Mental health and MS: Managing anxiety

23 April 2020

In the second blog of a new series focusing on mental health and MS, Will Berard writes about his experience of managing anxiety. 

Spider-Man, the bespandexed Marvel superhero, has a spider sense that warns him of danger before he can spot it. Although posited as one of the many ways in which he does, allegedly, whatever a spider can, such a sense is actually a very mammalian, nay, reptilian, affair.

The acute stress response, better known as the fight-or-flight response, starts in the amygdala and hypothalamus, regions of the brain shared by all complex vertebrates. Even Spider-Man. Needless to say, demyelinating lesions in those areas will disrupt this finely-balanced system: this is the root of MS-induced anxiety.

Anxiety is simply an inappropriate (or disproportionate*) triggering of the fight-or-flight response. It is the (mis-)activation of those evolutionary ancient neural pathways, ones that came in useful when reacting to the proverbial sabre-toothed tiger, but are somewhat of an inconvenience when the perceived threat is LIDL being out of frozen broccoli.

We’re all wired to spot threats and respond physiologically to them before our conscious mind has had a chance to identify them. In fact, we’ll often take our own threat response as a primary stimulus, and only then attempt to consciously identify, in our environment, the object that has triggered it. Not always, it must be said, correctly.

I find it easier to think of anxiety in MS as a purely physiological symptom, disconnected from any actual, “real world” stressors. It is obviously a theoretical viewpoint, as no one can abstract away the slings and arrows of outrageous fortune, particularly when one of them is having to live with MS. But it is helpful to address anxiety on its own, without adding to it the myriad worries of daily life.

As an occasional performer of stand-up comedy, I’m no stranger to stage fright. Nerves feel very similar to anxiety. So much so, in fact, that I wasn’t always able to distinguish between them myself. The physiological manifestation is identical: both involve a fight-or-flight response; but their object and underlying rationale is different. The same sensations take a positive or negative colour depending on the cognitive framing.

This was an important realisation for me: the emotional charge of the stress response can be inverted simply by looking at it differently. I must have known this, on some level: it is the central principle underpinning CBT, for instance; but it took this personal experience of “good nerves” to make me realise it. Now, whenever I feel anxious, I try to think of it as excitement (“LIDL is out of frozen broccoli? What an adventure, maybe Iceland has some!”). It doesn’t always work, but it’s a useful additional trick in the mental health toolbox.

A deliberate, self-inflicted triggering of the stress response (for that is, ultimately, what stepping on a stage and telling jokes at a bunch of strangers boils down to) helps me regain a sense of agency over it. I can experience it on my terms, in a safe environment, with, let’s face it, very little at stake.

Here again, the point I am making is applicable to any type of anxiety, whatever its origin. However, when it comes to anxiety in MS, I think there may even be a neurological basis to the benefits of performance anxiety. In the spirit of parity of esteem, allow me to make a detour via a physical symptom to illustrate.

I practise yoga to help with MS-induced stiffness**. Working muscles through their full range of extension and flexion helps not only through the mechanical stretching and relaxing of tissue, but also by calibrating the underlying neural network. By getting a sense of the whole span, I am in effect teaching my nervous system what the baseline of muscle tone should be.

Deliberately facing situations that make me apprehensive, and doing so mindfully and consciously, is the same principle. It’s about calibrating the threat-sense. A large part of the appeal of horror films proceeds from this idea. So too do initiation rituals, which feature trials and ordeals that are, ultimately, scary-but-safe.

As a matter of fact, receiving a MS diagnosis is one such ordeal. Like all traumatic, life-changing events, it puts things in perspective. Which is nothing but a re-calibration of what matters. Suddenly, worries and concerns that were a Big Deal are revealed to be trivial. Maybe there are more important things to worry about than one’s supply of frozen broccoli.


*) This ties in with emotional lability, which will be the object of a future article in this series.

**) This should not be construed as medical advice. The jury is still very much out on this when it comes to actual research.

*These are the views of Will and not those of the MS Trust*