Mindfulness-based Stress Reduction for Multiple Sclerosis: Feasibility, Durability, and Clinical Outcomes - DESCRIPTION (provided by applicant): The overall goal of this K23 Mentored Career Development Award is to enhance the candidate's transition to an independent investigator of stress and stress-management for neurological conditions. Psychological stress can have detrimental effects in multiple sclerosis (MS) and is associated with worsening neurological symptoms, increased lesion burden on MRI, and decreased quality of life. Mindfulness-based stress reduction (MBSR) has improved health outcomes across a variety of conditions yet there is limited data regarding MBSR for people with MS or neurological disabilities in general. Furthermore, once the intervention is complete there is conflicting evidence as to the sustainability of MBSR effects over time: some studies show maintenance of effects while others find attenuation over 12 months. To this end, the specific aim of the proposed research is to assess the feasibility of a course of MBSR for people with MS. The candidate will conduct a randomized controlled trial of MBSR vs. wait list/usual care control. This study is guided by three sub-aims: 1) feasibility, 2) preliminary health outcomes, and 3) durability of outcomes over one year. For feasibility, specific recruitment, adoption, and adherence criteria will determine success. For preliminary health outcomes, validated measures of perceived stress, quality of life, and common MS symptoms will be compared between MBSR and control participants at eight weeks. For durability, health outcomes will be tracked for 12 months post-intervention. At the close of the study, in-depth interviews with participants will explore actions, psychological outlook, environmental factors, and resources that enhance or deter stress-management maintenance. Qualitative data will provide context for quantitative outcomes and together these results will depict the stability of MBSR and the trajectory of behavior change post-intervention. Results of this work will inform two independent R01 applications to 1) conduct a full-scale three-arm trial to assess the efficacy of MBSR for MS compared to active and usual care controls, and 2) design and test a maintenance intervention to support/enhance stress- management behavior change. To ensure her success, the candidate has devised a comprehensive program of mentored research, didactic training, and professional development that focuses on four specific training goals: 1) Gain expertise in mind-body behavioral intervention trials, 2) Advance knowledge in mixed methods and behavior change research, 3) Enhance statistical knowledge and abilities with a Master in Public Health, 4) Continue professional development as a presenter, mentor, and leader in CAM research. This award will provide a unique opportunity for the candidate to work collaboratively with two of the nation's leading academic research institutions in CAM and conventional medicine. A cross-disciplinary team of experts in MS, mind-body medicine, stress outcomes, and qualitative methods will guide the candidate's research and advanced training. The proposed research has the potential to improve the clinical application of MBSR, further elucidate the transition from behavior initiation to long-term behavior change, and substantially improve quality of life for people with MS. Findings may not only be applicable to MS but may serve as a model for other conditions with physical limitations or neurological impairments, as well. Importantly, this mentored K23 Career Development Award will prepare the candidate to become a successful, independently funded investigator in stress and stress-management for neurological conditions.
