Breathing as a Coping Strategy During Panic Attacks

breathBreathing. It can sound so simple, yet with practice, this can be an incredible resource. There are a number of breathing strategies you can try to help with anxiety, and below are a few that I have found especially beneficial for my clients.

But first you may ask: Why use breathing as a coping strategy? When panicking, many people breathe much too quickly. According to Barlowe and Craske (2007), 50-60% of people who panic show signs of overbreathing, also known as hyperventilation. Overbreathing occurs when you react to a perceived threat that triggers the fight-or-flight response and you take in more oxygen than the body needs. Overbreathing is associated with panic attacks in two important ways: it can either produce a physical sensation that is frightening and that leads to a panic attack or the fear and panic can lead to overbreathing.

One breathing technique that can greatly reduce anxiety and increase relaxation is diaphragmatic breathing. The diaphragm is a large, dome-shaped muscle at the bottom of the rib cage. To start this practice, you can lie down with your knees bent, sit in a comfortable chair, or stand upright.

  1. Put one palm on your abdomen, just above your waist, and the other palm over your chest.
  2. As you inhale, guide the breath into the diaphragm, while keeping the chest still. Feel the hand on your abdomen rise.
  3. As you exhale, let all of the breath out of the abdomen, feeling it fall naturally, relaxing the diaphragm.
  4. Repeat steps 2 and 3 for the next few minutes.
  5. Return to breathing naturally.

Mindful Awareness, as described by Margaret Wehrenberg:

  1. Close your eyes, breathe, notice your body, how the intake of air feels, how the heart beats, what sensations are present.
  2. With your eyes still closed, shift your awareness away from your body to all five senses – sound, sight, touch, smell, and taste.
  3. Shift your awareness back and forth between your breath/body and your sense of what is around you.

Wehrenberg explains that this practice of mindful awareness helps you learn in a physical way that you can control what aspects of the world you notice and attend to. In other words, you have the option of switching where your attention is focused.

Another practice I use with my clients who are anxious is mindfully letting go of thoughts:

Start off with a few long, slow breaths as you settle in. Focus on the sensations of the breath in one part of your body, for example, the tip of the nose, or the belly as it rises and falls. As you keep your focus on your breath, it is expected that other thoughts will arise. Rather than pushing these thoughts away, notice what thoughts are arising, and label them. For example, “worry,” “judgment,” “thought about the past,” “thought about the future.” Once you have labeled your thought, watch the thought pass you by as if on a cloud moving through the sky, or on a leaf being carried down a stream. Then, return to the original point of focus – your breath.

When you are just starting out, try your breathing or relaxation exercise for a few minutes at a time, multiple times a day. One way to remind yourself to do this is to pick a few times each day to practice. For instance:

right when you wake up,
during a work break,
before bed,
or even while brushing your teeth or washing the dishes.

At first, it is important to practice breathing exercises when you are already feeling calm, so the exercise becomes associated with a sense of relaxation. Then, these breathing strategies can help you remain calm even in previously stressful or anxiety-provoking situations.

References:

Barlowe, D., & Craske, M. G. (2007). Mastery of your anxiety and panic (4th ed.). New York, NY: Oxford University Press.

Burns, D. (2015) Motivating the anxious client: A paradoxical approach. Psychotherapy Networker. Webinar retrieved from: https://www.psychotherapynetworker.org/

Wehrenberg, M. (2015). The neurobiology of anxiety. Psychotherapy Networker. Webinar retrieved from: https://www.psychotherapynetworker.org/

Wehrenberg, M. (2005). The 10 best-ever anxiety techniques: There are effective alternatives to medication. Psychotherapy Networker, September/October, 1-16

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