A major part of suffering comes with the inability to shift unhelpful, negative focus on troubling thoughts and feelings.   This cognitive reality is common in all the major mental health problems people suffer from: anxiety, depression, trauma, substance abuse, and eating disorders. Due to the lack of “wise-mind” skills most people suffering from these conditions hope their medication/s will help (and sometimes they do), and they become experts in self-medicating with short-term reinforcement (substance use, eating, anger, cutting, mindless consuming, etc.).  The self-medication habit simply leads to more suffering; after short-term relief, not only is the original problem the same but now new problems develop (addictions, obesity, consequences of outbursts, escalating self-mutilation, debt, etc.).  Mindful use of the breath can counteract this stuck attention, and prevent it from becoming secondary suffering – suffering more because of my thoughts and feelings about suffering now.   Note that heavy smokers will have difficulty doing these breathing techniques.  Before engaging in breath retraining work, check with your client to see (1) if they have a respiratory or cardiac condition, (2) if they  suspect that past unresolved trauma may cause intense limbic reactivity, (3) if they are aware of having any polyvagal dysfunction, and (4) if they suspect that a prior brain injury has impacted their breathing process. Implementing breath retraining in such cases will require much greater care and awareness on the part of the helper, and may necessitate a medical consultation..

The techniques noted here may be helpful for relaxation or stimulation as well as diverting stuck attention on unhelpful thoughts and feelings.  Always remind your client that they can stop at any time they feel discomfort beyond their coping capacities. After each practice, process outcomes with the client. Periodically check in with the client to see if they wish to continue. It helps to do the same breathing technique the client is doing. Now to the ten techniques.

1) Mindful awareness only: In this practice paying close attention to the way the breath is right now without any evaluations of adjustments.  Just paying close attention to breath as it is now.  Continue the practice for about ten full breaths as they are.

2) Deep, Slow, Calm Inhalation: In this practice simply ask the client to breathe in a deep, slow, calm manner.  They need to pay close attention to the inbreathe only.  Continue to six deep, slow, calm inhalations.  For most people inhalation is a little energizing.

3) Deep, Slow, Calm Exhalations: Do the same breath, but this have the client pay complete attention to only the exhalation phase.  For most people exhalation is relaxing. Do six breaths.

4) Short Hold on Inhalation: Do breath technique number 2, but this time have the client hold for the count of four at the end of inhalation.  Do five breaths.

5) Short Hold on Exhalation: Do breath technique number 3, but this time have the client hold for the count of four at the end of the exhalation. Do five breaths.

6) Slightly Extend Exhalation: Do breath number 3 again, but this time have your client slightly extend their exhalations for the count of four.  Lungs should fill accordingly, so they can continue to extend their exhalations to the count of four but not beyond.  Do four breaths. Observe carefully, since clients who extend beyond the count may experience light-headedness – very uncomfortable. It will limit any interest they may have in learning breathing techniques.

7) Square Breathing: Have clients do deep, slow, calm breathing and at the same time imagine following (with attention) their breath by making a square going right from the top of the lungs , down the right side, going left across the lower belly, and moving up the left side of the lung. Slow this down a bit. Complete five breaths.

8) Basic Three-Part Breathing: Have your client focus attention on the feeling of air flowing in and out through the tips of their nostrils for three breaths. Then move attention to the feeling of air flowing into and out of the lungs for three breaths – usually “felt” in the chest. End with attention being focused on the lower belly as it moves when lungs fill with and empty out air for three breaths.  End with the client following the flow of air sensation in their body from nostrils, though lungs/chest, and ending in belly. Complete four breaths.  This is good interoception training; such training allows clients to expand their inner body awareness.  Such expansion is sometimes required in body based trauma work as well as the feelings of the anxious and depressed body.

9) Mantra Breathing: Use either a brief ancient mantra or simply make one up that may help your client.  Your client may want to make up their own self-help mantra. Do deep, slow, calm breathing – but on the inhalation begin to say a private speech mantra like “I am good,” or “I can do this,” or “impermanence ends suffering,” or “over-attachment causes suffering.” or anything the client thinks may be helpful to them.  Continue the subvocal statement to the exhalation. Complete five mantra breaths.

10) Excitation Breath: For some depressed and/or fatigued clients a brief experience with stimulating, excitation breath may be helpful.  Do not do this if your client has a history of hyper-ventilation, respiratory or cardiac problems.  Complete three to four to five breaths, then check in to see if continuation is warranted.  Do very rapid, shallow breathing. See if it helps with mood.  Do not do more than two sets of breaths.

Hopefully your clients may benefit from learning ways to shift their stuck attention on problematic negative thoughts and feeling – and at the same time enjoy the many benefit of variation in breath.  Remember to consult medically if you have any information suggesting this should occur.

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness

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