Sometime ago I asked members for their help and input in putting together a short talk to present at a local support meeting for newly diagnosed AFers and lots of you chipped in - thank you all.
The meeting happened today and hopefully it will be run again in about 6 months or so.
Several people asked if I would post the notes of my talk - so here they are, not word for word so not a transcript but a reasonable representation - I hope.
AF - Talk - Anxiety - 15th Dec, 2017 - Exeter
It would be unusual not to have some concerns on the immediacy of what might happen next when newly diagnosed! Especially if you have previously been fit fit and healthy.
I would like to offer you today is a brief summary in simple language of the physiology of Anxiety and introduce to a few helpful exercises which can help you with anxiety.
I found as a practising Psychotherapist, that a simple explanation of the way our bodies are programmed to react to what is often called our Fight, Flight or Freeze reaction can often help understanding of what is happening physically and that alone can help.
If you know you are anxious then I would encourage you to do some of your own research - We haven’t the time today to go into a lengthy explanation of the ANS - Autonomic Nervous System but the clearest and most detailed explanation of how the ANS directly affects the heart I found on YouTube - a lecture & illustration by a neurologist by the name of Armando Hasudngan - Google Neurology - Autonomic Nervous System.
The ANS is split into 2 parts - the Sympathetic which when stimulated, programmes the body to go into Fight or Flight mode.
And the Para-Sympathetic which is often called the Rest & Digest because this mode is when digestion of food and extraction of nutrients from food is most efficient.
Most of the time we go through our days unaware of these operating systems - when in balance we can function.
Things tend to go awry when we become aware of these systems because something has either triggered the Sympathetic system to go into alarm or Fight or Flight mode or the Parasympathetic Rest and Digest system doesn’t kick in when we want to relax. And there can be many reasons for that.
There should be a balance between the 2 systems and this is often referred to as - Vagal Tone. If you have good Vagal Tone - your systems will be in balance.
Low vagal tone and one system which dominates the other can cause various physical symptoms, especially in the digestive system and directly affect the electrics of the heart. The good news is you can help to improve your vagal tone - but that is for another day - lets get back to anxiety.
I find there are 2 distinct parts to anxiety - the physical symptoms of anxiety which are sensations in our body and the emotional and psychological side - the fear, the worry, the sadness.
????? - How do you know you are anxious??????
List of common symptoms
Dry mouth or excess saliva
Faster Heart Rate
Problems sleeping or relaxing and ‘switching off’
Muscle tension causing aches and pains especially in the neck and shoulders and head
Stomach upsets - feeling the butterflies - nausea
Excess production of saliva and sweat
An ‘adrenaline rush’ feeling throughout the body
Every day expressions for fear and anxiety
Everyday expressions which indicate we are anxious :- Sick to my stomach……….Butterflies in my stomach……All of a jitter.............I cant switch off……….Cat on a hot tin roof etc etc
The Mayo Clinic also lists common symptoms of Anxiety as - feeling nervous, powerless and weakness as well as a sense of impending doom or danger.
A preoccupation with stressful thoughts - not being able to ‘quiet’ the mind.
There is appropriate anxiety - an acute reflex reaction which bypasses the cognitive (thinking part) part of the brain and is instinctively reactive to stimuli - we have little or no control of this reflex. It is very useful if you are about to be eaten by a predatory animal - it is the Fight, Flight or Freeze reaction which helped humans to survive in the wild. It helps the body to shut or slow down all none immediately essential functions such as digestion and conscious thinking by re-directing blood flow from internal organs to the muscles - ready to fuel them for action, to run away or fight. After the action the body returns to ‘normal service’ and the we come back into rest and digest mode. And that is what humans used to do - short bursts of intense activity and then a lot of resting and a bit of digesting.
Chronic anxiety happens when the Sympathetic system ‘off’ switch doesn’t work. We can’t or won’t ‘switch off’. We find it hard or impossible to rest and relax and digest.
Chronic anxiety, even at low levels, is insidious, dangerous and damaging to our general health and wellbeing.
Unfortunately we are our own worst enemies here because unlike many other animals - our brains are so developed that even when a danger is not immediately present - we invent one!
Inappropriate stress, worry thoughts, anxiety harms us and when you have AF it is very easy for us to get into a self fulfilling prophecy when we have persistent worry thoughts about having an AF episode - as we know stress may be a trigger for an AF episode.
Anxiety exacerbates AF and AF symptoms and AF induces anxiety so unfortunately Anxiety and AF tend to be bed fellows.
So how do you distinguish between what is anxiety and what is a symptom of AF?
Very difficult - the symptoms we posted above about anxiety could also be symptoms of AF - which may be why so many people feel ignored or dismissed when they visit the GP with ‘palpitations’ - that has certainly been so in the past. In fact AF used to be thought of as a natural part of ageing. Now it is known that the biggest risk factor of AF is the risk of stroke - but then that also used to be thought of as part of the natural process of ageing and that nothing could be done to prevent it! We now know through evidence that we can reduce the risk of stroke if we take an anticoagulant.
I found you gradually learn which is anxiety and which is AF - it comes with increasing self awareness. Instead of avoiding the problem symptom or expecting a magic pill solution, focussing on it. When you focus on it something quite amazing happens. I and many other people do that by practising simple techniques such as breathing exercises and Mindfulness which improve self awareness and help quiet the mind.
The doctors and nurses here do a tremendous job of helping us to manage and treat AF but they often do not have time or resources to help us cope with emotional and psychological impact of AF.
In a recent AFA - Poll
69% said of people polled said AF had interfered with their ability to be part of social activities -
(this may often be because of anxiety of what may happen if they have an AF episode)
90% said they felt Anxious - 60% moderately to severely.
72% were affected by a need for more support from family and friends.
77% said they had been affected by an inability to complete daily activities or household tasks.
70% found it difficult finding information about their condition and general health.
So how do you deal with it all?
Firstly once you understand that symptoms of anxiety are a useful and essential functioning part of the human body - I think of it as alarm system there to alert you to something being wrong. But remind yourself that the alarm system can’t always distinguish between an immediately life threatening situation and a faulty wiring system or a minor threat.
One of the increasingly popular methods of recognising anxiety and coping with both anxiety and AF is the practice of Mindfulness.
When I know there is something wrong - but not immediately life threatening - I practice a few simple techniques which I find help and I would like to introduce you to - if you would like & we have time?
Firstly I invite you to score your own anxiety level right now using a scale of 0-10.
0=a wet noodle, complete relaxation
and 10=cat on a hot wire, full blown panic attack
To help you to score yourself -
Close your eyes and just be in your body. Feel the chair supporting you. Notice any tension in your body - just notice where it is. Is it in your neck or shoulders? Is it in your stomach?
Now turn your attention to your breath. Are you breathing fast or slow? Are you taking deep slow breaths or are they fast and shallow? Just notice what is going on in your body?
Now think of a number to score yourself as to how relaxed or anxious you feel.
Now close your eyes again and refocus on your breathing. As you become more aware of your breath see if you can slow it down a little and use your diaphragm to take in and push out the air in your lungs.
(After daily practice the aim is to reduce the number of breaths down to about 6-8 per minute but it is an aim, not a requirement so go with whatever feels comfortable for you).
Now see if you can create a thought or an image which for you - represents the word Balance. If you can’t create anything then just repeat silently in your mind the word Balance.
Continue to breath evenly and as slowly as you can for about 2-3 minutes. If you find your mind wandering, just say to yourself ‘Oh my mind is wandering’. And refocus on the breath and the Balance image.
Slowly open your eyes and come back into the room.
Now score yourself again -
Did you rate yourself higher or lower after the exercise?
Congratulations- you have just completed a simple Mindfulness exercise.
If you scored lower after the exercise - daily practice of Mindfulness may help reduce your anxiety and help manage your AF.
My first worry thought with my first ever bout of AF when I felt my heart racing and thumping and I felt dizzy and breathless was - Am I having a heart attack? Am I going to die?
Well that was over 10 years and many, many episodes of AF later - I haven’t died yet.
Can you name a ‘worry’ thought you have?
Can you think of a challenge to that thought?
eg:- Could I be doing something? Should I be doing something?
There are many things you CAN do to reduce the chances of having AF - don’t smoke, reduce alcohol intake, eat healthily and take moderate exercise and reduce your stress levels.
If the answer to your question is - I’ve done everything I have any control over to limit my chances of AF so maybe there is nothing more I can do other than address my anxiety - have a plan to do that.
Distraction works - when nothing else is possible I find listening to music or an audio book works. The mind likes to be busy - it is really hard to quieten the mind and stop the worry thoughts - so if you can’t quieten it - distract it!
The question SHOULD I be doing something - ie:- summon urgent assistance - paramedics - get yourself to A&E is a very personal one and it is a very good idea to talk with your doctors and or your Arrythmia nurse when you should seek emergency help. Make a plan with them and write down the criteria you agree on and make that THE plan.
Sometimes just having someone else know you are having an AF episode so they are aware and can check on you may assist you to ‘sit it out’.
Accident and Emergency departments are brilliant but they are often overwhelmed so the wait to be seen may be hours long so I have found that I am usually more comfortable at home unless I start to feel very unwell.
If you found the second exercise helped in any way you may find that CBT (Cognitive Behavioural Therapy) techniques will help you with your worry thoughts as it explores the rational around the worries, tests whether or not they have any relevance to the reality and help you to take an appropriate action by developing a plan. We humans tend to feel better when we can ‘do’ something.
Other suggestions for worry thoughts are to journal them, to seek support from fellow sufferers - easy now we have internet and health forums. There are many knowledgeable and experienced AF’ers who willingly offer their support and share their experiences and so we learn from each other.
So what helps people cope generally with AF and the accompanying Anxiety?
For me it was knowledge and understanding, finding ways to reassure myself - self talk. Finding other people who had been through all this before and listening and learning to their experience. Having a plan in place for calling assistance if I think appropriate, especially if you live on your own - not always calling 999 because AF is not, for me, an emergency.
BUT - Complications caused by AF or AF compounded by other conditions may precipitate an emergency so know when to call for emergency help and that will be quite individual.
This is what others have said helped them:-
Using strategies for easing anxiety
Acceptance and adjustment to life changes
Making lifestyle changes to diet, drink and exercise
Exercise - knowing the right amount and the right pace - too much can be as bad as too little!
Identifying triggers for AF - eating large meals, alcohol, drugs, caffeine etc.
Taking supplements - with help of a professional. (Always check with your Doctor and pharmacist for contraindications.)
If you have Vagal AF - knowing what it is and how you can you tell if you have vagal AF and what can you do about improving your Vagal Tone which may possibly help.
Nutrition - much research coming out regarding micro-nutrients which is worth consideration.
Treating underlying conditions
Distractions - doing things you enjoy creates the Endorphine (feel good hormone) Effect - which counters the stress hormone cortisol, adrenaline, nora-adrenaline which produce the physical symptoms.
Setting realistic goals
Being Thankful (part of Mindfulness practice)
Just knowing that AF is not immediately life threatening - even though it can feel like it sometimes!
Knowledge - brought empowerment - understanding the condition, the medications and what they do, won't do etc.
Having treatment options clearly explained & having a treatment plan.
Having a Faith.
Go Well - best wishes CD.