Or maybe a better title is "How to Breathe"
RELAX.
Your stress is tearing you up. Otherwise, why would you go through the time and expense of coming to see me?
I am more and more convinced than often that very, very simple changes in nutrition and behaviors can result in lifelong improvements in mood and anxiety disorders.
One of these fundamental changes is paying attention to your "primitive" behaviors. Eating, sleeping, breathing, sex--let's face it, regardless of your species, you have to engage in these behaviors. When we get stressed, we tend to get "primitive."
Don't deny it--stress often results in increased eating, drinking alcohol, inappropriate sexual behavior, and poor sleep.
We know that we exist in a system--one linking our emotions with our thoughts with our behaviors. By influencing one part of the system, we can influence others.
Thus, breathing is a good place to start. Normally it is an unconscious behavior. By paying attention to our physical state when we breathe, we can shut out thoughts that generate anxiety and instruct our bodies to resume a more relaxed state.
Before you learn to breathe, I want you to think about a few things:
(1)Have a passive attitude: You cannot "force" yourself to relax--that doesn't even make sense! ACCEPT that you are stressed and give your body permission to assume a relaxed state.
(2) Quiet environment: There is no way you are going to be able to still your mind with screaming children beckoning you for chicken nuggets. Let them play the video games for a few minutes (better yet, put them to bed) and make your environment a restful one.
(3) Mental Device: It is nearly impossible for most high-functioning people to "shut down" their brain. It's even nearly impossible for low-functioning people like Psychiatrists. Despite that, it is possible to "trick" our brain into achieving a relaxed state. In your mind's eye, come up with a situation in which you CANNOT be anxious. This can be sitting on a beach, flying a glider, walking through rustling leaves, whatever floats your boat (floating on a boat actually is a pretty good one to use). "Get into" the imagery. Incorporate the smells, the textures, the sounds of the experience. Spend a good 10 minutes or so enjoying the experience in your mind. Now pay attention to your heart rate. Likely, it's a little slower!
Now that it is quiet, and you are using your mental device, start paying attention to your breathing. You are going to learn to breathe by fully expanding your lung capacity. The way to do this is NOT to breathe with your chest.
Think about it--when you are anxious and tense, your muscles tighten. There are a lot of muscles around your rib cage. So let's expand where there is not as much muscle--in your belly.
Even if you have rock hard, washboard abs (it is a little known fact that all Psychiatrists do 100 situps between each patient to maintain such a chiseled core), you can still expand your abdominal wall to let your diaphragm flatten out and pull more oxygen into your lungs. More importantly, doing this will allow you to express more carbon dioxide--and it is elevated blood CO2 that plays a major role in anxiety attacks.
OK--while lying in bed or sitting in a comfortable chair, place one hand on your chest and the other on your abdomen (belly). (If you have sinewy, concrete-like abs, be sure not to chip a nail.) Now imagine that you are wearing a pair of pants that is 3 inches too big, and you have to "pooch" out your belly to hold them up.
Try this--it likely will feel awkward.
Now try to do it again, pooching out your belly--the hand on your stomach obviously will rise. The trick is to keep the hand on your chest absolutely still! Try it.
Again--keep your shoulders absolutely still. In order to do this, you have to RELAX them (there's that word again he keeps mentioning). Take in several deep breaths like this, over and over. The hand on your belly should rise and fall. The one on your chest should not move.
Now try this--take in a breath over a count of four (1...2...3...4 in case you graduated from A&M with me), hold it for a second, and then exhale over a four count. Try this a few times, recalling your mental device and how relaxed you are becoming.
Again--1...2...3...4.
Do this for a few minutes, again being sure your belly hand is the only one moving. When you feel confident in your ability to maintain the breathing, you can rest your hands at your sides.
While you are breathing, I would like you to slowly repeat aloud or in your mind, the following phrase:
"Chest...Arms...Legs...Mouth."
This spells "CALM" if you didn't notice that already. If your mental device was fogged by intrusive visual imagery of tartar sauce and Spongebob, it is because you spelled "CLAM." While your former University of Texas instructors would be proud, I would like you to recall it in the correct order.
CHEST--is it relaxed? Am I keeping it still?
ARMS--am I clenching my fists? Are my shoulders hanging loose and limp?
LEGS--am I clenching anything that shouldn't be clenched? Are my toes curled?
MOUTH--is my mouth slightly opened with a relaxed jaw?
Again--1...2...3...4, Chest...Arms...Legs...Mouth.
I use diaphragmatic breathing daily. I try to start my day with at least a few minutes of relaxing breathing, and I do this whenever things start to feel overwhelming.
Diaphragmatic breathing can abort panic attacks, if it has been practiced and is used early enough. Please practice daily--the more you do it, the more automatic it becomes.