By intentionally altering our breathing we can have an immediate impact on our physiology, which in turn has an effect on our emotional state. Slowing the breath and extending the outbreath activates the parasympathetic, rest-digest, calming part of the autonomic nervous system.
Whilst we may be able to follow verbal instructions – such as breath in for 5 counts and out for 5 counts, the cognition and language comprehension required to follow such instructions is out of reach for people with severe and profound intellectual disabilities. However, we can potentially support another person to alter their breathing with our own breathing because the nervous system is wired to be social – i.e. we pick up cues from other people and to a certain degree synchronise physiologically with them. When people are together their bodily and emotional states can resonate with one another.
Sharing breath with another person, by becoming aware of one another’s breath at both a conscious and unconscious level can also create a profound experience and feeling of connectedness.
Guidance and instructions
Before you support someone else
To support a person to regulate their breath, you first you need to ensure that your own breath is calm and regulated.
To become more aware of your breath, try simply placing your attention on the air coming in and out and your mouth and nose and the sensation of your chest and tummy rising and falling. Placing your hands on your chest or tummy or lower back may help.
The following technique is recommended by the NHS for relieving stress and anxiety, and is most beneficial if done regularly, as part of your daily routine:
You can do it standing up, sitting in a chair that supports your back, or lying on a bed or mat on the floor. Make yourself as comfortable as you can. If you can, loosen any clothes that restrict your breathing.
- Let your breath flow as deep down into your belly as is comfortable, without forcing it.
- Try breathing in through your nose and out through your mouth.
- Breathe in gently and regularly. Some people find it helpful to count steadily from 1 to 5. You may not be able to reach 5 at first.
- Then, without pausing or holding your breath, let it flow out gently, counting from 1 to 5 again, if you find this helpful.
- Keep doing this for 3 to 5 minutes.
Pay attention to your breath through as many daily activities as you can. You may like to try diaphragmatic breathing which involves gently expanding your stomach when you breath in and allowing it to go back in when you breathe out. Your chest remains relatively still whilst diaphragmatically breathing. Play with different lengths of breath and patterns of breathing to see what works best for you to create a state of calm. Taking long, slow, comfortable breaths and extending your exhalation activates the parasympathetic nervous system and has a calming effect. If you start to feel dysregulated (i.e. uncomfortable, anxious, upset, distressed) make long exhalations to regain a sense of calm. Fast, shallow breathing could lead to hyperventilation and advice should be sought before attempting.
Supporting someone else’s breathing – some techniques to try
If the person you are supporting has any breathing difficulties, seek advice from a health professional before proceeding.
All communication cues and signals should be carefully monitored throughout. If breathing difficulties have been experienced, paying attention to the breath may cause distress.
You may need to seek advice from a physiotherapist or occupational therapist if there are restrictions to positioning and movement that make breathing difficult.
Optimal positioning can make a significant difference to effective breathing, also varying the angle and making use of tilt in space functions within seating can be beneficial. If the individual is lying in supine (i.e. on their back) the use of the angle adjustments on their bed could be beneficial, and again a physiotherapist or occupational therapist could advise on this.
- When you have gained awareness of your breath and it is well-regulated and calm, you can try to share space with a person so that the person can sense your breath. Think about where you position yourself so that the person can best sense your breath comfortably.
- If the person’s breathing is already calm and steady, you may want to join in with their breathing pace to create a sense of connection and togetherness. If their breath is erratic or fast, then it may be that your calm presence and slow breathing helps to slow and steady theirs.
- If appropriate, you could place your hands on the person’s upper chest and / or tummy to help draw their attention to their breath inflating and deflating the lungs. Be vigilant for any distress or discomfort and make sure that what you are offering is well-received.
- If possible, you can also try sitting back to back with the person so that they can feel your breath through their torso, and you can feel theirs.
- Extended vocalisations require longer outbreaths, and can therefore have a calming effect. You may like to think about allowing for opportunities and even gently encouraging vocalisations, perhaps by joining in with any humming, singing, chanting and vocalisations that the person enjoys and reminding them of these by initiating the vocalisation if you notice they are starting to become unsettled.
- Blowing bubbles is a great way to extend the outbreath. Not everyone can do this though, see our guidance on using bubbles for calm for both people who can and cannot blow bubbles themselves.
What to observe, assess and record
- Be aware of any changes in breathing and heart rate, for example, rate, depth, effort and changes in skin tone or colour.
- What was the person’s emotional reaction to the experience?
- Were there any aspects of the experience that need to be removed or changed to provide a more positive experience?
- What was the experience like for you?
© Julie Calveley, PhD, BSc(Hons) Psychology, BSc(Hons) Nursing, Registered Nurse Learning Disabilities, NAC Director
Email: [email protected]
Created February 2021