Stress and Multiple Sclerosis: Protecting Cognitive Functions from Anxiety

Living with multiple sclerosis is in itself a considerable source of stress: the uncertainty about the progression of the disease, the daily management of symptoms, the impact on professional and personal life. This stress, when it becomes chronic, is not only unpleasant to live with: it can genuinely worsen MS symptoms, including cognitive disorders. Understanding the link between stress and cognition, and learning to effectively manage stress, becomes a major challenge to preserve cognitive abilities.

Stress: an enemy of the brain

Stress is a normal physiological reaction to a perceived threatening or difficult situation. In the short term, it can even be useful by mobilizing our resources to face a challenge. But when stress becomes chronic, it turns into a real poison for the body and especially for the brain. Stress hormones, particularly cortisol, which are beneficial in small doses occasionally, become detrimental when secreted continuously.

The brain is particularly vulnerable to chronic stress. The hippocampus, this crucial structure for memory and learning, is very sensitive to the effects of cortisol and can even see its volume decrease under the effect of prolonged stress. The prefrontal cortex, the seat of executive functions such as planning and decision-making, is also affected. For people with MS whose brains are already weakened by the disease, these harmful effects of stress are even more problematic.

Stress and MS: a two-way relationship

The relationship between stress and multiple sclerosis is complex and bidirectional. On one hand, MS itself is a major source of stress: the initial diagnosis is a shock, the uncertainty about the future is anxiety-inducing, the daily management of symptoms is challenging, and the impact on professional and social life can be considerable. On the other hand, stress can influence the course of the disease by worsening symptoms and potentially promoting relapses.

Stress as a trigger for relapses

Several scientific studies have shown a link between major stressful events and the triggering of MS relapses. Bereavement, divorce, job loss, major conflict: these intense stress situations seem capable of precipitating a relapse in some patients. The likely mechanism involves the effect of stress on the immune system, which is already dysregulated in MS.

It is important to nuance: not all relapses are triggered by stress, and not all stressful situations cause a relapse. The relationship is statistical and probabilistic, not deterministic. That said, this association fully justifies efforts to better manage stress daily, not only for quality of life but also potentially for the progression of the disease.

Stress as a symptom amplifier

Even outside of relapses, stress can amplify existing MS symptoms. Fatigue, already so present in this disease, is considerably worsened by stress. Cognitive disorders become more pronounced: memory falters more, concentration becomes more difficult, the slowdown accentuates. Pain can intensify, sleep deteriorates, creating a harmful vicious circle.

It took me a long time to link my stress level to my symptoms. When I started really working on stress management, I was amazed to see how much my fatigue and concentration difficulties improved. It's as if stress added an additional layer of handicap that I could control.

Sandrine, 43 years old, MS for 8 years

Specific impact of stress on cognitive functions

Cognitive functions are particularly vulnerable to stress, and this for specific neurobiological reasons. Understanding these mechanisms helps to realize the importance of stress management and motivates the implementation of effective strategies.

Memory under pressure

Stress affects memory at several levels. First, it disrupts encoding: under stress, we find it harder to record new information because our attention is captured by the source of stress. Then, chronic stress can damage the hippocampus, a key structure of memory, reducing its ability to consolidate memories. Finally, stress can block the retrieval of memories: it's the famous memory lapse during an exam or speaking in public.

For people with MS who already have memory fragilities related to the disease, this additional impact of stress can be particularly disabling on a daily basis. An occasional forgetfulness can become a recurring problem if the stress level remains high permanently.

Attention scattered by anxiety

Anxiety, a major component of chronic stress, is a real attention thief. An anxious mind is constantly on alert, watching for potential threats, ruminating on worries. This permanent vigilance consumes a large part of the attentional resources, leaving little capacity available to focus on ongoing tasks. The result is difficulty maintaining attention, increased distractibility, and a sense of mental scattering.

Weakened executive functions

Executive functions, which allow us to plan, organize, make decisions, and adapt to new situations, are particularly sensitive to stress. The prefrontal cortex, the seat of these functions, operates optimally in a state of relative calm. Under stress, its activity is disrupted in favor of more primitive brain regions involved in the survival reaction.

Concretely, this translates into difficulties making decisions (even simple ones), a tendency to procrastinate, a reduced ability to plan and organize activities, and a reduced mental flexibility. These effects, added to executive dysfunctions that MS can already cause, can significantly impact daily and professional life.

Effective stress management techniques

The good news is that stress, even if it is a reality of life with MS, can be effectively managed. Many techniques have proven their effectiveness in reducing stress levels and its harmful effects on the brain. The important thing is to find the ones that suit you and practice them regularly.

Breathing: the most accessible lever

Breathing is the only physiological process that is both automatic and voluntarily controllable. This particularity makes it a powerful lever to influence our stress state. Slow and deep breathing activates the parasympathetic nervous system, which promotes relaxation and recovery, thus counteracting the effects of the sympathetic system activated by stress.

• Abdominal breathing: Inhale slowly through the nose while inflating the belly, exhale slowly through the mouth while pulling in the belly. Practice for 5 minutes for an immediate calming effect.
• Cardiac coherence: Inhale for 5 seconds, exhale for 5 seconds, 6 cycles per minute. Practice for 5 minutes, 3 times a day for lasting effects on stress.
• 4-7-8 breathing: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds. Very effective technique to calm acute anxiety.

Mindfulness meditation

Mindfulness meditation has been the subject of numerous scientific studies demonstrating its effectiveness in reducing stress and anxiety. It involves focusing attention on the present moment, without judgment, observing thoughts, emotions, and sensations without clinging to them. Practicing regularly, it permanently modifies the structure and functioning of the brain in a way favorable to stress management.

Specific studies on MS have shown that mindfulness meditation can improve the quality of life, reduce fatigue, decrease anxiety and depression, and potentially even improve certain cognitive aspects. It can be practiced alone using guided apps or in structured programs like MBSR (Mindfulness-Based Stress Reduction).

Physical activity: natural anti-stress

Physical exercise is one of the most effective and scientifically documented anti-stress methods. It triggers the release of endorphins, those well-being hormones, reduces cortisol levels, improves sleep, and boosts self-confidence. For people with MS, appropriate physical activity is doubly beneficial: it helps manage stress while maintaining physical capacities and potentially protecting the brain.

• Walking: Accessible to most people, walking in nature combines the benefits of exercise and contact with nature
• Swimming: Particularly suitable for MS because it avoids overheating and spares the joints
• Yoga: Combines gentle physical exercise, breathing, and meditation for a complete anti-stress effect
• Tai-chi: Slow and fluid movements that promote relaxation and balance
• Stationary bike: Allows for dosing effort and avoiding falls

Relaxation techniques

Various relaxation techniques can help reduce the physical and mental tension related to stress. Jacobson's progressive relaxation, which involves contracting and then releasing different muscle groups successively, is particularly effective in raising awareness of body tensions and freeing them. Schultz's autogenic training uses autosuggestion to induce a deep relaxation state.

Sophrology, very popular in France, combines relaxation, breathing, and positive visualization. It can be particularly useful for people with MS, helping them change their relationship with the disease and develop internal resources to face difficulties.

Reorganizing life to reduce stress

Beyond ad hoc stress management techniques, a more global reflection on life organization can reduce sources of chronic stress. This may involve sometimes significant changes, but the benefits on quality of life and cognitive health can be considerable.

Learning to say no

Many people with MS exhaust themselves trying to maintain the same pace and commitments as before the diagnosis. Learning to say no, setting limits, delegating certain tasks is essential to preserve energy and reduce stress. This is not a sign of weakness, but rather an intelligent management of limited resources.

Simplifying and prioritizing

Simplifying life by eliminating useless sources of stress and focusing on the essentials can considerably lighten the mental load. This can involve social commitments, material possessions, household tasks, and professional projects. Regularly asking the question: is it really important? does it make me feel good? allows sorting and refocusing.

Stress and cognitive stimulation: finding the balance

Cognitive stimulation with programs like EDITH and JOE is part of important strategies to maintain cognitive abilities with MS. But how to train effectively when stressed? And can cognitive training itself help manage stress?

Adapting training to stress level

Days of intense stress are not the best for demanding cognitive exercises. The stressed brain has fewer available resources, and performances will be poorer, which can create frustration and additional stress. On these days, prioritize EDITH with its exercises without time pressure and adapted difficulty levels. Save JOE and its timed challenges for calmer periods.

Cognitive training as an anti-stress break

Paradoxically, cognitive exercises can themselves become a moment of relaxation and disconnection from stress. Focusing on a game, solving a puzzle, taking on a small challenge: these activities absorb attention and divert it from anxious rumination. Many EDITH and JOE users report that their daily sessions have become a soothing ritual, a moment for themselves that breaks the daily worries.

My daily 15 minutes of games on EDITH have become my meditation time. I focus on the exercises, my mind stops going in circles over my worries, and I end my session more relaxed than at the beginning. It's my favorite anti-stress.

Helene, 51 years old, MS for 12 years

When to consult for stress

If despite your efforts stress remains overwhelming and significantly impacts your quality of life and cognitive functions, don't hesitate to consult a professional. Severe chronic stress and generalized anxiety are disorders that can be treated effectively with appropriate help.

• Psychologist: For cognitive-behavioral therapy (CBT) particularly effective against anxiety
• Psychiatrist: If drug treatment proves necessary as a complement
• Sophrologist: To learn personalized relaxation techniques
• Stress management coach: To reorganize life and priorities