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“It just seemed... almost too simple,” a patient remarked during their second biofeedback therapy session with me. “It” was the diaphragmatic breathing, or breathing deeply into one’s lungs with the contraction and expansion of the diaphragm, I had asked the patient to practice over the previous week and, really, it is almost too simple. Diaphragmatic breathing is breath in its most natural state; it’s how babies breathe and how we breathe when we sleep. What it is not is the breath of most of us going from day-to-day, feeling busy and stressed and always thinking about the next task to cross off our never-ending to-do lists. No, our breath resides in our chest, where it does nothing but engages our stress response cycle and increases our heart rate and muscle tension.
While it may seem funny to think about an automatic physiological process—and, further, to bring it into the therapy room—doing so is a simple and easy way to bring about relaxation. It’s at this point in my explanation of relaxation tools that I feel like some of the patients I encounter think they’re being swindled. I get looks that speak volumes:
Wait a minute, dear. I come here and tell you about the 234 things that are stressing me out, and you’re telling me what I need to do is think about my breathing? Did you not hear how complicated my day-to-day life is? And you’re telling me you I’m just breathing incorrectly?
I can empathize with expecting a complicated fix for a complicated problem, particularly when patients have been managing chronic, debilitating medical illnesses. But after experiencing a multitude of medications, medical interventions, and psychotherapeutic intervention techniques, something simple and tangible is often a welcome change.
I’m never quite sure if patients are laughing at me or with me when I hand them “high-tech equipment,” or brightly colored stickers, to aid in their practice of diaphragmatic breathing. I suggest they put the stickers in places they encounter frequently, like a steering wheel, bathroom mirror, or refrigerator door, and check where their breath is every time they see a sticker. If they notice only their chest and shoulders are engaged in their breathing pattern, I recommend they take a few minutes to practice breathing more deeply and fully, engaging their diaphragm. I emphasize that it will take practice and time but that our breath is a powerful tool we have control over.
As with any recommendation, some patients will practice and some won’t. Further, of those who do practice, some—and I’d argue more—will report positive outcomes and some won’t. If nothing more, they have taken a few minutes throughout their week to engage in a healthy behavior and to connect with their bodies. And sometimes, the simple, doable exercise they’ve done has a substantial impact. For instance, that patient I mentioned earlier? The one acknowledging the simplicity of recognizing their breath? That patient has gained control over their hypertension and halved their blood pressure medication. It would be naïve for me to assert that diaphragmatic breathing is the only factor that caused this change, but I also believe it would be remiss to dismiss its role.
