Bob Van Oosterhout

Chapter 11 Getting Our Nerves in Balance
About Bob (...What about Bob?)
Anger and Impulse Control
Anxiety, Depression, PTSD
Behavioral Health Integration with Primary Care
Bring Truth to Fear: We CAN Work Together
Hard Times Cafe Model of Empowerment
Links to Videos for Online Stress Management at LCC
Managing Chronic Pain and Headaches
Mental Health
Moral Philosophy
Post Traumatic Stress Disorder
Practical Psychology: What Works and Makes Sense
Problem Solving - Responding Effectively to Problems
Slow Down and Lighten Up
Spiritual Writing
Stress Management
What Works
Resume/Curriculum Vitae
Comments, Suggestions, Discussion

Chapter Eleven

Regulating tension
Restoring and maintaining physical balance involves learning how to prevent the build-up of tension in our bodies. Chapter Six pointed out patterns of tension that correspond to the stress response, while Chapter Seven described how tension is produced when our autonomic nervous system gets out of balance. The next two chapters focus on developing specific skills that allow us to arrest and prevent the build-up of physical tension.

I cannot think of a situation where the accumulation of tension is helpful. Tension in a game or story can stimulate and excite us because there is resolution and a release of built-up suspense. However, on a physical level, the build-up of tension just gets in the way. Think of Olympic level runners. The most successful racers are those who are able to run in a relaxed way even when they are going as fast as they can. A runner starts to drop back as he begins to create excess tension by pushing or straining. Tension is essentially wasted energy. There is no build-up of surplus tension when there is a balance between energy and action.

I think of tension as a process rather than as a static condition. We often say that we "have" or "carry" a lot of tension, using the term as a noun. I think it is more accurate to regard tension as a verb and to say "we are tensing." Instead of thinking of tension as something we "have" or "carry," it helps to recognize that tension is something that we are doing as well as something that we have already done.

When we stop tensing, we begin to relax. The key is to recognize how and when we are tensing and to learn ways to stop it. I will describe two methods for doing this. This chapter explains the process of diaphragmatic breathing, which allows us to regulate our autonomic nervous system. Chapter Twelve describes a process called "grounding" which helps us become aware of patterns of built-up tension in our bodies and helps us learn to let them go.

Undermining tension at the source
Chapter Seven explained how the two parts (sympathetic and parasympathetic) of the nervous system work in opposition to each other. Stimulating the parasympathetic nervous system essentially deactivates the sympathetic nervous system, which supplies the energy that creates tension. We can stimulate the parasympathetic nervous system by changing the way we breathe. Specifically, it involves movement of the diaphragm, which is a muscle, shaped like a parachute, at the bottom of our lungs. When this muscle moves up and down in a slow, steady, continuous rhythm, the build-up of tension stops. This does not resolve tension that has built up over time, but it does immediately stop the build-up of additional tension.
Some have speculated that the movement of the diaphragm stimulates the right vagus nerve, which is a primary component of the parasympathetic nervous system. I am not sure of the exact physiological mechanism, but I have seen this effect in thousands of people over the past twenty-seven years. When the diaphragm is moving in a slow, easy rhythm , it ends the build-up of tension. This movement needs to be fairly precise to be effective. It doesn't work when there are stops and starts or pauses. It doesn't work when it is too fast or too slow. It doesn't work when we are trying too hard, which seems to create a tension-producing state that overrides the desired effect.

How to feel your diaphragm
A simple way to feel your diaphragm is to gently press the palm of your hand just below your sternum (breast bone), where your ribs began to separate. Sniff a few times, as if you were trying to get a whiff of a familiar smell on the wind. The bouncing that you feel under your hand results from the movement of your diaphragm.

How to breathe using the diaphragm
The first time you try it, it is helpful to keep your hand below your sternum as described above. As you inhale, allow the air to come all the way to the bottom of your lungs - you will feel the diaphragm move. Once the diaphragm is moving, it can be helpful to put your hand over your abdomen, near your belt line. Your hand will move out as you inhale and in as you exhale. Allow this movement to settle into a slow easy rhythm. Allow three to four seconds for the inhale and the same for the exhale. Do not pause between breaths. Start to exhale as soon as the lungs are full, and begin to inhale as soon as they are empty. Make sure that it is your breathing that is moving your abdomen, not your muscles. Pushing in and out with your abdominal muscles has no effect and will interfere with diaphragmatic breathing.

It is easier to breathe diaphragmatically if you are leaning back slightly. If you are leaning forward, your diaphragm presses against your stomach and intestines and this can restrict the movement a bit. A subtle but important part of mastering diaphragmatic breathing is to think of allowing it to happen rather than making it happen. Trying too hard generates tension, which overrides the parasympathetic nervous system. Be patient. A bit of practice may be necessary to get it right, but it is well worth the effort.

When done properly, diaphragmatic breathing immediately stops the stress response from building. You can feel a difference after three or four breaths. This can slow things down enough so that you can avoid saying or doing things that are likely to make a tense situation worse. Continuing to practice the diaphragmatic breathing during a stress situation helps to clear our thinking and allows us to evaluate our options. In twenty-seven years of working with diaphragmatic breathing, I have never seen someone continue to build tension when they are breathing diaphragmatically.

Things that get in the way
Occasionally, clients or students will report that diaphragmatic breathing is "not working" for them. Over the years, I've identified a number of things that seem to subvert the effects of this process. The most common is when the breath starts in the chest before the diaphragm begins to move. It is necessary for the inhale to come all the way to bottom of the lungs before filling the chest cavity. Think of filling a glass with water. The water goes to the bottom of the glass first and then fills the rest of the way. Our breathing needs to follow the same pattern in order to stimulate the parasympathetic nervous system.
Another common problem is breathing too fast or too slow. I have found that diaphragmatic breathing works only when there is a minimum of three seconds and a not much more than four seconds for each inhale and exhale (for a total of six to eight seconds for each full breath). I am not sure why this is true, but it consistently is. For example, I worked with a man who had a lung injury from breathing noxious chemicals. He was suffering from panic attacks, and I noticed that he was taking only about a second for each inhale and exhale. We used a stop-watch to train him to slow his breathing. The panic attacks stopped once he reached three seconds.

Pausing between breaths also seems to subvert the effects of diaphragmatic breathing. Again, I am not sure of the reasons for this, but my experience has been consistent. Stress symptoms begin to disappear when the inhale and the exhale are continuous without any pause between them.
A more subtle way to undermine the effect of diaphragmatic breathing is trying too hard. It can appear that someone's abdomen is moving up and down in a nice, easy rhythm when actually it is being forced by effort, thus creating tension and stimulating the sympathetic nervous system. The effort of forced breathing is usually evidenced by a furrowing of the brow or tensing of the jaw. It seems that when the autonomic nervous system gets contradictory messages, the sympathetic system wins and overrides the parasympathetic response. It is not necessary to breathe perfectly the first time you try it. But it's helpful to remember that your body's natural way to breathe when you are at rest is diaphragmatically. Our bodies want to breathe that way. We simply have to pay attention to it and allow it to happen.

Sometimes there appears to be a significant amount of tension in the diaphragm and you simply cannot seem to get the diaphragm to move. I have seen this particularly in working with clients suffering from chronic pain. In most cases, continuing to practice the diaphragmatic breathing (without trying too hard) eventually loosens things up enough so the diaphragmatic breathing has the desired effect. Occasionally, particularly in cases with there is severe acute pain, using other relaxation approaches first seems to settle things down enough to allow the diaphragm to began working.

What if I can't do it?
I have discovered some tricks that appear to help stimulate diaphragmatic breathing when it seems difficult. I have also used these approaches with children and mentally retarded people who weren't able to understand the directions for how to breathe diaphragmatically. The simplest technique is to lie prone (on the stomach) with a pillow under the chest. This restricts chest breathing enough so that the air moves down to the diaphragm. It usually takes a little longer this way than when we can start the process consciously, but I have found it to work well. A similar technique is to hold a pillow, or just our arms, gently against our upper chest.

We can often stimulate diaphragmatic breathing by making a very full exhalation - breathing out all of our air until the lungs feel empty. Then we simply relax. The next breath most often will move the diaphragm. I would recommend not doing this more than once, to avoid hyperventilation. Another technique is to press very gently against the abdomen during the exhale and then to lift your hand during the inhale. This seems to stimulate the diaphragmatic breathing.

Breathing patterns during stress and activity
It's not possible to breath diaphragmatically when we are physically active. We use our chest muscles to breathe when we need extra oxygen to support activity. We can feel our chest heave in and out whenever we engage in strenuous activity. Breathing this way stimulates the sympathetic nervous system and is the type of breathing that is evident during the stress response. Chest breathing is the opposite of diaphragmatic breathing. It is also the "normal" mode of breathing for someone who struggling with long-term stress. Clients and students will sometimes start out using a blended kind of breathing when first learning this technique. The abdomen clearly moves, indicating that the diaphragm is working, but the chest also moves. It makes a difference which moves first. I have found that there is eventually a positive effect if the abdomen rises first, indicating that the diaphragm has moved first. However, in my experience, if the chest moves first there is no effect on limiting the stress response.

Remembering to use it
The hardest thing about learning to control the stress response through diaphragmatic breathing is establishing the pattern and remembering to use it. We breathe all the time, and we're not used to thinking about how we breathe. Clients and students who are most successful set up a routine in which they link practicing diaphragmatic breathing with a normal activity in their daily schedule. Some like to practice when they first wake up; others after their morning shower or before breakfast. Linking diaphragmatic breathing with meals is a good practice, because stimulating the parasympathetic nervous system helps with proper digestion. Other popular times include during normal breaks, while driving, in the elevator, during commercials, while waiting, and before going to bed. Diaphragmatic breathing can be very helpful if one has trouble falling asleep. Sympathetic nervous system activation interferes with sleep. Stimulating the parasympathetic nervous system turns down the "nervous" energy that can keep us awake.

How often, how much and when
The amount of practice that has seemed to work best, in my experience, is six times per day for three to five minutes. Many have reported significant progress by practicing less. However, no one I have worked with has remained in a high-stress state after practicing diaphragmatic breathing six times per day for two weeks. Most people report that after consciously practicing for three or four weeks they notice they are breathing diaphragmatically without thinking about it. That's an indication that your body is regaining its physical balance.

Regular practice is not necessary once diaphragmatic breathing becomes your normal pattern of breathing during rest. It is still helpful to continue practicing at regular intervals, but many report that they automatically begin breathing diaphragmatically at times when previously they would have practiced, such as at meals or before bedtime. When diaphragmatic breathing becomes a regular part of our lives, there is a tendency to notice when our breathing changes in response to increased stress levels. We now have a very helpful indicator that not only helps us recognize potential stressors but also cues when to practice diaphragmatic breathing in order to stop tension from building before it really gets going.