Setting a Foundation: Diaphragmatic Breathing

Diaphragmatic Breathing (AKA - Deep Breathing, Balloon Breath, etc.) is by far the most common "mind-body" or experiential exercise that I use in my practice.  There is a great deal of research regarding the effectiveness of deep breathing (in particular and relaxation training in general) with various physical and psychological ailments, and it has an interesting history as part of the development of what is known today as cognitive-behavioral therapy. Deep breathing has essentially become a foundation of most stress-management, anxiety, and chronic pain treatments that are performed from a cognitive-behavioral perspective.

.....However, I'm too lazy and busy to cite any of that stuff, I didn't start a blog to spend more time looking up articles and literature, leaving me less time to actually do some good work with myself.  I'll drop some names for those who have further interest:  Barlow (for modern treatment of anxiety), Wolpe (for old school behavior therapy using relaxation), and to cap it all off, Bensen (who wrote a landmark book, The Relaxation Response).  I also have an awesome old book with an adjoining record by Borkevek and someone else. Can't quite remember off the top of my head....

Now on to the fun stuff.....

I've practiced DDB (deep diaphragmatic breathing) on and off and on and off for several years, but here I am going to put a plan into place that is similar to what I recommend to some of my patients.

STEP 1: Calibrate my Stress Thermometer



 The stress thermometer, also known in some circles as SUDs (subjective units of distress) rating is just a simple and surprisingly reliable way to measure how stressed or tense you are feeling at a given moment.  It's important for some people to see proof that they are changing, and keeping track of how different you feel before and after relaxation practice is a good way to do that.  

I'm going to use the 10-Point stress thermometer posted above, although this is calibrated a little high for my tastes (e.g. a 5 is colored green and considered "good").  It makes a nice point that a certain amount of stress is good, it mixes things up for me so I feel like I'm starting over fresh, and I liked the pictures.  When doing my ratings, I will be thinking about muscle tension specifically as opposed to the cognitive effects of stress.  Since it's Sunday and I have work to do I'm sitting at approximately 5.5 right at this exact moment.  In a few minutes we'll see if I can change that.

STEP 2:  The Brief Practice

 

There are multiple ways to think about DDB, and I use different explanations depending on the person that I am working with, but it basically boils down to this: 

Shallow breathing, up in your chest, is part of the stress response.  Breathing deeply (e.g. expanding your stomach) helps to activate the relaxation response.  Deep breathing can feel a little unnatural because we tend to sit around pretty tense all of the time, but once you settle into a natural rhythm it feels primal, natural, or just right.

WHAT YOU DO (Hypothetically): Sit up, sit down, lay down, whatever.  It doesn't matter.  Take a deep breath focusing on filling up and expanding your stomach with air so that your belly pokes out before your shoulders rise.  When you feel all full either hold it for a second and exhale all at once, or let the air hiss out slowly.  Some people like to imagine a balloon in the belly that they are filling with air.  Some like to imagine breathing through the soles of the feet.  Some like to place one hand on the stomach and one on the chest (pictured above) and make sure the belly hand rises before the chest hand.  I do the soles of the feet thing.

Do this for 60 seconds, or, if you prefer, 10 breaths (one set of inhale-exhale is a breath).  I prefer to count.  Then reassess your level of stress on the thermometer.  Here, I'm going to do it now....

...........annnnnnnd 10.  Ah, that does feel nice.  I would say that my tension level right at this moment is probably 3-ish.   So with just a 60-second practice I dropped 20-25% of my subjective feeling of tension and put myself solidly in the green zone. 

But wait, there is more...........................

STEP 3: Add in the Body Scan

Learning to relax my body quickly and easily is really only one part of the equation of overall relaxation training.  Aside from learning to relax I also want to improve my awareness of when I am tense, and where I am "carrying" that tension.  This is where the body scan comes into play, and a body scan works this way:

a) begin with your normal 60-second DDB pratice

b) after you reach 60 seconds or 10 breaths, make note of your overall tension (mentally, while continuing to breath deeply)

c) open your minds eye, or focus your attention (however you want to think about it) on the muscles of your forehead.  As you inhale, notice how the sensations within these muscles change.  As you exhale, notice how a little bit of the tension seems to float away or melt away with your breath.

d) when your forehead muscles feel as comfortable as you would like, drop your attention lower to your face, or your neck, wherever you would like to go next.

e) repeat with different body parts until your whole being feels comfortable and relaxed

Some people like to imagine breathing the oxygen directly to the body part they are focusing on, feeling it soak into the muscles.  Some people experience a feeling of warmth, or of coolness and/or lightness or heaviness as they relax.  This is okay.  I tend to be a warm and heavy sort of relaxer.

My practice just now took about 10 minutes to complete, and I would have to rate my tension WAYYY down in the green zone on that thermometer, near zero.  Doing this also makes me question my initial callibration (which is okay, and part of the point of the exercise).  I think I started at a 6 or 7, dropped down to 5 with my 60-second practice, and got down to a 2 or 3 with the body scan.  





STEP 4: Plan the Ritual (Schedule Regular Practice)

Now these practices are useful during stressful events and circumstances to a degree.  But they are really meant as lifestyle altering interventions.  That is to say, you should practice daily to change your awareness of your body and your average level of tension, rather than waiting until stressful times are reigning o'er the land.  I usually recommend that patients practice 3-5 times per day doing a brief 30-60 second breathing exercise, and practice once per day doing a longer body-scan.  That's a pretty high bar to set, but if someone really believes they can do that, that is probably what is best. 

.....I'm going to be a pain-in-the-ass patient and complain to myself that I do not have enough time to do that many practices, and certainly not to RECORD the impact each time.  It's ridiculous....I'm much to high-powered and important for all of this (ahem).  It is worth keeping in mind that I don't want to stress myself out more with my relaxation practice, so I am going to make a deal with myself.  I will do a body-scan practice each evening and record the change in my thermometer, and I will practice sporadically throughout each day but not pressure myself to write anything down.

Conclusion:  If anybody actually reads this, stumbling across it due to the new-age-y title, you may be thinking "hey, I didn't go to all the trouble of typing in these words and clicking on this link to learn some basic stress management. Where is the "psychonaut" in all of this?  Where is the hero's journey into the unconscious?  The celestial jaunts across the astrological spheres?  The symbols, the insights, the POINT OF SELF-EXPLORATION/"

And my only answer is "fuck you." 

..Actually, my personal belief is that learning to spend a little time focusing on breathing is a pretty important foundation for a self-exploration practice, or a gateway into the self if you prefer.  The breath is almost literally a bridge between the conscious and un-.  It's a process that is in some ways and at some times outside of our own control and beneath our notice, but we can also grasp ahold of it and regulate it through force of will.  Breathing exercises also form a foundation for pratices I might get into in the future, including mindfulness meditation, active imagination, self-hypnosis, and chi gung. 

ALSO please keep in mind that I don't recommend that you do anything I talk about in this blog.  I am not a licensed professional, and this blog is for MY organization of my thoughts, and YOUR entertainment only.

Welcome to my little corner of the internet, where I hope to chronicle a little corner of myself.   I know how awkward ICE-BREAKING can be, so I'll keep this short and sweet.

I'm a future clinical psychologist, currently in graduate school.  I hope to emphasize psychotherapy practice over research in my future career, although I am planning to keep a toe or two in the research pool (despite how chilly it can be!).  I would describe myself as a cognitive-behavioral therapist who believes in experiential learning and emphasizing the therapeutic relationship.  I suppose that really means that I tend to be eclectic in an Arnold Lazarus sort of way. Some interests of mine include psychotherapy history, grief work, the psychology of religion, complementary and alternative medicine (e.g. hypnosis, meditation), and integrated healthcare/behavioral medicine. 

Doing psychotherapy is hard.  Being a primate with an unnecessarily large brain is hard.  Affording a therapist can be next to impossible for most of us.  For these reasons, as a psychotherapy trainee, I like to practice what I preach.  That is to say, I like to actually try out the sorts of discrete techniques that I might use with a patient.  In fact, I like to try out therapy techniques that I might never use with a patient.  I feel (or should I say hope and pray?) that this makes me a better therapist and a more exciting lecturer because I have some real visceral experience with the mumbo jumbo that I'm selling to people.

This little slice of the internet, therefore, is a place for me to organize the therapy techniques that I apply in a self-help fashion, sometimes structured sometimes decidedly un-, with my own poor psyche.  I don't recommend that anyone who might read this blog try any of these things on their own.  I don't plan to cite a ton of sources or research.  Let's all enjoy the simplicity of being strict phenomenologists here as I record the experiences that I have, some interesting, some boring.