MS and Stress: Recalibrating for the Holidays

MS and Stress: Recalibrating for the Holidays
A Conversation with Patricia Daily, LCSW

People with MS frequently say that stress makes their MS symptoms worse, so the question is, does stress make MS worse?

We need to think about this in two parts. Part one is to think about things that make the disease process in MS itself worse, that is, increase the risk of exacerbations and new lesions. There have been a lot of studies that have tried to determine whether stress causes exacerbations. There isn’t conclusive evidence that stress can make the MS disease process worse, although no one has ruled that out.

But part two of living with MS is – how are your symptoms doing and how are you feeling?  A lot of things can intensify symptoms.  Anything that stresses your body can make you feel worse.  Many people with MS don’t do well in the heat because heat can make MS symptoms more noticeable and troublesome.  It does not cause new lesions, however.  So, yes, things that cause stress in your life can cause stress in your body and make symptoms more intense and troublesome.  That’s not the same thing as causing new lesions.

We know that a lot of people have elevated stress during the holiday season and could experience a worsening of MS symptoms…

It is important to remember that situations are neutral.  It is the meaning that we attach to them that makes them stressful.  So, the holidays can be a time of a lot of stress because it’s supposed to be the perfect time and the perfect event. Everyone has an idealized notion about what the holidays are supposed to be like and everybody tries to get there - by, for example, baking 47 different kinds of cookies.  I just need to say that 47 different kinds of cookies won’t necessarily get you there.

In general, what have you have found to be some successful strategies for coping with stress, particularly around the holidays?

Last year, I had my knee replaced in the middle of November and so I was out for the holiday season. And I didn’t go into any stores – so I didn’t have to deal with any crowds or listen to any bad Christmas music.  That helped a great deal. Because crowds are exhausting and there’s a lot of bad Christmas music.

And I delegated. I made everybody else do things, like go get the tree. And we didn’t have our traditional arguments at the Christmas tree place. I just let it go.  We didn’t need the perfect tree.  Delegating some things really helped to ease the stress level.  I recognized that everything didn’t have to be perfect. We even bought some hors d'oeuvres at Costco if you want to know the truth. So you made choices that you wouldn’t necessarily have made if you hadn’t had knee surgery and sort of were forced to make those choices.

 I had no choice. I couldn’t do some things. And the great thing is – it was all okay. It worked out just fine.  I needed to make those choices and it worked for all of us.

Every year, our big holiday celebration is on Christmas Eve – we have a big dinner where everybody brings their favorite food. So for years, I’ve made things like homemade egg rolls, tamales, tortellini or empanadas or Chinese dumplings. And then everybody else brings stuff and it is all about the really fabulous food.  For me, the idea of buying stuff is just anathema.  But last year I bought the egg rolls. And actually it went off without a hitch and we had a great time.

But, all kidding aside, we all have traditions and ways we think things need to be done. Traditions are nice – they make us feel safe and secure.  A lot of us don’t like to give up traditions because they have meaning.  But I’ve found it’s useful to ask the question – what part of this tradition is really the important part? Was it the egg rolls?  Or was it being together?  My brother-in-law thought it was the egg rolls so he was a bit disappointed. But, for me, it was just being together with my family.

So, dealing with stress during the holidays has a lot to do with adaptation.  Is it hard for people to make adaptations?

Yes, because it can feel like something is being taken away from you. But you could also look at it as an opportunity to try something new.  So when you think about making changes for the holidays, you could say, “Well l couldn’t make 47 kinds of Christmas cookies anymore.” Or instead you could say, “I’m going to support the Girl Scouts - all my Christmas cookies are going to be Thin Mints.”  It’s an empowering choice to make.

There’s another thing to think about with traditions. We assume that the traditions that are important to us are important to everybody. So, I think sometimes when you think about changing holiday traditions, you think it’s going to break everybody’s heart and actually maybe it doesn’t.  We might have a notion in our minds about what it all needs to look like. Perhaps being able to say, “Okay, I can’t do the whole thing – I cannot do all 10 of these things or traditions.  I’m going to pick 5.”  It’s about making conscious choices, instead of being on automatic pilot for the whole thing.

What other strategies do you have for managing stress?

Stress uses up a lot of energy, a lot of juice. When people have MS they don’t have the same kind of energy reserves they used to – they don’t have the backup tank. They don’t have overdraft protection.

So think about your energy and stress as a finite quantity. And be aware that you need to make choices about how much energy you can take on just like you would do with a budget. You can say – alright, we can’t buy all of those things. We can buy some of those things. Which ones do we really want and how are we going to think about what’s important here?

So, it’s about prioritizing and thinking about how you can use your resources most effectively?

Yes.  You don’t have to go to every holiday party. You can choose not to go to the ones you don’t want to go to. During the holidays there are a lot of opportunities to overdo things.  So just be aware of that. There’s a lot of opportunities to overeat, overdrink and overspend.  You can use the fact that you can’t do everything you used to be able to do as an opportunity to think about what you really want to do.  It’s sort of a forced simplification.

And if people have identified coping strategies that help with stress, I would think that being more aware of those personalized strategies during the holiday season is important?

Yes, it is important to be aware of your particular stress-reducing strategies. If taking naps or attending a hydrotherapy session are good coping strategies for you, it’s important to not let the holiday season get in the way of those things for you.  

It’s really about recalibrating – thinking about simpler ways to do things. And that can take a while.

People always ask if you’re ready for the holidays.  The truth is - the holidays will come, they will happen, and it will be fine. So in the long run, nobody needs another cookie. And probably nobody needs another gift either. And everybody likes gift cards.  Whether you bake the cookies and get all the gifts bought or not.  The important part is to be able to enjoy it when it gets here.