Stress Management and Stroke
Hello! I am Elijah today we are going to speak about stress management as it relates to your stroke.
Agenda
The order of the presentation will proceed as follows:
We will define stress, discuss the importance of stress management and explain the body’s natural response to stressors. Then we will discuss common concerns faced by survivors of stroke leading to increased stress followed by an explanation how chronic stress impacts recovery. Lastly, we will describe helpful intervention to address and mitigate stress and identify helpful people in your support system with whom to discuss your stress.
What is stress?
The World Health Organization defines stress as a state of worry or mental tension caused by a difficult situation. Stress is a natural human response that prompts us to address challenges and threats in our lives. Often after major life events, individuals tend to prioritize addressing their physical health rather than emotional health on their path to recovery. I believe that it is important to consider stress management because stress related mental health disorders are significantly greater in stroke survivors compared with the general population. Moreover, stroke survivors report experiencing persistently high levels of stress which are associated with poorer long term health outcomes. Stress can be internal or external, positive or negative, actual or perceived. Stress can be cumulative and continue without relief.
Biological Responses
The biological process of stress starts when an area of the brain that contributes to emotional processing called the amygdala sends a distress signal to the hypothalamus which acts as your body’s command center by communicating with the rest of the nervous system whether to engage in “fight or flight”. The hypothalamus communicates with the autonomic nervous system responsible for involuntary reactions such as breathing, heart rate, blood vessel dilation, and heart rate. The autonomic nervous system controls the sympathetic nervous system which gives the body the energy it needs to respond to potential threats, as well as the parasympathetic nervous system which takes the body through a “rest and digest” process after recognizing the threat has passed. In other words, if the sympathetic nervous system were a gas pedal, the parasympathetic nervous system is the break. During this very quick process, the body experiences an increase of adrenaline and cortisol to the bloodstream so that the individual can focus on only the bodily systems responsible for addressing the perceived threat. These typically reduce once the stressful event ends. What happens if an individual perceives the stressful trigger to always be present or does not find a healthy way to manage it? Long term exposure to the stress response system can be detrimental to one’s health. For example, high adrenaline and cortisol levels correlate significantly to high blood pressure, high blood sugar, a suppressed immune and digestive system.
Common Stressors in Stroke Survivors
Emotional changes are common after serious life events such as stroke and it is important to advocate for yourself to others so that they are aware of your stressful triggers. For many people immediately following a stroke, it is common to stress about the unknown. In this case, it may look like a constant state of worry about personal gains, unfamiliarity with stroke implications on daily activity, or uncertainty with long-term support services. Additionally, many stroke survivors have spoken to their personal experiences with significant stress related to the impact their stroke has made on their caregiver.
Long-Term Effects of Chronic Stress
For many stroke survivors, the recovery process includes episodes of anxiety characterized by restlessness and difficulty concentrating, depression, heightened irritability, lethargy, and emotional latency. It is important to understand how these factors impact one’s health outcomes after having a stroke, as well as how they diminish motivation necessary for the recovery process. Moreover, chronic stress in stroke survivors often correlates with poor medical adherence, slower recovery, higher mortality, and the need for more intense caregiver assistance due to its ability to worsen pre-existing health conditions.
Impact of Stress on the Recovery Process
Motivation: Perceived psychological stress has negative effects on emotion, mood, and memory which are vital processes for motivation. This often leads to feelings of hopelessness if not managed in a healthy manner
Poor Medical Adherence: Due to the impact of chronic stress on memory and focus
Increased Caregiver Need: Unhealthy coping mechanisms such as alcohol and substance abuse, lack of motivation to be an active participant in their own recovery process leading to muscle weakness.
Higher Mortality: As mentioned previously, the body naturally enters a state of ‘high alert’ during stress and chronic stress can lead to increased risk of cardiovascular disease due to the rise in heart rate and blood pressure.
Interventions
Mindfulness: Deep breathing and meditation draws your focus inward to lessen the stress by reducing activity in the amygdala and slows down the release of cortisol, the stress hormone, from the adrenal gland. This could be beneficial for decision making and mood. When meditating, you can start with one minute in pure silence and try building up to more time.
Journaling is a great grounding exercise to increase focus and introspection and can also be beneficial for increasing positive thoughts.
CBT: Individuals tend to magnify or minimize an event in their life leading to a cognitive distortion of reality. Cognitive restructuring aims to help people disturb negative thought patterns through cultivating more positive and functional thought habits. In this way, the individual may find that their thoughts and perception of stress may not be an accurate representation of reality. Cognitive restructuring can be a tool to address potentially harmful perceptions of self, others, or events.
Diet and Exercise: A healthy diet without toxins such as alcohol or nicotine can help reduce stress. Movement helps increase blood flow and deepen your breath while also giving the individual an opportunity to feel their body and return to a calm state. It is important to know your limitations so that you do not push yourself towards exhaustion. Examples include yoga, Pilates, or walking. According to the American Heart Association, it is recommended to reach at least 40 minutes of moderate aerobic activity a week or 20 minutes of vigorous activity.
Fostering Healthy Friendships and Relationships: Social participation in supportive environments to reduce potential feelings of isolation brought upon by life changes can be a helpful way to reduce stress.
Support System
Physicians can be helpful for early detection of symptoms associated with chronic stress and can provide health education about stress management.
Psychological Therapists can work with the stroke survivor to identify causes and complete psychological assessments to inform the individual’s best course of action.
Speaking to your caregiver and family about specifically what is leading to increased or prolonged stress. Having someone that you are confident in to listen non judgmentally and with greater context to your personal life. Additionally, your family and caregivers have the greatest amount of insight into your daily personal lives and can help you make any lifestyle modifications.
