By Dr. Stephen E. Walker, PhD, CC-AASP
Have you ever wondered how your thinking might influence your physical health, performance or well-being? In the second quarter issue of 2005, research was presented by Dr. Alan Rozanski in the Journal of the American College of Cardiology focused on developments in the field of Behavioral Cardiology. This article reviewed research on the origins, physiology and impact of emotional social chronic stress risk factors on the development and course of heart disease and stroke.1
Rozanski offers a strong review of the literature that illustrates how depression, anger, anxiety, marital discord, occupational stress, and Type D personality traits are associated with those emotional catalysts that hurry us along toward a heart attack. We all have some kind of a genetic set point for heart disease that comes from our family history. As for stress and the role that emotions play, it is clear that emotions are among the culprits that trigger chemical shifts in our blood so it becomes toxic to the endothelium that lines the arterial walls. But how?
Readers seeking clarification as to how much of this disease is attributable to our poor choices in diet can take heart. Dr. William Roberts, editor-in-chief of the American Journal of Cardiology, is more inclined to focus on our poor choices in diet. He states, “Of the 6.5 billion people on this planet, 5 billion will never have to worry about heart disease because their diets contain no meat, and it matters little whether they exercise.” As such, he is a champion of cholesterol lowering medications in the Western world and EBCT heart scans which provide a coronary calcium score…”to date, the best measure of coronary vascular disease (CVD) in people without symptoms.”2
Cardiac Psychology does focus on the modification of diet, smoking, obesity and maladaptive behaviors that increase our risk of heart disease. But, for those who try to limit their intake of meat, exercise regularly and otherwise try to maintain a healthy lifestyle…stress is the X factor, and one that implores us to manage our emotions more conscientiously, especially since we can not alter our genetic imprint. It is the stress hormones that accompany the booms and crashes in our disposition. When these are added to the by-products of the food choices we make, metabolic disease ensues damaging the endothelium of our arterial walls. In a huge percentage of people this process also triggers inflammatory agents that surge through our blood producing pockets of plaque throughout the system. The process quietly evolves over many years until Inflammation, “sticky” platelets and an unstable piece of plaque ruptures. Then the party begins in the form of a “cardiac event or stroke” usually in an unsuspecting victim. Every 4 minutes someone dies experiencing their very 1st cardiac symptom. The truth of the matter is that the disease takes a long time to develop, and if we were more attuned to prevention and early diagnosis in the United States, we’d probably have prevented a lot of heart attacks.
Our Self-talk reveals the Mind/Body connection.
Having practiced psychotherapy for several years it is clear to me that no one is immune to “negative emotions.” Virtually all of us have a “bad day now and then.” However, the problem becomes more pronounced when you realize that many of us have “never had a good day” as emotions are concerned. There is sparse relief in our diversions too, as the most popular television shows in every market are the local news….followed by CSI, CSI Miami, CSI NY, NCIS, etc. Want to relax tonight and watch some television? Let’s see…we can hear about murder and mayhem that have actually become the news in our neighborhoods, or we can see dramatizations of it on every network.
Psychologist Dr. Johan Denollet, from Tilburg University in the Netherlands, has developed a psychological test called the DS14 that helps measure the nature and influence of the chatter in our own minds. The term chatter refers to the way in which we talk to ourselves, our self-talk. This internal dialogue is significant in that it is ongoing and characteristic of our emotional experience and affect. It is sensible for us to examine the quality and distinguishing features of that inner dialogue.
Do you often make a fuss about unimportant things?
Do you often feel unhappy?
Are you often irritated?
Do you take a gloomy view of things?
Are you often in a bad mood?
Do you often find yourself worrying about something?
Are you often down in the dumps?
While reviewing these questions we likely recognize patterns in our own self-talk. If our chatter is comprised of self-talk that favors these descriptors; making a fuss, unhappy, irritated, gloomy, bad mood, worrying, down in the dumps…our negative affect and corresponding behavior could be contributing to the production of the stress hormones we talked about earlier. Furthermore, additional items in the DS14 examine the extent to which certain people become socially isolated and what that might mean to our overall health. Denollet explores social patterns such as the tendency to keep to ourselves, avoid social supports, difficulty making social contact and/or communicating with others.
Negative thinking is clearly a problem, but there is another corresponding concern that complicates the situation even more so. Many of those who characteristically think negatively are prone to have few friends and rarely engage socially with others. Perhaps the negative thinking has pushed others away, or maybe their irritability and agitation unduly effected their ability to network amongst coworkers neighbors or teammates. Whatever the case, if someone is deprived of exposure to others who think differently, or they are stuck within their own little pessimistic world…their incidence of heart disease is increased significantly. So ask yourself, “Do I shy away from developing social relationships? Do I tend to stick to myself and avoid communicating with others? If so, much of the literature indicates that a prevalent experience of negative emotions and the tendency toward social isolation intensifies your risk of a heart attack. Denollet’s research has identified negative affect and social isolation as noteworthy risk factors for CVD.³
So, What Can We do About it?
Pretty much all of us have been on a job interview. We tailor our resume and take the time to craft a good cover letter. Realizing the importance of a good first impression, we dress well, think positive thoughts, rehearse answering questions, focus on the positive attributes we can bring to the job…and we probably deemphasize those things that won’t help us much. We have to work at it but like any other life skill, practice helps us groove the thinking pattern. Remember when you first learned to drive a car and how uncoordinated it felt in the beginning? How much focused attention did it take? Now, it is likely that the basic driving skills are so well integrated by pattern and routine that they hardly require deliberate concentration. These things are guaranteed…if we emphasize a positive outlook and practice a good attitude, we are inclined to develop one. Our genetic predisposition may not make us an optimist, but the development of skill sets and consistent practices will engender in us a positive attitude and the ability to make conscious choices.
Dr. Karen Mathews was recently honored with the American Psychological Association’s award for distinguished scientific applications in the literature on this topic and offers us substantive data to suggest that “optimists are less likely than are pessimists to exhibit the common progression of this disease over time.”4 Other research linking patience, discipline, and close friendships…in addition to…emotional competence (the ability to regulate emotions across a range of situations) have been encouraging to say the least. Studies of professional, marital, interpersonal, and life enrichment activities that require effort but that also promote joy, engage people’s curiosity and provide meaning in life serve to enhance vitality and flexibility.5 The protective effects of these positive coping skills, impulse control, and strong social support are beginning to emerge in the literature of psychosomatic medicine, positive psychology and the writings of mainstream health advocates.6 Harvard psychologist, Daniel Gilbert, who is a leader in this field responds to those who question this kind of research with, “Why on earth would one want to study anything else?”7
Want to give it a try? Take an inventory of who you currently spend the most time with. Think about the nature of your exchanges and the degree to which you are able to think positively after each conversation. If they are important to you, share this article with them and see if they might be willing to “experiment” along with you. Put a chart together of those you consider the most positive and encouraging influences in your world and make it a point to get together more often. Notice people who are kind, loving, competent leaders, avid students of something, those who show persistence, creativity, are fair-minded, or likely to savor a beautiful scene or have a blessing to share. They are in your world for a reason so take the time to discover what good can come from their contribution to your life…and remember to practice, practice, practice.
The top 10 list of things you can do right now, to begin shifting the “emotional” momentum in your life:
1. Take the time to meditate for 20 minutes everyday on your life’s blessings and those things for which you are thankful.
2. Monitor carefully what you watch on TV and notice how you feel afterward.
3. Go to a comedy club, or a funny movie and laugh out loud.
4. Find a comic strip that you like to read, and follow it everyday.
5. Listen to music that is relaxing and yet inspiring (Chopin, Schubert, Springsteen)
6. Make a list of the most “important” things in your life.
7. Make a list of the most “important” people in your life…..tell them so.
8. Think about the last time you were so captivated while doing something, you lost your sense of time completely. Do it again.
9. Intentionally gravitate toward folks who are curious, have a zest for life, are thankful, hopeful, optimistic, & loving.
10. Practice modeling these same virtues for yourself, your coworkers, and your children.
Special bonus suggestion: Log on to Dr. Martin Seligman’s Positive Psychology website: www.authentichappiness.org and take 2-3 inventories that measure your signature strengths & current level of happiness.
1) Rozanski, A, Blumenthal, J, Davidson, K, Saab P, Kubzansky L, “The Epidemiology, Pathophysiology, and Management of Psychosocial Risk Factors in Cardiac Practice”, J Am Coll Cardiol 2005;45:5:637-651.
2) Roberts, W, “Aggressive Testing for and Treatment of Heart Disease and Stroke”, Seminar Proceedings, Denver, Colorado, Nov.19, 2005.
3) Denollet, J, DS14: “Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality”, Psychosom Med 2005; 67:89-97.
4) Mathews, K, “Psychological Perspectives on the Development of Coronary Heart Disease”, Am Psycholgst 2005; 60:8:783-796.
5) Bonanno, GA, Papa, A, O’Neil, K, Westphal, M, Coifman, K, “The Importance of Being Flexible; The Ability to Enhance and Suppress Emotional Expression Predicts Long-term Adjustment.” Psychol Sci 2004;15:482-7.
6) Gross JJ, “Antecedent and Response-focused Emotion Regulation: Divergent Consequences for Experience, Expression, and Physiology.” J Pers Social Psychol 1998; 74;224-3
7) Gilbert, D, Stumbling on Happiness, Knopf A, NY, 2005