Read the following interview by Osher Program Coordinator, Emma Owings, with Dr. Heena Manglani, new Harvard Medical School Post Doctoral Integrative Medicine Fellow. Dr. Manglani’s research focuses on improving whole person health for individuals struggling with Multiple Sclerosis (MS).
Q: What is your research area of focus?
HM: My research centers on improving whole health in people with multiple sclerosis (MS) by focusing on a) mind-body interventions, b) delivered early after diagnosis, c) to both people with MS and their care partners. MS is a neurodegenerative condition that can cascade deleterious physical, psychological, and cognitive symptoms. Unlike other neurological diseases, MS onsets in young adulthood affecting people diagnosed and their care partners. The unpredictable nature of the disease and its onset during the prime of people’s lives makes it challenging to accept and adjust to MS. Mind-body interventions offer practical, feasible, and potentially effective methods to improve multiple domains of functioning and well-being in MS. My research aims to study mind-body practices provided early in the disease course to mitigate functional decline by engaging both people with MS and their care partners—offering a comprehensive, whole health approach to coping with the MS disease and its sequelae.
Q: What led you to your interest in integrative medicine?
HM: Integrative medicine offers an alternative to biomedical approaches for treating MS. While medical treatments focus on preventing disease progression, integrative approaches have the potential to enhance life quality. Practices such as mindfulness meditation, yoga, and tai chi may be particularly valuable across the disability spectrum. Individuals with mobility limitations may partake in mind-body practices more safely than other exercise-based interventions. In fact, people with MS often report a strong interest in engaging in complementary and alternative approaches but cite a lack of guidance from medical providers as a major barrier. I am interested in gaining an in-depth understanding of the mind-body approaches people have trialed, the barriers and facilitators to practicing, and their preferences for these types of interventions. To this end, I aim to conduct qualitative research in MS to characterize people’s experiences with different mind-body practices. I will use this data to develop a mind-body program in people with MS early after diagnosis.
Q: What currently motivates your work?
HM: My research interests are motivated by two burgeoning areas of research: dyadic and whole health interventions. There is a wealth of evidence across neurological conditions that early, dyadic interventions may help individuals become aware of distress, use mindfulness and acceptance techniques, and make lifestyle changes together to improve health. In parallel, there is preliminary evidence on the importance of various mind-body practices to promote whole health and psychological well-being in MS. One of the pilot studies in MS from my graduate lab found that a brief, four-week mindfulness-based intervention improved processing speed (Manglani et al., 2020) and reduced difficulties in emotion regulation (Schirda et al., 2020) relative to adaptive computerized brain training and waitlist control. This initial evidence suggests that brief, group-based mindfulness-based interventions may yield benefits to cognitive and psychological functioning in people with MS. With the many mind-body practices advertised, I am excited to conduct some qualitative research to better understand experiences with and preferences for mind-body interventions. Informed by this data, I aim to design a mind-body dyadic program that may enhance coping, adjustment to illness, and quality of life.
Q: Have you encountered any surprising results or challenges while pursuing your research?
HM: I have been surprised by two discoveries. First, there appears to be a dire lack of clinical psychologists with expertise in MS, who can tailor interventions such as mindfulness-based therapies to this population. Investigations that can lead to evidence-based care are scarce, likely due to a limited number of clinical researchers who have a deep understanding of the MS disease process and its impact. The second surprising discovery is the lack of randomized controlled trials (RCTs) on different mind-body practices in large samples of people with MS. Without well-powered mind-body RCTs, we may not be able to offer specific recommendations for complementary therapies that may prevent symptom progression and improve quality of life in MS. As such, there is a critical need for greater training of clinical psychologists, therapists, and other mental health providers as well as large RCTs to conduct rigorous research on mind-body practices in MS.
Q: What impact do you hope to see from your work over the next 3-5 years?
HM: In the next few years, I aim to develop and test the efficacy of a mind-body treatment program in MS informed by qualitative research. I hope to test the impact of this mind-body intervention on physical, psychological, and cognitive functioning. Once validated, I hope to make this program readily available across clinics worldwide. Dissemination through virtual programs, mobile applications, and MS organizations is a pivotal next step to translating clinical research into clinical care. Surveying needs and providing whole health care to people with MS and their care partners early after diagnosis may be essential for sustaining functional engagement and quality of life. I envision that mind-body programs and support from care partners will empower people to live a whole and meaningful life with MS.