Managing anxiety is a journey; it's not always as simple as popping a pill.
Treatment is rocky terrain that can take years to traverse, with plenty of wrong turns along the way. And like any long, uphill hike against the elements, navigating through unknown territory requires an arsenal of tools - and breathing is one of them.
In fact, breathing - the thing that's meant to be as easy as, well, breathing - doesn't always come naturally to everyone. It is possible to be 'bad' at breathing, a notion that doesn't sit well with people already on the verge of a breakdown - 'what do you mean, I suck at the thing humans are meant to do automatically?!' And unfortunately, feelings of acute anxiety are often fuelled by poor breathing habits.
How 'bad' breathing makes your anxiety worse
Dr Olivia Harrison, a neuroscientist at the University of Otago, is an expert on the correlation between breathing and anxiety. She was recently awarded the international 2021 L'Oréal-UNESCO For Women in Science fellowship to further her research into understanding the disorder, with a particular focus on how an individual's response to symptoms of anxiety - such as a racing heart, sweating or shortness of breath - can further exacerbate their feelings of panic.
Speaking to Newshub, Dr Harrison said in many cases, people who experience a sudden surge of stress, fear or nervousness will begin to breathe incorrectly, which can produce a range of uncomfortable and disconcerting symptoms. This perturbing onset of physical symptoms only escalates the initial anxiety, fuelling a cycle of panic between the brain and body.
"When we get anxious, even though the thoughts are happening inside our brain, the symptoms [are presented] by our body: heart racing, sweaty palms, breathing quickly, or even holding your breath. We have these thoughts, they cause anxiety, our body goes into fight or flight mode," Dr Harrison explained.
"If we don't notice we're having these symptoms - we don't notice that we're breathing a bit faster or holding our breath - then we suddenly feel a bit light-headed, or other symptoms start to happen, like sweating. Then we feel even worse... it can take you by surprise and then perpetuate anxiety. Breathing is really [influenced by] anxiety; changes in our breathing can lead to all these other symptoms."
It's long been known that breathing and anxiety are intrinsically linked. When someone experiences an intense onset of anxiety, it will often cause them to hyperventilate. Breathing too rapidly can lead to unsettling sensations such as faintness, tingling and shortness of breath - symptoms that exacerbate the initial panic. Others hold their breath in times of stress, worry or fear, which leads to similar symptoms. Feeling like you can't get enough air into your lungs is not a pleasant experience, and can lead to acute, sometimes disabling bouts of distress.
How your breathing can work to alleviate anxiety
On the flip side, while 'bad' breathing can intensify anxiety, 'good' breathing can soothe it. How many times during a moment of stress has someone said, "Just take a deep breath?"
Although it's a bit like telling someone in a pit of despair to "just be happy" - it's easier said than done, thanks Karen - breathing correctly is a good place to start. While it might not stop a full-blown anxiety attack in its tracks, deep, slow breathing is like taking the lid off the pot before it bubbles over - bringing that rapid boil down to a gentle simmer.
"We've known breathing is really important for managing anxiety for centuries. What's really cool about breathing is we can change it," Dr Harrison said.
"All those other symptoms - racing heart, sweating, flushing - it's really hard to control those, but we can control our breathing. It's both a window to these symptoms and an opportunity to try and manage them.
"The real hope is that moving towards changing our breathing will have these flow-on effects with everything else. We know that if we want to slow down our heart, or any of those other symptoms associated with anxiety, the first real step is taking a proper breath and slowing things down."
So how do I take control of my breathing?
While mastering anxiety may feel like an insurmountable task, taking control of your breathing is a good step to take. Like anything else, over time, repeated patterns become a habit - and bad breathing can easily become habitual if it's not corrected. This is reversible however, and breathing can be retrained by an expert. You'll be inhaling and exhaling like a pro in no time.
"There are some wonderful treatment programmes out there now, lots of physiotherapy practices will do breathing retraining," Dr Harrison said.
"There's something called breathing pattern disorder, or breathing dysfunction, where you've got into such bad habits with the way that you breathe, that it's now automatic. It means you're not breathing in the way that's best for your body or in a way that can soothe anxiety, but there are clinics and specialists available that can help us with that."
In the meantime, if you feel that familiar sense of dread beginning to creep up, Dr Harrison suggests trying to take longer and slower breaths rather than big, deep gulps of air.
"[Breathing correctly] is definitely longer and slower than you'd think," she said.
"I really love a phrase by [Auckland-based physiotherapist] Dr Tania Clifton-Smith: if in doubt, breathe out. It's something you can do in a moment of anxiety, as we often hold our breath, and we hold it at the top of our breath.
"If in doubt, have a long, slow breath out - it's a real starting point."
What else can I do to manage my anxiety?
Although pharmacotherapy can be helpful, Dr Harrison is a proponent of a holistic approach to managing anxiety. Exercise is a great way to tackle the disorder, she said, as well as filling free-time with hobbies and interests that bring joy.
"There are so many things we can do, and I think that's really exciting - there's no one-size-fits-all," she said.
"I think the very first thing to do is to think about what in your life makes you really happy, whether it's exercise or baking. It's about finding the time and valuing those activities as important to your mental health. Also being open to introducing new things and new techniques as they come, but a great starting point is what makes you happy in the first place."
Of course, identifying you have anxiety is a crucial first step in the journey to mastering life with the condition. And in a world where mental health is never far from the forefront of public discourse, it has never been easier to start reaching out and seeking help.
Social media platforms offer a plethora of advice - some good, some questionable - but it can be a good place to realise that you are not alone. Talking about mental health is no longer a taboo topic reserved for the psych ward; now, it seems like more and more people are admitting they are struggling. Chances are, the person you're speaking to is also dealing with their own demons.
"There's a lot of different starting points; identifying that you have anxiety is the most important first step, and then, starting to talk about it," Dr Harrison said.
"You'll probably find a lot of people around you have different methods or strategies to manage anxiety. It's also important to recognise that we're living in a very tumultuous world and it's really normal to feel worried. It's just making sure our reactions to that aren't becoming disabling in our lives or stopping us from doing things.
"Then there's lots of resources - the Mental Health Foundation has a list of all the tools available. Think about what works for you - it's really where you feel comfortable as a starting point and take it from there."
Dr Harrison notes that with so many options available, learning to manage anxiety is a highly individualised process. If your friend swears by meditation but you can't even make it through the opening credits of a movie before reaching for your phone, chances are the practice isn't quite right for you.
Her upcoming studies, supported by the L'Oréal-UNESCO For Women in Science fellowship, will look at how treatment plans can be tailored to individuals in the future to remove some of the "trial and error".
"Anxiety is unique to every individual and needs to be treated as such. The treatments that work well for some people do not work for everyone. We also know that many common treatments don't always stick, and it may be because we are not giving people the necessary tools for their specific anxiety profile," she said.
It's also important not to be disheartened if your experience with anxiety doesn't align with someone else's. This also applies if you're seeking help from a professional, such as a therapist or counsellor. Just like you don't have to remain loyal to your hairdresser, you're not married to your GP or psychologist - sometimes you have to talk to a few people to find the right fit.
"It's a real journey - think of it as a journey, not a destination," Dr Harrison said.
"Mental health is not a pot of gold at the end of a rainbow, it's something we're working towards continuously."
Where to find help and support
- Shine (domestic violence) - 0508 744 633
- Women's Refuge - 0800 733 843 (0800 REFUGE)
- Need to Talk? - Call or text 1737
- What's Up - 0800 WHATS UP (0800 942 8787)
- Lifeline - 0800 543 354 or (09) 5222 999 within Auckland
- Youthline - 0800 376 633, text 234, email firstname.lastname@example.org or online chat
- Samaritans - 0800 726 666
- Depression Helpline - 0800 111 757
- Suicide Crisis Helpline - 0508 828 865 (0508 TAUTOKO)
- Shakti Community Council - 0800 742 584.