Step-by-Step Guide to Diaphragmatic Breathing

The purpose of various relaxation techniques like diaphragmatic breathing, meditation, yoga, mental imagery is to help the body reach homeostasis in states of heightened arousal. Whenever, we face a stressful or anxiety provoking situation, our body reacts by going into state of heightened physiological arousal both at neurological as well as hormonal levels, and the sole purpose of these techniques is to help reach physiological calmness. Diaphragmatic breathing is one such relaxation technique and perhaps the easiest one to learn and practice in day-to-day life. It is easy because breathing is an act that we perform without any hesitation or thought. But factors like stress, poor posture, clothes that cause restriction of movement, lead us to breathe from our chest instead of from diaphragm. Diaphragmatic breathing is controlled deep breathing and involves the movement of lower abdomen, whereas, normal breathing emphasizes on the expansion of the chest.

There are lots of benefits of diaphragmatic breathing and it plays an important role in meditation which helps in managing stress, anxiety, lack of sleep, posttraumatic stress disorder (PTSD) etc. It also helps lower heart rate and has been highly recommended for patients with chronic obstructive pulmonary disease (COPD). The beauty of diaphragmatic breathing technique is its simplicity; it can be performed anywhere and at anytime and does not require special equipment.

Here’s step by step guide to diaphragmatic breathing:

1. Take a comfortable position: Start by taking a comfortable posture. With your eyes closed you can either sit in a comfortable chair or preferably lie down on your back on the floor. It is recommended for the beginners to wear loose clothes, especially around the neck and waist. To begin with, it is recommended that you keep your hands on your stomach so that you can feel the rise and fall of your abdomen. Once you have mastered the technique, you can perform diaphragmatic breathing almost anywhere and at any time—while driving, standing, or while talking to someone.

2. Concentration: Just like other techniques of relaxation, diaphragmatic breathing also requires concentration. For the beginners, it is recommended to practice the technique in a quiet place with less interruptions and noise. While practicing, you might experience that your thoughts begin to wander. This is normal. Whenever you feel this happening, bring your attention back to breathing. You can in fact imagine these thoughts leaving your body as you exhale metaphorically.

Whereas, normal breathing is an involuntary and not-a-conscious activity, diaphragmatic breathing is a conscious and voluntary one. Concentration can be enhanced by focusing your attention on the components of each breath. Each breathing cycle is composed of four phases–inhaling; slight pause; and exhaling; followed by another slight pause before inhaling again. When performing this technique, isolate and recognize each phase and try to control the pace of each phase-breathing thereby regulating your breathing. During the phase of exhalation, body experiences the highest form of relaxation, so try to focus on this phase and experience how light and relaxed your body feels during this phase.

3. Visualization: This can be easily attached to diaphragmatic breathing and can enhance the effects of this breathing technique. The two most commonly used visualizations along with suggestion are discussed below:

(i) Breathing clouds: Start by closing your eyes and try to focus all your attention on your breathing. As you inhale, visualize the air being inhaled as pure, clean, fresh, rejuvenating, and with healing power. Imagine this whole air traveling throughout your body from your head to toe. Now as you exhale, visualize the air leaving your body as some dark cloud of smoke comprising stressors, tension, and toxins that are inside your mind and body. During each phase of inhalation and exhalation, feel the clean, fresh air with healing power circulating though out your body and all the stress and tension leaving your body as you exhale. Repeat this breathing cycle for five to ten minutes. As you perform the breathing technique, observe that your body becomes more relaxed, stress-free and tension-free. Also, the color of the exhaled cloud becomes light in color from dark to light, which is a symbol of your body becoming relaxed and cleansed from all the negativity.

(ii) Alternate nostril breathing: This technique may require some practice. Start by closing your eyes and concentrate on the breathing. Inhale through your nose or mouth and feel the air entering your body and reaching down your lungs and experience a rise in your stomach as you breathe in. Now feel your stomach descending as you exhale. As you become relaxed, through breathing, take a slow deep breath again. This time exhale solely through your left nostril. After you take out all the air from your body through left nostril, begin inhaling only through your right nostril. Repeat this breathing cycle for fifteen to twenty times. Breathe in through your right nostril and breathe out through your left nostril. After fifteen to twenty cycles, now shift the passage of breathing cycle; start by slowly inhaling through your left nostril and exhaling through the right one. Repeat the cycle for fifteen to twenty times. As you do, visualize the air as it flows through your body. Use your fingers to control inhaling and exhaling, it will also helps you better visualize the air flow.

(iii) Energy breathing: This is a breathing technique in which you breathe not only through nose or mouth, but through your whole body. This helps vitalize the body. In this breathing, the whole body in a sense assumes the role of one big lung. This technique can be performed while sitting or lying down on the floor. This technique has three phases. First, attain a comfortable position; now imagine a hole at the top of your head. As you inhale, visualize energy entering the top of your head in the form of a light beam. Now as you inhale, take this energy down to your abdomen. As you breathe out, let it (energy) go out from the top of your head. Repeat this ten times. As you perform this technique, let the light touch all the inner parts of your upper body.

Now move on to the next phase; visualize that the center of each foot has a hole. Again imagine energy in the form of a light beam. As you breathe in from your diaphragm, let the flow of energy move up to your abdomen from your feet, while focusing only on the lower parts of the body. Repeat this ten times. As you do, let the energy in the form of light reach all the inner parts of your lower body.

Now uniting the movement of energy from the top of your head and feet, direct it to the center of your body while inhaling with the diaphragm. Then allow the flow of energy to reverse direction as you breathe out. Do this ten to fifteen times. Every time you circulate the energy in your body, feel each body part and each cell getting rejuvenated. This technique, however, requires practice.

Also read Five Tips for Better Sleep
Also read Sleeping Problems and Anxiety and Stress—A Two-way Street
Also read Posttraumatic Stress Disorder

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Self-Help Techniques to Manage Anxiety

Anxiety is one of the most common yet most debilitating mental health conditions that can range from worry to full-blown anxiety disorders. There would rarely be anyone who has never worried about anything in his or her life and therefore, occasional worry or fear is rather a part of normal life.  We often worry about the wellbeing of our loved ones or we may fear for our own safety too. Sometimes we worry about our financial situations or our work while at other times we are just concerned about our future. These occasional worries are not always bad; in fact, they are somewhat good for our survival. They help us prepare ourselves to deal with life’s challenges. However, worries can sometimes take acute form and become unbearable, excessive, irrational, or even uncontrollable and are accompanied with physical symptoms such as increased palpitation of heart, sweating, and trembling. If you too are experiencing these symptoms, you might be suffering from full blown anxiety disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes seven primary types of anxiety disorders: phobic disorders of the “specific” or of the “social” type, panic disorder with or without agoraphobia, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). GAD is the most common of these anxiety disorders and is characterized by chronic excessive worry about a number of events or activities. The subjective experience of excessive worry in GAD is accompanied by following symptoms:

  • Restlessness or feelings of being keyed up or on edge
  • a sense of being easily fatigued
  • difficulty concentrating or mind going blank
  • irritability
  • muscle tension
  • sleep disturbance

However, an individual who worries a lot does not necessarily suffer from anxiety disorders. Sometimes having an unhealthy lifestyle can make you feel anxious. Following are some self-help techniques that can help you keep anxiety in check and manage symptoms of anxiety, though these must not be considered a substitute for professional help or treatment:

Exercise/Running: Performing regular exercise and going for jogging or brisk walk has been scientifically proven to help allay anxiety symptoms. Exercise releases chemicals, i.e., endorphins in the brain that can counter symptoms of anxiety and improves mood. It also helps in lowering stress hormone cortisol that is secreted when we are anxious. Several studies have shown overall benefits of exercise on mind and body. Exercising for half an hour four times a week has been recommended for those suffering from anxiety.

Socialize: Meet people you trust and share your thoughts and feelings with them. Isolation and loneliness has been shown to increase the symptoms of anxiety. You can also talk to your trusted friends over phone and share your worries with them. Since anxiety is often based on irrational thoughts, talking to others can bring sense to our unwarranted thoughts. Suppressing and keeping your thoughts to yourself, on the other hand, can make them overwhelming and difficult to deal with. You can join some support group also, where other anxiety patients like you share their thoughts, feelings, progress, etc. Make socializing a part of your daily routine no matter how difficult it sometimes may feel.

Muscular relaxation technique: Try Jacobson’s progressive muscle relaxation technique.  Since individuals who experience anxiety symptoms tend to have high arousal, progressive muscle relaxation technique can help release physical tension.

Sleep: Lack of good sleep can aggravate the symptoms. So in order to keep your anxiety symptoms under check, get qualitative 7 – 8 hours of sleep a night.

Deep breathing: Breathing from your gut has been scientifically proven to lower the arousal level of body. Hence, deep breathing exercise can help calm your body and mind. Use deep breathing to relieve immediate symptoms of anxiety like hyperventilation or shortness of breath.

Stay in the present: Anxiety disorders are often future-based, which means, you tend to worry about the things that you feel are going to happen. So in such instances, try to focus on the present. Ask yourself about what is happening at the moment. Mindfulness can help you stay in the moment. Mindfulness is a technique where we are made aware of what is going on around us through our five senses. What do we see, hear, smell, feel, and taste. A regular practice in mindfulness can help you ease anxiety symptoms.

Train your mind: Anxiety is often based on thoughts; therefore, in order to deal with it, one has to work on one’s thoughts. Be accepting to the fact that you cannot actually control everything. Try to do your best instead of striving for perfection. Research studies provide evidence regarding link between perfectionism and mental health disorders like anxiety and depression. Replace negative thoughts with positive ones and try to maintain positive attitude about life.

Challenge your thoughts: Most of the worries and fears in anxiety are irrational and without any base. Identify your apprehensions and challenge each and every single thought that comes to your mind.

Eating healthy: Avoid consuming alcohol and caffeine and focus on eating a well-balanced diet. Eating healthy food helps maintain healthy mind and body. Stay hydrated. It may seem like too simple a remedy but staying hydrated can go a long way in managing anxiety. Whenever you experience anxiety symptoms, drink water as it helps lower the arousal.

Use art as mode of expression: Art therapy has also been found to help relieve anxiety symptoms. Use dance or painting as a mode of giving outlet to your thoughts and feelings. It can also help you take your mind off your worries.

Professional help: If you feel that your anxiety symptoms are interfering with your daily functioning, don’t hesitate to take professional help from a psychiatrist or psychologists or other healthcare provider in your community. Professional treatment mostly includes medications for severe symptoms, along with cognitive behavioral therapy.

Also Read: Posttraumatic Stress Disorder
Also Read: PTSD: Brain Biomarkers May Explain Variance in Symptom Severity
Also Read: Childhood Anxiety Related With Later Alcohol Problems
Also Read: Test Anxiety—Strategies to Overcome

 

PTSD: Brain Biomarkers May Explain Variance in Symptom Severity

Researchers at Yale University and the Icahn School of Medicine have identified biomarkers, using sophisticated computational tools, which may explain why some people have more severe posttraumatic stress disorder (PTSD) symptoms than others.

The findings published in Nature Neuroscience may help evaluate who would be at greater risk of PTSD symptoms.

The study of combat veterans who had been exposed to extreme incidents, demonstrated that those veterans who had severe PTSD symptoms had distinct patterns of neurological and physiological responses affecting associative learning—the ability to discern harmful stimuli from safe ones in the environment.

Ilan Harpaz-Rotem, associate professor of psychiatry at Yale and co-corresponding author of the paper said, “We are shedding new light on how people learn fear and unlearn it.”

The researchers wanted to unravel why some people suffer greatly when experience a traumatic event while others exhibit few or limited side effects.

Retired soldiers who had undergone intense circumstances during combat deployment were examined for physiological responses while being presented with pictures of two different faces. In classic fear-conditioning tests, the subjects were given slight electric shocks after viewing one of the faces, but not the other. Later, the faces that were combined with shock were switched in an attempt to have the subjects “unlearn” original fear conditioning and test their ability to learn that something new in the environment is hazardous.

The findings deduced using computational modeling revealed that in people with severe PTSD symptoms, the amygdala and striatum were less able to track changes in threat level, which may serve as biomarkers for PTSD symptom severity.

According to Harpaz-Rotem, “There were pronounced variances in the ‘learning rates’ of those with severe symptoms and those without symptoms.” Highly symptomatic individuals tended to overreact to a mismatch between their expectations and what they actually experienced. In a war zone, a garbage can might contain an explosive device, he explained, but those with severe PTSD symptoms have a harder time unlearning the fear in civilian life in comparison to those with less severe symptoms.

The study’s co-author and associate professor of comparative medicine and neuroscience at Yale, Ifat Levy said, “The study has offered novel understanding of the neurobiology of PTSD and a better understanding of learning processes among people with this disorder which might pave the way for refining potential PTSD treatment in future.

PTSD is a common anxiety disorder that develops after exposure to a harrowing event or ordeal. It can occur at any age between childhood and adulthood. Those suffering from PTSD may experience startling thoughts and memories of the event. Sleeplessness, depression, or other anxiety disorders frequently co-occur with PTSD.

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doi:10.1038/s41593-018-0315-x

 

Posttraumatic Stress Disorder

What Is Posttraumatic Stress Disorder (PTSD)?

Someone who is the victim of (or threatened by) violence, injury, or harm can develop a mental health problem called postraumatic stress disorder (PTSD). PTSD can happen in the first few weeks after an event, or even years later.

People with PTSD often re-experience their trauma in the form of “flashbacks,” memories, nightmares, or scary thoughts, especially when they’re exposed to events or objects that remind them of the trauma.

Psychologists, therapists, or psychiatrists can help people with PTSD deal with hurtful thoughts and bad feelings and get back to a normal life.

What Causes PTSD?

PTSD is often associated with soldiers and others on the front lines of war. But anyone — even kids — can develop it after a traumatic event.

Traumas that might bring on PTSD include the unexpected or violent death of a family member or close friend, and serious harm or threat of death or injury to oneself or a loved one.

Situations that can cause such trauma include:

  • violent attacks, like rape
  • fire
  • physical or sexual abuse
  • acts of violence (such as school or neighborhood shootings)
  • natural or man-made disasters
  • car crashes
  • military combat (sometimes called “shell shock”)
  • witnessing another person go through these kinds of traumatic events
  • being diagnosed with a life-threatening illness

In some cases, PTSD can happen after repeated exposure to these events. Survivor guilt (feelings of guilt for having survived an event in which friends or family members died) also might contribute to PTSD.

What Are the Signs & Symptoms of PTSD?

People with PTSD have symptoms of stress, anxiety, and depression that include many of the following:

Intrusive thoughts or memories of the event

  • unwanted memories of the event that keep coming back
  • upsetting dreams or nightmares
  • acting or feeling as though the event is happening again (flashbacks)
  • heartache and fear when reminded of the event
  • feeling jumpy, startled, or nervous when something triggers memories of the event
  • children may re-enact what happened in their play or drawings

Avoidance of any reminders of the event

  • avoiding thinking about or talking about the trauma
  • avoiding activities, places, or people that are reminders of the event
  • being unable to remember important parts of what happened

Negative thinking or mood since the event happened

  • lasting worries and beliefs about people and the world being unsafe
  • blaming oneself for the traumatic event
  • lack of interest in participating in regular activities
  • feelings of anger, shame, fear, or guilt about what happened
  • feeling detached or estranged from people
  • not able to have positive emotions (happiness, satisfaction, loving feelings)

Lasting feelings of anxiety or physical reactions

  • trouble falling or staying asleep
  • feeling cranky, grouchy, or angry
  • problems paying attention or focusing
  • always being on the lookout for danger or warning signs
  • easily startled

Signs of PTSD are similar in both adults and teens. But PTSD in children can look a little different. Younger kids can show more fearful and regressive behaviors. They may reenact the trauma through play.

Symptoms usually begin within the first month after the trauma, but they may not show up until months or even years have passed. These symptoms often continue for years after the trauma. In some cases, they may ease and return later in life if another event triggers memories of the trauma. (In fact, anniversaries of the event can often cause a flood of emotions and bad memories.)

PTSD also can come on as a sudden, short-term response (called acute stress disorder) to an event and can last many days or up to one month.

People with PTSD may not get professional help because they think it’s understandable to feel frightened after going through a traumatic event. Sometimes, people may not recognize the link between their symptoms and the trauma.

Teachers, doctors, school counselors, friends, and other family members who know a child or teen well can play an important role in recognizing PTSD symptoms.

Who Gets PTSD?

Not everyone who goes through a traumatic event gets PTSD. The chances of developing it and how severe it is vary based on things like personality, history of mental health issues, social support, family history, childhood experiences, current stress levels, and the nature of the traumatic event.

Children and teens who go through the most severe trauma tend to have the highest levels of PTSD symptoms. The more frequent the trauma, the higher the rate of PTSD.

Studies show that people with PTSD often have atypical levels of key hormones involved in the stress response. For instance, research has shown that they have lower-than-normal cortisol levels and higher-than-normal epinephrine and norepinephrine levels — all of which play a big role in the body’s “fight-or-flight” reaction to sudden stress. (It’s known as “fight or flight” because that’s exactly what the body is preparing itself to do — to either fight off the danger or run from it.)

How Is PTSD Treated?

Many people recover from a traumatic event after a period of adjustment. But if a child or teen has experienced a traumatic event and has symptoms of PTSD for more than a month, an expert’s help is recommended.

Therapy can help address symptoms of avoidance, intrusive and negative thoughts, and a depressed or negative mood. Mental health professionals who can help include:

  • psychologists
  • psychiatrists
  • licensed clinical social workers
  • licensed professional counselors
  • licensed trauma professionals
  • bereavement specialists

Cognitive-behavioral therapy is very effective for people who develop PTSD. This type of therapy teaches ways to replace negative, unhelpful thoughts and feelings with more positive thinking. Behavioral strategies can be used at an individual’s own pace to help desensitize him or her to the traumatic parts of what happened so he or she doesn’t feel so afraid of them.

Eye movement desensitization and reprocessing therapy (EMDR) combines cognitive therapy with directed eye movements. This has been shown to be effective in treating people of all ages with PTSD.

In some cases, medicine can help treat serious symptoms of depression and anxiety. Medicine often is used only until someone feels better, then therapy can help get the person back on track.

Finally, group therapy or support groups are helpful because they let an individual know that he or she is not alone. Groups also provide a safe place to share feelings.

Looking Ahead

PTSD can be very challenging and may require a lot of patience and support. Time does heal, and getting good support from the family can help an individual move forward.

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