Controlled or abdominal breathing

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When tense, a person’s breathing is rapid and shallow, which can lead to hyperventilation or panic attacks. Hyperventilation is a process where shallow breathing gets rid of too much carbon dioxide which can lead to light-headedness, breathlessness, feeling of suffocation, blurred vision, and numbness or tingling in hands or feet as well as a hot, flustered feeling. Mild hyperventilation can lead to increased perpetual anxiety and apprehension [1210].

When teaching clients breathing retraining, it is important they understand and feel the difference between shallow, chest-level breathing and controlled, abdominal breathing. A good way to do this is to ask clients to practice each type of breathing. However, it is important to inform clients who are extremely anxious that they may experience trouble breathing deeply and may need to try this when feeling less anxious (some clients may always have trouble with this). Encourage clients to increase their breathing speed. Ask them to place their hand gently on their abdomen and feel how shallow and rapid their breathing is, only the chest moves up and down. Compare this with abdominal breathing based on the following instructions for the client provided by Lee and colleagues [310]:

  1. Rate your level of anxiety on a scale from 1 to 10.
  2. Sit as comfortably as possible in a chair with your head, back and arms supported, free legs and close your eyes (if you like).
  3. Place one hand on your abdomen right beneath your rib cage
  4. Inhale deeply and slowly, send the air as low and deep into your lungs as possible. If you are breathing from your abdomen you should feel your hand rise, rather than your chest.
  5. When you have taken a full breath, pause before exhaling. As you exhale imagine all of the tension draining out of your body.
  6. Do 10 slow abdominal breaths. Breathe in slowly counting to four, before exhaling to the count of four (four seconds in, four seconds out). Repeat this cycle 10 times. Hold final breath for 10 seconds, then exhale.
  7. Now re-rate your level of anxiety and see if it has changed.

Controlled breathing techniques can help reduce overall levels of tension and are a useful strategy to use when faced with high-anxiety or high-risk situations when relapse is likely. A client worksheet for abdominal breathing is included in the Worksheets section of these Guidelines.