New Harbinger Publications: In chapter four of the book, “Health Promoting Behaviors,” you recommend that the patient keep a separate journal. How does journaling help?

Robert T. Fraser: The journal allows the reader to elaborate on thoughts, desirable behaviors, and other thoughts and feelings, which can then become the objects of focus in the other exercises he or she does in the workbook. The journal really offers a very useful kind of day-to-day type of tracking.

NHP: Do you think that many of the methods you describe in the book could also be successfully applied to other autoimmune diseases, such as rheumatoid arthritis or immune-mediated type 1 diabetes?

RTF: Yes, many of the psychosocial strategies in this book would be very useful to individuals suffering from other autoimmune disease.

NHP: Do you think that much of the stress and tension associated with MS is mainly in response to the physical effects of the disease, or would you say that the thoughts and feelings about simply having the disease are a greater source of distress for sufferers?

RTF: Over the last thirty-five years, there have been fourteen studies examining the relationship between stress and the progression of MS. As a whole, the data to date suggests that chronic stress, family difficulties, or job loss are likely to make the physical symptoms of MS worse. In one study, the Mohr group at University of California, San Francisco, recently linked an increase in stressful life events to an increase in brain lesioning four to eight weeks after the stressful event. But certainly the stress an individual feels from day to day can result from both the physical impact of the disease and his or her thinking about it and the cognitive distortions that result.

Dawn M. Edhe: I agree. The causes of distress vary. Certainly some of these problems arise because of neurologic changes in the brain that happen because of the demyelination that occurs in MS. Others happen as a result of response to the consequences of the disease, things like decreased activity and increased isolation for some. Still other sources of distress can be caused by social issues like family problems and occupational concerns.

NHP: Chapter six of the book focuses on alternative therapy solutions for patients. Can you describe some of these?

Allen Bowling: In our clinic, we make an effort to provide user-friendly, MS-specific complementary and alternative medicine information that is individualized to each patient. We often encourage patients to consider the levels of polyunsaturated fatty acids, vitamin D, and calcium in their diets. We also often encourage patients to explore alternative therapies that have shown promise for specific areas of concern. For anxiety issues, we might recommend acupuncture, exercise, imagery, massage, meditation, prayer or other kinds of spirituality, tai chi, or yoga. Exercise and hippotherapy—a treatment that involves horseback riding—can be beneficial for urinary problems. Cognitive problems sometimes respond to ginkgo biloba, cooling, and music therapy. We know that exercise is beneficial for depression, and St. John's wort has shown some promise in this area, too. Fatigue can be eased using caffeine, cooling, exercise, tai chi, and yoga. Issues with chronic pain can be addressed using acupuncture, imagery, and meditation. Meditation, exercise, and valerian supplements can benefit those struggling with sleep problems. And patients with muscle-spasm problems can see improvements by exploring cooling, exercise, hippotherapy, massage, tai chi, yoga. Of course, when we discuss these therapies with our patients, we provide information about what we know and what we don't know about the safety and effectiveness of the alternative therapies.

NHP: Chapter three addresses the various types of therapists and therapies available. Are there therapists that specialize in treating those with autoimmune diseases like MS?

RTF: Therapists specializing in the treatment of MS patients can be found at or through local MS Society affiliates or Rehabilitation Psychology, Division 22, of the American Psychological Association.

NHP: How do you feel about the use of antidepressant or anti-anxiety medications by patients suffering from MS?

RTF: I think that for some people with MS who have a depressive or anxiety disorder—and not just the occasional blues, nervousness, or stress—medications can be quite useful if used properly and monitored closely, particularly in the beginning. The techniques described in the book as well as psychotherapy are also very helpful for depression and anxiety. But this is pretty involved information; there are no quick answers. People interested in these issues should definitely read the appropriate chapters in the book to learn about the use of medications, therapy, and other treatments for dealing with emotional distress.

NHP: In chapters seven and eight, you discuss employment and disclosure strategies for patients. Do sufferers commonly have to face work-related discrimination because of their disability?

RTF: I would say that discrimination is common and our data suggests that there is a push to move people with MS out of their occupations and onto long term disability/SSDI once the condition is diagnosed. Five years after diagnosis, only about 25 percent of people with MS are still employed.