Coronary Heart Disease and Migraines

Most diseases are triggered by the body's immune system's failure to work correctly. Coronary heart disease and migraines are example of a patient suffering both from psychological and physical stress-related disorders. Psychological and emotional stress weakens the immune system, which makes it disease responsive. When the body is always under stress, it becomes accustomed to working with the released stress hormones, which ultimately follow dangerous chemical changes in the body which increase the risk of serious stress-related diseases. Overcoming stress can be achieved by cultivating positive thoughts and changing ones thinking which will eventually change the reality overtime and also by discovering the art of healing through art therapy. This paper will majorly focus on migraine and coronary heart disease as stress related problems.  In order to treat and manage these two stresses related illnesses, intervention plans are required; the paper therefore investigates on two interventions in cognitive restructuring which include reframing and art therapy.

Migraines

Migraine is a disease that affects the nervous system, generic neurological disease; it causes episodes of headaches often causing nausea or even actual vomiting (Sauro & Becker, 2009). The most common types of migraines are migraine without aura also known as common migraine and migraine aura also the classic migraine ("What is migraine?” 2017). Other types include migraine aura without headache, basilar migraine, hemiplegic migraine opthalmoplegic migraine and vestibular migraine.

Symptoms of Migraines

Common migraine is also known as the migraine without aura and the symptoms may include pulsating pain which is the most significant and head movements may even make it worse, sensitivity to light, sensitivity to sound, nausea, pain on one side of the head and vomiting.  Migraine with aura or rather the classic migraine share the same symptoms with common migraine but its preceded by a sign or a warning (an aura) before the headache begins. The most common type of aura is the visual aura which includes temporal partial loss of vision, dizziness and flashes of light (Silberstein & Freitag, 2001). The second type is numbness which starts at the hand then travels up the arm and may involve the face, lips and eventually the tongue and thirdly affected speech and other odd sensations. Each aura might last just for a few minutes before experiencing the migraines.

Migraines as Stress Related Illness

Stress can be one of the major triggers to various types of headaches though what triggers the nervous system varies between people (Parashar & Babbar, 2014). This is because genetics play a part in the disease. Other triggers include; hormonal changes, environmental, physical, medicinal and dietary factors.   Stress related migraine happens to be directly proportional to stress level faced by an individual. During a stressful situation the brain releases stress hormone known as cortisol which can affect metabolism, blood pressure and immune reactions like inflammation (Shyti & Van, 2015). Chronic stress makes the body to continuously release cortisol which keeps inflammation in check but after a while cells becomes less receptive to the hormone which causes its own hosted problems like anxiety and mental problems. This drags down the immune system. The underlying problem with migraine sufferers is that they have a very sensitive nervous system which reacts to small stimuli with an exaggerated response.

Diagnosis and Treatment

A specific test has not been identified to confirm a migraine thus diagnosed by the typical symptoms.  First the potentially serious causes of headache are ruled which can either be a brain tumor or stroke then a series of tests are done to make a specific headache diagnosis ("Migraine: How It's Diagnosed and Treated", 2017). The tests are done by taking a history and doing a careful neurologic examination. Diagnosis of migraine itself is based on the features of headaches and it’s not diagnosed until an individual has had at least five characteristic attacks in their lives (Silberstein & Freitag, 2001). Treatment is usually learning to identify and avoid triggers to prevent headache and having effective medication to take when a headache begins to relieve pain and restore one’s ability to function normally. Non pharmacological treatment methods other than drugs are also available and they play a vital role in dealing with the chronic pain that is associated with migraine ("Tension Headache Relief with Simple Stretches - Ask Doctor Jo", 2017).  These therapeutic approaches involve relaxation, meditation, hypnosis, cognitive reframing and art therapy in managing the pain.

Coronary Heart Disease

The coronary heart disease is a condition in which the blood vessels narrow due to atherosclerotic plaque depositions which builds up inside the arteries limiting the supply of blood and oxygen to heart (Helfant & Gorlin, 1970). If the plaque raptures, it can trigger the formation of a blood clot causing coronary thrombosis which completely obstructs blood flow to the heart resulting in chest pain known as angina ("Cardiology: Coronary Artery Disease - OnlineMedEd", 2017).  The two types of angina are stable angina and unstable angina. Overtime the heart muscles may get weakened leading to abnormal heart rhythms ("Overview of Coronary Artery Disease", 2017).  When the thrombus completely blocks the vessel then one will eventually experience a heart attack.

Symptoms

The symptoms can be very noticeable and obvious in some cases. The most common symptom is discomfort or chest pain, also known as angina though the pain varies from person to person. While other people might lack the symptoms associated with the condition. Angina can be just a mild uncomfortable feeling at the chest or a very painful feeling accompanied by tightness at the centre of the chest which may spread to the other parts of the body (Copper & Marshall, 2013). Other symptoms include; extreme fatigue with activity or shortness of breath, heart attack indicating a complete blocked coronary artery, palpitations, oedema and general weakness ("Coronary Heart Disease ¦ Treatment and Symptoms", 2017).

Coronary Heart Disease as a Stress Related Illness

Stress has a significant physiological effect on the human body. Consistent stress can lead to serious long-term illnesses. When one constantly experiences stress, the flight or fight response is always active and this puts excess strain on the body’s physiology and can really damage the body causing conditions like heart disease, stroke, diabetes or even cancer. Consistent stress on the body contributes a lot to the occurrence of these conditions (Musselman, & Nemeroff, 1998). Chronic stress causes excess strain on the heart thus increasing the blood pressure damaging artery walls making them repositories for plaque. So now when one feels threatened the arteries don’t expand and the heart muscle doesn’t get more blood and this stress in the circulatory system overtime can eventually lead to heart attacks and coronary heart disease. A study by the American Heart Association states that every 40 seconds, one American dies due to cardiovascular disease. Under stress, blood clots preventing free flow of blood throughout the body which leads to heart attack and stroke

Diagnosis and Treatment

Common tests are stress tests. The body is put through a series of steps like exercising at a fast pace to increase the heart rate to see how the heart responds on an electrical test. If it shows any abnormality that points towards the possibility of having blockage in the heart arteries then the test can be supplemented by doing an ultrasound to confirm if there is any weakness in the heart (McMurray & Dickstein, 2012). Other diagnostic methods include blood tests and taking a thorough medical history. Treatment depends with the symptoms and how a severe the disease is. In some people, medical therapy works as well as surgeries for example angioplasty or stent and a bypass surgery which is an open heart surgery. Medical therapy include taking of aspirins to relieve pain and other medications prescribed that prevent the plaque from rupturing. All the treatments aim to increase blood flow and therefore oxygen delivery to the heart muscle and to decrease oxygen consumption by the heart to prevent future heart attacks.

Cognitive Reframing Intervention

In order to prevent and manage the stress related disorders such as migraines and coronary heart disease, a combination of strategies and programs should be designed to bring about behavior changes and therefore improve the health of the patient (Kress & Sadler, 2014). Cognitive restructuring is a health intervention tool and also a major part of Cognitive Behavioral therapy which creates change by influencing the patient’s thoughts and beliefs which are often destructive, harmful and maladaptive, and converts them to beliefs which are constructive and positive thus leading to a healthier lifestyle. The technique of cognitive restructuring is exercised on patients who experience pain, such as that brought about by migraines and the coronary heart disease (Sadler & Jenkins, 2017).

The technique teaches individuals to avoid trusting automatic thoughts as accurate representation of the reality (Mathur and Seminowicz, 2017). The main objective of this tool for intervention of stress related disorders is to test every thought of the patient for accuracy.  Cognitive reconstruction is based on the knowledge that patients suffering from migraines and the coronary heart disease experience pain in two ways. The first is the physical pain to which the nervous system responds. The second type is psychological pain which in most cases makes it worse for those experiencing physical pain.  Reframing means that the individual asserts control over the psychological pain by experiencing physical pain without identifying with it.

Procedure for the Intervention

Patients suffering from migraines and the coronary heart disease tend to experience constant pain and may therefore be frustrated; therapists in this process can intervene through cognitive restructuring by providing the patient with a paper to fill known as the Thought Record (Mathur and Seminowicz, 2017). The A+B=C stress equation is an important model in this technique. In this stress equation, letter A stands for the activating event which is triggered by different stressor types, B stands for Beliefs which an individual uses as an automatic template to interpret and perceive negative circumstances; C stands for the consequences which arise as a result of an individual’s constant beliefs, perceptions and self talk in response to the activating agent. In addition to the equation, letter D and E are added where D is for Debating thoughts and E stands for Effective thoughts used as a replacement.

The first step is for the patient to make clear records of the events in A, B and C on the thought record form. This form is made of separate columns where the events are recorded. It is easier for the patient and therapist to manipulate thoughts which have already been listed. The second step in the cognitive restructuring requires the therapist and the patient to find the characteristic patterns of dysfunctional beliefs. The negative thoughts in certain situations should be identified especially cases of anger as a response to stress. Such thoughts should then be listed down in the disputing column of the thought record.  The final step requires the patient to restate the original positive beliefs which are not distorted and are therefore more accurate. New ways in which a situation can be handled should be identified and written down in the effective column of the thought record. Stress inducing thoughts which lead to more pressure for the patient are then converted using a new approach which responds positively to the activating agent (Cuijpers & Anderson, 2014).

Draw backs and Tips for Cognitive Reframing

One of the limitations of the cognitive restructuring technique is that it is difficult for the patient to use it without the assistance of a therapist. Most people tend to think that they can identify their distorted thoughts and therefore deem the task to be of little use. Another drawback is the difficulty in realizing the additional errors made when restating beliefs. Due to the necessity of a third party, patients are required to work with a trained cognitive restructuring therapist for fifteen sessions in a week. For the technique to work effectively, patients suffering from migraines and coronary heart disease should think of this task as mental weightlifting processes in which positive mental muscles are formed. Though the technique is time consuming and repetitive, it should be practiced regularly so that the patient can automatically correct themselves when their thinking is distorted.

Art Therapy Intervention

Art therapy, also known as creative arts therapy is often deemed a leisure activity for those with minor problems (Schwedt, 2014). However, it is a complementary health intervention for those who suffer from migraines and the coronary heart disease. Patients suffering from these illnesses experience mood changes, physical and psychological pain which have a negative impact on them thus leading to stress.  Art therapy recognizes that physical pain is often influenced, increased and prolonged by emotional, psychological and social factors. Art is used to relief symptoms arising from migraines and the coronary heart disease.

The pain experienced by patients demands attention; art therapy is used to divert the attention from the senses to different sensory modalities. The painful stimuli become less activated when psychological pain is diverted to other projects ("Chronic Pain and Art", 2017). In this intervention, stress relief, relaxation, self esteem and awareness are developed thus managing the painful experience. Patients suffering from migraines or the coronary heart disease may often experience lack of control in their lives due to the pain. Art therapy is an intervention that enables the patient to source inspiration from their experience to gain personal control. The Migraine MasterPiece Art Contest is an example of one of the interventions used by the National Headache Association to create awareness and thus leads to treatment (Ernest & Power, 2015).

The Process of Art Therapy

To manage the pain that arises from migraines and the coronary heart disease, patients ought to understand that stress management through art therapy not only enables them to cope with the illnesses, it also reliefs the pain both psychologically and physically (Case &Dalley, 2014). Two approaches are used by the pain management doctors who must be specialized in both art and psychology. These approaches are the subconscious expression and the conscious and intensive process. The subconscious expression approach emphasizes on how patients express themselves through experience. The process intensive approach uses art as a journey in which the patients discover themselves personally ("Migraine Art Therapy- Tess' Jack in the Box", 2017). Both approaches assist the therapist to understand the underlying problem of the patients and therefore guide them in managing the stress related illnesses.

The first step in the procedure for art therapy is for the therapist to assess the condition of the patient suffering from migraines or the coronary heart disease (Waller, 2014). The second task in this intervention is to engage the patient in an exploration task. An array of materials for art projects such as photography, painting, collage and drawing are required based on the preference of the patient. The main drawback of art therapy[y is that the patient may sometimes experience overwhelming emotions when expressing themselves through the art. However, the patient should continue with the task because the feelings diminish as part of the healing process.

Art therapy in Reducing Stress

Unlike art making, art therapy in not just about relaxing and playing with the markers, it involves measuring the levels o stress in the patients such as determining the levels of cortisol. The therapists engage the patients in activities which facilitate change in the response of the patient towards living with migraines or the coronary heart disease thus lading to stress reduction (Rubin, 2016).  Art therapists are required to design their sessions with the patients in a way that employs interventions such as self perception, expression of emotions and self perception. 

Conclusion

Stress related illnesses such as the coronary heart disease and migraines often interfere with the quality of life of the patient and may often cause depression. The stress experienced by a patient leads to slow recovery and further weakens the immune system. These stress related illnesses cause patients to experience both physical and psychological pain which can be managed through the use of stress related interventions such as art therapy and cognitive reconstruction. These programs enable the patients to change their perception on their conditions. Overall, Art therapy and cognitive reframing can be used as interventions which in turn lead to treatment of the patient.

References

Cardiology: Coronary Artery Disease - OnlineMedEd. (2017). YouTube. Retrieved 4 October           2017, from https://www.youtube.com/watch?v=pzM-uOOYccQ

Case, C., & Dalley, T. (2014). The handbook of art therapy. Routledge.

Chronic Pain and Art. (2017). YouTube. Retrieved 4 October 2017, from             https://www.youtube.com/watch?v=x5MQXmwvD4Y

Cooper, C. L., & Marshall, J. (2013). Occupational sources of stress: A review of the literature         relating to coronary heart disease and mental ill health. In From Stress to Wellbeing        Volume 1 (pp. 3-23). Palgrave Macmillan UK.

Coronary Heart Disease ¦ Treatment and Symptoms. (2017). YouTube. Retrieved 4 October           2017, from https://www.youtube.com/watch?v=ROKzTsL3wO8&t=187s

Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014).            Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical           Psychology Review, 34(2), 130-140.

Ernst, M. M., O'brien, H. L., & Powers, S. W. (2015). Cognitive‐Behavioral Therapy: How    Medical Providers Can Increase Patient and Family Openness and Access to             Evidence‐Based Multimodal Therapy for Pediatric Migraine. Headache: The Journal of        Head and Face Pain, 55(10), 1382-1396.

Helfant, R. H., Forrester, J. S., Hampton, J. R., Haft, J. I., Kemp, H. G., & Gorlin, R. (1970).            Coronary heart disease. Circulation, 42(4), 601-610.

Kress, G., & Sadler, J. (2014). Team cognition and reframing behavior: the impact of team    cognition on problem reframing, team dynamics and design performance. In Design        Thinking Research (pp. 35-48). Springer International Publishing.

Mathur, V. A., Khan, S. A., Keaser, M. L., Hubbard, C. S., Goyal, M., & Seminowicz, D. A.   (2015). Altered cognition-related brain activity and interactions with acute pain in         migraine. NeuroImage: Clinical, 7, 347-358.

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... &           Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic        heart    failure 2012. European journal of heart failure, 14(8), 803-869.

Migraine Art Therapy- Tess' Jack in the Box. (2017). YouTube. Retrieved 4 October 2017, from      https://www.youtube.com/watch?v=6pDtzNLA01Y

Migraine: How It's Diagnosed and Treated. (2017). YouTube. Retrieved 4 October 2017, from      https://www.youtube.com/watch?v=Hi0uVJnj808

Musselman, D. L., Evans, D. L., & Nemeroff, C. B. (1998). The relationship of depression to   cardiovascular disease: epidemiology, biology, and treatment. Archives of general        psychiatry, 55(7), 580-592.

Overview of Coronary Artery Disease. (2017). YouTube. Retrieved 4 October 2017, from    https://www.youtube.com/watch?v=NZ14XjOQoFY

Parashar, R., Bhalla, P., Rai, N. K., Pakhare, A., & Babbar, R. (2014). Migraine: is it related to         hormonal disturbances or stress?. International journal of women's health, 6, 921.

Rubin, J. A. (Ed.). (2016). Approaches to art therapy: Theory and technique. Routledge.

Sadler, P., McLaren, S., Klein, B., & Jenkins, M. (2017). Advancing cognitive behaviour therapy       for older adults with comorbid insomnia and depression. Cognitive Behaviour Therapy,           1-16.

Sauro, K. M., & Becker, W. J. (2009). The stress and migraine interaction. Headache: The      journal of head and face pain, 49(9), 1378-1386.

Schwedt, T. J. (2014). Chronic migraine. Bmj, 348, g1416.

Shyti, R., Eikermann-Haerter, K., van Heiningen, S. H., Meijer, O. C., Ayata, C., Joëls, M., ... &          Tolner, E. A. (2015). Stress hormone corticosterone enhances susceptibility to cortical         spreading depression in familial hemiplegic migraine type 1 mutant mice. Experimental neurology, 263, 214-220.

Silberstein, S. D., Saper, J. R., & Freitag, F. G. (2001). Migraine: diagnosis and             treatment. Wolff’s Headache and other head pain, 7, 121-237.

Tension Headache Relief with Simple Stretches - Ask Doctor Jo. (2017). YouTube. Retrieved 4     October 2017, from https://www.youtube.com/watch?v=nWNf6Khc9go

Waller, D. (2014). Group interactive art therapy: Its use in training and treatment. Routledge.

What is migraine?. (2017). YouTube. Retrieved 4 October 2017, from             https://www.youtube.com/watch?v=yL22X5opGhY