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Does the heart play a role in the occurrence of emotions?

Does the heart play a role in the occurrence of emotions?


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It is a common belief that the heart is somehow related to emotions. When we are nervous,our heartbeat is effected (increased heart rate) and when we are happy, another pattern in heart function can be observed.

My question is the following. Does the heart have a significant role in the occurence of emotions, or is it that the heart is just an organ that pumps blood and these physiological changes are merely a by-product of processes relevant to emotion?
Is the heart's function of interest to any cognitive scientific field of study?


As it has been pointed in the other answers and the comments, the heart is indeed only an organ that pumps blood and all the processes responsible for emotions are carried out by the brain. However, the heart and generally the autonomous nervous system is of critical importance to somatic theories of emotion. These theories propose that bodily responses in the presence of a certain stimulus, initiate emotional processing. However, it is not that the heart, for instance, creates an emotion. It is the brain that notices any significant physiological changes like the heart rate being increased and makes an interpretation of this internal state taking into account the available stimuli. This idea originates with William James' theory of emotion but it was also incorporated in more recent approaches like the somatic marker hypothesis by Antonio Damasio.


Emotions are attached to heart.

Eg. if you feel scared in dangerous situation, sympathetic part of autonomic nervous system is activated. It increases heart rate and then blood flow to brain is elevated. More blood transports more oxygen and then brain functions better.


Injury, rehabilitation and psychology

Whether its recreational or professional, injury is a common occurrence at all levels of sport and exercise. Evidence has shown that physical factors such as over-training, equipment and playing conditions are the major contributors towards an athlete’s injuries. However, there are many other psychological factors that play a huge role in the gaining, prevention and rehabilitation of injuries. Factors that predict and moderate injury including personality (i.e. mental toughness, internal locus of control, trait anxiety etc.), history of stressors (i.e. life stress, previous injury), and coping resources (i.e. coping behaviours, social support, stress management, attentional strategy, medication).

Wiese-Bjornstal, Smith, Shaffer, & Morrey (1998) developed the integrated model of psychological response to injury and rehabilitation which comprise three main components: cognitive appraisal, emotional response, and behavioural response. These three components a underpinned by personal (i.e. injury components, individual difference in psychology, demographic and physical) and situational factors (i.e. Sport, social and environment) but initial impact the cognitive appraisal of an injury. Adherence to rehabilitation for full recovery from an injury predominantly follows the path of the Black arrows, whereas non-adherence is follows the path of the Red arrows:

Previous research has shown that cognitive appraisals such as self-worth, self-esteem and self-confidence have been found to decrease following an injury, but increase during and following a rehabilitation intervention.

Emotional responses to injuries can be monitored using the Profile of Mood States (POMS) and other related inventories such as the Brunel Mood Scale (BRUMS), the Sport Emotion Questionnaire (SEQ) or the Individual Zones of Optimal Functioning (IZOF). Studies have previously shown that although negative mood states generally decrease across a successful rehabilitation period, the improvements are not necessarily steady and predictable. Furthermore, emotional coping strategies such as avoidance, denial, impaired autonomy, support dissatisfaction and inhibition lead to higher levels of negative emotions. Mankad, Gordon & Wallman (2009) found that the simple intervention of logging emotional thoughts and feelings that have been experienced can reduce mood disturbances.

The first and second factors lead to appropriate behavioural response such as adherence to rehabilitation, coping, social support, interventions, pain management and return to competition.

Adherence to rehabilitation programs

Plenty of research has proven that adhering to a injury rehabilitation program is a hugely important aspect of recovery. Brewer (1998) outlined typical behaviours that are associated with adherence including:

  • Instruction to restrict physical activity and medical prescription compliance
  • Home rehabilitation exercises, cryotherapy and icing schedule completion
  • Regular and keen involvement in clinic-based rehabilitation programs

Successful adherence to a rehabilitation program can be measured using the Sports Injury Rehabilitation Adherence Scale (SIRAS) and the Sports Injury Rehabilitation Beliefs Scale (SIRBS).

The are several predictors to adherence to rehabilitation include personal factors such as self-motivation, self-assurance, assertiveness, independence and goal perspective. The most poignant personal factor that influences the behavioural response to athletic injury is athletic identity which can be measured using the Athletic Identity Measurement Scale (AIMS). Research by Brew et al. (2010) showed that athletic identity decreased dramatically from pre- and post-anterior cruciate ligament surgery and in those who struggled with their rehabilitation program. The former was suggested to be a self-protecting mechanism to curb the individuals athletic identity.

Additionally, an individual’s coping ability, social support availability, and cognitive behavioural interventions are shown to be effective in an athletes adherence to rehabilitation programs. Interventions such as guided imagery (i.e. mental rehearsal), relaxation, goal setting and biofeedback can be used to improve emotion regulation and reduce the emotional trauma that accompanies injury.

Personality characteristics, especially an individuals ability to tolerate and manage pain, is a rather overt characteristic that effects adherence. An individual with a low pain tolerance will find it difficult to remain upbeat and adhere to a rehabilitation program. However, Pain can be categorised into many forms such as performance, injury, acute, chronic, benign or harmful and is largely a subjective experience. The Sport Inventory for Pain (SIP) measures five aspects of the perception of pain including:

  • Direct action coping strategies
  • Mental coping strategies
  • Catastrophising and despair
  • Avoidance coping strategies
  • Somatic stimuli sensitivity

Pain reducing strategies used in rehabilitation today include techniques of deep, controlled breathing, relaxation and meditation. More recently, research has shown that music with a low tempo reduces perceived intensity and unpleasantness of pain experienced. Other strategies can include refocusing attention away from an acute pain due to injury towards an external stimuli. When chronic pain is present, focusing internally can heighten bodily awareness and an individuals perceived control over pain.

Situational factors such as a mastery-orientated climate, belief in the efficacy of treatment, comfortable clinical environment, convenience, exertion of exercises and social support are associated with adherence to rehabilitation. It is therefore crucial to provide a rehabilitation environment that takes advantage of all these factors for optimal rehabilitation progress.

At the end of the day, the ultimate goal of all athletes rehabilitation program is to return to competitive action. With the variability of injury, the rehabilitation process can be anything between a week to a year in the making. It is not uncommon to find an injured athlete that enters the final step of rehabilitation with a degree of worry and trepidation. These negative associations with a return to competition can be attributed to the fear of re-injury or believing their not strong enough to return. A review by Podlog and Eklund (2007) suggested that athletes with high competence, autonomy and relatedness tend to be have higher intrinsic motivation towards rehabilitation goals. In addition, athletes who were successful in returning to full competition recognised both the positives and negatives of injury to cope and overcome adversity which resulted in higher motivation to return to competition.


Physiological entrainment during coherence.

The top graphs show an individual’s heart rate variability, blood pressure rhythm (pulse transit time), and respiration rhythm over a 10-minute period. At the 300-second mark (center dashed line), the individual used HeartMath’s Quick Coherence ® technique to activate a feeling of appreciation and shift into the coherence state. At this point, the rhythms of all three systems came into entrainment: notice that the rhythmic patterns are harmonious and synchronized with one another instead of scattered and out-of-sync. The left side of the graphs shows the spectral analysis of the three physiological rhythms before the shift to coherence. Notice how each pattern looks quite different from the others. The graphs on the right show that in the coherence state the rhythms of all three systems have entrained to oscillate at the same frequency.

Coherence Is Not Relaxation

An important point is that the state of coherence is both psychologically and physiologically distinct from the state achieved through most techniques for relaxation. At the physiological level, relaxation is characterized by an overall reduction in autonomic outflow (resulting in lower HRV) and a shift in ANS balance towards increased parasympathetic activity. Coherence is also associated with a relative increase in parasympathetic activity, thus encompassing a key element of the relaxation response, but is physiologically distinct from relaxation in that the system oscillates at its natural resonant frequency and there is increased harmony and synchronization in nervous system and heart–brain dynamics. This important difference between the two states is reflected most clearly in their respective HRV power spectra (see figure and explanation below). Furthermore, unlike relaxation, the coherence state does not necessarily involve a lowering of heart rate, or a change in the amount of HRV, but rather is primarily marked by a change in the heart rhythm pattern.

Heart rhythm patterns during relaxation and coherence. The two graphs on the left show typical heart rate variability (heart rhythm) patterns during states of relaxation and coherence. To the right are shown the HRV power spectral density plots of the heart rhythm patterns at left. Relaxation produces a high-frequency, low-amplitude heart rhythm, indicating reduced autonomic outflow. Increased power in the high frequency band of the HRV power spectrum is observed, reflecting increased parasympathetic activity (the “relaxation response”). In contrast, the coherence state, activated by sustained positive emotions, is associated with a highly ordered, smooth, sine-wave-like heart rhythm pattern.

Unlike relaxation, coherence does not necessarily involve a reduction in HRV, and may at times even produce an increase in HRV relative to a baseline state. As can be seen in the corresponding power spectrum, coherence is marked by an unusually large, narrow peak in the low frequency band, centered around 0.1 hertz (note the significant power scale difference between the spectra for coherence and relaxation). This large, characteristic spectral peak is indicative of the system-wide resonance and synchronization that occurs during the coherence state.

Not only are there fundamental physiological differences between relaxation and coherence, but the psychological characteristics of these states are also quite different. Relaxation is a low-energy state in which the individual rests both the body and mind, typically disengaging from cognitive and emotional processes. In contrast, coherence generally involves the active engagement of positive emotions. Psychologically, coherence is experienced as a calm, balanced, yet energized and responsive state that is conducive to everyday functioning and interaction, including the performance of tasks requiring mental acuity, focus, problem-solving, and decision-making, as well as physical activity and coordination.

The Role of Breathing

Another important distinction involves understanding the role of breathing in the generation of coherence and its relationship to the techniques of the HeartMath System. Because breathing patterns modulate the heart’s rhythm, it is possible to generate a coherent heart rhythm simply by breathing slowly and regularly at a 10-second rhythm (5 seconds on the in-breath and 5 seconds on the out-breath). Breathing rhythmically in this fashion can thus be a useful intervention to initiate a shift out of stressful emotional state and into increased coherence. However, this type of cognitively-directed paced breathing can require considerable mental effort and is difficult for some people to maintain.

While HeartMath techniques incorporate a breathing element, paced breathing is not their primary focus and they should therefore not be thought of simply as breathing exercises. The main difference between the HeartMath tools and most commonly practiced breathing techniques is the HeartMath tools’ focus on the intentional generation of a heartfelt positive emotional state. This emotional shift is a key element of the techniques’ effectiveness. Positive emotions appear to excite the system at its natural resonant frequency and thus enable coherence to emerge and to be maintained naturally, without conscious mental focus on one’s breathing rhythm.

This is because input generated by the heart’s rhythmic activity is actually one of the main factors that affect our breathing rate and patterns. When the heart’s rhythm shifts into coherence as a result of a positive emotional shift, our breathing rhythm automatically synchronizes with the heart, thereby reinforcing and stabilizing the shift to system-wide coherence.

Additionally, the positive emotional focus of the HeartMath techniques confers a much wider array of benefits than those typically achieved through breathing alone. These include deeper perceptual and emotional changes, increased access to intuition and creativity, cognitive and performance improvements, and favorable changes in hormonal balance.

To derive the full benefits of the HeartMath tools, it is therefore important to learn how to self-activate and eventually sustain a positive emotion. However, for users who initially have trouble achieving or maintaining coherence, practicing heart-focused breathing at a 10-second rhythm, as described above, can be useful training aid. Once individuals grow accustomed to generating coherence through rhythmic breathing and become familiar with how this state feels, they can then begin to practice breathing a positive feeling or attitude through the heart area in order to enhance their experience of the HeartMath tools and their benefits. Eventually, with continuity of practice, most people become able to shift into coherence by directly activating a positive emotion.


What the Biblical word “Heart’ Means (Notable Work)

Introduction ( Published Annually)

In both the Old Testament (OT) and the New Testament (NT) the word “heart” is used to refer to the whole of the innermost part of the human, NOT merely the emotions.

However, in the twenty-first century English the word “heart” is used to express the emotions as an individual compartment of the inner part of the human.

It is common for Americans to divide humans into the physical and the metaphysical.

While this is a widespread insight, the way most Americans compartmentalize the internal (metaphysical) aspect of humans is diverse from many other cultures .

We Americans tend to see people as having two separate parts, wherein one part is the emotions, which we refer to as the heart, then a brain, which houses the mind.

The Bible does not divide man so easily – it focuses on all three making up the whole of a being – this is Biblically called the “heart.”

When both the Old and New Testaments speak about the heart, it never means merely human feelings (emotions) .

The Biblical word “heart,” is the inner aspect of a man, made of three parts all together, with the primary part: the,

1) Mental Process, which is the major part (where action & reaction take place) , which is to lead a person in their life.

2) Emotions (which only process as reaction) , as icing to enrich our lives.

3) Will, the seat of the will (discretionary, volitional, decision-making) where decisions are made between the rational and the emotive.

The following excerpts, though thorough,
are by no means exhaustive.

Strong’s Dictionary

According to Strong’s, the Hebrew word lebab ( 3824 ) is rendered: “ heart ” (as the most interior organ ) “ being , think in themselves,” “ breast ,” “ comfortably ,” “ courage ,” “ midst ,” “ mind ,” “ unawares ,” and “ understanding .”

Strong’s Greek Dictionary, states that the Greek word kardia ( 2588 ) is rendered: “heart,” i.e. ( figuratively ) , the thoughts or feelings ( mind ) also ( by analogy ) the middle. 1

According to Ed Bulkley, in his book, Why Christians Can’t Trust Psychology , the Scriptures use at least four terms to describe the immaterial part of man: the heart, soul, spirit, and mind. The descriptions and functions of these aspects of man seem to overlap.

Bulkley states:

The biblical term heart ( lawbab or lebab in Hebrew kardia in Greek ) is the clearest summary of the innermost center of the human being.

Perhaps the closest psychological term to the heart is the ego , the Latin word for “I,” borrowed by Freud to denote the “self.”

Peter describes the inner man as “ the hidden man of the heart ” ( I Peter 3:4 KJV ) , or the “ inner self ” (I Peter 3:4 NIV ) . It is the center of one’s being ( Proverbs 4:23 ) , where he believes and exercises faith ( Luke 24:25 Romans 10:9,10 ) . It is the location of the human deliberation, where wisdom is employed.

Understanding is said to be the function of the mind (Job 38:36 ) , yet the connection to the heart is undeniable. The heart is where a person discerns the difference between right and wrong ( I Kings 3:9 ) .

Finally, Bulkley says, the heart is the center of courage, emotions, and will.

Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day” ( 2 Corinthians 4:16 ) .

The heart is the center of man’s character – who he really is ( Matthew 15:18 ) .

The good man brings good things out of the good stored up in his heart, and the evil man brings evil things out of the evil stored up in his heart. For out of the overflow of his heart his mouth speaks” ( Luke 6:45 ) . 2

Vine’s Old Testament Dictionary

According to Vine’s:

The Hebrew word Lebab ( 3824 ), rendered “heart” is the seat of desire, inclination, or will and can be the seat of the emotions. The “heart” could be regarded as the seat of knowledge and wisdom and as a synonym of “ mind .” This meaning often occurs when ‘heart” appears with the verb “ to know ,” “ Thus you are to know in your heart.. .” ( Deut. 8:5, NASB ) and “ Yet the Lord hath not given you a heart to perceive [ know ] …” ( Deut. 29:4, KJV RSV, “mind” ) . Solomon prayed, “ Give therefore thy servant an understanding heart to judge thy people, that I may discern between good and bad.. .” ( 1 Kings 3:9 cf. 4:29 ) . Memory is the activity of the “heart,” as in Job 22:22: “ …lay up his [ God’s ] words in thine heart .”

The “heart” may be the seat of conscience and moral character. How does one respond to the revelation of God and of the world around him? Job answers: “…my heart shall not reproach me as long as I live ” ( 27:6 ) . On the contrary, “ David’s heart smote him… ” ( 2 Sam. 24:10 ) . The “heart” is the fountain of man’s deeds: “ …in the integrity of my heart and innocence of my hands I have done this ” ( Gen. 20:5 cf. V. 6 ) . David walked “ in uprightness of heart ” ( 1 Kings 3:6 ) and Hezekiah “ with a perfect heart ” ( Isa. 38:3 ) before God. Only the man with “ clean hands, and a pure heart ” ( Ps. 24:4 ) can stand in God’s presence. 3

Vine’s New Testament Dictionary

According to Vine’s:

The Greek word kardia ( 2588 ) , rendered “heart” ( English , “ cardiac ,”) , is the chief organ of physical life ( “for the life of the flesh is in the blood,” Lev. 17:11 ) , occupies the most important place in the human system. By an easy transition, the word came to stand for man’s entire mental and moral activity, both the rational and the emotional elements.

In other words, the heart is used figuratively for the hidden springs of the personal life. The Bible describes human depravity as in the “heart”, because sin is a principle which has its seat in the center of man’s inward life, and then ‘defiles’ the whole circuit of his action, Matt. 15:19, 20. On the other hand, Scripture regards the heart as the sphere of Divine influence, Rom. 2:15 Acts 15:9….

The heart, as lying deep within, contains “ the hidden man ,” 1 Pet. 3:4, the real man. It represents the true character but conceals it ( J. Laidlaw, in Hastings’ Bible Dic. ) . As to its usage in the NT it denotes (a) the seat of physical life, Acts 14:17 Jas. 5:5 (b) the seat of moral nature and spiritual life, the seat of grief, John 14:1 Rom. 9:2 2 Cor. 2:4 joy, John 16:22 Eph. 5:19 the desires, Matt. 5:28 2 Pet. 2:14 the affections, Luke 24:32 Acts 21:13 the perceptions, John 12:40 Eph. 4:18 the thoughts, Matt. 9:4 Heb. 4:12 the understanding, Matt. 13:15 Rom. 1:21 the reasoning powers, Mark 2:6 Luke 24:38 the imagination, Luke 1:51 conscience, Acts 2:37 1 John 3:20 the intentions, Heb. 4:12, (cf.) 1 Pet. 4:1 purpose, Acts 11:23 2 Cor. 9:7 the will, Rom. 6:17 Col. 3:15 faith, Mark 11:23 Rom. 10:10 Heb. 3:12. The heart, in its moral significance in the OT, includes the emotions, the reason, and the will. 3

Holman Bible Dictionary

Holman gives the most thorough explanation concerning the definition of the English word “heart,” when it states:

The heart is the center of the physical, mental, and spiritual life of humans. This contrasts to the normal use of kardia (“heart”) in Greek literature outside the Scriptures. The New Testament follows the Old Testament usage when referring to the human heart in that it gives kardiaa wider range of meaning than it was generally accustomed to have.

First, the word heart refers to the physical organ and is considered to be the center of the physical life. Eating and drinking are spoken of as strengthening the heart ( Gen. 18:5 Judg. 19:5 Acts 14:17 ) . As the center of physical life, the heart came to stand for the person as a whole.

The heart became the focus for all the vital functions of the body including both intellectual and spiritual life. The heart and the intellect are closely connected, the heart being the seat of intelligence: “ For this people’s heart is waxed gross … lest at any time they should … understand with their heart, and should be converted ” ( Matt. 13:15 ) .

The heart is connected with thinking: As a person “ thinketh in his heart, so is he ” ( Prov. 23:7 ) . To ponder something in one’s heart means to consider it carefully ( Luke 1:66 2:19 ) . “ To set one’s heart on ” is the literal Hebrew that means to give attention to something, to worry about it ( 1 Sam. 9:20 ) . To call to heart (mind) something means to remember something ( Isa. 46:8 ) . All of these are functions of the mind, but are connected with the heart in biblical language.

Closely related to the mind are acts of the will, acts resulting from a conscious or even a deliberate decision. Thus, 2 Corinthians 9:7 : “ Every man according as he purposeth in his heart, so let him give .” Ananias contrived his deed of lying to the Holy Spirit in his heart ( Acts 5:4 ) . The conscious decision is made in the heart ( Rom. 6:17 ) . Connected to the will are human wishes and desires. Romans 1:24 describes how God gave them up “ through the lusts of their own hearts, to dishonor their own bodies .” David was a man after God’s “ own heart ” because he would “ fulfill all ” of God’s will ( Acts 13:22 ) .

Not only is the heart associated with the activities of the mind and the will, but it is also closely connected to the feelings and affections of a person. Emotions such as joy originate in the heart ( Ps. 4:7 Isa 65:14 ) . Other emotions are ascribed to the heart, especially in the Old Testament. Nabal’s fear is described by the phrase: “ his heart died within him ” ( 1 Sam. 25:37 compare Ps. 143:4 ). Discouragement or despair is described by the phrase “ heaviness in the heart ” which makes it stoop ( Prov. 12:25 ) .

Again, Ecclesiastes 2:20 says, “ Therefore I went about to cause my heart to despair of all the labor which I took under the sun .” Another emotion connected with the heart is sorrow. John 16:6 says, “ because I have said these things unto you, sorrow hath filled your heart .” Proverbs 25:20 , describes sorrow as having “an heavy heart .” The heart is also the seat of the affection of love and its opposite, hate. In the Old Testament, for example, Israel is commanded: “ You shall not hate your brother in your heart, but you shall reason with your neighbor, lest you bear sin because of him ” ( Lev. 19:17 RSV) .

A similar attitude, bitter jealousy, is described in James 3:14 as coming from the heart. On the other hand, love is based in the heart. The believer is commanded to love God “ with all your heart ” ( Mark 12:30 compare Deut. 6:5 ) . Paul taught that the purpose of God’s command is love which comes from a “ pure heart ” (1 Tim. 1:5 ) .

Finally, the heart is spoken of in Scripture as the center of the moral and spiritual life. The conscience, for instance, is associated with the heart. In fact, the Hebrew language had no word for conscience, so the word heart was often used to express this concept: “ my heart shall not reproach me so long as I live ” ( Job 27:6 ) . The Revised Standard Version translates the word for “heart” as “ conscience ” in 1 Samuel 25:31 (RSV) . In the New Testament the heart is spoken of also as that which condemns us ( 1 John 3:19-21 ) .

All moral conditions from the highest to the lowest are said to center in the heart. Sometimes the heart is used to represent a person’s true nature or character. Samson told Delilah “ all his heart ” ( Judg. 16:17 ) . This true nature is contrasted with the outward appearance: “ man looks on the outward appearance, but the Lord looks on the heart ” ( 1 Sam. 16:7 RSV) .

On the negative side, depravity is said to issue from the heart: “ The heart is deceitful above all things, and desperately wicked: who can know it? ” ( Jer. 17:9 ) . Jesus said that out of the heart comes evil thoughts, murder, adultery, fornication, theft, false witness, slander ( Matt. 15:19 ) . In other words, defilement comes from within rather than from without.

Because the heart is at the root of the problem, this is the place where God does His work in the individual. For instance, the work of the law is “ written in their hearts ,” and conscience is the proof of this ( Rom. 2:15 ) . The heart is the field where seed (the Word of God) is sown ( Matt. 13:19 Luke 8:15 ) . In addition to being the place where the natural laws of God are written, the heart is the place of renewal. Before Saul became king, God gave him a new heart ( 1 Sam. 10:9 ) . God promised Israel that He would give them a new spirit within, take away their “ stony heart ” and give them a “ heart of flesh ” ( Ezek. 11:19 ) . Paul said that a person must believe in the heart to be saved, “ for with the heart man believeth unto righteousness ” ( Rom. 10:10 ). (See also Mark 11:23 Heb. 3:12 . )

Finally, the heart is the dwelling place of God. Two persons of the Trinity are said to reside in the heart of the believer. God has given us the “ ernest of the Spirit in our hearts ” ( 2 Cor. 1:22 ) . Ephesians 3:17 expresses the desire that “ Christ may dwell in your hearts by faith .” The love of God “ is shed abroad in our hearts by the Holy Ghost which is given unto us ” ( Rom. 5:5 ) . 4

Easton’s Bible Dictionary

Easton’s states:

According to the Bible, the heart is the center not only of spiritual activity, but also of all the operations of human life. “ Heart ” and “ soul ” are often used interchangeably (Deut. 6:5 26:16 compare with Matt. 22:37 Mark 12:30, 33) , but this is not generally the case. The heart is the “ home of the personal life ,” and hence a man is designated, according to his heart, wise (1 Kings 3:12, etc.) , pure (Ps. 24:4 Matt. 5:8, etc.) , upright and righteous (Gen. 20:5, 6 Ps. 11:2 78:72) , pious and good (Luke 8:15) , etc. In these and such passages the word “ soul ” could not be substituted for “heart.”

Easton’s goes on to say, the heart is also the seat of the conscience (Rom. 2:15) . It is naturally wicked (Gen. 8:21) , and hence it contaminates the whole life and character (Matt. 12:34 15: 18 compare Eccl. 8:11 Ps. 73:7) . Hence, the heart must be changed, regenerated (Ezek. 36:26 11:19 Ps. 51:10-14) , before a man can willingly obey God. The process of salvation begins in the heart by the believing reception of the testimony of God, while the rejection of that testimony hardens the heart (Ps. 95:8 Prov. 28:14 2 Chr. 36:13) . 5

Elwell’s Theological Dictionary

Elwell’s states:

The Hebrew and Christian views on the nature of man were developed in a religious setting: there is no systematized or scientific psychology in the Bible. Nevertheless, certain fundamental conceptions are worthy of note:

1. In the OT there is no very marked emphasis on individuality but, rather, on what is frequently now termed corporate personality. Yet

2. A. R. Johnson has shown that a fundamental characteristic of OT anthropology is the awareness of totality. Man is not a body plus a soul, but a living unit of vital power, a psychophysical organism.

3. The Hebrews thought of man as influenced from without, by evil spirits, the devil, or the Spirit of God, whereas in modern psychology the emphasis has tended to be placed on dynamic factors operating from within (though at the present time, fresh interest is being evoked in the study of environmental forces as factors influencing human behavior) .

4. The study of particular words in the OT and NT affords a comprehensive view of the underlying Hebrew and Christian conceptions of man.

The OT English versions of the Bible, several Hebrew expressions are translated “heart,” the main words being leb and lebab . In a general sense, heart means the midst, the innermost or hidden part of anything. Thus, the midst (or heart) of the sea (Ps. 46:2) of heaven (Deut. 4:11) of the oak (II Sam. 14:18) . In the physiological sense, heart is the central bodily organ, the seat of physical life. Thus, Jacob’s heart “ fainted ” (Gen. 45:26) Eli’s heart “ trembled ” (I Sam. 4:13) .

However, like other anthropological terms in the OT, heart is also used very frequently in a psychological sense, as the center or focus of man’s inner personal life. The heart is the source, or spring, of motives the seat of the passions the center of the thought processes the spring of conscience. Heart, in fact, is associated with what is now meant by the cognitive, affective, and volitional elements of personal life.

The book of Proverbs is illuminating here: The heart is the seat of wisdom (2:10 etc.) of trust (or confidence) (3:5) diligence (4:23) perverseness (6:14) wicked imaginations (6:18) lust (6:25) subtlety (7:10) understanding (8:5) deceit (12:20) folly (12:23) heaviness (12:25) bitterness (14:10) sorrow (14:13) backsliding (14:14) cheerfulness (15:13) knowledge (15:14) joy (15:30) pride (16:5) haughtiness (18:12) prudence (18:15) fretfulness (19:3) envy (23:17).

The NT word for heart is kardia. It, too, has a wide psychological and spiritual connotation. Our Lord emphasized the importance of right states of heart. It is the pure in heart who see God (Matt. 5:8) sin is first committed in the heart (Matt. 5:28) out of the heart proceed evil thoughts and acts (Matt. 15:19) forgiveness must come from the heart (Matt. 18:35) men must love God with all their heart (Matt. 22:37) the word of God is sown, and must come to fruition, in the heart (Luke 8:11-15).

Paul’s use of Kardia is on similar lines. According to H. W. Robinson, in his book “ The Christian Doctrine of Man ,” in fifteen cases heart denotes personality, or the inner life, in general (e.g., I Cor. 14:25) in thirteen cases, it is the seat of emotional states of consciousness (e.g., Rom. 9:2) in eleven cases, it is the seat of intellectual activities (e.g., Rom. 1:21) in thirteen cases, it is the seat of the volition (e.g., Rom. 2:5). Paul uses other expressions, such as mind, soul, and spirit, to augment the conception of man but, on the whole, it may be said that the NT word Kardia reproduces and expands the ideas included in the OT words leb and lebab. 6

Harris’s Theological Wordbook of the Old Testament

Harris’s states:

lebab is rendered heart, understanding, and mind (also used in idioms such as “ to set the heart upon ” meaning “ to think about ” or “ to want ”). Concrete meanings of leb referred to the internal organ and to analogous physical locations. However, in its abstract meanings, “heart” became the richest biblical term for the totality of man’s inner or immaterial nature.

In biblical literature, it is the most frequently used term for man’s immaterial personality functions as well as the most inclusive term for them since, in the Bible virtually every immaterial function of man is attributed to the “heart.”

By far the majority of the usages of leb refer either to the inner or immaterial nature in general or to one of the three traditional personality functions of man emotion, thought, or will. Thought functions may be attributed to the heart. In such cases it is likely to be translated as mind ” or “ understanding .”

To “ set the heart to ” may mean to “ pay attention to ” (Ex 7:23) or to “ consider important ” (II Sam 18:32). Creative thought is a heart function. Wicked devices originate in the heart (Gen 6:5). The RSV translates “ which came upon Solomon’s heart ” as “ all that Solomon had planned ” (II Chr 7:11).

Wisdom and understanding are seated in the heart. The “ wise heart ” (I Kgs. 3:12 RSV, “wise mind”) and “ wise of heart ” (Prov 16:23) are mentioned. This idiom can be so strongly felt that “ heart ” virtually becomes a synonym for such ideas as “ mind ” (II Chr 9:23 RSV) or ‘ sense ” (Prov 11:12 RSV). The heart functions in perception and awareness as when Elisha’s heart (i.e. Elisha’s perceptive nature RSV “spirit”) went with Gehazi (II Kgs 5:26).

As the seat of thought and intellect, the heart can be deluded (Isa 44:20 RSV “mind”). The heart is the seat of the will. A decision may be described as “ setting ” the heart (II Chr 12:14). “ Not of my heart ” expresses “ not of my will ” (Num 16:28). The “hearts” of the Shechemites inclined to follow Abimelech (Jud 9:3). Removal of the decision-making capacity is described as hardening the heart (Ex 10:1 Josh 11:20). Closely connected to the preceding is the heart as the seat of moral responsibility. Righteousness is “integrity of heart” (Gen 20:5) . 7

The New Testament Word Psyche

According to Vine’s the NT word psuche (5590), which can be translated “ soul ,” or “ life ,” is rendered “ heart ” in Eph. 6:6, “ doing the will of God from the heart .” In Col. 3:23, a form of the word psuche preceded by ek, literally, “ from (the) soul ,” is rendered “ heartily .”

See the following (RV) Scriptures: Col. 3:12 (NASB, NJ) Philem. 7, 12, 20 (NKJV, NASB) 2 Cor. 3:3 (KJV, NKJV, NASB, RS, AS) Eph. 1:18 (AS, RS, NASB) Heb. 8:10, 10:16 (RS, AS, KJV, NKJV, NASB) Luke 21:26 (KJV, NKJV) 2 Cor. 7:2 (KJV, NKJV, RS, AS, NASB) . 3

Conclusion

Hopefully from the plethora of references cited, it is beyond dispute that when the Bible refers to the heart it is not referring to the emotions solely. While the emotions are a blessing of God, that lend exuberance and passion, both in the negative and positive aspects of sensation they are never meant as the sole device of discretion.

This is the place of the seat of the will, but always according to the intellect in response to what God has said. And while we should consider the emotions in any decisions we make, this is always in a subservient role, never taking preeminence.

There is an abundance of references to the heart as having the lead role in decision-making. Both the Old and New Testaments present the word “heart” as always used to include the mental process (rational and reason), and the will (volition), as well as the emotions.

Final Definition

Personally, I believe the best definition of heart, is the focus and determination of the mind, and the response of the emotions.

The Bible never instructs us to be led by our emotions, but rather by our minds.

It is with our minds that we focus our attention and choose to obey God, and it is those actions that first are decided with our mind in consideration of what we focus on – that is what God holds us accountable for.

Biblically speaking, we are to focus on God’s Word and His Will,
as our Will determines the direction that we take.

Last Caution

We must always remember, what God says about the human heart, that it: “… is deceitful above all things, and desperately wicked,” 8 because man is a fallen creature, subject to sin however, it is also with our heart that we exercise faith 9 unto salvation .

Emotions
Yet at the same time we must always remember that without our emotions we are robots. Emotions are the icing of the cake and without them life becomes drab and pale, lifeless and purely analytical. Therefore, we are to rationally think with our minds, yet always understanding that our emotions do come into play and therefore be cautious that our emotions do not become our sole determinant when it comes to the decisions of our daily life. Enjoy our emotions, allow them to take their sacred place within our being, yet when all is said and done it is with our mind that we choose our paths.

1 . STRONG’S EXHAUSTIVE CONCORDANCE TOGETHER WITH DICTIONARIES OF HEBREW AND GREEK WORDS , James Strong, Baker Book House Company, Grand Rapids, MI 49546, USA, 1981, electronic media.

2 . WHY CHRISTIANS CAN’T TRUST PSYCHOLOGY , Ed Bulkley, PH. D., Harvest House Publishers, Eugene, OR 97402, 1993, Page 335, 336.

3 . VINE’S EXPOSITORY DICTIONARY OF OLD AND NEW TESTAMENT WORDS , W.E. Vine, Ellis Enterprises Inc., Oklahoma City, OK 73120, USA, 1988, electronic media.

4 . HOLMAN BIBLE DICTIONARY , General Editor: Trent C. Butler, PH. D., Gerald Cowen, Holman Bible Publishers, Nashville, TE 37234, USA, electronic media.

5 . EASTON’S BIBLE DICTIONARY AND BOOK SYNOPSIS , Easton, M.G., Ellis Enterprises Inc., Oklahoma City, OK 73120, USA, 1988-1999, electronic media.

6 . ELWELL’S EVANGELICAL DICTIONARY OF THEOLOGY , Walter A. Elwell, Baker Book House Company, Grand Rapids, MI 49546, USA, 1984, electronic media.

7 . HARRIS’S THEOLOGICAL WORDBOOK OF THE OLD TESTAMENT , Harris, R. Laid, Moody Press, Chicago, IL 60610, USA, 1980.

8 . Jeremiah 17:9-

9. Biblical Faith

Biblical faith is found in God’s word because of the consistency of witnessing miracle after miracle exhibited in God’s word, with the end result being that truly this book could not have been authored by man, but must have been offered by He who can see the ending from the beginning – God Himself, wherein this book deserves our greatest attention as God’s revelation to man. Biblical faith is to be primarilybased upon an interaction with God’s word, as is declared in Romans 10:17, which states:

Faith cometh by hearing, and hearing by the word of God

The Source of Biblical Faith
Biblical faith is created and grown wherein as a person reads the Bible, and the Holy Spirit opens their spiritual eyes to perceive that which is laid out, it is a logical reasonable process of coming to the conclusion that this book could not have been written by mortal man (2 Timothy 3:16) , because:

1) There are prophecies given in Old Testament, that are fulfilled in the New Testament.
2) There are prophecies given within the Bible as a whole, which are fulfilled since it’s closing.
3) There are scientific and natural insights presented in the Bible, which were once considered completely false in time, science has caught up with the Bible proving that it was correct in the first place, and that it is beyond human insight.
4) There is deep wisdom that is written between its pages, which are far beyond the capacity of a human being to create.
5) There are internal evidences found in the Bible when it is crossed-referenced within itself in such a way that it is obvious that 40 different men could not have utilized the exact same type of “Figures of Speech,” including: typology, such as seen in metaphor, similes, models along with prophetic symbols as seen in even the use of numbers, colors, events, material and substances, dates, mathematics, names, roles, and even people’s personality and lives all done to portray a shadow of things to come rather in heaven, or in the particular case of Jesus, the fulfillment of the Messiah as witnessed in His First and Second coming – as well as Last Days events – all done in such a way that the only explanation is that God orchestrated the creation of this Book.

All leading to the conclusion that this book was not written by man, but by a God that is outside of our time domain, who can see the ending from the beginning (Isaiah 46:9-10) who is all-powerful, and in total control of His creation (Isaiah 45:5-7) , and therefore worthy of our complete trust and faith in what He has said and what He will do (Isaiah 46 Jeremiah 29:11) .


New models for understanding and treating psychosocial risk factors in patients with coronary heart disease

Coronary heart disease (CHD) is the leading cause of death for American Indians and Alaska Natives, blacks, Hispanics, and whites. In 2002, 696,947 people died of heart disease (51% of them women), accounting for 29% of all U.S. deaths. In 2005, CHD is projected to cost $393 billion, including health care services, medications, and lost productivity. In roughly half the cases the first clinical manifestations of CHD, myocardial infarction (MI) or sudden death, are catastrophic: these events are sudden, unexpected, unpredictable, and fatal. Moreover, the traditional risk factors, cigarette smoking, hyperlipidemia, diabetes, and hypertension, do not fully account for the timing and occurrence of these events.

Research from our laboratory and others has suggested that psychosocial and behavioral factors may play a significant and independent role in the development of CHD and its complications (1,2). This evidence has also provided a rationale for developing psychosocial interventions for modifying the natural history of these clinical events. However, knowledge of the role of psychosocial factors in CHD has been impeded because there have been few intervention studies that have included effective treatments with appropriate clinical endpoints. By traditional "cardiology" standards, only "hard" clinical outcomes, such as MI or death, are considered legitimate endpoints. However, these endpoints occur infrequently over relatively short follow-up periods and require large sample sizes using multiple clinical sites. Unfortunately, these large scale studies are so expensive that they are not feasible for most investigators interested in psychosocial interventions.

Technological advances have provided new opportunities to study the relationship of psychosocial factors and CHD outcomes: transient myocardial ischemia, a condition in which there is an inadequate supply of blood to the heart, has proven to be a useful surrogate marker for CHD, and has been the focus of our work for more than a decade. Ischemia can be measured easily and reliably is prevalent among many patients with CHD (3) may be triggered by emotional stress (4-6) is associated with worse prognosis (7-10), and may be modifiable with treatment (11-13). Our research team at Duke, along with a number of collaborators including Alan Rozanski at Columbia University, David Krantz at Uniformed Services University of the Health Sciences, David Sheps at the University of Florida, and Alan Hinderliter at the University of North Carolina at Chapel Hill, have performed a series of studies that have provided new insights into the relationship of stress and CHD, which we highlight below.

Characteristics of transient myocardial ischemia during daily activities

The traditional method for the assessment of myocardial ischemia, exercise treadmill testing, is well-validated and accepted but does not typically reflect ischemia occurring outside of the laboratory setting during activities of daily life. Identification and quantification of ischemia is best accomplished by ambulatory electrographic (ECG) monitoring. Ambulatory ECG studies have noted that ischemia in daily life is subject to a variety of influences that produce a wide range of ischemic events over time: It has been shown that ischemia (a) occurs frequently, and that the majority of episodes are painless (14,15) (b) occurs at low heart rates, well below levels found to elicit ST-segment depression during exercise (15) (c) has a circadian rhythm with greatest density in the early morning hours (16-18) (d) is associated with variability over time that cannot be explained simply by changes in clinical status or fixed coronary obstruction (19) (e) frequently occurs in the absence of strenuous physical exercise and in the presence of stress both in everyday life (4,5) and in the laboratory (6,20) and (f) when induced by stress, may be an important predictor of adverse CHD events (7-10).

Characteristics of transient myocardial ischemia during laboratory testing

A number of studies have shown that myocardial ischemia is inducible in the laboratory during mental stress testing in a substantial subset of patients with CHD. The typical stress protocol requires patients to undergo a series of "mental stress" tasks such as performing mental arithmetic, outlining the shape of a star from its refection in a mirror, or giving an extemporaneous speech on a current events topic. We studied 132 CHD patients who underwent radionuclide ventriculography (or nuclear imaging of the heart) during exercise and mental stress testing (20). In this population, almost two thirds of patients exhibited evidence of ischemia in response to a battery of mental stressors. Interestingly, patients who displayed mental stress-induced ischemia in the laboratory were more likely to exhibit ischemia during daily life. These patients also were followed over a period of more than 3.5 years in which 28 patients suffered at least one cardiac event, such as fatal and non-fatal MI, or revascularization procedure such as coronary angioplasty or coronary bypass surgery. Patients who exhibited ischemia during at least one of the mental stress tasks were 3 times more likely to suffer a subsequent coronary event compared to patients who did not exhibit ischemia during the mental stress testing (10). Similar findings have now been reported by a number of other investigative teams (7-9). These findings suggest that ischemia induced by mental stress is associated with increased rates of adverse events in patients with CHD and may help to identify a subgroup of cardiac patients who may be especially appropriate for psychosocial intervention efforts.

Stress Management Training in CHD patients

There is now growing evidence that psychosocial interventions, independent of medical therapies, offer considerable benefit to patients with CHD (21). In a meta-analysis almost 10 years ago by Wolfgang Linden (22), 2024 patients who received psychosocial interventions and 1156 control subjects who received standard medical therapy and usually some form of exercise training were compared. Relative to controls, psychosocially treated patients showed greater clinical improvement not only in psychological distress, but also in lower blood pressure, heart rate, and cholesterol levels. More importantly, Linden et al. also concluded that patients who received psychosocial interventions were over 40% less likely to die and 65% less likely to have a recurrent coronary event than controls over a two year follow-up period. Although changes in cardiac risk factors were observed in the treatment group, the mechanisms by which the interventions reduced the event rates could not be determined.

One mechanism by which psychosocial interventions might contribute to improved outcomes is alterations in ischemic activity. In an initial study (11) we showed that, compared to usual care, patients in stress management showed greater improvements in wall motion abnormalities (detected by nuclear imaging) during mental stress testing and exhibited fewer ischemic episodes during ambulatory ECG monitoring. Stress management patients also showed clinically significant improvements in diary-reported chest pain and negative emotions, as well as improvements in perceived health and well-being. In addition, follow-up data suggested that the stress management intervention also had an impact on clinical prognosis. Twenty-two (21%) of the 107 patients who participated in the trial experienced at least one event: only 9% of the patients in the stress management group suffered an event, compared to 21% in exercise training and 30% in usual medical care. Thus, the stress management intervention not only modified the occurrence of ischemia, but also had a significant impact on longer-term clinical outcomes. A more extended follow up of participants revealed that the clinical benefits of stress management training were maintained over a period of 5 years, and there also was a significant reduction in medical expenses compared to usual care controls (12).

Because our study was not fully randomized, there remained lingering doubts about the significance of our findings. Consequently, we undertook a fully randomized controlled trial comparing exercise or stress management training compared to usual care in a sample of CHD patients with exercise-induced ischemia (13). CHD patients completed a comprehensive assessment of a number of biomarkers of risk including measures of vascular endothelial function, heart rate variability, and baroreflex sensitivity. They also completed a psychometric test battery including measures of depression and general psychiatric symptoms. After a 4-month treatment program, patients were re-assessed.

Results of our study showed that compared to Usual Care, patients in both active treatment groups exhibited lower post-treatment depression and reduced distress. Patients in both active treatment groups also exhibited smaller reductions in LVEF during mental stress testing and increased flow mediated dilation (FMD), which reflects improved vascular functioning. In a subgroup of participants, Stress Management patients showed improved baroreflex sensitivity (BRS), which measures the ability to buffer the blood vessels from large surges in blood pressure, and significant increases in heart rate variability (HRV), an index of autonomic nervous system function, compared to Usual Care controls.

Conclusions

These findings collectively demonstrate that behavioral treatments provide added benefits to routine medical management of CHD patients. In our latest research at Duke, patients who underwent four months of either aerobic exercise or stress management training exhibited greater improvements in psychosocial functioning, including less emotional distress and lower levels of depression compared to usual care controls. Moreover, we observed reductions in ischemic activity during mental stress, and improvements in FMD, HRV and BRS. Although “hard” clinical endpoints are widely considered to be the “gold standard” in evaluating the effectiveness of treatment, such studies invariably require large samples of 3000 patients or more. Because such studies are often prohibitively expensive, newer models are needed to evaluate effective and innovative therapies. As shown in the figure below, the use of surrogate endpoints such as myocardial ischemia offers considerable promise for furthering our understanding of stress and CHD. We conclude that behavioral interventions such as exercise and stress management provide additional benefits to CHD patients over-and-above routine medical management. Ultimately the long term effects of these behavioral interventions will need to be evaluated prospectively with respect to mortality and morbidity in larger samples of CHD patients. However, the present findings suggest that these interventions offer considerable promise to patients with stable CHD, not only in terms of improving their quality of life, but in improving important surrogate risk markers that could result in improved clinical outcomes.

1. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999 99: 2192-2217.

2. Rozanski A, Blumenthal JA, Davidson KW, Saab P, Kubzansky L. The epidemiology, pathophysiology and management of psychosocial risk factors in cardiac practice: The emerging field of behavioral cardiology Journal of the American College of Cardiology, 2005 45: 637-651.

3. Cohn PF. Silent myocardial ischemia: Classification, prevalence and prognosis. American Journal of Medicine 1985 79: 2-6.

4. Gullette, E.C.D., Blumenthal, J.A., Babyak, M., Jiang, W., Waugh, R.A., Frid, D.J., O’Connor, C.M., Morris, J.J. & Krantz, D.S. Effects of mental stress on myocardial ischemia during daily life. Journal of the American Medical Association 1997 277: 1521-1526.

5. Gabbay FH, Krantz DS, Kop WJ, Hedges SM, Klein J, Gottdiener JS, Rozanski A. Triggers of myocardial ischemia during daily life in patients with coronary artery disease: physical and mental activities, anger and smoking. Journal of the American College of Cardiology 1996 27: 585-592.

6. Rozanski A, Birey CN, Krantz DS, et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. New England Journal of Medicine 1988 318: 1005-1043.

7. Sheps DS, McMahon RP, Becker L, et al. Mental stress induced ischemia and all cause mortality in patients with coronary artery disease: Results from the Psychophysiological Investigations of Myocardial Ischemia study. Circulation 2002 105:1780-1784.

8. Krantz DS, Santiago HT, Kop WJ, et al. Prognostic value of mental stress testing in coronary artery disease. American Journal of Cardiology 1999 84: 1292-1297.

9. Jain D, Burg M, Soufer R, Zaret BL. Prognostic implications of mental stress induced silent left ventricular dysfunction in patients with stable angina pectoris. American Journal of Cardiology 1995 76: 31-35.

10. Jiang W, Babyak M, Krantz DS, Waugh RA, Coleman RE, Hanson MM, Frid DJ, McNulty S, Morris JJ, O’Connor CM, Blumenthal JA. Mental stress-induced myocardial ischemia and cardiac events. Journal of the American Medical Association 1996 275: 1651-1656.

11. Blumenthal, J.A., Jiang, W., Babyak, M., et al. Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and evaluation of mechanisms. Archives of Internal Medicine 1997 157: 2213-2223.

12. Blumenthal, J.A., Babyak, M., Wei, J., et al. Usefulness of psychosocial treatment of mental stress-induced myocardial ischemia in men. American Journal of Cardiology 2002 89: 164-168.

13. Blumenthal, J.A., Sherwood A, Babyak, M. et al. Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: A randomized controlled trial. Journal of the American Medical Association 2005 293: 1626-1634.

14. Gottlieb SO. Association between silent myocardial ischemia and prognosis: Insensitivity of angina pectoris as a marker of coronary artery disease activity. American Journal of Cardiology1987 60, 33J-38J.

15. Deanfield JE, Maseri A, Selwyn AP, et al. Myocardial ischaemia during daily life in patients with stable angina: Its relation to symptoms and heart rate changes. Lancet, 1983 2: 753-758.

16. Rocco MB, Barry T, et al. Circadian variation of transient myocardial ischemia in patients with coronary artery disease. Circulation, 1987 75: 395-400.

17. Nabel EG, Barry J, et al. Variability of transient myocardial ischemia in ambulatory patients with coronary artery disease. Circulation, 1988 78: 60-67.

18. Krantz DS, Kop WJ, Gabbay FH et al. Circadian variation of ambulatory myocardial ischemia. Circulation 1996 93: 1364-1371.

19. Barry J, Selwyn AP, et al. Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease. American Journal of Cardiology 1988 61: 989-993.

20. Blumenthal JA, Jiang W, Waugh RA, Frid DJ, Morris JJ, Coleman RE, Hanson M, Babyak MA, Thyrum ET, Krantz DS, O'Connor C. Mental stress-induced ischemia and ambulatory ischemia during daily life: Association and hemodynamic features. Circulation 1995 92: 2102-2108.

21. Wenger NK, Froelicher ES, Smith LK, et al. Cardiac Rehabilitation. Clinical Practice Guidline No. 17. Rockville, MD: US Dept. Of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute. AHCPR Publication No. 96-0672. October 1995.

22. Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Archives of Internal Medicine, 1996 156: 745-752.

Acknowledgement

I am grateful to a number of valued colleagues at Duke University Medical Center for their commitment to our research program. I am especially indebted to Andy Sherwood, Michael Babyak, Lana Watkins, Robert Waugh, Edward Coleman, Michael Hanson, Junichiro Hayano, Salvatore Borges-Neto, Jiang Wei, Elizabeth Gullette, Anastasia Georgiades, and Simon Bacon for their contributions to the studies described in this review.


What is the heart?

First, we’ll state the obvious: this article is not about the heart as a vital organ, a muscle that pumps blood throughout the body. Neither is this article concerned with romantic, philosophical, or literary definitions.

Instead, we’ll focus on what the Bible has to say about the heart. The Bible mentions the heart almost 1,000 times. In essence, this is what it says: the heart is that spiritual part of us where our emotions and desires dwell.

Before we look at the human heart, we’ll mention that, since God has emotions and desires, He, too, can be said to have a “heart.” We have a heart because God does. David was a man “after God’s own heart” (Acts 13:22). And God blesses His people with leaders who know and follow His heart (1 Samuel 2:35 Jeremiah 3:15).

The human heart, in its natural condition, is evil, treacherous and deceitful. Jeremiah 17:9 says, “The heart is deceitful above all things and beyond cure. Who can understand it?” In other words, the Fall has affected us at the deepest level our mind, emotions and desires have been tainted by sin—and we are blind to just how pervasive the problem is.

We may not understand our own hearts, but God does. He “knows the secrets of the heart” (Psalm 44:21 see also 1 Corinthians 14:25). Jesus “knew all men, and had no need that anyone should testify of man, for He knew what was in man” (John 2:24-25). Based on His knowledge of the heart, God can judge righteously: “I, the LORD, search the heart, I test the mind, Even to give every man according to his ways, According to the fruit of his doings” (Jeremiah 17:10).

Jesus pointed out the fallen condition of our hearts in Mark 7:21-23: “From within, out of men’s hearts, come evil thoughts, sexual immorality, theft, murder, adultery, greed, malice, deceit, lewdness, envy, slander, arrogance and folly. All these evils come from inside and make a man unclean.” Our biggest problem is not external but internal all of us have a heart problem.

In order for a person to be saved, then, the heart must be changed. This only happens by the power of God in response to faith. “With the heart one believes unto righteousness” (Romans 10:10). In His grace, God can create a new heart within us (Psalm 51:10 Ezekiel 36:26). He promises to “revive the heart of the contrite ones” (Isaiah 57:15).

God’s work of creating a new heart within us involves testing our hearts (Psalm 17:3 Deuteronomy 8:2) and filling our hearts with new ideas, new wisdom, and new desires (Nehemiah 7:5 1 Kings 10:24 2 Corinthians 8:16).

The heart is the core of our being, and the Bible sets high importance on keeping our hearts pure: “Above all else, guard your heart, for it is the wellspring of life” (Proverbs 4:23).


Summary

Throughout history and across diverse cultures, religions, and spiritual traditions, the heart has been associated with spiritual influx, wisdom, and emotional experience, particularly with regard to other-centered , positive emotions such as love, care, compassion, and gratitude. Current research provides evidence that the heart does indeed play a role in the generation of emotional experience, suggesting that these long-surviving associations may be more than merely metaphorical. In this chapter, we discuss a model of emotion that includes the heart, together with the brain, nervous, and hormonal systems, as fundamental components of a dynamic, interactive network from which emotional experience emerges. Further, we review research that has identified new physiological correlates associated with the experience of heartfelt positive emotions, with a specific focus on appreciation. We discuss the use of heart-based positive emotion-focused techniques to help people self-induce and sustain states of appreciation and other positive emotions. Finally, we summarize the outcomes of several studies in which these techniques have been introduced in organizational, educational, and clinical settings.


The Role of Emotions in your Decision-making and its Effects

Don't you think, it is very easy to convince someone when he or she is in a very good mood? If your answer is, "YES!", then have you ever thought what role emotions play in your decision-making process? Scroll down to get details.

Don’t you think, it is very easy to convince someone when he or she is in a very good mood? If your answer is, "YES!", then have you ever thought what role emotions play in your decision-making process? Scroll down to get details.

“There is no question whether emotion plays a part of decision-making. It plays a part of all behavior.” – Adam King

The above quote says it all. We all have emotions and these help us to live every minute of our life. Anger, sadness, happiness, fear, surprise and love are some of the most common emotions experienced by every human being. These emotions play a very important role in every aspect of our life and especially, in decision-making. The reason behind everything we do in our life, in one way or the another is related to emotions. What made the Mughal Emperor Shah Jahan build the Taj Mahal is nothing but a deep and passionate emotion of love. Negative incidences like war are also related to the emotions such as greed, hatred, anger or envy. One of the best examples of these is Hitler’s hatred towards the Jews which resulted in merciless killing during World War II. So we can say that whatever we do is influenced by emotions to a large extent.

Emotions and Decision-making

Though there are a lot of expressions of emotions, we can broadly divide them into two types: positive and negative. Positive emotions are love, care, understanding, friendship, happiness, satisfaction, etc., whereas negative emotions comprise anger, hate, envy, greed, frustration, etc. We think with the help of our brain, but most of the time we listen to our heart. Some people are more emotional than others and hence, their decisions are most of the time biased. Emotions influence our decisions, right from buying toys for ourselves to the careers we want to pursue or to something as important as finding partners who can love, understand and emotionally, support us. These emotions are responsible for many of our important decisions for which later on, we may feel regretful or consider them most cherished ones depending on the outcome. But the fact is that they do affect our decision.

How Emotions Affect Decision-making

Our environment, family background, education, life experiences and everything related to us play a very important role in keeping our emotions positive or negative. If your family and friends are cheerful and can boost you up when you are feeling negative, it helps you in coming up with positive decisions. When you are in a positive mood, you are more likely to make positive decisions or at least try to think about the positive side of the particular topic. Whereas, if you are in a bad mood you are more inclined towards the negative aspect of that topic. In such a situation, the decisions may or may not be correct. Of course, this holds true even in case of positive emotion. Many a time you love a person so much that you take a decision in favor of him/her, but later on regret it. Hence, over-optimism or over pessimism both, can hamper your ability to take a decision without exercising a bias. Excessive emotions result in clouded thinking which leads to poor decision-making. If we are in a bad mood and are very depressed, we end up messing things and sometimes, harming ourselves physically, financially or emotionally.

Emotional and Rational Decisions

If we compare emotional and rational decisions, then we can understand the outcomes of both the types of decisions. Emotional decisions are taken very fast as compared to rational decisions. Experience and incidents play a very important role in taking such decisions. Many a time these decisions are taken subconsciously, and actually reflect what we really want. We favor the person or area which we are interested in. These decisions may prove themselves to be the perfect ones but sometimes, immediate and emotionally driven decisions prove to be poor decisions. Emotions also make the decisions biased, because of the great intensity of feelings attached to the person or the matter. Sometime these decisions are rationally incorrect and hence, later on you may regret them.

Suggestions for Right Decision-making

We know that emotional decisions may or may not be the right ones, but it is also true that rational decisions are also somewhat based on emotions. We just have to take care of few things while taking decisions, in order to make them fair and justified. Use your intellectual abilities and consider both, the positive and negative side of the matter. Try to understand the difference between right and wrong side of the decision you are involved with rather than let your emotions drive you to it. Do not take any decision when you are angry, first, cool yourself down and then think about it. Being rational may result in a right decision, but taking a decision which is emotionally and rationally balanced can help you to justify the decision.

As emotions are an inseparable part of human nature, you cannot completely neglect them. This can be understood by a quote given by Dale Carnegie, American writer and lecturer, “When dealing with people, remember you are not dealing with creatures of logic, but with the creatures of emotion.” Hence consider all the aspects of the problem at hand, and try to keep your emotions out of your decisions.


Surprise

We can define surprise as the reaction provoked by something unexpected, new, or strange. In other words, it’s when a stimulus appears that the subject had not thought about beforehand. The subjective experience that accompanies surprise is a feeling of uncertainty, along with the sensation of one’s mind being completely blank.

In terms of physiological reactions, we usually see a decrease in heart rate and an increase in muscular tone. Breathing gets deeper, pitch goes up, and the subject makes spontaneous vocalizations.

The purpose of surprise is to empty the working memory of all residual activity in order to face the unexpected stimulus. To that end, surprise activates attention processes, along with behavior related to exploration and curiosity. Depending on the quality of the unexpected stimulus, joy (positive) or anger (negative) often follow this emotion.


Skipping a beat — the surprise of heart palpitations

Does your heart unexpectedly start to race or pound, or feel like it keeps skipping beats? These sensations are called heart palpitations. For most people, heart palpitations are a once-in-a-blue-moon occurrence. Others have dozens of these heart flutters a day, sometimes so strong that they feel like a heart attack.

Most palpitations are caused by a harmless hiccup in the heart's rhythm. A few reflect a problem in the heart or elsewhere in the body.

Heart palpitations symptoms

Different people experience heart palpitation symptoms in different ways. Palpitations can feel like the heart is fluttering, throbbing, flip-flopping, murmuring, or pounding. They can also feel like the heart skips a beat. Some people feel palpitations as a pounding in the chest or neck others feel them as a general sense of unease.

What causes heart flutters?

Palpitations can appear out of the blue and disappear just as suddenly. They can be linked with certain activities, events, or emotions. Some people notice their heart skipping a beat when they are drifting off to sleep others, when they stand up after bending over. Palpitations can be triggered by:

  • stress, anxiety, or panic
  • dehydration
  • low potassium
  • low blood sugar
  • too much caffeine, chocolate, or alcohol
  • fever

People with certain medical conditions, such as heart disease, anemia, and an overactive thyroid gland (hyperthyroidism) are more likely to experience palpitations. Palpitations can be related to drugs and medications such as cocaine, amphetamines, diet pills, some cough and cold remedies, some antibiotics, thyroid hormone, digoxin, or asthma remedies.

Why does my heart skip a beat?

There are several possible causes of heart palpitations.

Trouble from above. Some palpitations stem from premature contractions of the heart's upper chambers (atria). When the atria contract a fraction of a second earlier than they should, they rest an instant longer afterward to get back to their usual rhythm. This feels like a skipped beat and is often followed by a noticeably forceful contraction as the lower chambers (ventricles) clear out the extra blood they accumulated during the pause. These premature beats are almost always benign, meaning they aren't life-threatening or the sign of a heart attack in the making.

Two other heart rhythm disturbances that can cause palpitations from above are atrial fibrillation and supraventricular tachycardia. Atrial fibrillation is an irregular and often rapid heartbeat caused by chaotic electrical activity in the heart's upper chambers. Supraventricular tachycardia is a faster-than-normal heart rate (tachycardia means fast heart rate) that begins above the heart's lower chambers. Both of these may cause palpitations that may be brief or prolonged. Both should be evaluated by your physician.

Trouble from below. Early contractions of the ventricles can also cause palpitations. A solo premature ventricular contraction, or even a couple in a row, isn't usually a problem unless it's accompanied by fainting, shortness of breath, or other symptoms. A long run of premature ventricular contractions one after the other, though, is worrisome. They can degenerate into the deadly cardiac chaos known as ventricular fibrillation.

Other sources. Problems with the heart's timekeeper, called the pacemaker or sinus node, can cause palpitations. So can a breakdown in the coordination between the upper and lower chambers. Scar tissue in the heart from a heart attack or other injury and valve problems such as mitral valve prolapse can also lead to palpitations.

Diagnosing heart palpitations

Palpitations tend to come and go. Unfortunately, they are usually gone by the time you get to the doctor's office. That makes pinning them down a joint effort.

One of the most helpful pieces of information is your story of how your heart palpitations feel, how often they strike, and when. Try to answer some of these questions before seeing your doctor:

  • When you have heart palpitations, check your pulse. Is your heart's rhythm fast or slow? Regular or irregular?
  • When your heart skips a beat, do you feel lightheaded, dizzy, or out of breath, or do you have chest pain?
  • Are you often doing the same thing when they occur?
  • Do your heart palpitations start and stop suddenly, or fade in and out?

A physical exam can reveal telltale signs of palpitations. Your doctor may hear a murmur or other sound when listening to your heart that suggests a problem with one of the heart's valves. Your doctor may also blood tests if he or she suspects a thyroid imbalance, anemia, or low potassium, or other problems that can cause or contribute to palpitations.

An electrocardiogram (ECG) is a standard tool for evaluating someone with palpitations. This recording of your heart's electrical activity shows the heart's rhythm and any overt or subtle disturbances, but only over the course of 12 seconds or so. Your doctor may want to record your heart rhythm for longer to identify the cause of the palpitations.

If your palpitations come with chest pain, your doctor may want you to have an exercise stress test. If they come with a racing pulse or dizziness, an electrophysiology study using a special probe inserted into the heart may be in order.

Capturing heart palpitations in action

If you are at risk for a heart rhythm problem, or if palpitations are interfering with your life or mental health, a recording of your heart's rhythm for 24 hours or even longer may capture an electrical "signature" of the problem. Getting visual evidence of this signature can help determine how best to treat your palpitations.

A Holter monitor constantly records your heart's rhythm for 24 hours as you go about your daily activities. Small patches called electrodes are stuck onto your chest and attached to a recorder that you carry in a pocket or wear around your neck or waist. During the test, you keep a diary of what you are doing and how you feel, along with the time of day of each entry. When you return the monitor to your doctor, he or she will look at the recording to see if there have been any irregular heart rhythms.

Twenty-four hours often isn't long enough to detect palpitations. An event recorder can monitor the heart for days or weeks. There's even an implantable recorder that can invisibly monitor the heart for a year or more.

How to stop heart palpitations

If you have unexplained palpitations, start with the simple things first:

  • Don't smoke.
  • Cut back on alcohol, or stop drinking it altogether.
  • Make sure you eat regularly (low blood sugar can cause heart palpitations).
  • Drink plenty of fluids.
  • Get enough sleep.
  • Have your doctor or pharmacist check all of your medications and supplements to make sure none cause palpitations. For example, decongestants that contain pseudoephedrine or phenylephrine can trigger palpitations.

Stress and anxiety are two other key triggers of skipped beats. A two-step approach can help here. To keep palpitations away, try meditation, the relaxation response, exercise, yoga, tai chi, or another stress-busting activity. If palpitations do appear, breathing exercises or tensing and relaxing individual muscle groups in your body can help.

Deep breathing. Sit quietly and close your eyes. Place one hand on your abdomen. Breathe in slowly and deeply through your nose. Feel your abdomen move outward. Exhale through your nose or mouth, whichever feels more comfortable. Repeat.

If your heart is racing unexpectedly, you can try to stop it yourself with one of the following maneuvers. However, if they don't work promptly and the symptoms persist, have someone drive you to the emergency department or call 911.

Valsalva maneuver. Pinch your nose closed with the fingers of one hand. Close your mouth. Try to breathe out forcibly through your nose.

Bear down. Clench your stomach muscles and your anal sphincter. Then bear down as if you are having a bowel movement. (This is another way to do the Valsalva maneuver.)

Cold water. Splash cold water on your face, or immerse your face in a sink or large bowl filled with cold water.

The Valsalva maneuver, bearing down, and cold water stimulate the vagus nerve, which helps control the heart rate. Deep breathing helps relax you and ease the stress and anxiety that can come with palpitations.

Medical treatment for heart palpitations

If self-help techniques don't work, and palpitations are still bothersome, you may want to try some medical options. Medications called beta blockers are sometimes used to treat heart palpitations. They slow the heart rate and control the flow of "beat now" signals that regulate the heartbeat.

Sometimes a medical procedure called an ablation is needed. It can control palpitations caused by errant electrical signals in the heart.

Call your doctor if.

If you have palpitations with shortness of breath, dizziness, chest pain, or fainting, have someone drive you to an emergency department or call your local emergency number right away. These may be signs of a serious heart problem.


Arousal Context and Importance

Because arousal affects much of the body all at once, it has the ability to influence numerous aspects of people’ everyday experience. Within the context of social psychology, the experience of arousal has implications in a number of areas, including the experience of emotion, attitudes, lie detection, aggression, attraction, and love.

Experience of Emotion

The ability to experience emotion is one of the characteristics that distinguish humans from other animals. There are several theories that try to explain emotions. However, one theory focuses on how arousal, combined with the social environment, determines emotions. The two-factor theory of emotion, proposed by Stanley Schachter and Jerome Singer, states that when people are physiologically aroused, their emotional experience is determined by how they think about the arousal in addition, other people are able to influence a person’s thoughts. For example, when graduating from high school, a person is likely to experience a heightened level of arousal. However, this arousal may be labeled as excitement when around friends or as anxiety/despair when around parents or former teachers. In both cases, the same bodily arousal becomes labeled as two different emotions depending on the social context.

Attitudes

Perhaps due to its links with emotion, arousal is also an indication of how strongly a person holds an attitude. For example, if you wanted to know how strongly a person felt about a political candidate, you could measure that person’s heart rate, perspiration, and so on. The candidate that elicits the most arousal is the one felt most strongly about. However, measuring arousal in this fashion cannot tell you whether the person likes or dislikes the candidate just that they feel strongly.

Attitudes also have the ability to create arousal. This is likely when an attitude (e.g., “I love animals”) conflicts with another attitude (e.g., “Animals should be used for lab testing”), or with a behavior (e.g., “My fur coat looks great on me”). Lack of consistency among attitudes and/or behavior tends to produce feelings of tension and uneasiness (i.e., physiological arousal). According to Leon Festinger, people are motivated to relieve their aroused state by adjusting their attitudes to be more consistent.

Lie Detection

Arousal’s link to emotions, attitudes, and inconsistency make the measurement of physiological arousal a potentially useful tool for lie detection. A lie detector test measures various physiological indicators or arousal such as heart rate, breathing rate, and perspiration. The assumption is that lying (which is an inconsistency between what is true and what is reported to be true) produces arousal that can be detected by the machine. Unfortunately, as with the strength of attitudes, the machine can only assess the level of arousal, and not what may be causing it. For example, a person may be aroused because they are lying, or they may experience arousal because they are worried that they are accused of committing a crime.

Aggression

Due to the energizing nature of arousal, it has a key role in helping us understand why people become aggressive. When people encounter any type of undesirable experience, arousal levels and aggression tend to increase. Unfortunately, a number of things have been found to produce increased arousal. These include high temperatures, crowding, pain, loud noises, violent movies, bad odors, and cigarette smoke. In each case, these factors produce heightened levels of arousal and the likelihood of increased aggression.

One reason is that arousal produced from one experience (e.g., being in a crowd) may be directed toward another target. A good example of this would be a person who gets stuck in traffic while driving home from work. Upon returning home after an hour of sitting in a hot car, listening to people honking their horns, a parent may yell at his or her child for no apparent reason.

This link between arousal and aggression has important implications for how people deal with anger. A common misconception is that acting aggressive in appropriate contexts (e.g., playing sports, playing video games) is a good way to decrease aggression. However, because these activities also increase arousal, they tend to increase (not decrease) aggressive feelings.

Attraction

Just as arousal can transfer from one source to another to produce aggression, arousal also has the ability to produce positive feelings, such as attraction. In a famous study, Donald Dutton and Arthur Aron tested people crossing two bridges. One bridge was extremely high and shaky and heightened arousal. Another bridge was lower and sturdier, resulting in lower levels of arousal. To determine if arousal could produce attraction, they tested men’s reactions to a woman they met while crossing. The results indicated that men on the more arousal-provoking high bridge were more attracted to the woman.