“It feels like you are going to die”

A significant proportion of the people that come to see me have anxiety as either their main or accompanying problem. In many unexpected ways, modern life is more stressful than ever before, and there is potentially a lot to be anxious about. Although not directly life-threatening, the people I see have their lives blighted by anxiety and panic attacks and it is a major limiting factor in their happiness.

Drugs and CBT (Cognitive Behavioral Therapy) can offer relief in the short term, but seldom resolve the root of the problem. My approach to anxiety is first to understand what is going on in someone’s life to make them anxious, either now or in the past, and then to assess how this manifests as actual symptoms. By checking breathing, the ability to relax and noting areas of tension in the body, it is possible to provide the correct treatment and support that to rehabilitate an anxiety pattern.

If you are having an anxiety attacks, you most probably have either been told or have received the message that it is psychosomatic, or physical symptoms with a mental health basis. This is an over simplification and rather out dated notion (see MUPS). It is also not helpful, as the implication is that you either just have to deal with it or take medication.

Everybody is different, but approaches I commonly use to rehabilitate anxiety symptoms includebreathing exercises and Mindfulness training, stress-reducing acupuncture, tension-release massage and talking based therapy (Somatic Experiencing). Herbal medicine is often also very helpful, and some people’s panic attacks are partly due to nutritional deficiencies, for which diet and supplements can be used.

Pursed Lip Breathing

Before starting the exercise it is useful to get a sense of ‘where’ your breathing is taking place – in the upper chest (undesirable), or via the diaphragm (ideal). To test this sit in an upright chair or recline and place your dominant hand on your abdomen just above the belly button and the other hand on your upper chest. Take one moderately deep breath and note which hand moves the most and in what direction, the upper or the lower one. If the upper hand moves first, especially if it moves upwards towards your chin, this suggests an upper-chest pattern. The ideal is for your lower hand to move forwards (away from your spine) slightly as you breathe in. When this happens it means that your diaphragm is operating normally.

After letting that first breathe go, place your arms in one of the suggested positions (see pictures and the notes headed: Inhibiting shoulder rise) that ensure that you ‘switch-off’ your shoulder muscles when breathing. During this exercise – which should take no more than 5 minutes – you should aim to breathe in through the nose and out through the mouth, through pursed lips as if you were gently blowing through a straw. Imagine you are blowing at a candle approximately 6 inches (15cms.) from your mouth, in a way that would make the flame flicker but not go out.

After a normal inhalation, start to breathe out through pursed lips as described above, and at the end of the slow exhalation – as soon as you sense that you will need to inhale – relax your mouth, pause (not hold) without strain for a count of one, and then once more inhale gently through the nose. Breathing out fully creates a ‘coiled spring’ effect, making the next inhalation easier. Focus on the exhalation, and try to forget about breathing in.

Repeat for not less than 30 cycles, at least twice daily, and for a minimum of four weeks. Practice on waking and before bedtime, and before meals as well if you can. After some weeks of daily practice you should be able to achieve an inhalation which lasts 2-3 seconds and an exhalation lasting 6-7 seconds, without straining. Feelings of pain and anxiety should start to reduce with regular application and practice. A few cycles of breathing (6 cycles takes about a minute) can be repeated every hour if anxious or stressed.

The long, slow exhalation creates the opportunity for the inhalation to be deeper, but try not to pay particular attention to how you inhale….just ensure a full exhalation each time.

Note, breathing using the mouth is not how you want to breath out in the longer term. This first exercise is to start to get you to reconnect with the diaphragm and abdomen and to learn to breath out more slowly.

Inhibiting shoulder rise

You may already have noticed that when you take a deep breath in your shoulders probably rise up a little. This is undesirable and shows that you are using the upper chest more than you should, and that the diaphragm is getting lazy. When learning breathing rehabilitation it is important to inhibit shoulder rise by learning tactics that restrict accessory breathing muscles leading to ‘over breathing’. Techniques include:

• Sitting with both hand resting in your lap, fingers interlocked, and applying gentle finger-pad pressure to the back of the other hand, as you breathe in – relax this pressure as you exhale

• Push your forearms gently onto the arms of a chair, on inhalation – relax this pressure as you exhale

• Arms behind back, grasping a wrist with the other hand pull down slightly, on inhalation – relax this pull as you exhale

• Reclining with hands behind head (‘beach pose’) to open chest, perform entire sequence in this position