Emotional Self-Care During Tough Times

By Stephanie Watson

Stress may feel overwhelming with rising fears about the novel coronavirus and its impacts. But stress is ever-present in daily life, whether it's from a major upheaval like a pandemic, a personal trauma like a divorce or job loss, or even just minor day-to-day snags like traffic and long supermarket checkout lines. To all of these worries, arthritis, especially inflammatory arthritis, adds a whole other set of stressors.

“When you have a chronic illness, the disease and its treatments bring along a lot of stressful events and situations,” says Francis Keefe, PhD, professor in Psychiatry and Behavioral Sciences, and director of the Pain Prevention and Treatment Research Program at Duke University Medical Center. 

Stress involves more than just your emotions. It produces a physical response that leads to the release of inflammation-promoting chemicals in your body. In an inflammatory disease like rheumatoid arthritis (RA), more inflammation equals worse symptoms. 

The unpredictable nature of arthritis can leave you constantly wondering when the next flare might hit and how it could impact you. “The worrying can make [arthritis] symptoms worse as well,” says Neda Gould, PhD, assistant professor in the Department of Psychiatry and director of the Mindfulness Program at Johns Hopkins Medicine. 

You can’t totally eliminate stress, but there are a few things you can do to manage it and buffer its effects on your life. 

If you’ve ever experienced a mood boost after taking a jog or brisk walk outside, there’s a reason. Working out stimulates the release of feel-good chemicals called endorphins in your brain, which produce the “high” runners get. Meanwhile, exercise lowers levels of stress hormones like cortisol and adrenaline in your system.

Any exercise is good for you, but pushing yourself a little bit – gradually walking for longer distances or at a faster pace – increases your tolerance to stress. “What ends up happening is you build resil¬ience,” Dr. Keefe says. Just be mindful not to push past your limits and end up in pain. Therapeutic exercises like yoga are good for your mind and body as studies show that the practice reduces stress and anxiety. 

When worries plague your mind, several relaxation techniques can calm troubled thoughts, including deep breathing, mindfulness meditation  and progressive muscle relaxation. “Relaxation techniques are among the most effective tools for managing stress, and they’re often underutilized,” Dr. Keefe says. 

Which method is best? “The one that you’ll actually use,” he adds.

Think of each technique as one tool in a toolbox. The tool you choose depends on your need. Deep breathing slows the heartbeat and brings on a sense of calm when you’re having a stressful event. After taking a deep inhale of breath, you can say a positive affirmation as you exhale to help you relax. 
These techniques can be practiced anywhere. Taking a few minutes to meditate or progressively relax tight muscles a few times a day is good for your body and mind. 

Chronic conditions are isolating. Sometimes you can feel like you’re all alone. Having somebody who will listen when you need a compassionate ear is invaluable. The size of your support network is less important than the quality of support you receive, Dr. Keefe says. Surround yourself with people who are compassionate, nonjudgmental and under¬stand the unpredictability and impact of having a chronic disease.

You have a few options for support. Lean on family and friends. See a mental health professional who specializes in chronic conditions. Join a support group for people with arthritis, which will give you “a sense of connection to others in the room who are struggling with the same things you’re dealing with,” Dr. Gould says. The Arthritis Foundation has a network of support groups around the coun¬try. Learn more about LiveYes! Connect Groups.

Disease-modifying drugs (DMARDs) are very effective at managing inflammatory arthritis, but only if you take them. If your medication isn’t controlling your pain and other symptoms, it can lead to a lot of uncertainty and stress. Worried about side effects? Talk to your rheumatologist about what you’re experiencing. Not sure you can afford a new medication, wor¬ried about disease progression and whether you can have a baby or pass arthritis on to your newborn? Let your doctor know about those concerns, too. The unknown is a breeding ground for stress.

Some people with inflammatory arthritis say their pain makes it hard for them to fall asleep, and the sleep they get is often disrupted. Poor sleep  leads to more pain, which perpetuates the cycle. When you’re sleep deprived, you don’t function as well emotionally or physically.

“Practicing good sleep hygiene is ideal,” Dr. Gould says. Avoid caffeine and alcohol before bed, go to sleep at the same time each night and keep your bedroom cool and dark to promote better sleep. Your emotional health needs rest, too.

“A lot of the things we do to deal with stress can create stress,” Dr. Keefe says. “Many times, people turn to things that have a short-term stress alleviation effect, but over time actually make things worse.” He points to bad habits like eating junk food, drinking too much alcohol and smoking. Eating nutritious food, exercising regularly and not smoking are good for overall health. And when you feel healthier, you are better able to manage stress.