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Breathing Lessons
Breathing Lessons by Carol Krucoff, The Washington
Post May 2, 2000. This article was published also
in Reader's Digest Magazine in December 2000. Used
with permission
Think you know how to breathe? Try this simple test: Sit
or stand wherever you are and take a deep breath. Then
let it out. What expanded more as you inhaled, your
chest or your belly?
If the answer is your chest, you're a "chest breather,"
and like most people you're doing it all wrong. You may
also be putting your health in jeopardy.
For more information, take another deep breath-and keep
reading.
The technique is so powerful that physician James Gordon
teaches it to nearly every patient he sees, from people
with advanced cancer to those crippled by arthritis to
school children struggling with attention deficit
disorder. He's taught it to war refugees in Kosovo, to
anxiety-plagued medical students at Georgetown
University and to hundreds of health professionals who
have attended his workshops on mind-body-spirit
medicine. emerging field of mind-body medicine say few
people in Western society know how to breathe correctly.
Taught to suck in our guts and puff out our chests,
we're bombarded with a constant barrage of stress, which
causes muscles to tense and respiration rate to
increase. As a result, we've become a nation of shallow
"chest breathers," who primarily use the middle and
upper portions of the lungs. Few people-other than
musicians, singers and some athletes-are even aware that
the abdomen should expand during inhalation to provide
the optimum amount of oxygen needed to nourish all the
cells in the body.
"Look around your office, and you'll see so little
movement in people's bellies that it's a wonder they're
actually alive," Gordon says. "Then watch a baby breathe
and you'll see the belly go up and down, deep and slow."
With age, most people shift from this healthy abdominal
breathing to shallow chest breathing, he says. This
strains the lungs, which must move faster to ensure
adequate oxygen flow, and taxes the heart, which is
forced to speed up to provide enough blood for oxygen
transport. The result is a vicious cycle, where stress
prompts shallow breathing, which in turn creates more
stress.
"The simplest and most powerful technique for protecting
your health is breathing," asserts Andrew Weil, director
of the Program in Integrative Medicine and clinical
professor of internal medicine at the University of
Arizona in Tucson. Weil teaches "breathwork" to all his
patients. "I have seen breath control alone achieve
remarkable results: lowering blood pressure, ending
heart arrhythmias, improving long-standing patterns of
poor digestion, increasing blood circulation throughout
the body, decreasing anxiety and allowing people to get
off addictive anti-anxiety drugs, and improving sleep
and energy cycles."
Unlike any other bodily function, he notes, "breathing
is the only one you can do either completely consciously
or unconsciously. It's controlled by two different sets
of nerves and muscles, voluntary and involuntary. And
it's the only function through which the conscious mind
can influence the involuntary, or autonomic, nervous
system."
"Western medical education at the moment doesn't include
information of this kind," says Weil. "In the four years
I spent at Harvard Medical School and a year of
internship in San Francisco, I learned nothing of the
healing power of breath. I learned about the anatomy of
the respiratory system, and I learned about diseases of
the respiratory tract. But I learned nothing about
breath as the connection between the conscious and
unconscious mind, or as the doorway to control of the
autonomic nervous system, or about using breathwork as a
technique to control anxiety and regulate mental states,
or the possibility that breath represents the movement
of spirit in the body and that breathwork can be a
primary means of raising spiritual awareness."
Eastern healing techniques often prescribe conscious
breathing to help restore health to people who are
overly stressed. "In Japan, a diagnosis of autonomic
nervous system imbalance is common, but in the medicine
of the West we don't have this diagnosis," he says.
"Western medicine typically tries to blunt the
over-activity of the sympathetic nervous system or deal
with its consequences at a more superficial level by
giving drugs to suppress or control it." In contrast,
relaxation breathing works to increase parasympathetic
tone, slowing down the heart rate and decreasing blood
pressure, bringing the two systems into balance. And
unlike drugs, he says, "it's free of toxicity, it's free
of cost and it's literally right under our nose."
Techniques that use focused breathing to affect the
nervous system, change physiology and connect the body
with the mind can be traced back to ancient India, notes
Weil, who learned the breathing techniques he uses
through the study of yoga and by working with
osteopathic physicians.
"In many languages, the word for breath is the word for
spirit," he notes, citing the Latin spiritus, Hebrew
ruach, Greek numa and Indian prana. We lose this
linguistic connection in English, he says, except with
the words "respiration" and "conspire."
Many systems of meditation and numerous spiritual
practices also center on conscious breathing, Weil notes
in his recently released CD, "Breathing: The Master Key
to Self Healing" (Sounds True, 1999). "By simply putting
your attention on your breath without doing anything to
change it," he says, "you move in the direction of
relaxation."
Or as yoga master B.K.S. Inyengar explains in his
classic guide, "Light on Yoga" (Schoken Books, 1966):
"Regulate the breathing, and thereby control the mind."
There is little scientific research documenting the
healing power of breathing, in part because its practice
is so new in Western medicine. And unlike drugs or
devices, breathing has no manufacturer who must sponsor
studies to support its use.
Increased interest in studying the effects of
nontraditional healing therapies such as relaxation
breathing led to the founding in 1991 of the Office of
Alternative Medicine, now the National Center for
Complementary and Alternative Medicine, at the National
Institutes of Health. As a result, more medical
scientists are beginning to examine the health impact of
a variety of mind-body therapies such as meditation,
guided imagery and Eastern exercises – yoga, tai chi and
qi gong – which typically incorporate focused breathing.
One of the few studies to examine a clinical application
of yoga "belly breathing" found that menopausal women
who learned the technique were able to reduce the
frequency of hot flashes by about 50 percent. "The
average breathing rate is 15 to 16 cycles (inhaling and
exhaling) per minute," notes Robert Freedman, a
professor of psychiatry and behavioral neurosciences at
Wayne State University School of Medicine in Detroit.
"But with training, women can slow their breathing down
to seven or eight cycles per minute, which can
significantly reduce the frequency and intensity of hot
flashes."
Mind-body approaches have been reported in scientific
studies to be effective in the treatment of a variety of
stress-related disorders, says Herbert Benson, an
associate professor of medicine at Harvard Medical
School and president of the Mind/Body Medical Institute
in Boston. As an example, he points to research showing
that chronic pain patients who learned mind-body
self-care techniques in a 10-week outpatient program
reduced clinic visits by 36 percent for more than two
years after the classes.
Slow, deep breathing is central to most mind-body
techniques, says Benson, who estimates that "up to half
of doctor office visits could be eliminated with greater
use of mind-body approaches." Stress causes or
exacerbates a host of medical conditions that lead to 60
to 90 percent of visits to physicians, he says, adding
that training Americans to use self-care techniques
could cut U.S. health care costs by billions of dollars.
Deep diaphragmatic breathing and other mind-body
techniques can significantly reduce symptoms of severe
PMS as well as anxiety, depression and other forms of
emotional distress, according to research by Alice
Domar, an assistant professor of medicine at Harvard
Medical School and director of the Mind/Body Center for
Women's Health.
In addition, her studies suggest that these practices
can combat infertility. After completing a mind-body
group program for women with infertility – where 284
participants learned a variety of self-nurturing
techniques such as deep breathing – a surprising
percentage of women, 44 percent, conceived within six
months.
"These were women who had averaged 3½ years of
unsuccessful efforts to get pregnant," writes Domar in
her book "Self-Nurture" (Viking, 2000). "Though we're
still trying to ferret out the biological mechanisms
that explain this high percentage, I am convinced that
nurturing mind and body has a powerful effect on
hormones and other [physiological] parameters, and can
stimulate healing in a range of medical conditions –
including infertility."
Proper breathing is the first thing Domar teaches
virtually all her patients. "I start with something I
know will work," she says. "When they breathe
diaphragmatically, they'll feel better within 15
seconds, so they're hooked."
To teach the technique, Domar has patients make a fist
and squeeze it tight. "Then I ask them what happens to
their breath, and they realize that they've stopped
breathing," she says. "When we get anxious, we tend to
hold our breath or breathe shallowly." Domar then shows
patients how to breathe deeply into the abdomen, a
process most women tell her runs counter to the "hold in
your stomach" breathing they've done all their adult
lives.
Domar's favorite stress-reduction technique is a short
version of this breath-focus exercise, which she calls a
"mini-relaxation," or "mini."
"You can do a mini when you're stuck in traffic, at a
boring meeting, whenever you look at a clock or any time
you pick up a phone," she says. "I have patients who do
minis 100 times a day." Minis are also helpful for
people with medical conditions who can do deep breathing
when they're having an IV started or undergoing
chemotherapy.
Pamela Peeke, an assistant clinical professor of
medicine at the University of Maryland, incorporates
breathwork into her practice, in part by getting her
patients to exercise. "It's very hard to walk and take
little panicked breaths," says Peeke, who frequently
takes patients out for a "walk and talk."
In our stressed-out world, the fight-or-flight response
that kept our ancestors alive has turned into a "stew
and chew," contends Peeke, who studied the connection
between stress and fat at the National Institutes of
Health. If no physical response occurs after stress revs
the body up for battle, chronically elevated levels of
stress hormones stimulate appetite and encourage fat
cells deep inside the abdomen to store what she calls
"toxic weight."
For this reason, Peeke says, "I'm an absolute crazy
person about getting people to move." She encourages
Eastern movements, such as yoga and tai chi, which rely
on taking deep abdominal breaths. But she particularly
urges patients to do aerobic activity to help neutralize
the effects of stress. "When people learn to breathe
properly, they can calm themselves," she says. "Then the
stew doesn't have to turn into a chew."
In hospitals, breathing techniques once were taught only
to women for use during childbirth. Today, some
hospitals have begun teaching relaxation breathing to
patients of all ages and both sexes being treated for a
wide range of conditions. At the Washington Hospital
Center, nurse Julie Oliver incorporates breathwork into
support groups she leads, including one for people with
congestive heart failure and another for parents of
babies in the Neonatal Intensive Care Unit (NICU).
"Using the breath to quiet the body can be very
powerful," says Oliver, who is clinical manager of the
hospital's guided imagery program.
"Babies, especially premature babies, can sense how the
mother and father feel," Oliver notes. "If the parents
go in full of muscle tension and start jiggling the
baby, the baby gets too stimulated, and the staff may
need to tell the parents to back away, which adds to
everyone's stress."
Oliver had a chance to practice what she preaches last
month, when her newborn stayed in the NICU for three
days of observation. "I was so anxious to see Joseph, I
found myself getting all wound up," she recalls. "My
heart rate was up, my breathing was shallow and I was
feeling unbelievable muscle tension." So Oliver took a
minute to do several relaxation breaths, combined with a
positive thought: "I love my baby; my baby is going to
be fine." "I was able to go in and take Joseph in my
arms in a much quieter state of mind," she says.
Conscious breathing also was a part of her delivery.
"Focused breathing pulls your attention away from pain
and what's going on in your body," says Oliver, who
teaches the technique to heart patients about to undergo
procedures in the cardiac catheterization lab. She's
also begun teaching breathing to staff members. "It's an
ideal form of stress reduction," she says, "because it
doesn't take any time away from work and you can do it
anywhere."
At Duke
University Medical Center in Durham, N.C., nurse Jon
Seskevich has taught "soft belly breathing" to most of
the more than 15,000 patients he's worked with since he
became a full-time stress and pain management educator
for the hospital in 1990. About half the patients he
sees have cancer, and the others have a wide variety of
ailments including heart disease, cystic fibrosis and
lung disorders.
One of his most dramatic cases involved a lung cancer
patient. "I walked into the room to find this very large
man literally fighting for breath," Seskevich recalls.
"His pulse oxygen was 74, and you want it to be 90 or
above. I sat down next to him and started talking in a
calm voice. I asked him if it was okay if I touched his
belly. He nodded, so I put my hand on his belly and told
him to breathe into my hand, to let his belly be soft
and to let his abdomen rise into my hand."
After about six minutes of this, the man's pulse oxygen
was 94 and he was breathing comfortably. "I didn't tell
him to relax," Seskevich notes. "All day people were
telling him to relax, and it seemed to make his struggle
worse. I just told him to breathe softly into his belly.
We didn't cure his cancer, but we may have saved him a
trip to the intensive care unit."
Patients are hungry for self-care information, says
Seskevich. "People are very anxious to learn what they
can do for themselves," he says. "They become empowered
by these techniques and they do better."
Physicians and other health care professionals also are
flocking to continuing education courses offered by
mind-body medicine experts. "There are a lot of health
professionals today who aren't satisfied with the tools
they have, and to some extent feel lost," says Gordon of
Washington's Center for Mind-Body Medicine. "They are
looking for ways they feel they can help people again,
that will put meaning back into their practice."
Gordon's center sponsors week-long training programs for
physicians, nurses, social workers and other health
professionals. Weil's Integrative Medicine program
recently graduated its first class of physicians, is
starting an Internet-based associate fellowship program,
and is launching a continuing education program for
psychiatrists, oncologists and cardiologists – all of
which will include a unit on breathing and breathwork.
Harvard's Mind/Body Medical Institute has 14 affiliate
programs at hospitals around the country and is
negotiating with at least one other.
As graduates of these and similar programs bring
mind-body strategies to their practices, teaching
breathwork and other forms of self-care will soon become
a common part of American medical care, these experts
predict. "There's no question it's driven by consumer
demand, coupled with economic forces," says Weil. "Not
only do these strategies work, something like breathing
is a pretty cheap intervention."
"Sometimes I suggest my patients make signs to post in
their office, at their computers, or in their bedrooms,"
Gordon writes in his "Manifesto for a New Medicine"
(Addison-Wesley, 1996). "Signs that simply say,
'Breathe!'‚"
Carol Krucoff, the Health section's Bodyworks columnist,
is co-author, with her husband, Mitchell Krucoff, MD, of
"Healing Moves: How to Cure, Relieve, and Prevent Common
Ailments With Exercise" (Harmony Books, 2000). |
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