3. Breathe Deeply, Smoothly, Slowly, and on Long Intervals

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Chapter Summary

As mammals we hold our life’s trauma in our diaphragm. The diaphragm is a muscle sitting below the lungs that allows us to breathe calmly. The harder a mammal’s life has been, the less the diaphragm will move with each breath, and the more it will rely on other breathing muscles instead. When your diaphragm is stifled, the fear and grief circuitry of the brain are potentiated, and poison your thoughts and reactions. Breathing slowly and smoothly using the exercises in this chapter teaches the diaphragm to contract evenly, and increases diaphragmatic strength and range of motion. To rehabilitate your diaphragm, use the following four rules to ensure that you are breathing: 1) deeply, 2) on long intervals, 3) slowly and smoothly, and 4) assertively. Using a breath metronome (like in the video below) daily is essential to this rehab process because it will allow you to train these 4 things while focusing on other tasks.

 

Chapter 3: Breathe Deeply, Smoothly, Slowly, and on Long Intervals

Breathing is a form of gas exchange used by land animals to provide the necessary oxygen for the body’s cells to burn energy. The oxygen is used to burn sugars from the food we eat to provide us with the energy we need to move and think. In animals with lungs, breathing is called ventilation. During the ventilatory process, air is pulled into the lungs where gas exchange takes place. Oxygen diffuses from the air into the blood during inhalation, and carbon dioxide diffuses from the blood into the air on exhalation. When the environment requires that an animal move more than usual, its rate of breathing increases so that more oxygen can be delivered to its busy cells.

Mammals have muscles in the thorax that act to inflate and deflate the lungs. The most important is a specialized muscle beneath the lungs called the respiratory diaphragm. Other land vertebrates such as amphibians, reptiles, and the late dinosaurs feature a similar structure that is more simplistic, wired up very differently, and sits above rather than below the lungs. The mammalian diaphragm changes its behavior depending on how much movement the environment necessitates. The level of environmental adversity is used as a predictor. The diaphragm focuses on efficiency in safe environments but is reprogrammed for paranoid overexertion in threatening ones. This chapter will describe how stress causes the diaphragm to use quick shallow strokes, and how, by using long, full strokes, we can reinstate its proper function.

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A. Circulatory system of a cricket. B. Gills of a salmon

 

Distressed Breathing vs. Diaphragmatic Breathing

Breathing shallowly on short intervals promotes fear and nervousness; unfortunately, many of us do this habitually. This is known as distressed breathing, defensive breathing, nondiaphragmatic breathing, or thoracic breathing, and it is strongly associated with stress and anxiety disorders. Distressed breathing is characterized by shallow, rapid, uneven breaths, which are punctuated by gasps, sighs, and breath holding.

Distressed breathing has a reciprocal relationship with the stress and threat systems of the brain. We breathe more defensively when we are afraid, and we become more afraid when we breathe defensively. Conversely, if you improve your breathing style, you will develop control of your neurotic, negative thinking patterns. Indeed, you will find that diaphragmatic breathing is incompatible with anxiety.

People who breathe shallowly are usually unaware of the condition and do it throughout the day. Most of us breathe by default with “bated breath.” We wait for everything in our lives with abated breathing as if a judge were about to announce our prison sentence. Everyone instinctively knows that improper breathing is a source of tension and stress. This is clear from common phrases such as “waiting to exhale,” “sigh of relief,” “couldn’t catch my breath,” “breath of fresh air,” “give me some breathing room,” and “short of breath.” Breathing patterns are contagious and often modeled. Children learn how to breathe from their parents, and we consistently alter our breath patterns depending on who we are with, how they are breathing, and how they respond to our breathing. We perceive the breathing patterns of others from their movements, speech patterns, breath sounds, and facial tension.

Is your breathing unhealthy? Likely so. Imagine that you are threading a small needle with a thin thread. As you line up the thread with the hole, are you holding your breath? You shouldn’t be. Unfortunately, we cannot switch immediately to competent diaphragmatic breathing because of physiological alterations made by our bodies. These include diaphragmatic atrophy and a multitude of other physical changes to the muscles and nerves of the respiratory system. These changes are driven by gene activity, constitute phenotypic plasticity, and are largely responsible for the sympathetic upregulation we discussed in the last chapter. Fortunately, the changes are reversible. However, you cannot pay anybody to retrain your breathing for you, and there is no pill you can take. It requires time and discipline. As with the other exercises in this book, once you start to see the results, you will find the breath work rewarding.

Many therapists, books, and self-help resources promote breathing exercises. Most of these exercises last only a few seconds, are intended to counteract panic attacks, and give no guidelines on how to permanently change breathing style. Moreover, most guidelines tell people to breathe deeply or to “focus on the breath” without providing any other instructions. Simply focusing on the breath is beneficial because it prompts the individual to note when his/her breath is unnaturally shallow. It causes the person to think to his/herself, “Wait, my current predicament is not all that bad, so why am I breathing like there is something at stake?”

Awareness of desperation in the breath is the first step, but it does not address the problem at its source. Rather than simply focusing on the breath for a few minutes a day, we need to actively lengthen and deepen our breaths throughout the day to reprogram the unconscious breathing modules in the brainstem and to strengthen the muscles that power our breath. Consciously overriding the injurious subconscious commands will rewire your brain.

Experience pronounced distressed breathing first hand by doing the following activity:

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After performing this activity, most people report uncomfortable sensations, such as anxiety, panic, tension, increased heart rate, agitation, breathlessness, chest pressure, or even a sensation of starving for air. We unnecessarily subject ourselves to this every day. Defensive breathing is much like panting. An anxious person will breathe at an average rate of 18 to 20 breaths per minute (BPM), while a relaxed individual practicing diaphragmatic breathing will breathe around three to seven breaths per minute. Problems with diaphragmatic breathing are best conceptualized on a continuum rather than as a threshold. There are no firm diagnostic criteria for distressed breathing; virtually everyone is on the spectrum.

Newborns always breathe diaphragmatically, but, by age 10 and throughout adulthood, the normal breathing pattern is predominantly thoracic. This transition occurs during our early childhood as we learn which environmental stimuli to link to thoracic breathing. The process teaches us to be especially cautious in specific scenarios. By the time we reach adulthood, nearly every situation recruits thoracic breathing, just some more than others. Thoracic breathing is implicitly conditioned to common or habitual activities and postures, and these linkages are often never unlearned. This causes us to hold the breath when the telephone rings, breathe thoracically while at the keyboard, and gasp during speech.

Diaphragmatic Breathing Utilizes the Respiratory Diaphragm

Diaphragmatic breathing uses the diaphragm, a dome-shaped skeletal muscle that separates the thorax (containing the heart and lungs) from the abdomen (containing the intestines, stomach, liver, and kidneys). Only an eighth of an inch think, it extends across the bottom of the rib cage and contracts and expands to fill and empty the lungs. It moves much like a plunger. The diaphragm contracts moving downward on the inhale and relaxes moving upward on the exhale. The diaphragm can move as much as 10 centimeters, but most adults use only 1 centimeter or 10% of this range. I designed this chapter’s exercises to increase your diaphragmatic range.

How do you know if you are breathing with the diaphragm and what does it feel like? Use the conventional guidelines for diaphragmatic breathing in the activity below:

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A. Belly breather ensuring that stomach rises and falls. B. Motion of the diaphragm during breathing.

The motion of the stomach is truly the telltale sign of diaphragmatic breathing, and this method works for many people (Farhi, 1996). However, the vast majority of instructions for diaphragmatic breathing end here. This was discouraging for me because I felt there should be more substantial guidelines. I realized that my stomach was rising and falling only because I was using abdominal muscles, rather than my diaphragm, to suck it in and push it out. No matter how I tried to vary my approach to each breath, my stomach would not move unless I was using my abdominals to move it. My breathing was so nondiaphragmatic that monitoring the motion of my stomach did nothing for me. I wonder how many other people following these guidelines simply use their abdominal muscles to mimic the movement without actually breathing diaphragmatically.

I became convinced that my anxiety problem lay with my dysfunctional breathing style. I was determined to correct it, but I couldn’t find anything that could explain how. I would lay on the ground for hours trying to at least glimpse perceptions of my diaphragm to no avail. The diaphragm has relatively few proprioceptive nerve endings, meaning that it is difficult to tell how much it is contracting and where it is in space. Therefore, it is difficult to perceive consciously. This is why most people are completely unaware of the most central muscle in the body, until they have hiccups.

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A hiccup is initiated by a reflex arc that produces a spasm of the diaphragm (myoclonic jerk). Hiccupping involves rapid, abrupt muscular contractions. Of course, this is the opposite of how you want to breathe, i.e., slowly and smoothly. However, hiccupping helps you become acquainted with your diaphragm. Fake a few hiccups, and you will localize your diaphragm in space and sensorium. Another way to sense your diaphragm is to hold your breath for 20 to 40 seconds. You will feel a muscle between your stomach and chest pulsate. This is the diaphragm trying to jumpstart your breathing pattern. Why did natural selection hide our diaphragm from us? Perhaps, as with the heart, our genes don’t trust us to know how to consciously control the diaphragm. Grievously, the body has a vested interest in keeping us from interfering with the adaptive manifestations of trauma. If our environment is drastic, our genes want us to treat it as such.

Diaphragmatic breathing, also known as eupnea in the scientific literature, is an unlabored form of breathing seen in mammals that are resting peacefully (Lippincott et al., 2006). You can easily observe it in a sleeping infant, a kitten, or a puppy that is laying on its side. The key to sensing and recruiting the diaphragm is teaching yourself to breathe at a smooth, continuous, and constant rate. This automatically mobilizes the diaphragm because it is what the diaphragm was designed to do. Stress stifles diaphragmatic movement. When the diaphragm is stifled, we use other, less-efficient muscles to breathe.

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A. Diaphragm, lungs, and respiratory airways. B. Diaphragm shown within and outside the rib cage. C. The phrenic nerves send motor information to the diaphragm and receive sensory information from it.

Distressed Breathing Utilizes the Thorax and Clavicles

Distressed breathing is chest breathing. It involves moving the ribs around their joints of attachment to the vertebrae. This causes the ribs to pivot like venetian blinds. The thoracic (or intercostal) muscles of the thorax perform this function. The intercostals form the meat in between the bones of barbecued ribs. The external intercostals swing the ribs upward and forward, powering inhalation. The internal intercostals pull the ribs in and down, causing exhalation. In a nutshell, diaphragmatic breathing presses the floor of the lungs up and down, whereas thoracic breathing expands the walls of the chest inward and outward. Thoracic breathing does not fill the lower portions of the lungs with air as diaphragmatic breathing does. It is inherently shallow. It is also less efficient because it requires more work to accomplish the same transport of gas to blood.

Clavicular breathing is another form of distressed breathing that is even worse than thoracic breathing. It involves slightly shrugging the clavicles and shoulders. It is also called upper thoracic breathing, and it only pulls air into the top third of the lungs. Clavicular breathing is a serious problem, as it can practically eliminate the function of the diaphragm. A respiratory physiologist can actually measure the extent of clavicular and thoracic breathing using electromyography by placing electrodes on the muscles surrounding the clavicles and upper thorax. The electrode readout reports on how active these muscles are and thus how defensive the person’s breathing is. You can observe this yourself by paying careful attention to the movement of your shoulders during breathing. Clavicular breathing becomes especially obvious during exercise. Never breathe with your shoulders. Chapter 15 will explain why it is preferable to keep the shoulders still and pressed down toward the floor.

During ideal, diaphragmatic breathing, the thoracic muscles and the diaphragm work together with every breath. The diaphragm should guide the thoracic muscles, setting the pace and making each breath longer and smoother. As in the synergy seen between sympathetic and parasympathetic systems, the diaphragm is supposed to work in unison with the thoracic musculature. The problem starts when the thoracic musculature (like the sympathetic system) takes over. So now we have two major antagonists in our story: 1) overactive sympathetic system; 2) overactive thoracic breathing. …And guess what? They conspire and collude together.

The fear and grief circuitry of the brain is tied to thoracic breathing and inhibits diaphragmatic breathing. Habitual thoracic/clavicular breathing chronically overstimulates the sympathetic nervous system, keeping the heart rate and blood pressure elevated. Thoracic breathing loads the diaphragm with muscular tension, stiffness, and weakness causing you to experience sympathetic overload. On the other hand, the neural circuitry for self-soothing and the calming branch (parasympathetic) of the autonomic nervous system is linked to the diaphragm.

The diaphragm is structured and situated to contract slowly and steadily in order to take in just the right amount of air to oxygenate the body at rest. The diaphragm is designed to allow long, deep breaths of a constant rate. It moves at the optimal rate to procure the proper amount of oxygen needed in a tranquil environment, but its leisurely pace would be a hindrance in a hostile environment.

Thoracic musculature is designed to either assist the diaphragm or, during crisis, to make punctuated, shallow, rapid breaths. Thoracic breathing allows mammals to pull air in rapidly allowing active modulation of the breath in response to fluctuations in anticipated danger. In the short run, this would have helped our prehistoric ancestors prepare for the increased oxygen requirements they would need for “fight or flight” maneuvers. Sadly, most of us live in this mode, despite the fact that we are no longer protecting our bodies from predators or club-bearing maniacs. The modern world has “tricked” our bodies into thinking that our environment is too stressful to breathe peacefully. This drains our energy, ties knots in our muscles, and turns us into nervous wrecks.

Distressed Breathing and Social Rank

If you would like to experience thoracic/clavicular breathing, watch an internet video of a violent street fight and pay careful attention to your breath. The shallow rapidity will become apparent. Everyone recognizes the signs of distressed breathing whether it is in themselves or others. When you have been caught in a lie, when someone disrespects you, when you are exposed to or threatened by physical violence, you enter a state of respiratory distress. When it happens, you usually act at two extremes, either becoming conflict avoidant (submissive) or quick to anger. Respiratory distress is marked by breathing that is so shallow that it interferes with your speech, often causing your voice to falter. You may feel like you are choking and suffocating at the same time. It is usually obvious to the people around you, and most people are embarrassed when it happens to them.

The truth is that most of us live in a state of respiratory distress throughout the day. People hear it in the cadence of your voice and breathing and use it to make judgments about your social standing. I believe that, aside from posture and physical attractiveness, this is one of the most commonly used markers for social rank. Diaphragmatic breathing retraining will make it so that you are practically immune to respiratory distress. With enough retraining, people will be able to tell that you have little susceptibility to it. When your breathing shows no signs of distress, people will not want to challenge or provoke you because they realize that they will reach respiratory distress before you do. As you develop your capacity for diaphragmatic breathing, you will realize that the people around you are constantly fighting wars of attrition to see who will show signs of respiratory distress first.

Stifling and Neglecting the Diaphragm

Surgery and injury to the abdomen are common risk factors for distressed breathing. After colon surgery, a gastric bypass, a Caesarean procedure, or an appendectomy, the patient will have an incision wound on his or her abdomen. It is common for the recovering patient to try to reduce pain and protect the wound by inhibiting normal abdominal expansion during breathing. They learn to actively stifle the diaphragm because of fear of pain or of stitches bursting at the incision site. Learned pain avoidance causes the patient to neglect the diaphragm and become a chest breather. Numerous symptoms such as rapid, shallow breathing, breathlessness, and anxiety may become chronic, and it is uncommon for such patients to revert to diaphragmatic use even after the pain from the surgery is gone unless breathing retraining therapy is undertaken (Ford, 1983). You may have never had abdominal surgery, but, to some extent, past trauma and submissive signaling has stifled your diaphragm in a similar way.

A medical ventilator is a machine designed to move breathable air in and out of the lungs to provide the mechanism of breathing for a patient who is breathing insufficiently. When a patient is taken off an artificial ventilator, it is important to assess his or her breathing mechanics to ensure this person’s breathing musculature is strong and well-coordinated enough to support unaided breathing. Withdrawal from mechanical ventilation is known as “weaning.”  Think of your thoracic breathing musculature as a type of ventilator for your diaphragm. Years of stress have caused the thoracic muscles to take over, and the diaphragm becomes weak because of “disuse atrophy.” The good news is that the diaphragm grows stronger quickly (Levine et al., 2008). When you first start breathing diaphragmatically, it is difficult. In some ways, it is uncomfortable because it is as if you have been taken off a ventilator. You need to wean your diaphragm. Remove the ventilator, the crutch, of thoracic breathing and plunge headfirst into diaphragmatic strengthening.

The Four Rules of Diaphragmatic Breathing

In the thick of my anxiety, I could tell that my breathing was highly dysfunctional. I used myself as a model for what not to do, and slowly made inferences about how to do the opposite of my natural tendencies. I read for weeks about ventilatory mechanics and experimented with numerous breathing styles. Slowly, after five years of research, introspection, and trial and error, I developed four rules of diaphragmatic breathing:

1) Deep Breath (high volume): Breathe nearly all the way in by the end of each inhalation and all the way out by the end of each exhalation.

2) Long Breath (low frequency): Engage in long interval breathing, breathing in for 4 to 10 seconds and breathing out for 6 to 12 seconds at a time.

3) Smooth Breath (continuous flow): Breathe at a smooth, slow, nearly constant rate during all breathing.

4) Assertive Breath (confident): Do not let social concerns of life stressors conflict with the first three rules.

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Figure 3.1: A graphical representation of three of the rules of diaphragmatic breathing. The vertical axis designates depth of inhalation or volume of air in the lungs; the horizontal axis designates time.

A helpful way to increase your ability to monitor your breathing is to draw your breathing pattern on paper using these three rules as parameters.

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After my personal experimentation, I was convinced that adherence to these four rules guaranteed diaphragmatic breathing. I researched these concepts to find support for them in the scientific literature. Further research brought me to the realization that certain clinicians have been using tenets very similar to these for decades. For instance, psychologist Erik Peper has a system he calls “effortless diaphragmatic breathing,” which consists of a large tidal volume (>2000ml), slower respiration rate (< 8 breaths per minute), and continuous flow rates (Peper & Tibbetts, 1994). “Resonant” breathing and “coherent” breathing are two very similar breathing methods that are growing in popularity (Elliot & Edmonson, 2008). In fact, diaphragmatic breathing retraining is a widely used technique in a number of relaxation and biofeedback programs (Gervitz & Schwartz, 2003). It has also become popular in psychiatry and clinical psychology and is a fundamental tool used in cognitive behavior therapy (Hazlett-Stevens & Craske, 2009).

Diaphragmatic breathing retraining comes in many forms but almost always involves increasing the length of time of each breath and awareness of the movement of the belly. The participants of clinical stress reduction programs often report that “the breathing stuff” was the most important thing they learned. It is taught by health providers and medical professionals around the globe to treat a variety of physical and psychological disorders (Van der Kolk, 2014). Diaphragmatic breathing is well known to slow the heart rate and decrease blood pressure. It has proven to reduce sympathetic arousal, anxiety, panic attacks, and hyperventilation syndrome (Gervitz & Schwartz, 2003). It has also succeeded as an effective treatment modality in pain management (McGeary et al., 2014), motion sickness (Stromberg et al., 2015), breathlessness (Borge et al., 2015), a range of psychiatric problems (Vranceanu, et al., 2016), and various other medical disorders.

Scientists and clinicians appropriated the methodology for diaphragmatic breathing from India. This cutting-edge technique is actually an ancient tradition dating back before the common era. In fact, diaphragmatic breathing is practiced at most yoga studios. Yogis use long, deep inhalations and exhalations. The Buddhist form of breathing meditation called anapanasati or “mindfulness of breathing,” and the Hindu practice of pranayama or “control of breath” both explicitly utilize the first two rules. Yoga sages assert that the only way to control your mind is to cultivate control of the breath. These sages advocate that we never stop paying attention to it. Yogis who are masters of svarodaya, the yogic science of breathing, claim to be aware of every breath they take.

Diaphragmatic breathing has been around for thousands of years, and I believe that if made accessible it is the most powerful tool in psychiatry, and perhaps even in medicine. Why hasn’t it gone mainstream? How did I finish a formal education in psychology and brain science without being introduced to it? Most existing breathing practices don’t offer a systematic regimen aimed at permanently increasing depth and duration of breathing. Because of this, they don’t provide enough of a benefit to make a substantial difference, and thus are only used for extreme cases of anxiety. I believe the program outlined in this book is so powerful that it can provide a substantial benefit, even for people with no anxiety. Hopefully, by the end of this chapter, you will agree. In fact, most of the exercises in these chapters you cannot find anywhere else.

Depth of Breath: Tidal Range

The average adult human has a total lung capacity of about 5 to 6 liters of air, but only a small amount of this capacity is used during normal breathing. Nervous breathing will often involve inhalations of less than half a liter. We rarely breathe fully. Most of our breaths are usually confined to a narrow range. This range is called “tidal volume.” When you increase your tidal range, forcing yourself to breathe all the way in and out, you naturally accomplish the other two criteria of constant rate and longer interval.

Joseph Pilates saw forced exhalation as the key to full inhalation and advised that people squeeze out the lungs as if they were tightly wringing a wet towel. Doing this will improve the strength of your breathing musculature rapidly. Take advantage of this and increase your tidal range.

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Figure 3.2. This graph shows a sine wave that indicates normal tidal volume. The increase on the fifth breath depicts a deep inhalation that extends the tidal range into the inspiratory reserve. This is followed by a deep exhalation extending the tidal range into the expiratory reserve. Extending the tidal range in this way during breathing training will permanently broaden your tidal range.

Spirometry is the measure of the amount of air moved. An inspirometer, which you can purchase online for about ten dollars, allows you to keep track of exactly how much air you are capable of breathing in. I used an inspirometer for several weeks monitoring my lung capacity, recording the results and watching my capacity increase. I strongly recommend doing this. At first, I felt uncomfortable when I breathed all the way in. It felt like my lungs were going to pop and I would often cough. It took about 6 seconds for me to inhale completely and about ten seconds to exhale completely.

Within two months of performing Exercises #1 and #2 this all changed. There was nothing uncomfortable about being at either the top or bottom of my capacity, I didn’t cough, and it took me only 1 second to inhale completely and only 5 seconds to exhale completely. What is more, the maximum I could breathe in (vital capacity) went from 4000 to 5000 milliliters. While performing the activity below, focus on the uncomfortable sensations that arise as you breathe outside of your normal tidal volume. Try to reinterpret them as pleasurable. I try to associate satisfaction, satiety, and fulfillment with the sensation of taking a full breath – as if each full breath offers a relief and some form of sustenance that rejuvenates me.

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Figure 3.3. A. A graphical depiction of breathing above the normal tidal range for exercise purposes. B. A graph of breathing below the normal tidal range.

Mammals that have experienced recent trauma often exhibit “deep spontaneous breaths.” They exhale deeply to reset and restore equilibrium in their autonomic nervous system. This is known to us as sighing. Humans often inhibit this natural tendency. Instead of inhibiting it, sigh more deeply and slowly than normal, prolonging the sigh. When you feel the urge to sigh, use it as a reminder to activate the full set of breathing muscles. As you become fearful or frustrated your tidal range narrows and your breathing muscles become stiff. A deep sigh can flex through this rigidity and provide the muscles with a much-needed stretch. However, you should find that as you retrain your breathing, you experience the impulse to sigh much less. Sighing is common and frequent in people diagnosed with panic disorders. I used to sigh constantly, but after diaphragmatic retraining, I rarely catch myself doing it anymore.

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A. An inspiromter or incentive spirometer; B. Patient on a medical respirator; C. Two chest views from the side depict a narrow diaphragmatic tidal range versus a wide tidal range.

Length of Breath: Paced Breathing

The typical adult breathing pattern is marked by shallow thoracic breathing with a rate of 12-20 breaths per minute. Many people with anxiety average 18-22, which means each inhalation and exhalation last only about one and a half seconds. Breathing therapy techniques that use “paced respiration” recommend reducing the rate to 5-8 breaths per minute, and some practitioners advocate 3-5 (Brown & Berbarg, 2012). Paced breathing is intended to extend your normal, default breathing rate. Let me explain. Let’s say that you normally breathe at a rate of 20 breaths per minute. If you practice paced breathing at rate of 8 breaths per minute, this will gradually decrease your default rate, from 20 towards 8. The more you practice, the closer your normal rate will get to 8 breaths per minute.

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A. This graph displays a breathing rate of 20 breaths per minute during the first 30 seconds, then 10 breaths per minute during the next 30 seconds, then 6 breaths per minute, then only 2.

The sympathetic nervous system exhibits reduced activity when a person is taking fewer breaths per minute (Lichstein, 1988). If you were guided to increase your breaths per minute your sympathetic system would spike; yet decreasing it to 5 breaths per minute would cause the activity to plummet (Elliott & Edmonson, 2006). At 5 breaths per minute, heart rate and blood pressure drop, nervous sweating declines, and subjective discomfort in response to threat declines significantly (Gervitz & Schwartz, 2003). There is no easier, faster way to reduce sympathetic tone and the stress it causes. I believe that the most effective intervention for life stress is paced breathing and that it should be used outside of the clinic – by everyone – on a daily basis.

I firmly recommend using a breath metronome (sometimes called a breathing pacemaker) to aid you in pacing your breathing. The CD included with this book acts as a breath metronome. You can also download a breath metronome as a mobile app for your phone or tablet. They generally cost between $1 and $5. I have used several, but my favorite is “Breath2Relax.” It was developed by the U.S. Department of Defense for veterans and people with “shell shock” now known as post-traumatic stress disorder (PTSD). This app gives both audible cues and visual cues, featuring a cylinder that fills guiding your inhalation, and empties guiding your exhalation. You might want to go to the application’s settings and turn off all notifications, music, and extraneous options. You only need the visual and auditory timing cues.  If you don’t have a smartphone, but you have a computer or mp3 player I have free downloadable audio files on my website. You can also use the breath metronome videos I have uploaded on youtube.com.

It is very difficult to maintain paced breathing without using an external aid, like a breath metronome. Studies have shown that without using a breath metronome or an external pacing signal, the breathing rate quickly drifts back to baseline (Clark & Hirschman, 1990). You could use a clock or watch, or you could count the seconds in your head, but this quickly gets tiresome and you are very unlikely to stick with it for more than a few seconds at a time. This could not be truer for me. I don’t have the attention span to count the seconds for each breath in my head and my attempts at paced breathing without a metronome are pathetic. Without a breath metronome, you must use your full attention to measure each breath. Using a breath metronome frees up your mind to attend to other things. You can do almost any activity with your breath metronome playing in the background. Having one is essential because the rest of the exercises in this book will require that you use paced breathing. Please take a minute now and procure one.

Recommended Breath Metronomes:

  • Smartphone and tablet applications: Breathe2Relax, Breath Lesson, Breath Pacer, Breathe Well, Breath Counter, Pranayama, BioBreathing, Calming Breath, Deep Breath, Essence, Tactical Breather, and many others
  • Videos: https://www.youtube.com/watch?v=UrFhzX7E5Sc
  • The video at the top of this page will take you to a number of other breath metronome videos set at different breathing intervals

Now let us find a reduced “target” rate that is good for you. Try each of the paces in the table below for 30 seconds each until you find one that feels challenging but comfortable. For many people, the best starting point is 4 seconds in and 6 seconds out (6 breaths per minute). This is an extremely healthy way to breathe. I want to encourage you to work up from here towards an ultimate goal of 10 seconds in and 12 seconds out. If you want to go higher, or stay lower, that is fine too. Many experts think that ideally most people should work towards being able to breathe between 5 and 8 breaths per minute (Brown & Berbarg, 2012; Gervitz & Schwartz, 2003). For people over six feet tall the ideal rate is said to be 3 to 4 breaths per minute. For children under the age of ten this ranges between 6 and 10 breaths per minute. Any amount that you can extend your breathing intervals from what they are now, will be beneficial. Make your goal to train yourself to breathe at your target rate without any sense of effort or air hunger.

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Notice that in each row in the table above the exhalation is longer than the inhalation. This is because, when you breathe out relatively longer than you breathe in, you activate the vagus nerve, the parasympathetic system, and the body’s relaxation response. The longer you can extend your exhalations, the more the vagus nerve will be recruited to pacify the nervous system, and the more the heart will decelerate. To augment this try to relax consciously during the exhalations. Think of every exhalation as a long sigh of relief and peace.

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After paced breathing with a metronome for 5 minutes you will feel much calmer. Try doing it before a meeting, or a date and you will be amazed by your level of composure. Do it for 5-10 minutes before a negotiation or an interview and you will have a distinct advantage. At a party, excuse yourself for 5 minutes and when you return you will have fully regained your social equilibrium. It is especially useful after a stressful situation. It will allow you to completely recover. Use it after a work out to really relax the muscles that you just worked. I use a breath metronome every morning when I wake up, every night before I go to bed, while reading, while watching TV, while working at my desk, and during other activities. I don’t use the mobile app when I am driving because pressing buttons on a phone can be distracting and dangerous. Instead I listen to the breath metronome CD while in the car.

Whenever you are doing monotonous busywork, you should be breathing with a breath metronome. If you use your breath metronome while you watch a movie, you can get in 2 hours of paced breathing every time. We usually breathe thoracically when we watch cinema because of the suspense and violence, but paced breathing, even during an action flick, will detraumatize your psychological orientation toward action. Put your breath metronome on silent and place it next to your television or computer screen and follow the visual prompts. Or take it off silent and place it face down in bed next to you before sleep and follow the audio prompts in the dark. Regular use of a breath metronome will help you reprogram your breathing and with it your life. I think that breath metronomes should be found in every classroom, in every workplace, in every therapist’s office, in every yoga and Pilates studio, in every ambulance, and beside every hospital bed.

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A. Mobile phone with breath metronome application for paced breathing; B. a classical metronome; C. Set your phone next to your television so that you can perform paced breathing while watching.

Tips for Staying with the Breath Metronome:

  • If you have not filled or emptied the lungs before the metronome switches, go ahead and finish the breath that you are currently on. Quickly inhale or exhale the rest of the air, before you catch up with the metronome.
  • Sometimes the metronome will be going too slow, and you will feel air hunger. When this happens, disregard the metronome and take a few deep, quick breaths before you go back to breathing slowly at the metronome’s rate.

Paced breathing will feel very awkward at first. You may feel like you are getting too much air (hyperventilating) or you may feel that you are not getting enough (hypoventilating). If this is the case, you may have chosen a rate that is too far from your normal rate. Work up slowly to this low rate of breathing.

To Avoid Getting Too Much or Too Little Air

  • If you feel that you are getting too much air and feel dizzy simply breathe more slowly. You should be breathing at the same pace; just breathe less air.
  • If you feel that you are getting too little air and feel faint simply breathe more. Ensure that you breathe all the way in and all the way out.

Use the table below as a rough guideline for how to determine what your target pace should be under different conditions and cardiovascular demands.

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When not Using a Breath Metronome:

1) Try to focus on your breathing frequently throughout the day, monitoring it and deciding whether it is too shallow or fast.

2) Catch yourself getting ready to switch from breathing in to breathing out before you have taken a full breath. Instead of switching, prolong the inhalation.

3) Try to catch yourself on the tail end of an exhalation and try to prolong it rather than starting to inhale prematurely.

4) When you prolong an inhalation or exhalation, don’t speed it up. Increasing the rate will switch you to thoracic breathing. Stay at the same rate to keep the diaphragm engaged.

Smoothness of Breath: Constant Rate

At some point, I realized that paced breathing together with deep breathing was not enough. My inhalations and exhalations were at around 10 seconds each, but about 5 seconds into each breath, my breathing rate would quickly decrease without me even noticing it. After this lapse, I would try to make up for it at the end of the 10 seconds by either gasping or sighing. Basically, I was lazily holding my breath mid-count to get out of doing the work of strengthening the diaphragm. Instead, we should try to breathe at the same rate throughout each breath. In order to keep the diaphragm engaged it is imperative to breathe at a nearly constant rate throughout each breath. This involves breathing slowly, gently, and steadily.

The beginning of an inhalation always starts with the diaphragm. However, as you approach the upper limit of your tidal range you will transition to a swift thoracic inhalation in order to reach your full capacity. Avoid this. Try to get all the way to the top of your inspiratory reserve slowly and gradually, using only the diaphragm, without recruiting the thoracic musculature. Experience this in the exercise below.

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You experienced the impulse to switch to a rapid thoracic inhalation in the exercise above because your diaphragm is not accustomed to providing the force for a breath outside of its normal tidal range. I think of this weakness as a diaphragmatic speedbump at the end of the diaphragms habitual range. Forcing it inhale steadily past this range will strengthen it and accustom your nervous system to utilizing it in this way. Breaking down this restriction that limits your diaphragm’s range of motion is unique to the present system, yet integral to diaphragmatic retraining.

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A. The fifth inhalation in this graph is deep and long. However, the inhalation does not occur at a constant rate (the slope of the line varies). As you can see, it plateaus three times and ends with a gasp. This person is gasping and breath holding because they are uncomfortable breathing above their normal diaphragmatic range.  B. Shows a deep inhalation. However, it is very short in duration, so it is basically a thoracic gasp (the slope of the line is very high). C. Shows the optimal breathing pattern of a long, deep inhalation of a steady rate (with a constant slope).

Above I recommended that you invest ten dollars in an inspirometer to monitor the depth of your breathing. If you do so, purchase one with a flow rate indicator. This will provide real-time feedback on how steady your breathing is. To keep your flow rate steady, imagine smelling a rose, inhaling very slowly while savoring the fragrance. Or imagine that you are curled up with a small pet or a baby, and you are trying to make your breathing as smooth and calm as possible to soothe it and put it to sleep. Realize that quivering, jerky breaths would likely rouse and frighten it.

I also encourage you to spend $15 and buy yourself a stethoscope online to listen to your breathing. When you put the “bell” of the stethoscope up to your mouth, you can hear tiny distortions and discontinuities in the breath – desperate little gasps. These gasps are more noticeable when you are fearful and some people describe them as fluttering, or “catches” in the breath. It sounds a bit like the voice when it “cracks.” While listening carefully, it became clear to me that breathing, especially breathing deeply is a struggle. It doesn’t have to be though.

The more slowly and fully you breathe outside of your tidal range, the more you can hear and feel these points of weakness in the breath. The technical term for them is apneic disturbances, and they usually last for tiny fractions of a second. They are such a basic feature of most people’s breathing that they seem like they are natural and normal, but without doubt, they are suboptimal. These disturbances are caused by weakness in the diaphragm and correspond to absences in its range of motion. They are associated with the startle response and keep you feeling on edge. As the next activity shows, you do not need a stethoscope to hear these.

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A person cupping their hands from mouth to ear to amplify the sound of the breath. B. A depiction of a discontinuous, rough breath compared to a continuous, smooth breath.

Buddhist and Hindu practices emphasize breathing through the nose and down the back of the throat. Many meditators concentrate on the “ha” or “so” sound this produces. Creating an even sound throughout each breath will ensure that the breath is being taken in at an even rate. To do this focus on maintaining the same sound from the beginning of each inhalation/exhalation all the way to the end. You know you are breathing diaphragmatically if the sound of your breath is not changing. Other ways to make sounds that you can monitor for constancy include: breathing as if you are fogging up glass, making a hissing sound with your tongue, a “haaaa” sound with your voice, a buzzing sound with your throat, or a glottal sound with your vocal folds. Meditators also use mantras to accomplish this. Using a stethoscope, cupping your hands, or making a sound of some kind all accomplish the same thing. So perform exercise 4 using any of these methods.

I was concerned the first time I heard my breath amplified because I immediately recognized that these irregular pauses and gasps were unhealthy. These irregular pauses are magnified by adversity and are involved in the sensation of respiratory distress. Breathing is strained whenever a single inhalation pauses, slows or speeds up. When someone is stressed, you can often hear him or her straining for more breath, as the inhalation will be punctuated by multiple rapid gasps. Similarly, the exhalation may be punctuated by shudders. The gasps take place when one is continuing to inhale despite his/her body’s inclination to “switch” to exhalation. The weakness in the breathing musculature tells us to stop taking a full inhalation and go back to exhaling prematurely. This is the exact mechanism that causes us to breathe shallowly and that creates the diaphragmatic speedbump. This phenomenon of fighting against oneself for breath is sometimes called paradoxical breathing.

Imagine that your breath is an accordion that you have spent your life thrusting and thrashing in a distraught, feverish way. Imagine now playing the accordion by moving your hands very slowly and continuously stretching the accordion out to its full length and then gently pressing it closed, over and over.

We are constantly modulating the rate of each breath from second to second, depending on our level of air hunger and transient stress. We may alter the rate of a single breath many times. This is not ideal. Tell yourself that you will stick with the same rate for the entirety of each breath. If you need to change the rate because you need more air, change at the beginning of the next inhalation or exhalation, but never during an actual breath. One helpful way to assist you in this is through breathing exclusively through the nose, which we will discuss in Chapter 11.

People who perform intricate manual work, or who shoot targets find that holding the breath helps to steady the hands. Once you reprogram your breath to be continuous and smooth, breath holding is no longer necessary to keep you from shaking. Distressed breathing progresses like an automobile that is alternating between stalling and redlining. You want your breathing to be like a reliable car, engine purring, on a smoothly paved freeway, with the cruise control on.

Breathe Assertively

So far we have talked about breathing smoothly, more deeply and on longer intervals. The forth rule is to breathe assertively. We normally breathe as if we don’t have any faith in our own breath. A thoracic breather knows that a negative thought could interrupt the breath at any time and prematurely turn an exhalation into an inhalation or vice versa. This causes us to breathe not only shallowly, but cautiously and hesitantly, as if we are tiptoeing. It also keeps us from breathing efficiently because we are not taking advantage of inertia. If a breath proceeds steadily it can capture its own momentum, resulting in reduced effort. During hesitant, unsteady breath the breathing musculature is constantly building and then losing momentum.

Imagine the smooth, continuous oscillation of a pendulum. Each stroke captures its momentum (until gravity reverses the swing). Any pendulum would be useless if it slowed or stopped mid-swing. Picture your diaphragm stroking up and down in a slow but unfaltering, unagitated way. Breathe out as if you know that you are not going to switch prematurely – commit to each breath.

To feel comfortable doing this you must not be afraid of having others hear your breath. Be proud of how unwavering your breath sounds, and don’t think that people will hear it and be offended. Breathe decisively, and audibly if necessary, for all to hear. Breathing assertively is the key to true confidence.

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It is likely that a number of the people that you admire and find charismatic are simply assertive, diaphragmatic breathers. I believe Cesar Millan, a self-taught dog behaviorist, is such a person. He is widely known for his television series, “Dog Whisperer,” in which he trains aggressive and abused dogs. In 2009 The New York Times attributed his success to his personal sense of equanimity, describing this as “a sort of uber-balanced mien (Wallace, 2010).” Cesar calls it “calm-assertive energy” and says that he handles dogs as a pack leader (Millan & Peltier, 2006).

I am convinced that Cesar’s effect on dogs derives from his breathing. From observing him on video, it seems to me that his breathing is diaphragmatic and that it is not easily interrupted by the behavior of the dog. I think that he and people like him have an autonomous breathing pattern that is not susceptible to being stopped short by the behavior or misbehavior of others. Dogs are in tune with how the status hierarchy is conveyed through breathing. I think the dogs know there is nothing they can do to disturb his breathing, so they listen to and respect him. Mr. Millan’s technique works on abused and subordinated dogs as well as it does on aggressive and intractable dogs.

Respiratory rate, and fluctuations in it, is a language that all mammals speak. Try sitting near your cat or dog breathing calmly and then suddenly breathe short, quick, loud breaths through your mouth. They will become concerned, look nervous, and adopt your breathing pattern. If you do the opposite and breathe slowly and deeply, they are likely to relax and start stretching. If you breathe slowly and deeply while training or correcting them, they will heed you.

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A. Stethoscope; B. Accordion; C. Grandfather clock with pendulum.

Health practitioners often need to assess their patients’ respiratory rates, which is the number of breaths (inhalation-exhalation cycles) taken within 60 seconds. The method that a doctor or clinician uses to measure respiratory rate of a child, an animal, or an adult, will affect the measurement. Simply handling an animal will increase its respiratory rate, giving a false reading, unless the animal is handled very gently, in which case its respiratory rate may fall. Using a cold stethoscope to measure respiratory rate in a child will increase his/her respiratory rate, whereas other less “obtrusive” methods (like counting the number of times the chest rises) may not. For adults, all kinds of environmental factors will affect the respiratory rate. Clinical texts refer to the “invasiveness” of different methodological procedures for assessing the respiratory rate. For example, a doctor that acts either domineering or too accommodating will raise it. Different aspects of our environment are constantly “invading” our respiratory dynamics. Don’t allow the rate or depth of your breathing to be dictated by banal stressors in your environment.

The Connection between the Breath and the Mind

Even small stressors quickly lead to very shallow breathing. We can consciously tell when our breath becomes shallower, but we normally do not use this cue to regulate our breathing, as we should. In fact, when most people notice that they are breathing shallowly it causes them to breathe even shallower. Shortness of breath makes us feel like we are suffocating, and when we feel this way we can’t help but think negative thoughts. The feelings of pain and frustration are largely compounded and amplified by shallow breathing. Pride, vanity, and guilt are also ramped up by defensive breathing, and I will focus on these relationships in later chapters. Once you have internalized the four rules and are breathing deeply, smoothly and on long intervals, it will become clear to you that the mental bonds that we have with our ego, and the social hierarchy are severed when you are breathing diaphragmatically.

I think that the discomfort from shallow breathing magnifies many addictive behaviors by making us feel desperation. For example, our breathing becomes shallower when we are hungry, and the discomfort of it makes us feel a stronger craving for food. People use the phrase: “I am starving” when they notice that their hunger is affecting their breathing. Similarly, people turn to cigarettes, alcohol, and anger when they feel that negative life circumstances are affecting their breathing. People use drugs to change their emotional state, but the main thing they are doing is changing the state of their breathing. One can transform disordered breathing into quasi-healthy breathing in minutes using barbiturates, sedatives and opiates but of course this is short-lived, and the inevitable withdrawal symptoms actually accentuate disordered breathing. Paced breathing kicks in faster than drugs or alcohol do, and makes you a stronger person rather than a weaker one. Expect paced breathing to increase your distress tolerance, and your capacity for emotional regulation.

After I started paced breathing I had a new aura, a new persona. I found that children and animals approached me without hesitating. However, it made some adult males nervous. It does make people feel insecure at times. This is usually because they may assume at first glance that it is a façade. After a brief interaction they will quickly realize that you are not faking it. You can’t fake the calmness and poise made possible by diaphragmatic retraining. Distressed breathing, on the other hand, is a signal to predators that you are in panic mode. When someone “smells fear” they are really sensing distressed breathing. It tempts bullies to close in for the kill. Distressed breathing also has a tendency to intensify an argument and turn it into a fight. Diaphragmatic breathing safeguards you from violence; thoracic breathing invites it.

I used to try to breathe more shallowly than everyone else around me to be polite. This quickly becomes dangerous to your health. You may not feel comfortable with how secure you appear to others when you breathe slowly and diaphragmatically. You may feel that there is incongruence between it and your level of attractiveness, strength or status. I’m writing to promulgate the idea that there is never incongruity among these things. A part of us is afraid that breathing calmly around others is the ultimate insult. We are afraid that the other person will become angry if he/she sees us breathing too deeply.

We breathe the most shallowly around people that we respect or fear. Observe how your breathing changes when you are around the dominant people in your life. This is partly because when we breathe deeply, our emotional reactivity decreases and our facial response time is delayed. Our faces become calmer and at first, may appear less attentive. You might appear distant or disconnected. Notice how when you breathe on long intervals during a conversation, your face goes blank and non-expressive. We need to get over this fear that someone will see us and think that we look too calm. There should be no such thing as too calm. The best way to train this is to try to retain diaphragmatic breath during all social encounters. It will become sincere with practice. Don’t let any outside influences interrupt your breathing pattern. Breathe with impunity.

Breathe Diaphragmatically in Public

Diaphragmatic breathing in public is truly transformative. At first this simple activity will reveal your tendency for agoraphobia and social anxiety. Take your breathing app with you to a coffee shop or cafe and get a table by yourself. Sit there and pay attention to your level of poise. Try using the app with headphones and take a walk in a public place or down a busy street. When you use a metronome to perform paced breathing in public, you can feel yourself letting go of social concerns. You lose hesitancies and apprehensions about potential negative social interactions making your outward appearance more assertive and less defensive. Other people will see in your face that you are not afraid. You will start to appraise the vast majority of people as harmless. Instead of being a potential assailant, each person will become just another face.

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Breathe Diaphragmatically While Speaking

In social and public speaking situations we become short of breath. Even after practicing diaphragmatic breathing for two years, I realized that as soon as I began speaking to someone, I completely stopped breathing diaphragmatically. Because of this, I would try to take intermittent breaks from conversation to try to regain my composure. At some point, I had to force myself to continue to breathe deeply and diaphragmatically in speaking situations. This is difficult because you have to focus on what you want to say and simultaneously focus on monitoring your breath. This led me to realize that the best way to train this is to read aloud while breathing diaphragmatically. You will notice that it is uncomfortable at first, because we all normally speak within a very narrow tidal range. The trick to calming your speech is to prolong the speaking time and ensure that it is not punctuated by anxious gasps. The following exercise addresses this, and does not require a breathing metronome.

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Breathe Diaphragmatically During Exercise

I believe that breathing on longer intervals during exercise is a great way to strengthen the diaphragm. Try taking a short jog focusing on the sensations you feel when alternating between inhalations and exhalations. You are likely alternating far too quickly. Try blowing nearly all the way out and breathing nearly all the way in with each breath. This can feel uncomfortable, but I believe it is extremely healthful. To do this, you have to fight to resist the reflexes in your chest that prematurely interrupt a full exhalation

Ironically, many people breathe shallowly while exercising because they are concerned that they will not get enough air if they breathe too deeply. The sensation of elevated heart rate makes you want to take tiny breaths. Ignore the panic signals from your heart and ensure that you breathe all the way in and out near full capacity. As long as you are breathing heavily, you are getting plenty of oxygen. When you feel your heart beating hard in your chest but keep exhaling, you are restructuring your unhealthy breathing patterns and breaking through the trauma that underlies them. Don’t bother using your breathing metronome for this one, just make sure you are taking full breaths.

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Breathe Diaphragmatically While Eating

It is surprisingly difficult at first to follow a breath metronome while eating a meal. Attempting this makes us aware of just how tangled up our appetitive drives are with distressed breathing. The activity offers a puzzlingly difficult challenge that should pique your interest in the benefits of diaphragmatic breathing. The last two activities do not require the use of a breath metronome, but this activity, like the majority of the activities in this program, are greatly improved by the use of a metronome.

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Conclusion

The fear and startle response is embedded within most of our daily activities because these activities have been associated with disordered breathing patterns. As the last three exercises have illustrated, this program will help you reverse this by having you perform diaphragmatic breathing while engaging in various routines and subroutines. This will desensitize your stress system by pairing experiences that are normally paired with thoracic breathing, with diaphragmatic breathing instead. I was inspired to create a system based on this concept by my experiences in the yoga studio. The fundamental core of hatha yoga revolves around the yoking of various poses with calm breathing. Since developing the present program, I have found that this concept is not even new in the clinical arena. It is a little known technique called “generalization of diaphragmatic breathing.”

Diaphragmatic generalization is used by therapists to help clients associate peaceful breathing with distressing thoughts and with other activities such as standing, sitting, and walking to ensure that proper breathing predominates in most life situations (Peper & Tibbetts, 1994). Yoking relaxed breathing to various activities is a form of systematic desensitization.

Systematic desensitization is a psychological method used to help people overcome phobias and anxieties. It is a form of counter conditioning (a Pavlovian therapy) developed by South African psychiatrist Joseph Wolpe. The source of the person’s anxiety is discovered (i.e. spiders), the person is trained in relaxation techniques (i.e. reappraisal, anti-anxiety medicine, breathing and muscle relaxation exercises), and then the person is guided to use these techniques while being systematically exposed to increasing levels of fearful stimuli (talk of spiders, pictures of spiders, videos of spiders, real spiders).

If you can maintain diaphragmatic breathing while you are slowly and systematically exposed to stimuli that would normally increase your breathing rate, you can habituate to these external stressors and reprogram the way your breathing system relates to them. Taking this a step further, you can even desensitize yourself to your own attempts at assuming dominant or optimal postures that would normally cause you to breathe shallowly. For instance, I couldn’t hold my head erect, or look upwards, or sport a calm face while breathing diaphragmatically. This was because during my life these things had been thoroughly paired with thoracic breathing.

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This graph displays a healthy breathing pattern that is made shallow and short by a negative stimulus. This stimulus may be fear, submission, startle, or anger inducing. The change in breathing pattern may even have been induced by the person’s own dominant body language. Keeping this from happening, and ensuring that breathing is longer, deeper and smoother than normal during exposure to negative stimuli will ensure that the person is desensitized to these stimuli, and diaphragmatic breathing is generalized toward events that would have upset them in the past.

The more I paired different types of optimal postures with diaphragmatic breathing, the more they became a safe, fun place to be. The rest of the exercises in this book are intended to be performed with paced diaphragmatic breathing, guided by a breath metronome. This is done to make all nonsubmissive postures a safe and fun “place to be.” I have spent five years pairing hundreds of different activities with diaphragmatic breathing. I am sharing the ones that benefited me the most here. Below is the diaphragmatic breathing exercise that I would like you to combine with every exercise and activity in the remainder of this book.

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Not convinced that diaphragmatic breathing retraining will change your life? Do me a favor. Right now, do a deep back bend with and without paced breathing. Lie down on a carpet, bed or soft surface on your stomach. Then use your arms to lift your torso off the ground, performing a gentle “upward dog” pose without straining. Notice how shallow and irregular your breathing becomes when you do a back bend? Lie back down and imagine what it would take for you to improve your upward dog. Lots of time and effort right? Years perhaps? Now use the paced breathing exercise #10 above for five minutes at your target rate. Try the upward dog again while retaining this pace. You should feel like the upward dog is easier to hold and less stressful to perform. You should also have the sense that it would be simple to improve your upward dog and strengthen your lower back by combining the exercise with diaphragmatic breathing. When I combine these, I feel like my back is supported and safe, rather than exposed and vulnerable. This is the case, not only for your lower back, but for all of the muscles in your body. Thoracic breathing makes your muscles close down in tension, and diaphragmatic breathing makes them receptive to being toned and strengthened optimally.

The benefits of this breathing retraining regimen are cumulative. Every minute that you spend breathing diaphragmatically, you are making innumerable cellular and molecular improvements to your respiratory system. What is more, all of the mental work involved in learning to incorporate the diaphragm into your breathing is saved to procedural memory – routinized – making diaphragmatic breathing easier in the future.

After six months of paced breathing, I decided to try belly breathing again. This is the activity where one places one hand on the chest and another on the abdomen to check for natural movement of the stomach with breathing (outlined in Breathing Activity 2 in this chapter). Before I started, there was nothing I could do to use my breath to raise my abdomen. Only half a year later my abdomen rose and fell on its own with every breath.

I recommend spending around an hour a day paced breathing with a breath metronome in order to work up to breathing comfortably at 5 breaths per minute. Just as importantly, set the goal of ironing out all of the apneic disturbances in your breath, by breathing right through them, slowly and smoothly. We will return to these topics in Chapter 9 where we will look at extending the breathing exercises introduced in this chapter. Next, let’s put what you have learned about paced breathing to work and pair it with exercises intended to rehabilitate the windows of the soul: the eyes!

Chapter Bullet Points

  • Mammals that are untraumatized breathe with their diaphragm
  • The more traumatized a mammal is the less the diaphragm moves with each breath
  • Most humans breathe within a very narrow diaphragmatic range
  • The fear and grief circuitry of the brain are tied to thoracic breathing, and they inhibit diaphragmatic breathing
  • Weakness in the diaphragm is apparent in the form of tiny gasps called apneic disturbances which are associated with startle
  • Breathing slowly and smoothly forces the diaphragm to contract evenly, filling in these gaps, increasing diaphragmatic strength and range of motion
  • To engage the diaphragm, use the four rules ensuring that you are breathing: 1) deeply, 2) on long intervals, 3) slowly and smoothly, and 4) assertively
  • Using a breath metronome daily is essential because it will allow you to train these 4 things while focusing on other tasks