"Emotional Wellness Helps RA" is the title of a recent post on PsychCentral that caught my eye:

http://psychcentral.com/news/2009/08/05/emotional-wellness-helps-ra/7550.html

The incidence of depression among people with RA is twice that of the general population.  An additional study found that when spouses and partners of those with RA are depressed it correlates with a poorer prognosis for the person with RA.

Being emotionally healthy is essential for those who have RA and for their family -- it can alter the course of the disease and supports better pain control.

So how do you become "emotionally healthy"?

What the studies look at is depression -- that feeling of hopelessness, powerlessness and the sense that things will never change.  Other symptoms of depression can be persistent anger, sleeplessness (or always wanting to sleep), or an overall grey feeling -- nothing seems good or worth looking forward to.

These feelings can creep up and subtly worsen over time.  Early intervention is the best way to stave off a more serious bout of depression.

Yet most people don't treat depression.  They hope it will just go away.  They don't want to be whiners, or feel "weak."  Many folks also don't want to take more pills or feel like they have another disease, so they just try to ignore those downbeat thoughts.  They try to "act" cheerful or okay.

The bad news is that this strategy doesn't work.  And depression is wily and tenacious once it takes hold.

Dealing with it early is the most effective approach.  Here are a few ways to start if you find yourself regularly feeling blue or blah:

Talk to Somebody

Find a neutral, supportive person who can listen.  It is best to rely on someone who knows something about depression -- a religious leader, or a medical support person like a nurse or therapist.  Many communities have free or low-cost clinics that can be a great place of help and hope.

Talking to a professional can help you put your concerns in the hands of someone who is an expert in these matters.  You will get lots of good advice and perspective.

Physical Movement

This is free, easy, and one of the most researched tools to combat depression.  I didn't say exercise because that can connote a huge program that feels too overwhelming before you even begin.  What helps is just getting your body in motion.  A short walk every day.  Moving some parts of your body -- stretching, breathing, whatever you can do.

The more often you get your self moving each day, the more it helps.

Humor

OK, you don't find very much funny.  But laughing out loud or a good chuckle lifts your spirits and shifts your brain chemistry.  What tickles each of our funny bones is very individual, so you may have to experiment.  Is it a silly spot on YouTube?  An old movie like When Harry Met Sally?  Jokes from the Reader's Digest?  Jon Stewart?

Give yourself the prescription of two funny contacts a day.

Create Community

Who is in your tribe?  Pain and depression lead to isolation, which makes pain and depression worse.  Where are your friends?  To whom do you talk?  Facebook friends and chat rooms are a good place to begin, but be willing to move on to real-time relationships.  Invite someone for coffee.  Go out for breakfast after church or temple.

I know, you don't feel like doing this.  It's hard.  I get it.  Your cave feels safe.  But you need to get into the world and be around people.  Set a goal.  One outreach in two days.  Then you can build from there.

One of my favorite blogs is The Happiness Project by Gretchen Rubin.  The other day she had this great line:  "The absence of feeling bad isn't enough to make you feel good -- you must strive to find sources of feeling good."

As always, you are in charge, and your sources of feeling good are particular to you.  Remember it is an active process -- not a passive one.  Follow the practice of identifying what these sources of feeling good are.  You have to be willing to act on what you know and feel.

Depression is tough -- but I know you can take the first step towards healing.

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It's the time of year when we're thinking about vacations.

Maybe you are anticipating going away, or perhaps you've already gone.  Some of us are just dreaming about it.

Vacations are essential for everybody -- and particularly for those who have a chronic and painful condition.  The break in routine, the exploration of new sights, the creation of memories and relaxation all contribute to a healthier mind and attitude and body.

Yet we often put that need aside.  "I can't afford to get away!"  That's our usual excuse.

Whether we can't afford the money or the time or the energy, we give up and put vacations on the back burner in our mind.

The reality is that we don't need to go away for a week or even physically leave our homes in order to get some of the best benefits of a vacation.  We can create "mini-retreats" or even brief mental vacations that can offer us some of the best nourishment of a time away.

To do that, there are a few pointers.

"Set the table."

By that, I mean, put aside a little time and prepare for your mental break the way you would for any trip.  Think of where you'd like to go.  And it works especially well if you choose somewhere you've been and loved.  Using your memory and imagination, recall specific details of the place -- smells, sounds, the slant of the light, what you are wearing ... make it detail rich.

Last year my daughter and I took a brief trip to San Francisco for her high school graduation present.  It was one of the best trips of my life -- and I will never be able to repeat it.  So, I have thousands of delicious details tucked away in my mind so I can take that trip again any time I want!

Put lots of wonderful things on the table.

It's a vacation, remember!  So you get to eat, and put your toes in the water, and feel the sun, and listen to the birds and the wind in the trees -- whatever pleases you.

To ramp up your relaxation, use all your senses.  Eat something, listen to certain music, put out a scent.  Have a raspberry, sniff a rose, hold a beach shell.  The more you stimulate your senses, the more you will relax.  Look at pictures that remind you of how happy a time you had and are having again!

Spend as much -- or as little -- time as you please.

You will get the benefits very quickly.  Your pulse will slow, your mind will unclench, you may be breathing a little more easily, and for sure you will find yourself smiling.

That's what happy feels like.  You don't need to do this for very long.  The effects will last for a while.  When you need another break, do it again.

The best effects happen if we practice vacationing regularly -- every day, or twice a day.
You give yourself a big sunshiny happy vitamin.

That's a break we can all afford and it offers a rich payoff.

Bon voyage!

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Start with going to bed earlier -- and when you go to bed earlier, use that time to sleep! Many of us watch TV, or work on our computer, or try to solve problems or plan when we get in bed.

Those are not good ways to spend our time in bed. Bed is for sleep (and sex, but that's another column).

First step -- get in bed earlier, and then relax.

Practice progressive relaxation in which you tense and then release various muscles, moving from your feet to the top of your head. There are some great guided descriptions that you can listen to if you want help learning to do this. Put on music, or ocean sounds, or listen to a soothing story. But no crime shows or worse -- hospital dramas or political nonsense.

No TV at all is best.

Raising your core body temperature can also help you fall asleep -- so take a hot shower or bath before bed. Taking your pain medication close to bedtime can also help you sleep and stay asleep.

Make your bed a comfortable safe place -- if you meditate, this is a good time to practice. If you don't, this is a good time to start!

Staying asleep can also be challenging when your joints hurt.

Put the clock where it is hard to see -- worrying that you aren't asleep only makes it worse. Block noise and light and, if that's difficult, invest in earplugs or eyeshades or drapes!

Any exercise -- even a gentle walk around the block once or twice will help your body move into rest and stay there.

For some people, a few sessions of cognitive behavioral therapy can help create some habits that lead to better sleep. Ask your doctor for a referral or call a sleep clinic for a practioner who specializes in sleep issues.

If sleep is still eluding you, don't hesitate to ask your doctor for some help. There's nothing wrong with getting some medication to help you sleep -- it's that important.

I suggested that to Jane and she found that once she was sleeping almost every night, she had some new energy. Just as significantly, she found her joints were a bit better. There is some evidence that lack of sleep increases inflammatory cytokines, and even a small sleep deficit can have that effect.

So creating a reserve of sleep experiences can help with arthritis pain.

A restorative night's slumber adds more to your life than just rest. It is a key part of zest and resilience -- essential elements of living well with arthritis.

As always, I am interested in your experiences. How much are you sleeping and how does that affect you? Please write in and let me know.

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My friend Jane isn't sleeping so well. At first she thought it was just a phase, but now she's discovering that interrupted sleep is becoming her routine.

She's feeling it -- and not just in her joints. Her mood is more snappish. She doesn't have the physical bounce back. Her fatigue gets her down.

Mostly, she doesn't have any emotional "oomph" to cope with the daily hassles of her life with arthritis.

Sleep is an essential ingredient in the arthritis survival kit. Studies have shown that quality sleep can help repair not only physical but emotional and mental stresses.

Nobody knows exactly how it works, but what they do know is that lack of sleep, or constant interrupted sleep depletes all your resources.

So, the answer is to get some sleep! Enjoy the prescription to lay down some comfy "zzzz's."

But it is easier to prescribe sleep than to get it -- especially if you live with chronic pain. Pain wakes you up, worrying about pain can keep you from falling asleep, and if you are in too much pain to move around, you may not even feel like sleeping.

There are some ways to help yourself go to sleep, and stay asleep, and I am suggesting that you make it a mission and a priority to get more sleep. How much?

Well, Americans on the whole aren't sleeping -- you can see those stories everywhere. We need 7 1/2 - 8 hours, and most of us get on average 5 - 6 hours.

If you live with pain, you may only average about four.

Moving up your sleep quotient can begin with something simple. Next time, I'll be sharing with you various strategies for achieving better sleep.

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