Coping With Change

Coping with life changes or even changes in your pain levels can be a challenge with arthritis. Get tips and information about how to cope with the ups and downs and life changes.

Your Role as a Patient: What You Can Do

5 ways to enhance your chance of success with arthritis.

Succeeding with a chronic illness involves more than just following doctor’s orders. If you’re willing to work at it, these five habits will ensure you live successfully with arthritis:

1. Learn all you can.
   

   Knowledge is power. Read everything you can, and locate trusted sources of news and information (online or offline); find out where exercise classes are being held in your community; and ask lots of questions – of your doctor, your physical therapist and other health-care providers.

2. Pay attention to your emotions.
   

   Living with a chronic condition such as arthritis ups your chance of developing depression. Warning signs include constant tiredness, lack of appetite, trouble making decisions, disrupted sleep and feeling worthless. To head off depression, develop a network of family and friends who raise your spirits and can help you keep active.

3. Make your doctor your partner in care.
   

   You’re more likely to find success if you and your physician make informed decisions together. Make sure your doctor spends time with you discussing treatment options and answering all your questions. Talk about ways to improve your functioning, such as losing weight, becoming more active or reducing stress. Don’t be embarrassed to talk to your physician about anything, including admitting when you haven’t followed her advice. Agree to disagree when the two of you have different opinions – and keep talking about it.

4. Take action.
   

   It’s natural to be unsettled and upset after being diagnosed with arthritis or a related condition. But those who live successfully with chronic illness accept that their diagnosis is here to stay and they quickly start thinking about how to adapt their lives. Look at what you can do and what you may need to change (whether it’s activities, diet, exercise or stress level). Make a plan (with your doctor) and write it down. Talk to family and friends about the changes you’ll need to make. Letting others know about your plan can help you stick with it.

5. Invest in yourself.
   

   You don’t have to give up the life you had before you were diagnosed, but you may have to put that plan you made into action. It’s not surprising to hear that the most successful patients are the ones who made changes, such as exercising more, losing weight and eating more nutritious meals. Recognize your responsibility – and ability – to take good care of yourself in order to live healthfully. Make sure your goals are realistic, even if they involve only small steps right now. Enlist family and friends to help you make healthy changes, and monitor your own behavior frequently.

How to Build Resilience and Bounce Back Into Life

Building resilience is key to helping yourself cope with adversity – and feel better.

By Camille Noe Pagán

Diana Reyers knows a thing or two about bouncing back and building resilience. After being diagnosed with rheumatoid arthritis (RA) in 2005, the Ontario mother of two couldn’t keep up with her 50-hour-a-week management job. She went back to school to pursue a less stressful, more satisfying career as an esthetician, and even opened her own spa in 2008. But she had to give up that career, too, when she developed painful osteoarthritis (OA) in her thumbs. “I was left with little money and an immense feeling of being unfulfilled,” she recalls.

One day in 2010, during an especially bad neck spasm, she says, “I lay down to rest and had an epiphany: I was not going to beat arthritis, but I could live with it in a better way.”

She worked with her rheumatologist to find an effective medication combination< and took yet another professional turn, training to become a life coach. Now, she says, she has an “incredibly rewarding” career that allows her time to take care of herself and her family.

What makes people like Reyers not just survive, but actually thrive in the face of obstacles? In a word: resilience.

Resilience, says psychologist Robert Wicks, is “the ability to learn from and rebound from challenges, adversity and stress.”

When you’re resilient, you’re able to keep going mentally and physically in spite of the pain, grief and anger that may come with adversity. You can look beyond the problem and draw on constructive coping mechanisms like optimism, acceptance and faith that you can change things and get past setbacks without giving in to hopelessness and frustration.

Developing resilience is especially important for those with arthritis, adds Wicks, a professor at Loyola College in Maryland and author of Bounce: Living the Resilient Life (Oxford, 2009). “Chronic disease poses regular, and often immense, psychological and physical setbacks,” he says. “You have to be able to cope with them in order to care for yourself. Resilience is the difference between making arthritis one part of your story and [allowing it to be] your entire narrative."

A Remedy for Pain

A body of research shows that people who demonstrate higher levels of resilience tend to recover faster, manage pain better, be less susceptible to chronic depression and anxiety, and have better overall health outcomes than those who are less resilient. For example, a study published in the Journal of Consulting and Clinical Psychology looked at 300 women with RA and found that those who scored high on resilience questionnaires reported less RA-related pain than those with lower scores.

A study published in the Annals of Behavioral Medicine looked at 275 patients with knee OA and found that those who exhibited the most resilience-related characteristics were also the most likely to show self-efficacy – for example, taking the initiative to see a physician or to exercise regularly. They also reported less pain and an increased ability to perform everyday activities compared with less resilient study participants.

“Resilience impacts thoughts and, therefore, behavior in profound ways,” says Chicago-based psychologist and physical therapist Elizabeth Lombardo, PhD. “A less resilient person experiencing a flare might think, ‘Well, I can’t exercise,’ or ‘My doctor isn’t helping me enough.’ A resilient individual thinks, ‘How can I improve my situation? What can I do to get moving again?’”

Further, resilience requires tapping into a set of coping skills that reduce stress levels and the stress hormones that are known to exacerbate arthritis pain.

Build Your Resilience

Experts agree that some people seem to be naturally resilient, but a wealth of research shows others can develop it and bolster their buoyancy. “It’s a skill that can be developed and honed over time,” says Wicks.

Try these strategies to build your resilience – and bounce back better.

Focus on the upside. Studies show that optimism is part and parcel of resilience; the more hopeful you feel, the more resilient you’ll be. Boosting your optimism requires you to “reframe your experience so that you’re aware of the negative, but focused on the positive,” says David Hellerstein, MD, professor of clinical psychiatry at Columbia University’s College of Physicians and Surgeons in New York City. Ask yourself three questions, he says: “Does this provide new opportunities? Can I look at this differently? Is there any good to come out of it?" 

Learn from experience. If you have a chronic disease, you’re already more resilient than you probably give yourself credit for, says Patricia O’Gorman, PhD, a psychologist in Albany, N.Y., who specializes in trauma and resilience. “When you’re dealing with a new setback, that’s the time to ask yourself, ‘How have I dealt with problems in the past? What worked, and which strategies should I skip this time?’” When pianist Lisa Emrich, 43, was diagnosed with RA she took this approach, drawing on her experience with multiple sclerosis. “I saw a doctor right away, kept getting tested until I had a diagnosis, and worked with my physician to formulate a plan – in this case, medication plus occupational therapy, which ultimately allowed me to return to playing the piano,” she says.

Expand your knowledge. Ask lots of questions when you’re at the rheumatologist’s office, and regularly read up on arthritis and health. “Learning boosts resilience,” says Dr. Hellerstein. “The more you learn about how best to live with your condition, the more control you have. Control as well as resourcefulness give you the confidence to move forward in the face of adversity.”

Find your bliss. Make time to find and do things you love. As resilience researchers at the University of California, Riverside, wrote for the Handbook of Adult Resilience (Guilford Press, 2010), “emotions like joy, satisfaction and interest … provide individuals with a sort of ‘psychological time-out’ in the face of stress and help them perceive the ‘big picture’ of their situations." 

Get moving. In addition to its physical benefits, exercise “decreases anxiety and depression, improves sleep and increases the levels of mood-improving chemicals, including brain-derived neurotrophic factor (BDNF), a protein that improves brain health,” says Dr. Hellerstein. Studies have shown that physically fit people don’t experience the same spikes in blood pressure and stress hormones such as cortisol in stressful situations.

Seek support. Support systems are a linchpin of resilience. “If you don’t feel like you have to go it alone, it’s much easier to push forward when the going gets tough,” explains Wicks. Not used to asking for assistance? “Most people have a hard time with that,” points out O’Gorman. “Realize that it’s not a sign of weakness. Chances are, your loved ones want to help and are simply waiting for you to ask.”

Count your blessings. Researchers at the University of California, Riverside reviewed 225 studies and found that individuals who expressed gratitude or wrote in a gratitude journal at least several times a week felt more connected, autonomous, optimistic and happy – traits that contribute to resilience. “Gratitude makes you think about what you have, which, in turn, keeps you from focusing on what you don’t have,” says Wicks. “When you feel blessed, it’s easier to keep going – no matter what you’re up against.”

Reyers believes it. She is thankful for not only her family, friends and great new career, but also the lessons she’s learned from RA. “I look at RA as a gift that has taught me to slow down and enjoy each day,” she says. “Because of it, I have a more balanced life and existence.”

Reclaim Your Passion

Stop feeling bored because arthritis has “stolen” your favorite activity.

By Alexandra Kummernes And Glenda Fauntleroy

Achy joints can put a damper on your favorite pastimes. And giving up these activities can leave you feeling disengaged and bored.

But don’t blame it on a dull environment. A study by John Eastwood, PhD, a professor and psychologist at York University in Toronto, Canada, found that participants who lost touch with their emotions were more prone to boredom. Eastwood says emotional detachment breeds boredom because a person “loses compass points that steer us toward satisfying activity.”

Acknowledge your feelings and grieve your loss, says Eastwood. “Just don’t get stuck there.”

To get unstuck, find a comparable activity with similar underlying appeal. If you bowled, for example, on a deeper level you may actually crave the social connection.

Arthritis-induced ankle pain lead Gail Kershner Riggs, a retired faculty member in rheumatology and geriatrics at the Arizona Arthritis Center in Tucson, to give up gourmet cooking. But she preserves the inner joy of her hobby by hosting dinner parties: Friends bring the entrees while she fills in with side dishes and sets a beautiful table. “I still get to experience a delicious meal with friends,” says Riggs.

Consider re-engaging in new pursuits to satisfy your inner urges.

Passion: Camaraderie and competition
Former activity: Bowling, tennis, kickball, golf
New pursuit:Game night Invite friends over for a weekly game of Nintendo Wii tennis, golf, baseball or boxing. If you don’t have a Wii, hold backgammon, Scrabble, chess or bridge tournaments.

Passion: Creative expression
Former activity: Drawing, pottery, sculpture, woodworking
New pursuit:Art appreciation Visit museums and galleries to study the masterpieces of favorite painters. Volunteer at a local art fair or support the work of a local budding artist.

Passion: Water sports
Former activity:Water-skiing, kite-surfing, white-water rafting
New pursuit:Deep-water running Strap on a flotation device and jump into the pool. It’s non-impact and you’ll still be getting a cardio and strength workout. Or paddle on smooth water in a lightweight kayak, which is easy to maneuver and spares lower joints.

Passion: Communing with nature
Former activity: Gardening
New pursuit:Sponsor a school or community garden. Volunteer at an arboretum or botanical garden. Or broaden your knowledge by becoming a master gardener through your state or county extension service.

Passion: Outdoor adventure
Former activity: Hiking, rock-climbing, skiing
New pursuit:Drive to short, accessible paths to waterfalls, mountain views and scenic canyons.In a few steps you can immerse yourself in the natural world. Alternatively, you could rent a fully-equipped camper and stay overnight in state or national park.

Passion: Diverse cultures
Former activity: Globe-trotting
New pursuit:Travel vicariously with Couch Surfers (www.couchsurfing.org), a worldwide network that lets you host visitors from around the world (and vice versa). You’ll learn about the world’s far-flung places from people who live there.

Change Your Busy Ways

It’s time to take control of your schedule – for your health’s sake.

By Ellen Fix

Are you constantly adding more items to your to-do list – and not giving yourself a break until you get them all done?

Be mindful of the toll this kind of hyper-productivity can take. For Connie Merritt, a registered nurse with osteoarthritis, the stress of her jam-packed schedule landed her in the hospital with a panic attack.

“People with arthritis often over-compensate for their disability by over-committing themselves,” says Merritt, author of Too Busy For Your Own Good (McGraw-Hill, 2009). “When you end up with too many activities and not enough time to recharge, it could ruin your life.”

Try Merritt’s suggestions to set more reasonable goals – and ultimately, achieve a more balanced life.

Your Challenge: “I Can’t Say No.”

Make A Change: Set boundaries and say no with grace. Don’t explain or complain. Smile and say, “That won’t work for me,” or “I have a prior commitment,” or “Sorry, I’ll have to pass, let me know how it goes.” Think about it: One minute refusing to run someone’s errand could give you 45 minutes to take a walk or a hot bath.

Your Challenge: “I Always Multi-Task.”

Make A Change: Complete one task well before proceeding to the next. Focusing attention on one task invites you to live in (and more likely enjoy) the present moment. And consider this: A 2009 Stanford University study found that those who multi-tasked displayed disorganized memory, inability to filter out irrelevant information and difficulty switching between tasks.

Your Challenge: “I’m Too Busy To Socialize With Friends.”

Make A Change: Streamline your schedule. Clean a little every day – instead of hours on the weekend. Pay bills online, saving time sorting and filing. Get your meds via mail-order prescription service, so you won’t have to wait in line at the pharmacy. And make sure to use those extra minutes in the day on the phone or having coffee with a friend! Maintaining good social connections can increase life expectancy and improve one’s sense of wellbeing.

Your Challenge: “I’m A Slave To My To-Do List.”

Make A Change: Create a don’t-have-to-do list. Itemize activities, people and habits that drain your energy, and avoid them. If you must use lists, don’t aim for perfection. “Sometimes we go for 100 percent when 80 percent will do,” says Merritt. “You’ve got to let go at some point.”

Your Challenge: “You Can’t Step Away from the Screen”

Make A Change: Cell phones, computers and other gadgets are constantly competing for our attention. We think they’re helping us be more productive – but psychiatrist Edward Hallowell, founder of the Hallowell Center for Cognitive and Emotional Health in Sudbury, Mass., says they’re likely not. “These are traps. There’s no real productivity going on; it’s all superficial,” says Dr. Hallowell. “Yet we’re afraid to slow down because we won’t be perceived as successful. I’ve seen people go into withdrawal without their phone.” Consider those words if you’re about to check email for the 10^th time in as many minutes. Take a brisk walk instead to recharge your body and mind.