This section is designed to assist patients and their loved one in coping with the hardships of living with chronic illness while, understanding the impact that stress can have on their disease. Managing stress can result in a improved quality of life, improved self-esteem and has a positive effect on lupus flares.

1. STRESS AND LUPUS
Howard Hauptman, MD

2. STRESS

5. 2011 APA SURVEY
• MOST AMERICANS REPORT FEELING MOD-
HIGH STRESS LEVELS
• 44%: STRESS LEVELS INCREASED IN PAST 5
YEARS
• 39%: OVEREAT OR EAT UNHEALTHY 2/2
STRESS
• ≥ 50%: EXERCISE IS IMPORTANT, BUT ≤ 33%
WAS SATISFIED WITH LEVEL OF EXERCISE

6. STRESS
• A REACTION TO A STIMULUS THAT DISTURBS
PHYSICAL OR MENTAL EQUILIBRIUM
• PREVENTS US FROM LIVING IN A STATE OF
CONTENTMENT AND FULFILLMENT
• BOTH ACUTE OR CHRONIC STRESS CAN CAUSE
ILLNESS

7. STRESS
• OUT OF BALANCE BETWEEN:
DEMANDS PLACED ON US
V.S.
RESOURCES TO DEAL WITH THEM
• GOAL: DEMANDS, RESOURCES

8. DEMANDS
• ACUTE:
INFECTIONS
TRAUMA
DANGER
ENVIRONMENTAL: NOISE, HUNGER…
• CHRONIC:
WORK
RELATIONSHIPS/FAMILY
CHRONIC ILLNESS

9. DEMANDS
• MAJOR LIFE EVENTS
DIVORCE
DEATH OF A LOVED ONE
LOSS OF JOB
MAJOR ILLNESS

10. STRESS
• GOOD VS BAD STRESS:
STIMULATES SAME CHEMICALS/HORMONES
FIGHT OR FLIGHT RESPONSE
• ACUTE VS CHRONIC:
SUDDEN NEGATIVE CHANGES : DANGER,
INFECTIONS, ENVIRONMENTAL
TRAUMA: ACCIDENT, WAR, NATURAL DISASTER
ROUTINE: DAILY, WORK, FAMILY PRESSURES
CHRONIC ILLNESS

11. STRESS RESPONSE
• BRAIN: INCREASED HORMONE PRODUCTION;
CORTISOL, CATECHOLAMINES,
NEUROTRANSMITTERS
• HEART, LUNGS, CIRCULATION
• IMMUNE SYSTEM
• MOUTH, THROAT, SKIN, MUSCLES
• RELAXATION RESPONSE

12. MECHANISM OF ACTION

13. CORTISOL

14. SIGNS OF STRESS
• DIFFICULTY SLEEPING
• EASILY ANGERED
• FEELING DEPRESSED
• LOW ENERGY
• INCREASED ALCOHOL/SUBSTANCE ABUSE
• CHANGE IN EATING HABITS

15. STRESS AND DISEASE
• UP TO 80% OF PATIENTS REPORT UNCOMMON
EMOTIONAL STRESS BEFORE DISEASE ONSET
• LINKED TO DISEASE FLARES
• UNDERLYING DISEASE CAN CAUSE INCR. STRESS

16. STUDIES
• BF/CBT VS CONTROLS IN SLE: LESS PAIN, IMPROVED
PSYCHOLOGICAL AND PHYSICAL FUNCTION
• VACCINE STUDY: BETTER RESPONSE TO
VACCINATION IN NON-STRESSED PATIENTS
• RETROSPECTIVE STUDIES: SLE,RA FIRST/RECURRENT
FLARES ASSOCIATED WITH STRESSFUL PERIODS
• ?LIFETIME VS LIFESTYLE STRESSORS?

17. FACTORS THAT INFLUENCE THE
RESPONSE TO STRESS
• EARLY NURTURING
• PERSONALITY TRAITS
• GENETIC FACTORS
• IMMUNE DISEASES
• LENGTH, INTENSITY OF STRESSORS

18. STRESS REDUCTION

19. COPING WITH STRESS
• GET PROPER HEALTH CARE
• SEEK HELP: HEALTH CARE PROVIDER, FAMILY,
FRIENDS, COMMUNITY
• SET PRIORITIES
• EXERCISE DAILY
• SCHEDULE HEALTHY/RELAXING ACTIVITIES
• STRESS COPING PROGRAMS

20. STRESS COPING PROGRAMS
• EXERCISES: AEROBIC, YOGA, TAI CHI
• MINDFULNESS BASED PROGRAMS:
MEDITATION
• COGNITIVE-BEHAVIORAL THERAPY (CBT)

21. COGNITIVE BEHAVIORAL THERAPY
• IDENTIFYING SOURCES OF STRESS
• QUESTIONING THE SOURCES OF STRESS
• RESTRUCTURING PRIORITIES
• FINDING METHODS TO MANAGE/REDUCE
STRESS

24. STRESS
• CHOICES WE MAKE:
DISTINGUISH WHAT WE HAVE CONTROL
OVER VS NO CONTROL!
• “OUT OF CONTROL EVENT”
• MANAGING EXPECTATIONS: REALISTIC GOALS
• “SMALL STEPS”