Chapter fourteen
SOME SIMPLE SELF-HELP ANTI-STRESS TECHNIQUES
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Chapter fourteenSOME SIMPLE SELF-HELP ANTI-STRESS TECHNIQUES |
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Relaxation techniques
Meditation
Laughter and smile therapy
Talking therapy
Simple anti-stress techniques won't, alas, cure arthritis, but can help people cope better with it. Before you try these techniques, do first share any worries with your doctor. S/he may be able to help. Medical support's especially essential if you find you're sinking into a continuing depression, with relentless feelings of despair and lethargy.
The right sort of relaxation is a harmless anti-stress device worth trying by anyone, and may help reduce pain, anxiety, and even disease activity, as suggested in a randomised controlled study of 53 patients in America (Bradley, Young, Anderson et al, 'Effects of psychological therapy on pain behavior of rheumatoid arthritis patients', in Arthritis and Rheumatism 1987; 30; 1105-14).
Relaxation techniques work partly by relaxing tense and painful muscles and partly by relieving the anxiety which makes pain more difficult to bear. They are often used by pain management clinics. Relaxation tapes or CDs, special methods like the Alexander technique (which teaches awareness of posture and relaxation to reduce muscle tension) and sometimes hypnosis may be helpful. Jane Madders, qualified physiotherapist, lecturer in health education and author of Stress and Relaxation (Macdonald Optima), says:
"Relaxation can counteract the effects of high levels of arousal and the stress disorders these generate, it can dispel the fatigue and aches that are caused by prolonged muscle tension, it can help you tolerate pain, make personal relationships easier and give feelings of well being and aid restorative sleep.
"There are, of course, some things relaxation cannot do. It is no cure for conditions that require medical or surgical treatment, though it may well help them, and will be of great benefit in the recovery period. Relaxation cannot remove personal or work problems but you can learn to diminish your reaction to them and this in itself may go part of the way towards solving them. When you are more relaxed, it is easier to talk over your problems with someone else."
She explains, too, that good circulation and muscle relaxation help reduce the build-up of lactic acid in the joints. Lactic acid is a waste product resulting (with carbon dioxide) from the energy-generating breakdown of sugar and oxygen in the muscles. Normally muscle action would keep the blood flow pumping and taking away this excess lactic acid, but with unrelieved muscular tension, lactic acid build-up in even healthy joints that are tense can lead to pain, stiffness and physical fatigue.
Here's one simple relaxation technique: Robert H Phillips' 'Quick Release' method (from his Coping with Lupus, 1984, Avery Publishing, New York):
"First read the directions and then try it. Close your eyes, take a deep breath, and hold it while you tense or tighten every muscle in your body that you can think of (your fists, arms, legs, stomach, neck, buttocks, etc). Hold your breath and muscle tension for about six seconds. Then let your breath out in a whoosh, and let your body go limp. Keep your eyes closed, and breathe rhythmically in and out for about 20 seconds. Repeat this tension/relaxation cycle three times, and by the end of the third repetition, you'll probably feel a lot more relaxed."
In London the Royal Free Hospital tried out a non-drug pain control and relaxation self-help technique devised by the late Ursula Fleming. It's used especially for patients with chronic pain or an incurable illness. Woman magazine (15 February 1986) featured three readers who'd benefited from the technique, one with severe back problems, one with pre-menstrual tension, and the third, a professional pianist, with RA:
"I was immensely interested when I first heard about Ursula Fleming… as she used to be a pianist, which is my own profession. I have had an arthritic hip for several years and know I'm making the problem worse by tensing up in expectation of the pain. I find it almost impossible to relax. At first, the tape didn't seem to be doing me any good. But now I'm finding that the muscles really are less tense and, as a result, the pain has lessened…"
"Normally, I do think I am a fairly relaxed sort of person, but once the pain starts, a vicious circle builds up. I've been taking lots of treatment for arthritis, including homoeopathic medicine, and there's no conventional medicine I haven't tried. I've had every kind of pill there is."
"I know that relaxation will never cure arthritis, but I've been anxious to cut down the many pills I've been taking and to avoid major surgery. Already, the arthritis in my fingers has gone. For a time, it stopped me playing the piano, but I can play perfectly well again now."
Laura Mitchell was a qualified physiotherapist, who taught at St Thomas' Hospital, London and the London School of Occupational Therapy. She suffered from OA:
"…I have an arthritic spine, an arthroplasty of one hip joint, and removal of the other hip joint, plus a shortened leg bone, a built up shoe, a crutch and very shaky balance. I therefore know that having any disability means a continuous battle. Patience one can learn, but frustration always remains. Getting in or out of the car is a major event, and carrying a tray a difficulty."
That quotation is from her book Simple Relaxation, (John Murray, 1987). It's very readable, but with plenty of 'professional references' too. She explains how muscles work, what can go wrong, how tension builds up, and then goes on to explain her method of controlling tension and changing it, at will, to break the vicious circle of stress and tension.
For more about relaxation try:
Meditation's a technique anyone, however uncooperative their body, can use to develop inner resources to cope more effectively with stress and problems like a chronic disease. You don't have to shave your head or get involved with strange religions. You don't have to join an organisation, buy any equipment, attend any course, or even leave your home. It's easy and it's free.
Meditation's a way of calming the mind and making you feel good. It's not a cure, but a way of strengthening ourselves to help us deal with difficulties. It's a useful natural, non-drug technique we can call on to help us deal with stress and pain. If you're in pain, it's very comforting to have a way of creating an 'inner retreat' away from jagged nerves.
Psychiatrist Dr Sandy Burnfield, affirms:
"The effects will be beneficial and will lead to better concentration and memory, as well as a general improvement in relaxation and self-confidence. Eventually you will be able to use this technique in all sorts of situations, from waiting on a station platform to travelling in a bus. Some people find that they can regain peace and tranquillity through this technique if they are upset, anxious or angry about something. Others find that it helps them to get their lives in perspective, and some use it as prelude to sleep." (Multiple Sclerosis: A Personal Exploration, Souvenir Press).
I find the 'inner retreat' it gives me helpful at work, for instance, to relax me at lunchtime, when I can't get out for a change of scene; to relax me when I get home after a hard day at work; and to calm me if I wake in the middle of the night with a churning mindful of worries.
Some of the body's responses to meditation have been scientifically measured. It can induce what Dr Herbert Benson, of the Harvard Medical School, called 'The Relaxation Response', the opposite of the fight-or-flight response to the threat of danger or stress (see chapter 12). The heart rate decreases, so does the rate of breathing, and the body's metabolic rate. Blood lactate goes down: high levels are associated with attacks of anxiety. Dr Benson found that meditation can reduce high blood pressure in some people, and it can produce slower brain waves, the alpha rhythm associated with relaxed awareness.
Counting the breath
This is the simplest method to start with. It aims to replace the way we breathe when we're under stress, so that instead of breathing in a quick, shallow way from the top of our chest, we breathe lower down, 'abdominal breathing', allowing a more efficient and relaxed expansion of the lungs, while our mind learns to focus on one thing, and calms down.
Finding out more
If you want to read more about different types of meditation, East or West, try:
Laughter has been called stationary jogging, as it provides good exercise for internal body systems. — So it's perfect for the likes of us, and cheap, too. Though it can't cure illness, it can act as a natural tranquilliser. It has definite beneficial effects, which researchers are at last taking seriously. West Birmingham Health Authority opened the first NHS laughter therapy clinic for people undergoing treatment for stress. Many American hospitals already employ humour therapists.
A French doctor, Pierre Vachet, studied laughter for many years. He found that it increases oxygen intake, deepens breathing, improves circulation, speeds tissue healing, and strengthens the body against infection. French neurologist Henri Rubinstein says it can reduce the heart rate, stimulate the appetite and improve the digestion too. Apparently it can also boost production of endorphins, the body's natural painkillers and tranquillisers (see chapter 11). Liz Hodgkinson wrote a whole book on Smile Therapy (Macdonald, 1987)! She describes some experiments in America:
"In the experiments, a group of actors were asked to simulate a variety of emotions by putting the appropriate expression on their faces. They were asked to smile, to look surprised, angry, disgusted, fearful and sad. As they put on each expression in turn, various bodily functions, such as heart rate, skin temperature and blood pressure were monitored. In every case, smiling was the only expression which served to calm down the body's activity. All the other expressions, which indicated negative emotions, sent heart rate and blood pressure soaring."
She believes that facial expressions do, in time, actually alter emotions. So by first trying to look happy, you improve your chances of actually being happy, and doing your body good. People who smile and can see the funny side of life actually make other people feel good too. Gloomy faces spread gloom and fear. Fear stops people regaining their health, she believes:
"When we laugh, all our body systems are shaken up and tension is released. Laughter is a relaxing activity in itself, and could do more good than all the exercises, aerobics and mental tricks people are currently using to try and help them to relax… Henri Rubinstein states in his research papers that laughter is the best relaxant there is — as even one minute of laughter can give the body up to 45 minutes of therapeutic relaxation. Laughter, it appears, has much the same effect on the body as regular physical exercise, in that the 'high' produced goes on working long after the exercise is over. Laughter is, after all, another form of bodily exercise."
Having a sense of humour is a vital escape valve from worries and difficulties. Smiles and laughter help get things in perspective again. Replace a miserable expression with a cheerful one and, says Liz Hodgkinson, even though illness or pain may still be present, "the healing process can actually be set in motion". Though the illness may not disappear your reactions to it will alter, and make you better able to see solutions and ways of coping.
Liz Hodgkinson quotes Ursula Fleming (mentioned earlier in this chapter), who also believed in the value of laughter:
" Laughter is essential to getting well. Each of us has to understand that life has to be laughed at, otherwise it becomes unbearable… People who are afraid cannot laugh, but once they have learned to laugh, they have then triumphed over themselves and their disease…"
"The most important aspect of getting well is… to alter the emotions. Only by changing the way you feel can you start to get better. The body responds to positive emotions, and particularly to lightheartedness."
With the support of his doctor, Norman Cousins made 'laughter therapy' a keystone of the treatment programme for his AS, with good results. He wrote about it in Anatomy of an Illness, As Perceived by the Patient (first published in Britain in 1987, by Bantam, with detailed bibliography and medical references). He reckoned that just as negative emotions can make people ill, so positive emotions ought to help make us well again.
He arranged special laughter sessions for himself, hired a projector and some of his favourite Marx Brothers and Candid Camera comedy films, and read funny books. He laughed so much he was asked to move out of his hospital room because he was disturbing the other patients! He felt less pain ("ten minutes of genuine belly laughter had an anaesthetic effect and would give me at least two hours of pain-free sleep"), and his doctor measured beneficial effects in his blood. He took sedimentation rate readings just before as well as several hours after the laughter episodes. Each time there was a drop of at least five points, not massive, but enough, and it was cumulative.
Norman also used, under strict medical supervision, ascorbic acid. His physical problems didn't disappear overnight, but in time he recovered sufficiently to go back to his editorial job full-time, "and this was miracle enough for me". As Adjunct Professor of Medical Humanities at UCLA (University of California, Los Angles) he founded what was later named the Cousins Center for Psychoneuroimmunology, to investigate the relationship between patient psychology and biological states and health.
Elsewhere, after five years' research into the effects of laughter and smiling on our emotional and physical well being, Occupational Therapist Alison Hortop developed a Laughter Therapy Workshop at Whitchurch Hospital, Cardiff.
In 2003 a 'laughter booth' was set up at the Royal Brompton Hospital in London. Professor Duncan Geddes, consultant in repiratory medicine there, agreed laughter is an important medicine:
"Laughter is an expression of happiness and happiness is good for all of us. It stimulates the body's defences, reduces pain and helps recovery from illness. Laughter therapy is developing fast and new research is looking into the ways that laughter happens, how it affects hormones, how it stimulates the brain and how it makes us all healthier and happier."
Dr Vernon Coleman prescribes laughter therapy in his book Natural Pain Control. He suggests keeping a list of favourite funny films and books and videos that make you laugh out loud. His choices include Jerome K Jerome, James Thurber, Stephen Leacock, Robert Benchley and S J Perelman. On the Laughter Yoga website there's an 'inspiration zone' with some ideas. My favourite laughter-makers would include the TV Fawlty Towers series with John Cleese and Co, the Yes, Minister series, anything with Peter Sellers; radio programmes like Tony Hancock's (eg the Blood Donor), the Round the Horne series, I'm Sorry, I'll Read That Again; and books by Gerald Durrell, James Herriot, Maureen Lipman, Tom Sharpe, and David Niven's The Moon's a Balloon. So — start smiling, and try taking the laughter medicine!
Talking over problems and sharing worries can help enormously with the challenge of 'living with arthritis'. Sometimes just putting fears or emotions into words helps get them in perpective and makes them easier to sort out. Perhaps a good friend can help, simply by listening to you, or your local Arthritis Care Contact, or phone the Arthritis Care helpline (0808 800 4050, email helpline@arthritiscare.org.uk), or other support group helpline or internet forum. Or try your doctor, your rheumatology nurse, or a priest, or a counsellor recommended by your doctor. Or the Samaritans (08457 909090, email jo@samaritans.org.uk), if you're feeling particularly low and unable to talk to anyone else.
The person you talk to needs to be the right sort of person, someone who'll let you talk and offload your worries, and clarify your thoughts and feelings, rather than a self-styled expert overkeen to dictate what you should do. Sometimes it helps just to pour out your thoughts and feelings on paper, in a diary or on scrap paper that can be thrown away later. Or write an article (or a book!).
Sometimes it helps to talk to a professional counsellor, someone trained to listen and to offer support and insight. Some can teach helpful skills such as relaxation. GPs may refer people to nurses, social workers, clinical psychologists, psychotherapists or other counsellors for emotional support.
If you'd like first to do some background reading on 'talking therapy', on counselling and psychotherapy, look at MIND's leaflet Understanding talking treatments or Making sense of counselling (both downloadable, or email publications@mind.org.uk or tel:0844 448 4448). Another readable guide is Lindsay Knight's Talking to a Stranger. A Consumer's Guide to Therapy (Fontana, 1986). She shows how different therapies work, who they benefit, what happens, and how long it takes. She stresses that therapy isn't just for people diagnosed as mentally ill, or severely distressed: it's for ordinary people with ordinary problems too.
Another shorter guide, helpful and clearly written, is Hilary Edwards' Psychological Problems. Who Can Help? (Methuen and the British Psychological Society, 1987). She explains what sort of help you might expect from a GP, voluntary organisations such as Relate, MIND, and specialist professionals such as a clinical psychologist, a psychiatrist, a community psychiatric nurse, a nurse therapist, and social workers. A community psychiatric nurse explains:
"My work involves counselling, support, and problem-solving. I also give a lot of practical information, such as how to get a home help, or where a lonely person can go to meet people."
A MIND worker says:
"The main things we offer are befriending, counselling, group therapies, help with welfare matters, and general support for people with problems and for their families… Most of our users are self-referred… People who use MIND have a wide range of difficulties. Many are suffering a life trauma, such as job loss, bereavement, the break-up of a relationship, or major illness…"
The British Association for Counselling and Psychotherapy (BACP) produces a directory of counselling agencies and individual practitioners, most of whom offer general counselling for such problems as anxiety, stress, low self-esteem and relationship difficulties. Some also specialise in a specific area such as careers, redundancy, or mid-life crisis. The 900 page directory is expensive, but you could see if your library has a copy or alternatively there's a free 'seeking a therapist' service on BACP's website.