Stress Management:
Right from the early days when multiple sclerosis was named and began to be ‘seen’ by physicians, those who took an interest in the disease noted that both the onset and exacerbation of MS were often closely correlated to some kind of stress. This took various forms, depending on the person’s circumstances. Some physicians noted the involvement of a prior infection, being exposed to cold and damp, some kind of physical trauma, severe physical exertion (usually referred to as overwork), or some kind of psychological trauma that produced acute or chronic mental turmoil.
It would seem that people who develop MS may have a genetic predisposition that sensitises them to stress. This article lists some recent studies that correlate MS onset or exacerbation with stress http://www.braininjury.com/multiplesclerosis.shtml
Unfortunately, once a link with a particular type of stress is identified by the research, very little seems to be done to follow up on it and discover what physiological mechanisms might be at work that would translate into a practical benefit for people with MS. It is of little help to people with MS to know that stress could trigger or exacerbate their disease, if no one tells them why it is happening and what they can do about it.
Apart from the research, which in general is often criticized for having some defect or other, or is contradicted by another piece of research which may itself be criticized for having some defect or other, what is the lived experience of people with MS?
An examination of posts that people with MS make to MS forums seems to confirm the hypothesis. People with MS often date the onset of their disease to some acute or chronic stressor. They also report that an acute or chronic stressor will precipitate a relapse or exacerbate their symptoms. This may be as simple as being ‘put on the spot’ like being watched while they perform a task. Their feeling of being ‘flustered’ is enough to magnify their symptoms, making something like foot drop worse, or suddenly being unable to move a limb that normally responds.
Other people report feeling less resilient to stress, unable to cope with the normal stressors of daily life, and feeling tremendously fragile. Where before they may have bent with the challenges of life, they now fear they may break.
There is a developing field in medicine which may be of some assistance to people with MS as time goes by. It is called Psychoneuroimmunology (PNI) and uses the study of interactions between genes, the immune system, endocrine system, neurology, psychology, and the environment to understand the onset, exacerbation and progression of disease. This can be characterised most simply as ‘the mind/body connection’. Any field of medicine that treats a person as an individual and looks at multiple systemic inputs (instead of a disease label) is to be welcomed, so long as this field of endeavour does not become another version of the ‘it’s all in your head’ school of medical treatment.
PNI seems to be in its infancy, and what practitioners there are, do not seem to be readily accessible. At its broadest this field of endeavour will recognise that mental illness is physical illness, and that physical illness can have a profound effect on the mind. However, it is making far more precise biochemical connections as to how stress can affect our health.
The brain is where our consciousness, emotions, beliefs and thoughts reside, but it is also the control centre that animates every part of our organism. MS is not a mental illness, but it resides in the mental and sensory organs, the brain, spinal cord and nerves. It is a physical illness that can disrupt mental function. It is sensitive to outside stressors which can potentially inflame the illness. The damage to the tissues of the CNS can cause mental illness including emotional lability, anxiety and depression, and the pain, disabilities and indignities of MS, together with the potentially catastrophic effect on social and economic roles, can cause terrible mental distress.
Managing stress may be another way for someone with MS to attempt to optimise their health outcomes. At the very least it can help a person deal with the symptoms they are experiencing, and the negative consequences that MS is having on their lifestyle and prospects. This can greatly improve quality of life.
Options for managing Stress:
The management of stress should start with the individual and their unique circumstances, but here are some points for consideration.
Stress, anxiety, depression, and general emotional challenges seem to come with the territory of MS. Each individual circumstance is different, and will require a different approach. Those who are lucky enough to experience holistic treatment for MS may be offered some form of stress management for the unique challenges of living with a disabling, chronic disease. For the rest, they or their carers will need to recognise when support is needed, and actively seek it out.
Links:
This article on PNI explains how sickness behaviours can be triggered by both sickness and stress http://www.apa.org/monitor/dec01/anewtake.aspx
What might be missing?
Right from the early days when multiple sclerosis was named and began to be ‘seen’ by physicians, those who took an interest in the disease noted that both the onset and exacerbation of MS were often closely correlated to some kind of stress. This took various forms, depending on the person’s circumstances. Some physicians noted the involvement of a prior infection, being exposed to cold and damp, some kind of physical trauma, severe physical exertion (usually referred to as overwork), or some kind of psychological trauma that produced acute or chronic mental turmoil.
It would seem that people who develop MS may have a genetic predisposition that sensitises them to stress. This article lists some recent studies that correlate MS onset or exacerbation with stress http://www.braininjury.com/multiplesclerosis.shtml
Unfortunately, once a link with a particular type of stress is identified by the research, very little seems to be done to follow up on it and discover what physiological mechanisms might be at work that would translate into a practical benefit for people with MS. It is of little help to people with MS to know that stress could trigger or exacerbate their disease, if no one tells them why it is happening and what they can do about it.
Apart from the research, which in general is often criticized for having some defect or other, or is contradicted by another piece of research which may itself be criticized for having some defect or other, what is the lived experience of people with MS?
An examination of posts that people with MS make to MS forums seems to confirm the hypothesis. People with MS often date the onset of their disease to some acute or chronic stressor. They also report that an acute or chronic stressor will precipitate a relapse or exacerbate their symptoms. This may be as simple as being ‘put on the spot’ like being watched while they perform a task. Their feeling of being ‘flustered’ is enough to magnify their symptoms, making something like foot drop worse, or suddenly being unable to move a limb that normally responds.
Other people report feeling less resilient to stress, unable to cope with the normal stressors of daily life, and feeling tremendously fragile. Where before they may have bent with the challenges of life, they now fear they may break.
There is a developing field in medicine which may be of some assistance to people with MS as time goes by. It is called Psychoneuroimmunology (PNI) and uses the study of interactions between genes, the immune system, endocrine system, neurology, psychology, and the environment to understand the onset, exacerbation and progression of disease. This can be characterised most simply as ‘the mind/body connection’. Any field of medicine that treats a person as an individual and looks at multiple systemic inputs (instead of a disease label) is to be welcomed, so long as this field of endeavour does not become another version of the ‘it’s all in your head’ school of medical treatment.
PNI seems to be in its infancy, and what practitioners there are, do not seem to be readily accessible. At its broadest this field of endeavour will recognise that mental illness is physical illness, and that physical illness can have a profound effect on the mind. However, it is making far more precise biochemical connections as to how stress can affect our health.
The brain is where our consciousness, emotions, beliefs and thoughts reside, but it is also the control centre that animates every part of our organism. MS is not a mental illness, but it resides in the mental and sensory organs, the brain, spinal cord and nerves. It is a physical illness that can disrupt mental function. It is sensitive to outside stressors which can potentially inflame the illness. The damage to the tissues of the CNS can cause mental illness including emotional lability, anxiety and depression, and the pain, disabilities and indignities of MS, together with the potentially catastrophic effect on social and economic roles, can cause terrible mental distress.
Managing stress may be another way for someone with MS to attempt to optimise their health outcomes. At the very least it can help a person deal with the symptoms they are experiencing, and the negative consequences that MS is having on their lifestyle and prospects. This can greatly improve quality of life.
Options for managing Stress:
The management of stress should start with the individual and their unique circumstances, but here are some points for consideration.
- Transforming stressors: It may be possible to approach a problem in a different way so that the stressor is neutralised or becomes a positive.
- Removing stressors: Perhaps the most effective way of managing stress is simply removing the stressor. Changing jobs, retiring, moving house, abandoning conflicts, getting financial advice, ending negative relationships and so on can all be very effective ways to improve mental equilibrium, provided that the new position provides the expected relief. There is no point making a change that just results in new or similar stressors.
- Avoiding stressors: This can be effective in the short term, but may reduce people’s capacities in the long run. It may still maintain a level of chronic stress if the person concerned feels that they are perpetually vulnerable through their avoidance strategy, or the stressor cannot be avoided at all times and the person feels a permanent fearful anticipation of the next encounter with the stressor.
- Changing attitudes to the stressor: If the stressor cannot be transformed or removed, then changing the view of the stressor can be an effective strategy, so that whilst the stress is still experienced, it has lost the power to cause suffering. This is easier said than done, and may involve changing the habits of a lifetime. There are so many elements to this. It can involve a profound understanding that worry really does not solve anything, and only produces ill health for the worrier. It can be about an understanding that what we resist, persists. It can be an attempt to deal with conflict in productive and assertive ways, seeking the win/win. It can be about modifying the home environment as much as possible to suit you, to transform relationships, to modify working hours or workplaces, to adopt different ways of communicating, to count one’s blessings, to forgive and forget, to cease from self-recrimination or self-criticism, to practice self-acceptance, to stop being a perfectionist, to live and let live, to abandon regret for the past and fear of the future, and to live in the present as much as possible. Many people will not even be aware of patterns of thought or behaviour that are working against them, and may need expert help from someone who can stand back, identify the self-defeating habits, and explain the ways in which these habits can be transformed.
- Social support: Friends, families, partners, support groups, volunteers or paid carers can all be sources of emotional support.
- Life coaching: A life coach can offer a different way of thinking about life’s challenges, help a person define their goals and then work towards them, offering moral support and focus.
- Counselling and psychology: Counsellors and psychologists do not prescribe medication, but can talk through issues and identify self – defeating thoughts and behaviours, and assist people to gradually change their thinking and the way they approach the world. Sometimes just working through worries and fears can be helpful, but in other instances a particular therapy such as mindfulness or cognitive behaviour therapy may be suggested. Some professionals specialise in counselling people who are experiencing chronic ill health, to assist them to deal with grief, accept their changed circumstances and make the most of what remains, perhaps changing direction to do things they were never free to do before.
- Psychiatric services: Psychiatrists are able to prescribe medication, and may do so after a brief consultation, and without any biochemical investigation prior to the prescription of a strong medication. Many of these drugs are alleged by some authorities to have very little antidepressant effect compared with other non-drug therapies, and many have a sedative effect, or other side effects, many of which can mimic the symptoms of MS, and some of which can be very dangerous, to the point of being life-threatening. Sedation for someone with MS who needs to remain as alert and active as possible to maintain balance and avoid deconditioning may not be helpful. Some of these drugs are addictive. A person with MS may want to investigate the side effects very thoroughly and weigh up the risks and benefits before taking one of these medications.
Many anxious and depressive states are thought to be caused by a lack of a particular calming neurotransmitter in the brain. Therefore, some antidepressants are based on making a particular neurotransmitter more available, but without necessarily supporting the production of those neurotransmitters. The notion that the neurotransmitter is in short supply may not necessarily be confirmed before the antidepressant is prescribed. It is just assumed from the clinical presentation.
There can often be a number of very different biochemical bases to anxiety or depression (such as a vitamin deficiency or endocrine problems like hypothyroidism, to name just two). There can even be biomechanical reasons, like pain and sleep apnoea, to name another two. There can also be many social and economic reasons for depression and anxiety. Not all mental disequilibrium is a mental illness. It can be a normal response to difficult circumstances. If the root cause of depression is not addressed, then a drug therapy may not be helpful long term. A person with MS could ask for a thorough examination of differential causes for any anxious or depressive state, before they accept any antidepressant drug therapy.
It is a well described phenomenon that there is something unknown in the MS disease process itself that can cause anxiety and depression. And then of course there is the pain, disability and loss of roles that the disease itself creates for the individual, which unsurprisingly can cause feelings of fear, grief, loss, anxiety and depression.
In addition to drug treatment a psychiatrist may also talk through these issues with a person with MS, and may also institute different non-drug therapies to assist the person to cope with these difficulties. - Diversional therapy: If a person with MS loses function and some of their former roles, they may not be able to do the things they used to enjoy, or in the same way. They may be left with a lot of time on their hands, and many barriers that have been created by MS may stand in the way of enjoying that time. Finding new and enjoyable ways to pass the time within their capacities, and being able to access the community is important for emotional health, and people with MS may need assistance to do this.
- Exercise: The health benefits of exercise are well known, including the positive effect on mental health. Unfortunately, for many with MS, neurological barriers make this difficult, and it may be difficult for the person with MS to reach the intensity and duration of exercise necessary to obtain the physical and mental benefits expected of exercise. Functional electrical stimulation, where accessible and affordable may reproduce those benefits however. In a subset of patients, exercise may make them feel worse and apart from their subjective experience, may also make them worse by objective standards, with increased pain, weakness, loss of walking capacity and sickness behaviours, similar to the reaction to exercise that is found in patients with chronic fatigue syndrome. In that case they will need expert assistance, encouragement and support with their exercise regime, and may need physiological support first, to rebuild their capacity to exercise.
- Meditation: Meditation may provide time out from stress and worry. Other health benefits have been claimed for meditation, and there are various types to choose from, including moving meditations. A person may need expert guidance with their study of meditation and this may create barriers to those with mobility issues. Even sitting in a meditation pose may prove difficult for people with MS, and they may need to adopt different postures.
Stress, anxiety, depression, and general emotional challenges seem to come with the territory of MS. Each individual circumstance is different, and will require a different approach. Those who are lucky enough to experience holistic treatment for MS may be offered some form of stress management for the unique challenges of living with a disabling, chronic disease. For the rest, they or their carers will need to recognise when support is needed, and actively seek it out.
Links:
This article on PNI explains how sickness behaviours can be triggered by both sickness and stress http://www.apa.org/monitor/dec01/anewtake.aspx
What might be missing?