Stress Awareness for CHD patients and families: Dr Rachel Avison

Since its launch in April 1992, Stress Awareness Month has been encouraging people to be aware of the signs of stress and ways to manage it.

We spoke to Dr Rachel Avison – Senior Clinical Psychologist at Leeds Congenital Heart Unit, to ask for her thoughts and advice on stress.

Read on to find out ways to help you, your family and even friends manage stress when life gets difficult.

All about stress

What is stress?

“Stress is a physical and emotional reaction to feeling under threat, be it a sudden and traumatic event or the pressure of day to day life.

It’s a normal response and we all encounter symptoms of stress from time to time. Though stress is not dangerous, enduring it for a long time can be bad for our physical and mental well-being. It’s important we can recognise the warning signs and are able to find ways to self-care.”
What are the signs of stress?

Physical symptoms

“We have an inbuilt survival system to help us when feeling threatened. The brain releases stress hormones (such as adrenaline) that may lead to physical responses, which are normal.
 
For example, you may notice things such as tight muscles and a faster heart rate.
 
This instinctive response prepares us for ‘fight’ or ‘flight’ (run away). However, modern stressful life events, like preparing for surgery, are not usually helped by this!”
 
“Common physical symptoms of stress are:
  • Muscle tension
  • Headache
  • Churning stomach
  • Bowel and bladder problems
  • Racing heart
  • Tiredness or exhaustion”

Psychological symptoms

“Sometimes feeling these common physical responses triggers worried thoughts. This, in turn, creates more stress and more bodily symptoms, creating a cycle of stress that can impact your emotional well-being.”
 
“Common emotional symptoms of stress are:
  • Worried thoughts, fear and panic
  • Feeling overwhelmed
  • Irritability or angry
  • Withdrawing from or avoiding people and activities
  • Feeling low in mood
  • Being self-critical” 
What causes stress?

“Stress varies widely from person to person. It could be external – the things that happen to us and around us that affect our feeling of control, such as coming into hospital.

Stress can also be internal – what happens inside us, both in the ways we feel physically and our thoughts, feelings and behaviour.
 
Stress is often a combination of external and internal factors, which create a vicious cycle.”
How can you manage stress?
“It’s not always possible to avoid stress but learning more about it helps you understand the causes and reduce its impact on your physical and emotional health.
 
As the response to stress is often physical, our body is one of the first things it affects. Try using the following relaxation techniques to help you to slow down and regain a feeling of control over uncomfortable physical feelings:
  1. Controlled breathing – find a quiet place to spend a few minutes taking deep slow breaths, if possible, breathe in slowly through your nose aiming to fill your lungs, then breathe out slowly through your mouth, then repeat. Do this as many times as needed until you feel calmer.
  2. Deep muscle relaxation – this aim of this exercise is to tense, hold and release different muscle groups in the body. For example, stretching your arms out above your head, holding for a few seconds and then bringing them slowly to your lap. Notice how your arms feel when they are relaxed, you may be able to feel a release of built-up tension. When ready, move on to different muscle groups, such as your shoulders and hands.
  3. Mindfulness – much of our stress is linked to thoughts and feelings about the past and the future so focusing on the here and now can be very helpful. Mindfulness involves calm awareness, so allowing thoughts and feelings to come and go non-judgementally and returning focus to the present moment.
  4. Exercise – regular exercise such as walking, cycling and sport can be a great way to relieve stress and physical tension. Not only does exercise reduce levels of the body’s stress hormones, it stimulates the production of our body’s natural feel-good hormones.
  5. Hobbies – anything we do that absorbs and interests us can help reduce the physical effects of stress on the body. Hobbies can refocus our minds and distract us from stressful thoughts and feelings, boosting our self-esteem and encouraging feel-good hormones.
  6. Self-care – this is about making time to look after you. Finding ways to nurture and soothe yourself is very important at times of stress. Be it relaxing in a warm bath, having time out to read a book, seeing close friends or going for a walk, anything that helps you to slow down and feel calmer is beneficial.”
“The good news is that because our mind and body are linked, the above strategies all help to calm our thoughts and feelings. Here are a few other useful things to try:
  1. Soothing self-talk – we can be very good at supporting others emotionally but hard on ourselves for feeling distressed. Soothing self-talk involves being our own ‘wise friend’ and comforting ourselves rather than being negative or judgemental. For example, not comparing yourself to others, aiming for ‘good enough’ rather than perfection, reminding yourself that you have coped with challenges in the past.
  2. Self-awareness – being aware of our stress levels allow us to put in place strategies, such as being organised to give us a feeling of control, breaking challenges down into smaller components and slowing down by being realistic about what we can actually take on. Remember, it is okay to say ‘no’ and to put your own needs first.  
  3. Talk to someone – sharing worried thoughts, dilemmas and struggles with others we feel able to confide in and trust can help us to process stress. Often, people feel able to share feelings with close friends and family members; however, if this does not feel possible, there are support services available to offer confidential emotional support.”
Where can I get further support?
“You are welcome to contact the Cardiology Counselling and Psychology Service on 0113 3926796 if you would like to discuss arranging confidential, emotional support for yourself or a family member.
 
We support patients and family members under the care of Leeds General Infirmary Adult and Paediatric Congenital Cardiology Department.
 
You can also discuss accessing psychological support and counselling via your GP or contacting your local IAPT service (Increasing Access to Psychological Therapies).”
 
“And finally, there are a number of useful websites with advice, top tips to manage stress and free resources available, including the following:
Thanks for speaking to us Dr Avison!
Remember if you need to get in touch with the counselling and psychology service, you can call them on 0113 3926796.

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