Stress and MS: Cognitive Reframing and Stress Reduction

Patient Expert

When faced with stress, effective coping skills are your way to staying above the fray.   Stress itself is not necessarily bad.   But an individual's perception and respond to a stressful event is very important.

General stress management techniques include: eating a balanced healthy diet; keeping physically, socially and intellectually active; taking prescribed medications as directed; getting adequate amounts of sleep; and resting if fatigued.   Strive for cardiovascular health.

Maintain a sense of humor and positive attitude.   Be aware of lifestyle habits that can negatively impact your physical and mental health.   Take advantage of cognitive and/or physical aids and strategies when needed.   Cognitive reframing can be one of the most effective stress management techniques available.

What is cognitive reframing?

Cognitive reframing, also called cognitive restructuring, consists of changing the way we view things, whether a situation, idea or event.   How we think affects what we feel, and how we feel affects what we do (or don't do).   Cognitive reframing takes practice, but by revising our habits of thinking, we can alter how we feel in a positive manner and change what actions we take in response to our thoughts.

Here is an example of a how cognitive reframing (i.e. changing your thoughts) can help you deal with a potentially stressful and derailing situation:

Sarah has decided to get back into better physical shape, and lose 15 pounds.   She begins her "New Year, New You" program and successfully attends for eight consecutive days, losing six pounds already.   Then she misses Tuesday because her son is home with a fever.   She means to go, but her son needs her... Oh, and there is an unexpected work deadline...

Response #1:   Sarah thinks, "I've missed Tuesday.   I've done it again.   Iâ�™m failing.   I am such a loser."   She feels terrible, deflated, sad, depressed.   She does nothing, drowns her sorrows in chocolate ice cream, and does not achieve her goals.

Response #2:   Sarah thinks, "I've missed Tuesday.   I've done it again.   But I was a good Mom today, and I will find time tomorrow."   She feels OK with herself, satisfied with her parenting, and optimistic about tomorrow.   She works out on Wednesday, continues the program, and   achieves her goals.

In the first example, Sarah uses negative self-talk, which is extremely psychologically damaging and can be physically debilitating.   Negative self-talk is often definitional (e.g. I am a loser) and easily becomes detrimental emotionally.   Positive self-talk more often will be descriptive (e.g. I was a good mom today) and help to foster optimism.

What is optimism?

"Optimism refers to the way we interpret events - both good and bad - which affects our ability to face life's challenges, which in turn affects mood, self-esteem, life satisfaction, and happiness." - Dr. Mary Beth Quig

Optimism helps people cope with setbacks, failures, and disappointments.   It inoculates against depression and allows people to try more and achieve more.   Optimism contributes to resilience and can lead to improved immune function, better health, and a longer life.

The way a person perceives and responds to stress, or a stressful event, may be more important than the stress itself.   Often it is not the actual amount of stress which is important for determining outcomes, but a person's coping skills.

One very important coping skill, or collection of skills, is the ability to reduce and manage stress.   Dr. Quig provided the following stress reduction techniques as effective strategies in facing physical and cognitive stress.

Learning how to relax

  • Deep muscle relaxation:   Beginning at your feet and progressing up to your face, deeply relax all your muscles daily.
  • Deep breathing exercise.
  • Guided imagery or visualization:   Picture soothing, ideal scene.
  • Meditation:   Spend 20 minutes daily in silence; observe breathing. As you breathe out say the word "one" silently to yourself.
  • Stretching exercises, including yoga.
  • Biofeedback training.
  • Self-hypnosis and auto suggestion:   Suggest positive thoughts to yourself in a relaxed state.
  • Behavioral rehearsal or desensitization:   Practice or visualize yourself behaving ideally in difficult situations.
  • Massage.

Resisting stress

  • Adequate rest and sleep.
  • Improve nutrition and eating habits.
  • Effective exercise and fitness program.
  • Moderate use of alcohol, caffeine, salt and sugar.
  • Eliminate smoking.
  • Fresh air, water and sunshine.
  • Optimistic mental outlook.

Reducing stress at work and home

  • Pace yourself - take a relaxation break.
  • Set goals - learn to manage time well.
  • Re-evaluate values and goals. Take stock of yourself.
  • Learn to make the environment as healthy as possible.
  • Learn to express self and communicate effectively.
  • Don't try to move boulders or change an immovable situation. Accept what is or decide to work to change yourself - never others.
  • Adopt a problem-solving and "can do" attitude.
  • Enjoy yourself and others - give yourself treats.

For more information regarding stress and Dr. Quig's presentation, please read Stress and MS: The Mind-Body Connection.

"Dames Who Reframe" - Presentation by Dr. Mary Beth Quig at NMSS Annual Women's Breakfast in Vienna, VA, on Saturday, September 15, 2012.

"Cognitive restructuring: Challenging your thinking" by Diane LaChapelle, Accessed September 20, 2012.