more compatible with a type B personality had reduced their risk of a second heart attack by half, compared to those who had not.  Not sur- prisingly, meditation is prob- ably the simplest, and per- haps, most fulfilling of all holistic therapies. Imagery and Visualization are therapeutic techniques which lead the participant through a series of images that promote relaxation with the result of calming the body's natural anxiety pro- voking chemicals.  These "images" may involve sever- al of the body's senses such as touch, sight, smell, motion, and hearing.  With proper training, a person can learn to guide themselves through those states, which provide a calming effect and can reduce their heart rate and blood pressure. Experiments in humans have demonstrated the abili- ty to control the hemody- namic response of stress (103). This calming effect may reduce the need for medications or their associ- ated side effects.  In addi- tion, these techniques may help to alter behaviors and risk factors which contribute to the development of CHD. The benefits of such therapy can last even after the par- ticipant is no longer engaged in the activity. Biofeedback utilizes instru- ments which monitor bodily functions and allow the par- ticipant to regulate those functions.  For instance, by listening to their heartbeat, a person is able to consciously increase or decrease their heart rate.  Likewise, such techniques have been utilized to effectively lower blood pressure, a major modifiable risk factor for the develop- ment of CHD (104).  Like many Mind/Body therapies, consistent utilization of these techniques serve to lower emotional stress and anxiety. Such factors may not only play a role in the develop- ment of CHD, but also be important following a serious heart-related event like a heart attack or coronary artery bypass surgery. Cognitive Behavioral Therapy is a Mind/Body technique, which uses brief psychother- apy to reduce the stress response and induce relax- ation. It is particularly useful in individuals with chronic illness, such as CHD, who require permanent behav- ioral change and accept- ance of that change. These techniques teach individuals how to identify stress trig- gers and actively treat them.  There are several components to cognitive behavioral therapy including behavioral rehearsal, edu- cation, group support, and training in coping skills and motivation techniques. Support groups are one example of a therapy fre- quently utilized in patients with heart disease. Hypnosis in essence is a form of deep relaxation.  It is a state of focused con- centration allowing the mind to be highly receptive to suggestion (68).  While not extensively studied for the treatment of CHD, hyp- notherapy has been demon- strated to lower blood pres- sure and heart rate, induce a state of deep relaxation, and decrease the output from nerve fibers-all effects which should be beneficial to the person with CHD. Further studies on its longterm effects on this condition have yet to be performed. SPIRITUALITY Spirituality is the belief in something, not necessarily
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