Don’t Start With The Breath
The field of trauma treatment is rapidly growing which means that I spend a lot of time studying different clinical approaches to treating trauma, and as I do, I witness countless yoga teachers, therapists, somatic therapists, massage therapists, and physical therapists telling the stressed out to take a nice deep breath to get grounded. To this I say: STOP! Please do not insist folks take a deep breath.
On the surface, it makes a lot of sense to tell people to take a deep breath. We commonly think of deep breathing as a way to slow down time, our breath, and ultimately our autonomic nervous systems. But guess what — lots of people with chronic stress, Post Traumatic Stress Disorder (PTSD), or Complex Post Traumatic Stress Disorder (C-PTSD), will find this act at best, damn near impossible, and at worst, triggering.
I only half jokingly blame subway commutes for most New Yorkers constricted breathing.
Constriction in Our Breathing Muscles
If you live with chronic stress or trauma there is a good chance that you experience constriction in your primary breathing muscle — the diaphragm.
Source https://goo.gl/images/39qZju
The diaphragm is a flat muscle and as your body fills with air the diaphragm contracts and moves down and as you exhale it moves up. When we are breathing at rest (when we are in a parasympathetic state) it should handle most of the work.
Working in conjunction with the diaphragm you have a whole set of secondary breathing muscles — the intercostals, scalenes, sternocleidomastoid, pec minor, and your abs.
Source: https://goo.gl/images/61o97P
These muscles are of your neck, chest, and belly. And theoretically when you are at rest, they are too. And even when you are working hard (a sympathetic state), they are only handling some of the load. That said, if you live with chronic stress or trauma these muscles are often overused and your diaphragm does almost none of the work.
I am going to ask you to sense into your body and feel this out with me. Imagine you are hiking and you see a bear or some other predator you find threatening. Sense into your body. What does it feel like? What are your muscles doing? It is likely your whole trunk is constricted. This is a life or death situation and your limbic system has taken the reins and it is going to do its damnedest to save you with some defensive mobilization or immobilization. Now, imagine something in the distance gets this predator’s attention and it turns away and runs off in the opposite direction to tend to her cub. She is gone and you return to your hike completely predator free. Phew!
Now I am going to ask you to imagine that you are running late for a very important meeting and you are stuck in traffic or on a stopped subway train without cell service. You are going to miss something very important and have no way to let the others know. Sense into your body. What is your breathing like and where are you breathing from? Is any air making it into your belly? Probably not. Your whole trunk is constricted even though this is not a life and death situation — it is just very stressful.
In both cases — actual life or death and perceived by your limbic system to be life or death — you braced. And when you relaxed, did you really? Or is your diaphragm still holding on for dear life and is your chest doing all of the breathing? Many of us don’t realize that we have not relaxed our diaphragms and that we are always bracing our primary breathing muscle to some extent or another.
I work as a beginning strength coach with the general population in New York City and I can tell you that for the most part, New Yorkers are a bunch of chest breathers hustling and living in a very stimulating environment. It is common for people living with trauma or simply with a lot of stress to be stuck in a defensive orienting state — fight or flight. Their trunks are always bracing just a little and that diaphragm rarely gets the chance to move.
What happens to muscles that have not been moved? That’s right — they get stiff and eventually weak. It does not feel good when you become keenly aware your muscles are stiff and weak. Telling a constricted person to take a deep breath in invites them to realize just how tight everything is inside. For some people that may be okay, but for some people — people like me — it can feel terrifying. It can feel claustrophobic, suffocating, and absolutely triggering. Deep breaths are a goal for folks like us — not the starting place.
Alternatives to Telling People to Take a Deep Breath
The good news is that there are countless alternatives to get grounded, present and mindful of the body. The following are a few techniques you can use rather than going straight for the breath.
Neutral Places in the Body
Ask your client to tune into their body and find a place that feels neutral. Encourage the client to put their attention there. Neutrality is often found in places like the hands or the seat. People might feel funny that their butt feels good, but it often does. Let them get grounded by feeling into a part of their body that feels supported and easy, rather than going straight for the center.
For me, when I began to incorporate mindfulness meditation into my own treatment I realized that the only place that felt safe to focus on was my hands. So that is where I started. Only after many months of daily sitting, as well as using other healing modalities, was I was able to move to focusing on the breath.
Five Things
For some folks, turning inward at all is dysregulating. Suddenly becoming aware of your state can be quite jarring at times. For clients who cannot ground by looking for resources inward, I ask them to become situated and present by looking around and naming five blue things, five red things, and five yellow things. It gets people to closely look at their environment and keeps their prefrontal cortex turned on as opposed to triggering a limbic response.
Sounds Far to Near, Near to Far
If I am encouraging someone to turn inward I will ask them to first listen for sounds far away — people talking outside, wind, cars and then closer sounds like water running through the pipes or cooking sounds in the kitchen, and then even closer from inside of their own body.
If I am trying to bring someone’s awareness back outside of them, I encourage them to do the same but in reverse — starting near and opening up to sounds far away.
If Breath is the Main Driver of Your Practice…
And if breath is the main driver of your practice like in yoga or certain mindfulness meditation practices, you can suggest the client follow the breath without manipulation. By being behind the breath (following it), the constriction can feel less stifling than being on top of it (focusing on it). But please keep in mind that for some people, following or focusing on the breath is a goal, not a tool to be employed right in that moment.
Getting the Diaphragm Moving Again
Lastly, if you work with the body you can help your client get their diaphragm moving again when they are ready. In strength sports we use a diaphragmatic breath and valsalva to brace for each lift. Singers, musicians, dancers, and yogis all use the diaphragm extensively. I instruct every person I work with to do the following, while I do it with them:
- Place their hands on their waste like a weightlifting belt so they can feel as they bring air into their belly.
- Then breathe in softly and slowly through the nose, until they fill with air. By breathing through the nose we are going to encourage the use of the diaphragm over the secondary breathing muscles. We are also limiting how much air comes in at once, telling the nervous system it is ok to stay relaxed. A sudden gasp for air will signal to the body it is “go-time” and will activate a sympathetic response. The body will brace again, and will defeat the purpose of this exercise.
- At this point many clients realize how hard it is for them to breathe this way and I reassure them that, yes, it is hard and comes with practice — and we are going to practice with every rep. (If your client is worrying that they won’t be able to take a diaphragmatic breath it will limit their ability to do so!)
- We do this exercise a couple of times together, me showing just how big I can get my belly and how even my thumbs on my back move because air is getting into my back and not just the front. In general there is often some giggling because it looks so odd for anyone to so publicly expand their stomach. This giggling is good — we are having fun! In general after about five breaths or so the client will see progress in getting increased air into the lower into their abdomen.
Deep Breaths as a Goal
Yes, now after years of diaphragmatic breathing, I can take a deep breath without panicking, simply because I can take a deep breath at all. But it took work. On behalf of the constricted breathers who panic when they notice their constriction, I am going to ask you to not start with the breath when working with trauma. Get creative or use the tools I listed above, but start somewhere safer — the extremities — or possibly outside of the body completely.