Building better mental wellness to age with optimism.
"Over the years, I have come to realize that the psychosocial aspect of my living with [rheumatoid arthritis] is the most overlooked aspect requiring acknowledgment, attention, and often treatment by members of my healthcare team. Managing inflammation and accompanying pain of RA figure largely in the minds of healthcare professionals, but not usually the impact on mental health. To me, the term ‘mental health’ is not sufficiently broad to encompass all of the non-physical effects of RA; rather, I prefer the term ‘psychosocial,’ which, to me, includes emotional and social which doesn’t always come to mind when people think of ‘mental health."
~Older adult living with rheumatoid arthritis
Coping with a chronic condition such as arthritis can be a challenge at the best of times, particularly when it’s accompanied by daily pain. While many treatment plans include strategies to manage the physical symptoms of arthritis, it’s also important to take care of your emotional and mental well-being.
Mental health and psychosocial well-being are essential components of overall health and wellness, especially as people age. Our emotions and mood can impact how we experience pain, while pain can also impact our emotions and mood. Studies have shown that people with arthritis are more likely to experience anxiety and depression than people without arthritis. The good news is that there are simple actions you can take to help look after your mental health, which in turn can help improve your physical health. Research has demonstrated the “plasticity of well-being,” meaning that we can learn to improve our mental well-being through training and practice.
The Arthritis Society connected with older adults living with arthritis to get their perspectives on chronic pain and mental health as well as strategies they use to maintain their emotional well-being. This resource will examine insights from people with lived experience of arthritis as well as from emerging research on mental health.
When we asked older adults about arthritis and mental health, they had the following to share:
When we asked older adults with arthritis about the most important topics to address around mental health and wellness, they identified the following areas. Read on to learn self-management strategies for each topic.
Getting a Good Sleep
Not getting enough sleep can have a big impact on our mood, while our mood can also impact our sleep. For people with arthritis, sleep might be disrupted by pain, worry, or medication side effects. Fortunately, there are tips and strategies you can use to help improve your sleep, which can in turn have an impact on your mood.
If arthritis pain is keeping you up at night, you might want to speak to an occupational therapist about whether placing a pillow under the affected joint might help. Practicing good sleep hygiene is also important, which means sticking to a regular sleep schedule, giving yourself time to wind down before bed, and avoiding screens for at least an hour before bedtime. Having a warm bath or using a warming pack before bed can also help reduce joint pain. Some people find it helpful to take pain relievers before bed, which could include medical cannabis. For more information, visit the Arthritis Society’s article on 10 Ways to Get a Better Night’s Sleep. You can also track your sleep for a week with this Sleep Diary [PDF 212kB] to determine if there are any patterns you notice that might impact the quality of your sleep so that you can try to address them.
Coping with chronic pain while trying to manage daily tasks can be exhausting. Fatigue can also be a common symptom of inflammatory types of arthritis as the body expends energy to fight the inflammation. This exhaustion can have a big impact on our mood, while our mood can also impact energy levels. If you find yourself fatigued throughout the day, there are a number of strategies you can put in place to help you manage and conserve your energy.
It can be helpful to keep in mind the 4 P’s of Planning, Prioritizing, Pacing and Problem-Solving:
Planning: Make a plan of the things you want to achieve during the day or over the week. Plan how and when you’re going to do certain tasks. Make sure that demanding jobs are spaced out during each day or week.
Prioritizing: If you list the tasks you need to do, you can order them according to importance and decide what task you can remove, delay or delegate.
Pacing: Break your activities up into achievable parts and spread them throughout the day or week. When doing an activity, take short, regular breaks. Change your position and activity regularly. Don’t wait until you are very tired as a guide for when to stop — plan ahead to change your activity or to rest before you start to feel tired.
Problem-Solving: Sometimes it’s not what you do but the way you do it that makes a difference. Look at your daily routine. Start to notice if you spend all morning doing the same type of repetitive tasks, or if your sitting position causes you pain or discomfort. Perhaps your body complains when you have to perform certain tasks, or you get very tired by the afternoon. If something you are doing causes a problem, ask yourself if you can do it differently. Take advantage of offers to help and use assistive device to reduce strain on your joints.
For more information on coping with fatigue:
Not only are physical activity and exercise a great way to help you manage your arthritis symptoms, but they also help boost your mood. As Harvard Health notes, “Exercise is an all-natural treatment to fight depression. Numerous studies have shown that exercise can often be an effective treatment for depression, sometimes as effective as medication. Getting started can be a challenge, but the Arthritis Society has a number of resources and articles to help you increase your levels of physical activity. Some arthritis-friendly activities include walking, yoga, tai chi, cycling (outdoor or stationary), and water exercise. There are many free yoga and tai chi videos online. However, before starting any new exercise routine, it’s important to speak with your doctor to ensure it’s appropriate for you.
If you are just starting out with exercise, it’s important to start low and go slow. Begin with shorter periods of lighter exercise and gradually increase the duration and intensity. To help you get moving, visit some of the Arthritis Society’s exercise resources:
Coping with Sadness, Depression, Worry and Anxiety
Managing the challenges of arthritis and adapting to the changes it brings can take a toll on our mental health. Additional life stressors or other factors can further contribute to sadness and depression. For some people with arthritis, depression may also be a pre-existing condition. Fortunately, there are strategies you can put in place to help you overcome obstacles and improve your ability to enjoy life. Having good mental health doesn’t mean your life will be perfect. It’s about living well and feeling capable despite challenges.
The Arthritis Society’s online guide to Mental Health and Well-Being provides concrete tools and strategies you can use to look after your mental wellness. These include activities you can practice on your own at home, such as mindfulness and meditation, progressive muscle relaxation, and challenging harmful thought patterns.
The Antidepressant Skills Workbook by Dr. Dan Bilsker and Dr. Randy Paterson is a great resource to help you work through some of the feelings you’ve been experiencing and develop skills in Reactivating Your Life, Thinking Realistically and Problem Solving. The workbook is available in multiple languages as a PDF download and also in English and French as audio files. The Government of Canada has also recently launched Wellness Together, which will help connect you to free mental health and substance use support, resources, and counselling with a mental health professional.
Cognitive Behavioural Therapy (CBT) has also been shown to help reduce symptoms of depression and anxiety. The Canadian Mental Health Association offers a free skills-building program nationwide that is based on the principles of CBT. You can find out more information about the program and how to get involved on the BounceBack website. People living in Saskatchewan can access the free, online CBT-based Chronic Health Conditions Course Including Chronic Pain. If you are located in Manitoba or Ontario, you can access the free Abiliti CBT program. For people experiencing worry or anxiety, Mindshift CBT is a free app available nation-wide form Anxiety Canada.
If you are experiencing negative emotions, it might be helpful to use the Arthritis Society’s Emotional Event Worksheet
[PDF 198kB] to work through some of your thoughts and feelings.
Managing Fear About Your Condition and Your Medication
Coping with a chronic condition like arthritis can cause fear and worry about a number things, including potential medication side effects, what might happen in the future, and dealing with disease progression or another flare. Emotions can play a significant role in the pain cycle, in that feeling stressed or worried can actually contribute to your experience of pain and increase its intensity. Fortunately, there are strategies that have been shown to help calm worry and reduce pain.
For some people with arthritis, anticipating the potential risks or side effects of a new medication can cause stress and anxiety. Research has shown that these types of worries or negative expectations can potentially cause a person to experience symptoms of side effects, even when they are given a harmless sugar pill or placebo and told it is medication. This is referred to as the “nocebo effect.” While it is important to understand the potential negative effects of a medication, focusing on the positive such as “most people tolerate this medication well” or “few people experience serious side effects” can help reduce the likelihood of the nocebo effect occurring. It is important to get the facts about your medication to limit the chance of bias or assumptions.
To learn more about medications used for arthritis, visit the Arthritis Society’s resources:
People with arthritis may also worry about the long-term effects of their medication, about whether it will lose its efficacy over time, whether their condition will get worse or if they will experience a debilitating flare. As one individual with arthritis points out, “having a [rheumatoid arthritis] flare doesn’t mean you can’t come out of it.” If you have concerns about your medication, its efficacy, or side effects, talk to your healthcare provider or pharmacist. They can help answer your questions and ensure you have the information you need to make informed choices.
Sometimes, the stress of arthritis can cause individuals to develop unrealistic thinking patterns that focus on the negative rather than the positive. For example, overgeneralization can lead a person to assume that the outcome of one situation will be the same for all situations, while catastrophizing can lead a person to expect the worst in a situation. The Arthritis Society’s Thinking Realistically worksheet [PDF 899kB] might help put your fears and worries into perspective, or you can try the Positive Coping with Health Conditions workbook by Dr. Dan Bilsker, Dr. Joti Samra and Dr. Elliot Goldner.
When dealing with the uncertainty and shifting nature of arthritis, it is important to focus on the aspects you can control rather than on those you can’t. While you may not be able to predict the course of your arthritis, you can control how you respond and adapt to changes. Other strategies to help you manage negative thoughts include cognitive behavioural therapy (discussed in the Coping with Sadness, Depression, Worry and Anxiety section) and mindfulness meditation (discussed in the Mindfulness and Meditation section).
Loneliness and Isolation
Loneliness and isolation can take a significant toll on an individual’s mental health and well-being. Arthritis symptoms can often reduce mobility and increase fatigue, making it more difficult to lead a full and active social life. Fortunately, technology is making it easier than ever before to stay connected with others. Websites like meetup.com or Eventbrite list many free (and some fee-based) events catering to every interest. Join a social group with a love for the outdoors, learn how to take better photographs, listen to an engaging speaker, or discover new cooking techniques, there is something for everyone!
Many seniors’ centres are now offering online or over the phone programming.Check with your local seniors’ centre for information about programs in your community to stay connected with others. Some local community services also offer free volunteer visiting programs, in which a volunteer will come to your house for a social visit. Dial 2-1-1 on your phone or visit 211.ca to learn about seniors’ centres and community services for older adults in your area.
You may also want to look for an arthritis or chronic pain support group in your area or online to connect with others going through a similar experience.
Meditation and Mindfulness
Increasingly, research is demonstrating the efficacy of meditation and mindfulness for coping with chronic pain and reducing anxiety. Meditation is a mind-body practice that involves training one’s awareness and attention using particular techniques. There are a number of different meditation techniques, including mindfulness. With meditation, the individual brings awareness to their body through an object of focus, such as their breath or thoughts. In mindfulness meditation, the individual is asked to pay attention to ongoing sensory experiences, thoughts and emotions moment by moment. This practice helps us to remember to stay fully aware of only what is actually happening, in the present moment both internally and externally, with no bias and no judgement.
The Arthritis Society has a number of resources to help you get started with meditation and mindfulness:
Meditation is a long-term pain management strategy and one that gets easier with practice.
Some people have also found the practice of “forest bathing” helpful for coping with arthritis. The practice emerged in Japan in the 1980s as a psychological and physiological exercise called shinrin-yoku. According to Ontario Parks,
There is a large amount of scientific evidence surrounding the health benefits of spending time in nature. Because of this, forest bathing became an integral part of preventive health care and healing in Japanese medicine…The idea is that when humans spend time in a natural setting, especially under the canopy of a forest, they experience rejuvenating benefits to the mind, body and spirit.
While there is currently limited research on the efficacy of forest bathing for arthritis, it seems to pose little risk and there is some evidence to suggest it can contribute to overall well-being. For more information on forest bathing and how to practice, visit Dr. Qing Li’s article “Forest Bathing is Good for Your Health” in TIME Magazine.
Additional Resources and Support
This information was reviewed in May 2021 with expert advice from:
Mary De Vera, PhD
Associate Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
Research Scientist, Arthritis Research Centre of Canada