Dealing With Fear of Pain
One of the most common triggers of anxiety that Sullivan sees in people who have a variety of health conditions, including psoriatic arthritis, is fear of pain or disability.
“People get very fearful of damaging themselves,” he says. This can be problematic because in the long term, things like physical activity can actually improve conditions like psoriatic arthritis, even if it means working through some aching and stiffness.
“The standard teaching is that pain is a sign that you’re damaging yourself, and you should stop,” Sullivan notes. “With chronic conditions, that’s often not the right message.”
It’s important, Sullivan says, to find the right balance between activity and avoiding discomfort in chronic conditions like psoriatic arthritis. But this requires overcoming the natural instinct that all pain is a sign of danger or ongoing damage.
To help overcome this fear, Sullivan recommends talking with your doctor about which kinds of activities are actually harmful to your joints, and which ones may sometimes cause discomfort but are likely to be beneficial in the long run.
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Sullivan says that learning to manage pain and managing anxiety tend to be closely related. “Fear of pain is a very important amplifier of pain itself,” he explains. “When we think that pain is a sign of something very dangerous, it’s given a lot of value and attention.”
How to Address Anxiety Head-On
Aside from dealing with fears related to your psoriatic arthritis that may be the root cause of your anxiety, there are steps you can take to reduce anxiety directly. Start with these tips.
1. Exercise Regularly
Aside from the potential benefit of easing psoriatic arthritis symptoms like pain, “exercise itself is a great home remedy for anxiety,” says Sullivan. “It has virtually no side effects. It improves your sleep, and it boosts your mood.”
The flip side of exercise as a remedy for anxiety, Sullivan notes, is that not getting enough physical activity often contributes directly to feelings of distress, along with loss of range of motion, strength, and endurance — which can also increase distress over time. Talk to your doctor about finding ways to incorporate more activity into your day without stressing yourself out.
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2. Be Mindful
Whether you feel anxiety coming on or you’re taking steps to prevent it, it can help to practice mindfulness techniques, guided imagery, or relaxation techniques, which may help you prevent or break out of a cycle of worry or panic.
3. Try Therapy
If your anxiety rises to the level of a disorder, says Sullivan, “there’s evidence supporting things like cognitive behavioral therapy, or acceptance and commitment therapy.” These types of techniques may be helpful, though they require the guidance of a therapist.
4. Find Support
Social interaction can reduce anxiety, Sullivan notes. This includes both positive interactions with friends and loved ones, as well as interactions with people going through a similar experience with anxiety, pain, or mobility limitations.
“If you have access to a group or others that you can work with, it can be quite reassuring” that it’s possible to live happily and successfully with your condition, says Sullivan.
“There’s nothing more believable to patients than other patients who have succeeded at something,” he adds. “It’s much more believable than having a professional tell you about it.”
The National Psoriasis Foundation is associated with several resources for support, including the One to One program, which pairs you with a mentor, and the Twill Care app, which can help you care for your mental health by connecting you with other people dealing with psoriatic disease. You can also find support groups through CreakyJoints and the Arthritis Foundation.
5. Consider Antianxiety Medication
In addition to psychotherapy and exercise, medication is often an important part of treating anxiety disorders. But be sure to speak with your rheumatologist, as some antianxiety drugs may be contraindicated for people with psoriatic arthritis.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are two classes of antidepressants commonly used to treat anxiety. Research suggests, however, that the SSRI fluoxetine (Prozac or Sarafem) and bupropion (Wellbutrin, Zyban, Aplenzin, Budeprion, or Buproban) — another antidepressant prescribed for anxiety — may exacerbate psoriasis.
Exercise caution, too, when it comes to benzodiazepines such as alprazolam (Xanax or Niravam), clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium). They may be prescribed for anxiety for short periods of time, usually no more than a month, as they are habit-forming. But they’re also associated with triggering psoriatic arthritis flares.
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6. Limit Caffeine Intake
Along with taking positive steps to address your anxiety, it’s important to look at certain behaviors that may be contributing to it, Sullivan says.
One common culprit is too much caffeine, which “is a stimulant and can make people quite anxious,” he notes. “That’s an easy thing to fix if you’re having a lot of anxiety.”
7. Get Good Sleep
Sleep is another area where most people can do better, according to Sullivan.
“We all think we can make do on six or seven hours, but there’s very good evidence that we don’t,” he says. “And being more irritable, having impaired concentration and problem solving, and not weathering social stresses as well are all part of what happens when you become sleep-deprived.”
RELATED: Psoriatic Arthritis: 10 Ways to Get a Better Night’s Sleep
8. Eat a Healthy Diet
Your diet can’t cure your anxiety, but certain foods can make it worse, while others might reduce it. Focus on consuming fruits and vegetables, lean proteins, healthy fats, and fiber- and nutrient-rich sources of carbohydrates. Protein at breakfast can help your blood glucose levels stay steady.
Avoid processed foods, alcohol, and sugary candy, and as mentioned above, caffeine.
9. Avoid Unhealthy Coping Methods
Finally, it’s important not to deal with anxiety by turning to unhealthy habits and behaviors that can ultimately be destructive, like drinking alcohol in excess or abusing certain antianxiety drugs.
“You can get into a sense of crisis where you’re looking for any relief in the short term, but [turning to these habits] often can create long-term problems,” Sullivan notes.
If you feel like you need help coming up with a plan to deal with your anxiety, start by opening up to your primary care doctor.
“[Your doctor] can provide a useful perspective on whether this is something you can manage yourself, or whether you need help, and also connect you with resources that are close to your home,” says Sullivan.
Additional reporting by Deborah Shapiro.