Anxiety and Arthritis

Being a mom, working a high-stress job as an emergency dispatcher, and dealing with osteoarthritis in the hips, knees, ankles, and feet is a lot for anyone to juggle. Julie B., 56, of Denver, Colorado, was so used to just pushing through and putting others’ needs first that when her symptoms anxiety started to creep in, she didn’t realize she was heading for a mental health crisis.

“At first the anxiety felt manageable but over time it became overwhelming. I felt it all the time, constantly. I would wake up every day overcome with dread, to the point where I was even considering how to end my life,” she explains. “Then one really bad day I told my husband, ‘I need you stay home from work with me today’ and he said immediately, ‘Yes, of course.’ That was when I knew I was really bad, because he didn’t even question it. All he had to do was take one look at me to realize how much I was suffering. We both knew I was in trouble.”

Julie’s husband sat with her all day while she cried and told him about the mental and physical pain she had to endure every day. They went to a doctor who took her concerns and pain seriously and started her on a daily anti-anxiety medication, as well as adjusted her arthritis treatments to help lessen her physical pain. The last key to Julie’s recovery was quitting her high-stress job. Now she is doing much better, but she says she shares her scary story frequently, especially with others who have a chronic illness.

“People really underestimate the toll these types of illnesses take on your mental health and think that anxiety is just part of the deal,” she says. “I want people to know they shouldn’t just suffer with it. There are things you can do — today — to feel better.”

What Is Anxiety, Exactly?

Everyone gets anxiety — that feeling of worry, dread, loss of control, fear, impending doom, and/or panic — at some point. Who hasn’t decided to break up with a partner or walked into a big meeting and felt their stomach clench, their palms get sweaty, and their heart rate shoot up?

Anxiety occurs on a spectrum, ranging from mild symptoms that pass quickly once you’re through a stressful situation to quite severe, which can cause regular symptoms like chest pain, trouble breathing, narrowing vision, nausea, diarrhea, or even suicidal thoughts. Because of the variation in anxiety symptoms, people can easily mistake anxiety for things like food poisoning, asthma attacks, or heart attacks, according to the National Institute of Mental Health.

At its core, anxiety is a normal and even helpful reaction that happens when your body releases adrenaline as a response to stressful or scary situations to help you fight or escape. But feeling anxiety frequently, getting anxiety that is disproportionate to the situation, or having anxiety as background noise in your daily life is not normal and can damage your health and well-being.

The Connection Between Arthritis and Anxiety

“My doctor didn’t believe my anxiety was related to my illness. She actually told me to wait until after recovering from my surgeries and then we’d deal with the anxiety,” says Rachel F., 36, of Arvada, Colorado, who just had a hip replacement and is scheduled for one in her other hip after she completes her recovery. However, taking care of three children and managing her life with limited mobility, experiencing excruciating chronic pain, and enduring a lengthy physical rehab was incredibly anxiety-inducing. “I worried about everything from my kids to my health and it made me really unmotivated to keep trying,” she explains. “Still my doctor told me my mental health wasn’t connected and that once I’d recovered physically, the anxiety would go away on its own.”

Sadly, this isn’t an uncommon reaction as many people, including doctors, don’t understand the intrinsic connection between mental health disorders and chronic illness, says Lisa S. Larsen, PsyD, a therapist who specializes in treating people with chronic conditions.

Almost one quarter of adults with any type of arthritis report having anxiety, according to the Centers for Disease Control. However, fewer than half of people with anxiety were receiving medical treatment and only one-third had spoken with a mental health professional about it, the CDC reported. Nearly 20 percent of young people diagnosed with rheumatoid arthritis reported clinical levels of anxiety, according to a study in the journal BMJ.

Much of anxiety stems from uncertainty and fear — and what is more uncertain than a diagnosis of arthritis or other disease that can affect you for the rest of your life? Anxiety and arthritis become a vicious cycle, with each making the other worse, says Stacy Lawrence, a licensed professional counselor and owner of Psychotherapy for the Lowcountry in Charleston, South Carolina.

“A lot of people feel anxious or depressed when they are in chronic pain,” she explains. “Chronic pain impacts our brain by keeping us in the stress response. Staying in the stress response impacts our brains and bodies in multiple ways, which makes arthritis symptoms worse.”

Common Causes of Anxiety

Patients diagnosed with arthritis or other diseases with chronic pain as a primary symptom may have worries and fears over many aspects of disease management. Here is a brief list of common things that arthritis patients have told us they worry about:

  • Medication and treatment: Whether they are working now, will continue to work in the future, will have side effects, and whether they will be painful.
  • Financial stress: What insurance will or won’t cover; the costs of treatments and specialists; extra money spent on other aspects of disease management.
  • Social concerns: Feeling lonely and isolated, losing friends, letting down loved ones, missing out on important activities and events, being pitied or babied, and people not understanding limitations and feelings.
  • Personal changes: Losing a career or job, having to stop beloved hobbies, not being able to properly care for children or pets, and coping with mental health and mood changes.
  • Meta worries: What the future will be like, potential disability, shortened lifespan, long-term care, lowered self-esteem, and chronic pain.

How to Cope with Anxiety from Arthritis

1. Practice good self-care

The bedrock of any arthritis treatment, both physical and mental, is taking care of yourself as best as you can. This might mean giving yourself a dedicated bedtime, taking a hot bath every night, avoiding certain food triggers, going for a gentle walk, saying no to activities that over-pack your schedule, or whatever it is that makes you feel loved and cared for, Lawrence says.

2. Get your pain and inflammation under control

“It’s normal to feel anxious about making pain worse or worrying about pain returning, if you’ve been able to have a small amount of peace from it,” Lawrence explains. But, in a terrible catch-22, worrying about pain can make pain feel worse — and experiencing pain can increase your anxiety.

Short-circuit this cycle by talking to your medical team about your options for managing your pain before it gets out of control, she says. Many arthritis patients accept that pain is a part of their disease they must get used to, when there are now more treatment options than ever to try to modify disease activity and quell inflammation. Be honest with your doctor about how you really feel and don’t give up.

3. Talk to a doctor about medication for your anxiety

When it comes to effective anxiety treatments, daily medication was the key for Julie. “I couldn’t do any of those other things people always tell you to do, like eating right and exercising, until I got my anxiety symptoms under control,” she says. Talk to your doctor about which medications are safe for you and won’t interfere with your arthritis treatments.

If your anxiety is episodic or limited to particular situations you can ask for “emergency” or fast-acting anxiolytics, which is what Rachel uses. Talk to your doctor about which medications are safe for you and won’t interfere with your arthritis treatments.

4. Consider therapy

Talk therapy can be incredibly healing for people with arthritis, Dr. Larsen says. Even if it doesn’t “fix” your problems, being able to talk about them and feel heard is very powerful, she says.

5. Ask for help with day-to-day difficulties

“Recognizing that I couldn’t do what I used to do and I needed to ask for help — and that it is okay to need help — was a huge relief for me,” Rachel says. Let loved ones wash dishes, walk the dog, or do the laundry. Or hire someone who can help with housework during severe arthritis flares. This can help reduce anxiety that stems from feeling overwhelmed by your daily demands.

6. Let others know what they can expect from you

Letting down loved ones is high on the list of anxieties people with arthritis have. One way to ameliorate this is to be open with them, Lawrence says. “Communicating with others about what you feel and experience is important for people in your life to understand what you are going through and be able to be supportive,” she explains. “There may be times when you don’t quite act like yourself and it will be helpful for others to understand — and you’ll worry less about what they’re thinking.” Consider sharing this article about the truth of what living with arthritis is really like.

7. Learn to identify what’s anxiety and what’s your illness

“It’s tough for me to tell sometimes what is my illness and what is my anxiety,” Rachel explains. “For instance, does that sharp pain mean that something’s wrong, or does it hurt because I’m worrying that it’s going to hurt?” If you are in doubt, give your doctor’s office a call as they can often tell what is serious and what isn’t. Over time, learning to trust your instincts about when something is wrong and trusting yourself to act on them can help lower anxiety, she adds.

8. Reframe the situation

If you’re concerned about something like an upcoming medical procedure or a tricky social situation, it can help to reframe it in a positive light by focusing on what you’ll gain from it, Dr. Larsen says. “For instance, look at a test as a way to get more information about your body rather than ‘bad news’ or remind yourself that a treatment, while painful, is relieving your symptoms or improving your life,” she says.

9. Make friends with your medical team

A lot of chronic illness patients report anxiety about their doctors, particularly if communication is poor. One way to deal with this anxiety is to understand how and when you can reach your doctors and to make sure you have time to ask questions, Dr. Larsen says. “View your doctors not as authority figures, but as members of your healing team, along with you,” she says. Here are signs you’re seeing the right rheumatologist.

10. Accept responsibility for what you can control

One of the predominant things arthritis steals from you is your sense of control of your life and your body. This can lead to a lot of fear and helplessness, which in turn can make your arthritis worse. Stop this anxiety by recognizing what you can control and taking responsibility for that, Dr. Larsen says. For instance, you may not be able to control your pain, but you can take charge of taking your medications exactly as prescribed and doing your physical therapy exercises, both of which may help lessen your pain.

11. Do ‘reality testing’ to stop catastrophic thinking

Another mental trick Dr. Larsen swears by is what she calls “reality testing.” Anxiety feels very real, but a lot of that worry is often based on unrealistic assumptions or future predictions, she says. Instead of getting sucked into this type of catastrophic thinking, check yourself with reality. Ask yourself “Have I done this before?” “How likely is my worry to happen?” “How do other people react to this?” A good therapist can help you do reality testing until you feel comfortable doing it on your own, she adds.

12. Acknowledge your new normal

A diagnosis of a chronic illness like arthritis means a real loss — of freedom, mobility, dreams, functionality — and giving yourself permission to recognize and grieve those losses can really help lessen anxiety, Lawrence says. “Many of us wish things would just ‘go back to normal’ but while there are many things we can still do and need to continue to live our life as much as possible, it is also important to grieve the loss of ability to do things or do them pain free,” she explains. “You’ll have less anxiety once you accept the loss of your ‘normal’ life and transition to your new normal.”

13. Practice mindfulness

Meditation and mindfulness training may sound “out there” but the mind is a powerful tool and there is a lot of science showing that learning these tools can significantly help with anxiety, Lawrence says. “You can use mindfulness skills to help manage pain and deal with your worries in a healthy way,” she says. Here’s what happened when one patient gave meditation a fair try.

14. Acknowledge the hurt

Ignoring your pain or worrying when it will return is a recipe for anxiety in chronic illnesses, Dr. Larsen says. Instead, it’s important to recognize when you’re in pain and that you are capable of handling it. “Say to yourself, ‘Yes, it hurts and it’s uncomfortable but I can get through this,’” she says. This doesn’t mean to tough it out and avoid taking medication or asking for help, but that simply acknowledging your pain will give it less power over you and will remind you that you have the tools to help yourself.

What to Do When You’re Overwhelmed by Anxiety

“I wish every person with a chronic illness and anxiety about it could understand one thing: You are not alone. It is so normal for people to feel like this and to think no one else could possibly understand what they are going through,” Lawrence says.

You don’t need to stay trapped in your cycle of worry and pain, she says. Start by reaching out to family and friends for support; be honest about your anxiety as well as your physical symptoms.

However, if your anxiety is impacting your ability to live your daily life or follow your treatment plan, or is causing any of the severe symptoms mentioned above, you must reach out for professional help, Lawrence says. Start by talking to your rheumatologist or primary care doctor. If that doesn’t help enough, ask for a referral to a mental health counselor and a psychiatrist who have experience with chronic illness, she says.

Here are some general health and mental health resources for your reference:

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