Tears may be dried up— But the heart, never.
—Marguerite de Valois
What makes a healthy heart? Certainly a healthful diet that includes Omega 3 fatty acids, regular exercise, adequate sleep, very moderate alcohol consumption, and no smoking. But did you realize that your emotional health is actually a better predictor of heart health than your other healthful habits?
Scientist William Harvey (1578-1657) noticed a connection between heart and emotional health as early as 1625. Early physician William Osler said that the typical heart disease patient is “a keen and ambitious man, the indicator of whose engine is always ‘full speed ahead’.” Of course, to any woman reading Osler’s observation, it is clear that things have changed for our gender; today, heart disease is the leading cause of death for today’s woman, who seems always on the go and buffeted by conflicting demands.
Even so, the connection between emotions and heart disease is somewhat poorly understood. Anger, depression, anxiety, loneliness, and constant stress are the feelings that researchers have identified as putting women—and men—at risk for heart disease. Researchers and cardiologists Dr. Meyer S. Friedman and Dr. Ray Rosenman are credited with coining the term “Type A Personality” in the 1950’s as basically an angry person who possesses three traits: free-floating hostility, impatience, and insecurity. “Trait anger” has also been associated with sudden cardiac death. People who score high on hostility scales more rapidly develop atherosclerosis. Perhaps most frightening of all, a Harvard study shows that 1 in 40 heart attack survivors experienced an “episode of anger” two hours before their heart attack.
For women, perhaps the most pertinent emotional experience associated with heart problems is depression, because depression is much more common for women than for men. A recent study demonstrated that patients who were depressed were three times more likely to die in the year following a heart attack. Also, women were twice as likely as men to develop depression after a heart attack.
Many people think of a depressed person as someone who is so deeply sad, hopeless, and lethargic that they are unable to function, but this is not so. There is also minor depression, in which a person has only a few symptoms, and dysthymia, a low-grade level of depression that continues for two years or longer. Depression can also occur after a major life-changing event such as a move. Finally, depression can be caused by a medical condition, such as multiple sclerosis or diabetes.
The problem with depression is that a woman who is depressed is less likely to notice her physical symptoms, or to do anything about them. It is well known that people who are depressed have trouble complying with their doctor’s orders, including taking medication. A depressed woman is less likely to exercise or eat a healthful diet. All of these factors can lead to ill health, including heart disease.
Anxiety and chronic stress can also precipitate heart disease. Anxiety may be generalized—in other words, a person may worry and feel keyed up—much of the time, no matter what is happening, or it may be specific, as in a phobia of some kind. Obsessive-compulsive disorder, as well as its associated personality disorder, is also a manifestation of anxiety. Intense anxiety can trigger cardiac arrest as the heartbeat abruptly turns fast and uncoordinated. Fortunately, anxiety is one of the easiest problems to treat, and for most people it can be managed without medication.
Chronic stress—work woes, financial problems, troubled marriage, caregiving, and even environmental stresses such as natural disasters—have also been linked with the development of heart disease. In my practice as a psychologist who teaches people ways to manage stress, I can say that the problem for most women is “must disease,” as in “I must do everything—today!—and I must do it well, and I must please everyone.” The only “must” in my mind is that women must learn to relax!
Further proof that anger, depression, anxiety, and stress lead to heart disease comes from the improvements that occur when these states are treated. The well-known Recurrent Coronary Prevention Project studied over 1,000 men and women who received routine medical care and group counseling about risk factors, or care plus group therapy to modify Type A traits. Those who attended group therapy had a whopping 44% reduction in second heart attacks. A similar longitudinal study demonstrated that not only do people who receive stress management have a significant reduction in second cardiac events, they also save an average of $1,228 in medical costs per year.
A whole-person approach to cardiac disease prevention is critical. When anyone recommends that you see a behavioral health specialist—a mental health practitioner who specializes in mind/body approaches—to help in your quest for better health and a longer life, take heed. Don’t make that well-meaning person wheedle, cajole, and beg you to do something good for yourself. Remember “must syndrome”? That seems to include putting everyone else’s needs first. Women must learn to recognize the signs that they need help managing stress or anger, or ending depression or anxiety.
Here are some concrete tips that you can implement today to help strengthen your emotional health:
- Understand what triggers a stress response for you. Either eliminate the trigger or find new ways to cope.
- Develop a daily relaxation practice: yoga, meditation, journal writing, biofeedback, guided imagery, walking, etc.
- Limit exposure to negative people and events.
- Develop an optimistic outlook. You don’t need to be a Pollyanna, but when the odds are with you, you have every right—and deserve—to feel positive.
- Increase positive social support. Join a club, volunteer, get active in church, etc.
- Talk to a psychotherapist if you have stress, anxiety, depression, or excessive anger that doesn’t resolve within a few weeks after your efforts to change.