Impact of a short-term stress management protocol on physiologic biofeedback measures of stress and mood in people with multiple sclerosis

Background and Objectives Stress exacerbates multiple sclerosis (MS) symptoms. We report a 10-year study examining objective and subjective measures of stress and mood in people with MS (PwMS) using a shortened and more practical form of the Stress Management Therapy for MS (SMT-MS), the Stress Management Protocol (SMP). Methods We analyzed data from PwMS who underwent a 4-session SMP at Cleveland Clinic between 2012 and 2022 (N=195; 90.5% female; 68.2% White; average age, 44.4 years; average disease duration, 12.1 years). Subjective data were collected pre-session using the Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD). Objective data, including breathing rate (breaths per minute, BPM), pulse (beats per minute, bpm), and blood oxygen saturation (%Sp02), were collected pre- and post-SMP. Statistical models assessed data differences and within-session improvement by session, as well as differences in pre- and post-session measurements . Results Subjective and objective scores improved significantly after Session 1. Significant intrasession improvements were observed, especially during the initial sessions. Significant overall improvements were observed in PHQ-9, GAD-7, and pre-session BPM and %SpO 2 . Greatest improvements in PHQ-9 and BPM were observed in patients completing 3 sessions and that %Sp0 2 were observed in patients completing 4 sessions. Discussion PwMS who participated in the SMP showed considerable improvement in outcomes within and across sessions. Our results show that a brief, 4-session SMP can improve both subjective and objective measures of stress and mood in PwMS and that PwMS are able to utilize the SMP/biofeedback tools outside of therapy, in a real-world environment.