| Arthritis by itself can be very stressful and very | | | | the negative.o Emotional reasoning. You assume that |
| taxing on your body. The source of the stress can | | | | your emotions reflect reality.o "Should" statements. |
| be from the pain that no one but you, can | | | | You are driven by "should," "must," and "ought to," |
| understand, or it can be having enough energy to get | | | | which cause you to feel guilty when you don't act |
| you through one day and being totally exhausted and | | | | accordingly.o Labeling and mislabeling. An extreme |
| having to stay in bed the next day. Or looking fine | | | | form of over generalization, in which you use highly |
| and feeling like crap or people looking at your rash or | | | | charged emotional language.o Personalization. You feel |
| that bent up finger, or maybe even the fact that | | | | you are the cause of an external event over which |
| know you have to depend on others in ways that | | | | you actually had little or no control. |
| are uncomfortable to you. Maybe the source of the | | | | You can see how many of these patterns of thinking |
| stress is that you can no longer do the things that | | | | are present, and how negative conclusions resulted |
| define who you are and who you want to be along | | | | from them by looking at the original A, B, C scenario. |
| with not being able to do the things you once did. | | | | As you can see, Joan's feeling that her husband |
| There are distressing thoughts that can come out | | | | doesn't love anymore is an example of magnification |
| because of how you perceive, define, and interpret | | | | and emotional reasoning and also over generalization. |
| the arthritis-related symptoms: "No one cares about | | | | The second challenge is to recognize the patterns in |
| my pain. In fact, no one loves me anymore." "I am so | | | | your own life. More than likely you have a good idea |
| exhausted; I'll never get out of this bed." And then | | | | of the kinds of automatic thoughts you have, but |
| there is this one, my favorite, "People should know | | | | being able to compare those thoughts to your |
| I'm not feeling well, even if I look okay." These kind | | | | experiences is another important step. You can keep |
| of thoughts or internal dialogue, are called "self-talk," | | | | a diary, or carry a small notebook with you to write |
| and the types of thoughts listed above are known | | | | down any feelings you have when you are |
| as negative self-talk. Therapists, called cognitive | | | | uncomfortable about an arthritis related situation, |
| therapists, who specialize in helping people identify | | | | then you will be able to jot down a few words about |
| their self-talk and understand the impact, both the | | | | the situation, or the thought you had, and which of |
| negative and the positive, it can have on their health | | | | the 10 cognitive distortions (or perhaps several of |
| and well-being. They also help you to change that | | | | them) this thought represents. This will help you to |
| self-talk when doing so would be helpful to you. In | | | | become more familiar with your own patterns of |
| many cases, you can work on these important | | | | thought, and then you can expand on this exercise |
| changes on your own and help yourself to cope | | | | to focus on personal change. In your diary or |
| better with all the stress that this disease called | | | | notebook, add a column describing what you did as a |
| Arthritis, will bring. | | | | result of your original thought. Next add a column for |
| One of the first steps you can take is to recognize | | | | a more likely explanation of the situation (substitute a |
| the negative self-talk and identify the patterns of | | | | rational reappraisal for your cognitive distortion), and |
| thinking behind it. After you have identify the | | | | then describe how you feel now and how you could |
| patterns behind this negative self-talk you can take a | | | | have acted differently. |
| look at some ways to identify, in practical ways, | | | | This is an example of rational reappraisal: When your |
| your own patterns, making sure that you keep in | | | | arthritis is bad enough to affect your ability to |
| mind the benefits and the risks of making changes, | | | | function at work on a particular day, your first |
| as well as the personal commitment required to | | | | thought is a dysfunctional thought, like, "I'm no good |
| succeed. | | | | at my job." This is what is called all-or-nothing thinking, |
| Psychologist Albert Ellis wrote a book called A New | | | | magnification, and jumping to conclusions. The more |
| Guide to Rational Living, where he describes the "A, | | | | realistic response would be to tell yourself that you're |
| B, C's" of thinking. A being the actual event or | | | | just having a bad day at work because of your |
| situation that takes place, B is our subjective thought | | | | arthritis and then go home early to get some rest |
| or belief about A, and C is the consequence. Ellis | | | | that you probably need so you will be rested for the |
| argues that C, the consequence, is a result of B, not | | | | next day. You can reassure yourself that you are |
| A. Let's take the scenario I am about to give you as | | | | usually well respected for the work you do and that |
| an example of what Ellis is talking about. | | | | this doesn't happen every day. Your boss knows |
| A: The situation. Both Jack and Joan work full time. | | | | about your arthritis and has told you that despite the |
| Usually Joan cooks a full meal at dinner. She looks | | | | fact that you may have to take off extra time on |
| better than she feels. For several days she has been | | | | occasion, you are one of the most productive |
| rather tired and she has noticed more joint pain. Jack | | | | employees she has. Reassessing your thoughts, you |
| doesn't notice that anything wrong with Joan and she | | | | are feeling less anxious and more empowered. |
| really doesn't want to upset him. She has a doctor's | | | | These exercises might feel like you're practicing a |
| appointment in a week and Jake just keeps | | | | formula, but it's a strategy that works because |
| expecting her to have his meals fixed and on the | | | | allowing yourself to become aware of the ideas and |
| table. | | | | feelings that will guide your actions and gives you |
| B: Joan's thoughts. Why can't "Jack get it?" "Can't he | | | | options for actions you didn't know you had. |
| see I'm not feeling well? Why should I have to ask? | | | | Here is a list of issues you to keep in mind as you |
| Again, maybe he wants and deserves someone who | | | | work on maintaining the process of change:o When |
| can do more for him and make his life easier. He's | | | | you have kept a diary for a week or two, it will help |
| been working late recently. Maybe he doesn't care as | | | | you to focus on your efforts to change one thought |
| much about me anymore. Maybe I should let him | | | | pattern at a time. That way you will be less |
| know how I feel, but he won't believe me or he'll | | | | overwhelmed.o When you find that you consistently |
| refuse to help me. Then what will I do? | | | | have difficulty changing your thoughts, you might |
| Now we are going to change the self-talk, B, and | | | | consider why you are holding on to your present |
| then look at a different set of consequences, C. | | | | way of thinking. Are there certain thought patterns |
| B: Joan's new thoughts. It's really hard for my | | | | that are serving you in some way? What are the |
| husband to tell how badly I'm feeling because I do a | | | | advantages of always feeling that you should do |
| really good job of downplaying it. I really don't him to | | | | something or a fear that something worse could |
| worry. Right now, he's so preoccupied with some | | | | happen if you change a particular recurring thought. |
| work changes that are stressful, and I'm not going to | | | | Figure out what this meant to you in relation to how |
| bother him about my pain and exhaustion. However, | | | | you're coping with arthritis.o When you start changing |
| if I want to keep functioning at work and at home, | | | | your actions, there might be others who respond to |
| this would be the right time. Maybe I should take a | | | | you differently. You may think your changes are |
| risk. | | | | positive; there will be others who benefited from |
| C: The consequence. Joan tells Jack that she's | | | | your negative self-talk. It's important that you |
| recently been feeling increased joint pain and has | | | | communicate to others that you are taking the steps |
| been really exhausted. She makes a suggestion that | | | | necessary to change the way you think and behave |
| maybe he fixes the meal or maybe they can order | | | | in certain situations. Let them know that you hope |
| out. Jack's reaction first was to be angry, about the | | | | that everyone involved will benefit in the long run |
| impact of Joan's arthritis and also at himself for not | | | | from your commitment to personal change and |
| seeing what was going on with her. Actually this helps | | | | growth. There will be cases where there will be |
| Joan and Jack to talk about Joan's arthritis in a whole | | | | conflicts and you must be prepared for that.o If you |
| new light. Jack is really glad to hear that Joan has an | | | | start to think that your thoughts are getting in the |
| appointment with the rheumatologist. Joan decides it's | | | | way, to the point where these kind of exercises |
| time she asked Jack to go with her so he can better | | | | alone are not bringing the relief you need, you might |
| understand and learn more about what she has been | | | | want to consider reaching out for understanding or |
| going through on a daily basis. Jack says yes. | | | | advice from someone you can trust. This could be a |
| Self-talk that has negative consequences has also | | | | friend, family member, your physician, or a spiritual |
| been called "dysfunctional thinking," "cognitive | | | | counselor. If this kind of reality check doesn't help |
| distortions," or "automatic thoughts." Psychiatrist | | | | then you may want to think about seeing a |
| David Buns, in his book, Feeling Good: The New Mood | | | | psychotherapist. Your doctor or the local mental |
| Therapy simplified these and other ideas behind | | | | health association can be helpful source for a referral. |
| cognitive therapy, making them easier for those who | | | | A professional specifically trained in cognitive therapy, |
| don't have a degree in the medical field to | | | | or cognitive behavioral therapy (CBT) may be |
| understand. | | | | another source to help you with this process. There |
| Burns describes 10 common patterns of automatic | | | | is some evidence that the kinds of negative self-talk |
| thoughts, or cognitive distortions. These are common | | | | that has been discussed in this article are related to |
| everyday ways of responding to the situations that | | | | poor medical outcomes in arthritis and that |
| we all slip into from time to time. The onset of | | | | individualized therapy such as such as CBT is helpful in |
| arthritis and the ongoing challenges that arthritis | | | | reducing fatigue and depression. If you think that this |
| brings, makes it easier to respond to these situations | | | | type of therapy wouldo Be helpful for you and you |
| more than ever before. Listed below you will find | | | | would like to contact a therapists trained in CBT in |
| summaries of Burns' 10 common patterns:o All or | | | | your area, contact the Association for Advancement |
| nothing thinking. You see things only in black and | | | | of Behavioral Therapy (AABT). The AABT doesn't |
| white.o Over generalization. From one negative thing | | | | certify or recommend therapists, but it maintains a |
| you set a whole pattern.o Mental filter. You focus on | | | | large database of therapists. |
| everything in a negative light.o Disqualifying the | | | | Being able to understand and use self-talk can be a |
| positive. You disregard the positive experience.o | | | | useful tool in coping with arthritis. Recognizing, |
| Jumping to conclusions. Without all the facts you | | | | understanding and using your thoughts to help you to |
| form a negative interpretation. This will include | | | | understand your feelings and guide your actions |
| "mind-reading" (making assumptions about why | | | | related to arthritis can make it possible for you to |
| others act as they do) and "fortune-telling" (predicting | | | | deal with the many different situations as they |
| a negative outcome).o Magnification (also known as | | | | happen, but it can also help you throughout your |
| catastrophizing) or mini-mization. You tend to magnify | | | | whole life in the long term. |