Break the vicious cycle

About stress

What is stress?

Stress is a term used to describe the body and mind's reaction to everyday tensions and pressures. Too much stress can increase pain, and can make a person more prone to illnesses such as heart disease or mental problems.

Stress and arthritis

Too much stress can also make it harder for people with arthritis to face the extra problems imposed by their disease. These problems may include medical expenses, changes in lifestyle, side effects from drugs, and concern about the future. By learning to cope with stress in a positive way, you can reduce your pain, feel healthier, and deal better with the extra demands of your disease. It is for these reasons that stress management is an important part of taking care of your arthritis. Learning stress management, or how to cope with stress in a positive way, is a skill. Like any skill, it needs to be practiced.

This information first explains how the body and mind react to stressful events. Then it describes a program for managing stress. For more help, ask your doctor or see a counselor or psychologist.

Typical stressors

Stress and chronic disease

People with arthritis experience the same kinds of stress as everyone else. However, sometimes having a chronic disease as well can add special problems. People with arthritis may become more dependent on family members and health care professionals. They may also have to adapt to changes in their job status, hobbies, energy level, or body image. None of these adjustments are easy--and all can be upsetting.

Reacting to stress

When you are under stress, your muscles become tense. This muscle tension can increase your pain. A vicious cycle of stress, pain, and depression may develop. However, if you learn how to manage stress, you can help break that cycle.

Some of the body's reactions to stress are easy to predict. At stressful times, the body quickly releases chemicals into the blood. This sets into motion a series of physical changes. These include a faster heartbeat and breathing rate, higher blood pressure, and increased muscle tension.

These physical changes give the body added strength and energy. They prepare the body for dealing with stressful events such as giving a speech, aiding an accident victim, or fighting or fleeing from an attack. When stress is dealt with in a positive way, the body restores itself and repairs any damage caused by the stress. However, most of the time, people don't deal with stress in a positive way. Thus, stress-related tension builds up and, with no outlet, takes its toll on the body.

The mind's reaction to stress is harder to predict. These mental reactions vary according to the situation and the person. They may include feelings of anger, fear, anxiety, annoyance or frustration. A small amount of stress can help people perform their best--during an exam, an athletic event, or on stage. With too much stress, people may become accident-prone, make a lot of mistakes, and may not be able to function. Stress can be compared to a violin string. If the string is too loose (not enough stress), it won't produce music. If the string is too tight (too much stress), it will break. Some degree of stress is necessary to function properly.

Realize that people respond in different ways to events and situations. Some people like to be busy, with lots of activity. Other people may prefer a slower pace, with less activity. What one person finds relaxing may be stressful to another.

Signs and symptoms of stress

Managing stress begins with learning the signs and symptoms of stress.

• Tiredness/exhaustion
• Muscle tension
• Anxiety
• Indigestion
• Nervousness/trembling
• Sleeplessness
• Cold, sweaty hands
• Loss of or increased appetite
• Grinding teeth/clenching jaws
• General body complaints, such as weakness, dizziness, headache, stomachache, or pain in the back or muscles.

It's possible that some of these symptoms may be caused by problems other than stress, such as the flu. Ask your doctor about symptoms that last for more than a week. If your doctor decides that stress is the problem, you can work together to understand and relieve it.

Make stress work for you

The key to managing stress is to get stress to work for you instead of against you. A complete program for managing stress has three parts:

1. Learn how to reduce stress.
2. Learn how to accept what you can't change.
3. Learn how to overcome the harmful effects of stress.

Suggestions for following these guidelines are described in the following pages.

Ways to reduce stress

Identify causes of stress

What causes you the most worry and concern? What situations make you feel anxious, nervous or afraid? Once you know what the stressful aspects of your life are, decide whether or not you can change them.

Keep a "stress diary" to record the events in your life that cause stress. Record any physical symptoms you have. Try some of the ways to manage stress suggested in this program, noting if they helped you. Soon you will learn what upsets you the most, and which ways help you cope the best. Then try to prevent those situations from occurring. For example, if important family events usually make you anxious, plan to get extra rest ahead of time so you are better able to cope.

Share your thoughts and feelings

It's usually helpful to talk to someone about your concerns. Perhaps a family member, friend, co-worker or member of the clergy can help you see your problems in a different way.

Learn to tell people when you can't do certain things. Saying "no" to people is important and you shouldn't feel guilty when you do. You may find that turning down extra duties--even for a short period of time--reduces your stress.

Respect your limits of energy, pain, and time. If you don't, you can become so worn out that you can't be the kind of friend, lover, or parent you want to be.

Realize that you have the right to decide if you want to discuss your arthritis. If having arthritis limits your activity, that may be a good reason to mention it. Otherwise, your arthritis is a private matter.

Learn to express anger and other negative emotions without hurting others. It's all right to be angry! However, try to say, "I'm feeling angry, " instead of, "you are making me angry. " This lets you express your feelings without blaming someone else. "Striking" someone with words will only make that person feel under attack. This can make the conflict harder to resolve. Learning to express your feelings will enable you to improve relationships with the people who are important to you.

Try to avoid depression

A condition such as arthritis can bring about feelings of depression. You may feel sad or "blue, " or have more serious thoughts of hopelessness and despair. Depression can make you feel miserable and also increase your pain.

You may wonder, "why me?" or "why are other people able to do things I can't do?" You may be angry or feel sorry for yourself. It might help to know that these are common feelings of people who have arthritis.

Usually feeling depressed depends on how you deal with events in your life, whether they are real or imagined. If you believe you're a helpless victim of depression, you probably won't do anything to overcome it. Here are some tips to help you manage depression:

• Realize that you are responsible for how you feel. If you are aware that your state of mind is up to you, then you are more likely to take an active approach to improving your mood.
• Take care of yourself. You're special--so pamper yourself. Try something good to eat, take a leisurely bath, or buy something nice for yourself.
• Be a "doer." When you're sad or lonely, go to an event. Get involved in neighborhood or volunteer organizations. Don't forget the joy of giving.
• Find new activities to replace old ones so you can continue to grow and develop. Discover new creative outlets, such as hobbies, skills or interests.
• Remember that it's all right to cry. A good cry can be a healthy way to relieve tension.
• Keep in touch with family and friends, by phone if you can't get out. Don't let your arthritis set you apart from others.
• Try to discover what set off your depression and learn to avoid those events in the future.
• Be alert for signs of depression that last for more than two weeks. If you continue to have signs such as eating or sleeping too much or too little, or feeling hopeless, forgetful, restless, or more tired than usual, tell your doctor. Sometimes this type of depression is caused by a change or an imbalance in the body's chemistry. Often certain drugs can correct such an imbalance.

Simplify your life

Look at your activities. Decide which ones are most valuable and omit those that aren't. Many tasks or chores may seem necessary. But are they? They may be important only in your mind. Your family and friends enjoy you more when you're rested and healthy. Therefore, don't get worn out trying to do too much. Instead, do a few things well.

In addition, ask for help when you need it, and accept it gratefully. You may also use aids and devices to make your everyday tasks easier.

Manage time and conserve energy

When you usually have pain and limited energy, it's natural to work harder on days you feel well. Instead of getting worn out trying to do everything, organize each day the night before or in the morning. Plan to do the most stressful or hardest task early in the day. Schedule rest periods, and remember to take them before you get worn out. Pace your activities by doing a heavy task and then light ones. Don't try to do too many heavy chores in one day.

Set goals

Goals give you something to work for, and they give you satisfaction once you achieve them. Set short-term, achievable goals, taking one day at a time. Remember to include hobbies and friends. Because of the uncertainty of your arthritis, be flexible about the time needed to complete a goal. Take some time to think about your long-term goals. How has your life changed since you last thought about your goals? Has your arthritis affected them? What is most important to you now? What do you want to achieve?

Avoid drugs and alcohol

Realize that drugs and alcohol don't solve life's problems. When people who smoke are under stress, they tend to smoke more. Some people use alcohol, marijuana, or other drugs in an attempt to solve or to escape from life's problems. These substances can only add to your health problems. They don't help you manage stress. In fact, in the long run they can increase your stress. Instead, see a mental health counselor or ask your community health service or hospital about programs offered in stress management.

Seek support and education

Most Arthritis Foundation chapters have clubs and support groups. Many chapters offer educational programs such as the Arthritis Self Help Course, which meets for two hours each week for six weeks. The course emphasizes many topics, including stress and pain management. These groups can allow you to discuss problems or concerns with people who have similar ones. Sharing will help you realize that you are not alone.

Try to stay healthy

Remember that having arthritis is only one part of your total health picture. Sometimes people feel so overwhelmed trying to manage their arthritis that they forget about the rest of their health. You control your diet, weight, exercise, and attitude, for example. By becoming as physically and mentally fit as possible, you can improve your energy, state of mind, and your level of stress.

Make time for humor and fun

Schedule time for play and become involved in activities that make you laugh. There is almost a magical quality about laughter. No matter how sad your mood, laughing can make the world look brighter. Laughter dissolves tension--you can't be "uptight" and laugh at the same time! Joke with friends or see a funny movie. You know yourself--do what is fun for you.

Seek help if you need it

Get help to cope with constant, hard-to-solve problems. For instance, a mental health counselor or therapist may be able to help you work through a serious marital problem or severe depression. He or she might be able to help you find positive ways to express anger, if that has become a major concern.

Change yourself, not others

Realize that you can change only yourself, not other people.

Many people spend too much time and energy trying to reform their spouses, children or doctors. They want to make them different, or to have them act in a certain way. When these changes don't happen, people tend to feel frustrated, tense, and upset. No one has the power to change another person. When people change, it's generally because they wanted to do so.

Accept imperfection

Have the courage to be imperfect. Stop trying to be the ideal parent, spouse, child, patient, employee, or boss. No one is perfect! Trying to be perfect is admirable, but doing so takes its toll on your time, energy, and the way you feel about yourself.

Realize that life isn't always fair. Drugs have side effects, doctors may sometimes be grouchy, and families don't always understand.

Try to "roll with the punches." Being flexible helps you keep a positive attitude, despite hardships.

What is relaxation?

Learning how to relax is one of the most important ways to cope with stress in a positive way.

Relaxation is more than just sitting back and being quiet. Relaxation is an active process involving methods that calm your body and mind. Learning how to relax takes practice, just as learning how to ride a bicycle takes practice. Once you know how, it becomes "second nature."

Keep in mind that there's no right way to become relaxed. Whatever works for you is what's important. Listed below are a few suggestions. Try out different methods until you find one or two that you like best. If you need help, see a mental health counselor or contact your local Arthritis Foundation chapter.

Relaxation techniques

• To begin with, try to set aside time in a quiet place, away from people, TV, radio and other distractions.


• Close your eyes. Slowly tense and then relax muscles that feel tense. Begin with your feet and work up to your neck.


• Sit in a comfortable chair with your feet on the floor and your arms at your sides. Close your eyes. Breathe in, saying to yourself, "I am . . . ," then breathe out saying " . . . relaxed." Continue breathing slowly, silently repeating to yourself something such as: "My hands are . . . warm; my feet . . . are warm; my forehead . . . is cool; my breathing . . . is deep and smooth; my heartbeat is . . . calm and steady; I am . . . happy; I feel calm . . . and at peace."


• Light a candle, and focus your attention on the flame a few minutes. Then close your eyes and watch the image of the flame for a minute or two.


• Imagine a white cloud floating toward you. It wraps itself around your pain and stress. Then a breeze comes. It blows away the cloud, taking your pain and stress with it.


• Think about a place you have been where you once felt pleasure or comfort. Imagine it in as much detail as possible how it looks, smells, sounds and feels. Recapture the positive feelings you had then and keep them in your mind. Don't make any room for negative thoughts, stress or pain.


• Imagine that you've put all your concerns, worries and pain in a helium filled balloon. Now let go of the balloon and watch it float away.

Sometimes simply letting your mind wander or "go on vacation" will help reduce your stress. Here are a few suggestions. Invent your own!

• Watch a sunset.
• Take your shoes off and walk in the grass.
• Sit in a park on a warm, sunny day and listen to the birds.
• Sit in front of a fire in the fireplace.
• Gaze at fish in an aquarium.

Overcoming barriers to relaxation

To overcome barriers to relaxation, you must really want to learn to relax. Some common "stumbling blocks" to relaxation include these:

• Feelings of guilt for taking time from your busy schedule
• Being made fun of by others
• Not being able to stop and take time
• Fear of "loss of control."

Remember that relaxation will help you gain better control of the demands made on you. If you devote time to relaxation, later you'll be able to do more and enjoy yourself more.

From time to time it may seem impossible to stop and relax. You may find yourself in a rut--tense because you're so busy, and too busy to relax. If this happens, start wherever and whenever you can. If you're waiting in traffic, take a few deep breaths, and let the air out slowly. If you're at work, take a short break in the rest room, lounge or snack bar. Close your eyes, breathe deeply, and try to forget about everything, except your breathing. Notice which muscles are tense--perhaps your neck, forehead or shoulders--and relax them.

You may think that a high level of body tension means that you're "in control," and that feeling relaxed seems like a loss of control. Realize that muscle tension drains your energy and can increase your pain. Relaxation actually helps you gain control over your stress and pain.

It takes time and effort to learn a new skill. Therefore, don't give up before you have a chance to reap the benefits! Knowing how to relax can become part of your life. Remember, like any habit, learning to relax takes time to become automatic.

More relaxation tips

• Practice every day, even for just 15 minutes. A new habit must be repeated often until it begins to feel as though it's a part of you.
• Choose your favorite methods. Be creative. Remember, there is no one, best way to relax.
• Work in short relaxation breaks during your day, whenever you can. Try using very simple methods such as deep breathing for even a minute or two.

Make stress work for you

Managing stress can help you have less pain and feel healthier. It can also help you cope with the extra demands made on you by your disease. By following these suggestions, you may be able to get stress to work for you instead of against you.

Learn to identify those situations you can do something about and those you can't. Work at reducing the cause of your stress by communicating better, and respecting your limits of energy and pain. Simplify your life, "look on the bright side," and develop and keep a sense of humor. Prepare for stressful events by getting extra rest.

Remember that you can't change others. Keep in mind that no one is perfect. Seek professional help for serious problems.

Practice relaxation methods to overcome the effects of stress that you can't avoid. Engage in hobbies and simple pleasures that give you joy.

Finally, remember that managing stress is your job. With stress under control, it'll be easier to keep your arthritis under control.

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from the pamphlet originally prepared for the Arthritis Foundation by Beth Ziebell, PhD. This material is protected by copyright.