Managing Emotional Challenges and Stress
Living with the challenges of a chronic disease like RA can be stressful and emotionally challenging. It is no wonder that studies have found that patients with RA, particularly those with active disease, are at high risk for depression and anxiety.1-3
Because people with RA face increased risk for emotional problems and stress, it is important to have tools that you can use to deal with these problems and the self awareness to know when you need help.
Emotional problems you may experience
People with RA tend to experience more stress, anxiety, and depression than other people and the first step in finding relief from these problems is recognizing them.
Anxiety typically happens in response to circumstances in life, such as living in a war zone or living with the uncertainty and stress of having a chronic disease like RA. Different stressors, like financial uncertainty and worry about the future can trigger or worsen anxiety. There are a number of effective treatment options for dealing with anxiety. The first step is to bring your anxiety to the attention of your doctor. Your doctor can refer you to a professional trained to help.
Since anxiety typically occurs as a response to certain circumstances in life, which, for a person with RA may include the uncertainty of having a chronic illness, treatment approaches that address those life circumstances may be particularly useful. These typically include psychotherapy, counseling, or stress reduction training. These interventions can help a person understand the source of anxiety and develop ways to handle anxious feelings.
In addition to non-drug interventions, there are some medications that are effective in treating anxiety. These include some types of benzodiazepines, such as Valium (diazepam) and Xanax (alprazolam) and certain antidepressant medications, such as Zoloft (sertraline), Paxil (paroxetine), Wellbutrin (buproprion) and Effexor (venlafaxine).
Stress affects most people, whether it has to do with work or difficult life situations. However, a person with a chronic disease like RA tends to live with more stress than others. This stress manifests itself physiologically, cognitively, and emotionally. People with RA experience the physiologic stress of pain, stiffness, and inflammation, the cognitive stress of uncertainty about the future, and the emotional stress of anxiety about the course of the disease and how it will affect the body over time.
RA challenges a person to live with quite a bit of uncertainty. Stress may have an effect on the immune system and may have a role in triggering an RA flare or worsening of RA symptoms.4
Tips for dealing with stress
- Deep breathing can be a rapid and effective way of coping with stress when it arises: breathing triggers an immediate relaxation respons
- Make sure you get enough sleep: being rested will make you less susceptible to situational stress
- Drink plenty of water and get proper nutrition: being hungry or dehydrated can make you more susceptible to stress
- Learn relaxation techniques (eg, meditation, deep breathing, yoga)
- Get regular exercise: being in good shape will help you not only physically, but emotionally, and will help reduce your stress level
- Stay focused in the “here” and “now” and learn to let go of what you cannot control
- Give yourself time and space to transition between work and home life: don’t bring work home with you and keep your personal life away from your work environment
- Devote your time and energy to things that you enjoy
Adapted from Sutton AL. Arthritis Sourcebook : Basic Consumer Health Information About the Risk Factors, Symptoms, Diagnosis, and Treatment of Osteoarthritis, Rheumatoid Arthritis, Juvenile Arthritis, Gout, Infectious Arthritis, and Auto-immune Disorders Associated with Arthritis, Along with Facts Abo. Detroit, MI: Omnigraphics; 2010.
There are many effective interventions that you can use to reduce stress in your life, including a regular exercise program, yoga, meditation and other relaxation techniques, and counseling. One effective way to acquire skills to help you reduce stress is to work directly with a professional trained in strategies for stress reduction.
Depression is common in people with RA, especially those with active disease who experience RA-related disability. Since depression is a dangerous condition that can increase your risk for doing harm to yourself, it is important to be aware of the signs of depression so that it can be diagnosed and treated as quickly as possible. Diagnosing depression can be difficult and should be left to a professional. If you notice the symptoms of depression in yourself or a friend or family member, alert your doctor and ask for an evaluation. There is agreement among mental health experts that the best treatment for major depression is a combination of antidepressant medication and psychotherapy or counseling. While each type of treatment can provide some relief for depression, the combination works together and can be highly effective.
Only a qualified physician (typically a psychiatrist) can determine which antidepressant medication will be best for you. However, a variety of types of antidepressants have been used successfully to treat major depression. These include a group of antidepressants called tricyclics, such as Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine), and another group of antidepressants called serotonergic antidepressants, including Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), and Prozac (fluoxetine). Other types of antidepressants may also be useful, including Wellbutrin (bupropion HCl), Serzone (nefazodone), and Desyrel (trazodone). Because different antidepressants cause slightly different kinds of side effects and no individual person will react the same to every medication, you will need to work with a psychiatrist to find the right antidepressant for you, based on how well it works and how well you tolerate it. It may take up to 6 weeks to find out how well a particular medication will work for you. So, work closely with your psychiatrist and be prepared to give the process time.
Consider an RA support group
When it comes to coping with the emotional and practical challenges posed by RA, there is wisdom in the old adage “there’s strength in numbers.” When you join an RA support group, you tap into the experience, knowledge, and connections of many people who are struggling with difficulties similar to your own. A support group can be particularly useful as a place to talk about the emotional challenges and stress associated with living with RA.
A support group may be led by an experienced health professional, such as a social worker, psychologist, nurse, or doctor, or it may be member-led (such groups are sometimes called peer or self-help groups). Even if you see yourself as an independent, rugged individual, there are a number of practical benefits that you can get from being a member of a support group. Your fellow support group members may have the latest info on treatments and other developments in RA research and you can get a lot of useful information by comparing notes with other RA patients on symptom management strategies and alternative treatments.
Benefits of support groups
- Forum for talking about your feeling
- Opportunity to be social
- Source of encouragement
- Source of information about anything having to do with RA, including tests, drugs, and surgery
- Opportunity to be with other people who know what you are experiencing
- Find a role model and be a role model
- Learn from RA patients who have more experience than you in living with RA
- Offer your experience to those who have been newly diagnosed
Adapted from Fox B, Taylor N, Yazdany J. Arthritis for Dummies. Hoboken, NJ: Wiley Publishing, Inc; 2004.
To find an RA support group in your local area, talk to your doctor or call the Arthritis Foundation at 1-800-283-7800.
- Covic T, Tyson G, Spencer D, Howe G. Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors. J Psychosom Res 2006;60:469-76.
- El-Miedany YM, Rasheed AHE. Is anxiety a more common disorder than depression in rheumatoid arthritis? Joint Bone Spine 2002;69:300-6.
- Dickens C, Jackson J, Tomenson B, Creed F. Association of depression and rheumatoid arthritis. Psychosom 2003;44:209-15.
- Sutton AL. Arthritis Sourcebook : Basic Consumer Health Information About the Risk Factors, Symptoms, Diagnosis, and Treatment of Osteoarthritis, Rheumatoid Arthritis, Juvenile Arthritis, Gout, Infectious Arthritis, and Auto-immune Disorders Associated with Arthritis, Along with Facts Abo. Detroit, MI: Omnigraphics; 2010.
- Walker JG, Littlejohn GO, McMurray NE, Cutolo M. Stress system response and rheumatoid arthritis: a multilevel approach. Rheumatol 1999;38:1050-7.