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Breathing techniques
Normal breathing is slow, effortless, regular, fluid, and quiet with virtually no movement above the diaphragm. Some master breathing retraining quite rapidly, while others may require months of practice. The goals are to change from erratic breathing to slow regular, rhythmic abdominal breathing and to make this kind of breathing automatic. This shift in breathing results in long-term changes in the nervous system and anxiety symptoms. Here are the steps:
 Loosen your clothing (belts, ties, collars, clothing around waist and abdomen). Remove contact lenses or glasses if you wish.
Lie on your back or in the half-lying position with pillows under your back and knees to relax your abdominal muscles.
Relax your entire body. Especially warm and relax the abdomen. Also release tension in the chest, shoulders, neck, face, and jaw. Using the upper body’s muscles to breathe wastes energy.
Place a telephone book over the abdomen (the area below the diaphragm down to the pelvis. Practically, this means putting the book below the ribs and over the navel). The book provides resistance to strengthen the diaphragm and encourages abdominal movement.
Bring your lips together. Breathe comfortably and rhythmically, not deeply, through your nose. As you breathe in, let your stomach rise slowly, gradually and quietly. Think of your stomach as a balloon easily filling gently with air. Move smoothly into the exhalation without pause. Expiration is quiet, passive and relaxed. The in-breath and out-breath are approximately equivalent in time, the out-breath perhaps a little longer. Transition smoothly between the out-breath and the in-breath, with little pause between phases. Keep all of your body above your diaphragm relaxed and still, moving only your abdomen. You’ll see the book gently rise as you breathe in and fall as you breathe out, while the upper body remains still.
6. Practice. It might take a few weeks until abdominal breathing becomes automatic. Here are the suggested guidelines:
Practice twice a day or more, for five to ten minutes each time.
For the first few days, just breathe at your regular rate. If at any point you feel dizzy or faint, or if your diaphragm cramps, stop immediately. You might need to build up gradually to five to ten minutes over the course of days or weeks, beginning with only a few seconds of practice. Generally, dizziness and faintness result from improper breathing. These symptoms will disappear if you get up and walk (eg. up stairs) to increase the body’s carbon dioxide production. When you resume practice, be sure that you are not breathing fast or deeply, only slowly and regularly.
After about a week, begin to gradually slow your breathing rate. Perhaps you’ll eventually reach a rate of six to ten breaths per minute (ie. about six to ten seconds for each complete breath cycle). However, don’t worry about the rate. Focus on achieving a rate that feels comfortable.
After the second week, progress to the seated position, then to standing and leaning against a wall, standing unsupported, slow walking, and fast walking. Remember, first relax your entire body, warm and relax your abdomen, then breathe slowly, regularly and abdominally.
Try re-breathing in a variety of situations (eg. in bed as you wake up or before sleeping, walking down the hall, jogging, watching TV or on the train)
As you gain confidence, try consciously re-breathing in slightly stressful situations before anxiety symptoms appear (eg. in a traffic slowdown). Then try it in situations where anxiety symptoms have already begun to appear. Just notice the symptoms. Think to yourself: 'My breathing is causing this. I’m not going mad or having a heart attack. These symptoms are harmless and reversible. I know how to breathe.' Then relax your body, warm your abdomen and breathe slowly and regularly. Watch your symptoms come and watch them subside, like a scientist watching an experiment.
Do not attempt breathing retraining without first discussing this with your doctor if you have diabetes, kidney disease, or other disorders which might cause metabolic acidosis. In such cases, breathing may have become rapid to normalise the metabolic acidosis, and slowing down your breathing could be dangerous.
From 'The Post Traumatic Stress Disorder Source Book', Glenn Schiraldi
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