Managing stress in multiple sclerosis

19 July 2023

Stress is a common and sometimes unavoidable part of life. What someone finds stressful and how it affects them varies from person to person. It’s not possible to remove all sources of stress, but it may be possible to control stress. This might be by changing the situation to limit the source of stress or by learning to change how you react to stressful events. This article looks at the causes of stress and ways to manage it.

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 our health may be threatened.

The stress reaction (also known as the fight or flight response) has an important purpose. It’s designed to help us survive in emergency situations. When we feel under threat, a cascade of automatic physiological reactions occurs to make us more able to deal with the threat. The body releases stress hormones (such as cortisol and adrenaline). Our heart rate rises and we see an increase in blood pressure. Muscles tense and blood glucose levels go up 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. 

These include:

Chronic stress can also suppress the immune system. This decreases our resistance to colds and flu and slows down wound healing. Behavioural and cognitive problems are also frequently experienced. So increased irritability and impaired memory and concentration are common.

Stress and MS

The belief that stress causes relapses is widespread amongst people with MS. But is there any scientific evidence to back this up?

A link between psychological stress and MS symptoms was first identified by Jean-Martin Charcot in 1868. Over the last 30 years or so, a growing number of studies have found a relationship between stressful life events and both the onset of MS and relapses.

Some studies have found people with MS are more likely to report stressful life events before their first symptoms. Other studies have found that people with MS who experienced distressing events had a higher risk of relapse than those who weren’t. Other studies also find an increased risk of developing new lesions within two months of the onset of a stressor. High-risk stressors include death of a close relative, family and work stresses and financial worries. As well as serious life events, 'daily hassles' unrelated to MS have also been linked with relapse.

Although some studies find a significant relationship between stress and relapse, many do not. So firm conclusions cannot be made. There are many unanswered questions. The mechanisms underlying stress and relapse are not fully understood. But the relationship between stress and the stability of the immune system is a likely pathway. Yet, it’s still 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 increase the production of glucocorticoids which suppress immune system activity). In contrast moderate stressors increase production of inflammatory cytokines which increase disease activity.

Managing stress in MS

Many people with MS find living with the uncertainty of the condition to be stressful. Learning how to manage stress effectively is an important skill for everyone. But it is particularly important for people with MS and for those who care for them. A survey of people with MS found that the majority wanted advice on the role of 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.

What are the early warning signs that you're getting stressed?

Everybody reacts to stress differently, but there are some common early warning signs.

  • Physical warning signs include headaches, fatigue and dizziness.
  • Emotional warning signs include anger, mood swings and inability to concentrate.
  • Behavioural warning signs include overreacting, clumsiness, over-reliance on alcohol or drugs and withdrawing from social relationships.

Keeping a stress diary

Many people find it useful to keep a stress diary. It can help in a variety of ways including identifying any patterns.

  • You can make links between stressful events, your reactions to them and any subsequent symptoms.
  • It can enhance feelings of control and help you manage your illness more effectively. Many of us find ourselves feeling worry, dread, or regret. Controlled worry time limits negativity, reduces anxiety and increases control.
  • By designating a time and a place for worrying (say, 8 to 8.30 pm each day).
  • You could make a written note of your worries anytime during the day (a three or four word reminder will do), but do not worry until the designated time.

You may find that some worries may recede during the day and others may be easier to handle. You could even team up with a 'worry partner' and share your 'worry time' with them.

Other ways to manage stress

There’s no quick fix for stress and no single coping strategy will work for everyone, but some other things you could try include:

  • discussing your worries with someone else
  • staying active which can help improve your mood and is a good way to let off steam
  • planning ahead to help you prioritise tasks or break them down into smaller more manageable tasks
  • relaxation or mindfulness techniques.

If you’ve tried some of these techniques and find they’re not helping, speak to your GP or MS nurse. They may be able to refer you to other sources of help such as stress management course, cognitive behavioural therapy or counselling.

Developed from an article written by Dr Gail Kinman, Reader in Occupational Health Psychology, University of Bedford in 2009.

Find out more

Stress and MS – from the MS Trust A to Z.

Brown RF, et al.
Relationship between stress and relapse in multiple sclerosis. Part 1. Important features.
Multiple Sclerosis 2006;12(4): 453-464.
Summary (link is external)
Mohr DC, et al.
Association between stressful life events and exacerbation in multiple sclerosis: a meta analysis.
British Medical Journal 2004;328(7442):731.
Full article (link is external)
Buljevac D, et al.
Self reported stressful life events and exacerbations in multiple sclerosis: prospective study.
British Medical Journal 2003;327(7416):646.
Full article (link is external)
Ackerman K, et al.
Stressful life events precede exacerbations of multiple sclerosis.
Psychosomatic Medicine 2002;64(6):916-920.
Summary (link is external)
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