“I discovered an amazing tool for dealing with rheumatoid arthritis,” wrote Carol Adamson, one of my patients. “That marvelous tool sits on my shoulders between my ears! I cannot change my diagnosis…but I have total control over how I deal with it.… Rheumatoid arthritis cannot touch that power.” A diagnosis of arthritis — whether it’s rheumatoid arthritis (RA), osteoarthritis (OA), or another type of arthritis — can mean a lifetime of medicines, frequent doctor visits, and changes in lifestyle. And that’s in addition to the joint pain, stiffness, and other symptoms of arthritis, not to mention its underlying unpredictability. The best treatment for individuals faced with a situation like this involves not just the body but also the mind and the spirit. In this article, I will focus on some powerful mind–body techniques that a person with arthritis can use to cope with the pain, physical limitations, and sometimes unsettling emotions that can accompany the condition. I will also share insights from some of my patients (like Carol, whose words you read above). My patients’ experiences are valuable to me as a physician, and they illustrate how consistent use of meditation and other mind–body techniques can bring significant improvements in well-being. I encourage you to consider these techniques and to apply them. The key to success is consistent daily practice. Do not give up.
The role of the mind
First, let’s explore what we know about the effect of the mind on the body. In some traditional healing systems, such as traditional Chinese medicine, it has long been appreciated that the human system is more than just the physical body. Science confirms that the mind and the body are indeed intimately related. We know that there are clear interactions between the nervous, immune, and endocrine (hormone-producing) systems and that the mechanisms regulating stress and pain share many central nervous system pathways. Meditation, for example, can modify central nervous system responses and, over time, cause the brain to show a totally different pattern of neural (nerve-related) activity. In other words, meditation can make the processing of pain or stressful stimuli less damaging.
The key to channeling the power of our minds is to discipline our thoughts and build the mental and emotional layers of our inner selves into an “infrastructure” that will have an effect on our physical selves. Mind-body techniques offer us this discipline. As we work on our inner selves, new infrastructure is continuously being built, and various levels of the whole person (physical, mental, emotional, and spiritual) are fortified. This process — and it is important to remember that it is a process that takes time and patience to master — allows us to see possibilities that we had never seen before.
About the techniques
As another of my patients, Arlene Hilding, puts it, “A thinking person can choose to live each day well. This conscious decision necessitates taking control and depersonalizing pain and various impediments. Pain as such can be regarded as neutral.” Taking control and depersonalizing pain are indeed two main goals of the mind–body techniques described here. Many of them require little or no equipment, and you can start trying them out today.
Meditation is one of the most well-known mind–body practices, and numerous books and tapes are available to help you with it. At its essence, meditation is focused awareness, be it on a task or on one’s self. Meditation requires that you be very patient, as the mind does not always want to focus. To help you keep your focus, many meditation styles have you place your attention on your breath. Relaxing and quieting the mind by focusing on your breathing can reduce stress — even the stress that comes with arthritis flares. Studies have found that meditation, if practiced regularly, can ease pain and anxiety in individuals with RA. I suggest starting with five minutes of meditation every morning and evening and increasing the duration over time. My patients who meditate usually look forward to this practice, and many report that it gives them a heightened sense of calmness and control.
Contemplation is related to meditation but differs in fundamental ways. Unlike meditation, where there is a single focus such as the breath, contemplation has you choose an inspirational passage or spiritual text to reflect on as you go about your day. For many, contemplation may be an easier technique than meditation, as it fits naturally within any day or way of life. It has been my experience that, over time, contemplators develop richer relationships, live more fully in the present, and discover their own unique contributions. Carol Adamson, for example, found a way to live fully in the present, despite her arthritis: “One of the things rheumatoid arthritis has taught me is the beauty of my hands. RA has taken away so many of the things my hands used to do, but on most days my hands still open the world to me. I’m thrilled when I can plant a flower. I can no longer trust my hands to hold a baby, but I can reach out and touch a baby’s skin and bond with a new little person. I can hold hands with a loved one and intimately connect.”
In guided imagery, sometimes called visualization, your imagination is intentionally “guided” toward thoughts that put you in a relaxed, focused state. This process of “redirecting” thoughts can change how you perceive pain, transforming the unpleasant images and thoughts that often accompany it. In addition, using imagery helps you feel that you have some control over your pain. With practice, imagery can be very powerful and healing. The following was the experience of my patient Janice Duncan, who used guided imagery to help her cope with a bleeding skin ulcer that was not healing. “I decided to try and stop the bleeding by meditation and visualization. I could actually see the inside of my leg. I came down from my knee and was ‘traveling’ along the large calf muscle to approach the ankle area. As I got down there I could clearly see the structure, the bones, tendons, and blood vessels. It was really beautiful, with everything in different shades of red, and with the white bones and tendons, it looked as though it was all backlit with a muted light. As I watched, I saw a small dark puff of blood shoot out of a blood vessel. I could see a small hole where it came out so I concentrated on that hole. I saw it began to fill in and I could feel the tightening of the area. It was really amazing. When the hole was completely closed I closed my eyes and felt myself go to sleep.”
If you’d like to try guided imagery, you can call upon your own imagination, as Janice did. Or you can do as many people do and look for audio recordings or imagery scripts to help you.
Writing in a journal about important or stressful life experiences was shown in a 1999 study to have a clinically relevant effect on the health status of people with RA. In other words, it made a difference in how they felt. A simple exercise such as writing can potentially reduce symptoms of pain and depression and help stop the feeling that you are losing control. Writing down their experiences for this article gave many of my patients a feeling of resolution of their inner conflicts and rewarding new insights. Daily writing for as little as 20 minutes is encouraged.
Music is considered a universal language, and studies have shown that it can have a positive effect on health. Heart rate variability (HRV) is one measure of how well the brain, nervous system, and heart are working together to keep the two parts of the autonomic nervous system in balance. (This is important because the autonomic nervous system controls key body functions such as heart rate, breathing rate, digestion, and blood pressure.) There is some evidence that classical music and spiritual music such as Gregorian chant have a positive effect on HRV and help restore balance to the autonomic nervous system. Listening to music is a simple and uplifting technique for many people with arthritis.
Yoga is an ancient Indian practice that has gained a popular following in the United States. There are many schools of yoga, such as Iyengar, Sivananda, and Kripalu. The different styles share a system of precise body postures — known as asanas — coupled with controlled slow breathing. Research has shown yoga’s benefit in many chronic conditions. For example, a recent study at Johns Hopkins University found that participants with RA who did an eight-week program of yoga, consisting of two one-hour classes a week with home practice, had significantly fewer tender and swollen joints than they did before starting the class.
Yoga can be very physically demanding, so it’s best for people with arthritis to choose a gentle style. I generally advise people who are not familiar with yoga to talk with the instructor about their arthritis before starting a class. Yoga can be individualized, and modifications can and should be made to accommodate joint inflammation or decreased range of movement. Also, a number of yoga centers and senior centers offer chair yoga, which incorporates relaxation and yoga movements while you are seated in a chair or wheelchair. This method allows people with limited mobility to do modified versions of many of the standard yoga postures. Modified yoga can bring physical, emotional, and mental benefits similar to those of regular yoga practice. Done in a group, all types of yoga also provide social interaction, which can decrease the feelings of depression that sometimes accompany arthritis. One piece of advice: When you are doing yoga, try not to be concerned about the “perfect pose.” Yoga practice is like a form of art — you are the artist, and you get to create your own unique practice.
Tai chi, which originated in China, uses slow, fluid movements. It is very safe and can help strengthen the body and improve balance. A related practice called qi gong (pronounced “chee-gong”) incorporates slow breathing, good posture, focus, and visualization. One advantage of qi gong over tai chi is that it may be practiced sitting or even lying down. Many community centers teach tai chi or qi gong, and the Arthritis Foundation sponsors tai chi classes for people with arthritis. You can contact your local Arthritis Foundation chapter to find a class near you. For contact information, call (800) 283-7800 or enter your zip code here.
The Feldenkrais method
Also known as “meditation in action,” the Feldenkrais method consists of precisely structured sequences of movements that an instructor guides you through, using the sequences as the basis for “movement explorations” in which you involve your whole self — thinking, feeling, and using your senses as you move. The explorations are designed to make you aware of your habitual movement patterns and to provide you with options for moving more comfortably and efficiently. The theory underlying the Feldenkrais method is that when individuals experience how they perform an action, they open themselves up to learning how to attend to the whole self while improving functioning. Although there is little research into the Feldenkrais method in people with arthritis, it is a very good technique for discovering less painful ways of moving the body. It allows you to see your body as an ally, as an anchor to the present moment. You can learn more about the Feldenkrais method, and find a practitioner near you, at www.feldenkrais.com.
Massage is popular among my patients. The key with massage is to use soft massage techniques rather than deep tissue massage, which can make arthritis pain worse. Done properly, massage can relieve pain and promote relaxation. The simple component of physical touch in massage is particularly helpful to people who are socially isolated. If you think massage might be helpful to you, check for massage therapists within your local community and inquire about annual packages, which are often much less costly than paying for individual sessions.
Cognitive-behavioral therapy, or CBT, is a form of psychotherapy based on the idea that our thoughts — not external things like people, situations, and events — are the source of our feelings and behaviors. In CBT, the therapist’s role is to gently guide your conscious mind away from overly negative thoughts and into a more realistically positive way of thinking. CBT therapists do not tell you what to do — rather, they teach you how to do. They use several specific techniques for this purpose, such as goal setting. Once you have learned some of these techniques, it takes only minutes for you to put them to use in response to all kinds of challenges. To find a CBT therapist near you, go to the Web site of the National Association of Cognitive-Behavioral Therapists.
Mindfulness-based stress reduction (MBSR)
The mindfulness-based stress reduction (MBSR) program is a course of meditation that was developed by Dr. Jon Kabat-Zinn and colleagues at the University of Massachusetts Medical School. “Mindfulness” is defined as moment-to-moment nonjudgmental attention, actively cultivated and developed through focused awareness. MBSR teaches participants to notice their thoughts and emotions and relate to them in a way that gives them increased compassion for themselves and others. It can also provide a sense of clarity and calm. In addition, a number of studies have shown that MBSR can reduce stress and other psychological symptoms and may help relieve chronic pain.
The MBSR program consists of eight weekly meetings and a full-day retreat. Classes involve training in mindfulness, discussion of mindfulness’s application in daily life, and training in meditation and gentle yoga. (You can search for MBSR programs in your area.) As with most mind–body techniques, daily practice of MBSR is essential. At least 45 minutes a day is recommended.
Prayer and spiritual practice
All spiritual practices offer powerful ways to integrate your belief systems into your daily life. Forgiveness is one example of a spiritual practice that can change how you feel about any situation, including situations related to your physical state or circumstances. Through the understanding that comes with forgiveness, you can grow in gratitude, compassion, and inner resilience.
The wide variety of mind–body techniques makes it possible for you to find a technique that works well for you. Remember that these techniques are meant to supplement conventional treatments, not replace them. It is important to continue your medical care and work with your rheumatologist or family doctor. Avoid the common pitfall of starting a technique and not applying it daily. And above all, enjoy your healing journey and reap the benefits of a better relationship with yourself, with those who are close to you, and with the world at large. Remember that you are always in charge.