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Section 14
Mindfulness-Based Breathing

Question 14 | Test | Table of Contents

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In the last section, we discussed four aspects of exercise and diet to help reduce the severity of panic attacks. We went over the benefits of exercise; aerobic exercise; non-aerobic exercise; and diet tips.

Breathing exercises have the unique characteristic of quickly and efficiently relaxing a person without making them drowsy. Through these exercises, clients can quickly and painlessly energize themselves to take on the rest of the day. 

In this section, we will present five breathing exercises that you might consider teaching or recording for your anxious clients, which are 1-to-8 count; 1-to-4 count; 5-to-1 count; three-part breathing; and alternate nostril breathing. 

Five Breathing Exercises

♦ Technique: 1-to-8 Count
First, we will present the 1-to-8 Count. I recorded the following exercise for my clients:

Step #1 - Take a deep, slow breath and close your eyes.
Step #2 - Exhale fully and completely, making sure to get the last bit of air out of your lungs. Breathe in again.
Step #3 - As you inhale, try to see the number 1 in your mind; at the same time, focus on the inhalation.
Step #4 - Hold your breath for three seconds. 
Step #5 - Exhale, and as you breathe out the air fully and completely, mentally say "two" and visualize the number two in your mind.
Step #6 - Breathe in again and mentally say "three," focusing on the number three and the inhalation. Hold your breath for three seconds.
Step #7 - Exhale fully and completely while mentally visualizing and saying "four."
Step #8 - Inhale, saying "five," exhale saying "six."  Remember to visualize the number and focus on the inhalation.
Step #9 - Inhale, counting "seven" and exhale counting "eight."
Step #10 - Repeat the entire sequence from one to eight. Slowly open your eyes. 

After completing this breathing exercise, do you feel calmer? Did you have any difficulty visualizing the numbers? Were you able to focus on the inhalation? Did you finish the exercise?

♦ Technique: 1-to-4 Count
Next, we’ll move on to the 1-to-4 Count.  This one is a little shorter and is ideal for clients who do not have enough time to complete very long exercises. 

Step #1 - Take a deep, full breath. 
Step #2 - Exhale fully and completely.  Inhale again and mentally count from one to four. 
Step #3 - Hold your breath, and again count from one to four. 
Step #4 - Slowly count from one to eight while exhaling fully and completely. 
Step #5 - Repeat the sequence four times. 

After completing this breathing exercise, did you run out of breath before reaching number eight while exhaling?

♦ Technique: 5-to-1 Count
In addition to the 1-to-8 and the 1-to-4 counts, the third breathing exercise we will suggest is the 5-to-1 count:

Step #1 - Say the number five to yourself and as you focus on the number take a deep, slow breath. 
Step #2 - Exhale fully and completely, making sure to get the last bit of air out of your lungs.  Mentally count four and inhale.
Step #3 - As you begin the exhalation, tell yourself, "I am more relaxed now than I was at number five."  Be sure not to rush the thought. 
Step #4 - Inhale, mentally counting three.  Tell yourself, "I am more relaxed now than I was at number four" as you exhale fully and completely. 
Step #5 - Count number two and then number one, mentally repeating the phrase: "I am more relaxed now than I was at number two." 
Step #6 - Allow yourself to feel the deepening relaxation.  As you approach number one, you should feel calmer and more relaxed.

After having completed these three breathing exercises:  the 1-to-8, 1-to-4, and 5-to-1 counts, did you feel relieved of any tension?

♦ Technique: Three-Part Breathing
The fourth breathing exercise I record for my clients is the three-part breathing exercise:

Step #1 - Take a deep, diaphragmatic breath.  Imagine that your lungs are divided into three parts. 
Step #2 - Visualize the lowest part of your lungs filling with air.  Use only your diaphragm; your chest should remain relatively still. 
Step #3 - Imagine the middle part of your lungs filling, and as you visualize the expansion, allow your rib cage to move slightly forward.
Step #4 - Visualize the upper part filling with air and your lungs becoming completely full. Your shoulders will rise slightly and move backwards.
Step #5 - Exhale fully and completely. As you empty your upper lungs, drop your shoulders slightly. 
Step #6 - Visualize the air leaving the middle portion of your lungs, and feel your rib cage contract. 
Step #7 - Pull in your abdomen to force out the last bit of air from the bottom of your lungs.
Step #8 - Repeat the exercise four times.

After completing this breathing exercise, did you have any trouble visualizing your lungs expanding and contracting? Were you able to complete the inhaling visualization before you started to exhale? 

♦ Technique: Alternate Nostril Breathing
In addition to the 1-to-8, 1-to-4, and 5-to-1 counts, and the three-part breathing exercises, we will move on to the fifth and last breathing exercise: alternate nostril breathing. Although it may sound unusual, many clients have reported that it is as effective if not more effective than the previous four: 

Step #1 - Place your right finger over your right nostril, pressing lightly to close off the nostril.
Step #2 -Take a deep, full breath inhaling with your left nostril. 
Step #3 - Visualize your lungs filling fully and expanding completely.
Step #4 - Remove your finger from the right nostril and lightly close off the left nostril. 
Step #5 - Exhale slowly through the now open right nostril. Be certain to exhale fully and completely.
Step #6 - Inhale through the right nostril. 
Step #7 - Close off the right nostril, and exhale fully and completely through the left nostril.
Step #8 - Repeat slowly and rhythmically for ten more breaths.

After having completed all five breathing exercises:  the 1-to-8, 1-to-4, and 5-to-1 counts, the three-part breathing, and the alternate nostril breathing exercises, which one left you feeling the most relaxed? 

In this section, we presented five breathing exercises that you might consider teaching or recording for your anxious clients, which are the 1-to-8 count; 1-to-4 count; 5-to-1 count; three-part breathing; and alternate nostril breathing. 

- Dattilio, F. M. (2001). Crisis Intervention Techniques for Panic Disorder. American Journal of Psychotherapy, 55(3), 388-405. doi:10.1176/appi.psychotherapy.2001.55.3.388
Reviewed 2023

Peer-Reviewed Journal Article References:
Hourani, L., Tueller, S., Kizakevich, P., Strange, L., Lewis, G., Weimer, B., Morgan, J., Cooney, D., & Nelson, J. (2018). Effect of stress inoculation training with relaxation breathing on perceived stress and posttraumatic stress disorder in the military: A longitudinal study. International Journal of Stress Management, 25(S1), 124–136.

Loo, L.-M., Prince, J. B., & Correia, H. M. (2020). Exploring mindfulness attentional skills acquisition, psychological and physiological functioning and well-being: Using mindful breathing or mindful listening in a nonclinical sample. Psychomusicology: Music, Mind, and Brain. Advance online publication.

Lotfalian, S., Spears, C. A., & Juliano, L. M. (2020). The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior. Psychology of Addictive Behaviors, 34(2), 351–359.

QUESTION 14
What are five breathing techniques that help clients reduce stress?
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