6. Managing Stress

Managing stress can be beneficial for many reasons, including decreasing your risk for a SCAD recurrence.  Managing the Body, the Environment, your Emotions, and thoughts (BEET) can all be helpful.  There are lots of strategies to manage stress, some of which we describe here. Which ones will work best for you?

Managing the body

Stress creates a set of physical responses (including muscle tension, elevated heart and respiration rates, and increased levels of adrenaline). Calming the body can reduce the stress response, and its downstream consequences, like stressful thoughts and emotions. Ways to manage the body include the following. Try them to see which one(s) work best for you!

• Relaxation exercises
• Mindfulness meditation
• Ensuring good sleep habits
• Curbing caffeine and alcohol intake
• Taking a warm bath
• Going for a walk
• Taking a gentle yoga or stretching class (with your doctor’s approval).

Managing the environment

Sometimes, problems in the environment need to be resolved in order to reduce stress.  After a SCAD, it might make sense to make changes in life circumstances, even temporarily,  to allow time to heal.   Cutting back on one’s responsibilities or assertively asking for what you need from significant others are ways of managing the environment. Another way is by removing yourself from sources of stress, including people who cause you stress.

Managing emotions

Emotions are like untrained puppies. It is very difficult, and sometimes impossible, to control emotions.  Emotions have a life of their own, and show up on their own schedule. Emotions that SCAD survivors very commonly encounter, like fear and uncertainty, can be particularly overwhelming.   While we can’t always control emotions, we can “take a step back” from emotions, acknowledge that they exist (“there’s fear again”) and what they are trying to tell us, but try not to get hijacked by emotions, remember that emotions come and go, and eventually let them pass.   Skills for tolerating distress can help you while you wait for emotions to pass.  (See the Wellness Exercises in this app. Of course there will still be moments when emotions overwhelm us, and this is a good time to increase self-care and seek out the comfort and connection of social support (see the module on “Maintaining Healthy Relationships”.)

Managing thoughts

In addition to producing physiological responses such as increased muscle tension, heart rate, and blood pressure, stress also produces more negative thinking. It’s normal for someone who’s stressed to think about the worst case scenario and think that it is likely to happen. Just like emotions, thoughts are difficult to control but we can manage thoughts by stepping back and being more skeptical about what our minds are telling us. Here are a few quick tips for managing overly negative thinking:

• Identify the thoughts that bother you most. Challenging these will have the most positive impact.
• Consider the evidence that you have for & against the thought. Focus on facts, not your beliefs.
• Ask yourself: “What's the worst that can happen?” and “Is it really likely?” Consider whether your fear is based on a realistic chain of events.
• Consider a more rational response. Acknowledge a chance for bad and a greater chance for neutral.
• Repeat, repeat, repeat. Continue to monitor yourself for overly-negative thoughts, repeat & reapply.