you are affected by a stressor, your body goes into the fight-or-flight response. One of the components of this response is an increase in your breathing rate and a move to upper-chest breathing. Diapragmatic breathing can reverse this process. This simple exercise made a great difference in Matt’s life. Let’s look at how and why:
Matt’s Story
“My anxiety is a battlefield. It has both a mental and a physical aspect. I worry and live with various fears on a daily basis. I get nervous when I am in an interview or meeting, a crowd of strangers, while driving (particularly if I am going somewhere new) or anywhere that I feel that I am trapped and can’t escape easily. I feel overwhelmed. The negative thoughts pile up and seem insurmountable. When these feelings last for a while, I start to beat myself up for not being able to get it together and I become depressed. I also start thinking that I am getting physically sick, developing a new allergy or having a stroke. I think that I am losing my mind and will need to check into the asylum. I also get obsessive and start double-checking locks and the stove to see if it is on. My chest gets tight and there is pain on either side of my upper body. My back and neck become tight. My stomach churns. I get bouts of dizziness. I feel like adrenaline shocks are shooting through my body. I sigh a lot.
Sometimes, the physical symptoms can be much worse. I feel the tightness in my neck and back as well as the pain in my chest. As the anxiety grows, I begin to feel that I am not breathing right. I can’t take a full breath. I can’t swallow. Then my heart starts beating faster and I feel tightness and throbbing in my temples. As the anxiety increases and overwhelms me, I hit panic mode. My lips, the sides of my face, hands and feet will go numb and tingle. I feel like I have hive-like blotches on my face. Once my face was so numb and hot that I thought my eyes would be forced shut while driving and that I would crash. Immediately after the stressful situation passes, the numbness starts to go away but leaves my face and lips feeling puckered. I actually feel silly at that moment looking at myself like I just sucked on a lemon.”
When I first met Matt, he was twenty-eight years old. He had had surgery for strabismus (being cross-eyed) and later a gastric bypass which brought his weight down from 430 to 230 pounds. Although his appearance was improved, it did not change his low self-esteem. He complained of feeling lonely. He had a college degree in fine arts and multi-media but in spite of being bright and creative, he only had a low-level technical job. Matt had a history of panic disorder; however, it was his generalized anxiety and low-grade chronic depression that brought him to my office for therapy. His anxiety was persistent, demoralizing and interfered with his functioning. For the most part, he had suffered in silence. The gastric surgery eight years prior had left him with multiple “stomach problems,” including gas, nausea and constipation. He reported that he had been taking an antidepressant that inhibited the reuptake of serotonin and norepinephrine for four years and at top therapeutic dose. Each time that his family physician tried to lower the dose, Matt felt that it caused “pill withdrawal,” upset his digestive system and threw his nervous system into turmoil, giving him increased anxiety, stomach pains and dizziness. He was adamant about not giving up his pills.
Matt was also convinced that many of his anxiety symptoms, particularly the numbness and the facial sensations and manifestations, had a physical cause. The presence of vague physical symptoms, often involving every system of the body, is an important feature of GAD. However, his ill-defined facial symptoms were unusual: they did not seem to be due to drug abuse, caffeine or medication. There was no family history of thyroid disease or diabetes. I was pleased when he told me that his family physician had also referred him to an endocrinologist for evaluation. A few weeks later, I received a report from the endocrinologist. He had ordered hormone studies to try to explain Matt’s symptoms but was pessimistic that the results would give him an answer. He also wanted to rule out an allergic reaction. All the studies came back within normal range.
Matt’s initial evaluation showed much “grist for the mill” for therapy. I decided to follow my gut reaction that his facial symptoms were due to anxiety. Education is a crucial part of the initial treatment process. Knowledge allows perspective, reduces feelings of helplessness and increases a sense of control over frightening symptoms. I decided to go back to basics and taught Matt to do a breathing exercise to see if that would help his symptoms. I told him to take in a deep breath through his nose and then let it out very slowly through pursed lips. Remember, it is the slow letting out of air that lowers the pulse rate and encourages relaxation. Most likely, Matt hyperventilated when he became anxious. This rapid breathing caused a decrease of carbon dioxide (CO2), which upset the body’s acid balance and caused physical symptoms such as muscle spasms and contractures. The deep breathing exercise helped bring this balance back to normal. The same effect can be gained by having the client breath into a paper bag, thus rebreathing CO2. I hoped that this exercise would allow Matt to consider anxiety as a causative factor in his distress, offer him a new coping skill and help us form a therapeutic alliance.
Matt’s biggest challenge was trying something new, particularly if it was geographically outside of his comfort zone. As with many anxiety-prone people, two of his stumbling blocks were his difficulty with change and his fear of the unknown. Change is difficult for anyone; for nervous people, because they value control and predictability, change is a haunted house filled with dark rooms. Any loss or threatened loss of control like a new job, a move to a new location, meeting new people or even trying new things causes them to feel helpless and subsequently anxious. They catastrophize and anticipate a negative outcome. It is difficult for them to relax and just go with the flow.
Anxious inner voices from the past often act as roadblocks to action for these individuals. When they are planning a trip, they may hear an internal voice saying, “That’s awfully far from home.” The inner voice may stem directly from parents, grandparents, teachers or older siblings who may have been anxious themselves and significantly influenced the clients’ lives. Unfortunately, people who are anxious seem to accept these internal warnings as dictums rather than as a sign of the other person’s own anxiety and fear. I try to help my clients step back from these warnings and consider their own desires and choices. I offer encouragement by saying, “Do you really need all that protection? You do not have to listen to the committee in your head. Think it through yourself and use your own judgment to decide what is right for you.”
Matt faced a double problem: There was a history of anxiety on both sides of his family. He described his mother as intelligent, warm and affectionate but also overbearing, anxious and overprotective. She had multiple health issues and often stayed in bed for a week. “Pills and doctors—she had a fix for everything,” Matt said. His maternal grandmother also got attention by complaining about physical things. His mother was the disciplinarian in his childhood home and often threatened him with a wooden spoon. His father, a draftsman, was “cold and unemotional but also anxious and a worrier.” His father could be sarcastic and had a rule book about what was appropriate. He worried constantly about his father’s reaction. At the beginning of therapy, I always ask clients to describe the people who raised them. Looking back at their descriptions often gives me clues to better understand how they became who they are and how they may see other people. Insight often comes from these connections.
These themes all played out in Matt’s life. Anxiety, particularly about being away from home, had been an issue with him for some time. His dream growing up was to go to New York and become a musician. His mother told him, “Go to college. That’s what I need from you.” She told him to be “the best.” Feeling great pressure, he went to a university in New York to study music technology. He became depressed and anxious and often couldn’t stop crying. Feeling worthless, embarrassed and ashamed, he took a semester off, returned home and worked for a title company. Then he attended college in Philadelphia and majored in multi-media. He wrote music and recorded voiceovers. He still speaks of New York as “the scene of my failure.”
Admitting that he needed to seek praise and approval his whole life, Matt was very sensitive to the remarks of others. “I didn’t think I had done a good job unless someone told
