In clinical care of patients, the spiritual aspects can be easily overlooked, and yet recognition may be central in the patient’s symptom presentation, and in providing optimal care. This presentation focuses on how to assess the spiritual aspects, in practical clinical questions, and in common spiritual themes that may be present in clinical situations.

The presentation discusses “Near Death Experience” elements, comparison to delirium, and the challenges of various biological theories in understanding the “NDE”. It is vital that health care workers can recognize when a patient has had an “NDE,” and not minimize or discount such an important or possibly unexplained experience for the patient. NDE stories can be used to help patients struggling with fear of dying, with grief, with suicidal ideation, or lack of purpose. Finally, understanding the NDE can broaden our perspectives of consciousness; of how we perceive life and death; and how we can come to terms with the end of life for ourselves and for our patients.

Mindfulness training is increasingly used as a therapeutic intervention to manage stress and enhance emotional well-being. Mindfulness is defined as the capacity to notice one’s thoughts, emotions, and bodily sensations without engaging in physical or emotional reactivity to these experiences. The practice of distinguishing between experience (what one notices) and the response to experience (e.g. judgment, negative affect) helps participants identify and mitigate habitual reactions that contribute to emotional distress. Mindfulness-based interventions have shown benefit for a variety of symptoms associated with MS (anxiety, depression, pain, fatigue, physical function), but their use with MS populations has been limited.

Psychological stress has a negative impact on the multiple sclerosis (MS) disease process. Stressful life events significantly increase the risk of MS exacerbation, and stress management has been shown to reduce the risk of new lesion development on magnetic resonance imaging (MRI). In addition to preceding physical symptoms, stress often precipitates mood disorders, of which people with MS are more prone. Compared to the general US population, people with MS have a higher lifetime prevalence of anxiety disorders (36% vs 29%) and depression (36%–54% vs 16%). Adverse consequences of mood disorders among people with MS include reduced functioning and quality of life, decreased treatment adherence, and increased risk of suicide. Thus, psychological stress and emotional well-being are important targets for MS research and clinical care.

This presentation presents the results of randomized clinical trial of Mindfulness-based Stress Reduction (MBSR) for people with MS conducted at the NUNM Helfgott Research Institute in collaboration with the OHSU MS Center