Stress Management For Heart Patients

Nalini Sahay

With Swamiji's inspiration and blessings I have been teaching yoga therapy for the last twelve years. When I first started teaching yoga, I was dealing with non-specific problems, like general fitness and controlling weight and diet. Over the years, I became interested in the management of anxiety and stress, and as I found that many problems originated from stress, whether it was on the work front or home front, I decided to specialise in stress management using my study of yoga therapy as a base.

In 1988 I joined the Escorts Heart Institute and Research Centre as a Stress-Researcher. The Escorts Heart Institute is a speciality hospital and it is the only one of its kind in Asia. I started taking classes for patients who were admitted to the hospital. Some of the patients were those who had had bypass surgery, others were those who had had heart attack (myocardial infarction) and also those who were suffering from angina.

Since it was a new experience for me I did not realise that when one is teaching in a hospital, one must bear in mind the frailty of the patients. The practices I started with initially were yoga nidra and ajapa japa. Both practices the patients found to be difficult as they had to concentrate deeply, and they were sitting on sofas and not lying on beds. After the second class, I changed my method of communication and teaching. The format for my class became a discussion about the stress fight-flight response coronary prone personality, importance of relaxation and how it can affect behaviour change, which is absolutely essential.

Stress is very much a part of our life. We cannot escape it but by being conscious of it, we can manage it. Stress can be of many kinds - it can be domestic, business, financial, emotional or related to our health. It has been described as the non-specific response of the body to any demand made upon it. Stress has been called the spice of life. It has also been accepted as a soft risk factor which aggravates the level of blood pressure, sugar and cholesterol. Therefore, we have to learn to live with stress and not allow it to affect us adversely.

The fight-flight response, which is our response for survival, is constantly working. This response secretes hormones into the system which make us more alert. This is fine if we are being chased by a bull but not if we are held up at a traffic light or are in a queue. These very hormones such as adrenalin act as coagulants, therefore it is important to control this response.

The coronary prone personality is the Type A person who is always in a hurry, who wants to get ahead in every sphere, who is a workaholic and in short, it is such an individual who is more prone to heart disease. That is why I now quote Sir William Ostler from his Lumein Lectures in 1910, who identified the coronary patient as "Not the delicate neurotic but the robust, the vigorous in mind and body, the keen and conscious man, the indicator of whose engine is always full speed ahead". This description still applies to the person who suffers from ischemic heart disease. Therefore it is essential for the patient who has had a heart attack or by-pass surgery to change himself. The process of change is very tough and the patient's anxiety to be accepted as normal is very high. Moreover this disease normally attacks men between the age-group of 35-50 and it can come on suddenly.

I teach three sets of exercises and the virtue of these exercises is that they can be done anywhere, anytime and pose no strain either physically or mentally.

EXERCISE I
Breath Awareness: Close the eyes and concentrate on the natural breath. Focus on the cool air flowing in through the nostrils and the warm air flowing out of the nostrils. No effort is required. After a few minutes start counting the breaths, i.e. when you inhale count 1 in, when you exhale, 1 out. Count up to 54. Make no errors in the counting, if you do, start again.

EXERCISE II
Abdominal Breathing: Place one hand on the abdomen and close the eyes. When inhaling let the stomach expand and when exhaling allow the hand to press the abdomen down. Do this a few times. Now start counting backwards from 54 to 0, i.e. 54 in, 54 out etc.

EXERCISE III
This exercise is derived from yoga nidra but I have simplified it. It can be performed either in the afternoon or at bedtime. You must lie flat on your back and close your eyes. Make a resolution to yourself mentally. The resolution may be "I will enjoy good health", or "'I must control my anger or diet", and this resolution you will repeat to yourself three times. Now you will count your breath backwards from 108 to 0. This process will take 15 minutes. After this you will repeat the resolution to yourself 3 times.

Exercises I and II are very effective if the person is feeling very angry, frustrated or unhappy. These relaxation exercises help the individual to switch off the present problem. This is accomplished by focussing on the breathing and concentrating on the counting. This is a neutral activity and so for a few minutes the body is allowed to perform its normal functions like respiration, circulation and digestion without getting messages from the sympathetic nervous system (the part of autonomic nervous system used to prepare the body to handle stress and the fight-flight response), and the parasympathetic system (part of the autonomic nervous system concerned with relaxation) takes over. Moreover, by using these techniques the patient's level of awareness is raised and he/she becomes conscious of these harmful feelings, which are often unreasonable. The patient learns to exercise control over higher behaviour. The emphasis of these exercises is on mind management. The patient, by becoming conscious of his behaviour, i.e. feelings of anger, hostility, impatience, attempts to curb them.

Exercise III helps the patient to become positive in his/her thinking and to be able to sleep better and wake up rested.

By regular practice of these seemingly simple relaxation techniques it is possible to add years to one's life and have an ongoing commitment to one's mental and physical health.