Remember to Breathe

The year 2020 has been a challenging year. A global pandemic, global warming, the current socio-political climate and a looming presidential election with its potential social and economic consequences have been plastered on our news feeds, discussed (or more accurately announced) on social media platforms, broadcast on television networks and have been at the forefront of everyone’s thoughts and discussions. Things are incredibly polarizing these days. This has led to increases in stress, anxiety and depression in the general population and in frontline or healthcare workers.1-3 It’s often difficult to identify, diagnose or treat these challenges.

As a pediatric pulmonologist, I have encountered an increase in what I believe to be anxiety or stress related respiratory symptoms since the pandemic’s onset. While it’s not always easy to identify or establish these challenges, I’m often able to rule out other more obvious diagnoses (e.g. asthma, allergies, respiratory infections etc.). When it comes to treating these conditions, if suspected, it can be even more challenging. There are times when a psychiatric professional may be helpful and even necessary, however there may be other options.

Remembering to breathe may have more benefits than you think. We continue to better understand the physiology and the biology of stress and how it impacts the body. Through this improved understanding, we’re also able to identify novel ways to intervene, including the use of breathing and meditation techniques.4, 5  When we are stressed out (e.g. being chased by a lion) we breath very quickly, leading to short, sometimes shallow breaths. This is a manifestation of the sympathetic response (the fight and flight component of our autonomic nervous system). When we’re relaxed (just after eating a meal, when we’re sleeping), we breathe deeply and more slowly, and this has been correlated to an increase in parasympathetic activity (the rest and repose component of our autonomic nervous system).

While the science isn’t perfect, there are several studies that highlight this relationship between breathing and the brain. It appears Sudarshan Kriya yogic breathing (cyclic breathing ranging from slow, calming to stimulating and fast) and pranayama (slow, deep breathing) have been associated with reductions (improvements) in negative emotional states including stress, depression, PTSD, anxiety and insomnia (reviewed in accompanying citations).4-6 While the biology or physiology behind this isn’t entirely clear, there is more and more evidence supporting the mental and physical benefits to controlled breathing techniques.

I suspect that we can all benefit from some form of stress reduction through controlled breathing. If there are substantial benefits to our mental and physical health with almost no side effects (except that we have to commit time to the practice), then I believe it’s really something we should consider prior to initiating anxiolytic medications. The trick is, how to implement the breathing techniques?

There are many resources available to help learn how to be mindful, how to meditate, or how to practice some form of controlled breathing. There are also great resources for helping you understand the impact stress has on our bodies. I suggest reading/listening to a few resources and choosing what works best for you. Below are a list of some that I have used:

Books:

 

Podcasts/Apps:

I’ve also found the process of focusing on my breath or thinking about nothing/emptiness incredibly challenging. For me, it was helpful to grasp onto something physical to promote or dictate how my breathing might manifest during these sessions. I’ve appreciated using The Shift, a wearable (low-tech) device made by Komuso Design (www.komusodesign.com) that helps to slow down my breathing (NOTE: I do not have any financial relationship to Komuso Design). It’s a physical object that helps me to focus on my breathing, something I’ve found quite difficult to do with my wandering mind.

We have a long way to go, as we work to recover from the current challenges to our society. As we move forward, please remember to breathe. It may help in more ways than you think.

 

Additional Helpful References:

  1. Antonijevic J, Binic I, Zikic O, Manojlovic S, Tosic-Golubovic S, Popovic N. Mental health of medical personnel during the COVID-19 pandemic. Brain Behav. 2020:e01881.

  2. Gallagher S, Wetherell MA. Risk of depression in family caregivers: unintended consequence of COVID-19. BJPsych Open. 2020;6:e119.

  3. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. The New England journal of medicine. 2020;383:510-2.

  4. Jerath R, Crawford MW, Barnes VA, Harden K. Self-regulation of breathing as a primary treatment for anxiety. Appl Psychophysiol Biofeedback. 2015;40:107-15.

  5. Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses. 2006;67:566-71.

  6. Jerath R, Beveridge C, Barnes VA. Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Front Psychiatry. 2018;9:780.