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The Value Of Breath Pacing

Publication date: 30 April 2014

In my last post I discussed capnometry, which is my favourite form of biofeedback because of the profound changes it can produce. I've been working on capnometry biofeedback software, and this week I used it for the first time in a client session. The resulting session report told quite a nice story, so I thought I'd write it up for my blog.

My client was an older female seeking help with anxiety and stress. She's already done a few sessions with me, and we've focused on breathing training in particular since assessment suggested she was a chronic over-breather.

Usually when I train breathing I work through biofeedback parameters in this order:

  • I start with EMG or muscle tension biofeedback because it's an easy way in for clients, and it's important that they exhale fully by releasing breathing muscles all the way.
  • I move on to capnometry biofeedback, the most important parameter (it's a measure of oxygen delivery to the brain).
  • Lastly I look at Heart Rate Variability biofeedback - I find if I do this one first it's easy to induce or worsen hyperventilation.

So this week with my client we recapped previous breathing work, using the capnometer, then tried out breath pacing as a means of regularising the breath at a slow rate of about 6 breaths per minute. I have some software for this purpose (you can download my audio breath pacer for free).

Here's what happened, shown graphically - first in terms of breathing rate:

breathing rate chart

The above graph shows breathing rate over the session. It's easy to spot where we used the breath pacer. 0 to 3 minutes is my client's first attempt at breathing using purely the capmometry biofeedback. You can see her breathing isn't very regular. From 3 to almost 7 minutes we're talking - you can see the breathing is even more irregular at this stage. 7 to 8 minutes is the first try of breath pacing (at 6 bpm) then again at about 11 minutes. During these times the breath is much more regular, indicating she's successfully following the pacer. (Incidentally I used 6 bpm because it's optimal for inducing heart rate coherence.)

Look what happens to end-tidal carbon dioxide. (Remember that the higher the ET CO2 the better, since it means more oxygen to the brain.)

ET carbon dioxide chart

You can see that ET carbon dioxide is relatively higher during each of the paced periods (about 7 minutes and about 11 minutes).

Interestingly, after a few minutes of paced breathing, I turned off the audio pacer and asked my client to continue in something like the same way but more naturally now. In fact her breath slowed to about 5 bpm, and the end-tidal carbon dioxide reached its highest level of the session (right at the end).

My client reported feeling calmer and clearer at the end of this short session.

I think the graphs nicely illustrate how pacing can help, but ultimately it's just a step on the way. It's the "body intelligence" that really knows how to breathe well, so I like to have my clients' breath breathe itself, so to speak (in other words without too much in the way of conscious manipulation). To some extent breath pacing goes against this principle, but still offers useful guidance for most people.

In the last part of the session we tried combined heart rate variability and capnometry biofeedback - putting everything together.

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