In fact, a study published in May 2014 in The Journal of Rheumatology found that about 36 percent of people who have the condition had clinically significant anxiety, based on a commonly used diagnostic questionnaire. While the evidence of widespread anxiety among people who have psoriatic arthritis is strong, it’s less clear exactly how the two conditions interact. But many health professionals believe that anxiety can make symptoms of psoriatic arthritis — or at least their burden — worse. This, in turn, can contribute to anxiety, creating a vicious cycle of effects. But there are steps you can take to break this loop and bring down the overall level of anxiety you experience. Not every solution works for everyone, and it may take some trial and error to find solutions that fit your needs and lifestyle. Here’s what you should know about anxiety and its relationship with psoriatic arthritis — including what can trigger it, its potential effects, and what you can do to reduce it.
How Anxiety Works
Anxiety isn’t something that can, or should, be prevented entirely. In fact, it’s a universal human response to uncertainty or threat, according to Mark D. Sullivan, MD, PhD, a psychiatrist at the Center for Pain Relief at the University of Washington School of Medicine in Seattle. Anxiety is “completely necessary for life,” says Dr. Sullivan. That’s because it helps you realize when you’re in a situation that may cause you harm, and ideally you can find your way out of it. Anxiety becomes a problem when it’s severe, persistent, and disabling — in other words, says Sullivan, when it “interferes with daily function.” This, broadly speaking, is what defines an anxiety disorder. But even if your anxiety doesn’t rise to the level of a disorder, it can still have a negative impact on your life. For example, you may choose not to take on certain tasks or activities out of fear that your psoriatic arthritis will make them painful or difficult, and experience regret or a sense of exclusion as a result. It’s clear, Sullivan says, that people who have painful or disabling health conditions like psoriatic arthritis experience more anxiety than the general population. “They’re dealing with aversive experiences and functional limitations,” he notes, “which creates conflict and distress.”
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. 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 help reduce anxiety directly. Start with these tips.
1. Exercise regularly
Aside from the potential benefit of managing 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.
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 help 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.” One potential resource for connecting with others is TalkPsoriasis.org, which is billed as the world’s largest online support community for people affected by psoriasis or psoriatic arthritis. It’s affiliated with the National Psoriasis Foundation.
5. Start journaling
Keeping a journal or log of your symptoms and how you feel about them can also be helpful for some people, but Sullivan warns against dwelling on the limitations your condition imposes. “Journaling can be helpful if you’re trying to figure out the best way around some barriers posed by your condition,” he explains. But “obsessively recording symptoms can be counterproductive,” and a sign that you’re “stalled out” in finding solutions to your problems.
6. Limit caffeine intake
Along with taking positive steps to address your anxiety, it’s important to look at basic self-care behaviors that may be contributing to it, Sullivan says. One common culprit is consuming 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 quality 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 notes. “And being more irritable, having impaired concentration and problem solving, not weathering social stresses as well, are all part of what happens when you become sleep-deprived.”
8. Eat a healthy diet
Eating a variety of nutritious foods is also important to make sure your brain is functioning as well as it can. “Some of my colleagues recommend what they consider to be anti-inflammatory diets,” Sullivan notes. These types of diets vary in their details but generally involve cutting out processed foods and focusing on fruits and vegetables, lean proteins, healthy fats, and fiber- and nutrient-rich sources of carbohydrates.
9. Avoid unhealthy coping methods
Finally, Sullivan emphasizes, 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 anti-anxiety 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,” he 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,” he notes.
