Diaphragmatic/Stomach Breathing Exercise adapted from Dr. Charles Carlson.
…the patient should understand why they are doing diaphragmatic breathing training, the mechanisms by which it is accomplished, and appropriate precaution to not engage in training that increases discomfort or pain. It is generally best to introduce the patient to the training while the patient is resting in a reclined position. The process of breathing training starts with having the patient exhale first, then letting the stomach rise as air enters. Then the patient releases the air or “just lets go” and the air moves out of the lungs…there is no controlled release. Then the patient rests for a short period before beginning the cycle over again.
A sample of the instructions (to be read to each patient) are presented below:
Breathing so that the stomach is moving in and out rather than breathing with your chest can help relax you. This stomach breathing, or diaphragmatic breathing, can help you relax and maintain calmness. Please remember the rule: you should do nothing to increase your sense of discomfort while you are practicing the breathing. To start breathing withyour stomach, or diaphragm, you should rest in a comfortable, reclined position with your head centered, supported and in the midline of your body; your eyes are closed, with smooth eyelids; and smooth forehead; your mouth is relaxed: with lips apart, teeth apart, and tongue relaxed; there’s no throat movement; your shoulders are sloped and even; elbows bent; your hands will be in a curled, relaxed position, not touching one another; knees are apart; and feet are pointing away from one another at a 45-90 deg angle. Then, place your right hand just below your rib cage on top of your stomach. Just exhale first to release air from your body—it should be a complete, relaxed release where there is no holding, controlling, or forcing of the release—it is like a balloon collapsing as you let your air go from your body. When you are ready to take your next breath of air in; let the stomach gently rise as if you are pushing your stomach up with the column of air coming in. After you take in a comfortable, normal breath, release your muscles and let the air go just as you did at first when you started the exercise….there is no controlled, gradual release, just let go all at once and have the air move naturally out of your body. Then, pause and rest for a few moments before you take air in again to start another breath cycle. The rest period between breaths is the deepest point of your relaxation when everything is quiet and you relax before taking air in again. (Pause for 10 seconds) From the beginning of the training, you should breathe at a pace that makes you feel comfortable. (Pause for 5 seconds) You also want to breathe naturally and not too deeply in order to avoid over breathing or hyperventilation. If you were to feel light-headed or dizzy, the chances are you are taking in too much air with each breath…take a little less air in on your next breath and the breaths that follow. (Pause 10 seconds) Most people find that counting to 4 while air is coming into your lungs may set a natural, relaxed pace. Once the air is released, the rest period is typically the time it takes to count from 1 to 4. So, a starting pace for you can be counted as “air in-2-3-4; release; and rest-2-3-4”. (Repeat the phrasing 2 times) Repeat the breathing pattern for several minutes to establish a comfortable, relaxed rhythm to your breathing. (Pause for 5 seconds) Let your stomach rise as air enters, then let the stomach fall as you release theair, and let everything rest until taking in your next breath of air. (Pause for 10 seconds) Your breathing rate will likely be somewhere between 3-7 breaths per minute as you practice diaphragmatic breathing. Let your breathing be slow and relaxed as your stomach moves up and down. The initial practice session should be for five minutes with each following session adding a minute to the practice session so that eventually the participant is able to practice diaphragmatic breathing continuously for 20-25 minutes. The criteria for the training is that there will be minimal chest movement during breathing because the primary motion from the diaphragm will involve the stomach moving out with each inspiration at a pace of 3-7 breaths per minute and the patient will report a positive relaxed feeling.