Why Breathing Exercises Might Not Be Enough for Severe Anxiety
The most common treatment for anxiety is relaxation via breathing exercises, but many clients with OCD or an anxiety disorder don’t find much relief from them for more than a few minutes. People with anxiety disorders have two basic features of their anxiety that are different from what the rest of us experience: Their anxiety is felt more deeply and is experienced more intensely. Their anxiety is often accompanied by catastrophic beliefs and an intense preoccupation with scenarios they are afraid of. While breathing can help most of us, it’s likely just going to frustrate these folks.
In this case, breathing exercises are kind of like bringing a knife to a gunfight. It’s still good to have breathing as a tool, but it’s not going to help you win.
Trying to Relax in a Disaster
The person struggling with severe anxiety typically has a deep-seated belief that the way they feel or what’s happening to them means something catastrophic. To put it more directly, it feels impossible to be calm, cool, and collected when the worst thing in the world is happening to you or could happen at any moment.
They’re often afraid that they are bad people, that their bodies will fail them when they are alone with their kids, that they are a danger to those they love, that life will fall apart if they aren’t perfectly on top of everything all the time, that they must be alert for certain dangers that others ignore, that their intrusive thoughts mean they are capable of something terrible, that their struggles with sleep are going to lead to an early death, or that they’ve made choices that will haunt them forever. For them, breathing feels like trying to achieve relaxation as you’re watching a tornado rip apart houses in your neighborhood. Your mind and body are just too wise, practical, and geared towards survival at all costs to relax in that scenario.
You have to start somewhere besides relaxation if you want to stand a chance of actually achieving relaxation. Relaxation is similar to happiness. You don’t just reach out and achieve happiness; it’s a byproduct of a life well-lived.
The Most Efficient Way to Change a Belief
If we want to help these folks find some relief, we have to work at the level of the belief first. It’s a simple but absolutely crucial adjustment. The most efficient way to change a belief is via experience, and the best way to have new experiences is to try on some new behaviors. We have a lot of control over what we do, but we have very little control over what we feel and the thoughts and worries that occupy our minds.
Imagine a person who believes a tornado is ripping through their neighborhood when it really isn’t. You can try to talk to them about it all you want and convince them it’s not happening (a talking approach). You can try to get them to relax via deep breathing (a feelings approach). But at the end of the day, some people are going to have to go out the front door and take a long walk around the neighborhood to realize it’s not happening (a behavioral experiment). They have to try on some new actions that help challenge the beliefs that something catastrophic is happening and that they need to monitor that catastrophe at all times.
Every single client I’ve ever treated with severe anxiety has a way that their behaviors are supporting that anxiety. There is a way, normally multiple ways, to creatively challenge that anxiety via slowly modifying behaviors. Doing that first and THEN adding breathing and talking is often the initial path to freedom.
Keep the Breathing Exercises, But Use Them Differently
The basic issue is the order in which we ask someone with anxiety to do these things and the reason we give them for doing them. Are we breathing to feel good about something before we do it? We are probably not going to achieve the goal of feeling good before doing hard things. I never have, and I don’t have an anxiety disorder.
Or are we breathing to get us through the thing we need to do to gain confidence, courage, and clarity on what’s real versus what’s mostly in our fearful imagination?
Talk and relaxation as a first line intervension works for most people, but it often doesn’t work for folks struggling with anxiety disorders or OCD. They need something different. We are asking them to do the same stuff but for a different reason and in a different order.
For someone with severe anxiety, we typically have to ask them to start first with behavior. Let’s take a walk around the neighborhood and approach the thing we are afraid of to learn that it’s not as much of a threat as we thought. That’s going to be very anxiety-inducing, so let’s use the breathing exercises to help you get through the behavioral exercises you need to do to change the belief. As you do that, your beliefs will loosen up and become more flexible so that talk and relaxation can actually begin to work.
We aren’t waiting for calm to happen before we act. We are letting action create the calm.
We aren’t using breathing to calm down before we act. We are using breathing to help us while we act.
We aren’t waiting for the person to be convinced before they act. We are acting and then working on becoming convinced.
It’s really incredibly simple, but it’s HARD.
I think the reason this isn’t the most common approach is that most people don’t need an approach this intense to get past their everyday fears… but folks who struggle with severe anxiety need this.
I think the other reason this isn’t common is that it’s uncomfortable for me, the therapist, to ask you to take a walk that is very scary for you — whatever your “walk” is in your anxiety recovery journey. But often that walk, done repeatedly, strategically, and compassionately, brings incredible freedom.
About Us
Tyler Slay, LPC, is the founder of Anxiety & OCD Specialists of Mississippi, the first counseling clinic in the state dedicated exclusively to treating anxiety, OCD, and related disorders. As a specialist trained through the Behavior Therapy Training Institute (BTTI) of the International OCD Foundation (IOCDF), Tyler provides evidence-based care for adults, teens, and children. He and his team specialize in treating OCD, Anxiety, Panic Disorder, Tics/Tourette’s, and PTSD, integrating Christian counseling for those who desire a faith-aligned approach.
Contact & Location:
Clinic: Anxiety & OCD Specialists of Mississippi
Address: 100 Highpointe Dr., Suite D, Brandon, MS 39042
Services: In-person sessions in Brandon, MS and statewide via Telehealth
Credentials: View Tyler Slay’s Verified IOCDF Provider Profile
