Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

Meanwhile, Felicity taught her the main means by which to stop or prevent panic attacks. The trouble probably began in Queeny when she was an adolescent. She wanted to look slim and beautiful, and one way she thought of to help this along was to hold her tummy in. She sucked her tummy in so well that the only way she could breathe was into her chest. While that may have helped her looks, it certainly didn’t help her health.

The diaphragm (which does normal ‘stomach’ breathing) is smooth muscle. It reacts slowly, but it can go on indefinitely without tiring out. But its slow reaction is undesirable under (real) emergency conditions when the body needs lots of oxygen. So, in an emergency, the body turns to the much faster-reacting striate or skeletal muscles of the chest wall. They quickly expand the chest cavity and suck air in to get the needed oxygen. That is, chest breathing occurs naturally in emergency-stress.

To understand how this works, it needs to be remembered that the chest cavity is a rigid structure formed by the ribs. It will expand a certain distance, but it will only contract by the same distance – the ribs coming together stop it from closing down any farther to blow more air out.

In normal diaphragm breathing, the out-breath is much longer than the in-breath, in the ratio from about 3:2 to 3:1. This means that the long out-breath slows down the whole breath cycle, resulting in relatively few breaths per minute. In chest breathing, the shortening of the out-breath to be equal to the in-breath (in a 1:1 ratio), speeds up each breath cycle, increases the number of breaths per minute, and thus increases the oxygen level in the blood stream very rapidly. That’s good, right? Wrong!

In our engineered safe society, if we abide by a few simple rules (walking on the sidewalk, not jumping over protective railings), there is no danger. Since there is no danger to deal with, if we arouse the autonomic-emergency-stress response, there is nothing for us to do – there are no tigers to run away from, no predators to fight and no food to be chased. There is no energetic activity (to use up the extra oxygen) for us to do when we are reacting with stress. But the stress response still occurs in us – being hard-wired in us to recognize (mostly imaginary) dangers and to react to them. So we get all that extra oxygen in our blood streams and the resulting extra energy. And we do nothing with it. If the extra oxygen in the body, due to chest-breathing, is not used up by activity, it has several effects on the body.

First, to protect irreplaceable brain cells from getting burned out by too much oxygen, when the blood oxygen level rises, a reflex automatically activates constriction of the blood vessels feeding the brain. The resulting reduction in the volume of blood feeding the brain, even although it is oxygen-rich blood, reduces the amount of oxygen the brain has available to it (anoxia), and the person feels ‘woozy’, ‘zonked out’ or dizzy. And that experience scares most people.

Second, the muscles receive an increased oxygen supply. This lowers the metabolic threshold of the muscle cells, and they tend to tense up – the person starts feeling ‘up tight’ or tense.

Third, the striate muscles of the chest wall react quickly, but they also tire out quickly. Very soon, their resistance to responding may make it feel to the person as though he/she cannot breathe. He/she may feel some muscle pain and perhaps interpret it as a heart attack. These events may scare the person even more.

Fourth, the sympathetic response is stronger (steeper) than the parasympathetic response of the autonomic nervous system (remember the slopes of ‘avoidance’ and ‘approach’ gradients in the introduction to chapter 4). In normal diaphragm breathing, the long out-stroke (controlled by the parasympathetic system) has time to neutralize the ‘anxiety’ created by the shorter in-breath (which is controlled by the sympathetic system). But in chest breathing, the relative shortening of the out-breath does not give enough time for the strong sympathetic response of the in-breath to be neutralized by the weaker parasympathetic response of the out-breath, and the person becomes more and more anxious and feeling under acute stress – anxiety or stress builds higher and higher.

So chest breathing quickly makes the person feel worse and worse, especially if the person is conscious of the bodily experiences occurring – as when the person is introverted or very introspective. The result is a panic attack.

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