Assessing risk to support decision-making in your daily life with MS

Risk management

COVID 19 · Article

Decision-making can be tricky for everyone, but even more so for people living with multiple sclerosis (MS). And this can be made even more complicated when making decisions that carry an element of risk.

Here we’re going to uncover the psychology of risk perception, explore why risk-based decision-making can be more difficult for people with MS and apply this to the current situation with the COVID-19 pandemic. We’ll also share some tips and advice to help you assess risk in your daily life.

    As humans, we are hard-wired to avoid threats and situations that are potentially dangerous to us at all costs. The ‘fight or flight’ response is an instinctive reaction to threats in our surroundings, causing physiological changes, such as an increased heart rate, within milliseconds. These reactions have evolved to help us respond quickly, preparing the body to either fight or escape from imposing threats.

    While this instinct may be good for avoiding simple and immediate dangers, it's not the best way to figure out what to do about more complex and long-term risks. Therefore, it’s important to take time to think and not immediately act on our initial response to potentially risky situations.

    In addition to our instinctive ‘fight or flight’ response, there are many other factors that affect how we will feel about and respond to risk in our day-to-day lives:

    Perceived control

    The more control we feel we have over a situation, the less risky we perceive it to be.4 We are under the impression that we’re at least partially able to reduce the threat of a risk if we have a level of control. This explains why many of us are not afraid of driving a car, but are afraid of flying, despite car accidents harming more people than travel by plane.


    We are more accepting of risks that we know a lot about and often perceive them to be a smaller threat than unknown risks we aren’t familiar with.

    This is what we’re seeing right now with COVID-19. At the start of the pandemic, very little was known about the virus and how it would affect us. This uncertainty and ‘fear of the unknown’ resulted in widespread anxiety, extreme behaviors such as panic buying, and becoming acutely aware of our own cleanliness and hygiene. However, our perception of COVID-19 as a risk is changing and will continue to change as we learn more about it.

    Length of time between engaging in risk and its impact

    A delay between engaging in an initial ‘risky’ event and the resulting impact can alter our perception of risk. A good example of this in daily life is the risk of a high-fat, unbalanced diet and heart disease. As the damaging impact of eating unhealthily is not immediate, the level of risk is downplayed.


    The perceived risk of an event happening is heightened when we have greater awareness of the risk. For example, the perceived risk of developing cancer tends to increase when we are aware of a friend being diagnosed – it hits close to home.

    Origin of risk

    We are less concerned about risks that we choose to be exposed to or that are the result of our own actions, than risks that are imposed on us by other people. For example, people are often frustrated to see someone using their phone when crossing the road, when they may in fact do the same themselves.

    Many of the decisions you face on a regular basis hold an element of risk. It’s important you are able to make a rational assessment of how risky a situation might be to ensure you can make the right choices for you. This article will provide you with tips and advice on how to deal with your decision making and the risks associated with this.

    The process of decision-making is complex and requires a range of cognitive and emotional steps to assess situations and make informed decisions. This can be more challenging for people with MS than for those without, with around 65% of people living with the disease experiencing an impaired ability to make decisions.

    It’s perhaps not surprising that for some people living with MS, decision-making is more challenging when the decision carries risk. This is because risk-based decision-making is more complex and requires more cognitive processing steps, which can be impaired in people with MS, than standard decision-making to assess the level of risk.

    With the emergence of COVID-19, effective assessment of risk is now more important than ever. If you’re living with MS, your condition is another factor that needs to be considered when assessing risk, adding an additional layer of complexity to the already difficult process of making risk-based decisions during the pandemic. For example, you may have to balance the risk of contracting COVID-19 against the risk of not attending your hospital appointments in person. If you consider the risk of the virus to be greater, it might be that you opt for a telephone consultation instead.

    The large volume of information about COVID-19 on the internet certainly doesn’t help. It can be overwhelming and difficult to know which information you can trust, causing confusion and worry. In a recent survey, 46% of people with MS said they were concerned about being at greater risk of contracting COVID-19, 49% were worried about experiencing a more severe form of the virus because of their MS, and 42% expressed fears that a COVID-19 vaccine wouldn’t work for them.6 However, this isn’t necessarily the case.

    It’s important you are able to effectively assess your risk of COVID-19 with MS and make decisions based on your own situation that are right for you. Take a look at this list of tips to help you approach your assessment of risk:

    • Stay well informed
      Keep up-to-date about the ongoing COVID-19 situation, without overexposing yourself to the news. We are learning more about the virus every day, so it’s important that you use credible sources such as the World Health Organization (WHO) or your government website for accurate and regularly updated information about COVID-19 in your area.
    • Use trusted MS sources
      Get specific information about COVID-19 and MS from reliable sources. These include scientific papers and Patient Advocacy Groups (PAGs), such as the MS International Federation (MSIF).
    • Talk to your healthcare team
      The COVID-19 outbreak is an ongoing situation and every individual and the circumstances around their health are different. If you have any concerns or questions about your MS and COVID-19, you should discuss them with your doctor or MS nurse. Talking through them and making decisions together can help put your mind at ease and give you confidence in the decisions made.

    Now you know a little more about risk and how it adds complexity to the decision-making process. Here are a few suggestions to help you best assess risk when making decisions in your daily life with MS:

    • Educate yourself
      A ‘fear of the unknown’ often results in an unrealistic perception of risk.4 The more you know about a potential risk, the easier it is for you to make a rational assessment of it.
    • Weigh the risk against its benefits
      List the risks and benefits associated with making particular choices (e.g. taking a long drive to visit a friend despite bad weather conditions) and think about your priorities. If the risks outweigh the benefits, then choose the decision that carries a lower risk or think about the steps you can take to reduce your risk.
    • Talk to a friend or family member
      If you’re unsure of whether you’ve come to the right conclusion on a risk-based decision, talk through your thought process with someone close to you to see if they agree. They can offer a different perspective on situations and provide reassurance that you are making the right decisions for you.

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