Carlye Weiner Psychologist Overview What is trauma Post Traumatic Stress Disorder Trauma in heart conditions Trauma and the brain Mindfulness Emotional Recovery Realistic Expectations Coping and good self care ID: 1045118
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1. Emotional Wellbeing and Heart HealthCarlye WeinerPsychologist
2. OverviewWhat is trauma?Post Traumatic Stress DisorderTrauma in heart conditionsTrauma and the brainMindfulnessEmotional RecoveryRealistic ExpectationsCoping and good self careAwakenings – Existentialism, insights and reflectionsIntimacy and relationshipsBody imageSex life adviceSupport for partners
3. What is trauma?‘Little t’ – eg parents separating, pet dying, best friend moving overseas, absent parent‘Big T’ – threat to life (perceived or actual)Either way, trauma ruptures your understanding of yourself and the world
4. Post Traumatic Stress DisorderRe-experiencing symptoms; eg unwanted thoughts, nightmares or flashbacksAvoiding reminders or resemblances of the event Intense or increased physiological arousal (e.g., hypervigilance, exaggerated startle response)Negative changes to mood or thinking patterns (including concentration, learning, etc)*Can be immediate or delayed-onset*Symptoms need to last longer than one month*Symptoms need to cause significant impairment or distress*Symptoms cannot be explained by a medication or other illness
5. Some Scary Numbers~4-8% occurrence of PTSD in the populationStudies suggest a 4-24% occurrence of PTSD in acute coronary syndrome~20% occurrence of PTSD with ICD implantation19-38% occurrence of PTSD with those who have had a cardiac arrestSymptoms tend to reduce over time even without interventionDepression rates: 14-45% (vs 10-16%)Anxiety: 13-60% (vs ~20%)
6. Impact on Physical HealthPTSD <--> cardiac eventsElevated PTS symptoms result in higher likelihood of re-admission for cardiac reasonsSympathetic Nervous System involved in both heart health and traumaReduced likelihood of medication adherence with PTS symptomsDelay in seeking treatment (?avoidance)
7. Trauma as lossLoss of sense of safetyLoss of understanding of the worldLoss of prediction and controlLoss of functioningLoss of independenceLoss of trustLoss of abilityLoss of sense of immortalityLoss of faithLoss of calm
8. Grief
9. Internal vs External Sensory SystemsTwo systems:Internal system - Interoceptors – heart rate, breathing rate, vital organs and digestion - Proprioceptors – balance, muscle tension, place in spaceExternal system - Exteroceptors – sit near the surface of the skin; receive touch, sight, hearing, taste, smell
10. StimulusDr ThalamusRelays information from the sensesFast pathway“Hippo on campus”Cortex - “thinking brain”Logic and reasoning“Amygdalabangdalaboom”Emotion centreMemoriesSlower but more accuratepathway+ + +
11. During a Traumatic Memory
12. Mindfulness…Paying attention to the present moment, and accept it, curiously, without judgement
13. Your Task…Spend the next 5 minutes being mindful with an object in the box in front of you…
14. What is Emotional Recovery?
15. Realistic ExpectationsAfter 12 months: 34% improved mental health, 50% similar, 15% poorer mental health than before surgeryPhysical condition directly affects mental conditionPhysical comes first. Sorry, biology says so!But there are things you can do to help your emotions process themselves along the way
16. Returning to Work54-80% return to work 12-13 months laterDepressed mood and denial are major predictors of returning to workWomen tend to return to work later or not at all compared to menWomen tend to return to domestic duties sooner than indicated
17. Practice ‘self care’ – ie soothing activityExercise, change of routineEat healthy, manage fluidsGet plenty of sleepMindfulnessDelegate – including apps, reminders, Webster packs, etcQuotes, images, inspirationConnect with othersSpend time aloneSpend time with nature or animalsCry, be devastated, catastrophiseGood Psychological Care
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19. AwakeningsExistentialism – who am I and why do I exist?- Unlocking the key to find meaning
20. Your JourneyAre you:Re-imagining…Re-evaluating…Re-assessing…Or simply, Recovering.
21. Break
22. Role of spouses in cardiac recoveryNumber one predictor of psychological recovery is social supportPartners typically have HIGHER anxiety and depression levels than patients!Partners feel less in control of the situation than patientsPartners’ mental health and wellbeing is directly related to patients’ adjustment to illness
23. How the partner relationship is affected:Five themes:OverprotectionCommunication IssuesSexual ConcernsChanges in Domestic RolesAdjustment to illness
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26. Let’s Talk About Sex BabySome couples report “modest” interference with sex life30% of heart failure participants said all sexual activity had ceased60% report prolonged effects to sex lifeReasonsFear – especially with ICDHypervigilance/ overprotectionMood (esp depression)Sexual dysfunction due to physical limitations or medication (esp beta blockers)
27. True or False:Exertion during sex is equivalent to walking up two flights of stairs
28. True or False:Having sex increases your chance of a heart attack
29. True or False:Following climax, your heart rate and breathing rate settles after about 6 minutes
30. True or False:Missionary is the safest sexual position after sternotomy
31. True or False:Women have more fears about returning to sexual activity than men
32. Body Image and ScarringMake positive statements a priorityLearn to look in the mirror and focus on strengthsYou are more than your looksFollow: Life After Surgery Project, Beating Hearts, Scars Are Beautiful Project, Six Times Open, Under the Red Dress ProjectHashtags: #ShowYourScars #BehindTheScars #EffYourBeautyStandards #ZipperClub #ZipperClubMemberhttps://www.youtube.com/watch?v=KyUupMamiic
33. RecommendationsCheck with a medical professional firstIf exercise is safe, so is sexual activityResume as soon as you feel able toBe mindful during your initial returnGet creative with comfort levels – FitBit, HR monitor, tactical rest!Take a mild pain killer prior (esp women)Avoid caffeine, smoking or alcohol before or afterAvoid having a big meal less than 2 hours beforeChoose positions that avoid strain (esp on sternum)Extra pillows – behind, underneath, even on sternumSmall steps to build confidence gradually (think cardiac rehab for the bedroom!)Do other exerting activities together – eg walks, exercise, scary moviesFoot massage!
34. For Partners:Be patient, don’t pressure or overprotectManage your own emotionsHelp with open communication – start firstAsk what they would like doneCheck in on how things have changed, how each are adjusting or copingGive your partner a job to do to help them feel useful
35. Activity - SymbolsCouples/ Carers:Self Care:
36. Accessing SupportHeart Foundation BlogSupport Young Hearts – FacebookSocial work/ psych department at health centre/ hospitalMental health workers – social workers, psychologists, mental health OTMental Health Care Plan and Chronic Disease Management Plan via GPTele-health now available for regional areas
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