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The Role of Psychologists in the Assessment and Treatment of Multiple Sclerosis

According to the National MS Society, there are approximately 2.3 million people across the world who have MS (1). To manage this disease to the fullest extent possible, people benefit from a comprehensive approach to their health and wellness. A comprehensive approach means having a comprehensive and interdisciplinary team of clinicians there to help you with the different aspects of your illness. Psychologists can play a critical role as part of this health care team. As you may know, psychologists help people deal with the emotional impacts of MS. But, they can also help people address a wide range of other needs as well.

"As you may know, psychologists help people deal with the emotional impacts of MS. But, they can also help people address a wide range of other needs as well.

Emotions are a natural part of life, and MS can feel like an emotional roller coaster ride. The onset of initial MS symptoms is unexpected, and it is normal to experience associated fear and anxiety. Then, while one is trying to manage the symptoms themselves, they must also cope with the challenges of the diagnostic work-up. The process can be long, frustrating, and presents many worries. The uncertainty associated with the diagnosis and prognosis can seed fear, anxiety and depression.

Worried womanPeople may experience grief over current or anticipated losses, fear about the “what-ifs”, anger over having the condition, anxiety about what treatment could be best, and concern about what the condition could mean for them, their goals and their family. But, even with the presence of fear, anxiety, anger and other such emotions, people may also experience an array of positive feelings too. For example, they may feel hopeful about the future due to advances in treatment options, they may develop a deeper appreciation of what is truly meaningful in their lives, and may become more eager to embrace life more fully.

Anywhere along the MS journey, one can experience a cauldron of feelings, which are likely closely connected to your thoughts, considerations and choices. But, emotions can also be impacted by MS itself, and/or the medications used to treat it and associated symptoms. Sometimes, the emotions persist and become so strong that they interfere with functioning, and may be a sign of an underlying psychological condition. People may question whether their emotions are normal given their circumstances, whether their illness or medications could be worsening their emotional health, and whether or not they may be suffering with a psychological condition such as a depressive disorder.

A psychologist can help a person and their medical team sort out concerns such as these, and better understand what is happening with the individual’s psychological and emotional health. They conduct assessments to evaluate emotional and behavioral concerns and to identify possible contributing factors. Based on the outcome of their assessment, they can then provide an individual with recommendations regarding treatment, and they can provide therapy if it is indicated or desired.

Changes in cognitive functioning can also occur with MS. Cognitive functions are functions related to thinking, processing, understanding and remembering. The specialty within psychology that focuses on these matters is called Neuropsychology. Neuropsychologists administer specialized tests that identify the nature and extent of cognitive dysfunction, and make recommendations about how to cope with those deficits if present. These psychologists integrate a significant amount of information (e.g., test results, medical and mental health history) into a clinical picture that ideally helps the individual and their healthcare team.

Fatigue is estimated to impact 80% of people with MS(3), and can range in severity from mild to severe. In fact, fatigue is one of the primary reasons an individual may stop working (3) and it can certainly negatively impact quality of life. Additionally, fatigue is “invisible” and nonspecific, which means it may be difficult to diagnose and understand. Fatigue can be a direct consequence of the long-term aspects of MS or a symptom of a flare-up. But, it can also be impacted by conditions like Major Depressive Disorder.

As part of a comprehensive work-up to identify factors impacting fatigue, psychologists often conduct the behavioral and psychosocial portions of the assessment. Based on the findings of the assessment, the psychologist can then provide recommendations and treatments that help a person address and manage fatigue. They can also collaborate with medical providers, and/or recommend referrals to other specialists (e.g., occupational therapy, physical therapy and nutritionists) who also may be able to help.

Comforting HerLiving with MS involves much more than simply taking a medication aimed at slowing progression or treating a symptom. People may find themselves re-evaluating their priorities, exploring what truly matters to them and taking unforeseen steps to better align their life with what brings them meaning and fulfillment. Having MS requires a person to make difficult decisions and it may bring people face-to-face with their fears. People can sometimes feel caught between denial and acceptance, and feel unsure about whether they want to pursue treatment or not. They can also struggle with issues relating to disclosure, work, family and recreation.

Seeing a psychologist can help people work through such concerns. As noted by the American Psychological Association, psychologists have “years of specialized education, training and experience that make them experts in understanding and treating complex problems” (4), such as coping with life stressors (like illness) and/or mental health conditions. Clinical Psychologists provide treatments (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy) aimed at helping an individual address their psychological, emotional and behavioral needs.

Clinical Health Psychology is a specialization within Clinical Psychology, and these psychologists have additional expertise in the biological, psychological and social factors relating to medical illness and its management. They contribute their expertise to the interdisciplinary treatment team through consultation and collaboration. Clinical Health Psychologists work closely with individuals and their medical provider(s) (e.g., primary care provider, neurologist, psychiatrist) to address a breadth of factors that may be impacting overall health and wellbeing.

The treatments provided by psychologists are provided through therapy. Therapy typically involves a collaborative and active process, that involves both talking and listening. But, it also includes moving toward better health and wellbeing through learning and applying what is being learned. In this way, the clinical services provided by a psychologist are not the same as what might be provided to an individual through social support (e.g., talking with friends, conferring with family, spending time with others). While a psychologist may certainly be providing an individual with support, that support is provided within a clinical context. Using research-based techniques and treatments, psychologists apply their years of training and expertise in the intricacies of human behavior, cognition, and health to help individuals better address the complexities of dealing with MS.

pain, fatigue, withdrawal and depression cycleOne could argue that having MS is not the same as living with MS. Living with MS means addressing the needs of both the body and the mind. As is now well known, the body and mind are interconnected; we cannot effectively address overall “health” without addressing both. For example, the processes happening within the body can impact the functions of the mind. And, the mind has to deal with the impacts of the illness and make decisions about what actions the body will take. Consequently, in order for either the body or mind to function at its best level, the functioning of the other must also be concurrently addressed. Thus, addressing the reciprocal relationship between physical and psychological health is critical.

Psychologists help bridge the intersection between the body and mind so that people can pursue their best possible overall health and fully engage in their lives. And, for this reason, psychologists often play a critical role in an individual’s comprehensive health care.

This article covered just a few of the symptoms and aspects of your condition for which a psychologist may be helpful; there are many more. And, please note that not all psychologists have specializations in the services or topic areas mentioned above. To find a psychologist that has the expertise you need, consider reviewing the MFN listings and contacting a few of the psychologists in your area. Be sure to ask questions about their qualifications to assist you with issues related to Multiple Sclerosis or other needs you’ve identified. Ideally, through doing your research and interviewing possible candidates, you will find a psychologist who will become a trusted member of your team, and who can help you as you navigate your journey. 

Please click on this search portal to find a experienced MFN professional. 
REFERENCES

  1. National Multiple Sclerosis Society. Epidemiology. 2014. Retrieved from http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS
  2. National Multiple Sclerosis Society. Epidemiology. 2014. Retrieved from http://www.nationalmssociety.org/Treating-MS/Comprehensive-Care
  3. National Multiple Sclerosis Society. Fatigue. 2014. http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Fatigue
  4. American Psychological Association. Help Center. 2014. Retrieved from https://www.apa.org/helpcenter/psychotherapy-myths.aspx

There are many myths and misunderstandings associated with seeing a psychologist and other mental health providers. Unfortunately, they maintain stigma and prevent people from utilizing important resources that may aid them in coping with their illness. While it is outside the scope of this article to address such myths, please visit https://www.apa.org/helpcenter/psychotherapy-myths.aspx for additional information that will help you make an informed decision regarding including a psychologist as a member of your treatment team.