WHAT IS THE NERVOUS SYSTEM
Multiple sclerosis is a disease that attacks the brain and spinal cord that make up our central nervous system (CNS). Therefore, it is important to understand what the nervous system is, and how it works. This is because regulation of the (CNS) plays a vital role in managing stress, and anxiety that often accompanies the disease (Briones-Buixassa, L. et al, 2015).
THE AUTONOMIC NERVOUS SYSTEM
This is the part that consists of two branches called the sympathetic and the parasympathetic nervous systems. They are interconnected and work together to regulate balance within the body. This state is known as homeostasis. Homeostasis is a term first coined by Walter Bradford Cannon in 1926. It refers to a reaction in the body that enables a state of stability when faced with external conditions (Godoy, L.D, et al, 2018).
THE SYMPATHETIC NERVOUS SYSTEM
This is the branch of the system that deals with our ‘fight or flight responses’. This is a reaction that prepares us for fearful situations, by activating stress hormones. Cortisol and adrenaline are released and you may become aware of this with a raised heart and breathing rate, and it is strongly associated with responses to anxiety.
THE PARASYMPATHETIC NERVOUS SYSTEM
This controls our recovery. It is the part of the CNS that is activated for relaxation, and is necessary for healthy digestion and the repair of the immune system. Activities that promote activation of this branch of the nervous system are meditation, and yoga.
WHY IS IT IMPORTANT TO REGULATE THE CENTRAL NERVOUS SYSTEM?
When we encounter changes in our environment our CNS responds accordingly. For example, by meditating and doing yoga your parasympathetic system is activated helping you to relax.
If you sense a stressor in your environment the sympathetic nervous system will help us adapt to alert us, so we can deal with the situation.
Following these CNS responses, for people experiencing acute stressors, their bodies return to normal once the stressor is removed. However, if the fear fight or flight response is prolonged, then this can cause our nervous systems to become dysregulated. This means your body will continue to remain in a state of high alert even once a trigger is removed. This can be unhealthy, and is linked to depression, anxiety and poor attention and memory, increasing the likelihood of developing mental illness (Ochoa-Morales, A. et. al, 2019). cite). Chronic stress that has been associated with nervous system dysregulation, include trauma, chronic illness and/or pain, and emotional exhaustion.
COMPONENTS OF NERVOUS SYSTEM REGULATION
Genetics and biology play a role. Evidence suggests that the chemicals released in our brain have an effect on our bodies, and can affect the way our cells behave (Bruno, A, et al. 2020).
Our thoughts, coping behaviours, cognitive functioning, emotions, self efficacy, and interpersonal relationships can help to regulate the nervous system by the release of calming hormones such as oxytocin.
Environmental factors such as societal issues, life history, family, and relationships impact upon our ability to cope with stress (Cibrian-Landeral, T. et al, 2018).
SELF REGULATION
There is a lot of evidence to suggest that your nervous system becomes programmed during your lifetime. This process is known as neuroplasticity (Voss, P. et al. 2017). Research has developed to understand the ways our minds are connected to bodily systems, and that our thoughts may have an impact on how our nervous system behaves. Therefore, understanding how your nervous system works, and how ‘homeostasis’ is a dynamic process that can be modified by forms of self care, it could help you to understand the importance of self compassion, and develop ways to regulate the stress you are exposed to both as part of your condition, but also in your day to day life.
OVERVIEW
Research suggests that normal life stressors can have a major impact upon your sense of well-being, and mood. It can affect behaviour and the state of physical and psychological well being. For healthy individuals short episodes of acute stress may not impose a health burden, but for patients with a MS, stress can exacerbate existing symptoms caused by the disease, and impair the ability to function (Khatibi, A. et al. 2020).
DOES STRESS CAUSE MS?
It is currently unknown as to whether stress is related to the onset of MS, but there is a wide body of evidence suggesting it can aggravate relapses and increase the likelihood of mental illness (Briones-Buixassa, L. et al, 2015). A systematic review of over two decades worth of research, investigates the relationship between stress and MS, and shows supporting evidence for how psychological stress can negatively influence the course of the disease (Artemiadis, A.K, et al. 2011).
COMPONENTS OF STRESS
All of us are unique. Therefore, components of external stress remain an individual experience, and are not by any means universal (Vijayasingham, L. 2018). For example, a person whose employment relies heavily on their physical capabilities, will be seriously impacted by mobility problems that accompany MS. However, for others who can commit to work based tasks in a seated position, this may not indicate a severe source of stress.
GETTING HELP
It may help you to validate your individual experiences of stress with your GP, and identify them as a significant factor within the onset or worsening of MS symptoms. This can widen the scope of discussion with your clinical support team, and improve the likelihood of attaining the appropriate treatment (Rocca, E, 2020).
PROCESSING APPARATUS
Our cognition controls our thoughts, memory, language, learning and perception. These 'executive functions' can become impacted by the stress of living with MS (Mikula, P. et al. 2021). These cognitive processes help to form beliefs, and attitudes, or unconscious emotional experiences that determine our responses to external situations, and can impact upon our behaviour and ability to cope with day to day life (Cibrian-Landeral, T. et al, 2018).
STRESS & THE PSYCHOLOGICAL RISK FACTOR FOR MENTAL ILLNESS
COGNITION - Memory impairment, poor concentration and judgement. Worry and anxiety can lead to negative confirmation bias:this can be defined as a tendency to confirm negative beliefs, rather than look for other more positive aspects of a situation (see symptoms & diagnosis) (Gromisch, E.S. et al, 2020).
EMOTION - Low mood, anxiety, depression, anger, feeling overwhelmed and isolated.
BEHAVIOUR - Diet, exercise, sleep patterns, social withdrawal, procrastinating and neglecting responsibilities, and susceptibility to substance abuse.
LOW SELF EFFICACY - A reduction in a person's ability to visualise overcoming challenges, low self worth and misjudgments around personal capabilities.
RUMINATION - Along with impaired reasoning and low self efficacy, rumination presents a psychological risk factor for developing mental illness. Rumination is a negative thought process that is repeatedly given an excess amount of analysis (Ochoa-Morales, A. et al. 2019).
SOCIAL RISK FACTORS
GRIEF & LOSS
Studies have shown that individuals who experience early attachment trauma, bereavement, or a stressful divorce are more susceptible to developing symptoms of MS. Whilst trauma induced stress has not yet been identified as a causal factor for the disease, it has been recognised that the onset of chronic stress diminishes healthy activity of the immune system. A single factor involving emotional stress may not be sufficient to cause a disease, but a combination of these may be seriously impactful (Papa, A, et al. 2021).
FINANCIAL CONCERNS
Individuals of lower socioeconomic status (SES), have been associated with higher rates of depression and anxiety and a reduced ability to cope with stress. A study from 2019 shows how patients of higher SES are more likely to engage in outdoor pursuits invoving exercise, and consume a healthier diet. This promotes resilience and brain development consistent with more adaptive coping mechanisms (Schwartz. C.E, et al, 2019). The role of SES may also impact upon social and economic resources available to patients, causing potential delays in diagnosis and treatment.
Conversley, research has shown that living in poverty is not necessarily a prerequisite for poor coping mechansisms associated with the onset of stress and illness. In some cases experiencing hardships during early life, can be a prerequisite for developing emotional resilience. However, current research in this domain needs further exploration, and individual familial dynamics of each patient need to be considered (Wister, A. et al, 2018).
PERSONALITY
Some personality traits can be identified as risk factors for poor coping and high levels of stress. A cross-sectional study conducted in 2011, investigated patients over a 20 year period, and was able to determine personal characteristics as predictors of maladaptive behaviours (Tziallas, D. et al, 2011). In particular 'neurotiscism' was a trait identified in those who have experienced stressful life events, and is linked to individuals becoming more susceptible to experiencing frustration and negative emotion.
The personality traits we acquire throughout life are a mixture of genetics and our environment, and therefore, are somewhat out of our control. However, by identifying certain traits that may make you more vulnerable to the negative effects of stress may help in setting goals towards changing certain thought patterns. Personality traits such as extraversion and conscientiousness were found to be more adaptive to daily stressors, and consistent with healthier coping styles (Strober, L.B. 2017).
ATTACHMENT RELATIONSHIPS
The influence of our early attachment relationships on our neurological and behavioural responses to stress have been strongly suspected. This connection has been demonstrated in non-human research by American Psychologist Harry Harlow and Seymour Levine over 50 years ago (Kentner, A, et al, 2019). The evidence suggests an association between a lack of early nurturing and poor stress management that can have a long term effect on our resilience to coping with stress later in life.
Whilst this phenomena has not been directly demonstrated on humans due to ethical considerations, MS patients reporting traumatic experiences of childhood neglect and abuse commonly show a lower resilience to stress (Artemiadis, A.K, et al, 2011).
Early childhood experiences that lead to chronic stress later in life, can also impact on how we see ourselves. If we perceive a lack of social support, it can reduce the likelihood of self compassion, and increase the risk of self harm and suicide. Therefore, it is vital that you discuss any consequences of early maternal care with your G.P, and promote opportunities for therapeutic interventions where necessary.
DEVELOPING RESILIENCE TO STRESS
Watch the video above to hear Fred Foley (Ph.D.), discussing how the stress of MS can worsen the condition. He also describes how feelings of frustration and anger are perfectly normal responses to living with MS, and you can help develop resilience to stress using relaxation techniques, such as mindful meditation and breathing exercises (National MS Society, 2010).