Stress and Emotions in MS

1. Stress and Emotions in MS Roger Baker Professor of Clinical Psychology, Bournemouth University Consultant Clinical Psychologist, National Health service Paris 2013

2. Summary of talk • Stress and the effect on the body • The stress of having MS • Do stressful life events effect MS symptoms? • How to cope with the stresses of MS • Emotions and how to cope well

3. “STRESS” Hans Seyle “Stress and disease, Science, October 1955 “The Stress of life” 1956. New York;Mc-Graw Hill

4. “a stressor” is a life event which stretches or strains the individual “stress” is the biological or psychological change in the individual as a result of the “stressor”

5. Stages of Stress“General Adaptation Syndrome” Aroused and Alert • 1) Awareness of distress: tension, agitation, reoccupation with an event. 2) Awareness of impaired performance: Poor concentration, loss of interest in things, clumsiness, making more errors. Struggle to cope 1) Weak, tired, listless, physical problems, signs of being run down. Exhaustion 1) The bodies resources become depleted, immune system affected, fatigue, physical illness more likely.

8. ₪ Mind & Body • Lowers immune functioning (DeRijk et al 1997) • Slows the rate of wound healing (Keicott-Glaser et al 1998) • Diminishes the effect of vaccines (Glaser et al 2000) • Reduces the gene expression of growth hormone in blood cells (Malarkey et al 1976) • Induces DNA damage (Dimitroglon et al 2003) • Affects the accuracy of DNA repair (Cohen et al 2000) Stress (Cohen et al 2008)

9. ₪ Mind & Body “The research supporting the hypothesis that frequent intense negative affect can directly damage the body is overwhelming” (Mayne 2000)Review in ‘Cognition & Emotion’

10. The Journey of the Person with MS

11. Receiving a diagnosis of MS

12. Why me?

13. Why me?

14. Shattering the Assumptive World • MS affects young people • Totally changes their life plan • Their future in work relationships having a family

15. Unpleasant symptoms Physical symptoms can include; Stiffness/ spasms / tremor / pain loss of function or feeling in limbs balance problems bowel and bladder control problems debilitating fatigue vision problems speech/ swallowing problems impaired sexual functioning

16. Unpleasant Symptoms Cognitive impairments can include; learning and memory problems remembering recent events and remembering to do things recall speed focusing attention, concentrating mental speed problem solving word finding

17. Impact on social functioning Relationships and friendships Family functioning Education Employment Finances Sex life Bringing up children

18. Contemplating the future

19. unpleasant

20. unpredictable

21. uncontrollable

22. Need to adjust after each attack

23. Overall the “stress load” for the person with MS is very high

24. Do stressful life events cause exacerbations in MS?

25. A Prospective study of stressful life events and exacerbations in MSBuljevac, Hop,Reedeker, et al 2003 • 73 MS patients rated stressful events each week • Neurological examination for exacerbation of symptoms • Also assessment of infections • Measured increased risk of exacerbations in weeks after stressful events vs exacerbations after non stressful weeks

27. “the risk for occurrence of exacerbation associated with a four week period with one stressful event in it was about double after four weeks without reported stress” Independently of the stress effect, infections also increased the risk of exacerbations

28. Meta-analysis of 14 studies of stressful life events and exacerbation in MSMohr,Hart,Julian,Cox and Pelletier 2004

29. Conclusion • The overall effect size for the impact of stress on MS exacerbations was d=0.53, which is clinically meaningful. • As a comparison the overall effect size for the benefits of beta interferon on MS exacerbations is d=0.36. • The findings have been confirmed using more objective neuroimaging markers of inflammation (Mohr et al 2000, Palumbo et al1998)

30. Many people with MS adapt well to living with the illness (Antonak and Livneh 1995, Brooks and Matson 1982)

31. Dennison, Moss-Morris and Chalder (2009) reviewed 72 studies which investigated what contributes to a good or a bad psychological adjustment

32. Factors assisting Psychological Adjustment Cognitive Factors Positive re-appraisal Perceived control over life situations Perceived control over MS Management Optimism Hope Benefit finding Acceptance of illness Spirituality

33. Behavioural Factors Problem focussed strategies Seeking social support Positive health behaviours Social/environmental Factors High perceived social support Positive relationships with family/spouse

34. but what about emotions?

35. The review only reported negative emotional styles “Coping studies are plentiful and most have demonstrated a consistent relationship between certain (negative) emotion-focussed coping such as avoidance and wishful thinking and worse adjustment” Dennison, Moss-Morris & Chalder 2009

36. A Broader Emotional Model to understand adjustment

37. STRESSFULEVENT

38. Worsening of symptoms

39. Relationship problem

40. Money problems

41. StressfulEvent Appraisal Of meaning of event memoryof event

42. stressfulevent Appraisal Of meaning of event memoryof event past memoriesemotion schemas

43. StressfulEvent Appraisal Of stressful event memoryof event past memoriesemotion schemas

44. ₪ Mind & Body “Poor emotional intelligence” “Emotionally unaware” “Alexithymic” “mild asbergers” “somatizer” “Emotionally illiterate” Impoverished emotional experience

46. STRESSFULEVENT EMOTIONAL EXPRESSION Appraisal Of stressful event memoryof event past memoriesemotion schemas

48. Negative control Positive control C O N T R O L O F E M O T I O N S experience event expression EMOTIONAL EXPRESSION STRESSFULEVENT Appraisal Of stressful event memoryof input past memoriesemotion schemas

49. Negative control Positive control C O N T R O L O F E M O T I O N S Event experience expression STRESSFULEVENT EMOTIONAL EXPRESSION Appraisal Of stressful event memoryof event past memoriesemotion schemas Successful emotional processing

50. Negative control Positive control C O N T R O L O F E M O T I O N S Event experience expression STRESSFULEVENT EMOTIONAL EXPRESSION Appraisal Of stressful event memoryof event past memoriesemotion schemas Successful emotional processing