Take a Deep Breath!

In my work with children and families, one of the things I spend a lot of time doing is making suggestions that I think might help them address the problem that brought them to see me.  One of the most common things people say in response is “Oh, I tried that already – it doesn’t work.”  And there is nothing with which this happens more frequently than the idea of trying breathing exercises to learn to cope with anxiety.

There’s a simple reason most children and parents tell me that deep breathing doesn’t help the child feel better – it doesn’t.  Yet breathing techniques have been shown in many research studies to help both children and adults cope with anxiety.  They just need to be learned and practiced properly.

Anxiety is one of the most common problems of childhood, and occurs frequently in the form of “normal” fears and worries that fall far short of being an anxiety disorder, and which most families cope with just fine.  Often even such everyday anxiety can become bothersome enough to cause a family to consult me.  Sometimes children do experience anxiety disorders that are severe enough to cause significant interference with their functioning.  Almost all children will be familiar with some triggers for anxiety, such as fears of spiders or snakes, large active dogs, being alone at night, severe weather, a big upcoming test, a bully at school, or their place in the middle school social hierarchy.  When it’s strong enough, anxiety can cause loss of sleep, muscle tension and fatigue, distractibility, a decline in school performance or reluctance to attend school, or withdrawal from social situations.  In some cases it can cause headaches, stomach aches or other physical symptoms.

When fear or worry raises its head, and a child seems stressed or agitated, parents, teachers and other adults will quite logically and appropriately suggest deep breathing as a way to cope.  It seems like it should work, many of us as adults have learned to use it, so why does it so often seem to fail for anxious children?

For one thing, most children are already anxious and agitated when adults suggest that they take some deep breaths.  There are two problems with this.  First, anxiety is harder to calm when it is high than when it is low.  Second, breathing is a skill, and none of us are very good at learning a new skill when we are upset.  So an anxious child asked to take a deep breath is liable to do one of two things.  Often they will just refuse to try.  Or they may try, but do it poorly (remember, it’s a skill, and they haven’t been taught), not experience any relief, and conclude that it won’t work and isn’t worth trying again.

Wait a minute – breathing is a skill?  But I’ve been doing it all my life!  It’s true, we’ve all been breathing since the moment we were born, and it comes quite naturally to us.  It’s also natural for breathing to change when we are anxious – it tends to become more rapid and shallow, and in extreme cases can come to resemble the pattern we think of as “hyperventilation” (the technical definition of hyperventilation has nothing to do with what our breathing looks like, but that’s a topic for another day).  An anxious child told to take a deep breath will typically suck in what feels like a large amount of air, usually through their mouth, while lifting and tensing their shoulders and tensing their abdominal muscles.  The result is actually a constriction of breathing and a reduction of lung volume, inadequate exchange of oxygen for carbon dioxide, and increased tension and distress.  They often repeat this pattern fairly rapidly, because they want to feel better and figure the sooner it happens the better.

No wonder it doesn’t work.

There are two keys to helping children learn to use relaxed breathing to feel better.  One has to do with the fact that relaxed breathing has to be taught as a skill, with proper technique.  Rather than breathing deeply, the focus should be on breathing slowly, and on learning to use the diaphragm rather than the muscles of the upper chest and back.  It’s pretty easy to learn, but it helps to learn from a coach who can actually demonstrate the technique and give the child feedback as they practice.  The second key is to teach the technique while the child’s anxiety is low, then have them practice it regularly every day when not anxious.  That way, the child has a chance to perfect their technique and become more confident in the skill.  Parents can help the child by monitoring and reinforcing their practice.

Once a child becomes an expert at relaxed breathing, they have a chance to be much more effective in coping with their anxiety when it spikes.  The real benefit, though, is that the accumulation of practice over time makes the child less likely to become anxious in the first place.  It’s like running for cardiac fitness – you don’t do it when you think you’re having a heart attack.  It’s doing it regularly that may help prevent you having a heart attack in the first place.

Helping children learn relaxed breathing and other techniques to cope with anxiety is a major part of my practice.  If you’d like to learn more, or are interested in making an appointment for your child, please don’t hesitate to get in touch.