Breathing: Introduction

Breathing is a necessity of life that most people take for granted. With each breath of air, you obtain oxygen and release the waste product carbon dioxide. Poor breathing habits diminish the flow of these gases to and from your body, making it harder for you to cope with stressful situations. Improper breathing contributes to anxiety, panic attacks, depression, muscle tension, headaches, and fatigue. As you learn to be aware of your breathing and practice slowing and normalizing your breaths, your mind will quiet and your body will relax. Breathing awareness and good breathing habits will enhance your psychological and physical well-being, whether you practice them alone or in combination with other relaxation techniques.

Let's examine a breath. When you inhale, air is drawn in through your nose, where it is warmed to body temperature, humidified, and partially cleansed. Your diaphragm, a sheet-like muscle separating the lungs and the abdomen, facilitates your breathing by expanding and contracting as you breathe in and out.

Your lungs are like a tree with many branches (bronchial tubes) that carry air to elastic air sacs (alveoli). The alveoli have the balloon-like ability to expand when air is taken into the lungs and contract when air is let out. Small blood vessels (capillaries) surrounding the alveoli receive oxygen and transport it to your heart.

The blood that your heart pumps carries oxygen to all parts of your body. An exchange occurs in which blood cells receive oxygen and release carbon dioxide, a waste product that is carried back to your heart and lungs and exhaled. This efficient method of transporting and exchanging oxygen is vital to sustain life.

When you breathe, you typically use one of two patterns:
1.chest or thoracic breathing and
2.abdominal or diaphragmatic breathing.

Chest or thoracic breathing is often associated with anxiety or other emotional distress. It is also common in people who wear restricted clothing or lead sedentary or stressful lives. Chest breathing is shallow and often irregular and rapid. When air is inhaled, the chest expands and the shoulders rise to take in the air. Anxious people may experience breathholding, hyperventilation or constricted breathing, shortness of breath, or fear of passing out. If an insufficient amount of air reaches your lungs, your blood is not properly oxygenated, your heart rate and muscle tension increase, and your stress response is turned on.

Abdominal or diaphragmatic breathing is the natural breathing of newborn babies and sleeping adults. Inhaled air is drawn deep into the lungs and exhaled as the diaphragm contracts and expands. Breathing is even and nonconstricting. The respiratory system is able to do its job of producing energy from oxygen and removing waste products.

By increasing your awareness of your own breathing patterns and shifting to more abdominal breathing, you can reduce the muscle tension and anxiety present with stress-related symptoms or thoughts. Diaphragmatic breathing is the easiest way of eliciting the relaxation response.

Symptom Relief Breathing exercises have been found to be effective in reducing generalized anxiety disorders, panic attacks and agoraphobia, depression, irritability, muscle tension, headaches, and fatigue. They are used in the treatment and prevention of breathholding, hyperventilation, shallow breathing, and cold hands and feet.

Time for Mastery While a breathing exercise can be learned in a matter of minutes and some benefits experienced immediately, the profound effects of the exercise may not be fully appreciated until after months of persistent practice. After you have tried the exercises presented in this chapter, develop a breathing program incorporating those exercises you find most beneficial and follow your program with patience and persistence.

This chapter is divided up into four sections:
1.Breathing for awareness and relaxation,
2.Breathing to release tension,
3.Breathing to stimulate alertness, and
4.Breathing for symptom control.

1. Breathing For Awareness And Relaxation

Your first step is to increase your awareness of your breathing habits and to learn how to use breathing as a relaxation skill.

Breathing Awareness

1.Close your eyes. Put your right hand on your abdomen, right at the waistline, and put your left hand on your chest, right in the center.
2.Without trying to change your breathing, simply notice how you are breathing. Which hand rises the most as you inhale the hand on your chest or the hand on your belly?

If your abdomen expands, then you are breathing from your abdomen or diaphragm. If your belly doesn't move or moves less than your chest, then you are breathing from your chest.

The trick to shifting from chest to abdominal breathing is to make one or two full exhalations that push out the air from the bottom of your lungs. This will create a vacuum that will pull in a deep, diaphragmatic breath on your next inhalation.

Diaphragmatic Or Abdominal Breathing

1.Lie down on a rug or blanket on the floor in a "dead body" pose your legs straight and slightly apart, your toes pointed comfortably outward, your arms at your sides and not touching your body, your palms up, and your eyes closed.
2.Bring your attention to your breathing and place your hand on the spot that seems to rise and fall the most as you inhale and exhale.
3.Gently place both of your hands or a book on your abdomen and follow your breathing. Notice how your abdomen rises with each inhalation and falls with each exhalation.
4.Breathe through your nose. (If possible, always clear your nasal passages before doing breathing exercises.)
5.If you experience difficulty breathing into your abdomen, press your hand down on your abdomen as you exhale and let your abdomen push your hand back up as you inhale deeply.
6.Is your chest moving in harmony with your abdomen or is it rigid? Spend a minute or two letting your chest follow the movement of your abdomen.
7.If you continue to experience difficulty breathing into your abdomen, an alternative is to lie on your stomach, with your head rested on your folded hands. Take deep abdominal breaths so you can feel your abdomen pushing against the floor.

Deep Breathing

1.Although this exercise can be practiced in a variety of poses, the following is recommended: lie down on a blanket or rug on the floor. Bend your knees and move your feet about eight inches apart, with your toes turned slightly outward. Make sure that your spine is straight.
2.Scan your body for tension.
3.Place one hand on your abdomen and one hand on your chest. 4.Inhale slowly and deeply through your nose into your abdomen to push up your hand as much as feels comfortable. Your chest should move only a little and only with your abdomen.
5.When you feel at ease with step 4, smile slightly and inhale through your nose and exhale through your mouth, making a quiet, relaxing, whooshing sound like the wind as you blow gently out. Your mouth, tongue and jaw will be relaxed. Take long, slow, deep breaths that raise and lower your abdomen. Focus on the sound and feeling of breathing as you become more and more relaxed.
6.Continue deep breathing for about five or ten minutes at a time, once or twice a day, for a couple of weeks. Then, if you like, extend this period to twenty minutes.
7.At the end of each deep breathing session, take a little time to once more scan your body for tension. Compare the tension you feel at the conclusion of the exercise with that which you experienced when you began.
8.When you become at ease with breathing into your abdomen, practice it any time during the day when you feel like it and you are sitting down or standing still. Concentrate on your abdomen moving up and down, the air moving in and out of your lungs, and the feeling of relaxation that deep breathing gives you.
9.When you have learned to relax yourself using deep breathing, practice it whenever you feel yourself getting tense.

Complete Natural Breathing

1.Begin by sitting or standing up straight in a good posture.
2.Breathe through your nose.
3.As you inhale, first fill the lower section of your lungs. (Your diaphragm will push your abdomen outward to make room for the air.) Second, fill the middle part of your lungs as your lower ribs and chest move forward slightly to accommodate the air. Third, fill the upper part of your lungs as your raise your chest slightly and draw in your abdomen a little to support your lungs. (You might imagine you're blowing up a balloon.) These three steps can be performed in one smooth, continuous inhalation, which with practice can be completed in a couple of seconds.
4.Now hold your breath for a few seconds to experience your full lungs.
5.As you slowly exhale, pull your abdomen in slightly and slowly lift it up as your lungs empty. When you have completely exhaled, relax your abdomen and chest.
6.Now and then at the end of the inhalation phase, raise your shoulders and collarbone slightly so that the very top of your shoulders are sure to be replenished with fresh air.

2. Breathing To Release Tension

Use the following exercises to enhance relaxation and release tension.

Breath Counting

1.Sit or lie in a comfortable position with your arms and legs uncrossed and your spine straight.
2.Breathe in deeply into your abdomen. Let yourself pause before you exhale.
3.As you exhale, count "One" to yourself. As you continue to inhale and exhale, count each exhalation by saying "Two . . . three . . . four."
4.Continue counting your exhalations in sets of four for five to ten minutes.
5.Notice your breathing gradually slowing, your body relaxing, and your mind calming as you practice this breathing meditation.

The Relaxing Sigh

During the day, you probably catch yourself sighing or yawning. This is generally a sign that you are not getting enough oxygen. Sighing and yawning are your body's way of remedying the situation. A sigh is often accompanied by a sense that things are not quite as they should be and a feeling of tension. Since a sigh actually does release a bit of this tension, you can practice sighing at will as a means of relaxing.

1.Sit or stand up straight.
2.Sigh deeply, letting out a sound of deep relief as the air rushes out of your lungs.
3.Don't think about inhalingÑjust let the air come in naturally.
4.Take eight to twelve of these relaxing sighs and let yourself experience the feeling of relaxation. Repeat whenever you feel the need for it.

Letting Go Of Tension

1.Sit comfortably in a chair with your feet on the floor.
2.Breathe in deeply into your abdomen and say to yourself, "Breathe in relaxation." Let yourself pause before you exhale.
3.Breathe out from your abdomen and say to yourself, "Breathe out tension." Pause before you inhale.
4.Use each inhalation as a moment to become aware of any tension in your body.
5.Use each exhalation as an opportunity to let go of tension.
6.You may find it helpful to use your imagination to picture or feel the relaxation entering and the tension leaving your body.
3. Breathing To Stimulate Alertness

These exercises can be used to stimulate and tone your entire breathing apparatus and refresh your whole body.

Purifying Breath

This exercise can be practiced by itself or combined with other breathing exercises.
1.Begin by sitting or standing up straight in a good posture.
2.Inhale a complete natural breath.
3.Hold this breath for a few seconds.
4.Pretend that you are blowing through a straw and exhale a little of the air with considerable force through the small opening between your lips. Stop exhaling for a moment and then blow out a bit more air. Continue this procedure until all the air is exhaled in small, forceful puffs.

The Windmill

When you have been bent over your work for several hours and are feeling tense, this exercise will relax you and make you more alert.
1.Stand up straight with your arms out in front of you.
2.Inhale and hold a complete natural breath.
3.Swing your arms backward in a circle several times and then reverse directions. For variety, try rotating them alternately like a windmill.
4.Exhale forcefully through your mouth.
5.Practice a couple of purifying breaths.
6.Repeat this exercise as often as you like.


This exercise is a useful one to use when you feel stiff and tense. It has the added benefit of stretching your torso, making it more flexible for breathing.
1.Stand up straight with your hands on your hips.
2.Inhale and hold a complete natural breath.
3.Let the lower part of your body remain stiff. Bow forward as far as you can, slowly exhaling completely through your mouth.
4.Stand up straight again. Inhale and hold another complete natural breath.
5.Bend backwards as you slowly exhale.
6.Stand up straight again and inhale and hold another complete natural breath.
7.Continue this exercise first bending backwards and then to the left and right sides.
8.After each round of four bends, practice one purifying breath. 9.Do four full rounds.
4. Breathing For Symptom Control Or Release

Abdominal Breathing And Imagination

This exercise combines the relaxing benefits of complete natural breathing with the curative value of positive autosuggestions.
1.Lie down on a rug or blanket on the floor in a "dead body" pose.
2.Place your hands gently on your solar plexus (the point where your ribs start to separate above your abdomen) and practice complete natural breathing for a few minutes.
3.Imagine that energy is rushing into your lungs with each incoming breath of air and being immediately stored in your solar plexus. Imagine that this energy is flowing out to all parts of your body with each exhalation. Form a mental picture of this energizing process.
4.Continue on a daily basis for at least five to ten minutes a day.

Alternatives to step 3:
3a. Keep one hand on your solar plexus and move the other hand to a point on your body that hurts. As you inhale, imagine energy coming in and being stored. As you exhale, imagine the energy flowing to the spot that hurts and stimulating it. As you continue to inhale more energy, imagine this energy driving out the pain with each exhalation. Keep a clear picture of this process in your mind as you alternately stimulate the spot that hurts and then drive out the pain.
3b. Keep one hand on your solar plexus and move the other hand to a point on your body that has been injured or is infected. Imagine the energy coming in and being stored as you inhale. As you exhale, imagine that you are directing energy to the affected point and stimulating it, driving out the infection or healing it. Picture this process in your mind's eye.

Alternative Breathing

While this relaxation exercise is generally useful, people suffering from tension or sinus headaches often find it particularly beneficial.
1.Sit in a comfortable position with good posture.
2.Rest the index and second finger of your right hand on your forehead.
3.Close your right nostril with your thumb.
4.Inhale slowly and soundlessly through your left nostril.
5.Close your left nostril with your ring finger and simultaneously open your right nostril by removing your thumb.
6.Exhale slowly and soundlessly and as thoroughly as possible through your right nostril.
7.Inhale through your right nostril.
8.Close your right nostril with your thumb and open your left nostril.
9.Exhale through your left nostril.
10.Inhale through your left nostril.
11.Begin by doing 5 cycles. Then slowly raise the number to from 10 to 25 cycles.

Breath Training

This exercise, which has been adapted from Nick Masi's 1993 audiocassette, Breath of Life, has also been called "breathing retraining" and "controlled breathing." Individuals with panic disorder or agoraphobia have found it particularly helpful. When most people feel panic, they have a tendency to gasp, take in a breath, and hold onto it. The resulting sensation of fullness and inability to get enough air in turn produces quick, shallow breathing or hyperventilation. The hyperventilation triggers the panic attack. Breath training provides a crucial counting or pacing procedure that helps to counteract this process. Here are the steps to follow.

1.Exhale first. At the first sign of nervousness or panic, at the first "what if" thought that you might pass out, have a heart attack, or be unable to breathe, always exhale. It is important to exhale first so that your lungs open up and it feels like there's plenty of room to take a good deep breath.
2.Inhale and exhale through your nose. Exhaling through your nose will slow down your breathing and prevent hyperventilation. As an alternative to breathing through your nose, inhale through your mouth and make a purifying exhalation through your mouth by pretending that you are blowing out through a straw.
3.Lie on your back with your hand over your abdomen, and the other hand on your chest. Exhale first, and then breathe in through your nose, counting "One . . . two . . . three." Pause a second, and then breathe out through your mouth, counting "One . . .two . . . three . . . four." Make sure that your exhalation is always longer than your inhalation. This will protect you from taking short, gasping panic breaths.
4.After you feel comfortable with step 3, you can slow your breathing even further. Breathe in and count "One . . . two . . . three . . . four"; pause and breathe out, counting "One . . . two ... three . . . four . . . five." Keep practicing these slow deep breaths, pushing the hand on your abdomen up, but allowing very little movement for the hand on your chest. When your minds drifts, refocus on your breathing.

Alternative Positions:
1.Lie on your stomach with your hands folded under your head. Continue to count "One .. . two . . . three" as you breathe in and "One . . . two . . . three . . . four" as you breathe out. As in step 4 above, breathe even more slowly by counting to four as you inhale and to five as you exhale.
2.Step 4 can also be done while you are standing, walking, and sitting. Pace your steps to match the same slow rate of your breathing.

When paced breathing feels comfortable and natural, you can replace counting with the words "in" as you inhale and "calm" as you exhale. Maintain the same pace, making each exhalation last slightly longer than each inhalation. Breathe in through your nose and breathe out through your mouth. Always exhale first.

Controlled Breathing

If you find that it is difficult to use the counting techniques described above, you can make a pacing tape that will teach you controlled breathing. First you need to decide how to set the breathing rate that is best for you. Depending on how slowly you breathe when you are at rest, your rate can be set at either eight or twelve breaths a minute. To determine which interval will be better for you, relax and count how many breaths you take over a period of three minutes. If you counted more than thirty breaths, follow the instructions for a twelve breaths per minute tape. If you counted thirty or fewer, follow the instructions for an eight breaths per minute tape.

To make a twelve breaths per minute pacing tape:
1.Say the word "in" for two seconds.
2.Say the word "out" for two seconds.
3.Pause for one second.
4.Continue to repeat "in" for two seconds and "out" for two seconds, followed by a one-second pause.
5.Keep the tape going for about five minutes.

To make an eight breaths per minute pacing tape:
1.Say the word "in" for three seconds.
2.Say the word "out" for three seconds.
3.Pause for one second.
4.Continue to repeat that sequence for about five minutes.

After you have made your pacing tape, practice breathing with the tape four times per day. When you feel comfortable, practice controlled breathing with the tape off for thirty seconds and then turn the tape back on for one minute to see if your pace is still matched to the tape. If your breath rate remains the same, try turning the tape off for two minutes at a time, and then for five minutes. Each time you finish breathing on your own, turn the tape back on again to see if your pace is still matched to the tape.

Authors: Martha Davis, Ph.D., Elizabeth Robbins Eshelman, M.S.W., Matthew McKay, Ph.D. Publisher: New Harbinger Publishers, Oakland, CA 8.5x11, 256 pages, 1995,

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