Transcript Stress and Emotions in MS - Emotional Processing Therapy

Stress and Emotions in MS
Roger Baker
Professor of Clinical Psychology, Bournemouth University
Consultant Clinical Psychologist, National Health service
Paris 2013
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
“STRESS”
Hans Seyle
“Stress and disease, Science,
October 1955
“The Stress of life” 1956. New
York;Mc-Graw Hill
“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”
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.
₪
Mind & Body
Stress
• 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)
(Cohen et al 2008)
₪
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’
The Journey of the Person with
MS
Receiving a diagnosis of MS
Why me?
Why me?
Shattering the Assumptive World
• MS affects young people
• Totally changes their life plan
• Their future in work
relationships
having a family
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
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
Impact on social functioning
Relationships and friendships
Family functioning
Education
Employment
Finances
Sex life
Bringing up children
Contemplating the future
unpleasant
unpredictable
uncontrollable
Need to adjust after each
attack
Overall the “stress load” for the
person with MS is very high
Do stressful life events cause
exacerbations in MS?
A Prospective study of stressful life events
and exacerbations in MS
Buljevac, 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
“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
Meta-analysis of 14 studies of stressful life events
and exacerbation in MS
Mohr,Hart,Julian,Cox and Pelletier 2004
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)
Many people with MS adapt well to living with
the illness (Antonak and Livneh 1995, Brooks and Matson
1982)
Dennison, Moss-Morris and Chalder (2009)
reviewed 72 studies which investigated
what contributes to a good or a bad
psychological adjustment
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
Behavioural Factors
Problem focussed strategies
Seeking social support
Positive health behaviours
Social/environmental Factors
High perceived social support
Positive relationships with family/spouse
but what about emotions?
The review only reported negative
emotional styles
“Coping studies are plentiful and most have
demonstrated a consistent relationship
between certain (negative) emotionfocussed coping such as avoidance and
wishful thinking and worse adjustment”
Dennison, Moss-Morris & Chalder 2009
A Broader Emotional Model to understand
adjustment
STRESSFUL
EVENT
Worsening of symptoms
Relationship problem
Money problems
Stressful
Event
Appraisal
Of meaning
of event
memory
of event
stressful
event
Appraisal
Of meaning
of event
memory
of event
past memories
emotion schemas
EMOTIONAL EXPERIENCE
Feelings of:
Stressful
Event
memory
of event
Appraisal
Anxiety
Of stressful
event
Sadness
past memories
emotion schemas
Anger
₪
Impoverished emotional experience
“Poor emotional intelligence”
“Emotionally unaware”
“Alexithymic”
“mild asbergers”
“somatizer”
“Emotionally illiterate”
Mind & Body
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
past memories
emotion schemas
Anger
EMOTIONAL
EXPRESSION
Negative
control
Positive
control
CONTROL OF EMOTIONS
experience
event
expression
EMOTIONAL EXPERIENCE
feelings of;
STRESSFUL
EVENT
Appraisal
Of stressful
event
memory
of input
past memories
emotion schemas
Anxiety
Depression
anger
EMOTIONAL
EXPRESSION
Negative
control
Positive
control
CONTROL OF EMOTIONS
Event
experience
expression
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
EMOTIONAL
EXPRESSION
Anger
past memories
emotion schemas
Successful emotional processing
Negative
control
Positive
control
CONTROL OF EMOTIONS
Event
experience
expression
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
EMOTIONAL
EXPRESSION
Anger
past memories
emotion schemas
Successful emotional processing
Negative
control
Positive
control
CONTROL OF EMOTIONS
Event
experience
expression
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
EMOTIONAL
EXPRESSION
Anger
past memories
emotion schemas
Successful emotional processing
Negative
control
Positive
control
CONTROL OF EMOTIONS
Event
experience
expression
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
EMOTIONAL
EXPRESSION
Anger
past memories
emotion schemas
Successful emotional processing
Negative
control
Positive
control
CONTROL OF EMOTIONS
Event
experience
expression
EMOTIONAL EXPERIENCE
STRESSFUL
EVENT
memory
of event
Feelings of:
Appraisal
Anxiety
Of stressful
event
Sadness
EMOTIONAL
EXPRESSION
Anger
past memories
emotion schemas
Successful emotional processing
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
Behavioural Factors
Problem focussed strategies
Seeking social support
Positive health behaviours
Social/environmental Factors
High perceived social support
Positive relationships with family/spouse
Emotional factors assisting adjustment
Accept and listen to emotions
Talk about emotions and events to friend or
counsellor
Increased understanding of stressful event
Increased understanding of emotional life
Re-appraising stressful event
It is important to understand the person’s
emotional processing style
We need to consider emotional
processing style alongside
cognitive and behavioural factors
for a fuller understanding of coping
with the stresses of MS