Positive Coping with Rheumatoid Arthritis a skills workshop
About this workshop Created by: Dan Bilsker PhD Centre for Applied Research in Mental Health & Addiction Faculty of Health Sciences, Simon Fraser University The information in this presentation is for educational purposes only and not intended to replace the advice of your health care provider. Consult your physician to discuss access to other health professionals and support services that may help to manage your care. 2
Health Stress Model Health Condition Physical Symptoms Pain Limitations STRESS Psychological Problems Low Mood Worry & Tension Irritability & Anger Isolation It s hard enough carrying the burden of a health condition without the extra burden of psychological problems. 3
Psychological Problems: 1. Frequently occur along with chronic conditions like RA. 2. Are a risk factor for worsening of chronic conditions. 3. Act as a barrier to adoption of self-care behaviours. 4
Psychological self-care A psychological self-care book has been developed for people dealing with chronic health conditions Positive Coping with Health Conditions Teaches skills for dealing with psychological problems Based on Cognitive Behavioural Therapy (a talking therapy) A healthcare provider, family member or group can support you in learning these skills 5
The Positive Coping workbook Download pdf (Free) Download Relaxation Training audio (Free) Or download excerpts from the book that teach particular skills (Free) www.carmha.ca/selfcare 6
The Stress Symptom Test Over the last two weeks, how much were you bothered by: 1. Feeling stressed? 0 1 2 3 4 5 6 7 8 9 not at all a little moderately severely 2. Feeling sad, down, or uninterested in life? 0 1 2 3 4 5 6 7 8 9 not at all a little moderately severely 3. Feeling anxious or nervous? 0 1 2 3 4 5 6 7 8 9 not at all a little moderately severely 4. Feeling angry? 0 1 2 3 4 5 6 7 8 9 not at all a little moderately severely 5. Not having the social support you feel you need? 0 1 2 3 4 5 6 7 8 9 not at all a little moderately severely 7
8 The 7 coping skills
Relaxation Symptoms Pain Physical tension Excessive worry and anxiety Limitations of activity Listen to the Relaxation method on the CD (17 minutes) Practice regularly Choose a "portable" relaxation method 9
Managing Worry Physical Tension & Symptom-trigger Worry Thoughts (catastrophizing, interfering, circular) Find calming/realistic thoughts: e.g., what would I say to a friend in a similar situation? Each time worry thinking happens, challenge it & practice realistic thinking Set Worry Times to worry towards solution 10
Problem-Solving INEFFECTIVE PROBLEM SOLVING Identify a mildly difficult problem, to start Come up with three possible actions Evaluate pros and cons of each Choose one Make a specific, realistic and scheduled action plan 11
Activating Your Life INACTIVITY Select Target Areas Set Goals Social contact Self-care (eg exercise) Enjoyable activities Specific Realistic Scheduled 12
Activating cont d 13 Underactivity cycle Worry about becoming tired or worsening the symptoms Avoiding physical or social activity Reduced strength Less energy More pain Overactivity Cycle Frustrated by the health condition - Refusing to accept limits Pushing yourself to do as much as possible, especially on good days Exhausting yourself - Crashing and requiring days or weeks for recovery
Managing Depressive Thinking Overly negative interpretation of health status and expected outcomes Demoralization, Low Mood, Poor self Care, Poor adherence Identify Depressive Thoughts (eg. Magnifying limitations caused by the illness) Find realistic thoughts: e.g. can I get more evidence about limitations? Each time depressive thinking happens, challenge it & practice realistic thinking instead 14
Managing Anger Anger Thoughts (Blaming, Magnifying injury, Rehearsing prior harm) Irritability, Resentment, Easily Provoked Identify Anger Thoughts (eg. Magnifying injury or unfairness) Find realistic thoughts: e.g., what are the consequences of thinking in this way? Each time Anger thinking happens, challenge it & practice calm thinking instead 15
Relationship-Building 1. Use Activating Your Life to increase social contact 2. Improve your relationships Recognize Connecting Bids by others Make more Turning Toward responses to others bids Make more Connecting Bids Turning Toward Connecting Bid Turning Against Turning Away 16
Also in the workbook: How to apply coping skills to the challenges of chronic illness Pain Sleep Nutrition Physical Activity 17
Pain Activating Your Life Know your limits (Harm vs Hurt) Pace your activity (even on a bad day) Problem Solving e.g. take pain medication according to a fixed schedule Relaxation Pain Experience Anxiety & Tension 18
Sleep Relaxation practice Problem Solving Set a regular sleep/wake schedule Reduce sleep interfering activities Managing Worry When unable to sleep: Review problem-solving sheets Add any new ideas or information When you re tired, back to bed Repeat as necessary (likely only once or twice) Transform worry into problem-solving 19
Physical Activity Activating Your Life Know your limits Set a realistic physical activity goal Choose the most comfortable kind of activity (Endurance, Flexibility, Strength, Balance) 20
Nutrition Problem-solving Set a realistic nutrition goal small changes Make your goals specific and scheduled Praise yourself generously for small successes 21
www.carmha.ca/selfcare Thank you! 22