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This meeting was held at the Royal Society of Medicine (RSM) on 6.10.08, attended by 60 people. It was organised by the RSM Section of Hypnosis and Psychosomatic Medicine, chaired by the president of the section, Dr Martin Wall. .
Two out of three patients present with ill health, functional somatic syndromes and persistent morbidity without medical explanation. This frustrates patients and doctors, and is estimated to cost the NHS £9 billion pa. The conference provides the evidence base that the cause of these is breathing pattern dysfunction (overbreathing). It recommends the NHS to teach patients and staff to breathe better by commissioning the self-help educational methods described (MBCT, yoga, Papworth)
2 Dr David Beales is a physician and independent GP practising hypnotherapy, Mindfulness Based Cognitive Therapy (MBCT) and whole person medicine, which he teaches to medical students. He spoke on breathing and behavioural change, from CBT to hypnotherapy, a subject which he has researched and obtained good results, making his work a pleasure, which he radiated. He may be contacted at email@example.com
He said that two out of three patients (70% of patients presenting to GPs in primary care, and 56% of those in secondary care) have symptoms (such as irritable bowel syndrome, fibromyalgia, panic attack disorder, chronic pain, loss of cognitive ability) which are medically unexplained (non-pathological) because their test results are normal. This frustrates patients and staff and cost the NHS around £9 billion per annum. In the USA Barsky estimated that the cost of medically unexplained and functional illness is $900 billion.
David believes that many of these symptoms can be explained by dysfunctional breathing. He quoted Carl Jung: Touch an emotional complex and the breathing changes…….Each breath has an emotional signature. He described the breath as the leader of the limbic system orchestra, from which the organs of the body take their cue. Good breathing creates good body chemistry, and bad breathing creates bad body chemistry and dis-ease.
The disease cycle starts with perceived threats to our security - stress. As a survival mechanism against rare physical danger (such as meeting a predator) our emotional brain and sympathetic nervous system is programmed with 200,000 year old software to react immediately with the adrenaline reaction of fight/flight. To prepare the body for the strenuous action required, our breathing automatically changes to fast and shallow into the top of our chest through our mouth, - overbreathing. When the stressor has gone, it takes our breathing at least 10 minutes to recover.
However, violent action is not appropriate for today’s stressors, which are typically parking fines, tax demands, messages on mobile phones from boss, partner, news bulletins, ‘Do not leave luggage unattended’ announcements. These stressors are not rare but semi continuous in many peoples lives, without sufficient recovery time, so overbreathing becomes habitual. This may lead to a vicious spiral - the worse we breathe, the worse our health becomes, so the worse we breathe…..
Breath volumes that are greater than metabolic need wash too much carbon dioxide out of our lungs. Below the normal level of around 35-40 mm of mercury, low carbon dioxide levels in the blood.causes respiratory alkalosis (pH above 7.45 cf normal 7.4) and hypocapnia, resulting in contraction of smooth muscle around air tubes and small blood vessels, leading to asthma and hypertension.
Hypocapnia also leads to the failure of haemoglobin to release enough oxygen to the cells (the Bohr effect) causing fatigue. Also renal compensation, releasing bicarbonates in an attempt to restore body PH. This interferes with many bodily functions including calcium deposition, producing osteoporosis in bones, supposed to be suffered by 1:3 elderly women and 1:8 elderly men.
Over breathing can be diagnosed with a questionnaire, such as the Nijmegen, when the score is 23 or above. It lists 16 symptoms, scoring 1 for rarely, 2 for sometimes, 3 for often, and 4 for very often.
Treatment. Much of the above mentioned frustration and money could be saved if doctors understood the cause and referred their patients to courses to teach them to breathe better. Good breathing is through the nose into the diaphragm, and is regular and appropriate for the body’s metabolic needs. At rest the rate should be 6 – 8 breaths per minute, (but the average is about 14) David uses a tool for patients to take themselves through a healing cycle using the pnemonic AWARE:
A- In the presence of an emotionally Arousing event. W – Watch you reaction on a scale of 1 to 10. Reduce Arousal by slowing the Respiration rate by lengthening the outbreath, through pursed lips, a throaty (ujjayi) breath, or by humming. Enjoy breathing in gently a remembered state of pleasure.
He demonstrated a volunteer fitted up with a nasal device to a capnograph machine. This measures carbon dioxide levels and showed them on the screen. She could control her own carbon dioxide levels by controlling her breathing. He teaches his patients to do this, usually in 1-3 sessions, with sometimes spectacular results.
He quoted a man who was cured in one session, and a woman who had been in and out of mental hospital for 2 years and had not responded to intensive CBT, who was substantially improved in 3 sessions.
3 Ranju Roy is a yoga teacher, and the former executive director of the Association of Yoga Studies. He also worked as an art therapist and family therapist in the NHS. He spoke on Breath body and mind, the animating principle of prana. He can be contacted at firstname.lastname@example.org
In both the yoga tradition and the ancient Indian medical system (ayurveda), disease is construed as a blockage of the smooth flow of prana (life force, akin to chi in the Chinese tradition). Symptoms are ‘the mind being troubled’ (dis-ease) with emotional tightness, negative thinking, trembling of the body and disturbed breathing.
Prana is the life force (vitality) and is thought to come into the body with the breath. He quoted ancient texts: ‘A healthy mind has an easy breath’, and ‘When the breath wanders, the mind is unsteady. When the breath is stilled, the mind is stilled, and the yogi obtains the power of stillness’ (health).
One of the aims of yoga is improvement of health by stilling down the mind/body system from a hyper-aroused state. This enables us to see more clearly. The inhale stimulates us and prepares us for action, (sympathetic nervous system) and the exhale calms us down so we recover (parasympathetic nervous system) He emphasised the importance of long, smooth exhalations: ‘As a lamp in a windless place doesn’t flicker’.
He taught us ujjayi breathing in which we partially close the glottis, caressing the throat so that a slight hiss can be heard. This enables us to listen to the breath, like the mindfulness practice of watching the breath. This practice is vital for good health.
He quoted: ‘Being aware of the breath forces you into the present moment – the key to all inner transformation. Whenever you are conscious of your breath you are absolutely present. You may also notice that you cannot think and be aware of your breathing. Conscious breathing stops your mind. And if you look more closely you will find that those two things – coming fully into the present and ceasing thinking – are actually one and the same thing – the arising of space consciousness.’ (Ekhart Tolle : A New Earth p 246)
Ranju then led us into various yoga practices and visualisations to help us become aware of hunched shoulders and to relax them, to open our constricted chest and also have a feeling of opening the central axis of our spine to allow prana to flow. This process was assisted by slow, tai chi like movements of our arms and trunk.
These made me feel more spacious inside. He quoted a Zen saying: ‘If you have an angry cow, put it in a big field’ Breathing can be the vehicle for spaciousness, to give ourselves and our emotions space. He agreed with a questioner that ‘Inspiration is like taking in spirit’, and that 'it’s as if we’re being breathed'.
Elizabeth Holloway is a research physiotherapist and PhD student at University College London. She has specialised in treating hyperventilation and asthma for over thirty years in the NHS and private practice. She spoke on Breathing and relaxation, integrated training (the Papworth method); effective and practical treatment for a wide spectrum of stress-related disorders. She can be contacted at email@example.com
The importance of good breathing has become neglected in modern conventional healthcare, but this was not so 40 years ago. She defined normal breathing as ‘appropriate to current metabolic needs’. Abnormal breathing may be obvious, (acute hyperventilation) but it may also be subtle, nevertheless causing the chronic ill health described above by Dr Beales.
The symptoms of over breathing are suffered by many people. For example, asthma, is diagnosed in over 5 million people in UK (8% or 1 in 12 of the population, and over 300 million people worldwide). She believes that relevant factors in asthma and many other diseases are inappropriate breathing habits.
To correct these, the Papworth method was developed in the 1960s in the Department of Respiratory Medicine, Papworth Hospital, Cambridge. Severely affected patients were admitted for 3 weeks to remove them from the stress of their normal life. They received two, 20 minute treatments per weekday, totalling 30 in all. Trigger factors were identified, such as tight jeans or corsets, and habitual stress.
Together with relaxation, breathing from the diaphragm was taught progressively. First, resting, (at a rate of 6 breaths a minute), progressing to standing and speaking, and incorporating visualisation of a pleasant scene. The patients were encouraged to spend their spare time practising these techniques to prepare them for return to everyday life and stressful situations.
We were invited to try the Bukeyto breath hold measurement of how many seconds we could hold our breath after the exhale while resting. (I did 17 seconds) Less than 20 is considered over breathing, but some were less than 10.
Elizabeth then demonstrated the Papworth treatment on a volunteer lying on a couch with a pillow under her knees to relax her diaphragm. She used her hands to encourage a reduction in the patient’s upper chest movement and to enable gentle diaphragmatic/abdominal breathing.
She created an atmosphere of calm and tranquillity, and took the patient’s awareness systematically through her body, tensing and relaxing muscles in turn, twice suddenly and the third time slowly. She led her through a guided visualisation, talking to her body, and telling it to let go of tensions, and reminding her to breathe gently into her abdomen.
My impressions were as follows: The patient went into an altered state of consciousness in which her breathing became normal of its own accord. The Papworth method’s repeated teaching of this for 30 sessions over 3 weeks, together with ample spare time between them to practise on their own and with fellow patients could break the habit of hyperventilation, thereby effecting a cure. Many complementary and alternative treatments now use similar relaxation and visualisation techniques to equally good effect.
5 Conclusion – overbreathing causes ill health in most of the population
Most healthcare staff have been taught to believe that breathing is unimportant, so neglect it in both their patients and themselves. On the contrary, breathing is actually the most important thing in life, as we breathe in both oxygen and vitality, and die without them.
Two out of three patients demonstrate breathing pattern dysfunction, blocking their vitality by reducing their carbon dioxide, and contributing to (if not causing) their dis-ease. Direct measurement of carbon dioxide is an important diagnostic and feedback tool.
Breathing depends on our emotions, and is like the conductor of our internal orchestra (our physiology via our autonomic nervous system) When we are stressed (as most of us frequently are) our breathing rate is fast and chaotic causing the adrenaline reaction of fight/flight. Habitually this may set up a vicious spiral of chronic overbreathing and ill health, with or without abnormal test results (pathology).
6 Recommendation - commission self-help breathing treatments in the NHS
Post Darzi the NHS has the new aim of improving health by teaching patients self-help, (as well its old aim of alleviating sickness). NHS should therefore commission the treatments and courses described in this conference - yoga, Papworth method and MBCT (which is recommended by the National Institute of Clinical Excellence, NICE, see paper ‘Improving Health by ending the Prozac Nation, section 9.28 of www.reginaldkapp.org).
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