Unhealthy Coping Strategies in MS May Lead to Worse Quality of Life

New study recommends 'regular supervision' of patients' coping methods

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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People with multiple sclerosis (MS) may be more likely to use unhealthy or ineffective coping mechanisms than healthy individuals — and these “maladaptive strategies” are linked to worse mood and a poorer quality of life among patients, according to a new review study.

Rather than also relying on active coping strategies, like seeking social support or creating positive meaning, patients tended to use only more passive strategies, like denial or simply not dealing with stressful situations and emotions. Such avoidance, however, is associated with increased depression, anxiety, fatigue, and a worse quality of life in MS patients.

“Since the patterns of coping with MS are associated with the components of quality of life and psychosocial health, regular supervision on coping strategies is recommended,” the researchers wrote.

“Working with [people with MS] for adapting the coping strategies and maintaining effective coping patterns can also lead to diminished stress and enhanced adjustment,” they added.

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The study,”Relationship of coping strategies with mood symptoms, disease related characteristics and demographic variables in patients with multiple sclerosis: a systematic review study,” was published in Multiple Sclerosis and Related Disorders

Healthy vs. unhealthy coping strategies

Like other patients with chronic diseases, people with MS develop different types of coping strategies to manage feelings of uncertainty and stress. Coping can be problem-focused, which is aimed at actively changing the nature of a stressful situation, or emotion-focused, which involves managing feelings or reactions to stress.

When a person is able to switch between these types of healthy strategies to deal with different stressors or negative environments, it is referred to as adaptive coping. Other forms of coping that are ineffective or unhealthy in difficult situations are called maladaptive.

“Effective coping strategies protect individuals against cognitive, environmental, and biological factors that cause anxiety,” the researchers wrote.”They are unique to every person and may be different depending on various factors such as age, gender, and cultural issues, among others.”

Various studies have reported links between coping strategies and MS mood symptoms or life quality, but have “reported scattered and inconsistent relationships” between the two, according to the researchers.

Now, a team of scientists in Iran and Argentina conducted a systematic review to summarize existing data relating to coping strategies in MS and their relationship with clinical characteristics.

From an initial screen, 39 studies were deemed relevant and included in the review. These studies spanned from 1997-2021, and were all cross-sectional, meaning they each assessed data at a single point in time.

The team assessed the identified coping strategies using a variety of different scales across the studies. Even so, they identified certain trends across many of the studies.

In studies that compared MS patients with healthy people, individuals with MS were less likely to use active coping strategies like seeking social support or problem-solving, and more likely to use emotion-focused strategies like avoidance or denial.

Among MS patients, differences were observed based on a range of clinical and demographic factors. Two often linked demographic factors that seemed to drive differences in coping were occupation and education.

Specifically, some studies found that patients with less education or who were unemployed were more likely to use substance abuse as a coping mechanism. Unemployment also was linked to maladaptive strategies like behavioral disengagement — such as withdrawing from a relationship or no longer doing activities the person previously enjoyed.

Differences also were identified, in some studies, between men and women. A greater use of religion, social support, and positive/healthy coping strategies were found among women as compared with men.

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Several studies found links between coping strategies and depression, anxiety, stress, or fatigue.

Impact on quality of life

Across several studies, it was generally observed that depression was associated with more dysfunctional and emotion-oriented coping, and with less problem-solving coping. Anxiety also was linked with emotion-oriented coping, as well as avoidance, humor or self-blame, denial, behavioral disengagement, or substance abuse.

“The connection between coping strategies and psychological symptoms has led to suggestions that interventions aimed at improving adaptive coping behavior may result in a reduction in mood symptoms, particularly where advancing physical disability might impair adaptive coping efforts,” the researchers wrote.

Consistent with that hypothesis, some studies indicated that training in coping skills led to fewer role limitations, the promotion of well-being, and less depression, anxiety, and stress.

While some studies found a link between higher disability and more avoidance behaviors, others found no relationship between coping and level of disability. Similarly, while relationships between higher fatigue and maladaptive coping strategies were observed in some studies, another found no link.

Emotion-focused coping, including denial, avoidance, behavioral disengagement, self-distraction, social withdrawal, and wishful thinking were generally associated with a lower quality of life in the studies.

In contrast, strategies based on acceptance and active coping, like problem-solving or emotional expression, were linked to a higher quality of life.

“These results show that problem-focused coping protects [quality of life]; on the contrary, emotion- focused coping is a risk factor for altercation,” the researchers wrote. “Indeed, using coping strategies that focus on the search for social support or on the problem reduces negative adaptive outcomes.”

Overall, the study “indicated that [people with MS] use more dysfunctional coping strategies,” the researchers concluded.

Thus, the team recommended that all MS patients be screened for coping — and that healthcare professionals promote positive healthy strategies as part of routine clinical care.

“Coping assessment should be effective for identifying the strategies that reduce unsuitable reactions to stressful events of life,” the team wrote. “Implementing positive coping strategies not only may lead to decreased undesired outcomes, but also could reinforce sense of confidence among [people with MS].”

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