We often focus solely on our physical health but looking after our mental health is also vital to our sense of wellbeing. Jo Johnson, a consultant neuropsychologist with a special interest in MS, introduces practical steps you can take to improve and maintain your mental wellbeing.
Mental health like physical health is determined by a number of factors including genetics, life events and also thoughts and actions. As MS can affect regions in the brain that control emotions, people living with MS may also experience changes in mental health that are neurological rather than the result of anything that is happening in day to day life.
Research suggests at least half of people with MS will experience mental health symptoms at some point, most commonly depression or anxiety. People with a family or personal history of these symptoms are more vulnerable. When you see your MS nurse, it may be worth discussing any previous experiences of mental health symptoms or instances of mental health problems in your family.
It is common for people to experience symptoms of low mood and anxiety in the first couple of years after a diagnosis of MS, with often very intense feelings in the early months. From a young age most people have an idea of how they want their life to progress. This might include having long-term partners, children, financial commitments and career paths.
A diagnosis of MS introduces uncertainty about the future and people often experience feelings of loss and grief at the thought of losing the life as they had planned it would be. Feelings might include sadness, tearfulness, disappointment, anxiety, anger and even guilt. It is not surprising to feel like this at times and for many these feelings may come and go as life moves forward. However, for some, they can persist and become a self-perpetuating state of low mood that starts to interfere with daily life. It helps to acknowledge and express these feelings. If you find it hard to talk about this to other people, keeping a journal of your honest thoughts and feelings can be beneficial.
The good news is there are things you can do to improve your mental health and to stay mentally well whatever your situation or diagnosis.
What can you do about it?
The first step is to realise that your mind requires care in the same way as your body. If for the whole of this year you eat high fat and sugary foods, smoke and don’t take any exercise, there is a good chance that by next year you will be less physically healthy than you are now. This principle is the same for mental health.
The first step is to learn what can be done to improve mental health. It then requires a conscious decision to prioritise and practise what helps.
It’s important to note that if you feel low or anxious most of the time, have trouble sleeping and have little or no interest in life, you need to speak to your GP as you may need medication first to improve.
If your symptoms are more variable or you are on medication, research shows that looking more closely at how you think and what you do can be as much help as taking pills. Here are five examples.
Jo’s top tips for staying mentally fit
From changing your internal soundtrack to focusing on the here and now, here are five ways you can maintain your mental wellbeing
1. Manage your thoughts
Everyone experiences thoughts that are unhelpful or upsetting from time to time. Be aware of these thoughts and their impact on mental health. Last year I published a book called ‘Shrinking The Smirch’. In the book we ask the reader to imagine their thoughts are being played on an imaginary iPod. Become aware of how much of the time you are listening to your mental iPod and how often it is playing unhelpful tunes. These could be to do with your MS or may be about other issues in your life. Playing those tunes over and over will make you feel sad, upset and fearful and make it harder to feel mentally well. Managing your thoughts needs practice.
Notice when you are listening to unhelpful thoughts and then imagine tugging out your mental iPod as if it were playing music you hate.
2. Learn to live in the now and spend less time in your head
Research shows that staying in the present moment helps mental health. Some people call this mindfulness but it just means concentrating on what is right in front of you instead of being on automatic pilot. Most of us spend a lot of time caught up in our heads – regretting the past, fearing the future or just trying to manage the challenges of the day. Getting hooked up into our heads causes stress but it also can mean that many moments of pleasure pass by unnoticed because we aren’t paying attention.
Take a moment to focus on what is happening in the here and now. What can you smell or see?
Are you hot or cold? Tense or relaxed?
3. Keep a gratitude diary
When life is tough it’s easy to lose sight of the good things. Research shows that recognising the good things that are happening strengthens the ability of the brain to focus on positive things.
At the end of each day, write down five things that have gone well or for which you are grateful.
4. Treat yourself with compassion
When you feel low, do you treat yourself like you would treat a friend and offer yourself support and understanding? Or do you tend to be a self bully and become harsh and critical? Unsurprisingly people who can show themselves kindness feel mentally better.
Be aware of what you say to yourself and try to be more friendly.
5. Think about food and mood and exercise
There is good evidence that a diet containing high sugar and fat, as well as too much alcohol, makes people more depressed and anxious. It is also true that a little regular exercise is better than anti-depressants for lots of people. Often people set themselves up to fail by setting unrealistic goals around food and exercise.
Try making small, achievable changes that are more likely to succeed – for instance, giving up butter on a Tuesday, parking the car slightly further from the school and walking the last bit or swapping one cup of coffee for water. If you can make even tiny changes but keep them up you will notice benefits to your body and your mind.
This article is part of the May 2015 issue of Open Door, the MS Trust’s quarterly newsletter.
Depression can be common in MS, either as a direct symptom or as a consequence of living with the condition. Find help to recognise and cope with depression here.
Anxiety is often linked to feelings of stress, depression or low mood, and is a common symptom for people living with MS. Find out more about what causes anxiety, and what you can do if you're experiencing it.
Find out how mindfulness practice can help you cope with the stress of life with MS, and try some of our video sessions.