PSYCHOTHERAPY BEYOND THE FRINGE, continued
To control or prevent a panic attack, all one has to do is to reinstate diaphragm breathing for about a dozen breath cycles. This can be done in several ways. The physician, concerned as he is primarily with the body chemistry, may suggest the person breathe for five or so minutes into a brown paper bag. That results in the person breathing his own carbon dioxide back in and not increasing the oxygen intake. This lowers the oxygen level with some benefit. But it does not reinstate diaphragm breathing. And who would want to breathe into a brown paper bag in public?
The old saw speaks of ‘whistling in the dark’. Most of us would think this is just a way to ‘buck oneself up’ or to scare ghosts and hobgoblins away. Actually, it makes sense. Most of us whistle only on the out-breath. That means the out-breath gets extended and chest breathing is made harder while whistling.
But the obvious thing to do is just to make long out-breaths – this is NOT to say do ‘deep breathing’. Let’s be clear on how to do this best. First, do NOT interfere with the IN-breath – let it happen as it wants to so that you can feel confident that you are getting all the oxygen you need. Just time the in-breath in your mind. Second, having timed the in-breath in your mind, make the OUT-breath two, or three, or four, or five times longer than the in-breath. It’s easy to do. And, if you do it, the only way it can be done is to reinstate the action of diaphragm breathing to keep pushing out the air after the chest wall has collapsed as far as it will go. Third, do these long out-breaths for only about three or four breath cycles at a time, interspersed with uninfluenced breathing for another about three or four breath cycles. The reason for this last stipulation is to ensure you don’t bring the oxygen level in your blood down too quickly, before the corrective vaso-dilation of the blood vessels in the brain has time to occur. If you drop the blood oxygen level too quickly, while the blood vessels in the brain are still constricted, you may feel even more dizzy due to increased anoxia (less oxygen still for the brain), and that may scare you more. But the basic trick in dealing with panic is bursts of three or four ‘long OUT-breaths’ and that is all.
Felicity gave Queeny this explanation. She practised long out-breaths a few times in the office, and she agreed to practice them several times every day and to use them if she started to become panicky. Yes, even breathing has to be learned, but mainly because we have taught ourselves how to do it in an erroneous way. If you have mastered normal healthy breathing, and can remember to make long out-breaths when you are anxious, you can avoid ever having another panic attack. And you have also mastered a way to make yourself less anxious and uptight at any time. Felicity added a last reminder: “Remember, Queeny, I did NOT say to take deep breaths, NOR did I say to stop breathing. Let your in-breath occur as it wants to. Just time it in your mind, then push OUT your out-breath so it is two to five times as long as your in-breath was. And do these long out-breaths in groups of 3 or 4 at a time only.”
Queeny has been in touch with Felicity from time to time across the intervening ten years. She reports that she has not had a panic attack since she consulted Felicity. Basic panic is about the easiest thing there is to deal with in psychotherapy, even although the subjective experience is about as severe as any.