Arthritis by itself can be very stressful and very taxing on your body. The source of the stress can be from the pain that no one but you, can understand, or it can be having enough energy to get you through one day and being totally exhausted and having to stay in bed the next day. Or looking fine and feeling like crap or people looking at your rash or that bent up finger, or maybe even the fact that know you have to depend on others in ways that are uncomfortable to you. Maybe the source of the stress is that you can no longer do the things that define who you are and who you want to be along with not being able to do the things you once did.

There are distressing thoughts that can come out because of how you perceive, define , and interpret the arthritis-related symptoms: “No one cares about my pain. In fact, no one loves me anymore.” “I am so exhausted, I'll never get out of this bed.” And then there is this one, my favorite, “People should know I'm not feeling well, even if I look okay.” These kind of thoughts or internal dialogue, are called “self-talk,” and the types of thoughts listed above are known as negative self-talk. Therapists, called cognitive therapists, who specialize in helping people identify their self-talk and understand the impact, both the negative and the positive, it can have on their health and well-being. They also help you to change that self-talk when doing so would be helpful to you. In many cases, you can work on these important changes on your own and help yourself to cope better with all the stress that this disease called Arthritis, will bring.

One of the first steps you can take is to recognize the negative self-talk and identify the patterns of thinking behind it. After you have identify the patterns behind this negative self-talk you can take a look at some ways to identify, in practical ways, your own patterns, making sure that you keep in mind the benefits and the risks of making changes, as well as the personal commitment required to succeed.

Psychologist Albert Ellis wrote a book called A New Guide to Rational Living, where he describes the “A, B, C's” of thinking. A being the actual event or situation that takes place, B is our subjective thought or belief about A, and C is the consequence. Ellis argues that C, the consequence, is a result of B, not A. Lets take the scenario I am about to give you as an example of what Ellis is talking about.

A: The situation. Both Jack and Joan work full time. Usually Joan cooks a full meal at dinner. She looks better than she feels. For several days she has been rather tired and she has noticed more joint pain. Jack doesn't notice that anything wrong with Joan and she really doesn't want to up set him. She has a doctors appointment in a week and Jake just keeps expecting her to have his meals fixed and on the table.

B: Joan's thoughts. Why can't “Jack get it.” “Can't he see I'm not feeling well? Why should I have to ask? Again, maybe he wants and deserves someone who can do more for him and make his life easier. He's been working late recently. Maybe he doesn't care as much about me anymore. Maybe I should let him know how I feel, but he won't believe me or he'll refuse to help me. Then what will I do?

Now we are going to change the self-talk, B, and then look at a different set of consequences, C.

B: Joan's new thoughts. It's really hard for my husband to tell how badly I'm feeling because I do a really good job of downplaying it. I really don't him to worry. Right now, he's so preoccupied with some work changes that are stressful, and I'm not going to bother him about my pain and exhaustion. However if I want to keep functioning at work and at home, this would be the right time. Maybe I should take a risk.

C: The consequence. Joan tells Jack that she's recently been feeling increased joint pain and has been really exhausted. She makes a suggestion that maybe he fix the meal or maybe they can order out. Jack's reaction first was to be angry, about the impact of Joan's arthritis and also at himself for not seeing what was going on with her. Actually this helps Joan and Jack to talk about Joan's arthritis in a whole new light. Jack is really glad to hear that Joan has an appointment with the rheumatologist. Joan decides it's time she asked Jack to go with her so he can better understand and learn more about what she has been going through on a daily basis. Jack says yes.

Self-talk that has negative consequences has also been called “dysfunctional thinking,” “cognitive distortions,” or “automatic thoughts.” Psychiatrist David Buns, in his book, Feeling Good: The New Mood Therapy, simplified these and other ideas behind cognitive therapy, making them easier for those who don't have a degree in the medical field to understand.

Burns describes 10 common patterns of automatic thoughts, or cognitive distortions. These are common everyday ways of responding to the situations that we all slip into from time to time. The onset of arthritis and the ongoing challenges that arthritis brings, makes it easier to respond to these situations more than ever before. Listed below you will find summaries of Burns's 10 common patterns:

All or nothing thinking. You see things only in black and white.
Over generalization. From one negative thing you set a whole pattern.
Mental filter. You focus on everything in a negative light.
Disqualifying the positive. You disregard the positive experience.
Jumping to conclusions. With out all the facts you form a negative interpretation. This will include “mind-reading” (making assumptions about why others act as they do) and “fortune-telling” (predicting a negative outcome).
Magnification (also known as catastrophizing) or mini-mization. You tend to magnify the negative.
Emotional reasoning. You assume that your emotions reflect reality.
“Should” statements. You are driven by “should,” “must,” and “ought to,” which cause you to feel guilty when you don't act accordingly.
Labeling and mislabeling. An extreme form of over generalization, in which you use highly charged emotional language.
Personalization. You feel you are the cause of an external event over which you actually had little or no control.

You can see how many of these patterns of thinking are present, and how negative conclusions resulted from them by looking at the original A, B,C scenario. As you can see, Joan's feeling that her husband doesn't love anymore is an example of magnification and emotional reasoning and also over generalization.

The second challenge is to recognize the patterns in your own life. More than likely you have a good idea of the kinds of automatic thoughts you have, but being able to compare those thoughts to your experiences is another important step. You can keep a diary, or carry a small notebook with you to write down any feelings you have when you are uncomfortable about an arthritis related situation, then you will be able to jot down a few words about the situation, or the thought you had, and which of the

10 cognitive distortions (or perhaps several of them) this thought represents. This will help you to become more familiar with your own patterns of thought, and then you can expand on this exercise to focus on personal change. In your diary or notebook, add a column describing what you did as a result of your original thought. Next add a column for a more likely explanation of the situation (substitute a rational reappraisal for your cognitive distortion), and then describe how you feel now and how you could have acted differently.

This is an example of rational reappraisal: When your arthritis is bad enough to affect your ability to function at work on a particular day, your first thought is a dysfunctional thought, like, “I'm no good at my job.” This is what is called all-or-nothing thinking, magnification, and jumping to conclusions. The more realistic response would be to tell yourself that you're just having a bad day at work because of your arthritis and then go home early to get some rest that you probably need so you will be rested for the next day. You can reassure yourself that you are usually well respected for the work you do and that this doesn't happen every day. Your boss knows about your arthritis and has told you that despite the fact that you may have to take off extra time on occasion, you are one of the most productive employees she has. Reassessing your thoughts, you are feeling less anxious and more empowered.

These exercises might feel like your practicing a formula, but it's a strategy that works because allowing yourself to become aware of the ideas and feelings that will guide your actions and gives you options for actions you didn't know you had.

Here is a list of issues you to keep in mind as you work on maintaining the process of change:

When you have kept a diary for a week or two, it will help you to focus on your efforts to change one thought pattern at a time. That way you will be less overwhelmed.
When you find that you consistently have difficulty changing your thoughts, you might consider why you are holding on to your present way of thinking. Are there certain thought patterns that are serving you in some way? What are the advantages of always feeling that you should do something or a fear that something worse could happen if you change a particular recurring thought. Figure out what this meant to you in relation to how you're coping with arthritis.
When you start changing your actions, there might be others who respond to you differently. You may think your changes are positive, there will be others who benefited from your negative self-talk. It's important that you communicate to others that you are taking the steps necessary to change the way you think and behave in certain situations. Let them know that you hope that everyone involved will benefit in the long run from your commitment to personal change and growth. There will be cases where there will be conflicts and you must be prepared for that.
If you start to think that your thoughts are getting in the way, to the point where these kind of exercises alone are not bringing the relief you need, you might want to consider reaching out for understanding or advice from someone you can trust. This could be a friend, family member, your physician, or a spiritual counselor. If this kind of reality check doesn't help then you may want to think about seeing a psychotherapist. Your doctor or the local mental health association can be helpful source for a referral. A professional specifically trained in cognitive therapy, or cognitive behavioral therapy (CBT) may be another source to help you with this process. There is some evidence that the kinds of negative self-talk that has been discussed in this article are related to poor medical outcomes in arthritis and that individualized therapy such as such as CBT is helpful in reducing fatigue and depression. If you think that this type of therapy would

be helpful for you and you would like to contact a therapists trained in CBT in your area, contact the Association for Advancement of Behavioral Therapy (AABT). The AABT doesn't certify or recommend therapists, but it maintains a large database of therapists.

Being able to understand and use self-talk can be a useful tool in coping with arthritis. Recognizing, understanding and using your thoughts to help you to understand your feelings and guide your actions related to arthritis can make it possible for you to deal with the many different situations as they happen, but it can also help you through out your whole life in the long term.

BOOKS

FEELING GOOD
The New Mood Therapy
by David Burns, M.D.

A GUIDE TO RATIONAL LIVING
by Albert Ellis, Ph. D., and Robert A Harper Ph. D.

WEB SITE

http://www.aabt.com