NRAS Live: The importance of stress management for those with RA

NRAS conducted a recent survey investigating people’s experiences of stress and how it impacts on the onset and/or exacerbation of inflammatory symptoms. In this NRAS live discussion, Clare Jacklin (NRAS CEO) will be presenting the headlines of the survey results and then ask for input from Will Gregory (Consultant Physiotherapist and Clinical Governance Lead Rheumatology Directorate from Salford Royal Hospital) and Sam Norton (Mental Health Researcher at King’s College London) on their impression of the survey results and what rheumatology health professionals could do to support patients more in relation to stress management.

They will also be joined by Emma Caton, Research Assistant at King’s College London, and Lead Author of the Stress Matters Report.

If you have any questions you would like to pre-submit in relation to this topic, please do so here: https://app.sli.do/event/vUHnu3anB8qTMaMVAcdihr

Download the Stress Matters report here: https://nras.org.uk/product/stress-matters-report/

Good evening and welcome to enas live uh I’m CLA jacqulyn Chief exec of the national rheumatoid arthritis society and I’m delighted to be joined here this evening by Emma Katen who is going to share with you in a few moments the findings of our stress survey um our

Stress matters survey I should say um and also to join an a panel discussion afterwards is will Gregory who is a a physio Rheumatology lead from sford and Dr Sam Norton who um well I’ll allow you to introduce yourselves it might be usas to get your titles absolutely right so

Will could you introduce yourself yes so I’m a physiotherapist and I’m one of the professional Advisory board for enas and I’m got a three-month role as interim Clinical Director for the Rheumatology team at softwood voil which is good fun looking after those kind of decisions and of course I’ve got a key

Interest in exercise as one of the more important ways we can improve uh the lives of people living with are they thank you will and Sam hi there CLA thank you very much um yes I’m my technical title is reader and research methods and statistics but that’s not

Very clear about what I actually do most of what I do is looking at mental health in people with long-term conditions such as rheumatoid arthritis thank you Sam and Emma hi I’m Emma Kon um and I am a research assistant um so I’ve been working with CLA um specifically on um this stress

Matters project lovely thank you very much and the reason we started this project was anecdotally over the many years I’ve worked at enas so many times people have said that stress has definitely exacerbated their symptoms or they have or they can put down um why they ra started from a stressful event

In their life and so we kept hearing this and we thought well we haven’t got any real facts to back this up and that’s what triggered this this whole project up so I’m without further Ado I’m going to hand over to Emma who’s going to share with you some of the the

Real take-home messages out of our stress matters survey report so over to you Emma okay thank you Claire so these are the um results as CLA said from the stress matters um questionnaire and Report um so just to give you a little bit of a background of who actually took

Part in the questionnaire so we received over 1, uh 200 responses um so those are the people that completed all of the survey and um we also had a section that looked at um any final comments um where people could just kind of put in whatever it

Was that they wanted um and we had um just under 400 responses from on that um so that was really nice in kind of giving a bit of cont context to some of the uh statistics that um I’ll present today um so the majority of participants

Were female they were over the age of 55 years old and they were white British and um 46 had had arthritis for over 10 years so the first few questions really asked about what are the causes of stress and how has that impacted on the onset of inflammatory arthritis um and

We found that 76% of respondents felt that their arthritis may have been triggered by stress or a stressful event and there are many different causes of this but the main causes were family and work and this included kind of really significant life events so for example the loss of a loved one or

Changing your job but also day-to-day stresses so things such as taking care of children or elderly relatives um but also like General work pressures and demands and then there was 81% of people who actually found the diagnosis process for their arthritis stressful and there were lots of mentions of having to wait a

Long time having to see the doctor repeatedly and over 20% of people felt that their concerns and anxieties were actually dismissed during their initial um Rheumatology appointment so following on from the diagnosis of um arthritis we then looked at what is the impact of actually living with um arthritis and how stress May

Influence that and living with ourth was actually identified as a cause of stress um there are several reasons for this so experiencing difficult symptoms a difficulty accessing health care support during flares and perhaps being unable to do things that people were previously able to do and therefore having to rely

On other people to kind of fulfill those tasks so 77% of people actually felt that their FL are triggered by stress um and these were similar events to what they believed initially triggered their symptoms so again work pressures family pressures but there also came this idea

Of it being a vicious cycle and I think the quote on the screen really illustrates this really well um in that people were experiencing stress which in turn triggered their flares um and then the flare itself generating stress because they’re in pain because they’re unable to do what

They want to do and it’s just kind of causing this never ending uh cycle of stressing and flaring and stressing and flaring so moving on to support to manage stress um our finding suggests that PO uh sorry Rheumatology patients um are not routinely asked about their mental health during their Rheumatology

Appointments so 75% um of patients have actually not said they weren’t asked about their mental health during their appointments and 84% felt that their consultant or their nurse actually only focused on the physical symptoms of their condition rather than mental or general well-being only 177% of respondents have

Been offered support to manage their stress and this support tended to be offered uh from the GP rather than any other healthc care professional so 52% of the people who were offered support were offered support from their GP and then the most common types of support that were offered were

Medication with 58% of they were offered medication um and then kind of other talking therapies so this is excluding things like CBT and act um which were also um regularly given but these other types of talk Talking therapies such as counseling and things like that were

Also um a type of support that was was offered to people so then we looked at the actual stress management techniques that kind of people are doing individually within their day-to-day lives um and as you can see here the top three were physical exercise um so kind of walking swimming

Going to the gym walking the dog um meditation and mindfulness and then also keeping informed about their IIA so lots of people actually when they gave their comments at the end mentioned using things such as the resources provided by enas um to actually keep up to date with kind of latest

News there was things such as medication kind of creative Outlets such as singing and art peer support and complimentary alternative therapies which include things like massages acupuncture um herbal medicine um and for most of these the people that kind of used these uh techniques actually did find them really

Helpful in reducing their stress so of those people that used physical exercise 96% found it useful in managing their stress and those who use peer support 95% found it useful in managing their stress so as well as as actually engaging in these activities it was really helpful specifically for Stress Management as

Well so finally then these are a few other things that people uh were kind of using as their stress management techniques so spending time outdoors and exploring nature um had a really positive impact and for those that were able to making changes to work so either retiring changing jobs or reducing

Hours and also acceptance was was a big thing that came out as well so 54% of people said that they either greatly or completely had come to terms um with their arthritis um and of those 48% found that acceptance had had a really positive impact um on their on their stress

Levels um so that that was kind of a really positive result and that was a very quick Whistle Stop tour of the results hope I haven’t missed anything too important um but yeah thank you Emma for that and uh welcome back to Will and and Sam um one of the things

That really struck me there the one the one of the final slides and I think people probably watching this would will question it to an extent is acceptance and what does acceptance really mean and I remember uh listening to a presentation once before and acceptance doesn’t mean that you’re happy about

Something but that you accept that that’s the way it you know you’ve got something that you’ve got to deal with is that something that you’ve come across um Sam in in your dealings with you know with people and how would you how would you explain what that sort of level of acceptance actually

Means yes I’m not an expert in kind of acceptance or acceptance and commitment therapy but that’s kind of an important important area that people focus on a lot these days like you said acceptance here is not necessarily to do with being happy about your situation but it’s about accepting what your situation is

And being able to make um appropriate kind of uh targets for your kind of behavior so you think about what your outcomes what you want how do you adapt your life in a way that you can you know if you have rat to arthritis there’s going to be lots of limitations and

Challenges with that how do you make sure that your goals that you have in life are kind of achievable within that that’s not say limiting your goals but thinking about things slightly differently and maybe being a bit more flexible so I think acceptance really has a lot to do with how how flexible

You are about how you approach things inde and then we’re going through you know we were we were really overwhelmed with the amount of responses that we got over 1200 responses which in itself told us that stress and and the topic of stress was really important to people

What were some of the things that really struck you when you were doing the analysis I think definitely um the large amount of people that actually said that they felt that this was a trigger for their stress at trigger for their arthritis um and kind of in such a

Varied way as well there was lots of different comments in relation to work pressure to family pressure um and that it wasn’t just necessarily big events like you know getting a divorce or you know retirement that actually there was lots of day-to-day pressures that had

Kind of built up um that was kind of leading to kind of flares and things like that um and also I think I I personally found coming kind of from a kind of psychology background um I did find it really interesting the amount of um I’m trying to think of the right words

Put me on the spot sorry kind of the how how big things such as physical exercise and these these things that you can kind of do dayt day what an impact that that actually was having on people’s ability to reduce their stress you know there was actually a large percentage of

People who said oh I I seek support by myself but a lot of that can come from physical exercise and from you know keeping up to date and things that you can do not necessarily you know needing to go and see like a health professional for there

Are things that they they have done by themselves I thought that was really interesting yes I think that was one of the things that really struck me was you know lots of people had actually found their own ways of managing stress it hadn’t been uh suggested to them or they

Weren’t really guided to that it was uh often you know know through trial and error um will being a physio of course you you know you will will see lots of people with inflammatory arthritis um and they will have been probably referred to you but more from a

Physical point of view do you feel or or has why isn’t it discussed more in clinic about how the mental health and the stress could impact on on their rheumatoid arthritis I think the second part of your question is this probably the easy one to dig

Into is why isn’t it disussed and partly it’s limited time in those appointments but that shouldn’t be the um crucial Factor necessarily I think from feedback when I’ve spoken to people sometimes there’s a concern as if you ask um the person you’re seeing in clinic you know how you doing what your

Stress levels like uh how are you coping well what’s the answer going to be and if the person then breaks down in front of you and it takes 20 minutes to console them well you’ve not necessarily got 20 minutes so it’s a bit like should you open Pandora’s Box because once

You’ve opened it how do you then put everything back in in a timely fashion so I think there’s partly a concern from a CIS point of view as to how do I ask this question in a way that gives me um the abilities to support my patient but

Not go beyond the confines within that clinical appointment but also knowing that you can then give an answer and from a medical practitioner point of view we’re quite keen on saying or certainly from a physio point of view if I talk from my core profession oh you’ve

Got a sore ankle here’s an exercise for your ankle you know that’s the answer you’ve got a problem here’s the answer whereas those broader kind of mental health problems where there’s not a clear answer by means of I’ll send you to this person or we’ll give you that

Tablet where it’s more complex to provide a solution I think it is difficult to encourage everyone in the team to undertake those conversations when they know it might lead to either a prolonged discussion they don’t possibly have time or the best skills for or um lead to a situation where they have to

Say I don’t know what the answer is and sometimes that’s all that your patient needs to hear is to say okay I can hear you really struggling we’ve got you on the best drugs we’ve got you the best treatment whatever else it’s still not quite hitting I don’t have many other

Answers I’m really sorry it’s not working quite as perfectly as it should do and perhaps just accepting that as kind of um Sam just described sometimes living with a long-term condition there is an element of accepting that it’s not going to be perfect all the time potentially although we’d love it to be

That way there’s issues that aren’t so easy to patch up as rapidly so I suppose that’s the query of why why it doesn’t get asked perhaps yeah and I think there’s an element there of perhaps um acceptance by the clinician the nurse the doctor or whoever that is there at

The time that they they don’t necessarily have to have all the answers right there at that point in time and many people think it’s and it came out in the survey as well didn’t it um Emma that just being listened to or taken seriously or

Acknowledged uh in some way we we have a question that’s come in uh well not a question but uh just a comment on Facebook thank you an for putting this in I find that rumatologist believing your symptoms means a lot less stress you know being taken seriously but

Sometimes uh it feels like medical professionals doesn’t believe how bad it possibly could be unless they see it in a CT scan or an x-ray but you know the actual way that somebody is feeling is is just as important important as what is physically being manifested you know

In your um teaching Sam you know is this part of of what you’re trying to get across to medical students Etc about that that psychology is just as much as as relevant as the physiology of these Corps with long-term conditions oh yeah absolutely um you know I wasn’t at all surprised when I

Saw some of the results and it said that only 25 % of people felt that they’d been asked about stress during their consultations you it’s a huge number of people that aren’t and it it’s something that I wouldn’t say it’s necess ignored but it’s yeah it’s something that’s left

As you know a slightly lower priority um I think when people see their rheumatologists most people have very good rheumatologists that will be very interested in their health and their physical functioning and really interested in looking at blood tests to check what their inflammation levels are

And making sure that they’re on the the right treatment to reduce their inflammation and halt their kind of disease progression that’s obviously going to have real long-term impacts but it’s sometimes the here and now that I think obviously don’t get talked about and as will was saying sometimes it’s

Just that little chat to check someone’s okay I think it’s also important really to focus on you know thinking at different levels it some people may be really struggling and may need urgent supports and I would hope that most of those people get you know talked about because it’s either relatively obvious

To the clinician or the the person feels confident enough to bring it up in that session we all know how hard it is to see a GP at the moment I’ve struggled with that myself recently um so sometimes speaking to your rheumatologist might be the the key

Person to talk to about that it’s important to recognize that um if you have problems with stress and your mental health it’s not just your GP that can refer you on so if they ask you know if you’re you have a problem you can talk to your G your rheumatologist and

You they can refer you onto talking Therapy Services you can even go and self-refer if it’s something that isn’t being discussed within the Rheumatology appointments because you know sometimes there’s limited time um or you know things are being delivered remotely it can be a problem there’s lots of things

Going on though that I think we’re trying to improve the situation I think everyone recognizes that there’s limited amount of time within a clinical appointment to talk about things and that some things get prioritized so there’s less time but that can never be an excuse for not talking about stress

And mental health I think a lot of centers now particularly where the ones that I work with at Kings College Hospital and at guys and St Thomas’s they’ve got some really nice systems now where they send people before their appointments a short survey where they can give some ratings about not just

Their physical health but also their mental health so it gives the the clinician an opportunity to be able to look at that and see does it look like I need to have a conversation it just allows them to be able to prioritize what they talk about and if you know

Symptoms like pain and fatigue are really high that’s obviously something to talk about but also if it looks like someone’s struggling with their mental health There’s an opportunity there I think to to to approach things slightly differently and think in the limited time that people have within the

Appointments how can we frame that that conversation I know enas has been doing some really good work as well with clinicians um talking about how they can approach difficult kind of conversations and topics about certain things that maybe get missed indeed and actually you you hit on something there of course

With the the Advent of uh more patient initiated followups for for people with long-term conditions that are are you know physically they are well managed their disease is reasonably well controlled they might be put on to Patient initiated follow-up Pathways they might be called something different in different places so this remote

Monitoring or do you feel it would will be beneficial in some ways because those questionnaires will be sent out and completed and sent back or will it be that those these sort of other areas of the impact of a long-term condition could be missed uh who wants

To go for to for answering that I’ll I think I’ll come to you will because I saw you nodding there yeah I mean I think that’s the hope and Sam described it very well the way that we are having these opportunities to send out um questionnaires or surveys to get data

Ahead of that appointment but it could also be if you are on that patient initiated follow-up pathway you’ll sent those every three months or something so there’s a lot more data that we’re given outside of that squeezed 20 minute followup so I’m hopeful that it’s the

The first one that you said that they’ll allow more time for those kind of conversations and perhaps if you have that data already submitted when you get to your appointment your rumatologist will be able to say okay I can see your numbers for the last three months they

Show this this and this I’m very happy your drugs working what else do you want to talk about you know because all of the business end of the numbers and figures and so on will have been done kind of outside of that limited appointment time but yes it does mean if

People aren’t so good on inputting data and sending their forms electronically or however it’s done outside of those appointments those people might then struggle to be heard um the other bit with the patient initiated followup is the hope that that means we have more secretarial support or admin supports there’s people to

Answer the phone because one of the big stresses I think is contacting your vaty department when there’s not enough people answering the phones so if patient vated followup means there’s a discrete phone line for that hopefully that stress of being 64th in the queue will be a thing of the

Past oh I like your optimism though will let let home glass half full definitely there um Emma what else was it that you thought really jumped out at you from the report when you were doing the yeah I mean the analysis of over 1200 responses was

Quite a marathon task so thank you first of all so much for doing that but what what was some of the other um nuances that you noticed in the the full report and by the way anybody watching you can get a copy of the full report um it’s h

You can download it from our website if you want to see it in full sorry oh no sorry just to add to um kind of what will was saying as well um when I was kind of did a couple of interviews Ono one interviews of people as well and

Looking at the comments I think a lot of people felt a little bit um like they didn’t want to bother anybody by picking up the phone and speaking to their rheumatologist or their GP and there was an idea of you know well what if the service is already overwhelmed and I

Don’t want to be a bother um and so I think it’s kind of also really important that’s what they’re there for that is what your doctors and nurses are there for is to kind of listen and and to explore these kind of other aspects besides physical health as well and so

Um it’s difficult but to not feel like you’re you’re burden burdening anybody because if it’s an issue to you it’s an issue to you and I think that that is is definitely something that perhaps needs to be um you know explained more kind of that

You know it is okay to kind of you know um kind of have those discussions in the first place even if it’s not necessarily the rheumatologist or the GP that is kind of initiating those conversations absolutely it’s okay not to be okay is basically what we’re

Saying you know that it’s and of course the you know what was clear as well is that the when getting stress or over issues around work or you know some other stressful activity or friends or family causing stress on and there was some really really heartbreaking uh free text that we were

Um we were able to see as well and people were having really tough time that not managing that stress can of course lead to a physical outcome as well and it is that you know you showed in that slide The Vicious Circle that the more stressed you are than your

Joints hurt more you you’ve got you know you’re not sleeping well that exacerbates things and then you’re and you might have a massive flare as opposed to getting it under control early on and it is a bit like early diagnosis of any condition if you get to it quickly

Enough you can probably manage the the the um outcomes further down the long the line but it’s hard to measure stress and I you know we all have stress in our lives but when do you know when to reach out for help and when you can you know

Sometimes muddle on and I think that’s what you were saying there’s there’s so much stoicism um that people are you know incredibly like British about these things I suppose that you know well I don’t want to be a bother I can cope everybody else copes so why can’t I cope

And of course that’s uh that’s a difficult one to crack really Sam you know what what advice might you have uh for people who might be thinking I could do with help but I you know is it is it at that level that I need help I

Suppose yeah I I think it’s really important to think about and think about those levels are important I think sometimes you know people have very severe levels of depression anxiety where it’s you know psychiatric levels of disorder and they may need to see a psychiatrist or someone to talk to to

About their condition and get some therapy that way I think most people will be living with you know what’s what we refer to as disease related distress it’s those stresses from having the rheumatoid arthritis or something like that that really impact on your day-to-day functioning where you may not

Have depression and anxiety but it’s still impacting on your mental health and it’s those bits are very hard to deal with there’s not within the NHS there’s really not anything you can do NR obviously has of lots of support you’ve got your kind of online interventions and the the N helpline to

Ph up for advice because that’s where you’re left a little bit by yourself and with your friends and family to almost muddle through and I think while we tend to be a bit stoic it’s good just to make sure we’re talking about those things not just your rheumatologist or the

Physiotherapist or the nurse that you have contact with but to to people like enas and your friends and family as well there’s nearly always something that can be done and I think social support in particular is a really good way of to buffer that impact of stress on your

Your kind of mental and physical health it’s really thinking about what support can I get from other people around me that could be friends and family or support groups like enr there’s huge range of things that reaching out to support sorry reaching out to support is

Not you know it’s not weakness it’s not that you failed you know it actually shows great strength um and certainly I see the way that peer support is helping people through our uh we have an online community called Health unlocked and it doesn’t seem to matter what time of the

Day or night somebody is is feeling low or or you know they might post there and there’ll be somebody else who is there going you’re okay you’re not alone and I think it’s just that feeling uh reducing that feeling of isolation in itself can make you make people feel a lot better

The peer support came out uh you know quite strong that those who had had that peer support be it through going to a local group or talking to somebody a volunteer in our um in our here for you um service Etc or on Facebook or wherever that that peer support you was

It something like 95% found the peer support was helpful was that surprising Emma um yeah so yeah 96% of people who accessed peer support found it useful and I think that um it it wasn’t surprising in that um I think being able to share experiences even if there’s not a solution to

Anything um can be really really helpful um and to kind of understand that other people are going through the same thing and to get kind of hints and tips off of people I was speaking to somebody who said I struggled to dry myself when I get out the shower and somebody else

Saying no well I use a hair dryer and that’s and I mean just been able to share little tips like like that that you know you won’t necessarily get from anywhere else you know it’s people that have kind of been through a similar thing and can kind of advise on certain

Things um and yeah it definitely came out strongly in in um in kind of the results and in what people were saying um and I think it is a really valuable valuable thing um I think just kind of having that kind of promoted a bit more within perhaps the health care services

Um I think it was 21% of people had had taken up PE support um and I think it is a really valuable thing and and perhaps that is something that that patients could kind of be made aware of a bit more um kind of when they’re attending their Healthcare

Appointments yeah that’s sort of being there done that got the T-shirt know what you’re going through you don’t have to do that explanation about what it’s like to live with ra that is vitally important and I I can sort of see see uh one of our lovely volunteers is on the

Chat Teresa Teresa who runs one of our local groups in hartfordshire and that you know it goes from strength to strength because of that that networking and that you’re right sharing those everyday um tips and techniques and I think um the other thing that really

Struck me out of the report is when we asked people what had they found that really worked for them and I’m sure will was delighted to see that exercise was the top thing that but exercise kind of frightens the pants off some people going well I might hurt myself more my

Joints might ache Etc um but course you know we we’ve done one of these enas lives once before with Will and showing the link between physical and mental health is so important but um what would you say to anybody uh will who who is perhaps a bit nervous about um trying

Exercise as a way of coping with their physical symptoms but also their stress level uh the word I use most commonly in clinic at the moment is Goldilocks so we want to do not too much exercise that it ends up aggravating your symptoms or making things worse but

Not too little exercise but just that Optimum amount in the middle so it was really interesting reading this paper it talks about how you know stress can throw off our hypothalamus pituitary adrenal system and I read that and thought oh yeah that gets activated when you exercise so having a little bit of

That is a good thing so exercise is good at decreasing stress through that same kind of pathway but it just needs to be just about the right amount and that’s what’s really difficult is some people will have been highly active before they got their arthritis and then somewhat

Limited and very frustrated and they’ll want to go out and still climb mountains and many people with ra do climb mountains but if you’re unfortunate and you don’t have that cap capability at this stage in your Disease Control it’s how you cope with the fact that you

Can’t do as much as you wanted to do your Goldilocks trying to eat that massive bowl of porridge or the too hot bowl of porridge I can get us isn’t it in the in the story so um this analogy might be going a bit too far but um and

Then there’s other people like you say who are petrified of exercising because they’ve not been able to and they’re concerned of what it might do to their joints we know that exercise helps joints if it’s that right level for you and helps the disease process generally so I think it is really um

Pleasing that it’s come back from this survey you know nearly two and three people said exercise was a help for their stress levels so that’s fabulous that that’s the lived experience of 700 people 800 people who answered the survey so it’s not just a textbook answer this is what’s happening up and

Down the UK and I must plug at this point the nraas smile ra resource because the importance of exercise module that we recently recorded is a fabulous resource and there’s um Professor metsios George meio who’s far more intelligent than me and knows far more about this than me he’s speaking

Beautifully on that session as well as some taster videos to try different forms of exercise that we think people might be able to build into their daily routine to kind of hit that Optimum level not too hot not too cold with the porridge or whatever it may be for your an

Allery and I think it is it’s it’s you know Finding what works for you ra is not a one size fit condition and nor is the solutions to to the with it so uh I’ll just re re um reiterate that so en.org do.uk smile can’t get my teeth in um

Gives you access to all these free modules but the one on exercise in particular as I said there are as will said there’s little taster sessions there so for 10 15 minutes you could try Cher yoga or you could try uh Tai Chi or you can see um there’s moving to music

So it’s working out what will work best for you um and trying it out and not being afraid to give it a a bit a bit of a go it doesn’t all have to be in some flashy gym on a treadmill with all the gear um and the Lyra and the sweatbands

And lifting weights it’s what works for you and and trying those uh little taster sessions have really proved to be very beneficial for a lot of people so I’ve been enourage you to all to take a look at that if you can somebody has mentioned in the chat as well about

Mindfulness um and Sam and Emma you know mindfulness it kind of was all the rage for a little while it’s kind of gone a bit quiet now that you know so again is it is it a not a one siiz fits all it works for some and it doesn’t for others

I personally don’t know an awful lot I haven’t practiced mindfulness but you know what what sort of comments would you have for people people who who are thinking of trying it were perhaps a little nervous I’ll come to you first Sam okay thank you yes so I guess there’s lots of different techniques

Like exercise may work mindfulness is something people may want to try as well and it’s it’s really developing a range of different techniques it’s a bit like um the the kind of the analogy of of the different bowls of porridge and you can have mindfulness and and go very deep

Into it and that may be a bit too much but there’s lots of things that I think are really helpful with stress one that I find particularly useful and with students I use quite a lot before exams of just doing something like a body scan so mindfulness there is really to help

You step back a little bit from your emotions and be a bit present in the in the current moment and something like a body scan where you focus on your breathing and the sensations in your body is just a good way of when you’re feeling overwhelmed

By stress or whatever else is going on is is just taking that little bit of a step back and allowing yourself to kind of breathe and and just take a little bit of a break so that kind of lowlevel approach there can be really useful so I

Think a lot of people tried mind forness and find it can be a bit too much to get deep into it and and don’t go into kind of Retreats but there’s lots of different ways to do it and I think a nice thing to think about as well if

You’re combining the mindfulness and and exercise if things like yoga and stuff like that that’s very easy to do at home I do a little bit of yoga and I do it really badly it’s definitely not about doing it well at all um it’s just trying to build those into your your daily

Routine and activities isn’t it and having that way of centering yourself with exercise and centering your thoughts and just yeah trying to not that let the stress kind of overwhelm you at times it’s it’s good ways to have coping mechanisms like that and there was some lovely comments

Weren’t there Emma about other things that people had found like singing and meditation um and it is just you know trying to find the right thing that works for for different people yeah absolutely and I think just you know having Hobbies I think is a was

Quite a key thing that came out even you know gardening and as you said you know arts and crafts and and all sorts and I think um it kind of comes into that self-care and self-compassion kind of sphere of things of kind of making time for yourself and you know life getting

Very hectic and having lots to do and and putting a side time that is just for you to do something that you enjoy doing um and kind of allow your mind to kind of go somewhere else whether it’s because you’re you know repotting a plant or you know whatever it is that

You’re doing um to just kind of I think you know my personal experience getting into the garden thanks to my dad um just coming kind of back in into the present rather than thinking about the emails and the washing up and everything else that I’m supposed to be doing so yeah I

Think having hobbies and taking time for yourself can can be really helpful as well and I suppose it’s um you know I’m probably lots of people feel this way that you know taking that time out to do something that brings you Joy and brings you that sort of peacefulness and you

Know we can often feel quite selfish about it but actually self care is not selfish at all it’s that analogy of you know make sure you put your own oxygen mask on uh when it goes on the airplane before you help somebody else because you’re no good to anybody if you just

Stretch yourself in all directions and then it all comes untangled so self-care shouldn’t be be something that you feel guilty about going off to a singing lesson or going for a walk in nature and as you say you know the laundry basket is overflowing you know whatever that’ll

Be there tomorrow as well that’s what my excuse is for not doing the laundry anyway um so but it’s been really really I think uh anybody that’s out there watching this if you took part in our survey I really want to say a sincere thank you because now we have a body of

Work that perhaps future researchers will be able to delve deeper into um and actually take stress and the you know the importance of asking those questions in a Clinic appointment and thinking about the whole person not just that swollen knee which at the time of course needs addressing but there’s more

There’s a body attached to that swollen knee or that painful elbow or that uh painful shoulder so thank you very much indeed one of the things a question that was put forward um uh before this um E before this evening was about there are still an awful lot of people very

Stressed over coid and coid and and for many people who haven’t mounted a um a good enough response to the vaccines many are still shielding and I really believe me you have not been forgotten we are doing an awful lot of work behind the scenes enas along with other patient

Organizations and there’s a big study being uh clinical trial going on at the moment to trying and see if a pre um uh a preexposure treatment for those that haven’t been able to mount a good response uh to the vaccines can be found uh we have had um uh reassurances from

Nice that if something was uh proven to be good in clinical trials and get licensed that it would be fast track so that we can get that out as soon as possible that doesn’t help you in this moment in time if you are one of those uh people that are still shielding and

Worried and concerned about going out in in public or in public places crowded places but I don’t I just wanted to make say and comment on that that you are not forgotten um and we are still working hard along with many other uh scientists and and uh patient organizations that

Are affected uh so thank you whoever did put that comment in I just wanted to say that so our time is up it flew by thank you very much uh Sam will and Emma for giving up your time after I’m sure what has been a very busy day I know Sam just

Came straight from from teaching uh to join us this evening our next um uh enas live is actually not I repeat not on the last Wednesday of every month as it normally is we’ve had to move it just to accommodate uh the people who

Will be able to be on our our panel and it’s about men it’s about men and rheumatoid arthritis just for you chaps out there because we realize that you know often what we talk about there’s a lot of women involved in these conversations so there won’t be a woman

In sight um and we’re going to call it the men’s room so please do join in the men’s room on the 14th of November at 7 o’clock and my colleagues Stuart and Tim will be hosting that with a an excellent panel so um that will be the last one

For this year we won’t be doing one in December because it falls around the Christmas period and we’re open to suggestions what sort of topics would you like us to address what sort of uh people might we have on our panels for next year we will continue them every

Month the last Wednesday of every month we will be doing enas live so please do let us know what sort of topics you might like to us to cover some of the ones that have been muted at the the moment are oral health um you know Dentistry Etc and looking after your

Gums and sometimes how that can be a an early indicator of inflammatory disease is your dentist might pick that up surgery um lots of other topics that are being put forward so do let us know what you want us to he and we will do our

Best to do that um the other things that any of our enas lives that we’ve done this year there’re still all available so if you missed one from back in February or March they’re all available on our YouTube channel so do go on there there’s uh some of the topics we’ve

Covered so far is remote monitoring what that will be like in in the future um exercises of course will you joined us on that one way back in the spring research how you can get involved in research what sort of research is going on uh pregnancy and ra foot health and

Orthotics we are really trying to cover as many of the topics that are important to you are beneficiary so please do check those out and uh lastly I want to say I won’t be joining in in the men’s room in November so this will be my last

Enas live for this year I’ll be back next year with again hopefully a lovely panel of people to speak to um but I just wanted to say it’s never too early to get your enas Christmas cards so we we have got them available so uh there

My colleague has just put up the um the link um please do it’s a great way to support your charity your patient organization and those funds will go of course to making sure that we’re able to do as much as we can to improve the lives of all those living with ra and

JIA so thank you very much uh yes I’ve seen somebody will this be recorded yes it has been recorded Jane and it will be on our YouTube channel to watch back from the beginning as have all our enas live broadcast so you can find them there thank you so much will Sam Emma

For joining me this evening and it’s now time probably to put your feet up and have a nice glass of wine um medicinal purposes only of course thank you very much indeed good night