Coping With Osteoarthritis and Mental Health
People with osteoarthritis (OA) are more prone to mental health issues than someone without OA. People with OA regularly report increased feelings of depression and anxiety. Oftentimes, the unwanted feelings increase based on the intensity of OA symptoms and the inefficacy of treatment. Although they are often found together, this connection is not due to a shared biological association between OA, depression and anxiety. Having OA does not guarantee poor mental health.
What it does promise is stress. Stress is a five-letter word that causes more damage than most four-letter words. In small doses, stress triggers minor changes to your thoughts, feelings and behaviors. You reduce or remove the stress by either the passing of time or the effective use of your coping skills. In large doses over time, stress triggers significant changes to your thoughts, feelings and behaviors. If you cannot adjust, the stress leaves a trail of carnage in its wake.
Take a moment to consider the damage stress creates.
- Stress damages your heart. During periods of high stress, your heart has to work harder than it normally does.
- Stress makes you sick. Stress has a two-pronged attack to make you feel worse physically. First, it lowers your immune system making you susceptible to illnesses. Second, stress lowers your threshold for new chronic ailments to present. In this case, you may have a predisposition to depression or anxiety and the increased stress allows them to emerge.
- Stress ages you. Your body contains countless cells. Each cell contains telomeres that shorten each time a cell divides. Long telomeres are related to being healthy and young. Stress inhibits your body’s ability to divide cells and maintain long telomeres.
- Stress adds weight. Stress hormones make it more difficult to burn fat. Also, people are programed to eat more during stress as a form of self-medication and as a means to strengthen the body.
- Stress hurts your relationships. When stressed, your patience goes down as your irritability goes up. Your frustration tolerance is lower. People will comment on your short fuse as they begin to keep their distance.
- Stress reduces your work performance. Small amounts of stress can boost performance. Chronic stress will lower your ability to think clearly, concentrate and pay attention. Stress decreases your fine motor skills. In total, these present quite a problem in a number of work settings.
OA and Depression
When mental health symptoms emerge with OA, depression is a likely product. Gaining awareness of thoughts, feelings and behaviors associated with depression can give you better idea of what it is.
- Feeling changes: Feeling sad, irritable, angry, hopeless, worthless and insignificant.
- Thought changes: You may think that the world is a worse place full of terrible people. You may think that people are judging you. You may be overly critical of yourself and others.
- Behavior changes: People with depression report having less energy to do things, and they stay at home more often. They may have reduced self-care shown by less exercise, worse diet and sleep changes.
With depression, the treatment usually focuses on your beliefs. Your beliefs filter all the information that you receive in a day. If your belief is that OA is the worst thing that has ever happened to you, you will feel more depressed. If you believe that OA is an inconvenience, but one that you can live with, your optimism will diminish your depression. Depression changes your beliefs to become more negative and pessimistic. Use the “three Ds” to check and challenge your beliefs. Here’s how:
- Detect. The first step is being aware of your beliefs. Check in with yourself throughout the day to gain awareness of what you are thinking about. What is going through your mind? How is this impacting your feelings and behaviors? Detection is focused on information gathering. Begin to put together a cause and effect relationship between what you think and how you feel.
- Debate. This step is the most crucial. Before beginning, you must understand that your depression wants you to be more depressed. Here, you must work to objectively reflect on the situation to see if the cause and effect relationships gathered from detection make sense. Is OA really the most terrible diagnosis in the world? Should you really quit your job, avoid your friends and refuse to leave the house? Use your rational mind to offer counter arguments based on fact rather than faulty beliefs.
- Decide. Using the information from the debate, make a decision about the situation while considering your goal of feeling happier. Many times people believe “I feel it so it must be true.” In reality, your feeling is based on the perception you create about the situation. Your perception will not match the perceptions of the other people in your life. Choosing happiness means that you decide to believe the explanation that ignores depression and distorted beliefs.
OA and Anxiety
Active depression over a period of time often leads to another mental health issue: anxiety. Just like with depression, you must understand anxiety to manage it.
- Feeling changes: Feeling worried, nervous, apprehensive and fearful.
- Thought changes: People with anxiety have thoughts that race and swirl around their mind. They think that they are “going crazy” or that their mind is “going to explode.” You may think that the worst is going to happen in whatever situation confronts you.
- Behavior changes: Like with depression, people with anxiety tend to isolate themselves because the outside world feels too scary and overwhelming. You will avoid and escape from situations that are outside of your control.
If you are experiencing any or all of the anxiety symptoms above, consider taking effective actions to improve symptoms and return to an improved state of well-being. Want to shed anxious thoughts? Many therapists use a technique called prescribed worry. This strategy works by embracing rather than ignoring anxiety. Here’s how to make worry work for you:
- Self-monitor – You already know that anxiety has become too intense, frequent or long in duration. Start to realize and accept the negative impact that anxiety has in your life. Begin to rate your anxiety on a 1-10 scale throughout the day and find periods of low and high symptoms. This will help track changes over time and look for patterns.
- Find the time and place – The best prescribed worry is done daily at the same time. Find a period of time when anxiety is present but not overwhelming. Experiment with different times of the day. If bedtime is very difficult due to worrisome thoughts keeping you up, complete prescribed worry about an hour before bed. A bathroom is typically a great location since a mirror is readily available and the bathroom carries a level of privacy with it. An appropriate site will be quiet, free from interruptions and distractions.
- Relax – Calming your body will allow your mind to be in a more desirable state. Even if you have had poor results in the past, try deep breathing again. This is the basis of all relaxation techniques. Try progressive muscle relaxation, guided imagery or autogenics to get the desired result. These will aid your reduction of worry while soothing your body in a way that will lessen OA symptoms.
- Worry – Now that your body is calm, it’s time to worry. During a prescribed worry session, you will go to your chosen location at your chosen time, look in the mirror and worry. The goal is to verbalize all of your worries, anxieties and fears. Voice how OA makes you feel and what you fear. Most people with anxiety feel like there is an endless parade of negative thoughts marching through their mind. Prescribed worry challenges this notion and most people find that their infinite worry actually amounts to a handful of stressors. The act of hearing you say them makes the worries more tangible and easier to address with action. Plan to set aside 10 minutes to worry but many find that they run out of things to say quickly.
- Act – Use the information gathered during the worry to refocus your energies. Act in ways that are helpful and efficient. Do not permit anxiety and worry to demotivate you and keep you stuck. The increased action is a natural anxiety buster.
The progression is simple. OA leads to unwanted physical symptoms. These symptoms trigger a stress response. The stress leads to depression and the depression leads to anxiety. In an ideal world, you would have a chorus of healthy coping skills to prevent stress. Since this s real life, working to defeat depression and annihilate anxiety separately. Now that you have the skills, aim at your target and fire.