Multiple sclerosis: Good stress management pays off

Healthy coping techniques can mitigate the negative impact of stress on the dysregulated immune system and disease activity in MS.

A large body of research describes a link between stress and clinical deterioration and the development of new brain lesions in MS, as we outlined in Part I. But there will always be some degree of stress in life, especially in people with a chronic disease as unpredictable as MS. Stress management strategies therefore have an important role to play.

Learning to recognise and cope with our own stress reactions

It has also long been known from other fields that health outcomes depend less on the stressor itself than on our response to the stress. People who have positive strategies for dealing with stress have better outcomes than those with negative attitudes. Thus, there is also evidence that healthy stress management techniques have anti-inflammatory effects and slow the development of new lesions.1-3 However, although often evident in clinical practice, scientific work in a biopsychosocial model of disease is sparse.

Many studies are unfortunately limited to occasional sessions with a psychotherapist. While this does show an effect, it would be more promising to also provide sufferers with techniques that enable them to incorporate stress management into their daily routine. Ideally, this will prevent energy-draining, negative emotions from building up to extreme levels in the first place. 

Mindfulness and relaxation techniques can help people pause and identify what is causing the most stress so they can take a step back. Instead of fixating on the negative things, the focus should be on being good to yourself, considering what might be good for you or who might help, patiently appreciating the small steps and remaining solution-oriented.

Physical activity appropriate to one's general condition, ideally outside in natural light, a non-toxic eating and sleeping routine, yoga or progressive muscle relaxation are proven, simple and accessible ways for everyone to dampen the stress response. Brief daily journaling ("What am I grateful for today?") has also been described as an effective way to consciously withdraw attention from negative thought patterns.

Breathing exercises as an immediate measure to calm stressed nervous systems

Meditation is also often recommended as a supportive measure for coping with mental stress as well as pain and fatigue.4,5 The influential coach and author Max Strom reflected on this in a (by the way, very worth watching) TED Talk6 something important: meditation is often recommended first - but although this is a valuable practice, this order is not ideal for many people. If someone is stressed to the breaking point and is told to sit quietly somewhere and think about nothing for 20 minutes, that's not going to work very well. Meditation is more advanced.

Actually, it would be more profitable to learn breathing exercises first, because these activate the vagus nerve, among other things, and sufferers usually feel better immediately - not eventually, but on the spot. An example is 4 7 8 breathing, an old yoga breathing exercise that you can do together during a short patient appointment, as well as before you go into a difficult situation or afterwards.6 Breathe in for 4 counts (always slowly through the nose and deep into the side ribs), hold for 7 and breathe out for 8. Repeat a few times. At the end, breathe in briefly once or twice more and (without counting and holding in between) breathe out again to allow the breathing to return to normal.

References
  1. Stress and MS | Overcoming Multiple Sclerosis. https://overcomingms.org/about-multiple-sclerosis/ms-encyclopedia/stress-and-ms.
  2. Mohr, D. C. et al. A randomized trial of stress management for the prevention of new brain lesions in MS. Neurology 79, 412–419 (2012).
  3. Heesen, C. & Gold, S. M. Don’t stress about it! Is stress management a disease-modifying therapy for multiple sclerosis? Neurology 79, 398–399 (2012).
  4. Gilbertson, R. M. & Klatt, M. D. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care 19, 225–231 (2017).
  5. Meditation for MS | Overcoming MS. https://overcomingms.org/recovery-program/meditation-for-ms.
  6. TEDx Talks. Breathe to Heal | Max Strom | TEDxCapeMay. https://www.youtube.com/watch?v=4Lb5L-VEm34 (2015).