Many of my patients with chronic pain also have anxiety disorders.
Fear and anxiety are normal biological responses of our body. However, when they are excessive,
they need to be managed and treated. Fear is an emotion that we have when we
perceive something that seems dangerous. Anxiety is an emotion that we have when we anticipate
a situation that can be dangerous to us. So, in simple terms, fear is quick and is related
to something in the present time. Anxiety is prologued and is related to future time.
In patients with chronic pain, they usually develop fear and anxiety related to pain.
People with chronic pain are familiar with an ongoing, baseline pain sensation,
but when there is an acute flare, or a new pain, they are afraid of what is going on.
Then, they start worrying about the future and anxiety starts popping up in their head.
Today, I will show you a quick technique to relieve excessive anxiety, it doesn’t cost any money,
you can do anywhere, as many times as you want. Let’s talk about Square Breathing today
We will use a breathing technique that is called Square Breathing or Box Breathing.
First, let me explain why we use breathing to reduce abnormal fear and anxiety.
Fear triggers our sympathetic system to release stress neurotransmitters and hormones.
Noradrenaline is released very quickly, it is the fight-or-flight neurotransmitter that makes our
heart to beat faster, increase our blood pressure, breath faster, boosts our energy so we can fight
the danger, opens our pupils so we can see better, and sends more blood to our muscles and brain.
Cortisol is the stress hormone, it is released much slower than noradrenaline,
it increases sugar in our blood and improves the brain’s ability to use that sugar to think faster.
It reduces body functions that are not supposed to occur when you are in a dangerous situation
such as appetite, sex drive, digestion and sleep. These two substances, noradrenaline and cortisol
are essential to survival. Without fear and anxiety, without noradrenaline and cortisol,
humanity would not have survived until now. Let’s go back to the patient with chronic pain.
Now, that person is having a pain flare up, a new sensation,
and it seems that this is not going away. The brain will activate the fear and anxiety centres.
More noradrenaline and cortisol will be released.
The person will start thinking more and more about pain, their future, and the consequences.
There are mainly three areas that the person will worry about:
1) Ruminating thinking 2) Magnification of pain
3) Feeling of helplessness Here are some examples:
Ruminating: “I can not seem to keep it out of my mind”
Magnification: “I become afraid that the pain will get worse”
Helplessness: “There is nothing I can do to reduce the intensify of the pain”
There are many techniques that we can use to help the person who have these
thoughts. I usually recommend them to speak to a psychologist. The psychologist can help them to
see these thoughts as unhelpful.
But I understand that there are many people who do not have access to a good psychologist,
and unfortunately there are few psychologists who are trained in the field of chronic pain.
So, I am going to do some videos showing techniques that I recommend to my patients.
They do not replace a good psychological support, but they can help some people,
especially in situations that the patient recognizes the fear
and anxiety triggers their pain or vice-versa, that pain triggers their fear and anxiety.
Let’s start with square breathing. First, find a comfortable position.
Usually I recommend a chair, but you can do this anywhere, even lying down or standing up.
If you have never done this, start with a pencil and paper. Once you learn how to do it,
you don’t need the paper anymore, and you can do it even with your eyes closed.
We are going to use breathing because we want to activate the parasympathetic nervous system.
The parasympathetic nervous system is the opposite of the sympathetic system. The parasympathetic
system is the rest-and-digest nervous system. It does the opposite of the sympathetic:
it reduces the pupil sizes, slows the heartbeat, relaxes the muscles, closes the airways,
promotes digestion, relaxes the bladder, and stimulates salivation and sex drive.
When we activate our lungs and forces our respiration to
slow down, we are sending signs to our brain that there is no danger,
there is no need to be super afraid and anxious. We are telling the brain that we are okay. We are
training the brain to calm down and stop the sympathetic release of noradrenaline and cortisol.
We are going to do 5 cycles of square breathing. Each square has 4 sides.
We start by breathing in for 4 seconds, then we hold our breath for 4 seconds,
then we breath out for 4 seconds and hold for 4 seconds. That is one cycle.
Let’s start. [cycle 1]
Breath in slowly, one, two, three, four…… Hold your breath, one, two, three, four……
Breath out one, two, three, four…… Hold one, two, three, four……
[cycle 2] Breath in slowly, one, two, three, four……
Hold your breath, one, two, three, four…… Breath out one, two, three, four……
Hold one, two, three, four…… [cycle 3]
Breath in slowly, one, two, three, four…… Hold your breath, one, two, three, four……
Breath out one, two, three, four…… Hold one, two, three, four……
[cycle 4] Breath in slowly, one, two, three,
four…… Hold your breath,
one, two, three, four…… Breath out one, two,
three, four…… Hold one, two,
three, four…… [cycle 5]
Breath
in slowly, one, two, three, four…… Hold your breath, one, two, three, four……
Breath out one, two, three, four…… Hold one, two, three, four……
That is it. Now you learned a new
technique that you can use when you feel excessive fear or anxiety related to your pain flares.
Write in the comments below if this has worked for you or not.
Please, don’t forget that this video is for educational purpose only.
If you have a condition that needs medical advice, please talk to your doctor.
And if there is an emergency, go to the nearest emergency department.
Don’t forget to subscribe to this channel and watch my next video here.
Goodbye.