Treating the Whole Patient: Incorporating Behavioral Medicine into MS Management

Amy Sullivan, PsyD, Director of Behavioral Medicine at the Mellen Center for Multiple Sclerosis at Cleveland Clinic, described the benefits of cognitive behavioral therapy (CBT) in helping patients with MS to manage the “behavioral trio” of depression, adjustment difficulties, and stress.“Normalize, don’t stigmatize,” was the overriding message in the session on “Science, Art, and Practice of Behavioral Medicine” presented by Amy Sullivan, PsyD, ABPP, at the Consortium of Multiple Sclerosis Centers (CMSC) 2020 Virtual Annual Meeting on May 26. Studies have shown that over 50% of patients diagnosed with MS also have been diagnosed with depression, over four times the average rates in the general population (between 2.3% and 16%). Significantly higher risk is seen with other mental health conditions as well: compared to the general population, people with MS are more likely to have an anxiety disorder, adjustment disorder, or bipolar disorder. “It’s important to help patients understand that these are common manifestations or comorbidities of neurologic diseases, and the person should not feel different or lesser because of a mental health condition,” stated Dr. Sullivan, PysD, ABPP, Director of Behavioral Medicine at the Mellen Center for Multiple Sclerosis at Cleveland Clinic.

“MS takes so much from our patients. We don’t want it to take their joy as well.”Dr. Sullivan spoke about the benefits of collaborative medicine. The Mellen Center uses an interdisciplinary team approach to ensure that patients get access to all areas of care. Screening tools are used to assess patients and track their progress, and include an open dialogue with patients to determine how stress and anxiety affect aspects of daily lives such as sleep quality. The comprehensive care team often encounters what Dr. Sullivan called the “behavioral medicine trio”: depression, difficulty with adjustment to the disease, and stress. “Depression can be a symptom of MS as well as a response to it,” she commented. “Explaining this to patients can help to normalize their feelings.” Among a variety of treatment approaches for depression, the team often employs cognitive behavioral therapy, which looks at the relationship between thoughts, emotions, and behaviors and their interaction with mood. The second part of the trio is adjustment disorder. This is defined as anxiety or depression in response to a serious diagnosis or chronic illness, and can result in distress and difficulty functioning socially or occupationally. Treatment focuses on normalizing the patient’s feelings, educating them about what they are experiencing, and providing management strategies.