When you’re stressed, your RA flares.
When your RA flares, you’re stressed.
Forgive us for stating the obvious, but it helps to remember that this particular Catch-22 affects everyone with rheumatoid arthritis. So does the eternal question of how to manage the stress and the pain.
Medication can help, but there are times when you’d prefer not to rely on meds. (A topic our own Arthritic Chick discussed quite eloquently here)
What about those mind-over-matter strategies? Can you really think your way out of the stress that leads to RA pain?
A recent study conducted by researchers at Wayne State University and Duke University tested two commonly applied mind-over-matter techniques—Written Emotional Disclosure and Coping Skills Training—to see which might be more effective for reducing stress and managing RA pain.
We spoke with Mark A. Lumley, Ph.D., a psychology professor at Wayne State and a lead author on the study about the results of the research and how they can be applied by anyone living with RA.
First, a bit about the study:
A total of 264 adults in Michigan and North Carolina participated. About 80 percent were women, the average age of the group was 55.1 years. Most had lived with RA for some time; an average of 13.1 years since their diagnosis.
About half the group was taught mental and gentle physical exercises to reduce stress. The other half was instructed to begin a regular program of writing in which they expressed and addressed their thoughts and feelings about a particularly stressful or traumatic life experience.
The effects of the two approaches were measured in several ways. Participants were asked to evaluate their pain. They also were examined by rheumatologists to assess physiological changes such as tenderness and swelling in the joints, walking speed, and the level of C-reactive protein (CRP) in the blood. (Higher levels of CRP indicate greater inflammatory activity.)
Here’s what the researchers found:
While the Written Emotional Disclosure therapy was helpful for some participants, its effects were short-lived. (Dr. Lumley has some theories about this, which we’ll cover in a separate blog.)
The Coping Skills Training (CST), on the other hand, reduced the participants’ reported pain, improved their moods, relieved tension and had positive measureable physiological effects. Even better than that, the effects were long-lasting.
Want to try the CST techniques for yourself? Dr. Lumley gave us five simple exercises you can put to use right now.
- Progressive Muscle Relaxation – “We can become oblivious to our general body tension, which aggravates arthritis tension. This exercise alerts your mind to how tense your muscles are,” Dr. Lumley explains. Tighten the muscles in your right foot. Hold it clenched for five seconds then rapidly release the muscles. Do the same for your right calf, then your right thigh, and so on right on up to your face. Take 20 to 25 minutes to work through all your muscle groups. “Pain ratings usually drop a few points during this exercise,” Dr. Lumley says.
- Controlled Breathing – “People need to learn to relax on the fly,” he notes. “This is a mini-practice you can do anywhere in thirty to forty seconds. Inhale, then exhale. Now inhale deeper and exhale forcefully. A quiet calmness flows through you when you release that second breath.” Use visual prompts to remind you to breathe. A Post-It note stuck to your computer screen or your bathroom mirror will jog your memory.
- Manage Your Pain Cycle – “RA folks have times when they’re feeling good and pain-free, so they do a lot of stuff and that triggers pain which sets them back,” he says. So, instead of basing your activities on the way you feel, determine a physical activity / rest cycle using the clock as a guideline. Work or play for a set length of time, then take a break for a set length of time, whether you feel you need it or not.
- Positive Thinking – “Pain tends to be worse when you’re in a negative mood,” Dr. Lumley points out. (No kidding, you say.) How to put positive experiences back into your life? List all the things you enjoy and the things you dream about doing—from the simple to the outrageous. “When people do this, they immediately come up with ten reasons why they can’t do these things,” he admits. To counter the negative impulse, think realistically about what you could put into your life. Then carve out a few minutes a day to do one of those things. Negativity seeps in when you’re feeling trapped; a few minutes of freedom will help.
- Cognitive Reappraisal – “A lot of people default to negative thinking when they’re in pain,” Dr. Lumley says. “We want to create some flexibility in the way you interpret a situation.” Your boss unloads on you. Is it because she’s a jerk or is it because she’s troubled by something else at work or at home? “At least entertain one alternative,” he suggests. “Opening a new possibility takes the sting out of the first negative thought.” If you tend to be a cynic, this might take a little work; but if you can master the technique you really will feel its benefits.