There are few life events more stressful, in my considered opinion, than surviving a heart attack. Not only is the actual cardiac event a traumatic and overwhelming experience in itself, but what very few cardiologists tell us before they boot us out the hospital door is how debilitating the day-to-day angst about every little subsequent bubble and squeak can actually be. I can recall, for example, feeling virtually paralyzed with fear over unexpected chest pains following my heart attack (symptoms, I later learned from my cardiac nurse, that are often called “stretching pain” – common in recently stented coronary arteries). These symptoms turned out to be relatively benign – NOT the massive second heart attack I feared they signaled at the time.
David Ropeik teaches at Harvard and is the author of Risk! A Practical Guide for Deciding What’s Really Safe and What’s Really Dangerous in the World Around You. His observations about worry and chronic stress – such as living with heart disease – may ring true for you.
He recently asked his Big Think column readers:
“Want something else to worry about? Worry about worrying too much. The evidence is building that chronically elevated stress shrinks your brain.”
For example, a study* published in the journal Biological Psychiatry asked participants about how often they had experienced stressful events, both recently and over the course of their lifetimes, as well as about their chronic ongoing stress. When researchers took functional magnetic resonance (fMRI) images of their brain, here’s what they found: the more stress, the smaller the brain in several particular cortical areas.
According to Ropeik, stress not only impairs formation and recall of long-term memory and is strongly associated with clinical depression, but – of special interest to heart patients – it seems to bring on a decreased ability to cope with further stressful experiences:
“So not only does the research on stress-associated brain shrinkage suggest that it causes functional mental impairment, one of the problems it appears to cause is the very ability to deal with further stress. This is a really scary positive feedback loop.”
Stress also triggers the body’s endocrine systems, prompting the release of hormones that can irritate lymphatic tissue that in turn alters our immune functions. They might cause the resting heart to beat faster or raise blood pressure and LDL ‘bad’ cholesterol levels. Dr. Daniel Brotman of Johns Hopkins Hospital was the author of a 2007 review paper on emotional stress and heart health published in The Lancet. He explained:
“Anybody who has narrowly avoided a car accident knows how much emotional stress can rev up your cardiovascular system. But having very frequent or ongoing bouts of ’fight or flight’ is not something the human body is designed to do.”
That’s where chronic stressors can become deadly threats to our hearts. Unmanaged stress, especially stress-related anger and hostility, can affect our health. It may cause:
- high blood pressure
- irregular heart rhythms
- damage to our arteries
- higher cholesterol levels
- the development and progression of coronary artery disease (atherosclerosis)
- a weakened immune system
Of course, there’s stress – and then there’s stress.
Clinical stress is caused by, among other things, worrying. There are everyday worries, and chronic worries, big worries and small worries. But worrying of any sort is, essentially, feeling threatened, and that can cause levels of stress-related hormones like glucocorticoids and cortisol to go up.
But Ropeik reminds us that there are many ways to reduce stress, and whole industries that peddle various products and pills and processes to help you stay calm.
“May I humbly suggest one that none of the meditation gurus and pill pushers talk about: understanding how the psychology of risk perception works.”
Ropeik cites researchers who have identified specific characteristics that make some threats feel scarier than the evidence says they actually are. These are the emotional reasons why we sometimes worry too much. Knowing them can help us worry less:
- Risks imposed on us (those other drunk drivers) feel scarier than the same risk if we engage in it voluntarily (driving drunk ourselves, which is actually riskier).
- Risks that involve higher ongoing pain and suffering (cancer) feel scarier than risks which involve relatively less pain and suffering (heart attack, which is actually more deadly).
- Risks that are human-made (nuclear radiation) feel scarier than risks that are natural (carcinogenic radiation from the sun, which is riskier).
If we’re aware of these risk perception factors, we can see how they can contribute to our worries, and we can fight back, at least a little, against those disproportionate fears. We can protect ourselves, at least a little, against the dangers of what Ropeik calls The Perception Gap – the risks that arise when our subjective/emotional risk perception system gets risk wrong.
“We can use that self-awareness as a sort of seat belt for when we drive in the dangerous environment of making subjective choices about risk, which sometimes can lead to dangerous errors, including worrying too much.
Our risk perception system mostly works pretty well to keep us alive, but it’s subjective, and sometimes makes mistakes, judgments that feel right but just plain don’t match the facts. Knowing why we make those mistakes can help us begin to avoid them. Which can help us protect ourselves, including from the risk that worrying too much will shrink our brains.”
There are many more risk perception factors in David Ropeik’s chapter called Why Our Fears Don’t Always Match the Facts, in his book, How Risky Is It, Really? which is available free online.
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* Ansell EB, Cumulative Adversity and Smaller Gray Matter Volume in Medial Prefrontal, Anterior Cingulate, and Insula Regions. Biol Psychiatry. 2012 Jan 2.
See also:
- Heart disease within “the comfort of denial”
- Got a minute? Try this mini-relaxation exercise for your heart health
- Women’s heart disease and chronic stress
- Is everyday stress gnawing away at your arteries?
- “Stress creep”: are you like the frog in the pot of boiling water?
- Do you think too much? How ruminating hurts your heart
- Four ingredients in the heart patient’s recipe for stress
- A heart patient’s guide to the three stages of chronic stress
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Heart Sisters 
I have a big fat bone to pick with the terminology of “anger and hostility”. I would say the chronic stress women would be more likely to feel is from abuse (subtle/gross), victimization and the “double-bind”, lose-lose either way, in the game of life. Sadness is what underlies anger. Because male stress is more often expressed as “anger and hostility” vs these other states, and just coincidentally, heart disease research focused on males for oh, say, 50 years or more, I believe the types of stressors females have encountered since time immemorial are equally destructive and ill-defined.
So what is the answer? For my own self, I found that EMDR (Eye Movement Desensitization and Reprocessing) was quite helpful in neutralizing some memory circuits of the emotions involved, though some still remain. It is also true that the heart disease/chronic disease epigenetic snowball starts rolling at a much earlier time than we may suspect, allowing disease to take hold. Clonazepam is also very helpful, but I wonder if I am furthering the depletion of the resiliency of my insula by relying on it, which your reference points to. I feel less capable of withstanding the demands over time. Whether that is the disease process or a result of the drug compensation, I don’t know.
I find your references to the INSULA to correlate with my own readings on the brain, particularly the right side, which seems to govern the regulation of autonomic processes (such as vasomotor response, fight or flight, heat, cold, exertion-emotion), according to Dr. Bud Craig’s work at the Barrow Neurological Institute. See his presentation to neurological fellows in Sweden, particularly after 35 minutes.
Insula as a starring role is not well appreciated in the heart disease experience, yet I believe it holds the key to why these very body states become so distorted, though we try to regulate the cardiological behavior with “cardiology” targeted drugs. Perhaps because this part of the brain becomes or is dysfunctional and can experience its own downward cascade and become unmanageable as related to heart symptoms.
The insula is under-appreciated and little is known or agreed upon theoretically, within cardiology or just brain science. Progress is occurring.
Thank you for finding more threads to weave together on a practical basis!
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A thoughtful perspective as always, Mary. Even the classic “fight or flight” stress response we’ve all heard about is largely a male reaction, according to a landmark 2009 study published in the journal, Psychological Review.
Until then, scientists generally believed that severe stress triggers a hormonal cascade that revs the body to either stand and fight, or try to flee. But this study suggests that in women, however, the oxytocin released as part of our unique stress response buffers the fight-or-flight response and encourages what’s called a “tend-and-befriend” response to stress.
There well may be these gender differences, but perhaps the outcomes (brain changes) are similar no matter who is experiencing chronic stress.
regards,
C
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