Health and emotions are closely linked. Health problems, such as pain and fatigue, can have a major impact on emotions, causing feelings such as worry, frustration, and sadness. Many people refer to these types of emotions as “stress”. It is important to remember that stress can also have an effect on your health – including your MS symptoms. So, it is important to learn to manage your emotions by managing stress and encouraging positive emotions in your daily life.

Step 1: Identify your triggers: Think about what situations, thoughts, actions, or symptoms are common triggers for your stress. In other words, what causes you to feel stressed?

  • Examples of common triggers include:
  • Increased physical symptoms, such as pain or fatigue
  • Social challenges, such as conflicts with others
  • An unmet need, such as too little sleep or hunger
  • Unhelpful thoughts, such as unrealistic expectations for yourself (see Working with Thoughts for ideas)

Step 2: Evaluate your response: Now that you have identified some of your triggers, think about how you typically respond to stress.

  • Are there certain things you do when you feel stressed?
  • Are there certain things you stop doing when you feel stressed?
  • Are your responses helpful or not helpful?
  • Do your responses make your situation worse or better?

Answering these questions can help you figure out what you would like to change in your response to stress. 

Step 3: Develop a plan: With the information from steps 1 and 2, develop a plan for how to handle triggers when they come up to prevent or reduce the intensity of your stress. You can use the “Stress Management Plan” Worksheet to assist you in your plan.

  • Make sure you start with the basics: be sure to take care of your body’s basic needs, including food, sleep, water, medications
  • Next, consider what has worked for you in the past.  Are there things you have done in the past that have calmed you down, or helped you get through difficult moments or challenges? Who has helped? Include these in your plan. 
  • Then, consider additional strategies, which might include:
    • Start with a strategy that will help you calm down or get focused, such as a relaxation exercise or talking with someone supportive
    • Use distraction: turning your attention away from a crisis can help you mobilize your resources to get through a stressful time. Distraction might include:
      • Activities: such as a hobby, exercise, or watching a movie
      • Contributing: do something that helps others such as baking someone cookies, sending a letter or email to someone you know who might be lonely, or volunteer.
      • Connect: talk to others, even if not about your stress. If you have a pet, play with your pet.
    • Engage in self-soothing behaviors: Be extra kind to yourself when going through a stressful time. Take time to engage in self-care or do something that reduces your stress. Enjoy music, nature, a good cup of tea, or other things that soothe you.
    • Think reassuring, calming thoughts: Deliberately think thoughts that calm or reassure you. The “Thinking Differently” module of MS Toolkit goes into more detail about how to use your thoughts to decrease symptoms, including stress.
    • Engage in activities that trigger positive emotions (see the Power of Positive Emotions)
    • Be self-compassionate: remind yourself you are doing your best and will get through the situation.

Step 4: Use your plan: Stress management plans can be used to both prevent and lower stress.

Having a plan will not take away your challenges, but it will:
• decrease the unpleasantness of your distress or strong emotions
• think more clearly so you can generate solutions to problems
• help you get throughproblems that don’t have an obvious solution
• avoid making your situation worse by managing stress in unhelpful ways
• reduce the impact of stress on your other MS symptoms, such as fatigue

Here are some important pointers for using your plan:
• Keep your plan handy: Store a copy where you can find it when you need it
• As soon as you notice your triggers or an increase in stress, follow your plan. The earlier you engage in self-management, the more likely your distress will be prevented or reduced
• Regularly practice self-management skills so you build up your emotional reserves. Similar to exercise, the more you engage in emotional self-care, the better you will become at preventing and managing distress.

  • Power of Positive Emotions
    Part of stress management is reducing negative emotions, as described above. However, the best way to manage stress is to both reduce negative emotions AND increase positive emotions. As you know from your own life, positive emotions can and do occur even when managing the challenges of MS. Positive emotions are any emotions that “feel good”. Examples of positive emotions include feeling joy, happiness, humor, contentment, confidence, calm, playful, or connected.

    Positive emotions play a vital role in our health. They can:
    • Serve as a break from stress and negative emotions (can replenish us)
    • Sustain our efforts to cope with challenges and stress
    • Build social connections: people who show positive emotions a lot tend to attract other people and build helpful support
    • Decrease distress
    • Increase flexibility of attitude and thinking
    • Foster creativity and problem solving
    • Prevent depression, chronic stress and anxiety
    • Improve our physical health
  • Fostering Positive Emotions
    Fostering positive emotions does not mean you are in denial of your stress or situation. Rather, building opportunities to experience positive emotions into your overall plan will help sustain you through stressful times. It will also help you get a break from or helpful perspective on your stress. It may also potentially decrease the intensity of your stress.
    • How can you increase positive emotions in your daily life?
      • Think about some of the things that you already do that elicit positive emotions, even if brief.
      • Give yourself permission to do things that produce on positive emotions. When we are stressed, we often cut out activities that prompt positive emotions. For example, you might think you don’t have time to have coffee with a friend, go for a walk, take a soothing bath, or watch a funny movie. However, you can’t afford not to do these things, as the positive emotions they may trigger will help you cope with your stressors.
      • Now think about what you can do in the future to experience more positive emotions. They need not be big or grand. Small opportunities to experience a positive emotion, such as watching a funny video clip every day, drinking a soothing cup of coffee, or doing a relaxation exercise can go a long way to building positive emotions into your daily life.
      • Schedule regular opportunities to cultivate positive emotions into your daily life. For example, schedule time to play with your children or pets, read a favorite poem, engage in spiritual practice, or talk to a dear family member or friend.
      • The frequency of positive emotions is more important than the intensity of them. So, frequent small moments of contentment or pleasure are more important than life-changing positive events like getting married or winning the lottery.

A Note for Family and Friends

You can help the person you care for by encouraging them to develop and use this module’s stress management plan. Encourage them to spend time putting a plan together, and provide them with encouragement to use their plan when you notice increased stress or triggers. Support them in taking time to use stress management skills such as relaxation exercises or exercise. Offering to listen and brainstorm when they feel stuck or overwhelmed are other ways to support them in managing stress.

Everyone experiences stress, including family and friends affected by MS. It is important for you, too, to takes steps to manage your stress. The stress management plan described in this module is not only for people with MS: its steps may be helpful to anyone. Use the tips and worksheet in this module to identify your own stress triggers and develop a plan for managing your stress.


The National MS Society has additional helpful tips for managing stress.

Their website has many other ideas for promoting emotional well-being, some of which can be found here.

Can Do Multiple Sclerosis has a webinar on stress management.

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