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The bidirectional effect of stress and functionality in MS and the interaction role of anxiety, coping and social support 2023 Moss-Morris et al

Discussion in 'Other psychosomatic news and research' started by Andy, May 18, 2023.

  1. Andy

    Andy Committee Member

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    Highlights

    • The stress-Multiple Sclerosis (MS) relationship is controversial, with low evidence.

    • The bidirectional hypothesis was confirmed through ecological momentary assessments.

    • Active coping was adaptive with high stress, but counterproductive with low stress.

    • Low-trait anxiety was related to a higher functionality only with low stress levels.

    • Research is needed in gold standard and third-wave therapies (mindfulness) for pwMS.
    Abstract

    Objective
    The present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stress-related psychosocial factors such as anxiety, coping and social support.

    Methods
    A one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted.

    Results
    The bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels.

    Conclusion
    People with multiple sclerosis may benefit from different types of psychological therapies, from gold-standard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model.

    Open access, https://www.sciencedirect.com/science/article/pii/S0022399923002325
     
    Andy, May 18, 2023
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  2. InitialConditions

    InitialConditions Senior Member (Voting Rights)

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    No, we need more research on the biological basis of stress and its interaction with the immune system, particularly in the brain.
     
    InitialConditions, May 18, 2023
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  3. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    If this is the sort of research envisaged we need one of it.
     
    Jonathan Edwards, May 18, 2023
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  4. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    Is it possible to demonstrate causality with these methods? I have doubts.

    Also the authors make the assumption that the thing that is called "stress" that is being measured is something that is modifiable with CBT. It could also be a sign of a biological process that is not modifiable. Or be related to financial difficulties rather than poor coping skills or other things that CBT might be able to change.
     
    Last edited: May 18, 2023
    Hoopoe, May 18, 2023
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  5. rvallee

    rvallee Senior Member (Voting Rights)

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    TL;DR: send truckloads of money to us, we'll find ways to waste all of it. I'm not entirely sure how different this is from indulgences. At this point they should just take bribes and do a sing-along about how giving the money is the cure. Who even cares at this point? Invalid is invalid, doesn't change anything what pretense people give themselves.

    Honestly just go back to the angels, demons and fairies stuff if you're going to do nonsense BS like this. Medicine has truly perfected the most pseudoscience of all the pseudosciences. This is some of the most useless work anyone has ever done.
     
    rvallee, May 18, 2023
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  6. Hubris

    Hubris Senior Member (Voting Rights)

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    We have known stress can affect the immune system for a long time, but wasting disabled people's time, energy and money with useless psycho-social therapies is unlikely to be of any benefit. If anything, some of those MS patients will end up more stressed and anxious once they realize they have been preyed upon by the people who were supposed to be helping them.
     
    Hubris, May 18, 2023
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  7. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    Let me guess...

    If the authors think they can prove a connection between stress and MS it will only take a few weeks after that before they declare in the media that MS is caused by stress and can be fixed with CBT and exercise.
     
    Arnie Pye, May 18, 2023
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  8. Hutan

    Hutan Moderator Staff Member

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    It will probably be a bit more nuanced - that their stress control techniques can stop illness progression. So, if your illness progresses, you haven't been managing your stress properly...

    I agree, stress could be having an impact on the progression of multiple sclerosis and other diseases. In that case, yes, we should be trying to understand how stress works, down to the actual biochemical process. And, of course, it makes the most sense to have a first line response of checking if society is giving an appropriate level of support to people with chronic disease.

    Reading the paper though, I don't know that this really is proof of much. There are so many opportunities for slicing and dicing and categorising things in a way that gives the desired answer.

    To investigate just one example, the paper does not say that the neurologist was blinded to the ongoing results of the year-long data-gathering.

    The neurologist used the EDSS scale to assess function at baseline and at the end of the study. The EDSS scale is from 0 to 10, with 10 being death due to MS, it is specifically for MS. Over the course of a year, the reported mean EDSS changed from 1.96 to 2.17. The final score had a slightly larger standard deviation than at baseline. The range throughout the study was from 0 to 6. That reported mean change, the change that so much of the findings of the paper hinges on should have hinged on (see my next post for a note about the findings of correlating between EDSS and stress), is tiny.

    In the range 0 to 3.5, the EDSS calculation is based on 8 categories such as Bowel and bladder function; Visual function. An EDSS of 0 requires a 0 for all 8 categories. An EDSS of 1 means 'no disability, minimal signs (that is a grade of 1) in one category. 1.5 is 'no disability, minimal signs (that is a grade of 1) in more than one category. A 2 is 'minimal disability in one aspect', so a grade of 2 in one aspect, and 0's or 1's in other categories. So, a person could go from a 0 to a 1 on the EDSS scale simply by moving from no signs to minimal signs in one category.

    There is a category of 'cerebral functions'. The wording that applies to this varies from source to source. In one, it is this:
    0=none; 1 = not apparent to patient or significant other; 2 = Patient and / or significant other report mild changes in mentation. Examples include: impaired ability to follow a rapid course of association and in surveying com- plex matters; impaired judgement in certain demanding situations; capable of handling routine daily activities, but unable to tolerate additional stressors; intermittently symptomatic even to normal levels of stress; reduced performance; tendency toward negligence due to obliviousness or fatigue
    In another EDSS calculator, the step change from 0 to 1 in the 'cerebral function' category is described as 'mood alteration'.

    I think there's a few things to take away from that.

    One is that a decreased ability to handle stress is recognised part of illness progression. So, if people are reporting more stressful situations or an increased rating of the Perceived Stress Scale or that their social support isn't adequate, then it may well be that their illness really is progressing. It does not necessarily mean that stress is causing the progression. You might want to give people tools to manage the perception, but it's not evidence for stress causing the illness progression.

    Two, is that spending a year meticulously recording all the stressful situations you encounter, and noting how you coped with each of them is likely to increase your awareness of stress in your life. How could it not? So, if someone asks you at the end of the year, something like 'are you finding you are having more stress in your life?', or 'do you think your symptoms are worse when you are stressed' you might very well say 'yes'.

    Three, is that we are talking about very subtle and minimal changes in most patients when the mean EDSS score changes from 1.96 to 2.17. And the difference between a 0, 1 or 2 in cerebral function is quite small and highly subjective, both on the part of the patient and the assessing neurologist. Remember, on one of the EDSS scales, '1' is a change in thinking that is not apparent to the patient or their significant other, but is apparent to the neurologist. The neurologist can't be blinded to the person's stress because they have to ask about how the patient is handling stress in order to make the EDSS assessment. It would be incredibly easy for a neurologist who believes that stress is important in illness progression and that CBT can help to be swayed by their expected outcome, and decide that the patient has gone from no cerebral symptoms to mild symptoms that the patient themselves aren't even aware of.

    Four, there was a substantial level of selection of the participants. Of the 121, only 34 were recruited, with 20 of the people who weren't recruited specifically declining to participate and a further 8 not returning calls. Of the 34, 8 changed their mind. There were 26 participants and only 21 made it to the end of the study. So, 21 participants out of 121, many of who will be presumably fully on board with the idea that stress makes MS worse. They've gone to a huge amount of effort for the study, they are invested in it and want to help the researchers. And these people are the ones answering the Perceived Stress Scale and answering the neurologist's questions about whether their symptoms have worsened with stress.

    Five, (and this is probably an extension of 3., but anyway) The mean change in EDSS was 0.21. So, it would roughly only require a step change of 1 in just 4 of the 21 participants to produce that change from the mean EDSS of 1.96 to 2.17. That result is so, so vulnerable to the subjectivity of both the patients and the assessor.

    So, yeah, despite this paper looking like science in the abstract, I don't think it amounts to much in the way of evidence.
     
    Last edited: May 18, 2023
    Hutan, May 18, 2023
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  9. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Where did it look like science in the abstract? - I must have missed that!!;)
     
    Jonathan Edwards, May 18, 2023
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  10. Hutan

    Hutan Moderator Staff Member

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    Whoops - I should have read the whole study instead of stopping at the reporting of the base results. They didn't even find a correlation between EDSS (the measure of illness progression) and perceived stress etc!!

    For goodness sake. It's not even as good as I thought it was, and that wasn't very good. There's nothing to this study.

    Edit - and of course that crucial result of no correlation is omitted from the abstract.
     
    Last edited: May 18, 2023
    Hutan, May 18, 2023
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  11. rvallee

    rvallee Senior Member (Voting Rights)

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    Honestly, that's always my starting point with BPS stuff and it hasn't failed me once so far. An entire discipline based on hot air, and even then, don't expect to find any actual hot air, just the idea of something like it.

    It's Meyers-Briggs medicine at best, and it's all downhill from there.
     
    rvallee, May 18, 2023
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  12. Joan Crawford

    Joan Crawford Senior Member (Voting Rights)

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    "The bidirectional hypothesis was confirmed through ecological momentary assessments"

    Word salad

    I have no clue wot this means.

    Pointless, useless nonsense
     
    Joan Crawford, May 19, 2023
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  13. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    "...preyed upon..." is the best term to describe what a lot of practitioners do, who offer smoke and mirrors to cure such diseases.

    :thumbup:
     
    DokaGirl, May 19, 2023
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  14. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    @Hutan

    Your critique finds errors and omissions that remind me of the various problems brought to light in the PACE trial.
     
    DokaGirl, May 19, 2023
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  15. rvallee

    rvallee Senior Member (Voting Rights)

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    This one annoyed me just enough to look it up and it just means using a daily diary. So I guess they think they can do that, confirm hypotheses just from reading daily diaries. Which actually makes it all even more nonsense than it already seemed to be.

    For sure this discipline loves to use weird terms that mean exactly the same thing as a common word everyone knows. It must play into the "mystery" of them knowing things we don't, but seem to actually be limited to using arbitrary terms that add nothing to meaning and only serve to confuse by pretending to sound more profound than they are.
     
    rvallee, May 19, 2023
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  16. rvallee

    rvallee Senior Member (Voting Rights)

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    Sounds like psychoanalysis, but written? They claim to confirm scientific hypotheses from simply reading some people's thoughts.

    The fact that stuff like that gets through peer review suggests that peer review is mostly a formality that applies conformity of thought more than anything.
     
    rvallee, May 19, 2023
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  17. DokaGirl

    DokaGirl Senior Member (Voting Rights)

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    Yes. Woo-woo obfuscation.

    "Ecological momentary assessments." Good grief.

    If writing in a diary is an "ecological momentary assessment, what's a shopping list? Or an email? Or posting here?
     
    DokaGirl, May 19, 2023
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  18. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Nor me. Some papers if anyone feels the need —

    Ecological Momentary Assessment: A Meta-Analysis on Designs, Samples, and Compliance Across Research Fields (2022)
    A Systematic Review of Momentary Assessment Designs for Mood and Anxiety Symptoms (2021)
    Content validity and methodological considerations in ecological momentary assessment studies on physical activity and sedentary behaviour: a systematic review (2020)

    All of which would seem to lead to the pinnacle of such research endeavours (talk about truth in advertising) —

    Reintroducing the Effortless Assessment Research System (EARS) (2023)

     
    SNT Gatchaman, May 19, 2023
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