Stress and Arthritis

Fact: Having a chronic illness like arthritis can make you stressed. Also a fact: Being stressed can make your arthritis worse. And… even knowing these facts is stressful. Figuring out how to deal with the stresses of your illness on top of those from your everyday life should be one of your top priorities, but it’s easy to get overwhelmed.

When Mathias P., of Portland, Oregon, was first diagnosed with ankylosing spondylitis he went into a tailspin. “I was just 28, I was super fit, I didn’t fit the profile of someone with arthritis, and I was devastated,” he says.

The stress of the diagnosis worsened his AS flare-ups and before long he was almost fully disabled. In addition, the stress caused other symptoms including hair loss, cold sores, weakness, headaches, increased pain, and crushing depression. “In the span of a month I went from a guy who had some pain but still did stuff to a person defined by my illness. I was so miserable I even briefly thought about ending my own life because I couldn’t see a future like this,” he confesses.

At his next doctor’s appointment, he told his doctor about all the symptoms that seemed to appear out of nowhere. “I told him, ‘I feel like I’ve lost everything I love about my life’ and I’ll never forget what he said next,” Mathias says. “He just looked at me and asked ‘Why? You can still do all those things; you just might have to do them differently now.’ It was like a light went on and I felt so much less stressed about my future.”

Mathias’s doctor talked to him about the correlation between stress and arthritis symptoms and told him that he should do whatever it takes to keep up with the activities and people he loved, to see this as part of self-care. “I can’t say enough about the importance of self-care and reducing stress,” he says, adding that after starting AS treatment he’s been able to return to rock climbing and sea kayaking, two of his biggest passions.

His reaction is a totally normal one for someone who receives a life-changing diagnosis like arthritis, says Lisa S. Larsen, PsyD, a licensed psychologist in Lancaster, California, who specializes in treating people with chronic illness and lives with one herself. “Stress and chronic illness go hand-in-hand, with one often triggering or worsening the other,” she explains.

How Stress and Arthritis Affect Each Other

Stress affects your illness in two major ways, according to a meta-analysis of 10 studies on the relationship between stress and arthritis, published in the journal Arthritis Research and Therapy. Stressful events work on a physical level, increasing levels of the hormone cortisol in your body. This then triggers the immune system hyperactivity that is the hallmark of inflammatory types of arthritis while also reducing your immune system’s ability to fight off harmful germs. Stress also affects you on a mental level, making you less resilient and able to deal with the symptoms of your disease. “When our patients say that stress worsens their disease, they may be correct,” the researchers concluded.

Fortunately, you can manage this vicious cycle of stress and its impact on managing arthritis. Here are some tips from Dr. Larsen and from fellow arthritis patients on how they cope with stress to minimize its impact on their arthritis.

Reset Your Mindset

1. Do ‘reality testing’

“A lot of stress comes from anxiety, the fear of the unknown,” Dr. Larsen says. One way to relieve anxiety from the uncertainty of chronic illness is to do what she calls “reality testing.” This means examining your fears and being honest with yourself about what the reality is.

“For instance, if my doctor prescribes me an injectable medication and I’m stressed out about taking it, I remember that the reality is that I know how to give myself injection, I’ve done it before, and there’s no reason I can’t do it again,” she says. “Sure, it hurts and it’s uncomfortable, but it is part of my responsibility to myself as a person trying to get better.”

2. Be analytical about it

A big stressor with arthritis is the long process of getting properly diagnosed and on the right treatment plan, but you can reduce this stress by reframing how you think about each step of the journey, Dr. Larsen says. “Think of it as being a scientist of your own body,” she says. “For instance, if I am stressed out about a blood test, I can think of it as a positive, as a way to find out what’s really going on in my body.” This small mental shift can significantly reduce your stress, she says.

3. Create a healing team

Your health care providers are going to play a big part in how you feel physically and emotionally so it’s important to find doctors and other care providers you mesh with, Dr. Larsen says. Doctors can sometimes be remote, cold, clinical, or even judgmental, which can feel even more stressful. One thing that helps her is to think of all her providers as one part of her healing team. “I view my doctors not as authority figures but as members of my healing team,” she explains. “That means I am also a member of my healing team, and just as I would expect other people in my healing team to step up and do their jobs, so must I if I want to get better.” (Here are signs you’re seeing the right rheumatologist, and what shared decision-making really means.)

4. Accept responsibility for what you *can* do

With arthritis it’s easy to focus on everything you can’t do. (Sleeping without pain? What’s that again?) However, recognizing everything you can do to help yourself is very empowering and will reduce the stress of your illness, Dr. Larsen says. “Accept responsibility for self-care and realize that there is only so much that a doctor or medicine, or anything outside of you can do,” she explains. “Yes, that puts a lot of responsibility on you as a person trying to get better, but it also empowers you to rely less on outside forces for your well-being and improve your attitude, which is also important to help you cope and heal.”

5. Make your peace with stress

It may sound counterintuitive but learning how to accept stress and put it in perspective has been key for Meghan H., of Ridgecrest, California, who has rheumatoid arthritis. “Some days are just going to be better than others and that’s okay,” she explains. “I tell myself to just do what I can do and not worry about the rest. Tomorrow will probably be better so there’s no point in stressing out about today.” (Here are more truths about living with an invisible illness.)

Take Rest Seriously

6. Schedule a nap in your calendar

“As someone who has lived with chronic illnesses for years, I have learned the hard way that when it comes to coping with stress, there is no substitute for rest,” says Monica C., of Phoenix, Arizona. The trick is to actually schedule your rest time, just like you would any other appointment. This way you will be less tempted to push through or forget about it.

7. Implement a bedtime routine

Chronic pain and sleeplessness (commonly known as painsomnia) can turn into a vicious cycle fast — and nothing is more stressful than insomnia. To make sure she gets enough sleep Meghan has developed a bedtime routine that helps her make sure her body is prepped to fall asleep and stay asleep. What routine works best for you will vary but it may include things like a warm bath, a heating pad, a special pillow set-up, a half-hour of quiet reading, meditation, or whatever else makes you feel calm.

8. Stay in your pajamas all day (sometimes)

Ever have those days where you just can’t get out of bed? You have arthritis, so of course you do. And that’s fine. Your pain and fatigue are real and legitimate and trying to push through your symptoms is incredibly stressful. It’s important to give yourself permission to cancel your calendar as needed, Meghan says. “Some days just need to be pajama days with a clear schedule and I’ve learned that it’s not just okay, it’s necessary,” she says.

9. Indulge in a bubble bath

For some, taking a long, warm bath is a once-in-a-blue-moon luxury but for Mary R., of Westerville, Ohio, they are a non-negotiable way of taking care of her rheumatoid arthritis and other chronic illnesses. “I have to have a bubble bath nightly if I want to get a good night’s sleep,” she says. The warmth helps her pain, increases relaxation, and reduces stress.

Hack Your Daily Routine

10. Simplify repetitive tasks

Much of life is doing the same old stuff over and over again. When you have a chronic illness like arthritis, the daily grind can literally grind you down — physically and emotionally. “Learning how to conserve energy as much as possible helps me reduce stress,” Monica explains. Look at your life to see how you can combine or simplify repetitive tasks, she says. For instance, can you buy pre-chopped veggies, use a minimal makeup routine, or carpool with a friend to work? All of these little changes can add up to big stress relief over time.

11. Eat small, frequent meals

“Large meals stress my body out and make me feel exhausted afterward,” Meghan says. Conversely, being super hungry also feels very stressful to her. Her solution? “I eat five or six mini meals spread out throughout my day,” she explains. A healthy snack of protein and a fresh fruit or vegetable provides consistent energy and helps defuse stress.

12. Schedule tasks around your flares

Learning when her pain will be the worst and her functionality will be the best has allowed Elizabeth P., of Ridgecrest, California, to better manage her rheumatoid arthritis. “I do a few easy things in the morning when my body is still warming up. Then early afternoon I do any large tasks because that’s when I feel my best. Afternoon I do dinner prep and by evening it’s only things I can do from a seated position,” she explains. Knowing what she can do and when helps her days feel less stressful.

13. Get organized

The more things you have, the more precious time and energy you have to spend caring for them. Clearing out clutter and creating a simple organizing system has been a big way to eliminate stress and help manage her illness, Elizabeth says. Not only does it mean less clean up but it also makes things easier for her kids to find which means she can rest more.

14. Keep simple child-friendly activities and snacks handy

Nothing stresses out a parent like having a needy child they feel they can’t properly take care of. Arthritis can make taking care of kiddos feel impossible some days. Reduce this stress by keeping a box of games, movies, art projects, and snacks handy that your kids can do without much help from you, Elizabeth says. Save them for the times when you’re having a particularly bad flare so they’ll feel special and the kids will be excited about them. For instance, you could make video games and microwaved pizza rolls a special “treat” for your rest days. Here are more tips for parenting young children when you have arthritis.

Help Others Help You

15. Get comfortable with boundaries

Setting boundaries can be tricky for many people as it can require some confrontation or at least telling others something you think they won’t like. But learning to set appropriate boundaries and being firm on maintaining them is the key to managing and preventing stress, Meghan says. This may mean having a set bedtime and asking guests to leave early. Or perhaps it means saying no to a party or other fun invite when you’re feeling overwhelmed. “Figure out what your limits are and don’t apologize for sticking to them,” she says.

16. Schedule a girl’s night in

Going out is a huge source of stress for Amanda S., of Denver, Colorado, who has inflammatory arthritis, chronic migraines, and type I diabetes. Not only does it take a lot of time and energy to plan and go out but once she’s there, her restrictive-but-necessary diet means she has to worry about the food as well. Her stress-free solution? Plan a girl’s night in. She invites a few girlfriends over to play games or watch a movie and then she doesn’t have to worry about getting dressed up or doing something physical when she’s in pain. She can make the snacks so she doesn’t have to stress over food restrictions. Bonus: Spending time with loved ones is a proven way to reduce stress.

17. Divide up chores among your family

Leave your superhero cape at the door. When it comes to lessening stress, one of the best things you can do is to allow your loved ones to take on more responsibility, Elizabeth says. Even though her children are small they can still do age-appropriate tasks like picking up toys, putting away clothing, or setting the table. Her husband also picks up the slack on days when she’s feeling overwhelmed or in pain. Just remember to let them do the task their way — as long as it gets done it doesn’t matter if it’s exactly the way you would have done it.

Take Care of Your Physical Health

18. Take physical signs of stress seriously

“Sometimes I feel stress before I even realize I’m stressed out,” Meghan says. And she can’t deal with her stress unless she recognizes how it’s affecting her. Her telltale symptom? “Hello, racoon eyes!” she says. Deep, dark undereye bags are a tip-off that she needs to do some self-care immediately.

19. Adopt a habit that promotes a healthy weight

Dennis L.’s chronic illnesses lead to serious fatigue, which in turn made him gain more than 60 pounds. The extra weight made his illnesses worse, putting serious stress on his body and his emotions, the British Columbia native says. “The weight itself caused me to feel stressed out and made it harder to deal with other stressors,” he explains. So he decided to lose weight — slowly and under the guidance of his doctors — by walking and riding his bike, along with watching his diet. Today he’s lost the weight, gained confidence in himself, and feels less stressed out in general, he says. “Today I am an endurance biker and runner and am fitter than I have ever been,” he says.

20. Find a workout you love

Have you heard the phrase “motion is lotion” for your joints? Exercise is one of the best things someone with arthritis can do for their body and their mind. We get how hard it can be to walk across the parking lot to the gym when you’re in pain, much less sweat through an hour-long class. “When I workout regularly I just feel better physically and I’m less stressed,” Amanda says. The trick is to find an exercise you actually love and can get excited about, not one that stresses you out more. For Amanda, she loves BodyPump classes as they incorporate weight lifting and some light cardio without feeling too intimidating, she says. For others, structured classes at the gym might be too much. Or just…

21. Stretch out your joints daily

Exercise doesn’t have to be an all-or-nothing thing. In fact, having that mentality can make exercise more stressful. For Elizabeth this means skipping long runs and formal yoga classes in favor of taking a walk and doing some full-body stretches at home. It keeps her limber, her joints flexible and lubricated, and, most importantly, reduces her stress. You could start with a short gentle yoga routine at home or try some water exercises at your local pool.

22. Nix the bedtime ice cream scoop

Comfort food can be comforting — but not if it increases your inflammation and stress. “For me, the key to keeping my stress and my illnesses in check is to eat an anti-inflammatory diet —mainly by avoiding dairy, sugar, and gluten,” Amanda says. This doesn’t mean you have to give up all your favorite foods but consider making healthy swaps, like having a mug of herbal tea before bed instead of hot chocolate.

Embrace a ‘Knowledge Is Power’ Attitude

23. Get educated about your disease and treatment

Knowledge is power — and feeling powerful automatically reduces stress. “Learning the actual facts about my disease really helped me stop freaking out,” Mathias says. He did basic research on the internet and brought a list of questions to each doctor’s appointment. “Don’t get me wrong, [having AS] still sucks, but now that I know why I feel the way I do and why my body is acting a certain way, it’s easier to do what I know I’m supposed to be doing,” he says.

Use Our ArthritisPower App to Manage Your Arthritis

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