Stress, Depression and Anxiety


How stress affects your heart

In stressful situations, your body releases stress hormones. In response, your heart rate and blood pressure increase, your breathing becomes faster and shallower, your skin starts to sweat, and your entire body revs up into high gear.

In the short term, these reactions make you more alert and able to deal with the stressful situation. But if you are stressed for a long time, other changes occur.

  • Fat cells released into the bloodstream for extra energy convert into cholesterol.
  • Platelets circulating in the blood become more “sticky.”
  • Patterns of daily life may change, making it more difficult to eat well, exercise regularly, and get enough rest.

How to manage your stress

How we think about an event determines its impact on our health.

  • Attend a stress management program to learn about stress, understand how it affects you, and identify stress management skills.
  • Be physically active every day to help reduce the effects of stress.
  • Identify and use your support networks (for example, friends and family).
  • If you feel overwhelmed or are having difficulty functioning in your daily activities, speak to your doctor, nurse, or a mental health professional about options available to help you (for example, books, websites or a referral to counselling services).

More information about stress

Stress Management Program

The Stress Management Program at the University of Ottawa Heart Institute offers a variety of techniques to better manage stress.

Each of the six 90-minute sessions covers:

  • an introduction to stress management;
  • relaxation exercises;
  • signs and sources of stress;
  • personal values and priorities to improve time management; 
  • Social support and assertive communication;
  • approach and avoidance coping.

The course is offered virtually and in person through the Cardiac Rehabilitation Program. Interested patients or family members may contact the Division of Cardiac Prevention and Rehabilitation at 613-696-7070 if interested. 


  • Don’t Sweat the Small Stuff…and It’s All Small Stuff, Richard Carlson (2000)
  • Full Catastrophe Living, Jon Kabat-Zinn (2013)
  • Stress, Sanity and Survival, Robert L.Woolfolk, Frank C. Richardson (1979)
  • The Relaxation & Stress Reduction Workbook, Martha Davis, Matthew McKay, and Elizabeth Robbins-Eshelman (2019)



Depression is common in people with heart problems. About one in five patients experience clinical or major depression. If you are feeling at least five of the symptoms listed below for two weeks or more, you may be developing depression and you may need to speak to your doctor or nurse.

  • Sad feelings
  • Loss of interest in activities you usually enjoy
  • Changes in appetite
  • Significant unplanned weight loss or weight gain
  • Sleep problems
  • Loss of energy
  • Difficulties with concentration or memory
  • Decrease in your typical social activities or withdrawing from friends and family
  • Feelings of worthlessness, helplessness, or hopelessness
  • Changes in sexual desire
  • Thoughts about death or suicide

How depression affects your heart

Depression may affect your heart directly and indirectly. It affects your heart directly by increasing the risk of blood clotting, plaque build-up and atherosclerosis. Depression also negatively affects your immune system, so you are less able to fight off germs and viruses.

Depression may affect your heart indirectly by influencing some of the decisions you make. People with depression often find it difficult to make healthy choices about quitting smoking, exercising, eating, or taking medications safely. They find it difficult to find the drive or energy to make healthy lifestyle changes.

What you can do if you are feeling depressed

  • Negative thinking is often involved in depression. Learning new ways to stop negative thoughts can be beneficial.
  • Do more pleasant activities—even if you don’t feel like it.
  • Exercise regularly. Getting out for a walk every day may improve your mood.
  • Set realistic goals and do one thing at a time.
  • Celebrate your achievements. You may need to record your daily activities to prove to yourself you are making gains.
  • Take time for yourself.
  • Talk about your problems or concerns; don’t bottle up your feelings.
  • Seek support from your family and friends and/or from support groups.
  • Participate in the Cardiac Rehabilitation Program.
  • Talk to your doctor or a mental health professional (for example, a psychologist or psychiatrist) about proven treatments for depression.

More information about depression


  • Feeling Good: The New Mood Therapy, Burns, D. (1990)
  • Mind Over Mood: Change How You Feel by Changing the Way You Think, Greenberger & Padesky (1995)



Anxiety is one of the most distressing emotions people feel. At some point in time, most cardiac patients will experience varying degrees of fear or nervousness related to their health condition.

Anxiety describes several problems including generalized anxiety (a mixture of worries experienced most of the time), panic attacks (intense feelings of anxiety during which people often feel they are going to die), and post-traumatic stress disorder (repeated memories of terrible experiences with high levels of fear).

Like depression, about one in five cardiac patients experience significant anxiety symptoms. These symptoms may include:

  • uncontrollable worry
  • feeling “on edge” or restlessness
  • feeling irritable
  • muscle tension
  • light-headedness
  • sleep problems
  • being easily fatigued
  • difficulty breathing
  • increased heart rate
  • headaches
  • sweating
  • gastrointestinal (stomach) problems

How anxiety affects your heart

Anxiety may play a role in cardiac problems by increasing the risk of an irregular heartbeat and triggering spasms. Both responses may lead to cardiac complications. Anxiety may also lead to unhealthy behaviours, such as smoking, overeating, poor sleep and decreased physical activity.

What you can do if you are feeling anxious

Learn to recognize when you are starting to feel anxious and plan ways to manage your feelings.

  • Learn new coping strategies to cope with anxious situations instead of avoiding them.
    • Practice slow and deep breathing.
    • Imagine scenes that are relaxing and pleasant for you.
    • Learn relaxation skills (for example, tense and release the muscles throughout your body.
    • Distract yourself from the thoughts or physical symptoms that contribute to your anxiety (for example, try counting down from 100 in multiples of three).
    • Do something pleasurable like reading a book or getting a back rub.
    • Share your fears and worries with someone you trust.
  • Challenge yourself to change the way you are thinking about a problem. For example, tell yourself “I can handle this, I’ve done it before,” or “I’m not going to die, it is normal for my heart to pump harder when I am exercising.”
  • Prepare solutions to problems that cause you anxiety, so you are ready in advance.
  • Determine how much control you have in each situation and let go of things beyond your control.
  • Talk to your doctor or a mental health professional (for example, a social worker, psychologist, or a psychiatrist) about proven treatments for anxiety.
  • Participate in the Cardiac Rehabilitation Program.

More information about anxiety


  • The Anxiety and Phobia Workbook (7th Ed.), Bourne, E. (2020)


Managing Emotions Program

The Managing Emotions Program at the University of Ottawa Heart Institute uses a cognitive-behavioral approach to treat depression and anxiety symptoms specific to the needs of cardiac patients.

The 10-session program, offered in person or virtually, covers the following topics:

  • The value of emotions
  • The basics of emotions management and coping skills
  • Values, priorities and time management
  • Problematic thinking styles
  • Emotional awareness and avoidance
  • Emotion-driven behaviours
  • Managing thoughts and feelings in uncertain situations
  • Communication

If interested in participating, patients may call the Division of Cardiac Prevention and Rehabilitation at 613-696-7070 or speak to their cardiologist for a referral to the program.