Managing Stress Before It Manages You

It goes without saying that some times in our lives are better than others. Perhaps you’ve suddenly lost your job, your mother has died, your child has been hurt at school, or you have learned that you have one of the many types of arthritis. No matter what the bad news is, your mind and your body immediately react, and you feel both emotional and physical distress.

Many of us think of stress as nothing more than an uncomfortable feeling in our gut. In truth, however, the stress response is what has helped humans to survive. In the caveman’s day, the stressor might have been an attack from a wild animal, the approach of an enemy, or an impending storm or forest fire. The stress response allowed our ancestors either to prepare to fight to save their lives, or to flee. (For this reason, the stress response is often called the “fight-or-flight” response.)

Although today’s stressors may be different, our bodies react to them the same way the caveman’s reacted. When we sense a threat, our body immediately prepares. Blood flow to parts of the body not involved in fighting or fleeing, such as the digestive system, slows down, while blood flow to our muscles, heart, and lungs increases. Our senses become more alert. Our sight, hearing, and sense of smell help us understand the possible stressor and determine what we need to do. All of this happens in seconds, as our brain calls for the production of chemicals such as adrenaline, which is the key to producing the fight-or-flight response. You may have noticed a warm feeling flowing though your body when you learned that something was seriously wrong. This was adrenaline, helping your body and mind gear up for necessary action.

Different people faced with the same situation will feel different levels of stress. For example, an emergency room nurse, trained to deal with crises, may find handling a person’s heart attack somewhat routine. The nurse may experience just enough stress to help him or her manage the emergency well. The person’s family members, however, may experience a great deal of stress and anxiety.

Though we are seldom in situations as dramatic as those of the caveman, today we still find ourselves in situations that cause us stress. For example, feelings of distress might occur from listening to an unsettling news report about a war, especially if you have a loved one in the military. Or you may feel stress when you simply have too much to do. It’s even possible to have the fight-or-flight reaction in response to driving in traffic, dealing with challenging coworkers, or managing finances. We can have stress responses to good news, too — our reaction to situations causing excitement and joy is called eustress (as opposed to distress). A wedding is a perfect example of a wonderful, positive situation that can cause a lot of stress if you are in the celebration or helping to plan it. Even though eustress is a response to something positive, it can bring about negative feelings, such as feeling overwhelmed or worried that you are not up to the challenge.

An important difference between the caveman’s stress and today’s stress is that much of today’s stress is a result of lower, but chronic, levels of pressure. Chronic stress can feel less alarming, but it too can take a toll on your health. For people with arthritis, one of the most common sources of chronic stress is coping with their chronic illness. And just as having arthritis can be stressful, feeling stress can make arthritis harder to deal with.

Stress and arthritis pain

When a person has arthritis, joint pain, inflammation, and swelling are often accompanied by muscle tension. If that person is also faced with a stressor, the adrenaline pumping through the body can cause the muscles to become even tighter, prompting an increase in pain. This begins a cycle in which chronically tight, painful muscles lead to fatigue, which leads to more stress, which leads to more pain and fatigue. Many people find that they have more flare-ups when they are under a lot of stress.

Luckily, finding ways to reduce stress can interrupt the negative cycle that stress feeds into and have a positive impact on arthritis. Since you can’t simply remove most stressors from your life (the traffic, your bills, and your difficult coworkers are not likely to just go away), developing a stress-reduction plan is usually the best way to proceed.

Understanding your stressors

Before you develop a stress-reduction plan, you need to pinpoint the factors causing your stress and understand what can be done about them.

Ask yourself what makes you stressed. Start by making a list of the things in your life that are causing you stress. Some items may seem minor, such as your spouse leaving dirty dishes all over the house or the kids not cleaning up their room. Other stressors may seem greater, such as dealing with a difficult boss, worrying about your arthritis, or suffering the loss of a loved one. Getting a list together may help you identify sources of stress you haven’t acknowledged.

Be specific. Be as specific as you can about your stressors. You might think to yourself, “My in-laws drive me crazy.” But what is it about your in-laws that upsets you? Do they arrive hours early for dinner and do nothing to help? Do they criticize you all the time? Being specific about the problem will help when you develop your action plan.

Ask yourself whether you can change the stressor. Next, try to identify whether the stressor is something that you can change. This can be difficult to figure out, but doing so is important. You want to spend your energy trying to change the things that can be changed — fighting what cannot be changed may only lead to more stress and frustration. The process of identifying what can be changed and learning to adjust to what cannot is embodied in the “Serenity Prayer.”

Creating a stress-reduction plan

Once you’ve decided that you can do something about the stressors you identified, get started on a plan. First, work on the stressors that can be easily changed. For example, say your arthritis is flaring and you can’t open jars with your sore hands. Rather than waiting until your flare subsides, find a jar opener that will allow you to open jars without pain. This was a relatively easy fix, and you no longer have this stressor on your list.

Some stressors are more challenging, as in the case of having a difficult boss. Your plan might include talking to the human resources department to get some suggestions on how to handle your boss, or role-playing with a friend to figure out what you could say to improve the situation.

If the stressor is that you are short on money and think going back to work is a good option, see who might help you head in that direction. Perhaps you can start by identifying your capabilities and where you can get help with your résumé and the job-hunting process. If your doctor feels that you should not go to work because of your health, then having a family meeting to see how to cut back on expenses might be a good strategy. In all of these scenarios, you are deciding that there is something that you can do, and you are being proactive.

Write the plan down. For each stressor you’ve identified, write down the steps of your plan. Taking the time to think about the issue and putting your plan on paper can help you feel more in control. Refer to the plan and rework it as you go along.

Develop new skills. Some of the steps in your plan may be small, and others may be larger and require more of an effort. Working on new skills can help you with the larger steps. Taking a course, getting retrained in a job, and going to a support group are ways that you can learn and develop skills. Learning new communication skills can also help in many situations. Write down four or five strategies that might be helpful and start working on at least one of these.

Direct your thoughts away from worry. Worrying increases your stress level and contributes to muscle tension, and it wastes precious energy. First, become aware of when you are worrying. Next, remind yourself that worrying doesn’t help, and that you are doing things to make the situation better. Finally, distract yourself with an activity you enjoy, such as calling a friend, engaging in a hobby, or reading a good book.

Watch that negative thinking. Make sure to identify what you are thinking and how you talk to yourself about the stressor. For example, if you have been diagnosed with arthritis and are thinking to yourself, “This is the worst thing that could ever happen to me,” then you may experience a lot of distress. If you are thinking, “Well, at least I know what I have, and I have a good doctor to help. I will do the best I can in this situation,” then you are helping to keep your stress in check just by talking calmly and positively to yourself.

Ask for help. If you feel that there is not much you can do to change a stressor, there may be people you can go to for help. For instance, if a family member is upsetting you because of his or her behavior and demands, you may think there is no way that you can change that person. But perhaps you can discuss the situation with your spouse, a professional counselor, or clergy member. One of these people may be able to offer some new strategies you haven’t yet considered. If that doesn’t do the trick, then helping yourself by shortening visits with that family member may be all you can do. Just telling yourself that you have done all you can do may help you feel less stressed.

Changing your reactions

Whether or not you can alter something that causes stress, you can always work on adjusting your reaction to the stress you experience. A variety of strategies can help you manage stress.

Deep breathing. Start by taking a long, deep breath, inhaling slowly through your nose. Hold that breath in for a count of two, and then slowly exhale through pursed lips. Do this at least three times. With each breath, slow down your breathing, and try to think only about your breathing rhythm. This technique can be used whenever you face a stressful situation — for example, when you are about to give a speech, meet with your boss, discuss a difficult subject with your family, or undergo an unpleasant medical test or procedure. The more you use deep breathing, the more relaxed you will feel with each breath. Practice two or three times each day until you notice the relaxation response occurring earlier in the sequence of breaths.

Guided imagery or meditation. Guided imagery is a process of turning your thoughts to relaxing images, often with the aid of an audio script that guides you. Such scripts are available as audio downloads, CDs, and tapes. First, get comfortable in a quiet room free of distractions. Then, play the recording. Some relaxation recordings focus you on gradually feeling less tension in your muscles; others describe a beautiful, calming scene. Although some people find prerecorded relaxation scripts helpful, you don’t have to buy one — you can make your own recording. See a sample guided imagery script that you can record yourself.

Meditation is the practice of focusing your awareness. There are many forms of meditation. In mantra meditation, for example, you repeat one word or thought in your mind to keep out distractions. Prayer can also be considered a kind of meditation. Aim for 20 minutes of guided imagery or relaxation a day.

Biofeedback. Biofeedback is a process of learning to manage your body’s physical responses by using your thoughts. This technique uses a machine with sensors attached to your body that measure physiologic functions such as skin temperature and muscle tension. The machine gives you instantaneous feedback about changes in these functions so you can make mental adjustments to relax muscles and reduce pain and stress. Many psychologists administer biofeedback and can teach you the technique in a series of sessions. Over time, you may be able to perform the relaxation techniques by yourself, without feedback from the machine.

Tai chi or yoga. These forms of exercise also work as relaxation techniques. Talk with your doctor or physical therapist to see if tai chi or yoga is right for you. Tai chi is typically gentle enough for most people with arthritis, but not all forms of yoga are appropriate. Choose a gentle style such as hatha yoga, and let your instructor know you have arthritis. Your local Arthritis Foundation chapter or community center may offer tai chi or yoga classes.

Taking good care of yourself. It may seem obvious that taking care of ourselves will reduce stress and make us feel better, but many of us shortchange ourselves in some way. Make an effort to get a good night’s sleep, take time to rest when you need to, eat healthfully, and get regular physical activity. In addition, keep up with your doctor appointments and take your medicines as prescribed. Also make sure to give yourself opportunities for fun and enjoyment — join a social group, participate in activities, hobbies, or sports you enjoy, and seek others who accept, support, and care for you. Do something daily that is just for you.

If you have tried these stress reduction techniques and they haven’t worked or you feel that stress is affecting your health, talk with your doctor. As you can see, there are many ways to reduce and deal with stress. The key is to actively manage it — and not let it manage you.

Wendy McBrair spent 30 years as a health-care professional in the fields of rheumatology and orthopedics, where she specialized in patient and community service, patient education, and advocacy.

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