Stress is a universal aspect of life – a predictable reaction to life’s surprises. Our world is constantly changing and presenting us with new situations and environments, and we draw on our resources to make adjustments to these changes. If the magnitude of the changes overwhelms our ability to adjust, we experience stress.
In our daily routines, we are aware of potential demands and know how to approach them, but when that routine is altered – when change occurs – we may stumble. Stress associated with change is generally a result of our anxiety and fear of the unknown: we don’t know what the future holds, and we may be afraid that we don’t have what it takes to meet this unexpected challenge.
Since RA is a life change that has a great deal of unpredictability associated with it, stress is a normal response to it. In fact, the most stressful part of RA is its unpredictability. People with RA do not know what they need to prepare for. The course of the condition varies among different people and varies over time in the same person. This results in people having to make frequent adjustments, which in itself can be stressful. People often say that if they only knew what to expect they might not feel so anxious, they might adjust easier. If they dwell on potential or unexpected future consequences, such as medication toxicity, medical bills, or pain, people will almost always begin to feel afraid. And, as we have seen, anxiety and fear lead to stress.
Stress changes the pain threshold by opening the pain gate. Stress also causes physical and mental fatigue, which interferes with restful sleep, further increasing pain. And stress affects the body in other ways; it can result in increased heart rate and perspiration and in elevated blood pressure.
But stress is not always harmful. Stress occurs with positive changes as well as negative ones. Consider how you felt when you graduated, bought a house, got married, or went on a long-anticipated vacation. We all know, too, that feeling a little stress can motivate us to get tasks accomplished. Everyone has experienced short-lived deadline pressure and responded to it with increased adrenaline and increased activity. When stress becomes a permanent part of your life, however, it can take its toll on you and your RA.
You can use coping skills to approach negative stress. First, you must identify the source of stress (define the problem). This includes identifying situations that cause you stress at work and at home. Determine which of these can be modified and which cannot. Avoid the frustration of trying to change the unchangeable, and start with a set of goals that can be accomplished.
To solve a stress-related dilemma (problem solving), begin by appraising the situation. What are its demands? Are they reasonable at this particular time? If necessary, modify as many of the demands as possible so that they are reasonable for you at this time. Then call on the following problem-solving tactics:
•    Propose a reasonable long-term goal (reasonable expectations).
•    Plan ahead (include short-term, attainable goals).
•       Provide a supportive environment (communication).
•       Promote your identified strengths (use all resources).
•      Put priorities into perspective (does it need to be done now?).
•      Prepare (get organized).
•      Place time slots in your schedule to allow for inevitable interruptions and rest breaks (expect the unexpected).
•      Pace yourself (one step at a time).
•      Positively reappraise the situation and your abilities (modify negative thoughts and behaviors).
•      Prove to yourself that you can do it.
•       Praise yourself for a job well done.
You can see almost any situation through by calling upon your imagination, and each time you overcome a stressful situation successfully you increase your ability to cope with stress. Each such experience will empower you! Remember, “A great part of courage is having done the thing before”.

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