The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support

Laia Briones-Buixassa, Brenda Montanes-Masias, Raimon Mila-Villaroel, Francesc X. Arrufat, Josep M Aragones, Sam Norton, Judit Bort-Roig, Rona Moss-Morris

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Objective: The present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stressrelated psychosocial factors such as anxiety, coping and social support.
Methods: A one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social
Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted.
Results: The bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping
increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels.
Conclusion: People with multiple sclerosis may benefit from different types of psychological therapies, from goldstandard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model.
Original languageEnglish
Article number111375
Number of pages7
JournalJournal of Psychosomatic Research
Issue number111375
Early online date15 May 2023
Publication statusPublished - Jul 2023


  • Anxiety
  • Coping
  • Functionality
  • Multiple Sclerosis
  • Social Support
  • Stress


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