Understanding Stress and Multiple Sclerosis (MS)
Stressful life events include everything from births to deaths, marriages and divorce, starting school and graduating. Almost by definition, life jumps from one stressful moment to the next. But people with MS (PWMS) have an added complication that forces us to pay more attention to these life events: an unpredictable, fatiguing, and sometimes debilitating illness.
There are studies that say stress can trigger the onset of MS or increase the odds for new exacerbations. But more studies fail to confirm these findings. On the other hand, PWMS regularly report that their diagnosis followed a stressful time, or that they experience more symptoms after major events. While research is important, it should go without saying that PWMS ought to make an effort to understand stress and how it influences our lives.
Dr. Hans Selye first examined stress early in the last century and called it the General Adaptation Syndrome. He reported that people showed distress and their health declined when forced to make changes in lifestyle or in their environment. But his work languished until Holmes and Rahe published a series of articles in 1967 that documented the effect of stress on human health.
They developed a life events scale that included 43 items (see below). Volunteers rated the amount of adjustment required by each event. The death of a spouse ranked highest. Other events included marriage, job loss, starting school, and bankruptcy. Holmes and Rahe accumulated the items on the list by having a group of people rank life events according to their impact. Once they had a reliable list of life events, they had two groups of people report how many of these events they’d experienced in the past year. The first group included only hospitalized patients. The second group included the healthy people who accompanied these patients to the hospital. When they compared the scores, the result rocked the world of psychology and medicine: sick people had experienced far more stressful life events than the healthy people who accompanied them.
Fifty years later, stress is a household word. It’s important to note, however, that researchers define stress differently than the conventional usage. Academics understand stress like Hans Selye: an adaptation syndrome. Stress for any individual is the accumulated changes they are forced to make. The greater the need to change, the greater the stress.
A deluge of studies on stress has followed the original research. It’s implicated in heart disease, cancer, accidents, and almost every other disease including the common cold. An area of study and practice, Health Psychology, has risen from these roots. Almost every family physician has told patients that some benign symptom is caused by stress.
Yet stress is misunderstood. It’s often thought to be felt, like anxiety. But it’s not something we feel. Anxiety may accompany stress. But stress still wears on us, even when we feel calm. People prone to anxiety may find that stress increases it. But, even without stress, they are still likely to have anxiety. Those who have little or no anxiety are still vulnerable to illness after stressful events.
Many people are surprised to learn that stress may not only come from negative events. Things like a new marriage, the start of school, getting a raise, or buying a house, also demand adaptation. While they are positive experiences for most people, they are still stressful.
Researchers have revised and expanded Holmes and Rahe’s original life events scale. The death of a spouse, once thought to be the most stressful event, has been replaced. Now we know it’s more stressful to lose a child. Newer lists may include a hundred items or more and often include positive events, like buying a car, getting a promotion, or even a raise. More recent work has also examined the traumatic stress of armed conflict in war zones and other violent events as well as what makes some people more resilient and able to resist the effects of stress.
Another surprise is that we’ve found there are negative effects from insufficient stress. Ironic as it may seem, a certain amount of change, challenge, and stimulation are good for us. People whose MS has advanced do well to remember this. We need an environment that stimulates and challenges us despite isolation.
Each person experiences stress in a different way. Consider the loss of a job. For a person whose personal identity is wrapped up in a professional position and whose paycheck supports a family, job loss ranks high on the list of stresses. For a young person who is starting out in the workforce and has a list of jobs he or she would like to try, a job change might have less impact. Someone whose primary activity is raising a family and managing a household might experience very little stress if the work runs out at a part-time job.
Other individual differences also influence how we experience stress. For example, introverts with MS seem to have an easier time managing isolation and the transition to a more sedentary lifestyle. Extroverts can experience reduced activity as a more significant loss, requiring a greater adjustment. For everyone, individual differences in personality, history, and circumstances influence how and how much stress does damage.
For PWMS the disease itself causes stress. These stresses can include the loss of work, physical discomfort, reduced social activity, managing medications and treatments, reduced income, the loss of marriages or other relationships, and other changes. Adjusting to the uncertainty of the disease, itself, is a major stress.
Can the unpredictable be managed? Sometimes. While stress is unavoidable, there are ways to reduce its impact. People can find and develop buffers. Regular exercise (adjusted to match a person’s capacity) and a good diet will help build resiliency. Avoiding cigarettes, excessive use of alcohol and recreational drugs contributes. So will meditation, yoga, mindfulness practices and other mental disciplines that increase psychological fitness. A supportive group of family and friends who can be called upon for emotional or even material support decreases our vulnerability. And it will never hurt to have regular check-ins with a trusted psychologist, counselor or other mental health professional, particularly in light of the increased vulnerability PWMS have for depression and anxiety.
Stress control will not cure MS. An increase in resiliency will not make us immune to other diseases or stop MS progression. But no one contests the value of increased resiliency and a solid buffer to protect us from the effect stress might have. Stress happens. It pays to be prepared.
Updated 07/14/2017. This article may be printed or posted without permission, but not without attribution.
The items in Holmes and Rahe’s Social Readjustment Rating Scale in rank order:
Death of spouse
Death of close family member
Personal injury or illness
Fired at work
Change in health of family member
Gain of new family member
Change in financial state
Death of close friend
Change to different line of work
Change in number of arguments with spouse
Mortgage over $10,000
Foreclosure of mortgage or loan
Change of responsibilities at work
Son or daughter leaving home
Trouble with in laws
Outstanding personal achievement
Wife begin or stop work
Begin or end school
Change in living conditions
Revision of personal habits
Trouble with boss
Change in work hours or conditions
Change in residence
Change in schools
Change in recreation
Change in church activities
Change in social activities
Mortgage or loan less the $10,000
Change in sleeping habits
Change in number of family get-togethers
Change in eating habits
Minor violation of the law
J. Lamar Freed, Psy.D. practiced psychology in Pennsylvania until his retirement in 2015. He continues to be active in the MS Society, with iConquer MS and with online and in-person support groups.