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Learning to Manage Your Stress with Rheumatoid Arthritis

Summary of a presentation at the Living with RA Workshop


The world is filled with stressors, even without a chronic disease. Arthritis can make everyday occurrences even more stressful. But we can learn to manage stress more effectively because how stress affects us depends partially on the meaning we attach to it.

Acute stress is a temporary incident, such as a rainy day wrecking picnic plans; you change the plans and the stress is resolved. Chronic stress comes from ongoing or permanent concerns, such has coping with arthritis.

Chronic stress requires a different type of coping strategy because you are continually reevaluating and adapting. How do you cope and have the resources to deal with something that feels like "too much."

Starting a journal or diary

The first step is being mindful of your stress. A stress management diary can help you find out what stresses you and how you respond. Get a little notebook, and make three columns on each page:

  • Date/Day/Time
  • Stressful Event Description
  • Physical/Emotional Symptom Produced.

Start keeping track. Each person with osteoarthritis may experience the illness in his or her own way. What may be the most difficult part for you may not be a problem for the next person. The diary can help you look at the patterns of your week, find out what bothers you the most, and what the stress causes, such as physical pain or anxiety.

You may find that even small things, such as waiting on line at a supermarket, lead to feelings of helplessness, anger, impatience, gritting your teeth - emotional symptoms. But walking around angry all the time can cause physical symptoms, such as pain in your joints. At the same time, anger can increase your perception of pain and helplessness. It can become a vicious, circular cycle. You need to interrupt that cycle in as many places as you can.

Changing your self-talk

You can break the cycle in your own mind with "self-talk," a concept used by David Burns in his book, Feeling Good: The New Mood Therapy. Your moods are created by your thoughts. Negative thoughts increase stress.

Here are 10 exaggerated ways of thinking, called "cognitive distortions" as presented by Dr. Burns:

  • all-or-nothing thinking
  • overgeneralization
  • mental filter
  • disqualifying the positive
  • jumping to conclusions
  • magnification (catastrophizing) or minimization
  • emotional reasoning
  • "should" statements
  • labeling and mislabeling
  • personalization

You can even have several distortions in one thought, "I should clean every day because I never have a clean house. People must think I'm a slob but it's impossible for me to vacuum when I'm in pain all the time, and I can't do anything about it." Pick this sentence apart to find out what's really true/false, important/unimportant.

You can challenge such automatic thoughts by recognizing the cognitive distortions and developing more realistic appraisals. "I'm too uncomfortable to vacuum now, so I'll do it when I feel better - or get someone to help me; it's okay not to have a perfect home; my friends understand. Right now, I'll listen to music to help ease my pain."

All-or-nothing thinking is particularly common when you have chronic pain. But thinking "there's nothing I can do" makes you feel powerless instead of mobilizing you. So, instead of saying "I can't do the five things on my to-do list," plan to do one thing you can do.

Look at the negative filters you use each day that put you in a position of having negative feelings. Learn to identify them and give them the boot - question them and refute them --so you get to a place where you fill yourself with more positive feelings. The way you think is self-taught - and you can re-teach yourself to think more constructively.

Using visualization to manage stress

Another important component of stress management is using visualization - using your mind's eye to "see" and create positive responses to stress.. As the poet John Milton said, "The mind is its own place and, in itself, can make a heaven of hell and a hell of heaven." Stress has to do with the thoughts you tell yourself, and images are visual images of thoughts. You can reduce your stress through your imagination. Our minds can create our world, much as a movie projector creates one on a blank screen.

Try this visualization to help reduce pain. Sit in a comfortable chair, close your eyes, and let yourself relax. Picture your sore joints. What color are they? What do they look like? You will slowly change the color to icy blue. With your paintbrush of soft, gentle bristles, paint slowly and carefully so as not to miss even one little spot. Work on each joint. As the icy blue healing paint covers each joint completely, notice the swelling continue to go down. Notice the difference in the feelings you experience. Enjoy the increased comfort and peace. Let the pain disappear. When you feel ready, slowly open your eyes.

Summary prepared by Diana Benzaia


Roberta Horton, LCSW, ACSW 
Director, Department of Social Work Programs
Hospital for Special Surgery

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