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Mind-Body Health: Coping with the Emotional Roller Coaster of RA

Living with a chronic disease like rheumatoid arthritis (RA) can be sort of like riding an emotional roller coaster. Everyone experiences stress, anxiety, and depression at different points throughout life, but people with RA must face the prospect of a potentially debilitating disease that affects even the simplest tasks of day-to-day living. Let’s face it—it’s stressful.

Stress is an inevitable—even healthy—part of life. A little bit of short-term stress has actually been shown to sharpen our cognitive skills and strengthen our immune system; however, long-term, chronic stress can really take a toll on our health, compromising our sleep, immune system, physical health, and emotional wellbeing.

If you’re living with rheumatoid arthritis (RA), stress can have damaging results. In fact, some research has suggested that stress may play a role in the actual inflammation that causes pain by releasing molecules called cytokines, which are partly responsible for inflammation associated with RA.[1],[2] Some people with RA notice that when their stress levels rise, so does their pain. In contrast, sometimes the cycle works in reverse—as RA symptoms worsen, stress levels rise. Regardless of which comes first, the stress or the pain, it’s important to manage your emotional health so that you can live well and thrive every day. One of the most important ways to minimize stress and promote emotional health is to maintain a healthy lifestyle. Get plenty of sleep, maintain a regular schedule, eat a healthy diet, and make lifestyle changes to accommodate your symptoms.

The best way to manage stress is to prevent it from occurring in the first place.

We’ll never live in a world that’s completely stress-free, but we can learn to navigate our stress-filled world with ease so that we live with stress, not under stress.

These mind-body techniques are excellent tools for managing stress, anxiety, and depression—and some have even been shown to reduce pain.

Meditation
Guided Imagery
Breathing
Laughter Yoga
Journaling
Progressive Muscle Relaxation
Tai Chi
Music Therapy
Aromatherapy
Nature

Meditation: Sometimes referred to as imagery or visualization, meditation refers to full concentration of the mind. The goal is not necessarily to clear the mind, but to control and discipline it so that it is not overrun with useless thoughts and fears.

Meditation has been shown to have a variety of benefits, namely that it promotes relaxation and peace. Research has also shown that meditation can reduce pain levels by 57 percent.[3] (To put this in perspective, morphine and other pain relievers have been shown to reduce pain intensity by about 25 percent.) The reduction in pain was not just a placebo effect, as brain scans indicated that there was almost no activity in the somatosensory cortex—an area of the brain that senses pain intensity—during meditation. Some research has found that meditation provides pain relief by increasing brain activity in regions associated with sensory information processing, such as the posterior insula.[4]

Meditation has even been studied in patients with RA and been shown to reduce fatigue and stress levels in these patients.[5]

Try it:

Mindfulness meditation refers to the ability to observe your thoughts and feelings from an objective distance, without actively trying to avoid them or judge them. Meditation doesn’t have to be formal or complicated to be effective. Most communities have meditation instructors and courses if you want to learn, but you can also try it on your own.

There are countless ways to meditate, but the simplest way to start is to assume a comfortable seated position in a quiet setting, close your eyes, and tune in to the breath. Focusing on breathing deeply and slowly helps to quiet the mind and induce a calm state. Some people find that it helps to count to ten with each inhale and each exhale, which helps slow the breath and maintain focus. Spend five minutes quietly attuned to your breath and let the peace wash over you.

 

Guided Imagery: Our brain perceives whatever we feed it—real or imagined—as real, and our body actually responds physiologically to the images that play in our brain. Guided imagery is a simple relaxation technique that can help you achieve a relaxed and focused state. It utilizes all of your senses to help you engage in a vivid imagery exercise that allows you to feel like you are experiencing something simply by imagining it.

Guided imagery is different than daydreaming because it is more directed and focused. In fact, there are several guided programs and audios available to navigate people through guided imagery sessions. During a guided imagery session, you may imagine yourself in a place—and then imagine the sights, sounds, smells, feelings, and even taste you would experience in such a location.

Guided imagery is an excellent tool for stress relief and has been shown to reduce blood pressure and promote relaxation. Imagining yourself in a peaceful setting can help you to relax and de-stress. Guided imagery is safe, effective, and easy to learn. You may choose to use an audio program or engage the help of a therapist or instructor, but you can easily follow your own script to create your own peaceful session:

  • Set aside 10-15 minutes of uninterrupted time in a place where you’ll be free from distraction.
  • Get into a comfortable position, either sitting or lying down.
  • Take a few deep, cleansing breaths.
  • Begin to envision yourself in a peaceful, relaxed setting. For some people, this might be a tropical beach and for others, it could be sitting around a campfire telling stories. Choose what feels peaceful and wonderful to you.
  • As you begin to envision your peaceful place, start to engage all of your senses to complete the picture. If you’re at the beach, you might hear the sound of the surf, feel the sand in your toes, smell the ocean breeze, and taste the tropical fruit. Or, if you’re snuggled into a winter cabin, perhaps you can feel the warmth of the fire, hear the crackling logs, and taste the sweet hot chocolate. Get specific as you imagine your scene. Focus on the details.
  • Stay in your “happy place” as long as you wish. Relax and sink into the peaceful feelings your imagery evokes.

 

Breathing: Stress and breathing are inextricably linked—high stress leads to shallow breathing and shallow breathing leads to—you guessed it—more stress.

Most of us don’t give much thought to our breath, believing that it’s something that happens involuntarily—and to some degree, that is true. Breathing is an automatic body function controlled by the respiratory center of the brain. Breathing allows for the exchange of gases—our cells need to take in oxygen and expel carbon dioxide.

Proper breathing not only allows for the exchange of gas, but it also soothes the autonomic nervous system. When we breathe correctly, we use our abdomen and diaphragm to suck air into the lungs (via inhalation) and push it out (via exhalation). Relaxed and proper breathing is slow, steady, and easy.

The stress response can cause the breathing pattern to change. People who are under stress typically take small, shallow breaths from the upper chest. If you watch someone who is stressed, they often use their shoulders rather than their diaphragm to move air in and out of the lungs.

Shallow breathing empties too much carbon dioxide out of the blood, which upsets the body’s balance of gases. While shallow breathing is often a result of stress, it can also cause more stress in the body, resulting in fatigue, tension, anxiety, and other symptoms. Consistent shallow and rapid breathing creates a prolonged state of stress.

Stress can be managed and reduced with proper breathing. Although breathing is an automatic body function, we can control it. With a little awareness, we can consciously shift into abdominal breathing, which has been shown to calm the autonomic nervous system and create a relaxation response. Abdominal breathing has been shown to reduce blood pressure, heart rate, and levels of stress hormones. Furthermore, it boosts the immune system and promotes a sense of calm.

Breathing is one of the best stress management tools out there—it’s simple, quick, and free, and can be practiced anywhere at any time. There are many different breathing and relaxation techniques and each of them has value. Anything that helps you shift from upper chest breathing to abdominal breathing will help reduce stress and promote relaxation. Try this:

  • Sit or lie down in a quiet, relaxed environment
  • Place one hand on your chest and the other on your abdomen.
  • Close your mouth.
  • Inhale slowly through your nose and focus on feeling your abdomen rise into your hand. (Try to keep the hand on your chest still.)
  • Sometimes it helps to place a rhythm or count to the breath. You could count to six as you inhale, hold the breath for two counts, and then count to six as you exhale.
  • Focus on slow, deep, rhythmic breathing.
  • Feel the stress and tension melt away from your body.

 

Laughter Yoga: When most people think of yoga, they think of moving, stretching, and contorting themselves into pretzel-like positions—but laughter yoga is a different type of yoga that combines laughter and yogic breathing exercises (called pranayama). During laughter yoga, participants engage in “self-triggered” laughter as a body exercise with eye contact and childlike playfulness. The laughter is physical in nature and does not involve comedy or humor. This simulated laughter eventually turns into genuine—and contagious—laughter.

Laughter yoga may seem silly at first glance, but there is some cold, hard science behind it. Clinical research has proven that laughter lowers the level of stress hormones such as cortisol and epinephrine in the blood and boosts the immune system.[6] Furthermore, it can help to foster a positive, optimistic attitude and counteract feelings of anxiety, depression, and helplessness.

Interestingly, the body cannot differentiate between fake and real laughter—both provide the same physiological and psychological benefits. So the simulated laughter in laughter yoga provides the same mood boost as the spontaneous eruption of laughter at something funny. What’s more, laughter can tighten the abdominal muscles and provide aerobic benefits. In fact, one minute of intense laughter is as beneficial as ten on a treadmill.

So, if you’re feeling bogged down by stress, pay a visit to laughter yoga class and feel your spirits lift. The practice has quickly become a worldwide phenomenon, with more than 8,000 laughter clubs on five continents in about 60 countries. Find a laughter yoga club near you.

 

Journaling: Sometimes the challenges of life can seem so overwhelming that it’s hard to make sense of it all. While some people find solace in talking with a friend or professional, many find relief in the form of a simple journal. Journaling, or expressive writing, can be a useful tool for processing negative thoughts and feelings and writing your way to a better frame of mind.

A journal is a place where you can record your thoughts and feelings about the events in your life. It is a stress management and self-exploration tool with a proven track record for relieving stress and providing emotional benefits. One study found that psychotherapy patients who used expressive writing experienced more progress and greater reductions in anxiety and depression than those who did not write in a journal.[7] Another study found that journaling was associated with significant decreases in worry and depression.[8]

Journaling is a safe and proven method for working through anxiety, stress, and emotions. The benefits are many:

  • A journal provides an opportunity to clarify your thoughts and feelings.
  • A journal is an excellent problem-solving tool. Often, by writing your problems down, you can arrive at solutions you weren’t able to see prior to journaling.
  • A journal provides a safe, non-confrontational environment in which to express anger and frustration—without taking it out on others.
  • A journal provides an opportunity for reflection and allows you to see patterns over time.
  • A journal helps you process negative emotions and move toward positive ones.

There really is no right or wrong way to journal. Your goal is to put pen to paper (or fingers to keyboard) and write with the purpose of moving into a more positive mindset. Some helpful guidelines for using journaling to relieve stress:

  • Make it a habit. Write for 15 minutes every day.
  • Banish your inner censor. Just write without worrying about grammar, punctuation, or spelling. This is simply a process for clarifying your thoughts and feelings, not a writing contest.
  • Write for yourself and yourself only. Keep your journal to yourself for the best results. If you know that no one else will read it, you’ll be more likely to write your honest feelings. This will allow you to let it all hang out.
  • Use a two-part process: 1) Write what happened, and 2) Write how you feel about what happened.
  • Keep digging. Keep writing and continue to ask yourself, “Why?” The more you dig, the more likely you are to peel away the layers of a problem until you arrive at the true source of your stress.

 

Progressive Muscle Relaxation: If you’re feeling stressed, it may seem counterintuitive to intentionally tense your muscles, but it might be your first step toward relaxation. Progressive muscle relaxation—or PMR—is a relaxation technique that involves tensing and then relaxing each muscle group in the body, one at a time. It is an effective tool for managing stress, anxiety, insomnia, and even chronic pain.

PMR is a subtle, simple technique that is easy to learn and can be used almost anywhere at any time. It is based on the premise that it is easier to relax a muscle from a place of distinct tension than it is to relax it from a place of lower tension. By tensing or tightening the muscles, you’ll create an exaggerated sense of tension, which will then result in more relaxation when you release the muscle. Furthermore, consciously tensing and releasing muscles will help you to recognize where you hold tension in your body.

There are many guided audio programs that will walk you through PMR, but the technique is fairly easy to learn and use on your own. It’s safe and effective. Try it:

    1. Carve out space and time for a PMR session. You’ll need 10 to 30 minutes for optimal results. Find a quiet, dimly lit space where you’ll be free from interruptions. PMR is best practiced while lying down, but you can do it sitting up as well.
    2. Close your eyes and take a few deep breaths before beginning.
    3. You will use breath and tension to move through the different muscle groups in the body. Take a deep inhale and contract the first muscle group (typically the feet), tensing but not straining. Hold this contraction for five to ten seconds and then exhale as you relax the muscles. Allow about 20 seconds to experience the deep sense of relaxation that follows the tension before you move on to the next muscle group.
    4. Gradually work your way up the body, consciously tensing and relaxing each muscle group one at a time. Most practitioners recommend beginning with the feet and ending with the face. For example:
  • Feet
  • Lower legs
  • Thighs
  • Buttocks
  • Abdomen
  • Chest
  • Upper back
  • Shoulders
  • Arms
  • Hands
  • Neck
  • Jaw
  • Mouth
  • Eyes
  • Forehead
  1. Remember—inhale to tense and exhale to release. Once you’ve relaxed a muscle group, try not to use it again. For example, after clenching and releasing your hands, just let them relax alongside you without lifting them or using them.
  2. Once you’ve finished the sequence, simply relax and breathe deeply and allow yourself to rest in this peaceful state.
  3. Take your time transitioning out of the relaxed state when you are finished. Move slowly and gently as you re-enter the activities of your day.

 

Tai Chi: Tai chi is a “soft” form of martial arts that originated in China almost 500 years ago. It is a system of slow, meditative, physical exercises designed for relaxation, balance, and health. Tai chi differs from other types of martial arts in that the movements do not really exert force. Instead, practitioners absorb force softly and then move with that energy to redirect it. Through a series of slow, rhythmic exercises that emphasize balance and coordination, practitioners work to balance the body’s opposing principles, yin and yang. The movements are slow and intentional and involve sweeping arm motions.

Tai chi requires focus, concentration, and self-awareness. Some people refer to it as a moving meditation. Tai chi improves balance, stimulates the immune system, improves endurance promotes relaxation, and cultivates inner energy. The practice was designed to increase health and longevity.

Tai chi is a relaxing and gentle form of movement that is accessible to people of all ages and abilities. There are really no contraindications for practicing it—even those sitting in a wheelchair can benefit from moving their arms and practicing their breathing.

Most Western beginners of tai chi learn the standard “24 Form,” which is a series of 24 movements that can be performed in about four to eight minutes. If you’re interested in practicing tai chi, look for a teacher who has been practicing for many years and who studied under a qualified tai chi master. With a burgeoning interest in tai chi, there are qualified instructors all over the world. Check with your local fitness center, yoga studio, or martial arts school to find a tai chi class.

 

Music Therapy: Music therapy is well established as an effective mind-body technique. It alters brain waves, slows breathing and heart rate, and triggers a relaxation response. Music has been shown to reduce blood pressure, improve immunity, ease muscle tension, boost creativity and optimism, and keep stress and depression at bay. Amazingly, the effects of music linger even after you’ve stopped listening. The American Music Therapy Association (AMTA) oversees the development of therapeutic applications of music and monitors educational and training standards for music therapists. But, you don’t need a formal music therapy program to benefit from the healing powers of music.

If you’re feeling stressed, you can treat yourself to your own little session of music therapy:

  • Put on some relaxing music and lie down in a comfortable position.
  • Choose music with a slow, repetitive rhythm.
  • As you allow the music to wash over you, focus on your breathing, allowing it to slow and deepen.
  • Concentrate on the silence between the notes, rather than analyzing the music.
  • Enjoy!

 

Aromatherapy: Aromatherapy refers to the practice of using essential oils or other aromatic compounds to enhance physical and emotional health and wellbeing. These essential oils are extracted from flowers, bark, stems, leaves, roots or other parts of a plant. Many practitioners believe that inhaling the aroma of essential oils can stimulate brain function. Furthermore, some essential oils can be absorbed through the skin, where they reach the bloodstream and promote healing.

Our sense of smell has a powerful influence on our emotions and mood. Aromas are powerful memory triggers and mood enhancers—so much so that they can be used to relieve stress, uplift our mood, and provide an energy boost.

Aromatherapy is used to address many issues, including pain, fatigue, stress, nausea, cognitive function, and more. If your life is overrun by stress, consider incorporating aromatherapy into your daily routine to boost your mood and ease your tension. A certified aromatherapist can help concoct the right aroma for you, but you can also experiment on your own. It’s important to note that essential oils are highly concentrated and need to be diluted with another oil or lotion before applying directly to the skin.

 

Nature: A growing body of research confirms that time spent in nature can improve our self-esteem and mood and induce a sense of awe and wonder. In fact, studies show that time spent in nature is more than therapeutic—it’s necessary. Researchers from Arizona State University have found that time spent in nature creates a sense of connectedness and inspires a sense of awe.[9]

The value of the sense of awe is that it tends to direct attention away from the self and toward the environment. This produces a calming effect and helps make everyday stress and anxieties feel more manageable.

In another study, researchers from the University of Essex found that individuals who exercised outdoors—or spent as few as five minutes of activity in a natural setting—experienced improved self-esteem and mood.[10] Any type of green environment improved self-esteem and mood, but the presence of water increased the effects.

Sometimes finding peace is as simple as getting outside. The sights, sounds, and smells of nature are soothing to the senses. Spending time near a babbling brook or rustling trees can promote a deep sense of relaxation, which allows the mind to wander and recharge.

Even if you’re not an outdoor enthusiast or if you live in a concrete jungle, there are still ways to connect with nature:

  • Visit an urban park. Read, take a picnic, or simply sit on a bench and breathe.
  • Walk along a river or creek. Even the most urban areas typically have short nature paths scattered throughout town.
  • Sit outside. Eat dinner on the porch. Drink your morning coffee in the backyard. Spend time outside soaking up the natural light.

 

References:

[1] Motivala SJ, Khanna D, FitzGerald J, Irwin MR. Stress activation of cellular markers of inflammation in rheumatoid arthritis: protective effects of tumor necrosis factor alpha antagonists. Arthritis and Rheumatism. 2008; 58(2): 376-383.

[2] Davis MC, Zautra AJ, Younger J, et al. Chronic stress and regulation of cellular markers of inflammation in rheumatoidarthritis: Implications for fatigue. Brain, Behavior, and Immunity. 2008; 22(1): 24-32.

[3] Zeidan F, Martucci KT, Kraft RA, et al. Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation. The Journal of Neuroscience. 2011; 31(14): 5540-5548.

[4] Gard T, Holzel BK, Sack AT, et al. Pain Attenuation through Mindfulness is Associated with Decreased Cognitive Control and Increased Sensory Processing in the Brain. Cerebral Cortex. Published early online December 15, 2011: doi: 10.1093/cercor/bhr352

[5] Zangi HA, Mowinckel P, Finset A, et al. A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: a randomized controlled trial. Annals of the Rheumatic Diseases. Published early online December 20, 2011: doi:10.1136/annrheumdis-2011-200351

[6] Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Alternative Therapies in Health and Medicine. 2001;7(2):62-72, 74-76.

[7] Graf MC, Guadiano BA, Geller PA. Written emotional disclosure: a controlled study of the benefits of expressive writing homework in outpatient psychotherapy. Psychotherapy Research. 2008; 18(4): 389-399.

[8] Gortner E, Rude SS, Pennebaker JW. Benefits of expressive writing in lowering rumination and depressive symptoms. Behavior Therapy, 2006; 37(3): 292-303.

[9] Shiota M, Keltner D, Mossman A. The nature of awe: Elicitors, appraisals, and effects on self-concept. Cognition and Emotion. 2007; 21(5) 944-963.

[10] Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental Science and Technology. 2010; 44(10): 3947-55.

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