Mindset Matters

Heartbeat Mindset Matters

By Paula Felps

Some of the most promising ‘new’ treatments for heart disease may be in your head.

For nearly four decades, Alan Rozanski, M.D., has touted the benefits of an often-overlooked treatment for heart disease. While he learned its value early on in his practice, it has only been in recent years that the mainstream medical community has taken note.

“Only recently have investigators begun to zero in on the medical importance of mindsets, such as optimism versus pessimism,” says Dr. Rozanski, professor of medicine at the Icahn School of Medicine at Mount Sinai and chief academic officer for the Department of Cardiology at Mount Sinai St. Luke’s Hospital in New York. “Optimism has long been linked to better performance in school and in such jobs as sales, sports, political endeavors and social relationships, but it’s also an important health issue that has not been well studied until now.”

As he found merit in the effects of mindset and optimism on cardiovascular health, Dr. Rozanski often lectured on the topic but felt that, while doctors found it interesting, they didn’t necessarily take it to heart or see it as relevant. Now, that casual interest has grown into awareness and action.

Last year, a team of researchers spearheaded by Dr. Rozanski released a meta-analysis of all published medical studies looking at the association between optimism and pessimism, as well as the occurrence of cardiovascular events and all-cause mortality. The 15 medical studies involved a total of about 230,000 patients.

They found that optimistic patients had a 35% lower risk of cardiovascular events than pessimists. That remained true after adjusting for other factors such as physical activity, gender, other risk factors and geographical location. The study, which was published in JAMA Network Open in September 2019, provides even more insight into the mind/body connection, and could help heart patients and their physicians approach conditions differently, he says.

“This study suggests that treating pessimism and fostering optimistic thinking maybe be well suited for various types of medical encounters, such as the conduct of cardiac rehabilitation programs,” he says, adding that rehabilitation programs are designed to help patients deal with both the physical and mental effects of life-altering events like heart attacks, strokes and bypass surgery. Adding optimism practices to that rehab could help enhance the adjustment.

The Heart/Head Connection

Like other forms of treatment, there’s no one-size-fits-all answer in treating pessimism, but Dr. Rozanski says the research shows there are many effective ways to corral and redirect it. Humans are hardwired to have a natural negativity bias, but genetics and conditioning can affect just how far each person sways toward optimism or pessimism. However, the recent study of neuroplasticity shows that it’s possible to rewire brain behaviors to change thinking patterns.

“Various promising approaches have been identified, including teaching pessimistic patients better coping skills and helping them learn how to recognize automatic pessimistic thoughts,” Dr. Rozanski explains. Patients then can be taught how to reframe those thoughts and literally change their way of thinking.

That’s exactly the kind of treatment Ken Levine, 63, wishes he’d had found years ago. Born with aortic stenosis, he had his first heart surgery at the age of 11 and had a replacement valve put in four years later. By the time he was 19, that valve was recalled, and he had surgery to implant a different valve.

“The emotional aspect was the hardest part of it,” he says. “Back then, they didn’t know to give counseling or talk about it. I ended up suffering from anxiety, PTSD, depression and panic attacks.”

Overall, it made Levine fearful of his heart failing and left him unable to trust his own body. But after seeking help, he learned new coping skills. He learned he wasn’t the only one who had those fears or bore the emotional scars of heart disease. And, as he learned more about how his thoughts affected his physical state, he changed the way he talked to himself.

“I learned how to center myself and breathe,” he says. “Even now, I have bouts of panic rising in my stomach, but it’s almost become second nature to just try to relax, focus feeling my feet on the earth and center myself. It’s much easier to deal with.”

Learning such techniques can have immediate effects on the body by lowering pulse rate and blood pressure, slowing the breath and refocusing the mind. Adding the perspective of optimism can further enhance individual health. “Optimism is the belief that, ‘I can handle things, no matter how they come out.’ Optimistic people tend to have more confidence and less doubt,” he says.

That has a direct physiological effect on the body, although it has taken a long time to connect the dots as to why. Negative emotions are shown to trigger biochemical reactions in the body, which can appear as inflammation or insulin resistance, for example.

“There’s a relationship between several factors. Health habits are powerful mediators; when there are negative psychological factors, people are more likely to smoke or eat poorly.”

The reverse is true as well. People with higher levels of positive emotion are more likely to tend to their health. They exercise regularly, watch their weight and eat more healthily.

“So, is it the optimism itself? It’s not just that one thing. But it affects how they live. Optimists not only believe they have a better future, but they are better at planning for obstacles and how to work around them.”

Finding Positivity in Uncertain Times

Recent months have brought new challenges and concerns, particularly for patients with heart disease. Dr. Rozanski recognizes that the COVID-19 pandemic has elevated the global stress level, but that doesn’t mean it’s impossible to remain positive and optimistic.

“Obviously, you want to take all due caution. When you feel you are taking the right steps to keep yourself safe, you’re automatically already going to feel better.”

He also advises people to stay informed, but not to bombard themselves with information.

“I’m not saying don’t listen to the news, but don’t overdo it. The thing is, you don’t want to turn too much attention to the negative. So be careful about how much you are exposing yourself to the news.”

He recommends putting on soothing music, taking a walk or listening to uplifting podcasts. Consider starting a gratitude practice, such as writing in a gratitude journal daily or just taking time at the end of the day to think about what things you’re grateful for.

“Take time out of your day to practice it,” he says. “The vast majority of our thinking is habitual and non-conscious. Just making a commitment to noticing negative thoughts oftentimes results in decreasing the toxicity of those feelings and thoughts.”

And most of all, remember the line from the musical Annie: The sun will come out tomorrow.

“When it’s raining, we have a tendency to think it’s going to rain every day,” he says. “It’s not. Right now, we have a tendency to think this is how it’s always going to be. It’s not. People need to remind themselves of that. There are better days ahead for them.”