Monday, May 15, 2000
Health
By Carol Krucoff
THINK you know how to breathe? Try this simple test: Sit or stand
wherever you are and take a deep breath. Then let it out.
What expanded more as you inhaled, your chest or your belly? If the
answer is your chest, you're a "chest breather,'' and like most people
you're doing it all wrong. You're also putting your health in jeopardy.
The technique is so powerful that Dr James Gordon teaches it to nearly
every patient he sees, from people with advanced cancer to those
crippled by arthritis to school children struggling with attention
deficit disorder.
"Slow, deep breathing is probably the single best anti-stress medicine
we have,'' says Gordon, a clinical professor of psychiatry at the
Georgetown University School of Medicine and director of the Center for
Mind-Body Medicine in the District of Columbia, the United States. "When
you bring air down into the lower portion of the lungs, where oxygen
exchange is most efficient, everything changes. Heart rate slows, blood
pressure decreases, muscles relax, anxiety eases and the mind calms.
Breathing this way also gives people a sense of control over their body
and their emotions that is extremely therapeutic.''
Obviously, everyone alive knows how to breathe. But Dr Gordon and other
experts in the emerging field of mind-body medicine, say that few people
in Western, industrialised society know how to breathe correctly. Taught
to suck in our guts and puff out our chests, we're bombarded with a
constant barrage of stress, which causes muscles to tense and
respiration rate to increase.
"Look around your office, and you'll see so little movement in people's
bellies that it's a wonder they're actually alive,'' Dr Gordon says.
"Then watch a baby breathe and you'll see the belly go up and down, deep
and slow.''
With age, most people shift from this healthy abdominal breathing to
shallow chest breathing, he says. This strains the lungs, which must
move faster to ensure adequate oxygen flow, and taxes the heart, which
is forced to speed up to provide enough blood for oxygen transport. The
result is a vicious cycle, where stress prompts shallow breathing, which
in turn creates more stress.
"The simplest and most powerful technique for protecting your health is
breathing,'' asserts Andrew Weil, director of the Program in Integrative
Medicine and clinical professor of internal medicine at the University
of Arizona in Tucson. Weil teaches "breathwork'' to all his patients. "I
have seen breath control alone achieve remarkable results: lowering
blood pressure, ending heart arrhythmias, improving long-standing
patterns of poor digestion, increasing blood circulation throughout the
body, decreasing anxiety and allowing people to get off addictive
anti-anxiety drugs and improving sleep and energy cycles.''
Unlike any other bodily function, he notes, "breathing is the only one
you can do either completely consciously or unconsciously. "It's
controlled by two different sets of nerves and muscles, voluntary and
involuntary. And it's the only function through which the conscious mind
can influence the involuntary, or autonomic, nervous system, which is
responsible for revving-up the body to fight or flee.
"Western medical education at the moment doesn't include information of
this kind,'' says Weil, who teaches breathing and other non-traditional
techniques to what he calls "doctors of the future'' through a variety
of programmes at his institution. "In the four years I spent at Harvard
Medical School and a year of internship in San Francisco, I learned
nothing of the healing power of breath. I learned about the anatomy of
the respiratory system, and I learned about diseases of the respiratory
tract.
But I learned nothing about breath as the connection between the
conscious and unconscious mind, or as the doorway to control of the
autonomic nervous system, or about using breathwork as a technique to
control anxiety and regulate mental states, or the possibility that
breath represents the movement of spirit in the body and that
'breathwork' can be a primary means of raising spiritual awareness.''
Eastern healing techniques often prescribe conscious breathing to help
restore health to people who are overly stressed.
"In Japan, a diagnosis of autonomic nervous system imbalance is common,
but in the medicine of the West, we don't have this diagnosis,'' he
says. "Western medicine typically tries to blunt the overactivity of the
sympathetic nervous system or deal with its consequences at a more
superficial level by giving drugs to suppress or control it.''
In contrast, relaxation breathing works to increase parasympathetic
tone, slowing down the heart rate and decreasing blood pressure,
bringing the two systems into balance. And unlike drugs, he says, "it's
free of toxicity, it's free of cost, and it's literally right under our
nose.''
Techniques that use focused breathing to affect the nervous system,
change physiology and connect the body with the mind can be traced back
to ancient India, notes Weil, who learned the breathing techniques he
uses through the study of yoga and by working with osteopathic
physicians.
"In many languages, the word for breath is the word for spirit,'' he
notes, citing the Latin spiritus, Hebrew ruach, Greek numa and Indian
prana. We lose this linguistic connection in English, he says, except
with the words "respiration'' and "conspire.''
Many systems of meditation and numerous spiritual practices also centre
on conscious breathing, Weil notes in his recently released CD,
Breathing: The Master Key to Self Healing (Sounds True, 1999). "By
simply putting your attention on your breath without doing anything to
change it,'' he says, "you move in the direction of relaxation.'' Or as
yoga master B.K.S. Iyengar explains in his classic guide, Light on Yoga
(Schoken Books, 1966): "Regulate the breathing, and thereby control the
mind.''
There is little scientific research documenting the healing power of
breathing, in part because its practice is so new in Western medicine.
And unlike drugs or devices, breathing has no manufacturer who must
sponsor studies to support its use.
Increased interest in studying the effects of non-traditional healing
therapies such as relaxation breathing led to the founding in 1991 of
the Office of Alternative Medicine, now the National Center for
Complementary and Alternative Medicine, at the National Institutes of
Health.
One of the few studies to examine a clinical application of yoga "belly
breathing'' found that menopausal women who learned the technique were
able to reduce the frequency of hot flashes by about 50%.
"The average breathing rate is 15 to 16 cycles (inhaling and exhaling)
per minute,'' notes Robert Freedman, a professor of psychiatry and
behavioral neurosciences at Wayne State University School of Medicine in
Detroit. "But with training, women can slow their breathing down to
seven or eight cycles per minute, which can significantly reduce the
frequency and intensity of hot flashes.''
Mind-body approaches have been reported in scientific studies to be
effective in the treatment of a variety of stress-related disorders,
says Herbert Benson, an associate professor of medicine at Harvard
Medical School and president of the Mind/Body Medical Institute in
Boston. As an example, he points to research showing that chronic-pain
patients who learned mind-body self-care techniques in a 10-week
outpatient program reduced clinic visits by 36% for more than two years
after the classes.
Deep diaphragmatic breathing and other mind-body techniques can
significantly reduce symptoms of severe PMS as well as anxiety,
depression and other forms of emotional distress, according to research
by Alice Domar, an assistant professor of medicine at Harvard Medical
School and director of the Mind/Body Center for Women's Health.
In addition, her studies suggest that these practices can combat
infertility. After completing a mind-body group program for women with
infertility--where 284 participants learned a variety of self-nurturing
techniques such as deep breathing--a surprising percentage of women,
44%, conceived within six months.
Proper breathing is the first thing Domar teaches virtually all her
patients. To teach the technique, Domar has patients make a fist and
squeeze it tight. "Then I ask them what happens to their breath, and
they realize that they've stopped breathing,'' she says. "When we get
anxious, we tend to hold our breath or breathe shallowly.''
Domar then shows patients how to breathe deeply into the abdomen, a
process most women tell her runs counter to the "hold in your stomach''
breathing they've done all their adult lives.
Domar's favourite stress-reduction technique is a short version of this
breath-focus exercise, which she calls a "mini-relaxation,'' or "mini.''
"You can do a mini when you're stuck in traffic, at a boring meeting,
whenever you look at a clock or any time you pick up a phone,'' she
says.
In our stressed-out world, the fight-or-flight response that kept our
ancestors alive has turned into a "stew and chew,'' contends Pamela
Peeke, an assistant clinical professor of medicine at the University of
Maryland, who studied the connection between stress and fat at the
National Institutes of Health. If no physical response occurs after
stress revs the body up for battle, chronically elevated levels of
stress hormones stimulate appetite and encourage fat cells deep inside
the abdomen to store what she calls "toxic weight.''
Peeke encourages Eastern movements, such as yoga and tai chi, which rely
on taking deep abdominal breaths. But she particularly urges patients to
do aerobic activity to help neutralize the effects of stress.
In hospitals, breathing techniques once were taught only to women for
use during childbirth. Today, some hospitals have begun teaching
relaxation breathing to patients of all ages and both sexes being
treated for a wide range of conditions. At the Washington Hospital
Center in the District of Columbia, nurse Julie Oliver incorporates
breathwork into support groups she leads, including one for people with
congestive heart failure and another for parents of babies in the
Neonatal Intensive Care Unit.
"Babies, especially premature babies, can sense how the mother and
father feel,'' Oliver notes. "If the parents go in full of muscle
tension and start jiggling the baby, the baby gets too stimulated, and
the staff may need to tell the parents to back away, which adds to
everyone's stress.''
At Duke University Medical Center in Durham, North Carolina, nurse Jon
Seskevich has taught "soft belly breathing'' to most of the more than
15,000 patients he's worked with since he became a full-time stress and
pain management educator for the hospital in 1990. About half the
patients he sees have cancer, and the others have a wide variety of
ailments including heart disease, cystic fibrosis and lung disorders.
One of his most dramatic cases involved a lung-cancer patient.
"I walked into the room to find this very large man literally fighting
for breath,'' Seskevich recalls. "His pulse oxygen was 74, and you want
it to be 90 or above. I sat down next to him and started talking in a
calm voice. I asked him if it was okay if I touched his belly. He
nodded, so I put my hand on his belly and told him to breathe into my
hand, to let his belly be soft and to let his abdomen rise into my
hand.''
After about six minutes of this, the man's pulse oxygen was 94 and he
was breathing comfortably. "I didn't tell him to relax,'' Seskevich
notes. "All day people were telling him to relax, and it seemed to make
his struggle worse. I just told him to breathe softly into his belly. We
didn't cure his cancer, but we may have saved him a trip to the
intensive-care unit.''
Patients are hungry for self-care information, says Seskevich.
"People are very anxious to learn what they can do for themselves,'' he
says. "They become empowered by these techniques and they do better.''
"There are a lot of health professionals today who aren't satisfied with
the tools they have, and to some extent feel lost,'' says Gordon of
Washington's Center for Mind-Body Medicine. "They are looking for ways
they feel they can help people again, that will put meaning back into
their practice.''
Weil's Integrative Medicine programme recently graduated its first class
of physicians, is starting an Internet-based associate fellowship
program, and is launching a continuing-education program for
psychiatrists, oncologists and cardiologists all of which will include a
unit on breathing and breathwork. Harvard's Mind/Body Medical Institute
has 14 affiliate programmes at hospitals around the country and is
negotiating with at least one other.
As graduates of these and similar programs bring mind-body strategies to
their practices, teaching breathwork and other forms of self-care will
soon become a common part of American medical care, these experts
predict.
"Sometimes I suggest my patients make signs to post in their office, at
their computers, or in their bedrooms,'' Gordon writes in his Manifesto
for a New Medicine (Addison-Wesley, 1996). "Signs that simply say,
'Breathe!' ''--LAT-WP
Carol Krucoff is co-author, with her husband, Dr Mitchell Krucoff, of
Healing Moves: How to Cure, Relieve, and Prevent Common Ailments With
Exercise'' (Harmony Books, 2000).
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