A heart attack, a stroke, a diagnosis of coronary artery disease — these are terrifying events. And then, at this moment of maximum stress, when you may be facing the idea of your own mortality for the very first time, your health care team orders you to…relax! Is that a joke? Isn’t relaxing for healthy people?

But the fact is, highly stressed people with coronary artery disease have a high risk of future heart attack or stroke, according to Michael McKee, PhD, of the Psychiatry and Psychology Department of the Cleveland Clinic. If you want to stay out of the emergency room — and if you want to heal — you have to recognize that stress may have contributed to your illness, and you have to find healthier ways of responding to it.

QUIZ: Are You Feeling Stressed?

New Ways of Thinking
Emotional stress puts physical stress on your heart by raising blood pressure, promoting inflammation and increasing your heart rate. Life’s pressures — money worries, job frustrations, relationship woes, family strains —can also lead to unhealthy coping mechanisms, such as overeating, heavy drinking or smoking.

Try This

The next time you start to feel stressed, pay attention to your body. Is your heart beginning to race? Is your breathing quickening? Acknowledge it’s happening and then address it: Close your eyes, slowly breath in and out, and let your thoughts go. Don’t fight against thinking — when a thought arises, let it in, but don’t dwell. Say to yourself, “I’m thinking.” This can help you refocus.

If you’ve been diagnosed with heart disease and you’ve relied on these behaviors to get through problems before, you may feel caught in a vicious cycle: “How can I kick unhealthy habits if they’re the very things that help me through stressful times?” You may also feel that all the advice to eat well and exercise is just another pressure — and you may respond the same way you did before your diagnosis: “I just don’t have the time.”

“It all starts with attitude,” Dr. McKee says. “If you always think the way you’ve always thought, you’re always going to do what you’ve always done.” The key, he advises, is to create new ways of thinking that are healthier for you. That begins with putting your health at the top of your priority list — not shrugging it off as something you’ll get around to dealing with eventually. “You need to concede that it’s important to take time to take care of yourself, and that doing so is what’s going to allow you to succeed for the rest of your life,” Dr. McKee says.

Tune In to Your Body
One of the first steps in managing stress is learning how your body deals with it. One method: biofeedback (typically done in a health practitioner’s office), which uses a machine to measure your body’s responses (heart rate, blood pressure, body temperature) to various triggers. Learning how to bring your body to a proper “resting state” is the key.  

In a healthy person, the heart beats fast when you inhale and slows when you exhale, Dr. McKee explains. But through biofeedback, you might realize that every time you think about your boss making yet one more get-it-done-today request, your heart keeps pounding and racing. Since you probably can’t change your boss’s behavior, you have to change the way you respond to it.

Biofeedback will train you to restore the healthy slow-fast variation of your heartbeat. An important element is practicing relaxation techniques that keep you on an even keel in the face of stress. As you get more in tune with your body’s responses, you’ll learn which techniques help you most.

Take a Deep Breath
Ever hear (or use) the phrase “I’m so busy I don’t even have time to breathe”? One of the best things you can do for your heart — whose job is to pump oxygen-rich blood around your body, after all! — is to make time to do just that. Dr. McKee points out that relaxation practices such as yoga, meditation and guided imagery all share a theme: their focus on breathing. In addition to letting you deal with stress, such practices can improve your mood, helping to fend off feelings of anxiety or depression that often accompany a heart disease diagnosis.

The ideal breathing rate is six breaths per minute, or 10 seconds per breath. It takes training to do it consistently, but focusing on your breathing regularly (for instance, in response to stress) will help you build to that level. Try it now: Breathe in for the count of six, then exhale for a count of four. Repeat.

MORE: Meditation for Beginners

Make Time for Your Mind
Like muscles, the ability to relax takes time to build. “You have to practice,” Dr. McKee says. “Your goals are to react less often, with less intensity, and to recover more quickly.” To strengthen your ability to relax, set aside time for daily practice, just as you would for physical exercise. For instance, book 15 minutes with yourself — go ahead, write it in your daily planner — to do a relaxation exercise or focused breathing.

Listen Up
Maybe yoga and meditation sound a bit too New Age for a hard charger like you. Try music instead. Recent research suggests that listening to music decreases blood pressure, heart rate and anxiety in heart patients. Other studies have found that slower tempo music holds the most benefit for regulating heart rate. To help you relax, put on a soothing piano sonata and let it sweep you into a state of calm.

MORE: Your Mind on Music

—    by Stacia Ragolia