I know! Belly breathing sounds gross. A bit too…er …physical, or embodied. But how else can I communicate the need for us all to breathe deeply? Of course we breathe in our lungs. Yet somehow, experientially, most of us associate our lungs with our heads or our necks, rather than deep in our bodies. So I call it belly breathing.
Belly breathing in a slow and practised way brings clients more fully into their bodies. It is very effective for relieving anxiety, for centring the self. It is drug-free, and costs nothing. It is pleasurable. And if practised regularly gives clients a sense of agency in dealing with life’s challenges. It is helpful for most dissociative clients. Belly breathing may take some time to become automatic, but most will feel a difference after two weeks of daily practice. If practised over months, most anxious clients report a really substantial change in their well-being.
The following is my protocol for teaching Slow Belly Breathing (I have gathered fragments from here and there to create this protocol):
“We are going to check your breathing rate to see if your breathing patterns are making you feel worse. Would that be ok? So, in a minute I’m going to ask you to count your breaths. I will say “Go” and then a minute later I will say, “Stop”. In between you will be counting each breath. Like this” (I demonstrate with my hand the rise and fall of a breath as a count of one breath). “You can’t get this wrong, but try to breathe in your normal way. Of course it’s a bit artificial here, but I won’t be watching you, I’ll be looking at the clock.” (Often I will write a couple of notes in the file as they count so they can relax more.)
I wait for the second hand to reach 12 and say, “Start”. Then at the full minute I say “And stop.”
I ask the client how many breaths and I write it down. (12-14 is a good range, or even lower) Some clients are breathing 24 breaths a minute (a near panic attack?), so it will be a big change for them. Many score about 17 breaths per minute.
Then I begin to talk about how we might be able to improve this score, and explain some of the symptoms of over-breathing (e.g.. Dizziness, nausea, panic etc.) I ask if the client would like to learn to improve their breathing. I also make sure that they understand that if this work makes them feel worse, to let me know: it is supposed to feel good, even if it is tricky at first. I then hand them a clipboard and a pen, so they can write down anything that will help them remember how to do this. I often use the whiteboard to note important parts of the process.
I ask the client to think of a saying like, “I am getting more and more relaxed everyday” or a song lyric, poem, Bible verse etc. that will last about 5 seconds. We play around with this, getting confused and playful together. Messy and laughter is good!
Once we have found a saying (and I have written it on the board), I get them to write it down and say it out loud looking at the second hand on a clock, seeing if they can get their words to end at about the five second mark. We may do this for a few minutes.
Then I get them to do the same internally, no words spoken. Timing it, feeling the rhythm.
The client then is asked to breathe in and out within about 5 seconds. I use my hand, raising it for the in breath, and lowering it for the outbreath. We play with this until a rhythm is found. I try to make it a bit ridiculous or playful. I also tell them to be careful of not breathing out fully enough (or the room will spin). We practice making sure they are getting it. (Note: all this fluffing around builds the relationship, slows everything down, models the mindfulness of this practice.)
Then I explain the next step is like patting your head and rubbing your tummy at the same time! We put it together so the client is saying the saying and breathing in and out so their breath and “the saying” end at the same time. At first, I may say the words out loud for the client to minimise the complexity of this.
We practice for a couple of minutes until the client has mastery, and then we plan the home practice. (Always check that the client is finding the process helpful, rather than triggering!)
Some clients are not breathing deeply into their diaphragm, and this will lead to dizziness or over-breathing. I then focus on getting the client to imagine they are trying to get the breath down into the pelvis. We practise together, deliberately pushing our bellies out as we breathe in. (Because I have a big belly most clients get past their own embarrassment! Oh dear.) Some clients continue to raise their shoulders as they breathe in so we may need to lie on the floor together so they can get bio-feedback as they try to change to belly breathing. It may take some weeks to change, so I simply say to clients not to stress, but to be gentle and uncritical as they try to make changes to their pattern of breathing. I reassure them it will be worth the effort.
At home, I recommend to clients they practise two times a day for 5 minutes until our next session. It is best to choose the most relaxed time of the day. Some clients can only manage to practise at night. That’s ok. I try to make sure they know this is not a test: it is a tool for them to use. It will just take longer if they can’t practise, that most clients say it makes them feel so good they want to practise.