Stress Management&Emotional Reactions to Heart DiseaseCarolyn Kienitz M.S.W.,R.S.W.
Emotions & the Heart in Everyday Language Heart ache Downhearted Soft hearted Disheartened Light hearted Fainthearted Chickenhearted Change of heart Sick at heart Learned by heart Heart of stone Right to the heart of…. Tender hearted Heart of Gold Broken hearted Bleeding Heart
What is stress? Stress is when life‟s demands seem more than you can handle. The most important component of our stress response is often not the actual stressful event, but how we evaluate the situation mentally.
It’s not stress that kills us; It is our reaction to it. Hans Selye
Fight or Flight It is what allows us to respond to danger and act to save our own life or that of another
Stress Responseour reaction to real or imagineddanger
Fight or Flight Response The „flight or fight‟ response is a series of biochemical changes that prepare you to deal with threat or danger. Without this response we could not have survived. Today the dangers in our lives are not always as concrete as a tiger jumping out of the woods at us, but the fight or flight response still serves us well. Whether it is a car cutting us off on the highway or running to rescue a child from danger, our bodies need to be able to respond quickly.
Fight or Flight – what happens? Any problem, imagined or real, can cause the cerebral cortex (the thinking part of the brain) to send an alarm to the hypothalamus (the main switch for the stress response). The hypothalamus stimulates the sympathetic nervous system, which make a series of changes in your body. Your heart rate, breathing rate, muscle tension, metabolism and blood pressure all increase. Your hands and feet get cold as blood is directed away from your hands and feet to the heart and larger muscles that can help you fight or run. Your pupils dilate to sharpen your vision and your hearing becomes more acute.
Fight or Flight - continued Unfortunately when the fight or flight becomes chronic, there can be long term negative effects. Your adrenal glands start to secrete corticoid which inhibits digestion, reproduction, growth, tissue repair; decreases the response of your immune and inflammatory systems, and over time can negatively affect the cardiovascular system.
IN OTHER WORDS Heart rate increases Blood pressure can become elevated Blood flow changes – more to heart and larger muscles The hands and feet become cooler
And more …. Our skin pales („white as a ghost‟) The blood clotting mechanisms increase and our blood becomes thicker Blood sugar elevates Digestion slows down or stops
And even more…. Sleep problems? Do you feel like exercising? Urges to “double up” ie cigarettes or alcohol Harder to diet or quit smoking.
Symptoms of Stress Anger Irritability Mood swings Crying Lowered sex drive Increased use of alcohol or cigarettes Insomnia And so on……………
And if your answer is ‘yes’ What if there are no simple answers?
Dr. Herbert Bensen Working at Harvard Medical School Researching ways to combat High Blood Pressure
Relaxation Response Breathing becomes slower and deeper Heart rate slows down Artery walls relax, BP lowers Hands and feet warm Muscles relax
Relaxation response continued Over time BP lowers and stays there Immune system seems to get a boost People still get stressed but don‟t stay that way as long Endorphins are released
Meditation Meditation focuses on calming the mind.1) Concentrative meditation focuses your attention on something specific such as your breath2) Mindfulness meditation describes a state of mind where you are aware but detached from everything you are experiencing
Benefits of Meditation Reduced anxiety More relaxed body Improved sleeping patterns Lower blood pressure and reduced pulse rate Lower levels of stress hormones in the blood Improved circulation Improved quality of life in those who suffer from chronic pain
Tai Chi Has been shown to improve blood pressure, stress reduction, balance, postural stability and fall prevention Other studies demonstrate pain reduction in osteoarthritis and improved physical function Improved sleep Some evidence that Tai Chi may improve immune function Appears to improve cardio vascular fitness
Yoga Provides stress reduction Can reduce blood pressure Recommended as helpful for sufferers of arthritis Study subjects demonstrated fewer angina attacks and improved exercise capacity Helps with weight loss Improves sleep
Other forms of relaxation Read a book Garden Woodwork Listen to music Sing Play an instrument Knit or sew Walk Play with a child
Pet Therapy The act of petting a dog can lower blood pressure People with dogs go for more walks
Laughter is the Best Medicine The arrival of a good clown exercises more beneficial influence upon the health of a town than twenty asses laden with medicine. Thomas Sydenham, 17th century
Humor and Health Muscle Relaxation Reduction in Stress hormones Enhances Immune System Reduces Perception of Pain Provides Cardiac Exercise Reduces Blood Pressure (women more than men) Respiration – similar to deep breathing
Common emotional reactionsto cardiac disease Denial Anxiety Anger Grief Depression
Common Emotional Reactions Denial
Common Emotional Reaction Anxiety
Common Emotional Reactions Anger The Hostile Personality is independent risk factor for Heart Disease
Common Emotional reactions Grief
Depression In a healthy population, major depression could be found in 4 - 6% of males, 18% of females Add a cardiac diagnosis to that population and the instances of major depression can jump to 20% or more (1)
Why should this concern us? Depression is an awful experience and affects the whole family Depressed people are less likely to return to work and are hospitalized more often Depression has been shown to increase the risk of further cardiac events, including death by 25%
Symptoms of Depression Persistent sad, anxious, or „empty‟ mood Feelings of hopelessness, pessimism Loss of interest, pleasure in activities that were once enjoyed including sex Decreased energy, fatigue, being „slowed down‟ Difficulty concentrating, remembering, making decisions Insomnia, or oversleeping Appetite and/or weight changes Thoughts of death or suicide or suicide attempts Restlessness, irritability, loss of sense of humor If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities, seek an evaluation for depression
Fortunately: Depression is treatable Antidepressants have been proven safe in cardiac population When depression is treated – research is indicating that risk factors can return to normal Not everyone needs an antidepressant
Exercise as a Treatment for Depression Must be aerobic 2 - 3 times per week 20 - 30 minutes at a time (more is better) At a rate that you can still talk but hard enough that you could not sing If you are older and out of shape – you will see results faster No side effects and fewer relapses
Dr. Benson’s Breathing Exercise Deep slow gentle breaths In through the nose Hold it Breathe out though pursed lips Your tummy should expand when you breath in