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REHABILITATION FROM HEART DISEASE AND STRESS MANAGEMENT: THOU SHALT IDENTIFY THY NEEDS AND PRACTICE STRESS-MANAGEMENT TECHNIQUES REGULARLY, WHEREVER AND WHENEVER YOU MUST.
What do you need? If things are going along quite well, you may not need any extra programs. But recently there has been more interest in stress-management techniques. Should everyone use them? We think not; but many could benefit from them. Herbert Benson described the mental and physical effect of the “relaxation response,” which occurs after relaxing in a specific, focused way. Two components characterize the techniques that elicit the response. One we can call “focusing”; the other, “defocusing.” The truth is, it’s not really that difficult. By focusing the mind, the response can be achieved, on the condition that all other incoming stimuli, such as thoughts and images, are pushed aside. After a short time, the recognizable response of relaxation is experienced.
There are two approaches to teaching relaxation?the group and the individual method. For most patients, we recommend the group method supervised by experienced group teachers. However, the person who has identifiable symptoms of anxiety derives a better result from the individual method. The techniques are deep breathing, progressive muscular relaxation, autogenic relaxation, imaging and meditation. Patients usually do not like all the techniques equally. You must find out what works for you and then use it. We recommend active rather than passive methods (such as audiotapes), unless you cannot do it for yourself. Patients should practice relaxation techniques with the same frequency as they exercise, that is, at least three or four times per week. They will then develop an expertise in “turning on” the technique, and will be better able to use it when necessary in “real life” situations.
In contrast to those who experience anger as a temporary emotional reaction to the cardiac event (“Why me?”), those who have ongoing problems with anger?be it thinking, feeling or expressing it?will need anger-management techniques. If there is a strong arousal (feeling “overalert”) component with associated anxiety, relaxation techniques are also useful. For someone who has reported negative thinking linked to anger, cognitive psychotherapy can be helpful. The group setting can be invaluable to patients with anger problems. As with all group treatment, the group must be led by an experienced group leader.
Over the years physicians have observed how cardiac patients seem to be pressured by time. Psychologists have developed elaborate methods to determine if you suffer from “time urgency,” such as feeling hurried or doing more than one thing at a time. Although the link to cardiac outcome is not clear, it seems that certain individuals can benefit from training in time management, by getting their lives into balance and by handling stress more competently. Many people are time-pressured at work; even if, as they often say, “that’s part of the job description,” changes are needed. Time pressure, anger and impaired stress management are often linked. For example, if people who are always in a rush take on “one more problem” or run into “one more thing,” the house of stress cards may collapse! Such people need to be aware that there is too much time pressure in their lives.
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