Regulated Breathing

Regulated breathing is a behavior therapy technique that involves an effort to slow an individual's breathing rate to below the usual rate and to install a regular breathing rhythm. Regulated breathing therapies, or “relaxed breathing” therapies, are commonly used in combination with other relaxation techniques for reducing physiological tension and arousal and for treating a variety of stress-related conditions. Research has demonstrated the effectiveness of regulated breathing as a part of treatment packages that have addressed conditions such as panic, headaches, chronic pain, asthma, hypertension, and irritable bowel syndrome, as well as for a number of anxiety-related disorders, including stuttering, sports performance anxiety, and panic disorder. In addition, regulated breathing techniques have been used effectively with children, adolescents, and adults involved in relaxation training as treatment for the various stress and anxiety-related conditions.

The notion behind the need for regulated breathing is that improper breathing can result in chronically altered levels of carbon dioxide in the blood. Carbon dioxide is considered to be a vital gas that must be maintained at certain levels in the blood to regulate the chemical (pH) balance in the blood. Too little or too much carbon dioxide can result in physiological distress (i.e., tension). It is believed that regulated breathing then helps reestablish metabolic balance and therefore produces relaxation. It is also true, however, that individuals who are working to regulate their breathing are performing voluntary actions that may serve as a source of distraction from anxious or distressing thoughts. This too may help calm an individual and reduce arousal. Either way, regulated breathing is thought to result in relaxation and to reduce or stop emotional distress.

Diaphragmatic breathing is the most common type of regulated breathing that is taught. The diaphragm is the major muscle involved in breathing. It sits underneath the lungs. For an individual to inhale, the diaphragm must contract and descend, expanding the belly. This allows the lungs to fill. There are other muscles around the chest that also assist with breathing by expanding the ribs and raising the chest and shoulders, making room for air to fill the lungs. Diaphragmatic breathing involves focusing on breathing with the diaphragm and minimizing the use of chest breathing muscles. The goal is often to slow respiration by 50% below typical breathing rates. The method consists of slow, deep, abdominal inhalations for a few seconds, followed by slow exhalations. Clients are often asked to count slowly and silently while practicing, aiming for 6 to 8 breaths per minute, which is significantly less than the 12 to 15 breaths per minute typical for most people. Therapists often place a large book or telephone directory on the abdomen to provide feedback to the individual regarding the use of a proper breathing technique. The weight of the book provides continuous feedback and helps increase and maintain awareness about the use of the diaphragm when breathing.

Paced respiration is another regulated breathing technique that involves inhaling and exhaling at a predetermined rate, usually with the help of some external pacing device such as a metronome. The metronome, or other pacing device, helps the client breathe at a [Page 980]slow preset rhythm. In teaching either diaphragmatic breathing or pace respiration, the focus on breathing is typically just one component of a treatment designed to reduce distress and produce relaxation. Regulated breathing is usually used in combination with other techniques such as relaxing specific muscle groups (e.g., progressive muscle relaxation), reciting mantras (meditative techniques), or techniques designed to alter or replace distressing thoughts.

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