Coherent Breathing in Therapy
The aim of psychotherapeutic treatment lies in bringing inner conflicts, unconscious urges and other disturbing mechanisms of inner life to consciousness and resolves their destructive impulses. “Where id was, there ego shall be,“ as the famous formula of Sigmund Freud goes.
Alike in medicine, in psychotherapy it is equally important to direct the view on symptoms and their history as well as on the general inner state. Mental burdens affect the nervous system, and a burdened nervous system affects mood and emotional well-being. When we suffer emotionally, the nervous system gets out of balance. In case we want to achieve betterment and healing, we have to regain this balance. So psychotherapy without influencing and regulating the autonomic nervous system cannot be effective. As humans, we are a unity of body and mind, so psychotherapy always has to work on the somatic and the mental level. Actually, it is impossible to separate them or to consider one independent of the other, as physiology always acts mentally and emotions always act physiologically. Thus it is of central importance to take notice of this interlacement in any kind of therapy and to bring psychotherapeutic methods of treatment and interventions into line with it.
The background of practical every mental disorder can be found in inappropriate and manifest stressful behaviour: depression, panic attacks, posttraumatic stress disorder, compulsive neurosis, attachment disorders etc. result from situations in our lives we could not cope with as they were too intense for us. They increased our inner stress level up to a point, where it solidified to a chronic posture, measureable as elevated sympathetic activation and weak vagal tone. The intimate connection between stress and mental problems has been proven by so many studies that we can take this as an irrefutable fact.
So stress leads to emotional problems and chronified stress finds its expression in bad mood. As inseparable ensemble of body and soul our soul cannot be in equilibrium when the body is overstrained.
From prenatal psychology we know that human life is sensitive to stress from its very beginning. Via the placenta, stress hormones from the mother enter the blood circulation of the child. But also toxic influences like alcohol or nicotine can imprint the stress level of an embryo or foetus. The earlier such burdens occur the more difficult it is to integrate them. This is why many babies are born with a chronified stress pattern. In the course of life, they can develop into mental disorders and diseases.
This is an example from scientific research: Even at the age of fifty, persons who were subjected to strong stress in early childhood had a diminished regulatory function of the parasympathicus, as a study could prove.
The significance of heart rate variability as measurable indicator for health and resilience is more and more recognized in medicine. Equally important is this aspect for psychotherapy. Therapists who are aware of this phenomenon can value the importance of autonomic physical processes for the functioning of the psyche and include this source of information in therapy. Mental and emotional states are expressions of the current state of the autonomic nervous system, which can be measured and represented by the figures from heart rate variability.
By understanding heart rate variability, psychotherapists are encouraged to
- pay more attention to autonomic physical processes,
- help to build up trust in the organismic wisdom,
- interpret symptoms as expression of failed inner cooperation and distorted inner communication,
- support in building up improved adaptability (higher variety in behavior, thinking and experiencing) and flexibility,
- recommend physical methods for improving HRV like endurance sport and breathing and relaxing exercises.
A therapist with experience in coherent breathing can give their clients a tool, with which they can effectively increase their heart rate variability, find more inner rest and improved health.
When working with improvements in physical awareness, we create a link to our beginning on a very deep level: We all started our lives as organic process seeking and constructing its autonomic regulation. This is where the foundation of personality is laid, and here the attention of inner work should be present. Only when this part cooperates, inner healing can be a sustainable success.
In many cases, patients with depression had a reduced HRV besides increased heart frequency. This constellation is typical for chronic stress. So it seems that depressions are connected with disorders of the heart function. In the same direction points the fact that depressive persons suffer from a significantly higher morbidity risk from heart circulation diseases as compared to normal persons. Also people with heart diseases have a higher risk of dying with an additional depressive disorder.
Besides treatment with drugs and psychotherapy, which should be recommended by a responsible-minded physician, simple exercises from coherent breathing offer an effective help. As already mentioned above, such exercises can be practiced at any time without effort. Persons with light or middle strong depressive illnesses need to commit to consistent practice with regularity, and then not only their mood will lighten up and their sleep will improve but also their self-esteem will grow, as they notice that they can help themselves at least a bit. I often could observe that clients with depression, when they practice with discipline can achieve significant and long-lasting improvement of their condition already after a few weeks.
An explanation for this effect can be assumed in the influence of the vagus on the brain, as proven by some studies. The vagal pathways to the brain influence brain centers which are occupied with controlling emotions and moods: Locus coeruleus, orbitofrontal cortex, insula, hippocampus and amygdala; in addition to that, slow and deep breathing stimulates the neuronal pathways underneath the diaphragm and at the same time activates the above mentioned pathways to the brain, which could have an influence on symptoms of depression.
Furthermore, the already mentioned “youth hormone” DHEA could play a role as mood elevator. Researches suppose that DHEA increases the serotonin concentration in certain areas of the brain and thus acts like an anti-depressant. There is strong evidence that trainings in heart rate variability considerably increase the DHEA level, what then also must be true for coherent breathing.
Newer studies indicate that a combination of physical exercises, mainly endurance sports and meditative practices, among which we can include coherent breathing, is especially successful in the treatment of depressive persons. What has been well-known to therapists for a long time is thus proven scientifically: Many persons suffering from depression can get over their mood swings with discipline and self-motivation. Constant physical movement and breathing exercises can cause surprisingly fast improvement in well-being.
However with very severe depressions, the problem of motivation can come in the way of this effective form of self-support: The depressive person needs to overcome her drive paralysis to start with breathing exercises, when the success can only be felt after some time.
In psychotherapy, specific issues, which burden people, are worked on: Issues in relationship, inner disturbances, specific or unspecific fears etc. In many therapeutic approaches, e.g. in depth psychology, the roots of problems should be discovered in early childhood. By going through the emotions from that time, the problems should resolve. In other approaches, e.g. in behavioral therapy, strategies are developed, which allow to cope with problems differently in the actual context.
The work takes place in groups or in single sessions. Anything a client can do for himself to make the therapy more efficient is a valuable and indispensable complement to any therapeutic work. Thus they learn to help themselves in part. For this purpose, coherent breathing as form of daily practice and as ongoing training in awareness is excellently appropriate.
Clients who learn to relax their breathing and to build up and stabilize breath-heart coherence lower their basic stress and gain more quality in life just by this. They can access the roots for their issues simpler and faster or develop and implement alternatives for action with more ease. They also realize that they can actively cooperate in their healing, in daily life as well as in therapy. And they develop a reliable competence in self-feeling, self-perception in the moment, which is of support for any kind of therapeutic work and increases one’s own quality in life.
It is also part of the responsibility of the therapist to point the clients and this aspect of self-therapy and to suggest and offer helpful and effective methods. Thus the client’s autonomy is strengthened and the dependency from the therapist as a person and from the therapeutic process is relativized.
Therapy is not just the matter of the therapist as an expert guiding the healing process. Rather, therapy is the product of cooperation between therapist and client.
Clients become co-creators in therapy, when they learn to better perceive and regulate their inner world. Becoming aware is initially becoming aware in and with the body. Breath provides the bridge for that: Breathing we become aware about how we feel. In our breathing, our inner state is reflected. Additionally, we also can regulate this inner state by influencing our breathing. What has lost its balance internally, can find back to coherence.
Mental disorders are often signified by too much or too little. A depressive person complains about too little drive, a maniac suffers from too much activation. Yet the basis for these two and many other illnesses lies in the same distortion of the vegetative nervous system: A dominating sympathicus and a weakened parasympathicus. This imbalance as characterized by latent fears, which lead to blocking motivation for action in the case of a depressive person and urge for ongoing activity in the other case.
Thus the differing methods of psychotherapy basically strive just for the same: Re-establishing a healthy equilibrium between sympathicus and parasympathicus. To achieve this goal, in most cases the over-activation of the sympathicus has to be reduced, while the parasympathicus gets reinforced.
With practicing coherent breathing, these two approaches can be combined – two birds in one swoop. Calmed breathing withdraws the sympathicus and empowers the parasympathicus. Because of the relaxed body posture during exercise, the sympathicus only needs to be present slightly, while the parasympathicus can play a stronger role. By practicing, the organism more and more gets used to the reversal of the relation between sympathicus and parasympathicus as usual up to now.
Whatever the client does, whatever method is used in therapy for balance the nervous system internally: the progress of therapy is supported by practicing coherent breathing, which accelerates the healing process. On the other hand, persons with severe traumatization only can open to verbal therapy with a re-regulated vegetative nervous system. Such clients first have to find peace on a deep level, which cannot be accessed by verbal language, somehow in their guts. From there, they can develop the ability to regain this relaxation again and again. Often it is the case that we can only achieve wholesome changes in therapeutic talk, when the strategies of coping with stress have been established and stabilized on the vegetative level. For it is there, where we find the fundaments of trust, on which any therapeutic work depends.
Whenever clients are ready, the interplay of therapy and breathing exercises work optimally. Daily exercises help to re-regulate mismanagements in the autonomic nervous system, while therapy works on basic changes, which have caused the original failure. Thus the client notices progress in therapeutic work more clearly as changes in daily life. At the same time, she develops her own competence to better rebalance disturbances and deregulations.
With reinforcing the inner perception, she has a diagnostic tool at her hand, which can give her accurate information about her relevant state of activation and can point out to her when to apply changes: in her thoughts or in her actions. And she has this tool with her at any time to influence and regulate her state by herself. Breathing practice includes the additional benefit in directing the attention from outside to the inside and thus empower and sharpening the inner sense.
Awareness on the breathing is a central part of my therapeutic work, whether I primarily work on the level of talking or include body and breathing explicitly. It proves constantly as beneficial to ask clients to be aware of their breathing when an issue is to be explored with the help of the inner sense. The task of psychotherapy is sometimes described as integration of dismembered parts of the soul by bringing them to consciousness. Such issues can only be found internally, less via thinking and more via emotional experience in the body, and this is especially true for early themes from a time before the emergence of verbal language. These issues are stored in the implicit or procedural memory and become conscious as physical sensations. For working with them, we need access to our inside as sensing our bodies.
The internal channel only opens when we have reached a certain level of relaxation. Tension is characterized by fixating the attention at stimuli from outside – we are in a posture of readiness for flight or fight, whether we are aware of it or not. In any case we direct our senses onto a possible threat. We are hardly at all aware of our inside. It only should provide the necessary energies that we can defend ourselves efficiently or run away in time.
Thus in therapy the ability to calm down at least a bit is needed, which is the ability to guide the nervous system out of the dominance of the sympathicus. Without cooperation of the smart-vagus system, therapeutic work is hardly possible. Many therapists start their sessions with giving time to the client to come to himself and to feel himself, often by suggesting to direct the attention to the breathing and to relax with that. Then from the inside issues arise, which become the object of work.
The setting and the person of the therapist should add to build up trust in the client. Otherwise it will not be possible to build up therapeutic contact and an atmosphere in which the client can open up. Additionally, relaxing the breathing helps for coming back to that beneficial atmosphere, when it has been lost in a phase of the work. Especially, when the client has collected experience with conscious breathing, this instrument can be used quickly and simply at any point of the therapeutic process, when the inner contact has been lost.