on mindfulness, but only found three studies that were good enough for them to draw conclusions from. Only four years later, when another group repeated the exercise, there were 12 high quality, randomised controlled studies they could review. Their analysis concluded that “MBIs (mindfulness-based interventions) are effective at improving mental wellbeing in People with MS”. I’ll admit, that’s not the most enthusiastic comment, but scientists tend to be super cautious in their conclusions.

Given that it is not an expensive treatment modality, and that it has countless other health benefits, why wouldn’t one meditate?

Dr George Jelinek, Overcoming Multiple Sclerosis

Studies on meditation tend to look at its impact on anxiety, chronic pain, depression, stress and fatigue. For MS, stress is what we are most interested in.

What’s the connection between stress and MS?

Stress and MS are closely intertwined. Not only is having MS stressful, but stress is also a trigger for new disease activity.

This connection has been explored in a number of studies, particularly trying to find out whether short term high-stress or long term chronic stress is to blame.

A study in Pittsburgh (2003) followed 50 women with MS through a variety of major life events, and observed that nearly half of all life events were followed by a relapse within six weeks. Another study (2000) estimated that after a major life event, people with MS are 1.6 times more likely to develop new lesions in the next eight weeks.

While these findings are alarming, in both studies researchers observed that the likelihood of new disease activity was dependent on how well each individual coped with the life event. Disease activity was higher in people who were stressed out over a long period of time than it was in those people with strong coping mechanisms who were able to process and move on from the life event in a relatively short period of time.

This fits well with the larger evidence base suggesting that chronic stress is actually much more damaging in terms of disease progression than “severe stress”. It’s the long term stresses such as job situation, family conflicts, bereavement, poor social support, anxiety and depression that are most impactful for people with MS.

For me, this finding is a clear call to action, to think about how I manage stress in my life. We don’t need to shy away from stress, but we do need to be mindful of how things impact us, and we need to build strong coping mechanisms.

This was clearly demonstrated in a clinical trial in 2012 where people with MS were given eight weeks of stress management therapy. The people who were given therapy had significantly fewer new lesions appear during the eight weeks of therapy compared to a control group. However, the effects wore off as soon as the therapy stopped. Six months later, disease progression was the same for the therapy group and the control group. This tells us that to get sustained results, we need to find ways to control our stress levels for the long term.

Can meditation or mindfulness really reduce stress?

So now we know that stress is bad news for people with MS, we need to look at how to cope with stress. Researchers have studied the impact that meditation has on stress, by testing cortisol levels in the body. Cortisol is the hormone released by the body that triggers fight or flight mode and creates the physiological responses to stress.

The evidence on how meditation affects stress is unequivocal.

Meditation has been shown to decrease cortisol levels and improve sleep for both novice and experienced meditators. Given that cortisol plays a key role in stress modulation, the results suggest that the beneficial effects of meditation may operate partly through this mechanism.

Additionally, meditation has been shown to be associated with activation of the prefrontal cortex and the anterior cingulated cortex, which are areas of the brain associated with concentration, as well as altering EEF tracings in many medical conditions.

These changes are associated with decreased levels of stress.

Levin, Hadgkiss, Weiland & Jelinek (2014), Meditation as an adjunct to the management of Multiple Sclerosis

Translation: meditation impacts both the chemical mechanisms that the body uses to regulate its stress response, but it can also modify parts of the brain associated with stress.

Given that stress has been shown to be implicated in relapses in MS and that meditation has been shown to relieve biological markers of stress, it is reasonable to hypothesise that meditation may have a direct impact on MS disease course through its effect of modulating the stress response.

LEVIN, HADGKISS, WEILAND & JELINEK (2014), MEDITATION AS AN ADJUNCT TO THE MANAGEMENT OF MULTIPLE SCLEROSIS

No wonder the Overcoming MS programme recommends 30 minutes of meditation a day!

Meditation tempers the way we react to stress, helping to more quickly restore balance in the mind and body, particularly the immune response. We explore how it does that separately, in the Neuroscience of Meditation.

OK, I’m sold. What else can meditation do?

Meditation can also help us to reduce some of the most common MS symptoms, including anxiety, fatigue, pain and depression.

• A study in 2011 looked at three different types of meditation and the effect they had on chronic pain. The study found that meditation was “helpful in reducing pain and improving quality of life measures in MS.” The three meditation practices they assessed were breath-focused seated meditation, moving meditation and walking meditation.
• A study in 2016 tested the impact of MBSR and conscious yoga, including breathing practices, mindful movement and yoga stretching. They found the interventions “significantly improved the physical and mental quality of life in MS patients.”
• A more recent study (2019) looked at whether online training in mindfulness would work, and found it was “an effective psychological treatment for the promotion of well-being in MS”, with improvements noted in depression, anxiety and sleep symptoms.

As well as showing that meditation can affect other aspects of life with MS, they also show that it doesn’t really matter which approach you follow to meditate. Studies took different approaches in how they taught and encouraged mindfulness practices, from face-to-face therapy, to online courses, to simply sitting and breathing mindfully. They all turned out to be beneficial.

When we bring all these different studies and observations together in one place, we can really start to understand the role of meditation in proactive healthcare for MS.

There’s clear evidence that stress is linked to the rate of disease progression in MS, and that regular meditation can help moderate how we react to stress, as well as ease long term stress and anxiety. Meditation can also help with other quality of life improvements by relieving depression and fatigue.

Most importantly, studies show that how you practice, or even how long you practice for, doesn’t really matter. What matters is having a consistent, regular practice – the benefits only last if you keep practising. Start now, and find 10 minutes in your day to be mindful and bring your whole focus to the present moment.

---

If you need help establishing your practice or want to find out more about how meditation and yoga can help you, join the community.