The indepth stress management of coronary heart disease is now a vital part of the total management of coronary heart disease. Recognition of stress as a cuase of heart disease is not new. However, the approach to stress in recent years has taken a new shape. Until now stress was managed by psychotherapy and tranquillizers. Now the patient himself is taught to manage stress.

The landmark work of Dr. Dean Ornish based on the ancient yogic Indian traditions has opened up new vistas in the management of coronary heart disease.

Abdominal Breathing

The abdominal breathing now enjoys prominent position in stress management. In adult life breathing is largely thoracic and at times abdominal. The practice of abdominal breathing is almost forgotten by the time we grow out of childhood. An infant breathes only abdominally. Of late the advantages of abdominal breathing have been understood very clearly. It at once calms the sympathetic system and activates para- sympathetic system, reducing the heart rate, systolic blood pressure, oxygen requirement of the heart and the viscosity of blood. In short, it acts like beta-blokers without any side effects. The abdominal breathing requires some practice. However, it is very simple and easy to practise in almost any situation. Once the technique is mastered, one may practise it daily, at least 3-4 times a day, for 10-15 breaths each time. The benefits derived from abdominal breathing may diminish if you are not regular in your practice. The effect of this yogic exercise is also dose- related. We call it 'Yogic Exercise' because it is a very useful tool for getting mental and physical relaxation. When an individual practises meditation, the mind becomes quieter with the abdominal breathing; the peace of mind that follows has a great power to heal. Healing follows the production of alpha activity in the brain and secretion of endorphins and health giving immunoglobins. Above all an individual experiences oneness with his larger Self within. This connects him with the wide world. Our participants who have regularly practised meditation and abdominal breathing have experienced a sense of great empowerment in their daily activities. Some have admitted to have gained greater control over their temper. Some have observed that they were able to modify their taste for fried foods and sweets without feeling deprived of them. They experience greater power over their life through this yogic practice.

Abdominal breathing is a powerful tool to bring about relaxation and activate the right brain. Only a minute of abdominal breathing with awareness kept on the inhalation and exhalatoin brings about the Yin mode of existence with all its benefits. The relaxation response is superior to the relaxation achieved during sleep.

Meditation

Meditation is begining to occupy a place in the conventional treatment of coronary heart disease. It has come to stay as an essential part of management along with medication and surgery. The stress management which was done uptil now with the help of psychotherapy, tranquillizers and group support now includes meditation in its therapeutic armamentarium.

Meditation is simply being in the present moment. The present moment frees the individual to change, explore new patterns, pleasures, and possibilities. It is a powerful way to heal isolation. The sense of isolation has been incriminated as the single most important factor in the rising incidence of coronary heart disease amongst the young who are prone to it on other scores (heredity, hypercholesteroloemina, diabetes, etc.)

There are many ways to meditate. No one way is best for everyone. One thing common to all forms of meditation is the art of paying attention. We do a lot of different things at the same time.

In order to mediate first pay attention to breathing. Breathing is central to every aspect of meditatin training. It is a wonderful place to focus the mind. Breath is a rich experience. It connects us with the whole universe. When you try to pay attention to breathing, you notice that the mind starts wandering. The wandering of the mind is a normal state of mind. From the meditative perspective the normal state of mind is severely suboptimal. It is more asleep than awake. It's energy is frittered away in thoughts of past and future. It is rarely in the present moment. Human beings have a capacity of shifting their awareness wherever they wish. Normally, individuals who have not been trained to meditate keep their awareness on the mind which has the habit of wandering. Cultivating and developing a capacity to keep the awareness in the present moment instead of the wandering mind is all what meditation is about. When you start focussing your awareness on breathing , you begin to ride the waves of breath, in and out. At this moment, the awareness begins to wander to the thoughts. Willingly, gently and kindly bring it back to the breath. If it wanders a million times, just lasso it back to breath a million times. This will train the mind to settle at one place. When the mind is thus cultivated, you begin to feel that you are in the present moment - time slows down and might even seem to stop. You are in a NOW, that is, continually unfolding. The moment you are in touch with the present moment, almost everything will become more vivid and alive. The calm experienced in meditation brings about penetrative insight (into our experience in the present moment). From this insight comes greater understanding, and therefore greater freedom to conduct our lives. The way we feel would lead to greater wisdom and happiness. The deep physiological relaxation which occurs in meditation is in itself healing. There is an access to deep inner resources for healing, the mind operating more effectively and helping to develop strategies, making sensible adoptive choices under pressure while coping its stress. One feels more engaged in life.

Meditation is a way of living which introduces us to that other part of our consciousness which is the common ground of all humanity. There we are not individuals; we are not separate entities with physiological content; where each one of us is actually the rest of humanity. As Guru of Dalai Lama explained, "anger, jealousy, hatred and aggression" thrive on concept of our inherent separate existence. Now all the recent researches in physics reveal that our separate existence is an illusion even if it is a stubborn one. In meditation we experience the emptiness of the concept of separate existence. This frees us from the qualities that separate us, and it generates in us compassion, love, and altruism which unite us.

Visualization

Visualization is an imaginative process of forming pictures in the mind's eye. When we visualize in a non-meditative mood, i.e. when our mind is full of other thoughts, visualization is not effective because it is unfocussed and passive. However, during meditation, visualization becomes active and focussed. Like the sunrays converging through a magnifying glass burn the paper, visualization during meditation brings about the desired effects. In our Program the participants visualize in a variety of ways : how their coronary circulation and function of heart improve and how they feel energetic in their daily routine. The beauty of this visualization is that though there may be no anatomical or physiological relevant to their imagination, even then it improves the clinical condition of the patient. Dr. Dean Ornish has also noted it to be useful to his participants.

Visualization also includes forgiving an individual who has done a great wrong or injustice to you in the past. This is a very difficult task. However, the participant is taught to condone not so much the act which was obviously wrong and unjust; he is asked to bring in front of his mind's eye the image of the person who perpetrated the wrong and believe that the individual was ignorant and chidish in his behaviour and hence he be pardoned for his irresponsible act. Thus the practitioner of visualization becomes free from the feeling of hostility against that individual. In other words, the thought of that individual loses the power to hurt him. Similarly, if the person himself is suffering from a sense of guilt, having done some wrong in the past, he may bring his own picture before the mind's eye and forgive self for the thoughtless act. This does not necessarily mean that he absolves himself from the responsibility of the wrong deed. Thus he releases himself from the feeling of guilt which keeps on haunting him.

After getting freedom from the sense of guilt he may resolve not to behave in such a manner again in future. So, the whole exercise of visualization during meditation is a very powerful weapon to heal the deep-rooted isolation. A participant in Dr. Dean Ornish's program, who was a retired army officer, said that the act of forgiving through visualization is more powerful than the most powerful weapons he ever used in the army.

Auto-suggestions

During the relaxed state of the body and the mind ( Shavasana) our participants are taught to use auto-suggestions to improve coronary circulation.

Auto-suggestions during meditation also have a very powerful effect on the physiology of the body. This has been the subject of bio-feedback and self-hypnosis in the management of various illnesses. We have taken help of auto-suggestions in our Program for even changing the food habits.

The beneficial effect of auto-suggestions in choosing the food habit of the participant is a subject of active research. Auto-suggestions during meditation increase the inner strength of an individual to choose the right type of food and enjoy it and feel empowered to give up eating his most favourite dishes. He can let go his favourite dairy-rich chocolate ice-cream without feeling the sense of deprivation and experience the fact that he can now do without it.

ITHAKA

[Ithaka is an island off the western coast of Greece, the native place of Odyssus, who travelled across the lands and seas after the fall of Troy. He met with many hazards and miracles in his voyage on his way to Ithaka.]

In this poem Ithaka is a metaphor for the land of our heart's desire. In quest of one's dreamland oe encounters many difficulties as well as adventures. But with courage one must sail on. It is this journey which is important ; travelling is more important than arriving. While travelling one enjoys seeing the world around, living in the present moment.

When you ultimately reach your Ithaka and perhaps find it not so fascinating as in your dreams, do not despair. Your experience during travelling has so much enriched you that you will understand what Ithakas mean!

As you set out for Ithaka hope your road is a lone one, full of adventure, full of discovery. Laistrygonians, Cyclops, angry Posiedon - don't be afraid of them: you'll never find things like that on your way as long as a rare excitement stirs your spirit and your body. Laistrygonians, Cyclops, wild Poseidon - you won't encounter them unless you bring them along inside your soul, unless your soul sets them up in front of you.

Hope that your road is a long one. May there be many summer mornings when, with what pleasure, what joy, you enter harbors you're seeing for the first time; may you stop at Phoenician trading stations to buy fine things, mother of pearl and coral, amber and ebony, sensual perfume of every kind - as many sensual perfumes as you can; and may you visit many Egyptian cities to learn and go on learning from their scholars.

Keep Ithaka always in your mind. Arriving there is what you're destined for. But don't hurry the journey at all. Better if it lasts for years, so you're old by the time you reach the island, wealthy with all you've gained on the way, not expecting Ithaka to make you rich.

Ithaka gave you the marvelous journey. Without her you wouldn't have set out. She has nothing left to give you now.

And if you find her poor, Ithaka won't have fooled you.

Wise as you will have become, so full of experience, you'll have understood by then what these Ithakas mean.

- C.P. Cavafy

Lessons from Geese
by Milton Olson

1. As each bird flaps its wings, it creates an "uplift" for the bird following. By flying in a "V" formation, the whole flock adds 71% greater flying range than if the bird flew alone.
   Lesson: People who share common direction and sense of community can get where they are going quicker and easier becuse they are travelling on the thrust of one another.
   
   
   
2. Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone, and quickly gets back into formation to take advantage of the "lifting power" of the bird immediately in front.
   Lesson: If we have as much sense as a goose, we will stay in formation with those who are headed where we want to go (and be willing to accept their help as well as give ours to the others).
   
   
   
3. When the lead goose gets tired, it rotates back into the formation and another goose flies at the point position.
   Lesson: It pays to take turns doing the hard tasks and sharing leadership - with people, as with geese, we are interdependent on each other.
   

   The geese in formation honk from behind to encourage those up front to keep up their speed.
   Lesson: We need to make sure our honking from behind is encouraging - and not something else.
   

   
   
4. When a goose gets sick or wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again or dies. Then they launch out on their own, with another formation, or catch up with the flock.
   Lesson: If we have as much sense as geese, we too will stand by each other in difficult times as well as when we are strong.

Diet and Yoga

We have already published a book entitled Wealth of Food, Heath of Heart. A mention about diet in the present context is due to our realization that diet is intimately connected with the successful yogic exercises like abdominal breathing, shavasana and meditation. The practice of these yogic disciplines promotes the motivation of the participants to take a low fat vegetarian diet. The intake of low fat vegetarian diet makes the yogic practices of meditation and shavasana easier for the participants. Diet and yogic exercises complement each other.

How Metabolism Changes with the Relaxation Response :

The body's metabolic rate that measures the overall biochemical activity is reflected in the amount of oxygen counsumed. This graph shows that oxygen consumption is reduced significantly in the meditators when they switch from resting (before) on to meditating (during) and again rises once meditation is stopped (after).

In the relaxation response, respiration and heart rates slow down, muscle tension decreases, blood pressure is reduced. The alpha brain waves increase, and blood lactate levfels are reduced.

How Sleep and Relaxation Response Differ

Though sleep and the relaxation response both cause a decrease in oxygen consumption, there is a much more significant decrease in the relaxation response. Though the graph only shows the relaxation response for a short amount of time this decrease will remain for as long as the relaxation response is elicited.

Reference : Benson, Herbert, and Klipper : The Relaxation Response. New York : Avon, 1976.

The above chart shows how sympathetic dominance leads to wear and tear, and para-sympathetic dominance promotes healing.

Yin - Yang

According to Chinese philosophy we human beings perform throughout our life either in Yin mode or Yang mode. Balance of both is required for happy and meaningful existence. Yin characterises a relaxation response and Yang stress response.

Too little stress may be as harmful as too much stress especially if you want to get a task done. Stress researchers have long recognized that some stress is need for optomum performance. However, once an optimum point is passed, increase in stress impairs judgement and alertness and the performance falls off. Ineffectiveness in solving problems and exhaustion with the signs of illness are indicative of overstimulation. Boredom, fatigue, and frustration are indicative of under- stimulation. The rational way of solving problems, creativity, and progress indicate optimum stimulation.

c) 1993 Naras Bhat, M.D., Stress Cybernetix.