Just Breathe.

If you read my last post, you may remember my running hamster analogy.  That spinning of the mind is often what drives our inability to sleep, fuels our uneasiness and sometimes makes it difficult to focus on a specific goal. In yoga, we call that “chitta vritti” – translation: consciousness fluctuations.  In medicine, we call it stress or anxiety.

We’ve all experienced stress and anxiety.  In fact, we all have varying degrees of this every day.   Some forms of stress and anxiety are healthy, even helpful at times. It’s what allows us to get out of bed each day, meet deadlines at work, achieve success and create meaningful relationships.  However, other forms are not.  It’s in these times of unhelpful or unhealthy stress and anxiety that we need to recognize it as such and call upon some new tools and coping strategies to move through with greater ease, balance ourselves and find peace.

As an emergency physician, I see patients and families who are under extreme stressors and are often feeling immensely anxious.  Oftentimes the stress response is appropriate in these situations, but I am also reminded of the tremendous burden excess stress and inappropriate surges of anxiety can cause.

While stress and anxiety have some distinct differences, they both represent varying degrees of nervous-system imbalance.    Let’s talk a little anatomy and physiology.

Gestation is the time when our nervous systems are under construction and being wired for equanimity and stability or for hypersensitivity and vulnerability to the stressors of the world outside of the womb.  As such, we are highly adaptable creatures – if you were a New Year’s baby born in Minneapolis or Miami, you would be able to adapt.

The nervous system includes the brain and those systems with which it interacts.  It is broken down into the central and peripheral nervous systems.  The central nervous system is your brain, connected to neurons that extend as long fibers traveling out to the body as the peripheral nervous system.  The peripheral nervous system is made up of two main branches – sympathetic and parasympathetic.  This is where the mind-body connection really comes into play.

You may recall that the action of the sympathetic nervous system is often referred to as the “fight or flight” response.  This is what allows us to react quickly in times of threat or stress.  The parasympathetic branch is often referred to as the “rest and digest” response.  Its job is to calm and slow us down, allowing things to digest, heal and reset.  As adaptable creatures, these two systems are constantly in flux attempting to keep us in perfect balance.  However, as we know, balance is not a steady state.  It is a scale that toggles one way or the other – influenced by a number of different factors.

Let’s think about it using a common analogy.  The sympathetic nervous system is like the gas pedal in your car.  The parasympathetic is like the brake pedal. Since it is not possible to drive smoothly while both accelerating and braking, at any given time one is more engaged than the other.  When you are feeling stressed or anxious, your sympathetic nervous system revs up, and like the gas pedal of a car which starts accelerating the engine, propelling the car ahead faster, your sympathetic nervous system tells your body to start producing hormones that work to speed up your heart rate, raise your blood pressure, quicken your breathing rate, etc.  Appropriate, if say someone is chasing you, not appropriate if you’re simply driving to meet a friend for coffee.  In inappropriate times of acceleration, we must have the awareness to hit the brake.  The brake slows things down, cools things off, allows things to equilibrate.  Simply put, the main role of the parasympathetic nervous system is to restore calmness to an overdriven system.

Just like a car has the necessary parts to speed up and slow down, we too have the mechanisms and biology in place to be able to connect and to calm ourselves.  When we talk about the mind-body connection, this is real stuff. It’s a physical and biochemical connection that is always in play.

One of the first embryologic developments of the budding brain becomes our brain stem.  Guess what that’s in charge of – breathing.  Before we added everything else – creativity, poetry, science, mathematics, art – we started with the most critical part first and formed a node whose primary function allows us to breathe.  As such, our breath is the direct conduit to our nervous system.

People experiencing anxiety may have a myriad of symptoms.    Some of these symptoms include rapid heart rate, pounding heartbeat, hyperventilating, nausea, dizziness, tingling, feelings of impending doom.   Those symptoms are a result of hormones activated by the sympathetic nervous system – cortisol, epinephrine, norepinephrine and others.

Want to hear something amazing?  These symptoms can be directly alleviated with deep breathing.

When you take a deep breath, the lungs expand, the diaphragm lowers and specific receptors and nerves are triggered to active the parasympathetic system.  Thus, when you start deep breathing, you are taking your foot off the gas pedal and pressing the brake.  It would be great if it was that simple.  If you’ve ever experienced a full-blown anxiety attack you know that it’s not.  But, I hope to convince you that with practice, you can learn to strengthen your own mind-body interface and improve your ability to control your nervous systems and sway the scale.

Below you will find two breathing exercises that may help you the next time your foot is pressing that gas pedal a bit too hard.

Diaphragmatic breathing:

(The basis for the practice of meditation)

Sit comfortably or lie down with your body supported in a way that promotes relaxation.

Place your right hand on your belly and your left hand on your chest.

Close your eyes or cast your gaze downward to eliminate visual distractions.

Notice the rise and fall of both of your hands with each natural breath.

When you’re ready, transition into breathing deeply into your low belly, letting your right hand rise and fall with each breath while your left hand finds stillness over your chest.

Do this for a few breaths, then return to your natural breathing.  You may feel a bit short of breath briefly, but eventually you will be able to “belly breathe” for longer periods of time.

This can be a helpful technique to promote sleep, calm you during a particularly stressful day, or can even be incorporated into your morning routine to start your day off with a sense of ease.

5-6-7 breathing:

A breath counting exercise designed to slow the breath and expand the exhalation phase, thus promoting relaxation and parasympathetic stimulation.

This can be done anywhere, anytime and in any position (ie, driving, standing in line at the DMV, in a work meeting)

Begin by focusing on your breath.

Inhale for a count of 4, hold the breath for a count of 4, then exhale for a count of 4.

Do this for a few breaths to warm up.

When you’re ready, extend each phase in an ascending fashion… inhale for a count of 5, hold the breath for a count of 6, then exhale for a count of 7.

There is no magic set of numbers.  Perhaps 6, 7, 8 or 4, 6, 8 feels better to you.

This technique works well for some people experiencing a panic attack, or sudden sympathetic reaction.

Now you are armed with two different breathing exercises designed to help you regulate your nervous system.  Remember, there is no perfection in this.  Practicing these techniques when you don’t need them will help you train your body how to use them when called upon.  It’s “driver’s ed” to avoid a crash.

The goal should not be to suddenly make anxiety and stress disappear – that is not practical.  What you can work toward is getting through these times more smoothly, avoiding unnecessary stress and anxiety and learning how to better acknowledge the symptoms (and in the case of anxiety/panic, better tolerate them).

Remember that anxiety and stress are universal things.  Recognize that the symptoms are temporary and begin to train your mind through your breath.

In yoga, the breath is a fundamental part of the process.  Join me next time to further explore a rational view of the health benefits of yoga from a medical perspective.

Be kind.  Be mindful.


Laura M. Hays MD, FACEP


Laura is a board-certified emergency physician, assistant professor at Campbell University School of Medicine and a registered yoga instructor based in Charlotte, NC.  Her ongoing practice focuses on body awareness and the exploration of how breathing techniques, meditation practice and physical postures can work together to help alleviate symptoms of common ailments.  One of her main passions is helping people manage stress and anxiety by cultivating their own mind-body connection. 

“I believe in the power of the pause. When the journey seems hectic and the world is moving so fast around you, take a moment to pause – breath, reconnect and find your intention. As a mom, an emergency physician and well, a human, I find this challenging at times. Yoga helps remind me to focus on the present, move with intention and stay balanced.  As we navigate through life’s amazing journey it is essential that we practice introspection, open-mindedness and show kindness and gratitude to others and to ourselves.”


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