Coherent Breathing for Management of Trauma and Stress

Educational Objectives

The goal of this lecture is to improve coherent breathing practices for trauma and stress. After hearing and assimilating this lecture, the clinician will be better able to:

1. Explain the role of the vagus nerve in voluntarily regulated breathing practices.
2. Employ coherent breathing in the treatment of chronic disorders such as generalized anxiety, schizophrenia, and inflammatory bowel disease.

Summary

Introduction: specific breathing patterns occur when individuals experience certain emotions (eg, breathing becomes more rapid during anxiety); pathways between breathing and emotions bidirectional; voluntarily changing pattern of breathing can alter emotional state

Vagus nerve: main pathway of parasympathetic system; bidirectional; voluntarily regulated breathing practices used to send messages through vagus nerve; 80% of fibers in vagus nerve carry information to brain and affect major regulatory centers; ascending pathways to brainstem branch to limbic system, hypothalamus, thalamus, cortex, and prefrontal cortex; variation in heart rate and respiratory sinus arrhythmia can serve as markers for activity of vagus nerve

Coherent breathing: slow and gentle breathing 4.5 to 6.0 breaths per minute; 5 breaths per minute most effective rate for average individuals; inhalation equal to exhalation (through nose if possible); no force or pressure should be exerted; gentle breathing parasympathetically effective

Posttraumatic stress disorder (PTSD): PTSD difficult to treat because memories often encoded subsymbolically (ie, without words) and contain physical sensations (eg, dysregulation of emotions, distorted perception of body); disconnection — individual suddenly and completely loses sense of emotional connection; social engagement — begins with eye contact and physical closeness; physiologic regulation requires ability to be still and close to another person; trauma — disrupts sense of connectedness and distorts social awareness, leading to defensive reactions rather than reactions that facilitate social engagement; sympathetic system overactivated and parasympathetic system underactivated in individuals who have experienced trauma; breathing practices can be used to balance systems; medications (eg, benzodiazepines, anxiolytics) dampen sympathetic system, but do not elevate parasympathetic system; breathing practices can reduce sympathetic activity and boost parasympathetic activity

Adverse effects of rapid breathing: can trigger panic attacks in patients with panic disorder, flashbacks in individuals with PTSD, and manic episodes in patients with bipolar disorder; reaction often delayed

Slow-breathing practices: generally safe; rate of breathing does not exceed normal

Study of anxiety disorder: open trial looked at effects of 2-day program of slow-breathing practices and guided meditation on 20 patients with treatment-resistant severe generalized anxiety disorder; immediately after program, scores on anxiety disorder and depression inventories decreased dramatically (benefits largely sustained at 6 mo)

Study of chronic schizophrenia: cognitive function (eg, attention, delayed memory) improved after 12-wk program (3 hr/wk) focused on 3 simple movements and ≈20 min of coherent breathing; coherent breathing improves long-range communication within brain, resulting in reports of “clearer mind”

Study of inflammatory bowel disease: in patients with Crohn disease, ulcerative colitis, or bowel resection who participated in 2-day program (6 hr/day), follow-up at 6 mo revealed improvements in physical symptoms, pain, disability, stress, anxiety, depression, quality of life, and levels of biomarker for inflammation (C-reactive protein)

Study of PTSD: survivors of tsunami — 183 Asian survivors in refugee camps participated in 8-hr breathing program (2 hr/day for 4 days); at end of first week, PTSD scores had improved >60%, and scores on Beck Depression Inventory had improved 90%; further improvements seen at 6 mo; veterans of Vietnam War — veterans who were declared 100% disabled participated in 6-day program; within 6 wk, PTSD scores dropped significantly; after 6 mo, significant improvements seen in subjects, compared with controls

Study of military duty: 4-hr program focused on movement, coherent breathing, and guided visualization; participation significantly increased energy and significantly decreased tension, anger, worry, and pain; 84% of participants reported they would perform breathing practices, and 85% reported their families would benefit

Design of programs: practices adapted for individuals affected by disasters; teachers teach simple techniques that rapidly bring relief; techniques safe regardless of type of trauma, physical condition, and age; tools can be used by members of different cultures, even those without access to electricity or supplies; practices sustainable (even children can be rapidly trained)

Conclusion: breathing practices can lead to permanent resolution of long-standing trauma symptoms and can be used in individual treatment and psychotherapy

Readings

Brown RP et al: Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatr Clin North Am. 2013 Mar;36(1):121-40; Brown RP, Gerbarg PL: Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med. 2005 Feb;11(1):189-201; Brown RP, Gerbarg PL: Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II — clinical applications and guidelines. J Altern Complement Med. 2005 Aug;11(4):711-7; Brown RP, Gerbarg PL: Yoga breathing, meditation, and longevity. Ann N Y Acad Sci. 2009 Aug;1172:54-62; Gerbarg PL et al: The effect of breathing, movement, and meditation on psychological and physical Symptoms and inflammatory biomarkers in inflammatory bowel disease: a randomized controlled trial. Inflamm Bowel Dis. 2015 Dec;21(12):2886-96; Katzman MA et al: A multicomponent yoga-based, breath intervention program as an adjunctive treatment in patients suffering from generalized anxiety disorder with or without comorbidities. Int J Yoga. 2012 Jan;5(1):57-65; Streeter CC et al: Treatment of major depressive disorder with Iyengar yoga and coherent breathing: a randomized controlled dosing study. J Altern Complement Med. 2017 Mar;23(3):201-207.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose

Acknowledgements

Dr. Gerbarg was recorded in Las Vegas, NV, at the 22nd Annual National Psychopharmacology Update, presented February 16-18, 2017, by the Nevada Psychiatric Association. For more information about this sponsor, visit www.nvpsychiatry.org/. The Audio Digest Foundation thanks the speakers and the Nevada Psychiatric Association for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

PG061202

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.