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
Our first question is simple: what is breathing? From the comparative biology perspective that we’re using here, breathing is a form of gas exchange used by land animals to provide their bodies’ cells with the oxygen that they need in order to burn energy. Oxygen allows cells to break down sugars derived from food and provide us with the energy we need to move and think. Breathing takes many forms—crickets simply circulate air through open tubes, while fish use gills to collect oxygen from water.
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.
A. Circulatory system of a cricket. B. Gills of a salmon
Mammals have muscles in the chest that act to inflate and deflate the lungs. The most important of these is a specialized muscle located beneath the lungs called the respiratory diaphragm. Other land vertebrates, including amphibians, reptiles, and the late dinosaurs exhibit a similar structure, although theirs is simpler and sits above the lungs rather than below. The mammalian diaphragm changes its behavior depending on the immediate circumstances, focusing on efficiency in safe environments but producing paranoid overexertion in threatening ones. This chapter will describe how stress causes the diaphragm to produce quick, shallow strokes, and how deliberately practicing longer, fuller breaths can reinstate its proper function.
Distressed Breathing vs. Diaphragmatic Breathing
Breathing shallowly, with short intervals, is known as distressed breathing. Also called defensive breathing, nondiaphragmatic breathing, or thoracic breathing, the behavior is strongly associated with stress and anxiety disorders and tends to cause nervousness and discomfort. Distressed breathing is characterized by shallow, rapid, uneven breaths, which are punctuated by gasps, sighs, and breath holding. It can easily become habitual, leading to serious long-term distress and dysfunction.
Distressed breathing has a reciprocal relationship with the brain’s stress and threat response systems. We breathe more defensively when we are afraid, and we become more afraid when we breathe defensively. Conversely, improving your breathing will help you control your negative and obsessive patterns of thoughts. Indeed, you will find that habitual diaphragmatic breathing is incompatible with anxiety.
People who breathe shallowly are usually unaware of doing so, and perform distressed breathing more or less constantly. Most of us have a default attitude of waiting with “bated breath” for events to play out around us, as if a judge were about to announce our prison sentence. We do this even when circumstances are normal, healthy, and unthreatening.
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 understands more or less instinctively that inhibited, irregular breathing is a source of tension and stress. This is clear from the popularity of idioms like “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 all alter our breathing to accommodate, or match, the actions of the people around us. We perceive the breathing patterns of others from their movements, speech patterns, the sounds of inhalation and exhalation, and their 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. Experience pronounced distressed breathing first hand by doing the following activity:
After performing this activity, most people report uncomfortable sensations such as anxiety, panic, or tension, accompanied by increased heart rate, physical agitation, breathlessness, a sensation of chest pressure, or even the feeling of starving for air. These are the typical outcomes of distressed breathing. Many of us unnecessarily subject ourselves to them every day. An anxious person will breathe at an average rate of 18 to 20 breaths per minute (BPM), or roughly three seconds per breath, while a relaxed person practicing diaphragmatic breathing will breathe only three to seven times per minute, allowing ten or more seconds per breath. Problems with diaphragmatic breathing are best conceptualized as falling on a continuum rather than as a threshold. There are no firm diagnostic criteria for distressed breathing; virtually everyone is somewhere on the spectrum.
Newborns always breathe diaphragmatically, but, by age ten, the normal breathing pattern is predominantly thoracic. This transition occurs during early childhood as we learn which environmental stimuli should be linked to distressed breathing. The process is normal, and prepares us to be especially cautious and alert in specific kinds of situations. By the time we reach adulthood, nearly every situation recruits thoracic breathing, just some more than others. Thoracic breathing is implicitly conditioned to occur alongside habitual activities and postures, and these associations are often never unlearned. That leaves us holding our breath when the telephone rings, breathing thoracically while sitting at the keyboard, and gasping during normal, everyday conversations.
Fortunately, it is possible to unlearn the links between distressed breathing and routine activity. Unfortunately, the process will take time. We cannot immediately switch from distressed breathing to competent, calm, diaphragmatic breathing, because we are held back by long-term physiological changes wrought by years of breathing shallowly and irregularly. These changes include diaphragmatic atrophy and a multitude of other alterations to the muscles and nerves of the respiratory system. The effects are driven by gene activity, constitute phenotypic plasticity, and are largely responsible for the sympathetic over-activation discussed in the last chapter. 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 instruct users only 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?” That is a great first step.
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.
Diaphragmatic Breathing Utilizes the Respiratory Diaphragm
Deep, non-distressed breathing is controlled by 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 moves air into and out of the lungs by changing shape. It moves like a plunger. When it contracts, the diaphragm moves downward, drawing in breath, resulting in inhalation. When it relaxes, it moves upward, expelling air and causing you to exhale.
The diaphragm can move as much as ten centimeters, but most adults use only one centimeter, or 10% of the total 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:
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. That makes it very difficult to perceive consciously, which makes the problem all the worse. In fact, one of the few times we notice our diaphragms is when we have the hiccups. With that in mind, try using exercise three as an alternative route to getting a feel for your diaphragm.
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 animals stomach will move with each breath. 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.
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, powering 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. One effect of this difference is that thoracic breathing does not fill the lower portions of the lungs with air, while diaphragmatic breathing does. Thoracic breathing is inherently shallow. It is also less efficient because it requires more work—more breaths—to transport the same amount of oxygen into your blood.
Clavicular breathing is another form of distressed breathing, and it is even shallower and less efficient than thoracic breathing. It is also called upper thoracic breathing, as it only pulls air into the top third of the lungs by slightly shrugging the clavicles and shoulders. Clavicular breathing is a serious problem, as it can nearly eliminate the function of the diaphragm, leading to weaker, less effective breaths. . 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. In general, you should 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 branches of the nervous system, the diaphragm is supposed to work in unison with the thoracic musculature. This synergy falls apart when the thoracic musculature (like the sympathetic system) takes over.
That gives us two major antagonists in our story about chronic stress and bodily dysfunction. First, we have the overactive sympathetic nervous system, and second, we have overactive thoracic breathing. And in what should come as no surprise, the two problems collude and collaborate, exacerbating and reinforcing the negative effects.
The critical link between breath and nervous system is emotion. The fear and grief circuitry of the brain activates thoracic breathing and inhibits diaphragmatic breathing. Habitual thoracic or clavicular breathing chronically overstimulates the sympathetic nervous system, keeping heart rate and blood pressure elevated and loading 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. Breathe deeply and your nervous system will begin to calm itself.
That emotional link has a functional purpose. 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, when the opposite is really true. The resulting distressed breathing 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. 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 so shallow that it interferes with your speech, 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.
Part of what this means is that our respiratory behavior affects our social standing and how we are treated and perceived. People hear changes in the cadence and pitch of your voice and breathing and use them to make both conscious and subconscious judgments about your social standing. Breathing is one of the most commonly used markers for social rank, other than posture and attractiveness. 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
Social and environmental stress are not the only causes of distressed breathing. It can also be the result of surgery or injury. After a colon surgery, a gastric bypass, a Caesarean procedure, or an appendectomy, for instance, the patient will have an incision wound on his or her abdomen. It is common for recovering patients to inhibiting normal abdominal expansion during breathing in an effort to avoid the pain of having their injuries disturbed. They learn to actively stifle diaphragmatic movement because of fear of pain or of stitches bursting at the incision site. Learned pain avoidance can be long-lasting, causing the patient to neglect the diaphragm and adopt thoracic breathing as a fixed habit. Chronic shallow breathing can result, along with breathlessness and anxiety. 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.
Fortunately, we have good models available for how to reinstate diaphragmatic use. The best of these is recovery from a ventilator. 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 akin to a ventilator for your diaphragm. Years of stress have caused the thoracic muscles to take control, and your diaphragm has weakened through atrophy caused by disuse. The good news is that the diaphragm grows stronger quickly (Levine et al., 2008). When you first start breathing diaphragmatically, it will be difficult. It will feel as if you have been taken off a ventilator; the muscles you are forcing to breathe for you are unused to it and not fully up to the job. You will need to wean your diaphragm, training it to support this new kind of breathing. . 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 four to ten seconds and breathing out for six to twelve seconds at a time.
3) Smooth Breath (continuous flow): Breathe at a steady, slow, nearly constant rate during all breathing.
4) Assertive Breath (confident): Do not let social concerns or life stressors conflict with the first three rules.
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 improve your ability to monitor your breathing is to draw your breathing pattern on paper following the examples in Figure 1 by working through the exercise below.
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 uses 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, techniques for diaphragmatic breathing retraining are widely used in a number of relaxation and biofeedback programs (Gervitz & Schwartz, 2003). They have also become popular in psychiatry and clinical psychology and are fundamental tools 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. 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), and is 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. For all of these reasons, diaphragmatic breathing retraining is used by healthcare providers and medical professionals around the globe (Van der Kolk, 2014). Participants in clinical stress reduction programs often report that “the breathing stuff” was the most important thing they learned.
Diaphragmatic breathing is also a very old practice. Scientists and clinicians appropriated diaphragmatic breathing methods from India, where they have been used for thousands of years as part of religious and social customs. In fact, diaphragmatic breathing is practiced at most yoga studios. Yogis use long, deep inhalations and exhalations. The Buddhist form of meditation called anapanasati or “mindfulness of breathing,” and the Hindu practice of pranayama or “control of breath,” both explicitly utilize the first two rules outlined above. Yoga teachers in every tradition make it clear that the only way to control your mind is to cultivate control of your 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 five to six liters of air, but only a small part 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 confined to a narrow range. This range is called “tidal volume.” When you increase your tidal range, which is done by deliberately breathing all the way in and out, you naturally accomplish the other two criteria of constant rate and longer interval.
There’s more than one way to deepen your in-breaths, but the exercise below is one of the simplest and most reliable. It’s based on the work of Joseph Pilates, who saw forced exhalation as the key to full inhalation. He advised his students to squeeze out their lungs as if they were tightly wringing a wet towel. Doing so improves the strength of your breathing musculature quite rapidly. Take advantage of this to increase your tidal range.
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. Using one consistently can be helpful to track your progress. Monitor your lung capacity for several weeks with an inspirometer, recording the results and watching your tidal range expand. At first, it can feel uncomfortable when you breathe all the way in. You might cough. It might feel like your lungs are going to pop. When I started I would often cough. At my fastest, 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 4,000 to 5,000 milliliters.
Nonetheless, the transition can be jarring. While performing the activity below, focus on the uncomfortable sensations that arise as you breathe outside 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. This kind of framing can be built into the activity.
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. Let the urge to sigh remind you to activate your 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.
Do be aware, though, that as you retrain your breathing, you should experience the impulse to sigh much less often. Sighing is common and frequent in people diagnosed with panic disorders; it is far less typical in calm, peaceful individuals. Here too, your experience may echo mine. I used to sigh constantly, but after diaphragmatic retraining, I rarely catch myself doing it anymore.
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 at a rate of twelve to twenty breaths per minute. Many people with anxiety average eighteen to twenty-two, which means each inhalation and exhalation last only one and a half seconds. A group of breathing therapy techniques called “paced respiration” help you slow this quick pace to a calmer and more grounded five to eight breaths per minute. Some practitioners advocate as few as three to five (Brown & Berbarg, 2012). The goal of paced breathing is to extend your normal, default breathing rate. It is intended to help your body feel settled when at rest. Imagine that you normally breathe at a rate of twenty breaths per minute. If you practice paced breathing at rate of eight breaths per minute, that exercise will gradually decrease your default rate from twenty down toward eight. The more you practice, the closer your breathing rate will come to that target of eight breaths per minute.
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 takes fewer breaths per minute (Lichstein, 1988). The correlation is direct and immediate: if you were to increase the number of breaths you took per minute your sympathetic nervous system would show a spike of activity, while decreasing your inhalations to just five per minute would cause the activity to plummet (Elliott & Edmonson, 2006). If you maintain a rate of five 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 activation 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 recommend using a breath metronome (sometimes called a breathing pacemaker) to aid you in pacing your breath. The CD included with this book acts as a breath metronome, or you can download one in the form of 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 individuals with “shell shock,” now known as post-traumatic stress disorder (PTSD). The app gives both audible and visual cues to help you time your breathing, displaying a cylinder that fills and empties in time with your target inhalation and exhalation rate. I also recommend adjusting the app so that it is focused exclusively on paced breathing by turning off all notifications, music, and extraneous options in the settings. If you don’t have a smartphone, but you have a computer or mp3 player, I offer free downloadable audio files on my website that will also work perfectly well. As a final option, you can use the breath metronome videos I have uploaded on youtube.com.
It is very difficult to maintain paced breathing without using an external aid such as a breath metronome. In clinical studies of paced breathing, most participants quickly return to baseline in the absence of an external pacing signal (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 can be extremely difficult to maintain, as it relies on sharp and unwavering focus. Most of us are unlikely to stick with it for more than a few seconds at a time. By contrast, 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. More than this, having one—and familiarizing yourself with its use—is essential because the rest of the exercises in this book will require that you use paced breathing. Please take a minute now to 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
The next step is to find a reduced “target” breathing rate that will help you slow and deepen your breath without overreaching. Try each of the paces in the table below for thirty seconds each until you find one that feels challenging but comfortable. For many people, the best starting point is four seconds in and six seconds out, for a total of six complete breaths per minute. This is an extremely healthy way to breathe. I want to encourage you to work up from here toward an ultimate goal of ten seconds in and twelve seconds out. If you want to go higher, or stay lower, that is fine too. The practice has to feel sustainable and good. Many experts think that most people should work toward being able to breathe five to eight times per minute (Brown & Berbarg, 2012; Gervitz & Schwartz, 2003). This standard varies slightly depending on size and age, however. For people over six feet tall the ideal rate is three to four breaths per minute, and it is between six and ten for children under the age of ten. Speaking generally, any extension of your breathing interval will be beneficial. Your goal should be to train yourself to breathe at your target rate without any sense of effort or air hunger. Be patient; this will take time.
Notice that in each row in the table above the exhalation is longer than the inhalation. This is because, when you breathe out 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 calming effect, try to consciously relax during the exhalations. Think of every breath out as a long sigh of relief and the acceptance of a moment of peace. When you’re ready to start, explore your ideal breathing pace by working through the activity below.
Paced breathing will help to calm you. Try working with the metronome for five minutes before a meeting or a date, and you will be amazed by your level of composure. Practice paced breathing for ten minutes in advance of an interview to give yourself a distinct advantage. At a party, excuse yourself for a few minutes. When you return, you will find your social equilibrium restored. It can help you relax your muscles after a workout, steady yourself after a stressful encounter, or prepare for the day.
Over the next few weeks, find places where you can include the breath metronome in your daily routines. I use it 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 my commute. 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 or your attention is otherwise free to roam, you should be breathing with a metronome. Watching a movie is a chance for two hours of calming, grounding practice. And it can enhance the experience, too—we usually breathe thoracically when we watch film and television because of the suspense and tension that it creates, but paced breathing will detraumatize your psychological orientation even during the most intense action or horror scenes. Use the metronome creatively by placing it next to the TV on silent, or putting it face-down next to your bed with the sound on. Let your use of it adapt to your routines. 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.
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 catching up with the metronome on the next breath.
- Sometimes the metronome will be going too slowly, and you will feel air hunger. When this happens, disregard the metronome and take a few deep, quick breaths before returning to your target breathing rate.
Paced breathing will feel very awkward at first. You may feel that you are getting too much air (hyperventilating) or 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, or feel dizzy during work with the metronome, simply breathe more slowly. You should be breathing at the same pace but inhaling less powerfully, filling the lungs a little less completely.
- If you feel that you are getting too little air, or feel faint, do just the opposite and increase the force of your in-breaths. Ensure that you breathe all the way in and all the way out.
If you’re having trouble settling on a breathing rate that feels comfortable, use the table below as a rough guide. It lays out estimated breathing rates for what your target pace should be under different conditions and cardiovascular demands.
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 too fast. If so, consciously deepen your breath.
(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 prolong it as far as is comfortable 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
The third element of healthy diaphragmatic breathing is smoothness of breath. This is a question of how you inhale and exhale, and ties together the previous two elements of your practice. Paced breathing and deep breathing together are not enough for long-term consistency; they still allow for too much variability on a moment-to-moment basis. This is where the speed of each in-breath and out-breath becomes important.
For instance, at the beginning of my own practice, my inhalations and exhalations had reached about ten seconds each, but about halfway through each breath the speed of my inhale would drop, leaving the second half of the breath weaker and less effective. I usually did not notice. 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 biggest barrier to smooth breathing is our tendency to switch from diaphragmatic to thoracic inhalation when you near the top of your tidal range. Every inhalation begins with the diaphragm, but as you approach the upper limit of your lung capacity you will want to transition to a swift thoracic inhalation in order to draw in that last bit of air. Resist this instinct. Instead, try to get all the way to the top of your inspiratory reserve slowly and gradually, using only your diaphragm, without recruiting the thoracic musculature. Use the exercise below to practice using your diaphragm throughout entire breaths.
You experienced the impulse to switch to a rapid thoracic inhalation in the exercise above because your diaphragm is not accustomed to providing steady suction for a breath outside of its normal tidal range. I think of this weakness as a diaphragmatic speedbump at the end of the diaphragm’s habitual range. Forcing smooth inhalations steadily past this range will rehabilitate the muscular knot in your diaphragm 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.
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).
As you practice, keep your flow rate steady by imagining yourself smelling a rose, inhaling very slowly as you savor its fragrance. Or imagine that you are curled up with a small pet. Make your breathing as smooth and calm as possible to soothe it gently to sleep. Realize that quivering, jerky breaths would likely rouse and frighten it.
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 and smooth your breathing is.
Another option, and a helpful addition, is to buy yourself a stethoscope to listen to your breathing. You can find these for around $15 online. 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 they are sometimes described them as “fluttering,” or as “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.
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. The 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.
So far we have covered methods for breathing smoothly, deeply, and on longer intervals. The fourth 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 them to breathe not only shallowly, but cautiously and hesitantly, as if they are tiptoeing. It also keeps them from breathing efficiently because they 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.
Model your breathing on the motion of a pendulum, or some other uninterrupted, inevitable oscillating process. Something that moves with certainty. Each stroke of a pendulum captures its momentum, until gravity reverses the swing. Any pendulum would be useless if it slowed or stopped mid-way. Picture your diaphragm stroking up and down in a slow but unfaltering, unagitated way. Breathe out with the certain knowledge that you are not going to switch prematurely to an inhalation. Commit to each breath.
Breathing is also linked to assertiveness in another way. To feel comfortable breathing with confidence you will need to be willing to let the people around you hear your breath. You must not be afraid of being heard or noticed. Instead, be proud of how your breath does not waver, falter, or hesitate. 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. Start by using your imagination.
The effects of assertive breathing can be dramatic. Many people who are widely admired and described as charismatic are simply assertive, diaphragmatic breathers. The dog behaviorist Cesar Millan, a self-taught dog behaviorist, is one such person. He is widely known for his “Dog Whisperer” television series, in which he works with 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 approaches dogs as a pack leader (Millan & Peltier, 2006).
There is good reason to think that Cesar’s effect on dogs derives from his breathing. His breathing appears to be diaphragmatic in his video appearances, and it seems not to be easily interrupted by the behavior of the dogs he works with. I think that Cesar 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 switch to short, quick, loud breaths. The animal will become concerned, look nervous, and adopt your breathing pattern. If instead you 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.
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.
The discomfort from shallow breathing magnifies many addictive behaviors by making us feel desperation. Our breathing becomes shallower when we are hungry, and the discomfort that causes can strengthen our cravings for food. People use the phrase: “I am starving” when they notice that their hunger is affecting their breathing. Similarly, many people turn to cigarettes, alcohol, and anger when they feel their breathing affected by negative life circumstances. 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, or opiates, but that effect is short-lived, and the inevitable withdrawal symptoms actually accentuate disordered breathing. By contrast, metronome-aided paced breathing kicks in faster than drugs or alcohol and makes you a stronger person rather than a weaker one. Over time, 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 we say that someone “smells fear,” we are usually describing their sensitivity to sensing distressed breathing. It tempts bullies to close in for the kill, and tends to intensify arguments into fights. Diaphragmatic breathing does the opposite, broadcasting confidence and assertive, noncombative calm. Diaphragmatic breathing thus 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 may appear less attentive. You might feel that it makes you look 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. When you first try it, the simple activity below will reveal your tendencies for agoraphobia and social anxiety. Later, it will help you reinforce the good habits you’re developing.
Here’s what you’ll do. Take your breathing app with you to a coffee shop or café, and get a table by yourself. As you sit, pay attention to your level of self-possession, your poise. Then, using headphones or visual cues, use the breathing metronome to practice paced breathing. You will gradually feel yourself letting go of social concerns. As this new attitude becomes your default, you will lose your hesitation and apprehension about potentially negative social outcomes, 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, or judgmental critic each person will become just another face.
Breathe Diaphragmatically While Speaking
Once you’ve become familiar with breathing diaphragmatically in public, try it in conversation. This is more difficult. Many of us become short of breath during social encounters, and especially when public speaking. I know this from personal experience: even after practicing diaphragmatic breathing for two years, I stopped doing it as soon as I began speaking to someone. At first, I tried workarounds, taking intermittent breaks from conversation to regain my composure. But that kind of behavior just isn’t sustainable, and it can also be socially disruptive. At some point, you will have no choice but to learn to breathe deeply and diaphragmatically while speaking at the same time. This is difficult because you have to focus on what you want to say and simultaneously focus on monitoring your breath. You may need to adjust the rate at which you speak.
The best way to start is to read aloud while breathing diaphragmatically. It will likely be uncomfortable at first, because we all normally speak within a very narrow tidal range. The trick to calming your speech is to prolong your speaking time and ensure that it is not punctuated by anxious gasps. The following exercise will guide you through the process. (Note that it does not use a breathing metronome.)
The principle here is much the same as the principle behind Exercise #2, above. Find your limit—how long you can read after each inhale—and then maintain that level of performance long enough to strengthen your breathing muscles. To get a sense of where that limit is, try reading this paragraph without inhaling. Keep going until you cannot possibly speak another word. There should be several seconds at the end where your voice changes appreciably and it becomes very uncomfortable to speak. Your voice will begin to waver and lurch, you will sound like someone in extreme respiratory distress, and it may even start to feel like you just got punched in the stomach. If you work on exercise #7 for just a few minutes every day, you will completely alleviate this impediment in short order.
Breathe Diaphragmatically During Exercise
Another effective way to strengthen your diaphragm is to pair diaphragmatic breathing with a cardiovascular workout. 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 persist in an exhalation even when you feel your heart beating hard in your chest, 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. Use the next exercise to get you going.
Breathe Diaphragmatically While Eating
There’s one other daily activity that deserves our attention. It is surprisingly difficult to follow a breath metronome while eating a meal. Attempting this makes us aware of just how entangled our appetitive drives are with distressed breathing. The activity below 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.
Conclusion: Generalized Diaphragmatic Breathing
For many people, distressed breathing is pervasive. It affects every aspect of daily life, from eating to sleeping to social interactions. This chapter has been aimed at helping you develop just the opposite: an ingrained habit for deep, diaphragmatic breathing that you practice every waking moment. Over time, this new habit will desensitize your stress system by pairing experiences that are normally stressful (and linked to thoracic breathing) with diaphragmatic breathing instead.
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. This is the core of the Program Peace method.
I was inspired to create a system based on this concept by my experiences in the yoga studio. Hatha yoga revolves fundamentally around yoking of various poses together 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. Forming those associations ensures 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 idea is simple: if 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 guided to use these techniques while they are exposed to increasing levels of fear-inducing stimuli. They might progress from talking about spiders, to looking at pictures of spiders, then videos of spiders, and finally holding real spiders.
The same principle applies to habits and behaviors that normally trigger a distressed and anxious response in you. If you can maintain diaphragmatic breathing while you are gradually and systematically exposed to stimuli that would normally increase your breathing rate, you can habituate to these 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.
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 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.” Having spent more than five years pairing hundreds of different activities with diaphragmatic breathing, I am sharing the ones that benefited me the most. Below is the basic, fundamental diaphragmatic breathing exercise that I would like you to combine with every other exercise and activity in the remainder of this book.
Here’s a way to quickly and easily get a sense of just how powerful generalized diaphragmatic breathing can be. Right now, do a deep back bend without paced breathing, and then again with it. Lie down on your stomach on a carpet, bed, or soft surface. Then, use your arms to lift your torso off the ground while your legs and hips lie flat, performing a gentle “upward dog” pose. Don’t push yourself past the point of comfort. 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 of yoga training? Not quite.
Spend find minutes practicing the paced breathing method in exercise #10 above . Now, try the upward dog again, but this time, retain your diaphragmatic breathing. The position should be easier to hold and less stressful to perform. Your back should feel supported and safe, rather than exposed and vulnerable, and you should have a sense of how to improve your upward dog and strengthen your lower back by combining the exercise with diaphragmatic breathing.
The reason this works so well is that diaphragmatic breathing affects muscles directly. Thoracic breathing makes muscles throughout your body close down with tension, while diaphragmatic breathing makes them receptive to being toned and strengthened optimally.
The benefits of the Program Peace breathing retraining regimen are cumulative. Every time you repeat a breathing exercise you make innumerable cellular and molecular improvements to the function of 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—which makes diaphragmatic breathing much easier in the future.
After six months of paced breathing, I decided to try belly breathing again. This is the activity where one places a 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.
Here are a few goals to work toward. First, belly breathing: once you’ve been practicing for a few months, moving your diapgragm should be second nature. Every breath should move your belly. You can check your progress by repeating breathing activity #2 from this chapter. Second, aim to iron out all of the apneic disturbances in your breath by breathing right through them, slowly and smoothly. And third, work toward increasing the target breathing rate you picked for yourself earlier in this chapter. Your goal should be somewhere in the vicinity of five to eight breaths per minute.
To get you there as quickly and easily as possible, I recommend spending about an hour a day practicing paced breathing with a breath metronome. We will return to these topics in Chapter 9 when we will look at extending the breathing exercises introduced in this chapter. For now, 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 and healthy breathe with their diaphragms.
- The more traumatized a mammal is, the less its diaphragm moves with each breath.
- Most humans breathe within a very narrow diaphragmatic range.
- The fear and grief circuits 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 the startle response.
- 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 fully, follow these four rules: (1) breathe deeply, (2) breathe at long intervals, (3) breathe smoothly, and (4) breathe assertively.
- Using a breath metronome on a daily basis is essential to developing a strong diaphragmatic breathing habit, because it will allow you to train yourself to follow those four rules while focusing on other tasks and activities.