Emma (not her real name) came to see me recently because she was struggling with panic attacks. She had been to see a counsellor in the past about it but that hadn’t seemed to work. So she contacted her doctor who gave her some medication, but she didn’t like the side effects. Her doctor had also referred her for CBT but there was a long waiting list and she was keen to improve her panic attacks as soon as possible. As a last resort she did some research and read that hypnotherapy can help with stress and anxiety and so she called me and booked an appointment.
Her panic attacks were getting quite severe and she had many of the common symptoms:
- An overwhelming feeling of fear
- Her heart racing
- Her mind in overdrive
- Shortness of breath
- A dry mouth
- Feeling hot and sweaty
- Feeling faint
A big part of the work that I do with clients is helping them to understand their anxiety better. I explained to Emma how the Stress Response is triggered when we perceive ourselves to be in danger (real or imagined) and all the symptoms she experiences are just the bodies way of preparing for fight or flight. I also explain to clients that the chances of fainting as a result of a panic attack are very rare. When we are anxious our blood pressure increases but generally we only faint when our blood pressure decreases.
During Emma’s first session we did some very simple hypnotic relaxation. This engages the parasympathetic nervous system, responsible for rest and relaxation. As I record every hypnosis session that I conduct, Emma was able to listen to the recording daily for 2 weeks until her follow up appointment. This meant that she was able to experience 15 minutes every day of deep, beneficial relaxation.
At her 2nd appointment Emma explained that she was already starting to feel calmer in general but had still had a couple of uncomfortable panic attacks. We discussed this in detail to understand more about how they start, where they happen, what she is thinking before an attack, what she is doing etc.
Emma explained that usually her first awareness that a panic attack is going to happen is a shortness of breath, followed by heart palpitations. This is very common as people with anxiety disorders tend to notice and focus on, rather than ignore, physical sensations. They then misinterpret normal bodily feelings as being abnormal, leading to feelings of worry and anxiety. For example, by rushing up the stairs to a meeting Emma found herself out of breath. Rather than attributing this to the exertion, Emma started to panic because she was out breath, and that usually means that she is going to have a panic attack.
Breathing is something that is fundamental to our survival and yet we take it for granted. Each time we breathe we bring oxygen into the body and release the waste product carbon dioxide. Poor breathing impacts on the balance of these gases in your body, making it harder to deal with stressful situations.
Chest, or thoracic, breathing is shallow and often irregular and rapid. It can cause symptoms such as light-headedness, heart palpitations, numbness, tingling and shortness of breath. It leads to a decrease in carbon dioxide levels in the blood, which in turn leads to too little oxygen reaching the brain and other parts of the body. In severe cases chest breathing can lead to hyperventilation, but for many people it is milder and can go unnoticed for years.
On the other hand, abdominal, or diaphragmatic, breathing is our natural breathing pattern and it is what we do when we are asleep. When we inhale the abdomen expands drawing air deep into our lungs. Diaphragmatic breathing is slower and deeper and more relaxing than chest breathing.
Working with Emma on her breathing technique would help to balance the oxygen and carbon dioxide levels in her blood, normalise her heart rate, reduce muscle tension and anxious thoughts. Diaphragmatic breathing is also a great way to trigger the parasympathetic nervous system and to elicit the relaxation response.
The technique below that I showed Emma is taken from The Relaxation & Stress Reduction Workbook but there are lots of different techniques you can try.
- Find a time and place where you won’t be disturbed
- Try to breathe through your nose
- Find a comfortable position that you are going to be able to relax in
- Scan you body and release any tension
- Take a moment to become aware of how you currently breath. Place your hands on your chest and your stomach and notice which hand rises the most when you inhale
- Then exhale forcefully but slowly to empty your lungs. This will create a vacuum that will pull a deep breath into your abdomen
- As you inhale imagine that your abdomen is a balloon and that as you inhale you are filling it full of air. You will feel the hand on your stomach gently rise as the abdomen expands.
- Once you know what it feels like to breathe from your diaphragm you can inhale slowly through your nose and then breathe out slowly through your mouth as though you are breathing out through a straw. Take long, slow, deep breaths that raise and lower your abdomen.
- If any thoughts, feelings or sensations catch your attention, just notice them and return to your breathing.
- Practice diaphragmatic breathing 5-10 minutes every day. Work on extending the time you practice up to 20 minutes.
Emma came back to see me 2 weeks later. She said that once she had got past the uncertainty of what she was doing she started to become more aware of her abdomen rising and falling. This made her more confident with what she was doing and more able to relax into the practice. She practiced most days and had started to notice throughout the day that her breathing had become deeper and slower in general. She had learnt that if her breathing did start to become shallow or rapid, rather than panicking, she just took a few moments to take her attention back to her breathing and take a couple of deep breaths. She found this helped to settle her down and she was able to focus her mind again on the task at hand. She’d also noticed that her panic attacks were getting less frequent and less severe.