Behavioral and Psychological Approaches to Breathing Disorders

331 Pages·1994·29.56 MB·English

by  Beverly H. Timmons (auth.)

Behavioral and Psychological
Approaches to Breathing
Disorders
Behavioral and Psychological
Approaches to Breathing
Disorders
Edited by
Beverly H. Timmons
St. Bartholomew's Hospital
London, England
and
Ronald Ley
The University at Albany
State University of New York
Albany, New York
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Llbrary of Congress Cataloglng-ln-Publlcatlon Data
Behavloral and psychologlcal approaches to breathlng dlsorders 1
edlted by Beverly H. Tlmmons and Ronald Ley.
p. cm.
Includes blbllographlcal references and lndexes.
ISBN 978-1-4757-9385-7 ISBN 978-1-4757-9383-3 (eBook)
DOI 10.1007/978-1-4757-9383-3
1. Hyperventllatlon--Psychosomatlc aspects- 2. Resplratory
system--Psychophys~ology. 3. Resplratory system--Diseases
-Psychosomatlc aspects. I. Timmons. Beverly H. II. Ley, Ronald.
[DNLM, 1. Resp1rat1on Dlsorders--physlopathology. 2. Resplratlon
Dlsorders--therapy. 3. Resplratlon Dlsorders--psychology.
4. Resplratlon--physlology. ~F 102 8419 1994]
RC776.H9B44 1994
616.2'0046--dc20
DNLM/DLC
for Library of Congress 93-44087
CIP
ISBN 978-1-4757-9385-7
© 1994 Springer Science+Business Media New York
Originally published by Plenum Press, New York in 1994
Softcover reprint of the hardcover 1s t edition 1994
Ali rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To my many teachers, especially the late Mrs. Magda Proskauer
-BHT
To the memory of my father, August Andreas Ley
-RL
Contributors
PAT A. BARELLI, M.D. • Department of Surgery (Ear, Nose and Throat), Univer
sity of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64108
CHRISTOPHER BASS, M.D., M.R.C.Psych. • Department of Psychological
Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU, England
DONALD L. BLIWISE, Ph.D. • Department of Neurology, Emory University
Medical School, Atlanta, Georgia 30322
DAVID BOADELLA, M.Ed., M.A.H.P. • Psychotherapy Training, Biosynthesis
Center, CH 8049 Zurich, Switzerland
FRANK A. CHANDRA (1925-1993), M.B.B.S., D-P.H. • Formerly, Depart
ment of Health, London, England
ASHLEY V. CONWAY, Ph.D. • Department of Psychiatry, Charing Cross and
Westminster Medical School, London W6 8RP, England
HERBERT FENSTERHEJM, Ph.D. • Department of Psychiatry, Cornell Univer
sity Medical College, New York, New York 10021
WILLIAM N. GARDNER, D.Phil., F.R.C.P. • Department of Thoracic Medi
cine, Kings College School of Medicine and Dentistry, London SE5 9PJ, England
CHRISTIAN GUILLEMINAULT. M.D. • Sleep Disorders Clinic, Stanford Uni
versity Medical School, Stanford, California 94305
ELIZABETH A. HOLLOWAY, M.C.S.P., S.R.P. • Knebworth Physiotherapy
Clinic, Knebworth, Hertfordshire SG3 6HG, England
GRAHAM JACKSON, F.R.C.P. • Cardiac Department, Guy's Hospital, London
SE l 9RT, England
vii
viii CONTRIBUTORS
SHEILA JENNETT. M.D., Ph.D., F.R.C.P. (Glasg.) • Institute of Physiology,
The University, Glasgow Gl2 8QQ, Scotland
PAUL M. LEHRER, Ph.D. • Department of Psychiatry, Robert W. Johnson Med
ical School, University of Medicine and Dentistry of New Jersey, Piscataway,
New Jersey 08854-5635
RONALD LEY, Ph.D. • Department of Psychology and Statistics, The University
at Albany, State University of New York, Albany, New York 12222
L. C. LUM, M.B.B.S., F.R.C.P., F.R.A.C.P. • Department of Chest Medici~e
(Emeritus), Papworth and Addenbrooke's Hospitals, Cambridge, CB3 8BX, En
gland; and "Summerleas," Dry Drayton, Cambridge CB3 8BX, England
KAREN H. NAIFEH, Ph.D., A.C.P. • Department of Psychiatry, Langley Porter
Psychiatric Institute, University of California Medical Center, San Francisco,
California 94143
DAPHNE J. PEARCE, Dip.C.S.T. • Speech Therapy Department, St. Bartholo
mew's Hospital, London ECIA 7BE, England
MAGDA PROSKAUER (1910-/990) • Formerly in Private Practice, San Fran
cisco, California
BEVERLY H. TIMMONS, M.A. • Department of Respiratory Medicine and Al
lergy, St. Bartholomew's Hospital, London EClA 7BE, England
JONATHAN H. WEISS, Ph.D. • Department of Psychiatry, New York Hospital,
Cornell University Medical Center, New York, New York 10021
ROBERT L. WOOLFOLK, Ph.D. • Department of Psychology, Rutgers State
University Piscataway, New Jersey 08854
Foreword
We start life with a breath, and the process continues automatically for the rest of
our lives. Because breathing continues on its own, without our awareness, it does
not necessarily mean that it is always functioning for optimum mental and
physical health. The opposite is true often. The problem with breathing is that it
seems so easy and natural that we rarely give it a second thought. We breathe: we
inhale, we exhale. What could be simpler? But behind that simple act lies a
process that affects us profoundly. It affects the way we think and feel, the quality
of what we create, and how we function in our daily life. Breathing affects our
psychological and physiological states, while our psychological states affect the
pattern of our breathing. For example, when anxious, we tend to hold our breath
and speak at the end of inspiration in a high-pitched voice. Depressed people
tend to sigh and speak at the end of expiration in a low-toned voice. A child
having a temper tantrum holds his or her breath until blue in the face. Hyperven
tilation causes not only anxiety but also such a variety of symptoms that patients
can go from one specialty department to another until a wise clinician spots the
abnormal breathing pattern and the patient is successfully trained to shift from
maladaptive to normal breathing behavior.
It has long been known that slow, rhythmic, diaphragmatic breathing can
soothe our inner storms and make us feel calm and composed. This property of
reciprocity has been used by many health care providers to reduce stress and
alleviate many stress-related symptoms and disorders. In a number of controlled
studies, my colleagues and I have shown that training in diaphragmatic breathing
exercise, deep muscle relaxation, visualization, meditation, and other stress
management techniques and their integration into daily life reduce hypertension
and may also reduce the incidence of coronary heart disease. It is difficult to
apportion the benefit contributed by breathing exercise, but I now believe it is
likely to be larger than I had originally imagined.
When we investigated the success of our initial training program, using a
self-administered questionnaire 4 years after completion of the training, we were
disappointed with the degree of compliance. Only a small percentage of subjects
were regularly practicing relaxation and meditation techniques 20 minutes once
or twice a day as prescribed. However, subjects had retained a significant part of
ix
X FOREWORD
the initial benefit obtained when they were practicing regularly under supervi
sion, apparently through practicing brief one-breath relaxation several times a
day and using cognitive strategies. Follow-up group sessions in an ongoing study
have revealed that the two components subjects feel they have benefited from
most, and that they are willing to continue using, are awareness about stress and
breathing exercise. Human nature makes it unlikely that most people, except
those strongly motivated, will comply with time-consuming practice in the long
term. Breathing exercise is a remarkable therapeutic tool in that it does not make
superhuman demands on people's time. It can be practiced anywhere and at any
time and while doing almost anything.
Beverly Timmons and Ronald Ley have done an excellent job of putting
together an unprecedented and comprehensive book in which experts have con
tributed chapters on various aspects of normal and abnormal breathing, how
disturbed breathing may impair health, and what therapies are appropriate. When
technological medicine badly needs to be balanced by a humanistic approach, a
book on such a vital subject as breathing is very timely.
Chandra Patel, M.D.
University College, London
Preface
We all know from our experience of emotions-anger, fear, sexual excitement
that our breathing changes with these states. Practitioners ofthe caring professions
have understandably wanted to know more about this prime example of mind
body interaction and how they might best harness it for use in relaxation training,
anxiety and stress management, behavior therapy, and other applications.
Therapists and other clinicians encounter problems, however, in extracting
the information they need when looking into the vast literature on human breath
ing and its disorders. One has to survey many different disciplines in order to
fully characterize even "normal" human breathing, but only a portion of the
knowledge in each of these fields is relevant to behaviorally oriented practice or
research. Then again, textbooks in respiratory medicine are almost exclusively
concerned with lung diseases. Finally, other sources-ranging from explications
of respiratory physiology to psychoanalytic models to esoteric teachings of
breathing practices-can be dauntingly difficult for all but specialists. No won
der we have often been asked over the considerable number of years that we have
been involved in this field whether there is a book that "explained breathing."
Our aim has been to fill this gap in the literature by putting together an
authoritative, comprehensive sourcebook that introduces the reader to the newly
developing field of "respiratory psychophysiology." We have chosen to focus on
the clinical aspects: the ways in which breathing may be disturbed and the
therapeutic methods currently available. The hyperventilation syndrome and
panic attacks are central subjects. In describing a range of therapies, we move
from the physical to the behavioral, cognitive, and psychodynamic.
We have adopted a multiauthor approach to ensure that we present current
and reliable accounts of each discipline relevant to our topic-although we are,
of course, aware that there are omissions, such as dyspnea, the role of breathing
in the psychophysiology of exercise, and in pulmonary rehabilitation programs.
We invited original contributions from clinicians, therapists, academics, and
researchers from both sides of the Atlantic. All but one of the chapters (Pros
kauer's) are newly published here. We have asked our contributors to focus on
those aspects of their specialties that are of interest to our clinician-readers and to
present this material in comprehensible form.
xi