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Cardiac Rehabilitation
Psychology Stress Talk
When people experience a problem with their heart, they often start to think about stress. Stressful events do not cause heart disease. Heart disease is a chronic disease process, with a number of factors contributing to problems with the coronary arteries.
What is clear is that having a heart problem is stressful. This leaflet is intended to help you think about how stress may be affecting you and your recovery. It can also help you think about ways to reduce stress and help you feel better.
Of the things that people have said they have found stressful about having a problem with their heart, here are just a few:
- Being in hospital and having medical tests and treatment
- Having operations postponed
- Having to make lifestyle changes (such as stopping smoking, or changing diet)
- Having to learn about and take lots of new medication
- Feeling at risk of further heart problems
- Troubling thoughts such as ‘why did this happen to me?’
- The impact of the heart problem on family and friends
- Family and friends being over protective
- Having to take time off work and then going back to work
How does stress affect the body?
There is lots of research that tells us what happens when people experience stressful events, like having a heart problem.
When we are in danger or under stress our bodies automatically produce chemicals to help us cope. The chemical that we produce is called Adrenaline. In a real emergency it can help save our lives. When we are in danger, adrenaline helps us to either fight the threat or flee from danger. All animals have this ‘fight’ or flight’ response. Imagine that you are crossing the road. Suddenly a lorry comes hurtling towards you. Your body will react by producing adrenaline that will help you run out of harm’s way.
Unfortunately, many stressful situations can’t be solved by physically fighting or running away. This causes the adrenaline build up in the body and you feel symptoms like:
- heart racing
- rapid breathing
- sweating
- feeling tense
- butterflies in the stomach.
When we are alert like this, we are more likely to think negative or threatening thoughts. For example, when you see the lorry hurtling towards you, a thought flashes through your mind:
‘The lorry isn’t going to stop. I’ll be killed’
The thought would probably be so quick that you wouldn’t notice it, but it triggers more adrenaline into the body. Frightening words, thoughts or memories trigger the body to release more adrenaline. After having a heart problem, many people have frightening thoughts about their heart. These usually get less over time, as confidence in the heart increases again.
When there is extra adrenaline in the body, it can cause other symptoms of stress. These can include:
- poor sleep
- irritability
- poor concentration
- restlessness
- feeling like you can’t be bothered
- low mood
- racing thoughts
- difficulty remembering things
All of these problems can become frustrating and cause additional stress.
The stress cycle is summarised overleaf.
The stress cycle
The good news is that there are ways out of this cycle!
What can I do about stress?
These suggestions have all been made by people who have previously attended the psychology talk at cardiac rehab.
Talking to other people – Often when you are feeling stressed, it can feel like you are the only person in the world that feels like this. If you talk to someone about how you feel, this stops the feelings being bottled-up inside. Sometimes you find out that other people are feeling the same. Or that they had a similar feeling in the past and they may be able to suggest things that helped them feel better.
Avoid dwelling on the past – Rather than thinking about what could have been or regretting things that have already happened, some people find it helpful to focus on what they are doing right now. Planning something that you will look forward to in the future can help.
Positive thinking – This is also called positive self talk. Positive thoughts have the opposite effect of negative ones. They switch off adrenaline. When you notice a negative thought, can you replace it with a positive thought?
Other positive statements are things like:
Try out a few different ones, or perhaps develop your own positive statement that helps you to think positive.
Getting information by asking the nurses and doctors questions – Sometimes people have frightening thoughts about their heart because there is something they are not sure about. This could be about their heart, the tests they had in hospital or their surgery or tablets they have to take. If you have a question that is causing you concern, ask one of the rehab nurses or a doctor to explain it to you.
Cardiac rehab – Many people say that the Cardiac Rehab sessions are helpful. There are a few different reasons for this. Firstly, they get more information about their heart and their treatment. Also, they meet other people who have had similar stressful experiences. This helps them to realise that they are not alone. It is also helpful to notice that over the weeks they are feeling better and are more confident that their heart is recovering.
Exercise – Exercise is not only good for your heart, but it can make you feel less stressed too. If you have extra adrenaline in your body, exercise burns it off, so the adrenaline will have less of an effect on your body. Also, it is helpful to set yourself some realistic goals about the exercise you want to do. When you do it, you feel more confident and pleased with yourself.
Relaxation – Relaxation can help to reduce some of the effects of adrenaline, especially tense muscles. This can help you feel calmer and help you to sleep better. You may have been given a relaxation tape by the nurses. Relaxation is a skill that takes some practice, so if it doesn’t work the first time, it is worth trying a few more times. You may already have ways to relax, like using meditation or yoga which are also very helpful.
Do enjoyable things - like hobbies, spending time with friends, or reading. If you are feeling irritable and fed-up, you may not feel like doing very much. This can make you feel worse because you are not getting to enjoy some of the things that you usually enjoy. Some people find it helpful to gradually build up their activity by starting to do small activities or outings for short amounts of time. As their confidence increases, they find that they are starting to enjoy the activities more, and their confidence in what they can do grows. This also helps to reduce stress.
It is normal to feel anxious or not yourself if you have had a stressful experience with your heart. If you are finding it very difficult to cope or you are feeling worse rather than better over time, please talk to one of the cardiac rehab nurses or to your family doctor. They will be able to suggest ways to help you out of the stress cycle.
Ways out of the stress cycle
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