Behavioral therapy for MS: How does it work – and who benefits from it? (Video)
Behavioral therapy is a special form of psychotherapy. The principle: our behavior influences our inner life, our feelings and our thoughts. And since behavior can (usually) be changed quite easily in a targeted manner - at least more easily than the emotions themselves - we can influence how we feel through our actions. That sounds very positive! But what does that have to do with MS? The answer: some symptoms of the disease are psychosomatic; they represent a mixed physical and psychological state. You can find out how behavior therapy can address this in this article and in the video interview with our expert, Dipl.-Psych. Sally Schulze.
On the bunk and off into the past?
Some clichés about psychological treatments are persistent: Only when all the alarm bells are really ringing in your head do you lie down on a couch with an understandingly nodding psychologist (white beard) and talk for hours about your childhood until the realization of a repressed early childhood experience finally breaks the spell - and the mental suffering disappears. This distorted image, which comes from psychoanalysis, has little to do with modern behavioral therapy. Here, patients become active themselves and develop effective and sometimes complex solution strategies using a learning approach. Supported by an expert, but still self-determined. Because behavioral therapy aims to help people help themselves. Childhood is not unimportant, but treatment begins here, today, now. Behavioral therapy is activating. It relies on the creative power, motivation and problem-solving skills of those affected.
Where does behavioral therapy come from?
This approach was originally developed by John B. Watson (1878–1958), a contemporary of Sigmund Freud, who relied on the findings of the then relatively new learning theory instead of depth psychology methods (most people still know Pavlov's "classical conditioning" from school). Since then, the approach has developed into a complex therapy method with a broad portfolio of methods. The focus is on observing behavior and changing it. Because: If we change our behavior, we also change our psyche - so the theory goes. Depending on the treatment goal, different undogmatic approaches from confrontation therapy, cognitive behavior therapy and so-called operant methods are combined. Systematic desensitization, contingency contracts, cognitive restructuring - to name just a few keywords. Sounds complicated? It is. For this reason, only people who have received a state license after a university degree in medicine or psychology are allowed to offer behavior therapy in Germany. Behavioral therapy is scientifically based and firmly anchored in conventional medicine.
A woman talks to her therapist.
Why behavioral therapy for MS?
Behavioral therapy can be helpful for MS patients for a variety of reasons: in processing the diagnosis, in dealing with some symptoms and in accompanying mental illnesses.
1. Strategies for dealing with the diagnosis of MS
The diagnosis of MS is a devastating blow for many sufferers. They feel fear, helplessness, anger – and a chaotic range of mostly unpleasant feelings. And that's OK. After all, the diagnosis changes your life fundamentally; it's okay to feel bad sometimes! Nevertheless, at some point the point comes when those affected have to (and want to) learn to deal with the diagnosis. Life goes on, and it can be very beautiful, even with an unpleasant diagnosis. Some manage to deal with the feelings all by themselves and develop a positive attitude. Others, on the other hand, get help – and benefit from psychotherapeutic support. This is neither pitiful nor weak, but in most cases simply a smart use of professional support. In other words: even if you are enthusiastic about cars, sometimes you just need a really good mechanic. What you learn in behavioral therapy, however, is not magic tricks. It takes some hard work on yourself and a little patience to achieve the goal: coping with the emotions that inevitably accompany the diagnosis.
2. Positive influence on psychosomatic symptoms and the course of the disease
Many patients with multiple sclerosis suffer from psychological or psychosomatic symptoms. Learning and memory disorders often occur, for example. Fatigue, a tormenting tiredness that unfortunately almost everyone affected is familiar with, is also a symptom that affects both the body and the mind. For these symptoms, behavioral therapy can reveal solutions that either alleviate the symptoms or at least make it easier to deal with them. But therapy can be even more valuable if it stops or slows down the progression of the disease. What some sufferers may find cynical given the clearly physical nature of MS can be explained quite simply: stress is considered to be one of the triggers for an attack, and psychotherapy can teach you to react differently to environmental demands. Dealing with stress is often one of the central goals of behavioral therapy. In this way, it can even have a positive influence on the course of the disease.
3. Depression and anxiety disorders: treatment for comorbid mental illnesses
Depression is a common comorbidity in people with a serious chronic illness. And it is also a serious illness in itself. With multiple sclerosis, the risk of developing severe depression is around 50 percent. The risk of developing less severe depression is as high as 70 percent. The frequency of depression is of course partly due to the emotional pressure caused by the illness, but neurophysiological changes that accompany the illness can also trigger depression. Behavioral therapy can produce very good results, particularly in less severe cases. Over time, those affected learn how to train helpful behavior and "unlearn" detrimental behavior. The goal is to break unfavorable thought patterns and incorporate positive activities into everyday life in order to find and maintain real joy in life. Since some symptoms of MS are very similar to those of depression, psychotherapy can also help to navigate through the thicket of unfamiliar states of feeling and find the right self-therapy for each individual. In cases of severe depression, the search may even lead to drug therapy being necessary. In this case, it is useful for the psychotherapist and doctor to work together to decide whether a combination of medication and psychotherapy should be used.
A young woman sits at the window and ponders.
How does behavioral therapy work?
Before the actual therapy, the “trial” session is a time for getting to know each other, during which the basic goal of the therapy is also discussed. During these discussions, the therapist will determine whether psychotherapeutic treatment is actually effective and useful in the individual case. This is also important because health insurance companies only cover the costs of treatment on behalf of the therapist. Otherwise, a therapy session costs around 80 to 100 euros. First, the behavioral therapist works with the patient to determine which current issues are particularly stressful and which external conditions and behaviors may be associated with them. They talk about the situation, the feelings, the thoughts, but above all about the behavior of the people. There is no general answer to what happens next - the individual situation and the goal determine the roadmap.
Where can I find a place for psychotherapy?
The search for a good psychotherapist who has time can be annoying, as demand has steadily increased in recent years. If you still want to search for one yourself, you can find specialised search engines on the Internet, which are mainly operated by professional associations - such as the German Psychotherapists Association (DPtV) or the Professional Association of German Psychologists (BDP). Caution is advised here, especially for those with statutory health insurance: some therapists registered there may not work with the health insurance companies, so this search method is more suitable for self-payers. If you are unsure whether you will find a suitable therapist there: the treating neurologist or family doctor can usually also make a recommendation for private treatment.
The safe way: Associations of statutory health insurance physicians
The Association of Statutory Health Insurance Physicians (KV) provides reliable information. The task of the 17 regionally organized institutions is to ensure that statutory health insurance patients receive medical care. This means that they have lists of therapists in your area who are guaranteed to work with the health insurance companies. In each federal state, a KV is responsible for patients, with the exception of North Rhine-Westphalia, which is divided into the KV North Rhine and the KV Westphalia-Lippe. In the case of an acute indication, you can use the KV's so-called appointment service centers (TSS) to make an appointment for a psychotherapy consultation, provided you have a corresponding referral with an urgency code. This consultation and the referral are the prerequisite for subsequent treatment. In acute cases, you are also entitled to a defined service: the appointment must not take longer than a week to make, and in the case of acute psychotherapeutic treatment, the appointment must normally not be more than four weeks in the future. However, you cannot choose a doctor of your choice via the TSS, and you must expect that the therapist assigned to you practices within a "reasonable" distance from your place of residence - this could be eighty or ninety kilometers in some cases. Even if you do not have a referral - and therefore it is not an urgent treatment requirement - you will receive support from the TSS. In this case, however, the arrangement can take up to twelve weeks. The best first port of call is in any case the nationwide telephone number 116117. There you will first be greeted by a friendly robot voice that will connect you to the patient service in your region using your postcode and further inputs on the telephone keypad. An online service and an app are also available; you will find the links below this article. The process sounds a bit complicated at first, so our advice is: just call the telephone number provided and clarify everything else there. The trained contacts there are well informed, solution-oriented and helpful - so you do not need to hesitate.
A psychotherapist speaks with a young woman via video call.
Digital or telephone services can complement therapy
Off to the couch? Perhaps the most comfortable is your own, because especially in times of pandemic, many people want to minimize or at least control their personal contacts. In addition, treatment in your own four walls also scores points for optimal accessibility. Digitalization does not stop at psychological counseling and support (some time ago we already drew your attention to the offer from MentalStark , a company that offers online psychological support for those who are unable to have children). The first providers are also offering digital help for depression and MS: For example, a study from 2015 using the example of the provider Deprexis showed that online psychological counseling can have a positive effect on the likelihood of depression in MS patients (you can find the link to the study below). The tool has now even been included in the directory for digital health applications (DiGa) of the Federal Institute for Drugs and Medical Devices. The statutory health insurance companies therefore cover the costs that may arise when using this application. Personal support from a trained therapist cannot replace purely online counseling, but can at least complement it. Telephone consultations with professional psychotherapists are better. Since the Corona pandemic, many have also been offering conversations via video chat. Telephone and video consultation times are also allocated via the KV's TSS.
Is psychotherapy really for me?
Regardless of the many professional reasons for psychotherapy, conversations with an understanding but emotionally uninvolved person can simply do you good. And sometimes there is also good advice beyond psychological categories, because psychotherapists also have common sense and life experience. But do you have to go to therapy for that? "Let a shrink tighten a few screws in my head? I don't need that. I have my life under control!" If you have this or a similar thought - forget it! Today, many people seek the support of consultants, coaches or therapists, even when they are facing relatively manageable challenges. A person with MS has every reason to do so, and there is nothing strange or weak about it. Quite the opposite: The decision to undergo behavioral therapy is a brave and active step towards an approach to being able to help yourself even better in the future - and to take control of the sometimes unruly emotions.
External sources
- E-appointment service of the Associations of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Physicians
- Link to the patient service app of the Association of Statutory Health Insurance Physicians and the National Association of Statutory Health Insurance Physicians for the medical on-call service in Germany
- An online program to reduce depression in patients with multiple sclerosis: a randomized controlled trial (The Lancet – English source)
- Directory for digital health applications (DiGa) of the Federal Institute for Drugs and Medical Devices
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