Spiritual Needs, Stress, and Cardiovascular Responses
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Spirituality is an important determinant of health that can affect patient healing, outcomes, and quality of life. Its effects on stress and physiological dysfunction have been widely studied, particularly regarding cardiovascular function. Can spiritual coping strategies help patients manage stress and improve their cardiovascular health? Spiritual coping mechanisms such as mindfulness, yoga, prayer, daily affirmations, and expressing gratitude can improve mental health states, but they also confer physical health benefits by improving recovery from stress-induced changes in cardiovascular function.
Spirit, Stress, and Cardiovascular Risk
Spiritual coping can be defined as using belief systems, attitudes, and mindfulness practices to manage emotional distress or hardship. While spirituality can have a religious connotation, coping behaviors like prayer do not need to be overtly religious in nature and may be reframed as taking a few moments in the day to set a goal or reflect on an accomplishment. Spirituality, more broadly, is the feeling of connection, purpose, meaning, and balance in life. Mindfulness and awareness practices can help achieve this by giving patients the tools to recognize and transform stress and help navigate adversity.
Spiritual coping mechanisms may help patients to self-manage stress and reduce the impact of stress-related cardiovascular reactivity1 such as increased blood pressure.2 The physiological symptoms of stress, including temporary states of hypertension and increased heart rate, are contributing factors to cardiovascular disease. The practices of mindfulness and meditation3,4 have both been shown to benefit blood pressure management, reducing the risk of arterial stiffness5 and hypertension3,6,7 through improved stress response, emotional regulation, and self-awareness of health-related behaviors.4,5,8,9 A systematic review of literature assessing spirituality in cardiovascular disease patients revealed that those who engaged in spiritual or religious coping strategies reported higher quality of life outcomes over time.10 Patients facing adverse cardiovascular events in palliative care settings also reported better coping through spirituality when they had the tools to effectively manage stress regarding their diagnoses; some even expressed feelings of hope, patience, and tolerance about overcoming their diagnosis.11
Attending places of worship is associated with positive improvements in health-related behaviors that influence cardiometabolic dysfunction.12 Religious attendance was associated with lower incidence of all-cause mortality and marked improvement in nutrition and exercise habits, along with lower rates of smoking and alcohol consumption.13-15 This was also shown to impact the risk for metabolic syndrome,16,17 with those expressing lower levels of religious faith experiencing more rapid disease progression.17 Those who have religious affiliations as part of their spiritual well-being also reported higher levels of purpose, belonging, and resilience adaptation. Including community in a spiritual practice such as attending places of worship may be important for treatment adherence and as a motivator for patients to make changes in their lifestyle.
Coping With Emotional Distress
Negative emotional states can alter the risk factors and trajectory of hypertension. Feelings of optimism, satisfaction,18 and purpose19 are associated with better cardiovascular outcomes by indirectly influencing health behaviors and directly influencing the impact of stress in the body.7,19 Social relationships, which play a strong role in maintaining positive emotions, were shown to counteract the physical stress responses of negative emotions such as anger and provided patients a support system that allowed them to return to normal resting blood pressure levels more quickly.7,20 Psychological well-being in itself is an important consideration for hypertension patients, and having strong social connections was an important mitigating factor for hypertension in all populations.7,21 Religious and spiritual involvement may be a potential intervention to build and strengthen these social connections.
Spiritual coping strategies may also be protective against the strain of diagnosis or emotional hardship; some cancer patients noted that they felt more connected to family, friends, and community through prayer, which improved their survival rates and quality of life outcomes in remission.22,23 Social support and feelings of interconnectedness to self, others, and a higher purpose were also associated with decreased mortality24 in patients in coronary palliative care, helping them accept the reality of their illness and the challenges it would engender in the course of their lives.11
Stress and depressive symptoms that can accompany difficult diagnoses are risk factors for incident hypertension and comorbid outcomes.7 Educating patients on effective coping strategies can improve their ability to handle diagnosis-related stressors and appears to ultimately affect their survival rates. It may also provide a critical self-management tool for dealing with the negative emotional states that can occur during remission. When recalling particular hardships they experienced during their illness, spiritual coping strategies helped breast cancer survivors recover more quickly from disruptions in mood and episodic blood pressure spikes.20
Spiritual coping mechanisms, especially during times of crisis or illness, can influence a patient’s recovery and ability to self-manage their illness and related stressors. These practices may include listening to music, reading inspirational or heartfelt writings, engaging in prayer or moments of positive affirmations, spending time with loved ones, and feeling supported by their communities. These interventions do not necessarily need to be framed in a religious or spiritual context; the important thing is to help patients connect with themselves on a deeper level and find meaning in some activity or practice that they enjoy.
An interesting systematic review published in 2022 showed a paucity of literature exploring the relationship between spirituality and medication adherence among patients with cardiovascular diseases.25 Approximately 50% of patients suffering from these conditions are non-adherent to their prescribed medications. In patients with hypertension and heart failure, medication adherence improved with high levels of spirituality, higher organizational religiousness, and prayer. The authors conclude that a better understanding of the relationship between spirituality and medication-taking behaviors will help to develop culturally sensitive, spiritually based, and patient-centered interventions to improve medication adherence.25
Spiritual Needs in Practice
Patients may find purpose, community, and encouragement through religious or spiritual practices and beliefs or other coping mechanisms that can help them engage with and sustain positive lifestyle changes. While religious faith may or may not be a part of your patient’s life, spirituality and related coping mechanisms have an undeniable impact on health. Functional medicine recognizes the importance of the mental-emotional-spiritual connection to physical health and addresses these concerns as a core clinical imbalance of the functional medicine matrix. Through empathetic listening and retelling of a patient’s health story and recommending ways they might reconnect to their own purpose in life, addressing spiritual needs can strengthen the therapeutic partnership and open up new avenues of healing for the patient. Learn more about tools and strategies to help patients achieve sustainable lifestyle change and improve their well-being through IFM’s new course Lifestyle: The Foundations of Functional Medicine.
- Ginty AT, Kraynak TE, Fisher JP, Gianaros PJ. Cardiovascular and autonomic reactivity to psychological stress: neurophysiological substrates and links to cardiovascular disease. Auton Neurosci. 2017;207:2-9. doi:1016/j.autneu.2017.03.003
- Shattuck EC, Muehlenbein MP. Religiosity/spirituality and physiological markers of health. J Relig Health. 2020;59(2):1035-1054. doi:1007/s10943-018-0663-6
- Levine GN, Lange RA, Bairey-Merz CN, et al. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. J Am Heart Assoc. 2017;6(10):e002218. doi:1161/JAHA.117.002218
- Loucks EB, Schuman-Olivier Z, Britton WB, et al. Mindfulness and cardiovascular disease risk: state of the evidence, plausible mechanisms, and theoretical framework. Curr Cardiol Rep. 2015;17(12):112. doi:1007/s11886-015-0668-7
- Zieff G. Ancient roots – modern applications: mindfulness as a novel intervention for cardiovascular disease. Med Hypotheses. 2017;108:57-62. doi:1016/j.mehy.2017.08.001
- Ponte Márquez PH, Feliu-Soler A, Solé-Villa MJ, et al. Benefits of mindfulness meditation in reducing blood pressure and stress in patients with arterial hypertension. J Hum Hypertens. 2019;33(3):237-247. doi:1038/s41371-018-0130-6
- Cuevas AG, Williams DR, Albert MA. Psychosocial factors and hypertension: a review of the literature. Cardiol Clin. 2017;35(2):223-230. doi:1016/j.ccl.2016.12.004
- Nardi WR, Harrison A, Saadeh FB, Webb J, Wentz AE, Loucks EB. Mindfulness and cardiovascular health: qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study. PLoS One. 2020;15(9):e0239533. doi:1371/journal.pone.0239533
- Loucks EB, Nardi WR, Gutman R, et al. Mindfulness-based blood pressure reduction (MB-BP): stage 1 single-arm clinical trial. PLoS One. 2019;14(11):e0223095. doi:1371/journal.pone.0223095
- Abu HO, Ulbricht C, Ding E, et al. Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review. Qual Life Res. 2018;27(11):2777-2797. doi:1007/s11136-018-1906-4
- Mangolian Shahrbabaki P, Nouhi E, Kazemi M, Ahmadi F. Spirituality: a panacea for patients coping with heart failure. Int J Community Based Nurs Midwifery. 2017;5(1):38-48.
- Hemmati R, Bidel Z, Nazarzadeh M, et al. Religion, spirituality and risk of coronary heart disease: a matched case-control study and meta-analysis. J Relig Health. 2019;58(4):1203-1216. doi:1007/s10943-018-0722-z
- Cozier YC, Yu J, Wise LA, et al. Religious and spiritual coping and risk of incident hypertension in the Black Women’s Health Study. Ann Behav Med. 2018;52(12):989-998. doi:1093/abm/kay001
- Idler E, Blevins J, Kiser M, Hogue C. Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study. PLoS One. 2017;12(12):e0189134. doi:1371/journal.pone.0189134
- VanderWeele TJ, Yu J, Cozier YC, et al. Attendance at religious services, prayer, religious coping, and religious/spiritual identity as predictors of all-cause mortality in the Black Women’s Health Study [published correction appears in Am J Epidemiol. 2017;186(4):501]. Am J Epidemiol. 2017;185(7):515-522. doi:1093/aje/kww179
- Brintz CE, Birnbaum-Weitzman O, Llabre MM, et al. Spiritual well-being, religious activity, and the metabolic syndrome: results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. J Behav Med. 2017;40(6):902-912. doi:1007/s10865-017-9858-7
- Allshouse AA, Santoro N, Green R, et al. Religiosity and faith in relation to time to metabolic syndrome for Hispanic women in a multiethnic cohort of women—findings from the Study of Women’s Health Across the Nation (SWAN). Maturitas. 2018;112:18-23. doi:1016/j.maturitas.2018.03.008
- Kubzansky LD, Boehm JK, Allen AR, et al. Optimism and risk of incident hypertension: a target for primordial prevention. Epidemiol Psychiatr Sci. 2020;29:e157. doi:1017/S2045796020000621
- Kim ES, Delaney SW, Kubzansky LD. Sense of purpose in life and cardiovascular disease: underlying mechanisms and future directions. Curr Cardiol Rep. 2019;21(11):135. doi:1007/s11886-019-1222-9
- Crosswell AD, Moreno PI, Raposa EB, et al. Effects of mindfulness training on emotional and physiologic recovery from induced negative affect. Psychoneuroendocrinology. 2017;86:78-86. doi:1016/j.psyneuen.2017.08.003
- Sin NL. The protective role of positive well-being in cardiovascular disease: review of current evidence, mechanisms, and clinical implications. Curr Cardiol Rep. 2016;18(11):106. doi:1007/s11886-016-0792-z
- Roh S, Burnette CE, Lee YS. Prayer and faith: spiritual coping among American Indian women cancer survivors. Health Soc Work. 2018;43(3):185-192. doi:1093/hsw/hly015
- Rudaz M, Ledermann T, Grzywacz JG. Spiritual coping, perceived growth, and the moderating role of spiritual mindfulness in cancer survivors. J Psychosoc Oncol. 2018;36(5):609-623. doi:1080/07347332.2018.1464091
- Abu HO, McManus DD, Lessard DM, Kiefe CI, Goldberg RJ. Religious practices and changes in health-related quality of life after hospital discharge for an acute coronary syndrome. Health Qual Life Outcomes. 2019;17(1):149. doi:1186/s12955-019-1218-6
- Elhag M, Awaisu A, Koenig HG, Mohamed Ibrahim MI. The association between religiosity, spirituality, and medication adherence among patients with cardiovascular diseases: a systematic review of the literature. J Relig Health. 2022;61(5):3988-4027. doi:1007/s10943-022-01525-5