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MS research update - Can spiritual or religious practices support people with MS? - 17 December 2013

Summary

This study examined whether religious faith or a more spiritual approach to life made a difference to living with MS.

They found that those who saw their religion as a stronghold in difficult times were more likely to reappraise their life, show more gratitude/awe, including experiencing and valuing beauty in life, and to have a somewhat more positive mood and conscious way of living. The researchers comment that faith was not used by this group as a tool to restore health. Having faith was related to a more reflective look at what was essential in life, to appreciate and value life and to face life as it is.

Those who were neither religious nor spiritual, were less likely to have a positive interpretation of illness than those who were spiritual but not religious and also those who were both spiritual and religious. However, they did not differ in other ways such as levels of life satisfaction, positive mood or fatigue. The researchers do not comment on what other sources of support this group might be using.

Background

Living with MS can be challenging and different people find different ways to cope with what MS brings to their life. This study examined whether religious faith or a more spiritual approach to life made a difference to living with MS including to life satisfaction, mood and coping strategies.

How this study was carried out

213 people with MS, aged 18 to 65, were recruited from outpatient clinics at four specialist hospitals in Germany. The average age was 43 and three quarters were women. Just over a quarter (27%) were living alone. The EDSS scores of the participants ranged from zero to 7.5 but averaged 3.7 which corresponds to a moderate level of disability.

Coping strategies

A questionnaire was used to assess how much someone adapted and coped by adopting positive approaches. The analysis focused on how someone used their own internal resourcefulness rather than using outside resources. Examples include reflecting on what is essential in life, adopting a healthy diet, changing their life in order to get well, positive thinking and avoiding thinking about illness. Two items addressed attitudes towards their belief: "My faith is a stronghold in difficult times" and "Because of my experiences I have lost my faith".

All the items were scored on a five point scale from disagreement to agreement (does not apply at all; does not truly apply; do not know; applies quite a bit; applies very much). The scores were added up and the participants divided into those with high scores who used these coping strategies more strongly, and those with lower scores who used them to a lesser extent.

Spiritual activities

A questionnaire was used to assess how much someone used various spiritual or religious practices. It looked at:

  • religious practices including praying, church attendance, religious events and religious symbols
  • humanistic practices including helping others, considering their needs, doing good and feeling connected
  • existentialistic practices such as seeing meaning in life, self-realisation and getting insight
  • gratitude/awe including feelings of great gratitude, feelings of wondering awe, and experiencing and valuing beauty
  • spiritual (mind body) practices including meditation, rituals and working on a mind-body discipline such as yoga, qigong or mindfulness.

All the items were scored on a four point scale according to how often the person participated: never, seldom, often or regularly.

Spiritual/religious categorisation

Participants were asked to score two questions: "To my mind I am a religious individual" and "To my mind I am a spiritual individual". Each one had the options: does not apply at all; does not truly apply; do not know; applies quite a bit; applies very much.

From this each participant was categorised into one of four types:

  • religious but not spiritual
  • not religious but spiritual
  • both religious and spiritual
  • neither religious nor spiritual

Life satisfaction

A ten item questionnaire was used to assess life satisfaction including satisfaction with their health situation and satisfaction with their own abilities to manage daily life concerns. Three items were added to assess satisfaction with support from family, partner, or friends.

For each item, the participant scored their satisfaction as terrible, unhappy, mostly dissatisfied, mixed, mostly satisfied, pleased, delighted.

Other measures

A person's mood, fatigue, and EDSS score were assessed and they were asked about how much they thought that daily life was affected by their MS

What was found

Three quarters (74%) of the participants were Christian, 4% were Muslims, 3% belonged to other denominations, and 18% belonged to none.

When categorising themselves, 70% did not regard themselves as religious – this was composed of 54% who were neither religious nor spiritual and 16% who were not religious but were spiritual. 19% were religious but not spiritual and 12% were both religious and spiritual.

The statement "My faith is a stronghold in difficult times" was true for just over a quarter (29%), half (52%) rejected it, and about one in five (19%) were undecided. Only 6% stated that they had lost their faith because of distinct experiences in life, 77% disagreed, and 17% were undecided.

Those who believed that faith was a stronghold in difficult times, were more likely to have reappraised their life and to have a more positive interpretation of illness and to experience gratitude/awe. However, having this belief showed no relationship to many of the other measures including life satisfaction, positive attitude, fatigue or EDSS score.

In comparison, those who rated themselves as neither religious nor spiritual were less likely to reflect on what was essential in life or to appreciate and value life, or to have the conviction that illness could have meaning and be regarded as a chance for development.

What does it mean?

Being spiritual or religious can be a source of support for people living with a range of health conditions. In this study, those who saw their religion as a stronghold in difficult times were more likely to reappraise their life, show more gratitude/awe, including experiencing and valuing beauty in life, and to have a somewhat more positive mood and conscious way of living.

The researchers comment that faith was not used a tool to restore health. Having faith was related to a more reflective look at what was essential in life, to appreciate and value life and to face life as it is.

Those who were neither religious nor spiritual, were less likely to have a positive interpretation of illness than those who were spiritual but not religious and also those who were both spiritual and religious. However, they did not differ in other ways such as levels of life satisfaction, positive mood or fatigue. The researchers do not comment on what other sources of support this group might be using.

Büssing A, Wirth AG, Humbroich K, et al.
Faith as a resource in patients with multiple sclerosis is associated with a positive interpretation of illness and experience of gratitude/awe. 
Evid Based Complement Alternat Med. 2013
abstract
Read the full text of this paper

More about spiritual sources of support

Different people will find different sources of support useful. Religious faith is important to some people. Spirituality, in its broadest sense, will be important to others and can include practices such as meditationyogaqigongtai chi or mindfulness. Some of these practices have a physical component which involves gentle stretching so they can be a useful form of exercise. All of them can help to induce calmness and mental clarity. They can focus attention on the present moment rather than worrying about what has happened in the past or might happen in the future. There is more about learning mindfulness for people with MS in an article from our newsletter, Open Door.

Spiritual practices can also help with managing stress and symptoms including painanxiety and depression.

Research by topic areas...

Diagnosis

Kraft GH.
Evoked potentials in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):717-20.
abstract

Symptoms and symptom management

Hughes C, Howard IM.
Spasticity management in multiple sclerosis. 
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):593-604.
abstract

Disease modifying treatments

Damal K, Stoker E, Foley JF.
Optimizing therapeutics in the management of patients with multiple sclerosis: a review of drug efficacy, dosing, and mechanisms of action.
Biologics. 2013;7:247-258. Epub 2013 Nov 27.
abstract
Read the full text of this paper

Baldwin KJ, Hogg JP.
Progressive multifocal leukoencephalopathy in patients with multiple sclerosis.
Curr Opin Neurol. 2013 Jun;26(3):318-23.
abstract

Kappos L, O'Connor PW, Polman CH, et al.
Clinical effects of natalizumab on multiple sclerosis appear early in treatment course.
J Neurol. 2013 May;260(5):1388-95.
abstract
Read the full text of this paper

Other treatments

Bombardier CH, Ehde DM, Gibbons LE, et al.
Telephone-based physical activity counseling for major depression in people with multiple sclerosis.
J Consult Clin Psychol. 2013 Feb;81(1):89-99.
abstract

Epidemiology

Green C, Yu BN, Marrie RA.
Exploring the implications of small-area variation in the incidence of multiple sclerosis.
Am J Epidemiol. 2013 Oct 1;178(7):1059-66.
abstract

Rehabilitation

Sandroff BM, Klaren RE, Pilutti LA, et al.
Randomized controlled trial of physical activity, cognition, and walking in multiple sclerosis.
J Neurol. 2013 Dec 10. [Epub ahead of print]
abstract

Kraft GH, Johnson KL, Amtmann D,, et al.
Future directions of multiple sclerosis rehabilitation research.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):721-30.
abstract

Co-existing conditions

Zéphir H, Gower-Rousseau C, Salleron J, et al.
Milder multiple sclerosis course in patients with concomitant inflammatory bowel disease.
Mult Scler. 2013 Dec 10. [Epub ahead of print]
abstract

Assessment tools

Rodriguez-Mena D, Almarcegui C, Dolz I, et al.
Electropysiologic evaluation of the visual pathway in patients with multiple sclerosis.
J Clin Neurophysiol. 2013 Aug;30(4):376-81.
abstract

Krokavcova M, van Dijk JP, Nagyova I, et al.
Perceived health status as measured by the SF-36 in patients with multiple sclerosis: a review.
Scand J Caring Sci. 2009 Sep;23(3):529-38.
abstract

Quality of life

Buzaid A, Dodge MP, Handmacher L, et al.
Activities of daily living: evaluation and treatment in persons with multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):629-38. 
abstract

Causes of MS

Hon GM, Erasmus RT, Matsha T, et al.
Multiple sclerosis-associated retrovirus and related human endogenous retrovirus-W in patients with multiple sclerosis: a literature review. 
J Neuroimmunol. 2013 Oct 15;263(1-2):8-12. 
abstract

Vitamin D

Salzer J, Biström M, Sundström P.
Vitamin D and multiple sclerosis: where do we go from here?
Expert Rev Neurother. 2013 Dec 9. [Epub ahead of print]
abstract

Carers

Hillman L.
Caregiving in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):619-27.
abstract

Corry M, While A.
The needs of carers of people with multiple sclerosis: a literature review.
Scand J Caring Sci. 2009 Sep;23(3):569-88
abstract

Psychological aspects

Black R, Dorstyn D.
A biopsychosocial model of resilience for multiple sclerosis.
J Health Psychol. 2013 Dec 9. [Epub ahead of print]
abstract

Schmitt MM, Goverover Y, Deluca J, et al.
Self-efficacy as a predictor of self-reported physical, cognitive, and social functioning in multiple sclerosis.
Rehabil Psychol. 2013 Dec 9. [Epub ahead of print]
abstract

Pepping M, Brunings J, Goldberg M.
Cognition, cognitive dysfunction, and cognitive rehabilitation in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):663-72.
abstract

Alschuler KN, Ehde DM, Jensen MP.
Co-occurring depression and pain in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):703-15.
abstract

Francis CE.
Visual issues in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):687-702.
abstract

Yang CC.
Bladder management in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):673-86.
abstract

Cook KF, Bamer AM, Roddey TS, et al.
Multiple sclerosis and fatigue: understanding the patient's needs.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):653-61.
abstract

Physical activity

Chua MC, Hyngstrom AS, Ng AV, et al.
Relative changes in ankle and hip control during bilateral joint movements in persons with multiple sclerosis.
Clin Neurophysiol. 2013 Nov 21. pii: S1388-2457(13)01183-8.
abstract

Oakes PK, Srivatsal SR, Davis MY, et al.
Movement disorders in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):639-51.
abstract

Sandoval AE.
Exercise in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):605-18.
abstract

Stevens V, Goodman K, Rough K, et al.
Gait impairment and optimizing mobility in multiple sclerosis.
Phys Med Rehabil Clin N Am. 2013 Nov;24(4):573-92.
abstract

Economics

Adelman G, Rane SG, Villa KF.
The cost burden of multiple sclerosis in the United States: a systematic review of the literature.
J Med Econ. 2013;16(5):639-47. 
abstract

Prognosis

Gajofatto A, Calabrese M, Benedetti MD, et al.
Clinical, mri, and csf markers of disability progression in multiple sclerosis.
Dis Markers. 2013;35(6):687-699.
abstract
Read the full text of this paper

Bone Health

Dobson R, Yarnall A, Noyce AJ, et al.
Bone health in chronic neurological diseases: a focus on multiple sclerosis and parkinsonian syndromes. 
Pract Neurol. 2013 Apr;13(2):70-9.
abstract

Review

Aharoni R.
New findings and old controversies in the research of multiple sclerosis and its model experimental autoimmune encephalomyelitis.
Expert Rev Clin Immunol. 2013 May;9(5):423-40.
abstract

Services

Kurpas D, Church J, Mroczek B, et al.
The quality of primary health care for chronically ill patients: a cross-sectional study.
Adv Clin Exp Med. 2013 Jul-Aug;22(4):501-11.
abstract
Read the full text of this paper [PDF]

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