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Why Deep Breathing Exercises Can Activate Panic in a Traumatized Person

This blog contains information that is very personal for me. I experienced a fairly traumatic childhood with an ACEs score (Adverse Childhood Experiences) over four. If you want to do some research on the Adverse Childhood Experiences research, go to Adverse Childhood Experiences (ACEs) (cdc.gov)

As the movement of encouraging people to do mindful breathing received a lot of traction, people were encouraged to learn something called box breathing, where the person breathes in deeply to a count of four, holds their breath for a count of four, exhales for a count of four and repeats the activity several times. It is intended to calm a person. The problem is for someone like me, it has the opposite effect.

But why?

Bessel van der Kolk is one of the leading trauma experts, author of the New York Times bestseller book, The Body Keeps the Score, and he provides a description of this phenomenon of panicking when asked to breathe deeply and explains what happens in the brain in his forward to Peter Levine’s excellent book Trauma and Memory. In it he states:

“… traumatized people are terrified of what’s going on inside of them. Asking them to focus on their breath may precipitate a panic reaction; simply requesting that they keep still often only increases their agitation.… The areas of the brain that are devoted to self-awareness (the medial prefrontal cortex) and body awareness (the insula) often are strong in people with chronic PTSD—body/mind/brain has learned to shut itself down. This shutting down carries an enormous price: The same brain areas that conveyed pain and distress are also responsible for translating feelings of joy, pleasure, purpose, and relational connection.”

“For well over a century we have understood that the imprints of trauma are stored not as narratives about bad things that happened some time in the past, but as physical sensations that are experienced as immediate life threats— right now. In the intervening time we have gradually come to understand that the difference between ordinary memories (stories that change and that fade with time) and traumatic memories (recurring sensations and movements that are accompanied by intense negative emotions of fear, shame, rage, and collapse) is the result of a breakdown of the brain systems that are responsible for creating ‘autobiographical memories.’” 

The only people who can truly understand how being instructed to do deep breathing and breath holding causes anxiety and even panic are those who have had terrifying thoughts that prevent them from finding these exercises to be calming. There isn’t some easy cure for stopping those thoughts as you can see from the brain information Dr. van der Kolk shared.

So what can a person do? It can be helpful to pay attention to the actual cruel thoughts you are having and any accompanying feelings and sensations when someone instructs you to do a deep breathing exercise. You can practice having countering conversations in your head that dispute what those cruel thoughts are saying to you. You can notice any tension in your body and can relax muscles. You can even do a body scan by going from the top of your head and down each area of your body to intentionally relax those muscles. Quite often as you do that you will naturally take a deep breath but it’s not because you have been told you must.

It’s my hope that if you do not struggle with relaxation breathing, you now understand why someone with a significant trauma history might need your compassion and support rather than any form of criticism or encouragement to try harder.

Invitation for Reflection

  1. Are you someone who has had the experience of being told to do relaxation breathing who becomes extremely anxious at the very thought of having to do that? How does this information help you understand what is going on in your mind and brain?
  2. Have you ever noticed someone who seems very uncomfortable when asked to do deep breathing and breath holding? Do you now understand what might be going on for them?
  3. As a result, what might you say to them to indicate you understand and there is a legitimate reason their discomfort?

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