by Heidi Hanson

I’ve been working on 3 articles about PTSD and the Healing Powers of the Breath. They are coming along, but I decided I first want to compile a bunch of actual exercises into a post and “Just Do It.” Do the exercises first and discuss the whole subject in depth later.
Briefly, the basic principle is:
Holding your breath, shortness of breath, constrained and tense breath, rapid breath = survival, fight/flight/freeze, activation of the nervous system, stress.
Natural, full, diaphragmatic breaths = opening up to life beyond survival, opening up to calmness, regulation of the nervous system, bringing about physical relaxation, improving health, being able to think.
For PTSD specifically, conscious breathing seems to act as a nervous system interrupter. The survival brain gets stuck in this pattern: stimulus in environment (trigger) leads to automatic response of autonomic nervous system (shallow breathing). Taking control of the breathing interrupts this circuitry and breaks the cycle.
Here’s a quote for ya: “Of all the various functions of our autonomic nervous systems, from heart beat, perspiration, hormonal release, gastrointestinal operation, neurotransmitter secretion, etc., the breath stands alone as the only subsystem the conscious mind can put into ‘manual override’ and so it is through manipulation of the breath that we can recalibrate the entire system.” (source)
Triggers can be maddening, so I’m thinking it would be a good idea to make a genuine effort to incorporate more of these breathing exercises into my life, especially when things get really bad.
Two Breathing Tests Prove I Suck at BreathingBefore getting into the exercises, I want to point out that there are tests online to measure how you are doing with your breathing.
As for myself, I breath shallow, relatively quick, tense breaths, even sometimes while I sleep. I’m pretty sure I suck very much at breathing.
First Breathing Test
Just to verify this, I took this breathing test and, indeed, according to the test my breathing pattern allows for an amount of oxygen in my system similar to that of a person with a serious physical disease.
To do the test: inhale and exhale as you normally do and then hold your breath. Time the number of seconds you are able to hold before experiencing discomfort. Begin breathing again the moment you can begin to breathe again in the same rhythm you were prior to counting. In other words, you resume breathing and stop counting the moment that, if you were to hold your breath beyond that point, you would feel discomfort and need to take in more air on your next in-breath than you take in during a normal in-breath. (This is not “extended pause length” in which you hold for as long as possible through low and medium discomfort)
In the video, the presenter Artour Rakhimov says, “Breath holding time can be as low as 5-7 seconds when people are severely sick.” 20-40 seconds is considered healthy.

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(The “normal” breaths per minute seems to vary by expert, but 14 seems to generally be considered not ideal. “Medical textbooks suggest that the normal respiratory rate for adults is only 12 breaths per minute at rest. Older textbooks often provide lower values (e.g., 8-10 breaths per minute)… Don Campbell and Al Lee, authors of ‘Perfect Breathing: Transform Your Life One Breath at a Time,’ agree that 10 or fewer deeper, slower breaths per minute is best for overall health” (source))

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Breathing ExercisesExercises To Try When Anxious or Triggered…1. Simple and Relaxing – Four In, Four Out Slow Belly BreathingSource: Psychology Tools
Also Called: Relaxed Breathing, 4 Count Breathing, 4-1-4-1 Breathing
The following is from the Psychology Tools download.
“When we are anxious or threatened our breathing speeds up in order to get our body ready for danger. Relaxed breathing (sometimes called abdominal or diaphragmatic breathing) signals the body that it is safe to relax. Relaxed breathing is slower and deeper than normal breathing, and it happens lower in the body (the belly rather than the chest).
Instructions:

  1. Make sure you are sitting or lying comfortably.
  2. Close your eyes if you are comfortable doing so.
  3. Breathe through your nose rather than your mouth if that is comfortable for you.
  4. Deliberately slow your breathing down.
  5. Breathe in to a count of 4
  6. Pause for a moment
  7. Breathe out to a count of 4
  8. Pause
  9. Repeat
  10. Make sure that your breaths are smoothsteady, and continuous – not jerky; pay particular attention to your out-breath – make sure it is smooth and steady

Am I doing it right? What should I be paying attention to?
Relaxed breathing should be low down in the abdomen (belly), and not high in the chest. You can check this by putting one hand on your stomach and one on your chest Try to keep the top hand still, your breathing should only move the bottom hand Focus your attention on your breath – some people find it helpful to count in their head to begin with (”In … two … three … four … pause … Out … two … three … four … pause …”)
How long and how often?
Try breathing in a relaxed way for at least a few minutes at a time – it might take a few minutes for you to notice an effect. If you are comfortable, aim for 5-10 minutes Try to practice regularly – perhaps three times a day
Variations and troubleshooting
Find a slow breathing rhythm that is comfortable for you. Counting to 4 isn’t an absolute rule. Try 3 or 5. The important thing is that the breathing is slow and steady Some people find the sensation of relaxing to be unusual or uncomfortable at first but this normally passes with practice. Do persist and keep practicing.”
Remember: If stressed, say slowly to yourself while breathing from your relaxed belly: “One, Two, Three, Four, Pause. One, Two, Three, Four, Pause.” Repeat for a few minutes.
2. For When You’re Super Anxious And Need a Quick Solution – Whole Body Muscle Tensing and RelaxingThis exercise switches on the parasympathetic nervous system (“relaxing” nervous system) more quickly than the others. It’s also more impactful than the others because it engages all the muscles of the entire body. This powerful impact can help you “snap out of it!” even in tough situations.
I gather that this exercise is a relative of Progressive Muscle Relaxation. In Progressive Muscle Relaxation, you relax and tense each muscle group progressively and reach deeper and deeper states of relaxation as you go. That takes time though. This one is more of an emergency measure. I’m calling it “Whole Body Muscle Tensing and Relaxing” because you do it with your whole body system at once rather than progressively. Because you tense and relax your whole body it’s much faster. If you are facing anything that is anxiety provoking, like a meeting or public speaking for example, this one can be done quickly. If you have more time, you can do it over again several times, or instead do Progressive Muscle Relaxation.
Instructions:

  1. Take a very deep breath in with your mouth open; fill your lungs up.
  2. Hold your breath.
  3. While holding your breath, tense muscles all over your body as tense as you can – face, fingers, toes, shoulders, stomach, butt, legs etc. – without injuring yourself (if you have a known issue go easy on that part of your body)
  4. Count 5-10 seconds while holding your breath and keeping all muscles tense.
  5. Then relax everything, let go of all the tension in your muscles and
  6. Slowly let your breath out.

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3. To Break Out of Being Triggered – 4-4-4-4 BreathingThis exercise is from Lieutenant Colonel Dave Grossman. Grossman has trained thousands of law enforcement personnel how to teach this exercise to trauma survivors. He has found that having a trauma survivor do this exercise immediately after the traumatic event helps their nervous system regulate around the experience and may stop the extreme cycles of PTSD from getting started in their body.
Instructions:

  1. Breathe in while counting to 4. Make it a deep, belly breath.
  2. Hold your Breath while counting to 4.
  3. Breathe out while counting to 4.
  4. Hold your Breath while counting to 4.
  5. Do this sequence 2 more times.

This exercise, as I understand it, is specifically for breaking the threat response cycle in the nervous system. There is perception of an overwhelming threat and the system goes into freeze/flight/fight response. The autonomic nervous system is telling the breathing to become shallow and fast in order to respond to the threat.
Then you step in and by using your voluntary muscles to open and close the breathing deliberately, slowly, fully and deeply, you are using the somatic nervous system (voluntary moving muscles) to influence something that, when in a trauma response, is under the control of the autonomic nervous system. The breathing acts as the bridge between the two systems.
Eventually, by putting this bridge into action, you break the connection between the threat and the breathing.
Although Grossman explains this sequence of physiological events really well in his article in relation to 4-4-4-4- Breathing, which he calls Autogentic Breathing by the way, this applies to all breathing exercises with the same characteristics.
For example, slow breathing in general seems to allow people to slow their entire system (mind, emotions,body) down enough to integrate pieces of what happened to them that came too quickly for their system to process during the event.
Additionally, deep breathing in general seems to allow emotional release and processing of the energy stuck in the body from the trauma (people may, after a while of breathing, begin crying, tingling, feeling hot or cold, releasing energies from the trauma).
All of the natural responses to trauma – the fight/flight response to stimulus, the arrested and unmoving state of not processing anything and repression of the energies and emotions from the trauma – are normally held static inside the body indefinitely to wreak havoc. Breathing is able to get a whole slew of things un-stuck and moving.
One video mentioned that, in the case of using any deep, slow breathing exercise when you are triggered, you can actually think about what you fear – the trigger – as you slow your breath. That would be interesting to try. The idea is to try to disconnect the thought of the trigger from the automatic response of fight and flight in the nervous system.
Very similar to this one is:
4. To Train The Mind and Body To Find Peace – 4-6-4-6 BreathingSource : Sonia Choquette
Instructions:

  1. Breath in for a count of 4
  2. Hold for a count of 6
  3. Breathe out for a count of 4
  4. Hold for a count of 6

Click here to jump to where Sonia gives the instructions for this exercise in the video.
I like how she said to envision it like a rectangle.
“The 4-6-4-6 breath trains the mind to be peaceful.” – Sonia
Exercises to Try for Deep Relaxation…5. For Soothing The Nervous System – The SighSource : Sonia Choquette
This one is very soothing and healing exercise that is like a balm for the nervous system.
Click here to go to where Sonia gives the instructions for this exercise in the video.
Instructions:

  1. Breath in.
  2. When you breath out, open your mouth and exhale the air with the sound of the air releasing, a soft sigh sound.
  3. Relax your shoulders, neck and other muscles and let everything go.
  4. Do 3 or 4 times, or however many times feel right.

“It’s like being wrapped in a warm blanket; it calms the nervous endings, it quiets the brain, it ground the body, it expands the lungs…” -Sonia
6. For Deep Relaxation – Buteyko Small Breath HoldsThis one is so relaxing. I think this is one of the best exercises I’ve done so far for entering deep relaxation. I really felt the switch she describes into the “relaxing nervous system,” the parasympathetic nervous system.
Instructions:

  1. With your mouth closed, take a small, but calm and relaxed, breath in.
  2. Take a small breath out.
  3. Block your nose.
  4. Hold for a count of 5
  5. Release
  6. Gentle, soft breathing in-between sets
  7. Tongue rests at the roof of the mouth; Teeth slightly apart; jaw relaxed; Drop shoulders; relax chest and belly; Relax facial muscles.

For some reason I find following along to her voice in the video more relaxing than doing it on my own.
(unfortunately the video about this technique was removed from Youtube.)
Dr. Mercola has an article about the Butekyo method. This looks like the same exercise:
Breathing Exercise to Quell Panic Attacks and Anxiety
Another breathing exercise that can help if you’re experiencing anxiety or panic attacks, or if you feel very stressed and your mind can’t stop racing is the following: Take a small breath into your nose; a small breath out; hold your nose for five seconds in order to hold your breath, and then release to resume breathing. Breathe normally for 10 seconds. Repeat the sequence: Small breath in through your nose; small breath out; hold your breath for five seconds, then let go and breathe normally for 10 seconds. This sequence helps retain and gently accumulate carbon dioxide, leading to calmer breathing and reduces anxiety. In other words, the urge to breathe will decline as you go into a more relaxed state.
Something very interesting noted in that article by Dr. Mercola, and the video that accompanies it, is that heavy breathing contributes to anxiety. Patrick McKeown (the gentleman in the video) explains that: Breathing heavier due to stress reduces carbon dioxide in the blood due to exhaling too much of it; the loss of C02 causes blood vessels to constrict. The main blood vessel to the brain can constrict up to 50% thereby reducing bloodflow to the brain. In response, the individual over-breathes more. It’s important to keep breathing calm and quiet when stressed – a deep breath that is very calm is completely different than a big breath that is stressed. His book is called “Anxiety Free.

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This is from Don Campbell, co-author of “Perfect Breathing: Transform Your Life One Breath at a Time.”
Instructions:
“Do this exercise five times a day and you’ll start thinking and performing better in no time:

  1. Inhale deeply
  2. Exhale with a short burst (as if blowing out a candle). This helps activate your diaphragm, which most people don’t use.
  3. Exhale with a long, slow finish to empty the lungs. Breathlessness comes from not expelling enough CO2.
  4. Inhale, filling your lungs from the bottom to the top, instead of taking short sips. Most use a third of their lung capacity.
  5. Hold for a moment to allow oxygen to saturate the cells.
  6. Exhale slowly and completely.
  7. Repeat steps 4 through 6 for five minutes.”

(source)

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