Make Mental Health a Priority

Released on January 25, 2022

PODCAST OPEN:

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control. Our host is Rebecca Gillett, an arthritis patient and occupational therapist, who is joined by others to help you live your Yes.

MUSIC BRIDGE

Rebecca Gillett:

Thanks for joining us on the Live Yes! With Arthritis Podcast. We're kicking off the new year discussing our mental health. And joining me as my special guest co-host today, Courtney Wells is back again with us. Thanks for joining me on this conversation, Courtney.

Courtney Wells:

Thanks for having me, as always.

Rebecca:

Joining us in this discussion about making mental health a priority today is Dr. Rachel Aaron. Dr. Aaron has been a previous guest on our podcast. Welcome back to the show, Dr. Aaron.

Dr. Rachel Aaron:

Hi, thank you so much for having me.

Rebecca:

Dr. Aaron, can you tell us again a little bit about your area of expertise and a little bit about yourself?

Dr. Aaron:

Absolutely. I am a clinical psychologist at Johns Hopkins School of Medicine, and my area of expertise is in the management of chronic pain. So, I work with patients who have all types of different chronic pain problems, including different types of arthritis, and work with patients to help manage that pain from a more behavioral or psychological perspective.

I also do clinical research to understand what factors make it harder to live with pain. And I research clinical interventions to figure out how we can help people with pain from a psychological perspective. I work really closely with physicians, therapists, occupational therapists, physical therapists, a lot of different types of providers in an interdisciplinary setting, to help patients target their pain.

Rebecca:

I think sometimes it's the piece that gets forgotten when we're seeing our doctor and trying to manage our pain and arthritis: that mental health piece.

Dr. Aaron:

Our mental health, our wellness, is often something that kind of goes to the bottom of a list of our priorities of what's important to us. And, you know, part of that is the culture that many of us have come up in. This idea that mental health isn't as important.

There can be a lot of stigma around mental health, stigma around choosing to prioritize mental health. So, a lot of times it's not something that we are addressing until things are a little bit worse than they needed to be. You know, ideally, we wanna be prioritizing our mental health before things get too distressing, too hard to manage. So, I think making it a priority is really important. And certainly bringing it up to other providers to help find the resources that can help you.

Courtney:

I completely agree. And I think it's interesting. My background is in social work and also public health. And when I think about mental health from a public health perspective, it's always so astonishing to me that we don't think about prevention very much about mental health.

Rebecca:

In the last couple years, it now is part of an intake in my doctor office. You know: Are you having any feelings of sadness, or loneliness, or depression? It's just one of those little forms you fill out when you check in. Is anybody reading that? You know what I mean?

Recently I have been struggling a lot with anxiety and stress. And I feel like I'm the one who brought it up to my doctor. Both my rheumatologist and my primary care hear it in my voice. They hear all the things I have going on. I'm the one who came to my doctor and said, "My life is really crazy right now. I'm overwhelmed. I have panic attacks. I was waking up in the middle of the night…" that kind of thing. And then I had a great conversation with my primary care, and she did put me on an anxiety med, but I was the one who broached the conversation.

So, when people are kind of stuck in their pain and in that kind of position, what advice do either of you have to give someone that courage to just speak up?

Dr. Aaron:

Just to take a moment to acknowledge how hard it is to bring this up. It's very hard. I like the questions on the intake form around depression and anxiety for normalizing that. You know, you're here for a medical appointment, and we wanna know. Because we recognize on some level it's communicating. Your mental health is related to your physical health. And we wanna know that, too.

I think this is something people can rehearse in advance. Kind of thinking about how you might feel comfortable bringing it up. Not all providers are gonna be terribly knowledgeable about how mood impacts physical health, knowledgeable about resources in the community. If you face a provider who isn't supportive or maybe has some of that stigma themselves, or doesn't understand, then maybe that's a reason to find another provider who thinks about health more holistically.

Rebecca:

Courtney, I know in a lot of your research and work that you've done, you work with a lot of patients with rheumatoid arthritis and chronic conditions. Do you have any insight or suggestions that you've heard work for patients?

Courtney:

Yeah. I'm so happy that you had a positive response because I do think that that's not the norm. It's getting better. I mainly work with younger people, adolescents and young adults, and they don't often get that response of welcoming that conversation.

When I work with patients, I try really hard to hook them up with resources and let them know that you have a right to this type of care. And that you should advocate for yourself and go to these places. If you're a high schooler, go to your school counselor, find somebody in these settings. Sometimes your rheumatologist isn't the best place for that. I think, like Dr. Aaron, said is really to do some work ahead of time, which is unfortunate because you're the one who's struggling, and you shouldn't have to do that.

Rebecca:

Right. Like where do you start? What concerns are you hearing from your patients about their chronic conditions dealing over this last couple years of the pandemic? Dr. Aaron?

Dr. Aaron:

Another complicated (laughs) question. In the beginning, I think for a lot of people, there were many benefits to some of the effects of the pandemic. Taking the piece out of getting to work, driving to work, parking, walking to the office, the pressures of needing to take breaks in a busy workplace. The need to maybe rest, take a nap in the afternoon. It facilitated a lot more flexibility.

What I see happening now is just this negotiation of the world that we live in and how to prioritize mental health within that model. And what types of behaviors are serving mental health. And what sorts of behaviors are not serving mental health. And that being a little trickier now than it used to be.

Courtney:

I've also heard from research participants about just the decision fatigue that they're having around “Am I high risk? Am I not high risk? Should I wear three masks, or should I not? Should I go to the event or not?” And this has looked different at different stages in the pandemic, but I know that that's taking a toll on people.

Rebecca:

As this has dragged on, we've learned more of what's working and what doesn't. And now that we have vaccines, there might be a better level of comfortability to go to your doctor's office and do the things you need to do to manage arthritis. But there's still fear.

I continue to mask and do things because I know there are friends of mine in this arthritis community who couldn't be vaccinated, or they're not building antibodies. Just thinking about the community as a whole and wanting to make sure that I know what it's like to have COVID, and I don't want anybody else to have to deal with it, you know? So, I think some of that all just kind of compounds on our mental health, too.

I feel like in a way it's been an up and down rollercoaster for people for the last couple years. I've heard that especially, you know, like the kids who are in school, not in school, remote, not remote. What this has done to the mental health of a lot of people over the last couple years is probably more profound than we'll know and will continue to find out over the next couple years.

Courtney:

Well, I think especially in the schools. Schools are finally understanding that mental health has to be a priority. And they're trying to ramp up some of those things. And so that's been a silver lining, I think, also of all of this.

Rebecca:

There's a lot of people in our community who are health care workers that have a chronic condition. They're managing patients and death and loss, and on a constant basis. It's gotta be really tough on everyone, right?

Dr. Aaron:

It reminds me of another big theme that I'm seeing in the patients that I work with. Which is just the importance of getting out of the house, and the importance of being active, and the importance of doing things that are physically healthy. And also things that are emotionally happy, emotionally good, that help you feel like you. And how important that is.

Sometimes we talk about mind and body, like they're two separate things. But we've got a lot of research to say that they're not. We can kind of conceptualize it as two, because it's easy to think about it that way. But we can't break the connection between what's happening in the body and what's happening in the mind. When we have stress build up in our body and we have tension build up in our body, that can lead to greater inflammation, and that can lead to more pain.

Courtney:

Because of the stress and the amount of just all the things that got piled on during the pandemic, my arthritis was aggravated in my jaw, which is for me the most frustrating joint to have that in, because it affects everything that I do. But when I get stressed, I clench my jaw. I clench it when I'm sleeping. I clench it when I'm working, pretty much all the time. And then it gives me more headaches and neck pain and all the things that just keep cycling around.

And I had to go back to occupational therapy and doing… getting massages… and doing the things that I haven't done in a really long time, because of just the amount of stress that I was dealing with. So, for me, that there was that very clear link between my physical health and my mental health. And how, in order to address one, I have to address the other. And I have to clear some time in order to do that.

Rebecca:

My stress and anxiety was aggravating my spine pain. I've had a couple surgeries on my neck, and I have OA in my spine, and degenerative disc disease. And so, when I'm stressed, I carry it in my neck and my shoulders. It just felt like the best way I could describe it to people was that it felt like somebody was choking my spine through the whole thing, top to bottom.

I actually took a pause. I said, “You know what? Like this is really impacting my back. My back is in so much pain.” My RA was starting to get aggravated as well. And I said, “I just need to focus on one thing at a time.” I have so many things going on personally, and then work is busy. And then taking care of my son. And he, you know, I'm like his Uber driver, so I'm constantly on the go. And I just didn't even have a minute to do the things that I know help alleviate that spine pain.

I just live that example of making my mental health a priority because it totally changed the course of what could have happened to me. I was feeling like, “Oh my God, if I keep on this track, I'm gonna be on a high dose of prednisone.” And I don't wanna do that. What's some advice you can give to people who are on that track like me?

Dr. Aaron:

I wanna call out something that both Rebecca and Courtney did that was so powerful: just being aware of that association. Both of you are having that pain in your body and getting those signals from your body. And you recognized that that was attached to some of the stressors in your life. And I think that step is actually very easy to overlook. So, I think as a first piece of advice, I would recommend people explore that.

I think a first step is just kind of be curious. When a physical condition is getting worse, to think about what else is going on in the bigger picture, in my broader life, that could be contributing to this? Exploring those relationships between stress in your life and pains and discomforts in your body.

Rebecca:

Yeah. It takes time to get there, to be able to figure out what your triggers are. But you know, as soon as you do, it's life changing, right?

Dr. Aaron:

Yeah. And then I think, at that point, it's that negotiation piece. Because we can't usually take time for ourselves without sacrificing something else. I like that you've called this making mental health a priority, because it really is about priorities and where that falls in line with other things.

Courtney:

Yeah, I really like your point about the sacrifice. That really resonates with me. Because I, as a mother, I think I take on too much, and I have been doing some of that negotiating with my husband lately of: OK well, if I'm gonna take back some of this time for myself, then that means you're gonna have to step up some of your time and use it towards the laundry or the dishes or cooking or whatever. And that gets frustrating for me. Because I don't feel like I should have to do that. It's just part of the way we do things. And it's hard to say no. I know for me, that's like one of my biggest issues: I can't say no to things that I really feel like I need to do.

Rebecca:

I've said this before and I'll say it again: Sometimes the best way to say yes for yourself is to say no. And I feel like I've done a lot of that this past year or two of the pandemic. OK, well I'm not gonna try to be everything to everyone anymore. I need to focus on me and my family. And that's all I can handle right now. That's all I have the energy for. And that's OK. And I think giving ourselves the permission to say that it's OK for me to be a little bit selfish right now and just take care of me and my family, because that's what's needed right now. It’s so hard to do. But I gotta say, it's one of the best things you can do.

So, when people are struggling with anxiety and stress and depression, is it good to set lofty goals? What kinds of goals should we work toward?

Dr. Aaron:

Great question. You know, this is where starting small is so important and also not really the way culturally that we think about goals. I think that absolutely starting incredibly small is such an important way to start. I love SMART goals: specific, measurable, actionable, realistic and time centered. This is such a powerful way to set goals.

Something that might seem small and simple is not. You know, going on a short walk, a couple blocks a day, is not, you know… If that's something that's hard for you, it's not as simple as it sounds. You've gotta get outta the house, in the cold, and get bundled up, and it might be a really bad pain day.

I think giving ourselves a lot of grace when we're setting goals, and setting ourselves up for success, because it also feels really terrible to set a lofty goal and then to not achieve the goal the way that you wanted to. Then, we're worse off than when we started because we haven't made that behavior change. And we feel bad about ourselves. So, I think starting small, setting yourself up for success, giving yourself grace when it doesn't go the way that you want… Revisiting the goal, making it more specific, more realistic.

I think one thing at a time, picking one thing at a time… And as you said, Rebecca, once you make some of those more foundational changes, that frees up room to make other changes in your life.

PROMO:

Go online 24/7 to check forums that may interest you and your situation. Get advice and join our conversations. Connect with other patients, caregivers and health care experts. Join our Online Community at https://liveyes.arthritis.org/#/Login .

Rebecca:

What suggestions do you have for people, and Courtney, chime in, too: What can people do to manage their mental health and pain long term?

Courtney:

Well, the first thing that I think of is what Dr. Aaron already said, which is that awareness piece. I know for me, I was diagnosed with an anxiety disorder when I was in college. And it took me probably 10 years to get a diagnosis and to really get the help that I needed. It takes a long time. And it can be really hard. And sometimes it's the person themselves not being aware and not knowing what to look for. And sometimes it's them being resistant. And so, I mean, there's all sorts of things that can be in involved in that.

But that self-awareness has to be there, or you can't go to the next step. You can't ask for help if you don't know that there's something that you need help for, or that there is help available. Those are the pieces that I didn't understand: that I could go out and get help, and what that would look like, and that it wasn't scary, and that people weren't gonna judge me, and that it was OK that I had to take medication. It took me a long time to come to terms with all of those pieces.

Rebecca:

It's not long term. It's only until I feel like I can make it through, maybe the other side of this pandemic. But I feel like it was something that I really did need once I started taking it and realizing how much it was helping me. I feel like that's a tough, tough thing for us, when we have chronic pain. We're tired of taking medications and I didn't wanna have to take another thing, but I'm really kind of glad I did.

Dr. Aaron:

Managing pain and managing mental health is a lifelong process. And it's going to change and evolve over time. I think it's important to have a set of strategies that you can use to help with mood, help with anxiety and help with low mood or depression. And strategies to help with pain. And that might be particular types of coping skills. That might mean medication. That might mean counseling. That might mean taking time off and really doing things for you.

It might mean just having hobbies and socializing. And doing those daily things. Hard times are going to be there. And so it's more about managing that than waving a magic wand and making them go away.

There's gonna be pandemics, or hopefully just the one in our lifetime. There's gonna be work stress, there's going to be changes in the weather. Things are gonna happen that are going to cause these symptoms to ebb and flow. And so, just being prepared for that… It's a marathon, not a sprint kind of a thing. And thinking about how you can build a framework that's gonna help you in the long term.

Courtney:

I also found it really interesting that I also… I've had juvenile arthritis for almost 40 years, and I haven't known my life without it. And I think that's a lot of that stigma that we talked about before. And my family history and the complexities that come along with that. And I've come now finally, as I'm nearing 40, to really realize that they're, for me, they're the same.

Like, I have two chronic illnesses, or I have multiple chronic illnesses. And they interact with each other. And sometimes I need meds and sometimes I don't, and just they're the same. And it took me a very long time to be able to be OK with they're the same, they're equal. One's not worse than the other. One's not more embarrassing than the other, but I have these different conditions and that's OK.

Rebecca:

I've been very open with my son about how stressful life's been for us for the last year. And how much anxiety it was causing me. That I started medication for it. And he's like, "That's not a big deal, Mom. It's OK." And I loved hearing that. Because I just wanted to make sure he knew, too, so that he's always feeling like he's open to talk about his feelings. That it's OK to ask for help. And there's nothing to be embarrassed about.

PROMO:

Whenever you need help, the Arthritis Foundation’s Helpline is here for you. Whether it’s about insurance coverage, a provider you need help from or something else, get in touch with us by phone toll-free at 800-283-7800. Or send us an email at https://www.arthritis.org/i-need-help .

Rebecca:

Dr. Aaron, we have a segment where listeners provide their feedback or their questions and that kind of thing. And so, we posted the question: What do you do for yourself to make your mental health a priority? We just have a couple comments that we can share.

One of the comments was from our friend, Cheryl Crow, who has her own podcast called Arthritis Life. And she is also an occupational therapist with RA and a friend of mine. She says therapy, connecting with friends and family, acceptance and mindfulness are strategies she employs. A lot of people talk about acceptance and commitment therapy. Dr. Aaron, can you talk a little bit about what that is?

Dr. Aaron:

Acceptance and commitment therapy is a great therapeutic approach, especially for folks living with chronic illness. And it centers around this idea that we can spend a lot of time fighting the things in our life that are hard. So, rather than pushing them away, really trying to live without them. I think of it as inviting them into the passenger seat of the car. So, they're not in the driver's seat. You are in charge. And you can live beside your pain and beside some of the distress that you live with and take some of the fight out of trying to make it go way.

Courtney:

I've also found mindfulness to be incredibly helpful for those same things. And something I try to do every day, but I don't always get to it.

Rebecca:

Another listener had posted that she does something that's called Vipassana. Have you heard of this? It's an ancient Indian technique, which is basically, she says, about keeping silent. This listener talks about, “I walk away when people get confrontational, and difficult people I do not engage them. And if they talk to me, I answer in just a few words, as few words as possible.” And she says these methods have helped her with stress management. Why do you think that's so, Dr. Aaron?

Dr. Aaron:

I think setting boundaries with the people around us is a huge part of managing chronic illness. And it is also something that's very difficult to do. (laughs) I think that's one of those sort of lifelong skills of learning what the boundary is and figuring out how you can comfortably enforce that with other people.

Rebecca:

She also talked about creating art on her iPad and reading, which are like you mentioned earlier, Dr. Aaron, some hobbies, like finding some things that bring you a little bit of joy in your day. Courtney, have you found creative outlets or anything like that that help you?

Courtney:

I have a lot of those things. I haven't been doing as much of them as I would like. I do read. I mean, that's a pretty consistent thing. And I've started to get into audio books a lot more, and that has given me something to look forward to, especially when I am commuting; I have a pretty long commute to work. So, at the end of the day, I'm looking forward to getting in my car instead of dreading it.

PROMO:

All over the country, we have support groups to help you manage your arthritis. Groups may meet virtually or face to face, depending on your location and the pandemic. Connect with others who care at https://connectgroups.arthritis.org/ .

Rebecca:

We like to end the podcast with talking about our top three takeaways from this episode. So, what advice or top takeaways would you have, Dr. Aaron, for our listeners to make mental health a priority?

Dr. Aaron:

I've got my takeaways, but I have four.

Rebecca:

That's fine.

Dr. Aaron:

My first takeaway, I think, is a freebie, because I wanna just say mental health is a priority. I think that's an important takeaway that bears kind of stating and repeating. Because a lot of us don't necessarily have that engrained in us as much as we should. I'll start there. Moving on, I think a takeaway is starting small. Not trying to take on the world all at once, but starting small and being very kind to yourself, as you think about ways to make mental health a priority in your life.

I think finding strategies that are important to you and figuring out how to implement them. And that's gonna look different across different people, and it's gonna look different across different times.

And finally: This is a lifelong journey. It's not something that… We don't take care of our mental health all in one go, and then we never have to think about it again. For every person, our mental health is something that that's going to ebb and flow and change over the course of time.

Courtney:

I think the things I really noted for this talk was about self-awareness. We talked about that a couple times and how that has to be the first step for everybody. And sometimes you need help with that. And then setting boundaries are really, really important for all of us. And then just asking for help, which is not easy to do.

Rebecca:

I just wanna remind our listeners: If you haven't downloaded our app, Vim, it's a great tool to help address your mental health. There's a lot of resources within the app that can help you find strategies that might help you manage your stress and your anxiety. But also there's a community of people who also are struggling with pain and arthritis that can cheer you on as you try to set some goals to manage your mental health. So, check it out. You can find more info at https://www.arthritis.org/vim . That's V-I-M.

Thank you so much, Dr. Aaron and Courtney, for joining me in this conversation today.

Dr. Aaron:

Thank you.

Courtney:

Thank you, Rebecca.

PODCAST CLOSE:

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation, to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to https://www.arthritis.org/liveyes/podcast . Subscribe and rate us wherever you get your podcasts. And stay in touch!