Rheumatoid Arthritis: Keeping a Positive Outlook

Realistic optimism fuels the body's immune system and triggers natural painkillers.

From the WebMD Archives

The stress of waging a constant health battle can get to you. Day after day, week after week. It's easy to get down, depressed.

Just ask Carla Guillory. She's become an expert at what psychiatrists call realistic optimism -- reining in your thoughts, keeping fears and negativity at bay. It's been Guillory's mental way-of-life for upwards of 20 years, ever since rheumatoid arthritis set in.

It's a simple formula: "I just don't think about what might happen, what deformities might pop up. I hold onto positive thoughts," Guillory says. Yet she's no Pollyanna. "I have less strength in my arms and hands. I move slower now. And I know I will get a little slower as I get older. But beyond that, I don't think about the future. I believe that I'll always do pretty well."

Guillory also gets a good bit of support from her family and friends. She stays active. She worked for many years after her diagnosis. She exercises when she can. She wouldn't think of skipping her medications.

All this adds to her quality of life, experts say. By taking care of herself and staying emotionally strong -- taking things in stride -- she's helping her body stay strong, even reducing her own pain. There's good scientific evidence that a positive attitude is necessary for optimal physical health.

It's the mind-body connection. As studies have shown, your state of mind is an essential element in your health and well-being.

The Importance of Optimism

"Optimism is necessary for good health," says Charles L. Raison, MD, a psychiatrist and director of the behavioral immunology clinic at Emory University School of Medicine in Atlanta. "There's growing evidence that, for many medical illnesses, stress and a negative mental state -- pessimism, feeling overwhelmed, being burnt out -- has a negative affect on immunity, which is especially important in rheumatoid arthritis."

Indeed, your brain can create all sorts of tailor-made prescriptions to nurture your body. Raison says these include endorphins -- the natural painkillers; gamma globulin, which fortifies your immune system; and interferon, which helps combat infections, viruses, even cancer.

When depression sets in, we're less likely to take care of ourselves, which means the brain doesn't get prompted to produce those great natural remedies, Raison says. We don't exercise, because we don't have much energy. We don't eat right. We lose sleep -- or we sleep too much.

Even worse, we forget to take the very medications that can help us feel better, Raison tells WebMD. "There's a lot of evidence that when people are depressed, they feel hopeless, they give up on themselves, which affects whether they take medications," he says. "There's also evidence that people who have a positive attitude, what we call realistic optimism, the fighting spirit... they live longer, do better... they take their medications."

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How Depression Makes Arthritis Pain Worse

People who are depressed are more sensitive to pain, Raison says. Existing pain can become more intense -- and new aches and pains can develop.

"There's a lot that's come to light on this in the past few years," he tells WebMD. "People who are medically healthy can experience moderate to severe pain when they are depressed. People with depression can actually feel pain that is comparable to people who have active rheumatoid arthritis."

That's because depression puts other brain chemicals out of whack -- those that affect how the body functions, Raison explains. Both the emotional and physical symptoms of depression involve nerve pathways into the brain and spinal cord. Two brain chemicals involved in regulating mood -- serotonin and norepinephrine -- also keep the body running smoothly. They help regulate our sleep, our sex drive, and they help keep aches and pains from dominating our attention.

If those brain chemicals are out of whack, so is the body. We get more headaches, back and muscle pains, joint pain, and digestive problems. We feel exhausted and don't sleep well.

"If you're depressed, you really need to see a doctor," says Raison. "If you need an antidepressant, you need to stay on it long enough that it starts working. The vast majority of people don't take it long enough to get a benefit. They often quit taking it after the first month." Many people don't realize that it may take up to eight weeks before they feel the full effects, says Raison.

Getting treated for depression truly can help relieve pain, Raison tells WebMD. "If we can treat people for depression, their pain will get better," he says.

Make Optimism a Goal When You Have Rheumatoid Arthritis

Good coping skills are an important part of this picture, Raison says. "You can get a good mental 'loop' going. Start by doing everything possible to keep your physical body in the best physical functioning possible. Treat your pain aggressively and early on. If you don't have pain, you are less likely to be anxious and depressed."

With rheumatoid arthritis, the unpredictability of the disease is the biggest problem, says psychiatrist Nadine Kaslow, PhD, a professor of psychiatry and behavioral sciences at Emory University and chief psychologist at the Grady Health System, both in Atlanta.

"It's important to figure out what you can control -- in other areas of your life and in your illness," Kaslow tells WebMD. "We know that the more people take control of treatment and activity level, the better they can cope."

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Tips for Staying Positive When You Have Rheumatoid Arthritis

Kaslow and Raison offer these tips for staying positive when you have rheumatoid arthritis:

  • Get adequate sleep. "The sleep-deprived person has more pain," says Raison.
  • Exercise as much as you can. "There is much research showing that exercise is great for improving mood, decreasing anxiety, treating depression," Raison tells WebMD. "Regular ongoing exercise produces long-term changes in the nervous system that promote well-being." Exercise is also a great treatment for rheumatoid arthritis. It helps relieve pain and prevent disability.

  • Practice mind-body exercises. Yoga and meditation are excellent for this, says Raison, "but these are best done under guidance of an expert."

  • Nurture supportive relationships. "Research shows that material possessions and status don't make people happy," says Raison. "It's clear that happiness comes from nurturing relationships that are supportive and that have as little conflict as possible. Our bonds are a very powerful source. They are essential for health and for working out internal conflicts."

  • Get counseling if you need it. "Or find a truly wise confidante," suggests Raison. "People who have one person they can talk to are known to live longer. It doesn't have to be a health care professional. But if you can talk to someone about your emotional baggage, it can help your physical pain, too."

  • Put the disease into perspective. "Don't let it run your life," says Kaslow. "When you need to focus on it, focus on it. But find ways to quit focusing on it."

  • Do things that you enjoy. "It's absolutely important to take inventory of those people and activities that bring pleasure, and build those into your life," says Raison. "If you love foreign movies, make an effort to see a foreign movie once a week. Look for those things that give you relaxation and satisfaction, and nurture them. They are beneficial for developing an optimistic, realistic, hopeful attitude."

  • Learn to relax. "Relaxation training is a process that involves deep breathing and systematically tensing and releasing different muscle groups," Kaslow explains. "Once you're relaxed, create a very positive mental image. You're laying on the beach, with the sand under you, the ocean air flowing over you. Or place yourself in the mountains, or in a gathering with friends -- anything that is peaceful, calming. Stay in that very comforting place for awhile."

  • Learn more about the disease. Join a support group. Read information from reliable sources. "Learn as much as you can about what you've got," says Kaslow. "That alone will help you feel more in control, better able to make decisions."

  • Talk to your doctor. "Good communication with your health care team is important," says Kaslow. "When you have flare-ups, you'll know what to do. It's called collaborative family health care. You and the members of your social support network work with your medical team to help you maintain your positive mental outlook."
WebMD Feature Reviewed by Brunilda Nazario, MD on October 09, 2008

Sources

SOURCES: Carla Guillory, rheumatoid arthritis patient. Charles L. Raison, MD, psychiatrist; director, behavioral immunology clinic, Emory University School of Medicine, Atlanta. Nadine Kaslow, PhD, professor of psychiatry and behavioral sciences, Emory University; chief psychologist, Grady Health System, Atlanta. WebMD A-Z: "Mind-Body Wellness." Cleveland Clinic, "Depression Basics." WebMD Symptom Finder: "Physical Symptoms of Depression." WebMD Guide: "Recognizing the Symptoms of Depression."

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