Dealing with Stress and Moving Towards Recovery: Stress Reduction Techniques and Finding a Local Mental Health Provider

Melissa M. Chudzinski, MA

Bullous pemphigoid (BP) has been shown to cause psychological distress for some patients, as some patients may have experienced a loss of ability to perform tasks, along with managing pain and scarring from the disease (Kouris et al., 2016). Patients may also experience difficulties adjusting to a daily routine, as well as increased stress regarding the disease and their individual prognosis (Kouris et al., 2016). Additionally, Kouris and colleagues (2016) explained that “both clinical symptoms and the effects of treatment can have a strong impact on physical and emotional status. They may lead to functional limitations, a need for increased family support, stress, and exclusion from social activities” (p. 601).

It is important for patients, families, and providers to be aware of the impacts of BP on psychological wellbeing (including the effects that the disease may have on levels of stress and anxiety). By taking a more holistic biopsychosocial approach, individuals living with BP, their families, and their providers may be better able to address, advocate, and cope with additional perceived barriers that may arise.

There are many different beneficial ways that an individual can cope with stress. Some different activities to assist with stress include visual arts (such as painting or photography), textile arts (knitting, crocheting, quilting, sewing, and embroidery), horticultural arts (including gardening), music therapy, and mindfulnessbased techniques (such as breathing exercises to aid in relaxation).

Mindfulness activities have been shown to be helpful in stress reduction. Some mindfulness-based activities include box breathing, body scan meditation, progressive muscle relaxation, yoga, and focusing on the senses (what you can see, smell, feel, taste, and hear around you).

Below is an example of box breathing and how to practice it:

1. Breathe out slowly, releasing all the air from your lungs.

2. Breathe in through your nose as you slowly count to four in your head. Try to focus on the air passing through your lungs.

3. Hold your breath for a count of four.

4. Exhale for another count of four.

5. Hold your breath again for a count of four.

6. Repeat for three to four rounds.

(Cleveland Clinic, 2021)

Box breathing can be beneficial for short-term stress relief, as it allows the body and mind to get into a calm state. This technique can be difficult at first, but over time with practice it can become easier.

Another mindfulness activity often used for stress relief is body scan meditation. This occurs when an individual focuses on a part of their body and nothing else. For example, someone sitting down could begin to focus on their toes or feet and how they feel on the ground. Then, slowly, the person begins to focus on other parts of the body such as how their legs feel against the chair, how their back feels, and so forth. Additionally, with progressive muscle relaxation an individual can also tense and relax their muscles. Practitioners recommend tensing and relaxing muscle groups one at a time, usually starting with tensing then relaxing the lower portion of the body and moving upwards. This type of activity should not be painful, and the tensing of the muscles should not be to a level of discomfort. If you find that this relaxation technique does not feel comfortable, stop, and try a different technique.

Practicing yoga has also been found to be effective for dealing with stress. The practice of yoga can assist with stress relief through balancing the body’s sympatheticparasympathetic systems. Yoga can allow one to become more aware of their body and the present moment. It can also help relieve physical tension that is kept in the body when a person is feeling stressed or overwhelmed. There are many free beginner yoga videos online to help you get started with the practice of yoga such as yogajournal. com/yoga-videos/best-yoga-youtube-channels/.

Sometimes it can be difficult to know about different stress-relieving activities. There are several phone apps that are available to assist with stress-reduction activities and mindfulness-based activities. Some of these apps include Headspace (headspace.com), Calm (calm. com), Healthy Minds Program (hminnovations.org/ meditation-app), and Smiling Mind. Additionally, some of the best ways to reduce stress include participating in healthy activities that you enjoy and find meaningful. Being involved in craft projects, going outside for fresh air, spending time with family and friends, and reading are a few examples. Last, if you are feeling stressed and overwhelmed, it can always be helpful to talk these feelings through with someone (such as a family member, friend, or professional).

Individuals with BP who may be experiencing difficulties in adjustment and stress may benefit from seeking a clinical health psychologist, clinical psychologist, or mental health counselor. Coping strategies and self-regulation techniques may assist individuals in the short term to help relieve some high levels of stress and anxiety (such as the use of mindfulness-stress reduction) (Norouzi et al., 2020), while psychotherapy (such as Acceptance and Commitment Therapy or Cognitive Behavioral Therapy) may assist with stress and adjustment in the long-term. It is important for anyone struggling with anxiety, stress, feelings of loneliness, and depression to connect with a mental health professional to better address their psychological symptoms and distress.

Sometimes navigating the healthcare system can be confusing and difficult. Some resources for finding a provider include connecting with your local psychological association (they sometimes have a “Find a Provider” list on their website). Another way to find a local psychologist that is a good fit for your needs is by using the American Psychological Association’s Psychologist Locator (locator.apa.org/). Here you can search your local zip code and find psychologists in your area. Usually, the locator will display the names of local psychologists along with their phone numbers, emails, insurances they accept, and a brief biography about who they are and how they practice. Here are some questions to consider when looking for a provider:

1. Has this provider worked with individuals with autoimmune diseases?

2. Is this provider experienced in working with certain age ranges?

3. Does the provider accept my insurance?

4. Does the provider have experience working with adjustment disorders, anxiety, or chronic stress?

5. Does the provider offer telehealth, in-person therapy, or both?

6. What therapies does the provider use in their practice?

References

1. Akarsu, S., Özbağçivan, Ö., Dolaş, N., & Aktan, Ş. (2017). Possible triggering factors and comorbidities in newly diagnosed autoimmune bullous diseases. Turkish Journal of Medical Sciences, 47(3), 832-840.

2. Cleveland Clinic. (2021, August 16). How box breathing can help you destress . https://health. clevelandclinic.org/box-breathing-benefits

3. Kouris, A., Platsidaki, E., Christodoulou, C., Armyra, K., Korkoliakou, P., Stefanaki, C., & Kontochristopoulos, G. (2016). Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study. Anais Brasileiros de Dermatologia, 91, 601-603.

4. Norouzi, E., Gerber, M., Masrour, F. F., Vaezmosavi, M., Pühse, U., & Brand, S. (2020). Implementation of a mindfulness-based stress reduction (MBSR) program to reduce stress, anxiety, and depression and to improve psychological well-being among retired Iranian football players. Psychology of Sport and Exercise, 47, 101636.

5. Ujiie, H. (2023). What’s new in the pathogeneses and triggering factors of bullous pemphigoid. The Journal of Dermatology, 50(2), 140-149.

Melissa is a graduate student finishing her Doctor of Psychology degree in clinical psychology in Buffalo, NY. She is a volunteer for the IPPF.