Deep Breathing: You're Doing it Wrong.

Monday, October 20, 2014 by Meg   •   Filed under Treatment Techniques

It usually goes down something like this: someone comes in and says, “I heard deep breathing is supposed to help with anxiety, but it  makes me feel worse.”

Red flag number one.

They go on. “Sometimes, even if I feel okay to begin with, I feel dizzy or like I am about to pass out when I start taking deep breaths.”

Even though panic and anxiety can cause dizziness, tunnel vision and lightheadedness, I count this as red flag number two if it seems to be made worse by the breathing. 

From me, it takes two words to see if I am right: “Show me.”

After years of clinical practice, one thing is clear: you people have no idea how to breathe. This is especially true in those who have a history of trauma (due to bodily disconnection or dissociation) and those with overactive sympathetic nervous systems (such as those with anxiety disorders or depression). And deep breathing done the wrong way can actually make anxiety symptoms worse instead of alleviating them.

Why Breathing Matters: The Sympathetic Nervous System

During the fight or flight response, we breathe more quickly, taking shorter, more shallow, breaths into the chest with longer inhales than exhales. This breathing is preparation: it increases oxygenation and revs us up. We may also get other panic symptoms like faster heart rate, tunnel vision, tingling in the hands and feet and the ever popular evacuation of bowels and bladder. (For more on these, check out: 8 Anxiety Symptoms You’ve Probably Experienced and Why They’re Necessary For Survival.) 

It makes sense for these things to happen in preparation for fleeing from a threat or defending ourselves from the same. But when our “deep breathing” technique is shallow chest breathing, we may inadvertently make things worse because chest breathing can stimulate the sympathetic system in the loop described above. Then we find ourselves wondering what’s wrong with us because we can’t calm down. 

But why? How can the way we breathe make such a difference? Air is air, right?  

The Parasympathetic Nervous System and the Vagus Nerve

Part of this difference may be due to the vagus nerve. The vagus nerve is the longest cranial nerve and goes from the head through the chest and into the abdominal cavity. A part of the parasympathetic nervous system—the system that calms us down after fight/flight— this nerve sends and receives messages to control functions in the digestive system, some glands, the heart and the lungs. Communication along this nerve from the brain is why we get the sensation of butterflies in the stomach when nervous and why we sometimes get chest pain when depressed. Most importantly for this relaxation breathing thing, the vagus nerve helps to lower blood pressure and heart rate. And it responds to sensations in the abdomen. 

You are said to have healthy vagal tone if you have a slight increase in your heart rate when you inhale and a decrease when you exhale. The deeper abdominal breathing, particularly if you elongate the exhale to stimulate the parasympathetic system at a higher rate, triggers the vagus nerve and reduces heart rate and blood pressure leading to more feelings of Big Lebowski-like mellowness without the drugs or Kahlua. 

The point it this: you need more deep abdominal breathing to simulate resting and activate the calming down part of the nervous system, as opposed to the shallow chest breathing which stimulates the part of the nervous system that gets us all tweaked out. 

So how to tell if you’re on the right track? 

Abdominal Breathing Versus Chest Breathing

Quick test: put one hand on your chest and the other on your abdomen. Take a deep breath. Did the hand on your chest rise first? Did your shoulders go up? Did your abdomen only expand halfway through your inhale? 

Congratulations, you’re doing it wrong. But don’t feel too bad; many people are. 

I have found this shallow breathing pattern to be especially common among women, though men do it too. Men seem to rely on it more from bad posture as opposed to training themselves to do it by constantly “sucking it in.” (So ladies, seriously, knock that shit off.) I have seen individuals unable to actually complete the breathing exercise in my office due to constrictive clothing. Tight clothes or sucking it in forces us to be chest breathers. When a portion of our self worth is potentially related to how large our stomach is, sometimes we subconsciously force air into the wrong areas and fuck ourselves up accidentally.

Uh oh.

Kids come into the world with little swollen bellies and the tendency towards abdominal breathing. This is what we want to retrain ourselves to do, to stimulate the parasympathetic system and trigger calm. 

Chest breathing = "Holy shit, we must need to increase oxygenation to run now!"

Abdominal breathing = "Yo, dude, all's well. Let's go lay on the lawn and ponder our existence."

But you don’t have to take my word for it. Deep breathing therapy has been shown to decrease stress and anxiety scores1, decrease fatigue and tension anxiety in cancer patients2, and alleviate state anxiety in pregnant women in preterm labor3. There are tons of studies and I won’t go over all of them. I think what you really want to know is: how do I make this work for me?

The 4-8 Deep Breathing Technique (or How to Breathe to Calm a Panic Attack)

  • First things first. If you're wearing tight pants, for fuck’s sake take them off. (Unless you’re at work in which case this may cause more stress in the long run.) Use your better judgment, get comfy and make sure you have space around your middle. That’s really the key. 
  • Lay down if possible (if sitting, just lean back). Put one hand on your abdomen and one on your chest. Touch the tip of your tongue to the roof of your mouth behind your teeth and take a deep inhale through your nose. Focus on inhaling into the abdomen first, letting the chest fill up later. Inhale to a slow count of four. 
  • Exhale slowly to the count of eight, letting your chest deflate first. When it feels like all the air is expelled, use your abdominal muscles to force what little air remains from the lungs. This part sometimes sounds like a shy cat hacking up a hair ball, which means it serves the dual purpose of calming you down and tormenting obnoxious felines. Score.
  • Repeat.  

Some practitioners encourage you to hold the breath on the inhale, but I have not found this to make a difference, and people occasionally report increased dizziness with the breath holding. However, if you feel that holding the breath for a few counts assists you in slowing yourself down, feel free to make it a 4(inhale)-5(hold)-8(exhale) technique. (This is the one Hannah tries in Famished when faced with a killer.) 

Everybody is a little different, but breathing is a universal way to relax, a function that happens automatically and that responds to concentrated effort. Plus you can’t really beat a free way to chill out and harass your cat at the same time. It really doesn’t get much better than that.  

But I want to hear from you. Do you have a deep breathing technique that works for you? 

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Related Posts: 

Citations
  1. http://www.ncbi.nlm.nih.gov/pubmed/9032712
  2. http://www.ncbi.nlm.nih.gov/pubmed/22500846
  3. http://www.ncbi.nlm.nih.gov/pubmed/20634635
 



Topic-Relevant Resources

Overcoming Trauma through Yoga: Reclaiming Your Body
Deep breathing and yoga poses designed to assist with healing through the body-mind connections common in PTSD.

The Anxiety and Phobia Workbook
Great resource to keep you on track with exercises for overcoming anxiety, panic and phobias

From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer Your Fears, and Put You in Control of Your Life
Techniques for reducing anxiety and living a happier, healthier life.

When Panic Attacks
Detailed overview of cognitive behavioral techniques for changing negative thought patterns

The Mindfulness Solution
Meditative and cognitive techniques for everyday use

Famished: An Ash Park Novel
Everyone's hungry for something. Some are more famished than others. Psychological suspense, thrills and chills from everyone's favorite foul-mouthed shrink.



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