Breathing as a Tool for Self-Regulation and Self-Reflection

Paivi Lehtinen, Minna Martin, Maila Seppa, Tina Toro, Hilkka Salmen

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781782203834
• eBook ISBN:
  9780429911576
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The book describes how to use breathing as a medium for self-regulation and self-reflection and how balanced breathing thus helps to promote mental and physical health and alleviate symptoms resulting from imbalanced breathing. The authors describe applications of psychophysical breathing therapy in many areas of life, developed by both themselves and other professionals trained by them. The approach of the book is based on the interactional aspects between mind and body. A person's breathing style influences their relation both to themselves and to others - and vice versa, and thus mental and also physical health. A comprehensive theoretical description of the psychophysical regulation of breathing and the consequences of imbalanced breathing is complemented by material derived from the authors' extensive clinical experience. Psychological orientations used by the writers include object relations theories, and psychodynamic, cognitive, brief and group therapy theories. As a new aspect the writers introduce how breathing patterns are learnt in early interaction. The writers also acknowledge how physical factors affect and interact with psychological factors in producing imbalanced breathing.

CHAPTER ONE
Introduction

Somewhere deep, very deep,
a light, tiny breath is born,
involuntary, but the first
expression of the self.

The approach taken by this book is a psychophysical one. This means an approach based on the mutual interaction between mind and body. There is some literature available in English on the psychosomatic aspects of breathing and psychophysical treatment methods in which breathing plays a central role. Nevertheless, it may be difficult to fully appreciate the wide significance of breathing from the available literature. Literature describing psychophysical aspects of breathing has not yet reached the mainstream of medically and theoretically grounded treatment. This book has started to fill the gap by taking a many-sided, comprehensive look at breathing, psychophysical breathing therapy developed by us, and the use of breathing as a tool in many professions and in many problem areas.

The book is intended for the training of professionals in health care and psychotherapy in particular. Its main target group is people helping patients with functional breathing problems, anxiety, and tension or stress symptoms. Practitioners working with patients with respiratory or other somatic diseases, as well as midwives and doctors helping women to give birth, may also learn new ways of thinking and acting from the book.

The book is suitable for school and kindergarten teachers, pastoral care workers, and others engaged in social or educational tasks or nursing. It will be useful for professionals in fields where breathing and the use of the voice are important, such as musicians and those working in the theatre, teachers, educators, and other people using their voice at work. It is also suitable for people offering physical training or guiding relaxation or mindfulness exercises. In addition to these groups, the book may provide tools for anyone interested in breathing and interaction.

The mindsets and treatment methods described in the book developed through many decades of cooperation between the movement therapist Maila Seppä and the special psychologist Päivi Lehtinen. This is how breathing school, a psychophysical short-term therapy group originally meant for patients with hyperventilation or somatic symptoms of anxiety, came about (Chapter Two). Development of the method and the theory behind it continues in cooperation between Maila Seppä, Minna Martin, and Matti Keinänen. The method has subsequently been applied in both individual and group therapy to help people suffering from many kinds of symptoms and problems (Chapter Seven). For this reason, the method is today more widely called psychophysical breathing therapy. We hope that psychophysical breathing therapy with its various applications will inspire health care professionals to further develop their interactive skills and methods of working with various patient groups.

Psychophysical breathing therapy involves numerous interwoven aspects. It is based on the knowledge on the psychophysical regulation of breathing described in the book (Chapter Three) and the significance of balanced breathing for physical and mental well-being (Chapter Four). We add to this the understanding of the significance of early interaction for learning ways of breathing and developing the stress regulation system (Chapter Five). The psychotherapeutic frame of reference is based on object relations theory and, particularly, the ideas of Donald W. Winnicott (1951, 1987). Studies of early interaction and the neurobiology of early childhood have also added to our understanding of how the regulation of breathing develops in interaction.

The influence of non-Western medical practices that have already to some extent become integrated in Western medicine, such as mindfulness and yoga, can be seen particularly in the psychophysical breathing therapy exercises described at the end of the book (Chapter Eight). Breathing is the thread or, in this connection, rather the breath connecting various types of theoretical views and practical experiences.

Breathing represents the interface between many fields of science and many professional groups. It is a no-man’s-land and yet belongs to everybody. In this psychophysical terrain we offer breathing as a new, albeit thousands of years old, type of conscious therapeutic method. We do not offer a method or techniques that patients could be taught and that would immediately eliminate their problems. We offer a way of being, observing, and living. The teachings in this book can be applied as preventive and therapeutic measures for many types of work. In addition, we provide professionals with means of coping, avoiding burnout, and finding their own breathing space. You can start reading the book at any chapter. Certain basic views and concepts are therefore repeated in several chapters.

Breathing is the basis and the basic expression of life. Breathing can never be completely grasped or understood. It is as if there were at the bottom of breathing an opening to a world that is unknown, frightening, unfamiliar, and therefore impossible to picture.

Where does the first breath come from, usually accompanied by a loud cry: “Here I come, I am, and I’m alive”? Where does the last breath fade out and disappear? It is no coincidence that the Latin word expirare and its derivatives, the English expire and French expirer, have a double meaning: not just to breathe out but also to die. Breathing always involves, even if unconsciously, the presence of death. Any disturbance in breathing, laboured breathing, or becoming conscious of one’s own breathing are therefore often difficult to face.

As we approach the unknown emptiness, sense its opening, we cannot see or feel anything because the spirit itself is not accessible to examination. Nevertheless, it has always been described. Art, rituals, religions, and myths have expressed it. A creative state is experienced as sacred, for it allows us to get in touch with the primary forces of life, with divinity (Rinpoche, 1992).

In Judaism, ruah, breathing, refers to the Spirit of God filling Creation. In Christianity, too, there is a deep connection between the Holy Spirit, without whom there is no life, and breathing. The creation story in the Bible says that the Spirit of God was hovering over the surface of the waters. And further: then God created man out of dust and blew into his nostrils the spirit of life, and so man became a living soul. An African bishop sought an equivalent for the word spiritus in his language. He finally translated it as “holy breath”. Indian Veda scripts tell that the world was created from God’s exhalation. In Buddha’s teaching, the Sanskrit word prana, meaning “vehicle of mind”, is used for breathing (Stinissen, 1988). The concept of mental breathing (Chapter Six) developed by psychiatrist Matti Keinänen (2006, 2015) is suitable for describing many of the basic aspects of our work in breathing therapy. It refers to mental mobility and good self-reflective and mentalisation abilities. The psychosemiotic concept of khora can be used as the basis for mental breathing:

A new person lives in his mother’s womb in a state preceding images, words, and thoughts. This basic state is preserved in that person throughout life as the womb and cradle of creativity. The concept of khora was created for this original state creating images and words. The word comes from Greek and can be translated as “space” or “place of infinite dimensions”. Even though the “memory of the womb” is personal, it has a living connection to what is common to us. In addition, it is the source of collective and cultural images. In orthodox Christian images, khora refers to the Virgin Mary as the mother of God and a temple (Kristeva, 1984; Siltala, 1993). Mental breathing created and formed in interaction receives its strength and energy from this source. As the child being born gives up the safety of the womb, he has a long journey ahead. He retains the memory of the womb, khora, his earliest image, as a resting place. The pulsation, variation between unity and separateness of that place provides space for creating other images of oneself and the environment. Khora has no shape; it is associated mainly with rhythm, going away and coming back, opening up and closing. It pulsates in the moment that is always present and thus escapes definition. Even as we try to explain it we have already hopelessly lost its authenticity. In our book, khora exerts its effect behind the text and the figures, and it is strongly present in the breathing exercises in Chapter Eight.

Before health care and psychotherapy assimilated breathing in their work, understanding of breathing was the province of religions, philosophies, and arts. This is why we wished to present the above views as background factors affecting our work, even though we will not come back to these themes later. Instead, we present in the book old and new information that is based on clinical experience and research and associated with the psychophysiology and psychology of breathing. Even though we draw on many sources, the various views fit together well, complementing each other.

CHAPTER TWO
Psychophysical breathing therapy

Maila Seppä, Päivi Lehtinen, Minna Martin

Inside and out you feel
simultaneously
cool and warm;
you feel the movement.

2.1. Development of psychophysical breathing therapy

In the early 1980s, patients presenting at psychiatric outpatient clinics with unexplained physical symptoms had often undergone somatic tests and examinations in various specialities which had revealed either no disease, or a disease explaining only part of the symptoms. Typically, the patients did not mention their anxiety or panic sensations, the attack-like nature of their symptoms, or a need to make changes to their lives. They mainly expressed worries concerning the bodily symptoms that were being investigated. Panic disorder was not introduced as a diagnosis in Finland until 1987, and the effects of imbalanced breathing associated with panic disorder and other anxiety disorders were not commonly known. According to current psychiatric diagnostics, most of these patients fulfilled the criteria of one or more anxiety disorders, often panic disorder. Some of them may have had depression.

Even before the diagnosis of anxiety disorders became more multifaceted, psychologist Päivi Lehtinen studied the psychophysiological literature on the hyperventilation syndrome. It helped her understand her patients’ symptoms (Lehtinen & Laine, 1988). Päivi Lehtinen had heard that movement therapist Maila Seppä specialised in breathing. Their reflections formed the starting point for a cooperation continuing for several decades that led to the development of a comprehensive treatment model and a new type of short-term psychophysical group therapy that was named breathing school (Lehtinen, 1995; Lehtinen, Tammivaara, Seppä, Luutonen, & Äärelä, 2000). The model was used for over twenty years and breathing school groups were attended by more than 700 patients. The presence of physical symptoms that the referring physician considered to be associated with hyperventilation proved to be a useful criterion for referring the patient for breathing school. When Päivi Lehtinen and Maila Seppä retired, this group therapy ended. Nevertheless, the method continues to be used for a very wide range of patient groups by people who have been through breathing school instructor training. Methods applied in breathing school groups are also used for individual therapy. To reflect the more varied therapeutic practice, the method is now called psychophysical breathing therapy.

It is rather interesting that at about the time the breathing school method was established, Jon Kabat-Zinn (1994, 2013) in the USA was contemplating how patients with psychosomatic symptoms could be helped. He says that these patients were considered incurably ill because no functional treatment methods existed at the time. Kabat-Zinn started developing a structured therapeutic method combining meditation and yoga (mindfulness based stress reduction, MBSR). Breathing school was based on the German breathing therapy (see Mehling, 2001) and psychotherapy tradition but, like Kabat-Zinn, Maila Seppä included in her treatment method influences from many other sources, such as yoga and traditional meditation. Many people recognise both similarities and differences between these methods. In her treatment method, Maila Seppä emphasised the significance of a person’s own feelings and interpersonal interaction for the regulation of breathing.

Breathing school was developed virtually from scratch. Early during its evolution, little information was available on other equivalent breathing therapy methods. Today it is clearly easier to find such information (see Caldwella & Himmat, 2011; Heller, 2012). One form was that of Jan van Dixhoorn, a Dutch physician, who started developing his method at around the same time as Maila Seppä, that is, in the late 1970s (van Dixhoorn, 2007). He has stated and shown in many of his publications (see 2009) that breathing therapy is a useful method to combine with other treatment for patients with somatic diseases and symptoms, particularly when no clear reason can be found for the symptoms and accurate treatment methods can therefore not be assigned. His method was originally developed to help people with voice problems. However, van Dixhoorn has performed his best-known studies on the effect of breathing therapy on the rehabilitation of patients with myocardial infarction. The aim of van Dixhoorn’s breathing therapy is to help patients improve their ability to observe their breathing and thus to regulate tension in the mind and body. He uses...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• DISCLAIMER
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHORS AND CONTRIBUTORS
• CHAPTER ONE Introduction
• CHAPTER TWO Psychophysical breathing therapy
• CHAPTER THREE Psychophysical regulation of breathing
• CHAPTER FOUR Imbalanced breathing in connection with health problems
• CHAPTER FIVE Breathing in interpersonal encounter
• CHAPTER SIX Mental breathing
• CHAPTER SEVEN Applications of psychophysical breathing therapy
• CHAPTER EIGHT Breathing exercises
• REFERENCES
• INDEX