Rheumatoid arthritis and social anxiety



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Anxiety is a feeling of apprehension or fear. The source of this uneasiness is not always known or recognized, which can add to the distress you feel.

Anxiety disorders are a group of psychiatric conditions that involve excessive anxiety. They include generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, and social phobia.

Arthritis pain and anxiety often go together. "In general, there seems to be a tendency for anxiety to amplify pain," says Mary Meagher, Ph.D., an associate professor of psychology at Texas A&M University.

Meagher's research supports this notion. In a recent study (Pain, 2000), she and another researcher randomly assigned 60 healthy college students to one of three groups. In one group, anxiety was aroused by the threat of an electric shock. Pain sensitivity was tested before and after. It was discovered that people were more sensitive to pain after their anxiety had been raised.

Meagher says there's a valid reason our bodies are designed this way; "During times of anxiety, the chance of survival is increased if pain is enhanced, so that the person behaves in ways that minimize the chance of injury."

The problem occurs when a person's anxiety level stays high for a long time, even when the immediate risk of injury is low. This can happen for many reasons, including failure to adjust to a chronic illness such as arthritis.

"Certain people have a lot of anxiety about their illness and what it's going to mean for their lifestyle," says Meagher. "In some cases, people start anticipating worst-case scenarios. In other cases, they go into denial about the reality of their situation."

One common fear is that the pain will only get worse. This can become a self-fulfilling prophecy. A vicious cycle may develop, in which higher anxiety leads to greater arthritis pain sensitivity, which leads to more anxiety, which leads to more arthritis pain, and so on. When anxiety keeps escalating this way, people are likely to grow increasingly frightened about their loss of control over the pain and stress.

There are ways to break out of this destructive pattern. One of the most helpful is to become more aware of your own thinking. If you notice that you habitually respond to pain with negative thoughts, such as "This is never going to end," you can make a conscious effort to replace them with more positive ones, such as "I'll feel better once the pain medication kicks in."

Of course, making these sorts of changes isn't easy once anxiety has already gained a firm hold. In such situations, professional treatment can be very helpful. These are some signs that you might benefit from professional help:

• Constant, exaggerated worrisome thoughts... also known as rumination
• Long-lasting feelings of stress over everyday activities
• A habit of expecting the worse, even when there is no reason
• An inability to relax, or trouble sleeping
• Unexplained physical symptoms, such as tiredness, trembling, muscle tension, headache, upset stomach, or irritability
• Repeated attacks of intense panic that strike without warning and include disturbing symptoms, such as chest pain, a pounding heart, shortness of breath, dizziness, upset stomach, and a fear of dying
• Repeated, unwanted thoughts or behaviors that seem impossible to stop
• Extreme, irrational fears that unnecessarily limit your life



In another important study published in Arthritis and Rheumatism (Arthritis Rheum. 2004 Jun 15;51(3):408-12.), the subject of anxiety in rheumatoid arthritis was examined in more depth.

Anxiety in rheumatoid arthritis.

VanDyke MM, Parker JC, Smarr KL, Hewett JE, Johnson GE, Slaughter JR, Walker SE.

Harry S Truman Memorial Veterans' Hospital, Columbia, Missouri 65201, USA.

OBJECTIVE: To examine the level of anxiety experienced by individuals with rheumatoid arthritis (RA). METHODS: Data from 2 previous studies were used to compare the level of anxiety (measured by the State-Trait Anxiety Inventory) in the following 4 subgroups: a general RA sample, a general osteoarthritis sample, a sample with both RA and major depression, and a normative sample of age-equivalent, working adults. Canonical correlations were used to examine associations between measures of anxiety and measures of both stress and depression. The relationship between anxiety and duration of RA was also explored. RESULTS: The general RA sample had state anxiety levels that were comparable to the normative sample, although trait anxiety levels were significantly higher (P < 0.001). In addition, individuals with RA who also met criteria for depression exhibited significantly higher levels of both state anxiety (P < 0.0001) and trait anxiety (P < 0.0001) than was observed in the normative sample. Canonical correlations revealed that measures of anxiety were correlated with both measures of depression (r = 0.83) and measures of stress (r = 0.50). Anxiety was not found to be significantly related to RA disease duration. CONCLUSION: These findings demonstrated that individuals with RA, especially if concomitantly depressed, tend to exhibit levels of anxiety that are generally higher than a normative group of age-equivalent, working adults. The substantial canonical correlations between anxiety and both depression and stress revealed that anxiety shares variance with these more frequently studied variables in RA. However, anxiety was not found to be related to RA disease duration.

It’s obvious then that attitude, anxiety and emotional stress play an enormous role in arthritis. Anxiety and fear can tense the muscles around joints, making them more painful and heightening the person’s sensitivity to pain. Seeing oneself as a helpless victim creates a cycle of more anxiety, more pain and more helplessness. Self-help courses have helped significantly. According to one study,4 four years after taking such a course, RA patients reported 30% less pain, 10% less disability and 50% fewer visits to the doctor. The control groups showed no improvement. The improvements related to patients’ attitude and increased self-confidence that they could cope with RA. Self-help techniques which can greatly increase self-confidence and ability to cope include:

• Relaxation exercises to reduce stress, such as tensing and then relaxing each muscle in the body, or closing your eyes and silently repeating a calming word for about 10-20 minutes;
• Distraction techniques to divert attention from the pain, such as remembering the words to a song or naming a food for every letter of the alphabet;
• Meditation techniques, such as to calmly and objectively observe the painful sensations, without being drawn into the pain emotionally.





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