Symptom Management

Five ways to deal with emotional stress

By Amy B. Sullivan, Psy.D., ABPP

Multiple sclerosis is a disease that has both physical and emotional symptoms. Emotional symptoms such as stress, anxiety, worry, fear, frustration, and depression are common, and can be both a reaction to the disease and a symptom of the disease. Additional reasons why an individual with MS may have neuropsychiatric symptoms include the MS disease course, a reaction to a disease-modifying therapy, or a biologically mediated reaction/pathophysiology.

Coping with the uncertainty of the disease is one of the major challenges of MS, and both anxiety and depression are amongst the most common complaints. They are seen at a higher rate in people with MS than in the general population. Anxiety, specifically, is reported in approximately 43 percent of MS patients and, for the person experiencing it, anxiety can be exhausting and very difficult to manage.

Given the high prevalence of anxiety in the MS population, it is striking that only 34 percent of those who experience debilitating anxiety have been diagnosed. Of those diagnosed, 52 percent were not being treated. Additionally, studies have shown that people with MS and anxiety were more likely to be depressed, drink to excess, and have suicidal thoughts.

Anxiety looks and feels different to each person, but common emotional symptoms include excessive nervousness or worry, difficulty controlling worry, fear, and apprehension. Physiological symptoms of anxiety can include butterflies in the stomach, increased heart rate, rapid breathing, cognitive complaints, fatigue, and more.

If you find that you are noticing symptoms of anxiety, it is important to learn to cope with it, as excess stress and anxiety can lead to worse MS disease outcomes, overall poorer physical health, and difficulty in both relationships and everyday function. Here are some suggestions to help cope with anxiety.

1. Recognize symptoms and seek professional help: First and most importantly, if you find that your anxiety has affected your daily function or that you cannot cope with it alone, please seek help. There are many trained mental health professionals, who practice cognitive behavioral therapy and teach stress management skills. These skills can help to enhance your coping strategies. By learning coping skills and stress management, there is reason for confidence that MS disease outcomes are more positive. Check out #NormalizeNotStigmatize on Twitter to find tweets about mental health issues specific to MS.

2. Get outside: Do you ever notice that you feel happier and have less stress when you are outside with nature? Test it out and experiment for yourself. Take it one step further and practice skills of mindfulness, or being in the moment. Try this: when you are outside, if you are able, find a comfortable place to sit in the grass and notice your senses. What do you hear? What do you see? What do you physically feel? What do you smell? What do you taste? You will notice that while doing this experiment, you are likely focused only on the present moment and not thinking about the past or the future (whether 10 minutes or 10 years in the future). Ahhh, I feel more stress-free just visualizing this experiment.

3. Invest in meaningful relationships: Meaningful relationships serve as a buffer to stress. Invest the time to develop a deeper relationship with someone that is important to you by giving them your attention and time. When you do this, you are also receiving an increase of endorphins (the feel good hormones), which help reduce anxiety and have many other positive

health benefits. Try asking a friend for coffee, lunch, or a walk. You could also go to a colleague’s office, instead of interacting through electronics. We live in a world where connection is instant, at our fingertips, and because of this, the ability to build strong relationships may suffer. Having only a few deeper and more meaningful relationships can be more beneficial than many distant, shallower connections, like through social media or in a large community or work group.

4. Get better sleep: Sleep issues in people with MS can lead to both physical and emotional challenges. Specific to anxiety, sleep disturbance can lead to worsening anxiety, fear, irritability, and stress. In addition, people with MS are up to three times more likely to experience sleep disturbances than the general population, yet are generally undiagnosed and untreated. To help, attempt to keep a sleep-wake schedule not just during the week, but also on the weekends. Also, try having a worry log next to your bed, this can be helpful if you are stuck on some worries or ruminating thoughts as you are winding down. Instead of keeping the thoughts in your head, have a journal next to your bed, write them down, and address them in the morning.

5. Practice deep breathing and mindfulness techniques: Practice deep diaphragmatic breathing or utilize mindfulness techniques as described earlier. Here’s how you can do deep breathing. Sit or lie in a comfortable position. Next put one hand on your chest and the other on your diaphragm, which is the area below your ribs. Now, take a slow, steady breath in and allow your breath to push out the hand that is on your diaphragm. Notice if your breath is stopping in your chest, which does not oxygenate your body and relaxing. Do this for as many times as you can, aiming for five minutes.