CRUfADclinic.
org
- homework
CRUfADclinic
Patient Handout
Module 2
Controlled breathing
[Link]
2
1. The fight-flight response and how it affects you.
When humans are threatened, their bodies react automatically so that they can try and escape or
deal with the danger. Human brains have been co-ordinating this reaction since the Cave Man era! As
discussed in lesson 2, the fight-flight response can help us to survive, but in panic disorder, it
gets triggered excessively and at inappropriate times. In panic disorder, this response is
triggered by personally perceived threats such as the threat of panicking rather than actual
physical threats like possibly being eaten by a shark.
When we perceive danger, our brains trigger the release of adrenaline from the adrenal glands,
which are thumb-sized glands that sit just on top of your kidneys. Adrenaline is a very fast-acting
hormone in the body and causes the intense symptoms experienced during the ‘fight-flight’ anxiety
response. Adrenaline only lasts a few minutes in the circulation before it naturally breaks down.
To recap from lesson 2, in the fight-flight response:
Our hearts beat fast to pump more blood to the muscles – in
panic this can be perceived as palpitations.
We breathe heavily to get oxygen, and in panic this can be
perceived as shortness of breath or choking sensations. Over
breathing also causes other symptoms such as dizziness, confusion, disorientation, light-
headedness and ‘pins and needles’ sensations.
Our muscles become tense, and ongoing tension can cause a tremor, shaking or ‘freezing’.
Our muscles also sweat to lose heat that running away or fighting would cause.
Our blood is diverted from our digestive system to our skeletal muscles, which can cause
feelings of nausea or abdominal discomfort.
The fight-flight response is a normal response of your body. The changes that occur in your body
during the fight-flight response are not dangerous or physically harmful. Learning to manage your
anxiety symptoms will help reduce the frequency and intensity of your fight-flight system firing.
Lesson 2 Panic Program · [Link] · page 2 of 4
3
2. Learning how to do controlled breathing.
Overbreathing is one of the major things that troubles Penny during panic attacks, and this is
common in panic disorder. Overbreathing is also called ‘hyperventilation’ and it can lead to the
following symptoms that can make the experience of panic worse:
Light-headedness or faintness An increase in heart rate /
Dizziness / confusion palpitations
Breathlessness, choking or Tingling sensations or numbness in
smothering the hands, arms or feet
A feeling of unreality Cold, clammy hands
Blurred vision Stiffness of the muscles
When you hyperventilate, you breathe out too much carbon dioxide, which lowers the level of carbon
dioxide in the blood. This worsens the symptoms of hyperventilation further. But don’t worry the low
levels of carbon dioxide are not dangerous because your body has other ways of keeping it at a safe
level.
To get rid of the hyperventilation symptoms, the level of carbon dioxide must be steadied, and the
fastest natural way to achieve this is to slowing down your breathing. Learning to steady your
breathing rate will help to prevent future episodes of hyperventilation and panic.
Slow breathing exercise – 3 easy steps.
Step 1: Sit or stand comfortably and have a watch or clock with a second hand with you. Slowly
exhale all the air from your lungs.
Step 2: Breathe in gently through your nose and breathe out gently through your mouth. Rest
your hands on your stomach to check that you are using your stomach
muscles (diaphragm) to drive your breathing rather than your upper chest.
You should feel your body slowly start to relax as soon as
you do this …
Step 3: Breathe in for 3 seconds and breathe out for 3
seconds. As you breathe out relax your body and say the
word ‘relax’ to yourself. Continue breathing this way until the symptoms of over
breathing are gone.
Controlled breathing is a very helpful way of controlling anxiety, and you can practise
it wherever you are.
Lesson 2 Panic Program · [Link] · page 3 of 4
4
At first you may need to find a quiet place to practise, but as time goes on you will more than likely be
able to do it whenever you feel the need. And, the more you practise, the more benefit you will
get. You should quickly find this helpful, which will make it easier to want to practise.
The homework this week is to count your breathing rate per minute three times every day and record
it on the chart, and practise the slow breathing technique three times every day. Record what you
were doing just before you counted your breathing rate on the following chart.
Breathing Rate Chart
Mon Tues Wed Thurs Fri Sat Sun
Time Morning
Breathing
Rate
Activity
Time
Afternoon
Breathing
Rate
Activity
Time Evening
Breathing
Rate
Activity
Once counting your breathing rate and practising slow breathing become really
routine, and even boring, we would like you to overbreathe for up to 30 seconds
until you get symptoms, and then use the slow breathing technique to control those
symptoms. Learning to control this overbreathing and the sensations associated
with it could be very powerful!
Lesson 2 Panic Program · [Link] · page 4 of 4