Take a Deep Breath and Reduce Stress

Caregiving is stressful

As caregivers, we know we cannot simply outlast stressful situations, no matter how strong or healthy we think we are. Even low levels of stress, those constant small irritants, can affect your health and your ability to provide quality care to your loved one.

Studies show that 40-70% of family caregivers suffer from stress, anxiety, depression and other conditions. This caregiver burden results from the imbalance between the demands of caregiving responsibilities and the caregivers own coping skills and resources.

Previous blogs on the Foundation’s website have focused on how mindfulness and meditation can help alleviate and manage the stress, created by daily challenges, that caregivers experience. The core of any mindfulness or meditation practice is breathing.

Breathing is easy to take for granted because it’s automatic. It’s something all living creatures do but only people, over time, become less adept at it.

We can all benefit from a better understanding of the mechanics of breathing, how to maximize its efficiency and, most importantly, how it should feel.

Deep breathing

When we inhale air (through the nose and sometimes the mouth), the diaphragm and other respiratory muscles contract. This contraction opens the rib cage, pushes the abdominal contents towards the pelvis and expands the abdomen. The specific “drawing down” action of the diaphragm creates a vacuum, sucking air into the lungs and filling them to capacity.

Exhaling is essentially the reversal of that action. The respiratory muscles “relax”, the diaphragm rises back towards the rib cage, and air is expelled from the lungs.

When done correctly this action causes the abdomen to rise and fall. Hence the terms “abdominal” and diaphragmatic” breathing. This is the most optimal way to breathe and the majority of us do it incorrectly.

Here is a simple exercise to help you determine how efficiently you are breathing.

  • Sit comfortably in a chair with knees bent and your feet flat on the floor.
  • Place one hand on your chest and the other hand on your belly, just below the rib cage. Breathe naturally.
  • Notice the movement or lack of movement in your hands. If you feel the hand on your belly move up and down (away from and then back towards your body) as you inhale and exhale, the diaphragm is engaged. If the chest has significant movement, it means that you may be using the muscles of your neck, shoulders and chest to breathe.

When we don’t fully engage the diaphragm, our body starts to use different muscles in the neck, back and chest for breathing. This leads to “shallow” or “chest” breathing which does not allow as much air to be drawn into the lungs.

Deep breathing and stress

When a stressful situation presents itself or a situation is perceived as stressful, our bodies react with the “fight or flight” response. Our heart rate increases, breathing becomes rapid and shallow and muscles tense up. If these reactions to the stressful event are not interrupted, they can create a harmful cycle where the stress causes a response that then increases the stress – and on and on.

Breathing deeply from the diaphragm reduces the stress and causes the body to relax by slowing the heart rate and stabilizing blood pressure. Lengthening the exhale sends a message to the brain that everything is okay, even when the stress continues and the mind is filled with anxiety provoking thoughts. Therein lies the power of diaphragmatic breathing.

Sometime just taking a few deep breaths before entering a stressful situation or when you find yourself in the middle of one can lower stress and anxiety levels

Benefits of deep breathing

Understanding exactly how we breathe and practicing the correct way to take a breath provides many benefits. Two aspects are especially valuable for caregivers. First, the body will respond positively to deep breathing by reducing the physical processes associate with the sympathetic nervous system, and shift instead into the parasympathetic response – slower more controlled breathing, decreased heart rate, and less muscle tension. Second, a deep breathing practice can be done any place, any time, and by anybody.

Practice, practice, practice

Breathing, like any activity where you wish to improve, requires practice. But you need to start slowly, monitor how you feel and do not force anything.

Below is a recommended beginning exercise to help improve your breathing and strengthen the muscles involved in taking a breath. This exercise can also be done on a flat surface on your back, with knees bent or a pillow placed under your knees and one under your neck for comfort and support. Be aware of your body at the beginning of the exercise and at the end. Work up to a practice of 5-10 minutes at least once a day.

  • Sit comfortably in a chair (or lying down). Feet flat on the floor, knees bent. Relax your shoulders, neck and hands.
  • Place one hand on your chest and the other hand on your belly, just below the rib cage.
  • Breathe in slowly through your nose, drawing the air in deeply towards your lower belly. The hand on your chest may move slightly, but the hand on your belly should rise and expand as you inhale. Imagine your belly as a balloon. When you inhale the balloon expands. As you exhale, the balloon deflates.
  • Exhale by relaxing your belly muscles and let them move inward releasing the breath out through the mouth (pursed lips). The belly should return to its original position. Your shoulders and neck should be relaxed.
  • Take inventory after you have finished the exercise. Is your body relaxed? Are your toes gripping into the floor? Monitor your body tension before and after each practice.

Stressing about breathing “correctly” can hold you back from actual improvement. The key is to simply focus on being mindful and explore the breath through practice.

It is the tool that’s always with us, accessible at any time for calm, balance and presence of mind. The amazing thing is that anybody – regardless of age, ability, location or beliefs – can utilize breathwork to better navigate life. It just takes practice and attention.

How to Breathe: 25 Simple Practices for Calm, Joy and Resilience

by Ashley Neese

Specific breath practices

Once you have an idea of how a deep breath should feel, have practiced and become more comfortable with diaphragmatic breathing, you will be able to use that breath to help alleviate and navigate stressful situations.

A breathing practice is an exercise that focuses on using various methods (length and duration of the breath) to create more optimal breathing patterns that can have a profound effect on your overall mental and physical health and well-being. The goal is not perfection, but practicing a more optimal and calming strategy.

A breath practice can be done sitting in a chair or on the floor, or lying down. It is recommended that you start in these positions (not standing) for body stability and support. Once a healthy practice has been established, you could confidently engage in several diaphragmatic breaths while standing near support, if needed. For example: Taking one or two deep breaths before entering a room to help release tension or refocus your mind.

Before you begin your practice, setting an intention can give you purpose and direction. An intention is different from goals, which focus on results. An intention might be to complete the practice without interruption; to take three good deep breaths; or to simply concentrate on the breath. The intention should be clear and simple.

There are many ways to breathe and influence the diaphragm. In How to Breathe, Ashley Neese describes a number of “portable” or “mini-practices”. The following examples may be particularly helpful to caregivers and can be used throughout the day when needed, without setting aside a specific time for a full practice. Even brief five-minute self-care breaks will help release tension, relax and refocus the mind. Make certain that you have already practiced deep breathing before taking these practices on the road.

It is also important to begin these practices in a safe space, and at your own comfort level and pacing, until you feel confident with the practice and your body’s response to it. As you begin practicing these or any breathing exercise, if they are challenging for you, start with just one or two good breaths, and work your way up to five. Once you feel comfortable with five full breaths, these practices can be done anytime you need them.

Five-Breath Grounding Practice – If you are feeling stressed or anticipate a stressful situation.

  • Set a quick intention.
  • Place your feet on the ground, hip distance apart.
  • Take five deep breaths in through your nose and long exhales out of your mouth.
  • Notice how you feel afterward.

Five-Breath Reset Practice – When you are feeling emotionally or mentally overloaded.

  • Set a quick intention.
  • Inhale through your nose as long as you can without discomfort, then exhale as long as possible through your mouth.
  • Repeat five times.
  • Notice if you feel a difference.

Five-Breath Alignment Practice – To refocus your mind on the present moment.

  • Set a quick intention.
  • Take a deep inhale through your nose while counting from 1 to 5.
  • Exhale through your nose while counting from 5 to 1.
  • Repeat this five times and become aware of where your mind lands.

Whether you call it diaphragmatic, deep or belly breathing, practicing these exercises at home can help prepare you for stressful caregiving situations that may arise in the future.

Final word

While diaphragmatic or deep breathing has been shown to alleviate some anxiety, it is important to realize that panic attacks, anxiety disorders, and depression are mental health conditions. These should always be assessed and treated by a licensed medical professional. If your anxiety feels out of control, affects your daily life, or simple relaxation techniques do not help, please contact your doctor or mental health professional.

Sources

How to Breathe: 25 Simple Practices for Calm, Joy and Resilience, by Ashley Neese. Ten Speed Press, CA and NY 2019

WellMed Blog: Just Breath! April 8, 2020 James D. Huysman, PsyD, LCSW, CFT. Accessed: 4/16/2021

Lung Health & Wellness. Breathing Exercises. Accessed: 4/16/2021

Harvard Medical School. Healthbeat: Learning diaphragmatic breathing. Accessed: 4/16/2021

American Lung Association. Five Ways You Might Be Breathing Wrong. Accessed: 4/16/2021

Mayo Clinic. Diaphragmatic Breathing. Accessed: 4/16/2021