Managing Moods: An Occupational Therapists Perspective

Mental Health And MS

For people living with multiple sclerosis, there is a 50% chance they will experience a depressive episode in their lifetime. Up to 40% of people with MS experience anxiety- 3 times greater than the general population. This is in addition to feelings of grief, anger, frustration, and erratic mood swings that are unavoidable primary and secondary symptoms in MS. 

As my fellow Can Do MS programs consultant and psychologist Peggy Crawford writes, “Mood changes can be treated through many means, including psychotherapy and medication. In addition, simple lifestyle adaptations with a focus on effective communication and reducing stress/conflict can help to reduce the negative impact of mood changes and improve function.”

Despite the high prevalence of mood changes, many people living with MS and their support partners are unaware of these common symptoms or how to manage them. It is important to ask your healthcare team members, including a mental health professional, how your MS may be impacting your mood and how your life can be improved through treatment and management. 

Identifying Mood Changes

From an Occupational Therapist perspective, we can help you manage your mood changes by first identifying the impact on daily activities: 

• Withdrawal or losing interest in meaningful activities 
• Decline in self-care (not showering, not eating or eating unhealthy, not taking medications correctly)
• Avoiding social situations and becoming isolated 
• Difficulty maintaining habits or routines 
• Lack of confidence or decreased feeling of self-worth 
• Difficulty accepting new techniques/devices to be independent Increased fatigue levels limiting participation 
• Difficulty sleeping affecting cognition and learning
• Muscle tension and pain limiting motor abilities
• Difficulty processing information 

Strategies An Occupational Therapist Can Help With

Then, an Occupational Therapist can work with you to implement strategies that can help:

• Identify physical and visual barriers
• Develop ways to manage fatigue
• Modify environments for optimal performance
• Adapt activities to increase engagement
• Identify tools to improve participation
• Encourage communication and social support
• Identify strengths that can be utilized for improving function

Other Ways An Occupational Therapist Can Help

Then, an Occupational Therapist can work with you to implement strategies that can help: 

• Identify physical and visual barriers Develop ways to manage fatigue 
• Modify environments for optimal performance Adapt activities to increase engagement Identify tools to improve participation Encourage communication and social support 
• Identify strengths that can be utilized for improving function 

The Four P's

We also know that fatigue can have a huge impact on our mood. An OT can help you develop a plan to conserve energy. At Can Do MS programs, we stress the importance of “working smarter, not harder” by using the 4 P’s: Prioritizing, Pacing, Planning, and Positioning. 

Prioritizing: 

• Evaluate your standards 
• Evaluate your priorities  
• Learn to say ‘No’ 

Pacing: 

• Pace your day! 
• Many little adjustments can reduce the feeling of anxiety when worrying about a huge ‘to-do’ list 
• Simplify tasks; Ex: Use clothing that is easier and faster to put on, purchase pre cut vegetables 
• Take rest breaks as needed & alternate high-energy/low-energy tasks 
• Break large tasks into smaller parts and pace them out 

Planning 

• Use calendars and schedules 
• Plan your day to have a mixture of “wants” vs “needs” Plan rest breaks before you need them 
• Balance out heavy & light activities throughout the day/week Rate your fatigue level periodically to facilitate your planning 
• Increase self-awareness of mood according to activities or times of day 
• Identify signs/signals of fatigue that can impact your physical function, mood and cognition 

• Look for others that can help/support you with activities (ex. rideshares for kids sports); Ex: After a shower, put on a robe and eat breakfast before getting dressed or doing your hair 

Positioning 

• Sit when you can to conserve energy! Create optimal workstations 
• Keep frequently used items within reach: ex. phone, printer, utensils, writing space, etc. Use appropriate chairs and ergonomic positioning 
• Keep kitchen supplies in easy to reach places Use rolling carts to move items 
• Use tools to limit challenging positions and conserve energy 
• Reachers, foot funnels, sock aids, large grip utensils, 3 in 1 commode, proper height beds and chairs, attachable toilet bidets; Ex: Tub transfer bench, chairs for seated grooming tasks, scooters/wheelchairs 

Finding Your Own Occupational Therapist

To find an Occupational Therapist that can help you with managing your mood, the best resources are other members of your healthcare team and the National MS Society Navigators (1-800-FIGHT-MS).