I’m thrilled to have a special guest poster on Life Despite Lupus today; Dr. Donald Thomas. A practicing rheumtalogist and Chair of the Medical Scientific and Advisory Committee of the Lupus Foundation of America DC/MD/VA chapter, Dr. Thomas is also author of The Lupus Encyclopedia, which will be released later this year. In the meanwhile, Dr. Thomas offers up plenty of tips for coping with lupus on his Facebook page. You can also hear him speak about living with lupus in this teleconference recording provided online via archive.org.
Many people who have systemic lupus erythematosus (SLE) feel that their lupus becomes more active when they are under stress. Guess what? It is not in their heads at all. Research studies support the fact that lupus can become more active during periods of stress. Also, although having lupus and being under stress can make someone feel that they have no control over their situation… studies also show that people can actually improve their quality of life by learning how to cope with stress better. Therefore, it is important to realize that there is more in your control than you may realize.
There are different types of “stress.” This article will address “psychological stress” and not “oxidative stress,” which is a biological process in the body that is also important in people who have systemic lupus. There are numerous studies in the medical literature that demonstrate that lupus activity becomes more active during periods of psychological stress. These stressful events can be as significant as divorce or the death of a loved one. However, stress from “daily hassles” has also been shown to increase lupus disease activity, while also causing increased problems with pain, fatigue, memory problems, insomnia, and overall quality of life. Since pain, energy loss, and memory difficulties are common problems affecting people who have lupus, considering stress as a possible contribution is very important for every person with lupus to consider.
Many physicians believe that stress may increase activity of the immune system and therefore increase lupus disease activity itself. There is not a lot of medical evidence to support this theory. However, interestingly, a study from Japan in 2013 found stress to be more common in Japanese people who developed SLE and suggested that stress may actually be a potential risk factor for developing the disorder. This finding suggests that stress may actually increase immune system activity (and that is the primary problem with lupus: the immune system is overactive). More studies are needed to address this theory.
Becoming stressed may not simply be a behavioral or learned problem in some people. There are gene abnormalities which can cause difficulty with people producing certain chemicals in the brain that are essential in dealing with stress. One study from 2006 looked at one of these genes in people who have SLE. This study showed that people with SLE who had this gene were more apt to have flares of their lupus disease, to include inflammation of the kidneys (nephritis), during stressful situations. Therefore, some people may be born with the tendency to become stressed more easily and potentially have increased lupus flares associated with those periods of stress.
The next natural question would be, “what happens if people with lupus learn to control or decrease stress?” Fortunately, there is some evidence that learning to decrease stress may in fact significantly help people who have lupus. A study in 2006 reviewed numerous studies addressing this question. It found that people with lupus who learned appropriate stress reduction strategies were able to improve their quality of life and even “possibly … moderate the evolution of disease.” Another study called the “Balancing Lupus Experiences with Stress Strategies” (BLESS for short) published results in 2013 showing that stress reduction techniques were able to reduce depression, improve social activities, reduce “health distress,”, and reduce those common lupus problems of pain and fatigue. People who have SLE and people who are under stress often feel as if they have little control over what happens to them. The good thing about these studies is that they show that people with SLE can have more control than they realize.
Therefore, I would recommend that everyone who has lupus learn how to prevent stress in the first place and learn how to decrease stress when it does occur. Most of us are not taught how to appropriately deal with stress during our lives. There is no doubt that it does take a lot of work. The following is a list of important stress reduction techniques that can be very helpful and beneficial to the person who has SLE. Although you may not be able to control your situation of having SLE in the first place, plus you could possibly be someone with a genetic predisposition to developing stress; the good news is that you can do things in order to prevent some forms of stress and to decrease their severity. I encourage anyone who suffers from recurrent stress to work very hard at every single thing on the following list. This is the same list that I use in my book The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families.
I wish you the best in health and life!
By Donald Thomas, MD
Stress Reduction Techniques from The Lupus Encyclopedia:
- Learn to say “no” to increased amounts of work and duties.
- When you have children, it is even more important to learn to say “no” to additional activities other than what is immediately important for your family and your health.
- Learn to ask for help in doing activities.
- Proactively lighten your load.
- Prioritize the important things in your life; cut out activities that are less important.
- Do yoga and/or tai chi.
- Get biofeedback training from a professional to learn to decrease anxiety and stress.
- Do deep breathing exercises and perform “mental imagery” exercises.
- Pray frequently.
- Prepare well ahead of time for any major activity.
- Learn to practice good time management.
- Plan specifically for periods of rest and relaxation in your routine every day.
- Learn to say positive things to yourself and compliment yourself for doing things well.
- Do not think negative things about yourself.
- When running errands or going to appointments, always get ready early and give yourself more time than you think you need; always plan on arriving early for any occasion.
- Schedule appointments and errands during less busy times such as early Saturday mornings. This can greatly decrease stress due to traffic, waiting in long lines, and the like.
- Learn not to argue with others. Learning and accepting that everyone has differing opinions or ways of doing things and that many conflicts are not very important is essential. Learn to take a deep breath, relax, leave before an argument begins or before you say something you may regret.
- Learn to live at or below your means. Too many people in America try to keep up with the “Joneses” or other family members and friends. Learning to stay out of debt can greatly decrease stress. Always ask yourself “is this something I truly need, or just something I want?” before you buy it.
- Whenever you feel stressed, put it into perspective compared to the important things in life (health, family, religion). Learn to “not sweat the small stuff.”
- Exercise regularly.
- Schedule in at least eight hours of planned sleep a night.
- Do not skip healthy, planned meals.
- Avoid unhealthy foods such as sweets, carbohydrates, greasy foods, and “fast food.”
- Consider counseling to learn better communication skills if you have difficulties with relationships.
- Consider attending lupus or chronic illness support groups to learn techniques with dealing with lupus, stress, and relationships.
What are your stress-reduction tips? Tell us about them below!
Donald E. Thomas, Jr. was born in St. Marys, Ohio in 1961. He grew up in a hard working blue-collar family, wanting to become a doctor at a young age after witnessing first hand the struggles of illness in his family. He is active as an Assistant Professor of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, MD and is currently Chair of the Medical Scientific and Advisory Committee of the Lupus Foundation of America DC/MD/VA chapter. The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families represents his desire to provide patients and their families one source that provides complete guidance in dealing with their illness and triumphing over it.
Birmingham DJ, Nagaraja HN, Rovin BH, Spetie L, Zhao Y, Li X, et al. Fluctuations in self-perceived stress and increased risk of flare in patients with lupus nephritis carrying the serotonin receptor 1A-1019 G allele. Arthritis & Rheumatism. October 2006;54(10):3291–3299.
Bricou O, et al. Stress and coping strategies in systemic lupus erythematosus: a review. Neuroimmunomodulation. 2006;13:283-293.
Takahashi H et al. Psychological stress in a Japanese population with systemic lupus erythematosus: finding from KYSS study. Modern Rheumatology (online). NOV 2013.
Thomas D, The Lupus Encyclopedia: A Comprehensive Guide for Patients and Families. Baltimore, MD. Johns Hopkins University Press: 2014.
Williams EM et al. An intervention to reduce psychosocial and biological indicators of stress in African American lupus patients: the balancing lupus experiences with stress strategies study. OJPM. JAN 2014;4(1):22-31.