Stress and MS            by J. Lamar Freed, Psy.D.
Dr. Freed is a psychologist in private practice. He has been diagnosed with MS since 1993.
In studies and by the experience of people with Multiple Sclerosis (MS), stress has been implicated in the onset or exacerbations of the disease. Yet stress is often misunderstood. Accurately understanding stress can be beneficial in keeping MS symptoms to a minimum and, in general, reducing one's overall vulnerability to ill health.
Stress was first observed by researcher Dr. Hans Selye early in this century and named the General Adaptation Syndrome. Selye observed that people were less healthy and showed distress when forced to make changes in lifestyle or environment. His work was suggestive in how we view stress, but it languished on the back shelves until Holmes and Rahe came out with a series of articles in 1967 to clearly demonstrate the effect of stress on human health.
Holmes and Rahe developed a life events scale that included 43 events, rated by volunteers according to the amount of adjustment required by each event. The highest rated event on the scale was the death of a spouse. Other events included marriage, loss of job, starting school, bankruptcy, and many others. These researchers placed the items in a questionnaire and scored each according to the rating they got from the first set of volunteers. Then they gave the questionnaire to people in an emergency room. They gave it both to the patients who were sick and to the people who accompanied them. They compared the scores. The result rocked the world of psychology and medicine: sick people had experienced far more of these life events in the year prior to their illness than the healthy people who brought them to the hospital emergency room.
Since these seminal studies the concept of stress has become increasingly important and recognized. Stress is now understood as the thing that happens to people when they are forced to adapt to new life circumstances. The greater the amount of change required, the greater the stress.
Items in Holmse and Rahe's
Social Readjustment Rating Scale:

Death of spouse
Marital separation
Jail term
Death of close family member
Personal injury or illness
Fired at work
Marital reconciliation
Change in health of family member
Sex difficulties
Gain of new family member
Business readjustment
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 inlaws
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
Mortgage or loan of less than $10,000
Change in sleeping habits
Change in number of family get-togethers
Change in eating habits
Minor violation of the law
These original studies have inspired a deluge of studies on stress. Stress has been implicated in heart disease, cancer, accidents, as well as MS and almost every other disease -- including the common cold. one whole area of study, health psychology, has risen from these roots. Almost every family physician has told patients that some benign symptom is "probably caused by stress."
Yet stress is still misunderstood. Stress is not the equivalent of anxiety. While anxiety prone individuals are likely to find their anxiety increasing with their stress, they also have anxiety in circumstances that are not new and to which they are not adapting. Similarly, people who suffer little or no anxiety are still likely to show the negative health effects of stressful life changes and adaptations regardless of their calm demeanor.
Another surprise to people looking at this area for the first time is that stress is not always a negative event. It is not always perceived by people under stress as bad. While lists of stressful events are dominated by negative stresses, they also include events that are very positive. Getting married, going to school, getting a new job, buying a house -- all these things demand adaptation and are therefore stressful. Yet they are seldom viewed as negative or as unwanted experiences.
Stress is what happens when we are forced to adjust to new life circumstances. Think about a plant that is moved from a cool spot with moderate light to a warmer, brighter spot. Even in what would be considered a better environment, the plant often fails to thrive for a period of time until it has adjusted. During this time of adjustment, it is more vulnerable to disease and more sensitive to shocks from the environment. Plant growers suggest that such a plant be left without water for a few days and that it be left undisturbed for even longer until it has reached a new equilibrium.
Like plants, humans have events in their lives that force them to adjust and adapt. Yet just as we are more complicated than plants, there are far more events that happen to us. Holmes and Rahe's original life events scale has been expanded by other researchers to include more events. The death of a spouse has been replaced at the top of the list by the death of child. Lists have been divided into positive and negative stress, and they have been expanded to include more than 120 items. The stressful value of buying a car, of promotion at work, of increase in income, of launching children, and many other things have been recognized.
Yet to understand stress, one must personalize one's experiences and understand one's own vulnerabilities. For example, the loss of a job would provide very different kinds of stress for different people. For a person in midlife who has highly identified with his or her job, the experience would be very stressful. But for a young person who was just starting out and had a list of jobs he or she would like to try, such a loss would require less adjustment. It could be even less stressful for a person who lost a part time job and was identified most directly with the role he or she played in the immediate family, in raising children or in keeping a home.
For people with MS, stress is even more individualized, because the disease may well add stresses and be reactive to stress in ways that complicate their lives substantially. Many MS bulletin boards on the Internet have examples of the kinds of stresses people face and how these stresses interact with the disease, with the life of the person with MS, and with his or her family.
It is important to understand stress and to monitor the life events to which one must adapt. Avoiding too much stress at one time will reduce one's overall burden of adaptation. One can make choices to not seek a new job, or to keep one's responsibilities at a lower level, or to avoid making certain changes. Doing so will reduce stress.
Ways To Increase
Resiliency Against Stress:

Get enough sleep
Eat a healthy diet
Exercise at least 3 times a week
Quit smoking
Use alcohol and caffeine in moderation
Keep up with your friends
Involve yourself in community activities
Have at least one close confidant
Have reasonable expectations
Yet some stresses are unavoidable because they are required by life's circumstances. Children grow up and leave, companies close, spouses get sick, parents die. Ideally one will organize the overall stress load to make the best use of one's adaptive resources. When successful, such management can only reduce one's vulnerability to the negative effects of stress.
Even when high stress is unavoidable, many researchers and clinicians believe one can reduce the impact of stress. One can buffer oneself from stress by staying in the best possible health with a reasonable amount of exercise and good diet. One can keep baseline commitments at a reasonable level so there is room for unexpected change. Responsibilities may be balanced with rewards. And maintaining a supportive group of family and friends who can be called upon for support is a powerful means of stress control, too.
Avoiding and managing stress will not cure MS. It cannot make one invulnerable to new episodes and it will not completely stop the progression of the disease. Indeed, researchers have looked at the other extreme on this scale and noticed the negative effects of not having enough stress in one's life. Nevertheless, high stress is the norm in this society and for most people with MS. And high stress is clearly associated with a corresponding vulnerability to ill health.
Think of it in a different way. By reducing stress we increase our resistance to diseases of all sorts. Regardless of how we think of it, paying attention to stress is a good idea.
For these reasons it is important for each person to understand stress and how it works for him or her. The benefit, while not necessarily specific to a particular symptom or disease, is that this approach will be helpful in reducing one's overall vulnerability to the whole range of potentially distressing and uncomfortable syndromes.
Revised 3/2006