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The following is an example of how people learn dysfunctional breathing,
how it is perpetuated, and how it can be replaced with adaptive breathing
that serves respiratory physiology. For several years a professional healthcare provider was
frequently (weekly) unable to go to work, finding herself “without enough oxygen”
(breathlessness) usually immediately after having eaten breakfast. Her consultations with the medical
profession had led nowhere, only to psychiatric medications. Based on her own interpretation of the
symptoms, she was certain that underbreathing was her problem. Her solution was to implement relaxation
and breathing techniques she had previously learned about from books and
colleagues. Her ETCO2 levels were observed with an educational capnograph
(the CapnoTrainer®, manufactured by Better Physiology Ltd) at rest as well as
when challenged with specific tasks and emotions. There was no evidence of overbreathing, or
hypocapnia. Nevertheless, based on her
responses on the Breathing Interview Checklist (Litchfield) and the ensuing
interview, it was decided to introduce guided intentional overbreathing where
symptoms, emotions, and memories could be explored as her ETCO2
values slowly diminished. After about
a minute of increasing the depth of breathing while slowing the rate, her
ETCO2 dropped to about 28 mmHg, where upon she immediately
exclaimed that “this is exactly what happens to me, and now I won’t be able
to get out of it for the rest of the day!”
When it was pointed out that the procedure was identical to that which
she had described as her own solution to the symptoms, she was flabbergasted
when she could also see for herself that her solution to the problem was its
cause! When she was asked to reinstate her previous pattern of eucapnic
(normal PCO2) breathing, she failed to be able to do so. She was then coached for recovery, which
included the following elements: diaphragmatic breathing (to make breathing
easy), passive exhale (to eliminate intention), allowing for more transition
time between the exhale and the inhale (to extinguish fear), systematically
minimizing the size of the breath (the desired operant), and thoughts
about happy events (to change the state).
Within about four minutes her PCO2 levels normalized and
she felt relaxed and relieved. As
these instructions were not consistent with her belief system, she expressed
her incredulity about the success of taking smaller breaths over and over
again. Guided overbreathing was
introduced a second time, and once again she was trapped in her vicious
circle pattern and was unable to reinstate eucapnic breathing. After four or five occasions, however, with
PCO2 biofeedback she quickly learned (1) how to intentionally
create a hypocapnic state by overbreathing (negative practice), and then (2)
how to intentionally restore optimal respiration (35 -40 mmHg) while
experiencing hypocapnia. She was no
longer victim to her own learned vicious circle breathing behavior. Eating and breathing behaviors had become decoupled as a result
of being in a hurry to finish breakfast, with the result of disturbed
respiration and the associated hypocapnic symptoms, e.g.,
breathlessness. Besides not being
aware of the origin of the problem, nor of the behavior she had learned as a
consequence, both her interpretation (e.g., not getting enough O2)
of her symptoms (e.g., breathlessness) and her solution (e.g., big breaths)
to their amelioration were faulty.
Thus, her first step to resolving her vicious circle breathing pattern
was cognitive: to learn a new belief system about breathing based on the
facts, to interpret her own breathing experience in a new way, and to replace
her old hypocapnic self-talk, “I can’t get enough oxygen,” with new
self-talk, “my body knows what to do.”
These new cognitive behaviors are best learned through awareness
training during the interval between exhalation and inhalation, where and
when the brainstem reflexes can be identified and experienced. Allowing for the reflex, and feeling it in
action, builds a sense of confidence, an important new positive reinforcement
for learning new breathing behaviors. The second step was to identify the (operantly) learned
breathing behaviors (e.g., taking deep breaths) that steered her into
hypocapnia, the specific discriminative stimuli (e.g., feeling in a hurry
while eating) that triggered these behaviors, the classically conditioned
stimuli (small breaths) that triggered the emotions (e.g., fear) that
motivated the behaviors, and the reinforcements that maintained the behaviors
(e.g., fear reduction). Her learning
was based on PCO2 feedback where she learned about the effects of
breathing patterns on her physiology and psychology. The third step was to extinguish the conditioned fear response
(the CR) to small breaths (the CS), thereby removing the negative
reinforcement for bigger breaths (fear reduction). The fourth step was to learn new breathing
behaviors (e.g., taking small breaths) triggered by new discriminative
stimuli (e.g., early-on symptoms of hypocapnia), and new conditioned stimuli
(e.g., also early-on hypocapnic symptoms) that provided new sources of
motivation and reinforcement (e.g., instant relief) for the new
behavior. All of these learning
considerations were specific to the client and became embedded in her own
physiology, a part of who she is; they were not generic prescriptive
exercises simply imposed on a learned faulty breathing pattern. Copyrighted by Behavioral Physiology
Institute, Santa Fe, New Mexico USA |