Keeping Hearty and Happy

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Keeping Hearty & Happy!! 

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. India has one of the highest burdens of cardiovascular disease worldwide. 

Heart diseases make a person vulnerable in many ways, physical and social activities decrease with time, leaving a long lasting effect on a patient’s overall wellbeing. But did you know that the wellbeing of your heart is closely linked with the wellbeing of your mind i.e. Mental Health. Anxiety and depression are common after a heart attack or a heart surgery. Research shows The prevalence of depression is, compared with the general population, significantly higher in patients with CVD [1]. However, we overlook these! 

Heart patients are at a higher risk of being diagnosed with severe Mental Health Conditions compared to the general population. Heart disease can be prevented by looking after our lifestyle choices. While we take care of our heart and body, we might give a blind eye to the factors that are equally responsible for managing and maintaining our overall health. That blindspot is your Mental Health. We have all heard the phrase ‘healthy heart is equal to healthy mind’ and we can not emphasize enough on this. 

Mental health conditions related to heart disease 

Anxiety and depression are the most common types of mental health disorders that are connected with heart disease. 

Anxiety disorders are a group of mental health disorders. Everyone experiences anxiety and fear at times – these are normal and helpful human emotions that help us deal with danger. However, some people experience excessive and irrational anxiety and worries that become ongoing and distressing, and that interfere with their daily lives. This may indicate an anxiety disorder. 

Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. 32% of patients with heart failure (HF) experience elevated levels of anxiety, and 13% meet criteria for an anxiety disorder [2] 

Some common signs and symptoms to help you understand Anxiety Spectrum more:

Physiological symptoms 

  • Churning feeling in stomach 
  • Feeling dizzy 
  • Gastrointestinal issues 
  • A churning feeling in stomach 
  • Feeling dizzy 
  • Gastrointestinal issues 
  • Feeling restless 
  • Hot and cold flushes 
  • Panic attacks 
  • Sleep problems

Psychological/ behavioral symptoms 

  • Catastrophizing 
  • Depersonalization 
  • Worrying that you are losing touch with reality 
  • Feeling like world is speeding up or slowing down 
  • Avoiding situations that may cause anxiety 

How to manage anxiety and take care of the heart 

  • Talk to someone you trust 
  • Keep a journal to track your moods and triggers 
  • Develop habit to understand your triggers in real time 
  • Find your own grounding techniques 
  • Take care of physical health, exercise, healthy diet etc 
  • Try alternative therapies i.e. yoga, meditation, aromatherapy, herbal treatments etc 

Treatment of the Anxiety 

  • Psychotherapy 

CBT has been the most studied psychotherapy in patients with heart disease. CBT appears safe and generally efficacious in this population. With careful diagnosis and appropriate treatment, anxious patients could have improved quality of life, functioning, and cardiac health. 

Cognitive Restructuring – This is when someone with anxiety challenges the negative thoughts and beliefs that contribute to their fear and anxiety. This can be done through techniques like journaling, visualization, and self-talk. 

Exposure Therapy – This is a type of treatment for anxiety that involves gradually exposing oneself to the situations they fear and avoiding in a safe and controlled environment. Exposure therapy can be an effective way of reducing social anxiety over time. Relaxation Techniques – Relaxation techniques such as deep breathing, meditation, and yoga can help people with anxiety learn to control their body’s physical response to anxiousness (i.e. heart rate) 

  • Pharmacotherapy 

Use of medications to treat Anxiety and manage its symptoms. Only a Psychiatrist can prescribe medication treatment for mental health related issues. A psychiatrist might need to work with a cardiac specialist to cater the needs of the patient. 

Depression 

A percentage of people with no history of depression become depressed after a heart attack or after developing heart failure. Depression and heart disease are among the most disabling diseases that people face today. “About one in five who have a heart attack are found to have depression soon after the heart attack. And it’s at least as prevalent in people who suffer heart failure” says Dr. Roy Ziegelstein

Depression has a large range of adverse health consequences, including impaired physical function, increased morbidity, and an increased risk of death. Several findings suggest that cardiac disease plays a central role in the development of these consequences [3] 

Behavioral and Psychological signs and symptoms 

  • Heart disease and depression often carry overlapping symptoms such as fatigue, low energy, and issues related to sleeping and carrying on the daily tasks of life 
  • People with depression, who are recovering from heart disease, have a lower chances of recovery and a higher risk of death than people without depression ● In depressed heart attack patients, decreased motivation to follow healthy daily routines is observed. Which can result in skipping heart medications, avoiding exercise and/or maintaining a proper diet. It is also seen that the patient continues or intensifies smoking and drinking habits 
  • This population can also experience changes in their nervous system and hormonal balance, which can result in heart rhythm disturbance (called an “arrhythmia”) to occur 

Treatment for Cardiovascular disease and Depression 

  • Cardiac rehabilitation– this program may include an activity and nutrition plan specifically developed for heart attack recovery. Being in a rehab center has significant recovery benefits, studies have shown that returning to normal activity and seeing the progress of other people recovering from a heart attack improves mood and confidence. The rehabilitation programme can also work in increasing the lost motivation to get better. 
  • Social support- It’s natural to withdraw and lose social confidence after a heart attack. But according to some studies, going out and meeting your loved ones can help the individuals in their recovery. 
  • Psychiatric and Mental Health Services- Sometimes going back to a normal life after a heart attack requires the guidance of a psychiatrist, psychologist, or psychiatric social worker. Psychotherapy, to treat depressive symptoms, can boost recovery. Using psychiatric medication to manage depressive moods can also help one in a long run. Support groups are also a great source to connect and reconnect with people outside of the home environment, which can turn out to be beneficial for your overall health. 

Sources 

[1] The intriguing relationship between coronary heart disease and mental disorders – PMC [2] Anxiety disorders and cardiovascular disease – PMC 

[3] Depression and Cardiac Mortality: Results From a Community-Based Longitudinal Study | Cardiology | JAMA Psychiatry

Blog written by Mental Health Professional, Mx. Kirti



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      Dass 21 Questionnaire

      Check your Depression / Anxiety and Stress Level

      /21

      Question

      1 (s) I found it hard to wind down.

       

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      2 (a) I was aware of dryness of my mouth.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      3 (d) I couldn’t seem to experience any positive feeling at all.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      4 (a) I experienced breathing difficulty (e.g. excessively rapid breathing,
      breathlessness in the absence of physical exertion).

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      5 (d) I found it difficult to work up the initiative to do things.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      6 (s) I tended to over-react to situations.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      7 (a) I experienced trembling (e.g. in the hands).

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      8 (s) I felt that I was using a lot of nervous energy.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      9 (a) I was worried about situations in which I might panic and make a fool
      of myself.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      10 (d) I felt that I had nothing to look forward to.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      11 (s) I found myself getting agitated.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      12 (s) I found it difficult to relax.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      13 (d) I felt down-hearted and blue.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      14 (s) I was intolerant of anything that kept me from getting on with what I
      was doing.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      15 (a) I felt I was close to panic.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      16 (d) I was unable to become enthusiastic about anything.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      17 (d) I felt I wasn’t worth much as a person.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      18 (s) I felt that I was rather touchy.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      19 (a) I was aware of the action of my heart in the absence of physical
      exertion (e.g. sense of heart rate increase, heart missing a beat).

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      20 (a) I felt scared without any good reason.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      21 (d) I felt that life was meaningless.

      0 - Did not apply to me at all.
      1 - Applied to me to some degree, or some of the time.
      2 - Applied to me to a considerable degree or a good part of time.
      3 - Applied to me very much or most of the time.

      Your score is

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      Locus of control

      A big question we all feel - am I in control of my life?

      This test helps you ascertain the degree of control that you believe  you have over your life and the events that occur. This belief plays a huge role in the satisfaction levels that we feel.

      /10

      1 / 10

      Is there some bad habit, such as smoking, that you would like to break but can’t?

      2 / 10

      Do you take steps, such as exercise and diet to control your weight and fitness?

      3 / 10

      Do you believe that your personality was firmly laid down in childhood so there is little you can do to change it?

      4 / 10

      Do you make your own decisions, regardless of what other people say?

      5 / 10

      Do you find it a waste of time to plan ahead because something always causes you to change direction?

      6 / 10

      If something goes wrong, do usually reckon it’s your own fault rather than just bad luck?

      7 / 10

      Are most of the things you do designed to please other people?

      8 / 10

      Do you often feel you are the victim of outside forces you cannot control?

      9 / 10

      Do you usually manage to resist being persuaded by other people’s arguments?

      10 / 10

      Are you sceptical about the extent to which your horoscope can tell you what you should do and what’s going to happen to you?.

      Your score is

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          How do You Cope with Anger?

          (The Behavioural Anger Response Questionnaire, BARQ)

          What do you most likely to do when you experience anger? This 34-item measure assesses your anger responses for children and adolescents – and may tell you which response you tend to favour when experiencing this strong, unpleasant emotion. A list of statements are provided below. State whether each of the statements are not true, sometimes true, or often true. This measure was developed specifically for children and young adolescents.

          /34

          1 / 34

          I say something nasty to the person who made me angry.

          2 / 34

          I use strong gestures (for example, make a fist, wave my arms, or give a hand sign).

          3 / 34

          I swear or curse, at the person who made me angry.

          4 / 34

          I hit or push the person who made me angry.

          5 / 34

          I express my anger by slamming a door, or hitting something.

          6 / 34

          I shout.

          7 / 34

          I wait until I am calm again and then talk to the person who made me angry. 

          8 / 34

          I carefully think it over and then tell the person who made me angry how I feel.

          9 / 34

          In a calm voice, I tell the person who made me angry how I honestly feel.

          10 / 34

          I try to understand what happened, so I can explain things to the person who made me angry.

          11 / 34

          I stay calm, and I try to talk about the problem and the person who made me angry. 

          12 / 34

          I leave the situation in order to calm down, and then try to solve the problem.

          13 / 34

          I do not show my anger but I talk about what happened with someone afterwards.

          14 / 34

          I leave the situation and look for someone who will agree with me.

          15 / 34

          I leave the situation, find someone to listen to my story, and ask for advice. 

          16 / 34

          I think about the problem first and then talk about it with someone.

          17 / 34

          I leave the situation and call a friend or family member to tell him/her how I feel. 

          18 / 34

          Even without planning it, I usually end up talking about my feelings with someone.

          19 / 34

          I get rid of my anger by playing music, writing, or painting. 

          20 / 34

          I just keep busy, until I stop feeling angry.

          21 / 34

          I work off my anger by doing some sport. 

          22 / 34

          I stay on my own to get rid of my anger.

          23 / 34

          I simply get very busy with other things to get rid of my anger.

          24 / 34

          I work off my anger by doing something else, like playing on the computer.

          25 / 34

          I tell myself that what happened is not important.

          26 / 34

          I try to forget what happened.

          27 / 34

          I put what happened out of my mind.

          28 / 34

          I do not want to have to cause trouble, so I keep my feelings to myself.

          29 / 34

          I just wait to feel better.

          30 / 34

          I try to keep busy so I can forget about what happened.

          31 / 34

          I keep thinking about what I wish I had done, but didn’t do.

          32 / 34

          I find it hard to stop thinking about what happened.

          33 / 34

          I am upset for a long time after this kind of situation.

          34 / 34

          In my mind, I go over the situation that made me angry again and again.

          Your score is

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          Are You Kind to Yourself?

          (The Self-Compassion Scale – Short Form, SCS-SF)

          Are you kind to yourself, and accepting of your personality? Self-compassion relates to your ability to ‘hold one’s suffering with a sense of warmth, connection and concern (Neff, 2003). This ability consists of self-kindness, self-judgement, the view that others suffer too (common humanity), feelings of isolation from others when one fails, as well as mindfulness towards one’s difficult situation and the extent to which one over-identifies with failure. This 12-item measure assesses your self-compassion ability. Simply answer each statement from ‘almost never’ to ‘almost always’ to indicate the extent to which you engage in these behaviours during difficult times of challenge and setbacks.

          /12

          1 / 12

          I’m intolerant and impatient towards those aspects of my personality I don’t like.

          2 / 12

          I’m disapproving and judgmental about my own flaws and inadequacies.

          3 / 12

          When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.

          4 / 12

          When I’m feeling down I tend to obsess and fixate on everything that’s wrong.

          5 / 12

          When I fail at something that’s important to me, I tend to feel alone in my failure.

          6 / 12

          When something upsets me I try to keep my emotions in balance.

          7 / 12

          When I’m going through a very hard time, I give myself the caring and tenderness I need.

          8 / 12

          I try to see my failings as part of the human condition.

          9 / 12

          When I’m feeling down, I tend to feel like most other people are probably happier than I am.

          10 / 12

          When something painful happens I try to take a balanced view of the situation.

          11 / 12

          I try to be understanding and patient towards those aspects of my personality I don’t like.

          12 / 12

          When I fail at something important to me I become consumed by feelings of inadequacy.

          Your score is

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          How Mindfully Aware and Attentive are You?

          (Mindful Attempt Awareness Scale; MAAS)

          Being mindful means being consciously, deliberately attentive towards your present circumstances and environment, and being curious and non- judgmental towards the thoughts and emotions that arise as a result of one’s situation. This 15-item measure of mindfulness, called the Mindful Attempt Awareness Scale (MAAS) is designed to assess how mindful you generally are.

          /15

          1 / 15

          I could be experiencing some emotion and not be conscious of it until sometime later.

          2 / 15

          I break or spill things because of carelessness, not paying attention, or thinking of something else.

          3 / 15

          I find it difficult to stay focused on what’s happening in the present.

          4 / 15

          I tend to walk quickly to get where I’m going without paying attention to what I experience along the way.

          5 / 15

          I tend not to notice feelings of physical tension or discomfort until they really grab my attention.

          6 / 15

          I forget a person’s name almost as soon as I’ve been told it for the first time.

          7 / 15

          It seems I am “running on automatic” without much awareness of what I’m doing.

          8 / 15

          I rush through activities without being really attentive to them.

          9 / 15

          I get so focused on the goal I want to achieve that I lose touch of what I’m doing.

          10 / 15

          I do jobs or tasks automatically, without being aware of what I’m doing.

          11 / 15

          I find myself listening to someone with one ear, doing something else at the same time.

          12 / 15

          I drive places on “automatic pilot” and then wonder why I went there.

          13 / 15

          I find myself preoccupied with the future or the past.

          14 / 15

          I find myself doing things without paying attention.

          15 / 15

          I snack without being aware that I’m eating.

          Your score is

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          The brief resilience scale

          (Brief Resilience Scale, BRS)

          The Brief Resilience Scale was created to assess the perceived ability to bounce back or recover from stress. The scale was developed to assess a unitary construct of resilience, including both positively and negatively worded items.

          The possible score range on the BRS is from 1 (low resilience) to 5 (high resilience).

          /6

          1 / 6

          I tend to bounce back quickly after hard times.

          2 / 6

          I have a hard time making it through stressful events. 

          3 / 6

          It does not take me long to recover from a stressful event. 

          4 / 6

          It is hard for me to snap back when something bad happens.

          5 / 6

          I usually come through difficult times with little trouble. 

          6 / 6

           I tend to take a long time to get over setbacks in my life.

          Your score is

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          The Warwick-Edinburgh Mental Well-being Scale

          (WEMWBS)

          The WEMWBS was developed and tested by a group of researchers at the Universities of Edinburgh and Warwick.
          The WEMWBS is used to measure subjective well-being in adults ≥16 years.

          As defined by the developers, mental well-being relates to a person’s psychological functioning, life-satisfaction and ability to develop and maintain mutually benefiting relationships. Psychological wellbeing includes the ability to maintain a sense of autonomy, self acceptance, personal growth, purpose in life and self esteem. Staying mentally healthy is more than treating or preventing mental illness.

          Below are some statements about feelings and thoughts. Please tick the box that best describes your experience of each over the last 2 weeks

          /14

          1 / 14

          I’ve been feeling optimistic about the future

          2 / 14

          I’ve been feeling useful

          3 / 14

          I’ve been feeling relaxed

          4 / 14

          I’ve been feeling interested in other people

          5 / 14

          I’ve had energy to spare

          6 / 14

          I’ve been dealing with problems well

          7 / 14

          I’ve been thinking clearly

          8 / 14

          I’ve been feeling good about myself

          9 / 14

          I’ve been feeling close to other people

          10 / 14

          I’ve been feeling confident

          11 / 14

          I’ve been able to make up my own mind about things

          12 / 14

          I’ve been feeling loved

          13 / 14

          I’ve been interested in new things

          14 / 14

          I’ve been feeling cheerful

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          Role Fitment

          The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

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          Copy - Personality Tests

          SCS(Self Compassion Scale)

          The brief resilience scale

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