Managing stress in multiple sclerosis
Dr Gail Kinman, Reader in Occupational Health Psychology
Department of Psychology, University of Bedford
Open Door - February 2009 pages 12-13
The stress reaction
Most people find life stressful at times. Some degree of pressure can be productive, as it can increase motivation and enhance performance. If the demands made upon us exceed our ability to cope, however, our health may be threatened.
The stress reaction (also known as the fight and flight response) has an important purpose: it is designed to help us survive in emergency situations. When we feel under threat, a cascade of automatic physiological reactions occurs in an attempt to make us more able to deal with the threat. The body releases stress hormones (such as cortisol and adrenaline), raises the heart rate, increases blood pressure, tenses muscles and increases blood glucose to increase energy levels. Once we believe the danger is over our body returns to normal but, if the threat is longer term, our mental and physical health may suffer.
Stress and health problems
Over the long term, stress can lead to a wide range of physical and psychological health problems ranging from fatigue, insomnia, anxiety and depression to gastrointestinal disturbances, muscle tension, hypertension and coronary heart disease. Chronic stress can also suppress the immune system decreasing resistance to colds and flu and slowing down the healing of wounds. Behavioural and cognitive problems, such as increased irritability and impaired memory and concentration, are also frequently experienced.
Stress and MS
The belief that stress causes relapses is widespread amongst people with MS. Is there any scientific evidence for such beliefs?
A link between psychological stress and MS symptoms was first identified by Jean-Martin Charcot in 1868. Over the last 20 years or so, a growing number of studies have found a relationship between stressful life events and both the onset of MS and relapses.
People with MS are more likely to report stressful life events prior to the first identified symptoms, compared to those with other neurological disorders or healthy controls. In terms of exacerbation of symptoms, a recent study found that people with MS who experienced distressing events had double the risk of subsequent relapse than those who were not exposed to such events.1 Another study found that 85 percent of clinically confirmed MS relapses were associated with stressful life events in the preceding six week period.2 Other studies also find that the increased odds of developing new lesions occur approximately four to eight weeks after the onset of a stressor.3,4 High-risk stressors that have been identified include death of a close relative, non-traumatic family and work stressors, financial stressors, conflict and disruption in routine. As well as serious life events, 'daily hassles' unrelated to MS have also been associated with relapse.
However, although some studies find a significant relationship between stress and relapse, firm conclusions cannot be made. There are many unanswered questions. Although the mechanisms underlying stress and relapse are not fully understood, the relationship between stress and the stability of the immune system is a likely pathway. As yet, it is unclear whether acute life events or chronic stressors are the main risk factors. There is some evidence that acute stressful events may protect against relapse as they are associated with the production of gluco-corticoids (which suppress immune system activity), whereas moderate stressors increase production of inflammatory cytokines (which increase disease activity).
Stress and caring
Caring for a chronically ill person can be stressful. The distress associated with caring for a loved one with MS has been described as 'chronic sorrow' and can lead to physical and psychological ill health. Studies have found the unpredictability and uncertainty of the disease and lack of opportunity for respite to be particularly stressful.
Managing stress in MS
Most people with MS will find managing symptoms and living with the restrictions and uncertainty imposed by the disease to be stressful. Learning how to manage stress effectively is an important skill for everyone; for reasons discussed above, it is particularly important for people with MS and for those who care for them. A recent survey of people with MS found that the majority wished for advice on the role played by stress in their disease and how best to manage it.
The impact of stress is dependent upon our beliefs, attitudes and behaviours, our personal resources and our ways of coping. A wide range of strategies can be used to manage the stress in your life.
I try not to worry too much about the things that I cannot change. Not always possible, I know! There are usually ways around problems and I'm lucky, I have a supportive husband and really good friends"
Making my feelings known to others helps to alleviate stress and low mood"
A glass of red wine! Screaming at the phone - very cathartic. Say "NO" occasionally! Give yourself permission to enjoy yourself - and stop feeling guilty"
Quotes taken from the MS Trust book Living With Fatigue
What are the early warning signs that you are getting stressed?
- Emotional warning signs include anger, mood swings and inability to concentrate
- Physical warning signs include headaches, fatigue and dizziness
- Behavioural warning signs include overreacting, clumsiness, over-reliance on alcohol or drugs and withdrawing from social relationships.
Keep a stress diary to detect patterns
- You can make links between stressful events, your reactions to them and any subsequent symptoms
- This will enhance feelings of control and help you manage your illness more effectively Many of us find ourselves feeling worry, dread, or regret excessively. Controlled worry time limits negativity, reduces anxiety and increases control
- Designate a time and a place for worrying (say, 8 to 8.30 pm each day)
- Make a written note of your worries during the day (a three or four word reminder will do), but do not worry until the designated time
- Some worries may recede during the day and others may be easier to handle
- You could team up with a 'worry partner' and share your 'worry time' with him or her
- Buljevac D, et al.
Self reported stressful life events and exacerbations in multiple sclerosis: prospective study.
British Medical Journal 2003;327(7416):646.
- Ackerman K, et al.
Stressful life events precede exacerbations of multiple sclerosis.
Psychosomatic Medicine 2002;64(6):916-920.
- Brown RF, et al.
Relationship between stress and relapse in multiple sclerosis. Part 1. Important features.
Multiple Sclerosis 2006;12(4): 453-464.
- Mohr DC, et al.
Association between stressful life events and exacerbation in multiple sclerosis: a meta analysis.
British Medical Journal 2004;328(7442):731.