"Breathe in, breathe out!" I first heard this as a young man, from an old doctor who liked to relax his patients with corny jokes while he prepared an injection. "Do you want to know how to live forever?" he asked. "Sure," I naively took the bait. "Breathe in, breathe out," he said. "As long as you keep breathing in and out you can't die."
Some thirty years later I heard the same words again from another doctor, a Ph.D., who is in the forefront of developing a learning model for retraining people to breathe. The "diploma" which Dr. Erik Peper awards patients and professionals who attend his workshops in breathing bears the title "Breathe In, Breathe Out."
The sequence and types of exercises in the pages to come are the fruits of Erik Peper's many years of careful research. The specifics, however, are the product of my helping people who suffer from panic attacks.
"Breathe In, Breathe Out" Knowing How We Breathe
The old doctor's joke isn't so silly, because it implies that we have control over our own breathing, unlike involuntary actions such as our heartbeat. It's easy to take a breath when we want to, or to blow out the birthday candles just when we're ready; we very consciously take a deep breath and blow hard. Most of the time, though, our breathing is on automatic and we don't think about it.
We humans have some breathing problems, probably because of this part-time conscious control over our breathing. We can easily learn to adjust or modify our breathing, just as singers, actors, and instrument players do. The problems come when we learn the wrong things, which don't have bad effects immediately but eventually become bad habits that create the symptoms of anxiety.
So now it's time to take a close look, from an anatomical standpoint, at how breathing is "supposed" to be done.
The Anatomy of Normal Breathing
The lungs are a complex maze of air passages and minute air sacs (alveoli), with an even more complex mesh of arteries, capillaries, and veins intertwining through the air passages and sacs. For our purposes, though, the lungs (there are two, one on each side of the chest) can be thought of as balloons. The balloons are emptied and filled not in response to their own actions, but in response to the actions of the entire torso, which encloses the lungs.
Breathing takes place through the air passages leading from the nose and mouth into the lungs. Although the bronchial tubes and lungs are lined with smooth muscles that regulate the flow of air, these are not the muscles with which we breathe.
The chest and ribs, which are attached to the spine in the back and the breastbone in the front, form a somewhat flexible cage enclosing the heart and lungs. The chest cage is narrower at the top, which has an opening occupied by the neck.
Looking at the illustration, turn your attention to the wide bottom of the rib cage. The bottom ribs are not connected to the rigid breastbone, but are held together by pliable cartilage. Attached to the bottom edges of the wide cage, from front to back, is a muscle called the diaphragm. The diaphragm is shaped like an inverted bowl or funnel. Through the middle of the bowl (or neck of the funnel) run the arteries and veins that carry blood from the heart, to the organs and lower extremities, and back to the heart. The esophagus runs through the same area on its way to the stomach, and major nerves run through here as well.
The diaphragm should be the main muscle of breathing, because its location in the body gives it the most room to move in a piston-like fashion. Below it are the soft organs and the belly, which can expand outward when a deep breath is needed. Above the diaphragm are the lungs, which are also soft and pliable.
The easiest way to understand how the diaphragm works is to make a relaxed, inverted bowl, with the tips of your fingers just interlocking.
With your fingers still interconnected, tense your hands and wrists, and, if you're doing it right, you'll see the bowl flatten down. That's almost exactly how the diaphragm works.
When it's relaxed, the bowl is most bowl-like (deepest). In terms of the piston illustration, the piston is up when the diaphragm is relaxed. At this position, the diaphragm is pushing up on the soft and pliable lungs, and the air in the lungs is forced out -- exhaled. If you pull in your abdomen at the same time you push up on the underside of the diaphragm, you force out even more air.
The inhale, of course, is the opposite. The diaphragm contracts, just as your fingers flatten out. That brings the piston down, creating more space in the cage. Air, naturally, is the only thing that can fill the space, so it moves into the lungs, filling them.
Other parts of the body also assist in breathing. If you tighten and pull in your stomach, you push more air out of your lungs, because you put pressure on the underside of the diaphragm-piston. If you let your stomach pooch out, the diaphragm has more room to move down into the area of the soft organs and you take in more air.
But the muscles between the ribs all up and down the chest, especially those between the more flexible lower ribs, can also work to make the rib cage bigger. Air comes in, again because there is more space to fill. Even the muscles of the neck, shoulders, and upper back assist in the breathing process.
When you're running hard or doing aerobic exercises, the idea is to breathe hard -- to inhale and exhale a lot of air. The more air the body needs, the more of the various breathing muscles go into action to create additional space for breathing.
When breathing is done correctly, the volume of the lungs is quite phenomenal. The diaphragm can move up and down as much as six inches. In the process, it gently massages the lower organs and aids in the blood's return to the heart. A large person can have a lung capacity of five quarts. Even a small adult can breathe in two or more quarts of air.
Habitual Diaphragmatic Breathing
When at rest, the correct way to breathe is with relaxed shoulders, upper chest, and stomach muscles, allowing the diaphragm and lower rib muscles to carry on the automatic breathing process. When you breathe in this way, your body continually adjusts the volume and breathing rate as needed to maintain the acid/base balance of the blood and other factors. Eight to twelves breaths per minute is normal breathing rate.
Habitual Thoracic (Chest) Breathing
Many, and that may mean most, people breathe in a slightly abnormal fashion. They tend to hold in their stomach, make little use of the diaphragm, and breathe using the muscles of the upper chest, neck, and shoulders. This style of breathing becomes automatic, and the body adjusts volume and rate as it does in diaphragmatic breathing.
Thoracic breathing depends on the more rigid system of muscle action in the neck, chest, and shoulder area. This means that the lungs are given less room to expand or contract and that the body must work harder. As breath volume is lowered, breathing must be speeded up in order for the body to maintain its chemical balance.
My own observations of the breathing of panic attack patients confirm what other researchers have discovered: people who have panic attacks chest-breathe. Their resting breathing rate has speeded up to twenty to thirty shallow breaths per minute. They also try to compensate by sighing frequently, sometimes as often as two or three times a minute, adding significantly to the loss of carbon-dioxide. Sighing is likely the result of the small air sacs' failure to expand, and the sigh allows enough air deeper into the lungs so as to keep the sacs and airways open. When sighing or taking a deep breath, the chest-breather visibly lifts the entire chest up away from the diaphragm, thereby creating more space in the chest cage, rather than allowing the diaphragm to pull the air in.
How Breathing Changes When You Become Anxious
So far we have discussed functional and dysfunctional breathing. Relaxed abdominal breathing is better. Tight thoracic breathing isn't as good and may lead to problems. Now, how did it get that way?
When a person becomes anxious, sad, scared, aroused, or angry, the body immediately begins to go through changes in order to cope with the new situation. Of course, we needn't concentrate only on the negative emotions; changes also occur when we are delighted, loving, excited, joyful, playful, and full of laughter. We increase the amount of air we breathe, by breathing faster and deeper. Our heart quickens its pace, more blood flows through the arteries and veins, our senses become more acute, we become more alert.
Human beings are capable of a great range of emotions and physical responses. We can be placid like the waters of a gentle pond, or raging like the ocean in a fierce storm. The change from placid to raging can happen in the twinkling of an eye. It's all part of being human, even necessary to being human. Problems arise when the emotional and physical responses can't be played out, when the storm has to be held inside, not unleashed in some civilized or uncivilized way.
It is the connection between emotions and physical responses that concerns us when we think about panic attacks. Recently I was watching a person whose breathing was being monitored as he was pretending to be angry with someone else. As soon as he began to work up some pretend-anger his breathing changed as if he were actually angry. His breathing became faster and deeper, and the carbon dioxide level of his body, as monitored in his breath, began to drop. I noticed something else: as this was happening, he didn't breathe out in the same way as when he had been relaxing a few moments before. As a result, he retained more air in his lungs each time he exhaled. His deeper and more rapid breathing was actually on top of the air remaining in his lungs. It was as if his body were trying to hold on to the carbon dioxide by preventing him from exhaling too much!
Actual experiments have shown that just imagining a stressful event will cause a person to breathe faster and retain many times more air in the lungs than when relaxed and unstressed. You can well imagine that if you've had panic attacks, just the thought of another attack can be enough to change your breathing and start you on the road to another attack, without you even being aware of it.
As you begin to check out your own breathing pattern and train yourself in more relaxed and functional breathing, remember how your thoughts and emotions can work for you or against you. Keep a positive attitude.
For many victims of panic disorder, thoughts, fears, and physical reactions become automatic and create a great deal of anxiety. There are proven methods for countering or neutralizing these thoughts and reactions, and these methods need to be part of every course of treatment. These will be found in the exercises you will be doing. Retraining your breathing and knowing positively that you can prevent attacks is essential to success in your recovery from panic disorder.
-- Bert A., M.Div., Ph.D.
No comments:
Post a Comment