STRESS MANAGEMENT AND CARDIOLOGICAL DISEASE: RELAXATION TECHNIQUES
We are addressing this to all those patients who are subject to anxiety, being “hyper” or overstimulated (in the sense of being “on the alert”) for much of the time. There is inconclusive evidence that this type of person may be at risk for more cardiac events than others, based on the theory that the cardiovascular system is set at a pitch that is unhealthy to sustain, much in the same way that an engine idles too high; increase the pressure and you will be in the red zone. It may also relate to those who have a concomitant cardiovascular response. By this we mean that with stress, the heart rate or blood pressure rapidly increases, and flushing may occur, but this subsides with the passage of the stress. The “edginess” we describe in this section can spill over into other vulnerabilities highlighted in the other sect ions; so don’t be surprised if you identify with the other tendencies. In particular, we see a cluster of those who identify with this section (Edgy), together with Angry, Pushy, Busy and Hurry. So, don’t be surprised if they all seem to merge together; they do, because they go together.We are also addressing those who read about and identified with anxiety and related symptoms in this book. To both, we are prepared to make a broad-based recommendation about relaxation techniques: they can benefit almost anybody, and one day they may be included in general rehabilitation programs, in the same way that exercise is routinely included nowadays. Are we getting carried away? We think so, to a certain extent, but as a counterpart to the “burn-off” of exercise, there is the “calm-down” of relaxation techniques. They are starting to enter the mainstream as approaches to dealing with CAD and all other types of illness, such as cancer, and are being incorporated into wellness programs everywhere. A boost was supplied in the 1970s with the publication of The Relaxation Response by Herbert Benson. In it, he describes a simple method for evoking the physiological as well as the psychological response of relaxation. The technique involved just two basic components: focusing and defocusing.Defocusing involves shutting out of your consciousness all the thoughts and feelings—the “distracting noises”—that enter your mind as a matter of course. For those of you who are Edgy or Shaky, this will be more easily said than done, as you are the type of person whose thoughts and feelings seem irresistibly impelled into your minds. You will need to learn to push these intrusions away. There is a fine art in doing this; you will find that if you try too hard, you may create a boomerang effect. We are talking about a gentle easing away, rather than a forceful pushing aside.Ideally, we recommend that you actively seek training in the focusing techniques. Just reading about them may get you into bad habits that are not easily correcred. So, you need to find someone with expertise in relaxation training. Should you learn individually or in a group setting? If you do not have prominent symptoms and a group is recommended by professionals or by fellow CAD patients, please go ahead; otherwise, we suggest an individualized program, which includes evaluation and learning of the basic techniques, one of which is taught each week; you will be able to demonstrate your ability to master each technique. The relaxation techniques are: deep breathing, progressive muscular relaxation, autogenic relaxation, imaging and meditation. Deep breathing is controlled, slow and deep, and has an abdominal component. Progressive muscular relaxation is familiar to many who have gone through prenatal classes, including the husbands! It is most effective as an initiator of a relaxation sequence; however, in a tense or “hyper” person it can be used with effect, and unnoticeably, for relaxation of the muscles. With autogenic relaxation, your mind focuses on specific muscle groups in terms of how they feel—hot or heavy, for example. Imaging is a skill well worth having; it involves conjuring up in the mind a scene that is full of relaxing cues, such as lying on a beach in Tahiti, with the waves lapping on the shore as the sun beats down. Although the relaxation therapist in the group setting will suggest a specific scene, in the end each individual will need to conjure up his or her own relaxing scene, as what makes you relaxed can have the opposite effect on someone else. We recommend imaging (imagining a relaxing scene) rather than active visualization (where an empowering story, such as fighting heart disease, is fantasized). Meditation can be the most difficult, but, in the end, the most satisfying of the relaxation techniques. This is particularly so if you see yourself as Mr. or Ms. Busy (see below), and are uncomfortable when your mind is not occupied. Being defocused is difficult for you, but once you persist with the meditation technique, your symptoms should subside, and soon you will develop the expertise to produce the relaxation response on demand.At the end of the relaxation course, you will become familiar with what works for you. You should then start to practice these techniques with the same frequency as a maintenance exercise program, that is, at least four times a week. The sequence is devised specifically for you, and usually consists of three of the techniques (for example, starting with progressive muscular relaxation, going on to deep breathing, and ending with meditation). The techniques should become second nature to you so that you can apply them in your daily life when you become anxious, “hyper,” tense, or whatever is responsive to the techniques.*86\214\2*
