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Promoting Emotional-Social Wellness for People with MS and Their Families: Challenges for Clinicians. Psychosocial Aspects of Wellness. Intellectual. WELLNESS. Spiritual. Emotional. Physical. Interpersonal. Kennedy, P. Adapted from Anspaugh D. et al, 1991. Dilemma #1.

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promoting emotional social wellness for people with ms and their families challenges for clinicians

Promoting Emotional-Social Wellness for People with MS and Their Families: Challenges for Clinicians

psychosocial aspects of wellness
Psychosocial Aspects of Wellness







Kennedy, P. Adapted from Anspaugh D. et al, 1991

dilemma 1
Dilemma #1

The psychosocial aspects of wellness

and the barriers to attaining those aspects of wellness are sometimes one and the same

intellectual challenges for people with ms
Intellectual Challenges for People with MS
  • Dealing with a changing self-image and the perceptions of others
    • Engagement and intellectual stimulation vs. the patient role (“MS career”)
    • Employment challenges
    • Cognitive dysfunction
    • Personality changes
emotional challenges for people with ms
Emotional Challenges for People with MS
  • Dealing with one’s own feelings and the feelings of others
    • Grief—a “normal” response to MS-related losses(Kalb, 2008)
    • Stress—daily life stresses are compounded
    • Depression—25-50% lifetime prevalence(Minden &Schiffer, 1987)
    • Anxiety—as common but less recognized(Feinstein et al., 1999)
interpersonal challenges for people with ms
Interpersonal Challenges for People with MS
  • Dealing with the impact of MS on relationships with family, friends, and strangers
    • Disclosing MS: the when, why, and how
    • Avoiding disability stereotypes
    • Sustaining old relationships; building new ones
    • Coping with a changing identity, shifting roles
    • Remaining visible to others
spiritual challenges for people with ms
Spiritual Challenges for People with MS
  • Finding meaning, direction, and comfort
    • Who am I now?
    • What did I do wrong?
    • Why did this happen to me?
    • What does this mean for my faith?
    • What gives me the strength to deal with this?
challenges for carepartners mckeown 2008
Challenges for Carepartners (McKeown, 2008)
  • Intellectual
    • Two full-time jobs
    • Loss of time for personal development
  • Emotional
    • Grief over changes and losses (Buhse, 2008)
    • Stress related to multiple demands (McKeown et al, 2008)
    • Anxiety about the unpredictable future (Buhse, 2008)
    • Depression (Aronson, 1997)
challenges for carepartners cont d
Challenges for Carepartners, cont’d
  • Interpersonal
    • Re-defining the relationship (spouse; parent; child)
    • Maintaining balance in the partnership
    • Maintaining social network
  • Spiritual
    • Who am I now?
    • Why did this happen to me?
    • What gives me the strength to deal with this?
  • Physical
    • Making time for self-care
dilemma 2
Dilemma #2

The psychosocial elements of wellness are not readily apparent to us; it takes time, effort, and expertise to identify them

challenges for clinicians diagnose and adios was easier
Challenges for Clinicians: “Diagnose and Adios” was easier
  • Seeing the whole person
  • Intervening early to minimize crises
  • Recognizing barriers:
    • Don’t ask, don’t tell
    • Not enough time; not enough resources
    • It takes a village…
  • Utilizing screening tools
  • Identifying referral options
  • Promoting hope and effective planning
  • Recognizing our “Invisible patients”
dilemma 3
Dilemma #3

It’s not easy to sort out what’s what

challenges for clinicians
Challenges for Clinicians
  • Recognizing that depression is never “normal” (“Who wouldn’t be depressed?!?”)
  • Distinguishing grief from depression
  • Distinguishing symptoms of depression from symptoms of MS
  • Distinguishing cognitive changes from depression
  • Identifying the patient who “aims to please”
challenges to diagnosing depression in ms
Challenges to Diagnosing Depression in MS
  • For at least two weeks:
    • Depressed mood most of the day nearly every day
    • Markedly diminished pleasure in most or all activities
    • Significant weight change (>5% up or down in a month)
    • Inability to sleep or sleeping too much
    • Motor agitation or significant slowing
    • Fatigue or loss of energy
    • Problems with thinking or concentrating
    • Feelings of worthlessness/excessive guilt
    • Recurrent thoughts of death
dilemma 4
Dilemma #4

“It takes a village…” but coordinating care for people with MS is harder than herding cats

challenges for clinicians1
Challenges for Clinicians
  • Finding clinicians with MS expertise in your area
  • Identifying the team “leader” (PCP, ob/gyn, you)
  • Finding time to communicate and collaborate with them
  • Devising a communication system that works for the team
  • Keeping the patient as the central focus
recommended strategies
Recommended Strategies
  • Teamwork—with other providers, with voluntary health organizations, with pharma
  • Regular visits—every 6-12 months
  • Routine screening assessments
  • Periodic contact with carepartner during office visits to assess informally how things are going
  • Educational materials from the National MS Society and other voluntary health organizations about important psychosocial issues
  • Referral to local chapter
society resources for your patients
Society Resources for Your Patients
  • 40+ chapters around the country
  • Web site (
  • Access to information, referrals, support (1-800-344-4867)
  • Educational programs (in-person, online)
  • Support programs (self-help groups, peer and professional counseling, friendly visitors)
  • Consultation (legal, employment, insurance, long-term care)
  • Financial assistance
society resources for clinicians
Society Resources for Clinicians
  • MS Clinical Care NetworkorkWebsite:


    • Clinical consultations with MS specialists
    • Literature search services
    • Professional publications
    • Quarterly e-newsletter for healthcare professionals
    • Professional education programs (medical, rehab, nursing, mental health)
    • Consultation on insurance and long-term care issues
recommended readings
Recommended Readings

Feinstein A. The Clinical Neuropsychiatry of Multiple Sclerosis (2nd ed.).Cambridge: Cambridge University Press, 2007. An excellent, highly-readable, evidence-based discussion of mood changes and cognitive dysfunction in MS.

Kalb, R, Holland N, Giesser B. Multiple Sclerosis for Dummies. Hoboken, NJ: Wiley, 2007.A comprehensive, introductory overview.

Kalb, R (ed.). Multiple Sclerosis: A Guide for Families (3rd. ed). New York: Demos Medical Publishing, 2006. A review of family issues by MS specialist clinicians.

LaRocca N, Kalb R. Multiple Sclerosis: Understanding the Cognitive Challenges. New York: Demos Medical Publishing, 2006. Evidence-based overview of diagnosis and treatment; discussion of psychosocial impact; vignettes illustrating compensatory strategies.