Mental Health Series Part 3: Training the Brain with Proven Therapies
In Part 2 of our Mental Health and Arthritis blog series, we discussed the benefits of strengthening mental health to decrease arthritis pain and facilitate postoperative healing. One way to start caring for your mental health is through working collaboratively with your care team on finding a strategy that’s right for you.
A 2020 article from Annals of Joint (AoJ) discusses the use of cognitive behavior therapy, psychoeducation, and relaxation therapy to improve psychological symptoms in arthritis patients. Below we explain a bit more about what these treatments entail and their tested effectiveness.
Cognitive Behavior Therapy
What is cognitive behavior therapy (CBT)?
In this type of treatment, therapists aim to help patients change their beliefs and the related emotions or behaviors.
A common, yet erroneous mindset that arthritis patients have pre-operatively is that a successful surgery will eliminate all of their pain.
This mindset is not only incorrect, because there is no surgery that does not cause pain afterwards, but it also has dangerous effects on patient behavior after surgery. When the patient experiences pain that they were not expecting, they may begin to have thoughts of doubt towards the success of the surgery, face depressive moods, and believe that the pain will never go away.
Therapists use CBT to help patients interpret the pain. Rather than deny that the pain will occur, CBT helps change the patient’s belief to accept that pain will occur. When their thoughts about the pain changes to accepting and understanding the pain, they will experience less of the negative behaviors like doubtful thinking and depressive moods postoperatively. In fact, this changed mindset leads to positive impacts such as faster recovery of function, improved surgical outcomes, and pain symptom relief.
Another CBT technique is encouraging the patients to use the “here-and-now” principle, with mental focus on current circumstances and function rather than on the past. This puts the patient’s focus on their daily goals and success in rehabilitation rather than dwelling on the pain they have or may be experiencing. These techniques help patients create coping strategies for both their mind and behavior to aid in their management of pain and decrease negative psychological symptoms. CBT is commonly used in combination with psychoeducation discussed below.
Is cBT effective for total joint replacement (TJR) patients?
The AoJ article cites several studies that have proven CBT to have the best postoperative pain-reducing effect in patients who have undergone total joint replacement surgeries. These studies have shown that CBT is effective in reducing negative psychological symptoms such as doubt, anxiety and depression, and in turn, decreases postoperative pain.
Psychoeducation
What is psychoeducation (PE)?
Psychoeducation provides patients with information to help them understand how the surgery will work to help them feel more confident before and after their surgery. The first stage of PE involves making the patient aware of the pain symptoms they will experience and the treatments for them. In the second stage, patients learn to prevent or control their negative psychological symptoms associated with their pain symptoms including anxiety, depression, and distress. Therapists provide techniques for patients to recognize their pain and apply coping strategies to manage the pain. The third stage is helping patients set goals and a plan to reach them, related to their rehabilitation and function post-surgery. Therapists help patients to recognize their personal strengths and focus on the positive outcomes of surgery, facilitating psychological growth.
Is PE effective for total joint replacement patients?
Although the studies in the AoJ article cites that PE notably improved the surgical outcomes, quality of life, and rehabilitation satisfaction in the TJR patients, the treatment method should be paired with others. The pain symptoms of a TJR are especially unique in that the surgical trauma and psychological factors are usually very strong. Simply being educated on the pain symptoms, coping strategies, and setting goals are insufficient in changing patient behavior or improving surgical outcomes. The combination of PE with other psychological or physical treatment is an effective option for postoperative pain management.
Relaxation Therapy
What is relaxation therapy?
This therapy teaches patients simple techniques to help reduce physical and psychological discomfort to achieve a state of relaxation. These skills include controlled breathing, focused muscle relaxation, and postural awareness and management. This therapy is based on the Benson theory, which posits that a particular brain wave pattern, alpha waves, will present during these movements, and these brain waves can make people feel happy.
In addition to psychological benefits, relaxation therapy can also stimulate physical benefits that reduce anxiety and pain, including decreased blood pressure, oxygen consumption, heart rate, and carbon dioxide elimination.
Common methods used in clinical applications of relaxation therapy include meditation, yoga, Tai Chi, progressive muscle relaxation, and breathing exercises.
Is relaxation therapy effective for TJR patients?
Like psychoeducation, relaxation therapy alone is not a sufficient treatment for addressing the psychological symptoms of a TJR and improving the postoperative pain symptoms, but used in addition to another treatment like CBT will be strong enough to improve psychological and physical symptoms.
In the final part of our Mental Health and Arthritis blog series, we will cover meditation and exercise as tools to improve mental health.
To get started on a safe yoga routine, check out this video we created with the help of Physical Therapist, Whitney Patton, on safe yoga exercises for arthritis pain.
Have you tried or thought about trying any of these treatments to manage your arthritis symptoms? Let us know in the comments!
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