Cardiac Rehabilitation Programme

Stress Management

Andrea Papitsch-Clark
Clinical Health Psychologist
Stress in everyday life
What does it feel like to be stressed?
What does it feel like not to be
stressed?
What causes YOU stress?
 Emergencies (e.g. fall, emergency stop, being
startled by something etc.)
 Life events (e.g. bereavement, illness,
marriage, holiday, change job)
 Daily hassles (e.g. stuck traffic jam,
arguments, queue in supermarket etc.)
What is stress?
What is stressful differs from one
person to the next, and also how we
experience stress may differ from
person to person.
Definition of stress: “stress is a
condition or feeling, experienced when
a person perceives that demands
exceed the personal and social
resources the individual is able to
mobilize” (according to Richard S
Lazarus)
Symptoms of stress
Physical Behavioural
Muscle tension, aches Smoking
Tension headaches Drinking more alcohol
Breathlessness Poor concentration
Change in appetite Putting things off
Tiredness, sleeplessness Inability to finish things
Increased blood pressure Avoiding people
Thoughts Feelings
Intrusive, unwanted thoughts Irritability
Worrying obsessively Anger or resentment
Inability to make a decision Loss of temper
Self-criticism Anxiety
Being critical of others Feeling tearful
Lapses in memory Loss of sense of humour
Feeling guilty
 Physiological effects of stress
Adrenaline is released when our brains perceive we are
under threat or in danger. Evolutionary fight or flight
response.

Body's reaction: The effect:

•Pupils dilate •Blurred vision
•Heart rate increases to •Palpitations, heart pounding
send o2 to muscles
•Light-headed
•Blood pressure rises
•Dry mouth, short of breath
•Breathing faster
•Indigestion, butterflies,
•Digestion slows down nausea
•Muscles tense, ready •Tremor, jelly legs
for action
Useful in real emergency…but not in everyday hassles
 Stress thermometer
Panic Too much adrenaline
Fear = Bad
Worried Most people have
Bad tempered raised adrenaline
levels after a
Tense
Some adrenaline = cardiac event -
Good Excited normal to feel
Alert worried.
Wide awake
Any other worries
Calm or events can be
Sleepy enough to put
adrenaline levels
Very relaxed
even higher
 Does stress cause heart disease?
 It is recognised that stress contributes
to CHD, but we can’t say for certain whether
stress directly causes CHD.
….BUT Long-term stress can make us feel miserable,
drained and unwell.

It can affect our attitude or ‘state of mind’ and

make us rely on ‘short-term fixes’ like smoking,
drinking, not exercising, unhealthy eating,
all of which DO contribute to heart disease…
 Does stress cause heart disease?

….ALSO stress can affect the heart by releasing

certain hormones that increase blood pressure
and can encourage clotting of the arteries.

Stress can also make us feel less motivated to

spend time on healthy behaviours such as
relaxation or exercise.
Unhelpful thoughts/interpretations
 Being under stress can lead to unhelpful thoughts
such as:
“There’s nothing that will help me”
“I’m not getting better, I’m getting worse”
“It’s dangerous for people with heart problems to
argue”
“I should be able to cope”
This can lead to a vicious cycle, with unhelpful thoughts
raising adrenaline and producing unpleasant physical
effects, which leads to more worrying thoughts, in turn
leading to more stress and so on…
 VICIOUS CIRCLE OF STRESS/ANXIETY
Trigger stimulus
Thoughts:
•Internal
“There’s not much you can
•external
do about heart problems”
“There’s something wrong
with my heart”

Feelings:
Behaviour:
Raised anxiety, fear,
Stop what doing, frustration
reduce overall
activity, lose fitness
etc.
Physical effects:
e.g. increase adrenaline
(increase HR, faster
breathing, tension etc.)
Coping with stress
 1. Learning to spot when stress levels
are building up
 Feeling stressed and
tense can become a habit
Panic
 Be aware of daily hassles
and strains increasing Scared
stress levels
Worried
 What was I thinking Bad
about, or doing or what tempered
had happened just before Excited
I started to feel like Tense
this? Alert
Wide awake
 Are there other ways of
looking at the situation? Calm
Relaxed
Challenging unhelpful thoughts
Remember that unhelpful thoughts can raise
adrenaline levels, and in turn increase stress.
BUT: can try to challenge unhelpful thoughts
 Ask yourself:

Is this thought really true/true all the

time?
Am I considering all the evidence?
Am I ignoring any strengths or positives?
Am I jumping to conclusions?
2. Challenge unhelpful thoughts
 Having considered these questions, can you come
up with a different, more balanced, more positive
thought?

“My heart is not worn out”

“Most people make a full recovery after a heart“ attack”
“There are many things I can do to prevent CHD”
“It was a blockage in an artery – not the heart that
caused the problem”
“Relaxation is not just being lazy it’s important for
health and well-being”
 BREAK THE VICIOUS CYCLE
Thoughts:
“There are many things I
can do to fight CHD”

Behaviour: Feelings:
Healthy lifestyle Positive, calm,
changes, active, optimistic, motivated
see friends, set
goals

Physical effects:
More relaxed
 3. Problem-solving

For example….
 Are you managing your time effectively?
 Can you cut back on some things if you’ve taken
on too much?
 Are your goals/expectations realistic?
 Can you speak to somebody about it?
 Can you prioritise the most important things that
need to be done?
 Can you say NO to some things?
 Adopting ‘Low stress’ ways of living
and working
Making time for enjoyable activities
Switching off from thoughts/worries
Slowing down, taking your time
Taking a break
Being relaxed; practising relaxation
Thinking about what you have achieved,
not worrying about what you haven’t
Talking about how you’re feeling
Leading a healthy lifestyle
 4. Relaxation
 Important for everyone to have times when they relax
during the day – stick to them – it doesn’t mean you’re
being lazy.

 Lowers adrenaline
 Reduces stress
 Lowers blood pressure
 Increases feelings of being in control
 Reduces pain
 Improves sleep
 Reduces tension
 Helps us feel better able to cope with problems
 Helps reduce fears and anxieties
 Improves well-being

Rest and relaxation are as important as work. Relaxation

is more than just watching TV!
 Things you can do…
 1. Learn to recognise when you are stressed before it
becomes a long-term problem. Be aware of daily hassles
keeping adrenaline levels high.

 2. Be aware of unhelpful thoughts and how they can

increase adrenaline. Try and replace with more balanced
alternative ways of thinking.

 3. Make time for yourself for relaxation and enjoyable

activities and stick to them. Practice breathing
exercises everyday

 4. Change ways of doing things to lower stress levels and

anxiety

 5. If things are too much to cope with, remember there

is help and support available. Talk to the CR team.
THANK YOU!
Any questions?