Socrates maintained that “we only value what we pay for”. Equally, we sometimes only value what the Doctor prescribes or diagnoses.
I often wonder how a patient with anxiety presenting to the GP would react if the GP spent the appointment taking the patient through a controlled breathing exercise and, instead of a prescription for Propranolol or Benzodiazapines gave the patient an exercise sheet to practice what they had just undertaken, as a first step.
Although controlled breathing is used widely across the NHS, I am not aware of it being used widely as a first step on the GP patient journey.
We know that by focusing on the breath and slowing it down it helps to turn off the body’s “fight or flight” alarm and reassures the brain that all is okay. It lowers the heart rate and improves oxygen levels in the bloodstream – all helpful elements of reducing anxiety and stress. It is indeed a “reset button”.
Controlled breathing is used too by the Military. Marines are taught how to control their focus and reduce stress in the most stressful situation – the war zone. According to Air Force Lt.Col Jannell MacAulay, Director of Human Performance and Leadership for the 58th Special Operations Wing, in the Air Force Medical Service: “You can’t hyperventilate and take deep breaths at the same time”….In stressful situations, the body’s sympathetic nervous system response, can be triggered. This response is intended to prepare the body for a dangerous or high-stress situations, but it can also happen in normal, less-monumental moments, like being stuck in traffic or studying for an exam”.
I remember seeing a woman, Joanne, who presented with a complaint that her “nerves were bad – I’ve always had bad nerves”. I knew the phrase from my childhood in the 1960s as most of the women in my working-class neighborhood would use that expression. What they were actually suffering with was a unequal, difficult, poverty stricken life that was the norm for most. Joanne spoke very quickly, gasping for breath in between demonstrating with her waving hand that she needed a minute or two to “catch me breath”.
I asked the woman what would tell her that her “nerves” were improving? She replied that she would be able to breathe better “My nerves are that bad, I can’t even breathe sometimes”. I slowed down my breathing a little and asked her “When you are breathing better, what will that look like Joanne?” She did some exaggerated breaths, rising and falling dramatically. I suggested that we do the future better breathing together so that I could get a better understanding.
She began the breathing, again exaggerated, and I met that with my exaggerated breathing. Then I slowly and gradually reduced the exaggerated style to a gentler, slower, breath, putting my thumb up to indicate that she was doing well. We did this for 15 minutes until it became normal, effective, controlled breathing.
I then asked her when she would like to practice breathing like this and she replied “Well, it will take time to learn it won’t it?” [despite having just demonstrated her new breathing] and I realized that she needed her long-held “change and recovery journey” to be a gradual one and that an immediate “cure” would not fit her mindset so I offered an agreement: “Absolutely – that is why I would like you to practice this every day Joanne”.
She asked when should she practice?
“In the morning, in the afternoon and in the evening” I replied [in other words – all day].
She agreed and asked me to write the instructions down. I did.
Joanne’s “bad nerves” vastly improved in the 3 sessions that I met with her.
The NHS use the following controlled breathing exercise: [unless you have a health condition that does not permit this I would add]
You will get the most benefit if you do it regularly as part of your daily routine.
If you’re sitting or standing, place both feet flat on the ground. Whatever position you’re in place your feet hip width apart.
Let your breath flow as deep down into your belly as comfortable without forcing it.
Try breathing in through your nose and out through your mouth.
Breathe in gently and regularly. Some people find it helpful to count steadily from 1 to 5. You may not be able to reach 5 at first.
Then let it flow out gently, counting from 1 to 5 again if you find this helpful. [ I would add: breathing out through the mouth as if you were blowing through a straw]
Keep doing this for at least 5 minutes.
This is a first step to controlled breathing. I would recommend The Art of Breathing by Dr Danny Penman as a great introduction.
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