Stress Management in Coronary Health

1. Stress Management in Coronary Health The Sunshine Coast Private Hospital

2. What is Stress? • Stress is the emotional, mental, physical and behavioural way we respond to pressure in our lives. Stress can be a positive or negative experience. What is a Stressor? • A stimulus or event that provokes a stress response (e.g. A situation or life event) Stress can be a positive or negative experience. (Slowick, 2012)

3. How does negative (Chronic) stress affect me?

4. What is the relationship between negative (chronic) stress and Coronary Heart Disease (CHD)? The Heart Foundation’s “Components of Stress” • Depression, anxiety, panic disorder • Social Isolation, lack of quality social support • Troubling Life events (bereavement, earthquakes, terrorist attacks) • Work Related Stressors • Anger and Hostility • Although “stress” itself hasn’t been found to cause CHD, many of the components of stress (Specifically Depression, social isolation and lack of quality social support) have been linked to the development and exacerbation of CHD and many other health conditions. (Bunker et al., 2003; The Heart Foundation, 2003)

5. Activity • What are your stressors (who, what, when, where)? • What are some techniques you have used to manage these?

6. How can I manage my stress? • Its easier to manage your stress than to reduce your stressors. • Identify times, situations, events or other triggers that cause you to feel stressed. • Try a range of different stress management techniques and find what works for you. Then use it in the situations that you identified above.

7. Meditation/ Mindfulness • Meditation is concentrated focus upon a sound, object, visualisation, breathing, movement or on attention itself. • Mindfulness is the concentrated unjudgemental awareness of the present moment. (The Guided Meditation Site, 2012)

8. Deep Breathing - Deep breathing relaxation is the use of controlled inhalation and exhalation into the lungs and abdomen to relax our own nervous system. Try this: Inhale for 6 seconds through the nose, exhale for 8 seconds through the mouth (Exhale is the most important part!) Deep Breathing and Meditation techniques can be used to complement each other. (Australian National University, 2012; The Harvard Family Health Guide, 2006)

9. Progressive Muscle Relaxation • Serial Muscle relaxation is the controlled contraction and relaxation of muscle groups in series. • Try this quick version: Close your eyes, relax all your muscles, tense all the muscles in your feet and hold for 10 seconds, then release and consciously relax your feet for 10 seconds. Next, tense your calf muscles for 10 seconds (be careful of cramps!), and then release for 10 seconds. Continue in a progressive manner to thighs, abdominals, hands, arms, chest, neck and face. Feel free to fall asleep! (WA Centre for Clinical Interventions, 2012)

10. Massage • Massage can be done by someone else, a spouse, family member, or massage therapist. But if you are in a situation where you cant have someone else do it. Try self massage! Hand massage – Start by stroking firmly the back of your hand from fingers to wrist and then gently glide back, repeat. Then squeeze the hand all over, pressing between the palm and fingers. Squeeze each finger individually and then gently stretch it before going to the next. Finally, with your thumb, apply light pressure all around the palm of your hand and wrist. Finish by letting your arm hang at your sides for a moment and stretching your fingers/hands wide a few times. • Try this: For Tense shoulders – reach one arm across the front of your body to your opposite shoulder. Using a circular motion, press firmly on the muscle above your shoulder blade for a minute or two, then repeat on the other side. If it still feels tense, repeat these actions a second time. (Health Reviser, 2012)

11. Exercise • Exercise improves blood flow to your brain, bringing additional nutrients to the cells in your brain, which in turn, enable you to think clearly. • Exercise also can assist with the release of a chemical called serotonin, which give a feeling of happiness and improve overall sense of wellbeing. • Research shows that both aerobic and resistance exercise can decrease cardiac mortality by 26% (Wise, 2010). • Appropriate exercises might include a brisk walk or the use of light weights. • NOTE: Appropriate exercises may vary between individuals with CHD. Talk to your doctor or exercise physiologist before commencing any exercise programs. (Young, 2007)

12. Tai Chi • Tai Chi is a Chinese martial art practiced in many communities in Australia. These occur daily, often in the morning. • Research shows that Tai Chi can have a positive effect on mood and has a well supported effect on stress reduction • The Taoist Tai Chi society offers beginners Tai Chi in Buderim, Maroochydore and Woombye. See www.taoist.org.au (Sandlund & Norlander, 2000)

13. Yoga • Yoga has been used for centuries in eastern cultures and there is a large amount of evidence suggesting that Yoga can significantly reduce risk factors that cause and exasperate CHD, including stress management. • Many local Gyms run free Yoga classes for members. Other classes are run by YogaHealth on the Sunshine Coast, see www.yoga.com.au. (Khalsa, 2007)

14. Alternative Therapies • Aromatherapy (Essential Oils are available from many chemists, health stores and online.) Use lavender, peppermint, bergamot or ylang ylang essential oils. These can be diffused via oil burner, electric diffuser, or you can put a few drops in some Vaseline and rub onto chest and neck. • Acupressure, Acupuncture and Reflexology all may also help in relieving stress. Use a trained professional when receiving these services.

15. Activity • Does anyone have any other stress management techniques that they could share? • Lets rethink on those stressors we discussed earlier (who, what, when, where). • What other techniques would you like to try for those situations?

16. Progressive Muscle Relaxation CD

17. An Analogy

18. “Stress is the trash of modern life-we all generate it but if you don't dispose of it properly, it will pile up and overtake your life.” – Danzae Pace “Besides the noble art of getting things done, there is a nobler art of leaving things undone. – Lin Yutang Thanks for Coming!

19. References Australian National University (2012). The 10 Best Ever Anxiety Management Techniques. Retrieved from the ANU website :http://counselling.anu.edu .au/brochure/10-best-ever-anxiety-management-techniques Bunker, S. J., Tonkin, A. M., Colquhoun, D. M., Esler, M. D., Hickie, I. B. Hunt, D., Jelinek, V. J., Oldenburg, B. F., Peach, B. F., Ruth, D. et al. (2003). “Stress” and coronary heart disease: psychosocial risk factors, Medical Journal of Australia, 178, 272-276. <https://www.mja.com.au/ journal/2003/178/6/stress-and-coronary-heart-disease-psychosocial- risk-factors> Health Reviser. (2012) You can do self massage, benefit from relief and relaxation. Retrieved from the Health Reviser website http:// www.healthreviser.com/content/you-can-do-self-massage-benefit-relief- and-relaxation> Khalsa, S. B. (2007). Chapter 9: Yoga as a therapeutic intervention. In P. M. Lehrer, R. L. Woolfolk & V. E. Sime (Eds.) Principals and Practice of Stress Management. New York, NY: The Guilford Press Sanderlund, E. S., & Norlander, T. (2000). The effects of Tai Chi chuan relaxation on stress responses and well-being: and overview of research, International Journal of Stress Management. 7, 139-149.

20. References Slowik,G. (2012). What is stress? Retrieved from the E healthMD website http://ehealthmd.com/content/what-stress#axzz2I2PE6R1l The Guided Meditation Site (2012) Mindfuless Exercises. Retrieved from <http:// www.the-guided-meditation-site.com/mindfulness- exercises.html> The Heart Foundation (2003). “Stress” and coronary heart disease: psychosocial risk factors. Retrieved from The Heart Foundation’s website: <http:// www.heartfoundation.org.au/SiteCollectionDocuments/Stress- Consumer-Information.pdf> The Harvard Family Health Guide (2006) Relaxation techniques: breath control helps quell errant stress response. Retrieved from <http:// www.health.harvard.edu/fhg/updates/update1006a.shtml> WA Centre for Clinical Interventions. (2006). Progressive Muscle Relaxation. Retrieved from http://www.cci.health.wa.gov.au/docs/ACF3C8D.pdf Wise, F. M. (2010). Coronary heart disease: The benefits of exercise, The Australian Family Physician, 39, 129-133 Young, S. N. (2007). How to increase serotonin in the human brain without drugs, Journal of Psychiatry and Neuroscience. 32, 1, 394-399.