How can something as easy as breathing exercises for anxiety and depression be helpful? Almost sounds too good to be true, right?

Well, first, keep in mind the utterly amazing fact that your body automatically knows how to inhale and exhale. Even when you are asleep.  Breathing is one of many cool things your body automatically does to keep you alive.

You don’t need to think about it. Breathe in. Breathe out. Voila. Breath just naturally happens.

But, breathing in a helpful way when you are anxious or depressed feels neither easy nor automatic.

In fact, you may inadvertently worsen the anxiety or depression symptoms depending on how you are breathing.

Modern day scientists discovered and fine tuned what Eastern masters knew long ago: Breathing affects health.

That is, breathing well goes hand in hand with feeling well. And with even feeling better than just ‘well’. 

So, it is safe to say that breathing exercises for anxiety and depression have been used effectively for thousands of years. As such, they have stood the test of time.

Further, a ‘fun fact’ about breath is that it is under both voluntary and involuntary control. In other words, breath is automatic, yet you can also intervene to intentionally change your breath in order to change your mood and physiology.

Thank you, autonomic nervous system!

Over the last decade or so, breathing exercises for anxiety and depression have become more widespread. And the techniques go far beyond the classic “just breath into a paper bag”. (Which is controversial at best.)

Breathing exercises designed for anxiety and depression actually work. And can be done anywhere, anytime, without any tools or pills. 

If you have ever had anxiety or depression, you know how awful every moment of existence can feel. Often, the two conditions occur at the same time. Talk about a double whammy.

The most highly recommended breathing exercises for anxiety and depression share some overlap. But, they are also different in many ways.

Breathing exercises to decrease anxiety and depression work because of how they affect heart rate and the mind. And whatever affects the mind affects the body. And vice versa.

Let’s break this down a bit. 

First up: Anxiety

Most everyone will experience anxiety at some point in their lives. The intensity varies from mild to moderate to severe. 

When you feel anxious, you experience changes in your body. For example, you may panic, hyperventilate, and/or breathe shallowly and quickly. Or your mind may start to race, and you suddenly feel woozy, nauseous, or as if you are going crazy. 

Anxiety is generally associated with breathing more shallowly and more quickly. This happens even if you are trying to do the exact opposite.  Hyperventilation can result, so less oxygenated blood flows to your brain. 

The most straightforward technique is simply to lengthen your exhale. 

Let’s call this technique the Exhalation Emphasis breath. 

Here is how to do the Exhalation Emphasis breath, either standing, sitting, or laying down:

  1. Before taking a breath in,  breath out. Push as much air out of your lungs as possible through that one exahalion. 
  2. Let your lungs naturally take in breath to fill the lungs. Do not force it. 
  3. On your next inhales/exhales, spend more time on breathing out than on breathing in. Some people count to do this. They may breathe in to the count of 3 and out to the count of 5. 
  4. Continue with the inhalation and the longer exhalation for at least a minute or so.

My favorite breathing technique to help with anxiety is called Alternate Nostril Breathing. 

The Sanskrit term is Nadi Shodhana. 

Practicing this breath will help you calm your nervous system. Just one minute of alternate nostril breathing can decrease stress and clear your mind! 

You can also try this technique when you’re feeling especially stressed or on edge.

The instructions sound complicated, but the practice is actually straight-forward. 

To do this, you will be breathing in and out through your nose only.

  1. Sit in a comfy position, perhaps with legs crossed.
  2. Place your left hand on your left knee.
  3. Bring your right hand to the area between your eyebrows.Place your index finger there.
  4. Exhale fully. 
  5. With your right thumb, close your right nostril.
  6. Inhale through the left nostril
  7. Close the left nostril with your ring finger.
  8. Open the right nostril and exhale through it.
  9. Inhale through the right nostril
  10. Close the right nostril and exhale left.
  11. Inhale through the left nostril.
  12. Close left nostril with your ring finger.
  13. Open the right nostril and exhale.
  14. Repeat for 1 or more minutes. 
  15. Finishing with an exhale on the left is recommended. 
Feeling anxious is not fun. Knowing that you can regulate  your breath in deliberate ways to help you manage anxiety is empowering. 

Depression

Depression is another psychological state that involves a lot of suffering. Breathing in particular ways can help to diminish depression. Skeptics are especially welcome to give it a try!

Cardiovascular exercise helps improve depression. Exercise creates hormonal changes associated with feeling better. However, when depressed, exercise is a big ask. It is probably one of the last things most depressed people want to do or feel capable of doing. 
Researchers have discovered that deep breathing that happens in cardiovascular exercise can be simulated through deliberate deep breathing.  

This is not your yoga teacher’s breathing. It is not chill, Zen, or about ohming. Nor is it the same as the types of breathing recommended to manage anxiety. 

Deep Breathing

Breathe in super deeply, as if you were about to go underwater. Start with your belly. Expand your lungs.  Imagine you have gills, and you are widening at your ribcage. Exhale. By doing this 20 times, you will derive similar benefits as with cardiovascular exercise. 

Equal Breathing

Research has also demonstrated that breathing in equal duration helps to alleviate depression symptoms.

Simply inhale through your nose for a count of 4 and exhale through your nose for a count of 4.

Breathing is not a panacea for anxiety or depression. However, the way you breath can  contribute to these conditions, and the use of breathing exercises for anxiety and depression can help you to feel better.

As with most things, the more you practice, the more natural what you are practicing feels. Over time, with practice, you may notice that breathing exercises for anxiety and depression occur naturally, often to the point they do not require deliberate effort. 

And that certainly can bring you a sigh of relief! (Long exhale please.)

Dr Elayne Daniels is a psychologist in private practice specializing in the interfacing of mind-body techniques to improve psychological well being.

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What images come to mind when you think of all eating disorders? How about when you think about what they have in common? 

Perhaps you think of a skinny white teenager? Or a young, rich woman purging? And/or a middle aged woman in a large body eating from ice cream cartons and potato chip bags? 

Oversimplified and misrepresentative images of people with an eating disorder are typical in the media.

One teeny kernel of truth is that all eating disorders aren’t the same. Yet, they share some overlap and in ways that may be surprising. 

The most well-known eating disorders are Anorexia, Bulimia, and Binge Eating Disorder. There are others, but let’s focus on the main three for now.

Anorexia is when a person has an intense fear of weight gain and a distorted view of their own body weight and size. In addition, people with this condition go to extreme efforts, such as semi-starvation, to lose weight. The disorder can easily take over a person’s life and have severe medical complications. 

Bulimia is diagnosed when someone regularly binges and purges. More specifically, binges are defined as a large amount of food, eaten secretively, and usually quickly. A core feature of a binge is feeling out of control. Loss of control can also occur when eating small amounts of food.

What makes a binge a binge is not necessarily the amount of food but more so the loss-of-control feelings of the person who is bingeing.

After the binge, unbearable guilt and disgust flood in. The sufferer then gets rid of the food by purging, which may include over-exercising, restriction, or laxative use.

Binge Eating Disorder is the most common of the three disorders. The primary symptom is recurrent binge eating without any method to compensate for what is eaten. Feeling out of control and a lot of shame are part of the suffering from BED. 

These three eating disorders are the most commonly known. Though they each have distinct symptoms, the disorders have overlapping causes and treatment implications. 

What all eating disorders have in common:

1. There is no ONE cause. 

Years ago, kids’ problems were blamed on the mother. Schizophrenia? Mother’s fault. Depression? Mother’s fault. The same was true with eating disorders. Yep, Mother’s fault. The blame then shifted to genes, and then onto societal pressure for thinness.

It is not that simple. 

Fortunately, science has advanced! 

Researchers and treatment providers know that all eating disorders occur due to a complex interplay of five fundamental factors – biological, emotional, interpersonal, social, and psychological. 

Take home message: The particular interaction of the contributing factors differs, but all five factors are implicated in all eating disorders. 

2. Appearances can be deceiving.

You can’t tell by appearance if someone has an eating disorder. That is right — there is no way to know if someone suffers from an eating disorder just by looking!  

The size of a person’s body is NOT an indicator, nor is gender, sexual orientation, or race, of an eating disorder. 

A perfect example: Anorexia used to be thought of as a rich white girl’s disease. We now know that Anorexia affects people of all economic means. 

Boys and men, LGBTQs, and BIPOCs are not eating-disorder-immune, either. In fact, rates of eating disorders are higher among the transgender community than in the nontransgender community. 

One of my pet peeves is the stereotyping by size of all eating disorders. You can’t tell if someone has an eating disorder by judging their body.

Please do not assume a person in a large body has Binge Eating Disorder, or any disorder for that matter. Someone with Binge Eating Disorder may be in an average size body. A thin body doesn’t equal Anorexia. 

You can not tell by looking at a body what is going on inside the person’s head — or their body.

3. Reaction to diet culture 

We live in diet culture, a belief system that equates weight and food with morality and virtue. Thinness is the end all be all.

Furthermore, You and I and everyone are influenced by it, even if not on a diet. Sneaky ways diet culture disguises itself are as “clean eating,” “healthy lifestyle,” or “wellness.” (If it walks like a duck and quacks like a duck….)

“Fish don’t know they are wet” applies here. Not to fish but to you and me. We are so surrounded by diet culture that we may not even realize it. Despite the fact that it is a $70 billion/year industry

More often than not, all eating disorders innocently begin with a diet.

Intentional weight loss efforts conflict with the body’s natural set point range of weight. The diet then gets out of control and spirals into an eating disorder. 

If there were no diet culture, eating disorders would be very rare.  

4. Interoceptive awareness derailed

Interoceptive awareness is your ability to perceive sensations from your body, in the present moment.

So if you notice you have a full bladder and have to use the bathroom, interoceptive awareness is to thank. When you notice hunger and fullness cues, you’re having a felt sense in the moment of your direct experience of hunger or fullness. Thank you, interoceptive awareness.

Another aspect of interoceptive awareness is emotions. How cool is it that every emotion has its own unique physical sensation or ‘autograph’ in the body? Anger,  for example, may show up in your body as tension. Happiness as levity. Sadness, for instance, as a heaviness.

The wiring of the mind and body is designed so they can communicate with each other.

To reiterate, noticing bodily sensations provides key info to assist with meeting biological and psychological needs. There is a definite evolutionary advantage to this default mechanism. 

Diet culture, unfortunately, messes with the innate, attuned interoceptive awareness mechanisms we are born with.

In other words, diets are all about rules, not about attunement with your body’s exquisite signaling system.

When on a diet, making decisions about what and when to eat are based on external methods (e.g. counting calories, following rules) rather than on trusting and valuing body sensations.

So, what happens is a disconnect from your body’s perfect system of communicating hunger/fullness to you.

Keep in mind that diets emphasize the external — weight, appearance, and rules, often determined and designed by someone you don’t even know. And created by someone who doesn’t know you or what you need nutritionally for optimal well being. 

Unfortunately, external persuasion occurs at the expense of interoceptive awareness. 

Your body’s capacity to communicate with you is a glorious built-in system. Dieting trashes it. 

Fortunately, interoceptive awareness can return online and is an important ingredient of treatment and recovery.

5. Walking heads – “I would rather not have a body”

With all eating disorders, there is a disturbance in how you experience your own body.

More specifically, you have lots of negative thoughts, feelings, and sensations about your body and yourself.

The eating disorder solution is to sever ties with your body, and to end the mind/body relationship.  In other words, to function as if your body weren’t there.

The idea is that it would be better not to have a body than to live in a body that feels like a nuisance, hindrance, or source of all things negative.

When your body feels like a receptacle of yuckiness, it’s no wonder being body-less seems like a better alternative. 

Another factor in the walking head phenomenon is low interoceptive awareness. All eating disorders are associated with a huge disconnect from the body as if the body were nonexistent. Further, semistarvation, bingeing/purging, and other eating disorder behaviors can cause dissociative states, whereby you might not even feel like you are in a body. 

6. All or none thinking, aka stinkin’ thinking

Also known as black/white thinking, good/bad, or dichotomous thinking. This is the tendency to think in extremes as if there are no shades of gray.

Words that may indicate all/none thinking include: always/never; good/bad; all/none.

For all eating disorders, good/bad thinking is the hallmark. Here are examples :

  1. I ruined my diet today by eating 5 m&ms, so I may as well eat the whole bag and start my diet tomorrow. Or purge after I’ve eaten the rest of the m&m’s. Or not eat until tomorrow night.
  2. Bread is bad. Fruit is good. I can’t eat carbs. 
  3. I will never find a romantic partner until I am thin. Being thin is my #1 goal.
  4. Being thinnest among my friends is all that matters. 
  5. If I eat a sandwich, I will get fat.

Cognitive behavior therapy teaches you how to identify distortions by evaluating their validity and offering reframes.  You also learn about your underlying belief systems.

Reframing distortions and addressing underlying belief systems is key to healing. 

We tend to believe what we think, even if what we think is not true.

Thoughts are super powerful; they determine feelings and behaviors. Often, thoughts are so automatic we may not even know we are having them. Therapy provides a method for identifying distortions and restructuring them to be accurate. 

In the examples above, the thoughts are deemed fact by the person thinking them. Consider the impact on the person’s feelings and behaviors. Distortions are fuel for and characteristic of all eating disorders. 

7. It is all about food

Eating disorders are called eating disorders because of a disturbance in eating behavior. The eating disturbances differ, depending on the disorder. Food may be withheld, restricted, eaten in large quantities, or purged.  

Interoceptive awareness goes offline, and people’s well being overall suffers.

An anti-diet Registered Dietician can offer humongous help with nutrition restoration. 

The anti-diet training and philosophy are key; otherwise, nutrition support is likely to make matters worse. 

8. It is not about food 

Recovering requires more than nutrition restoration because all eating disorders have a mental health aspect.

Addressing and resolving mental health problems is essential to full recovery.

Granted, as a psychologist I am biased. But I can tell you I’ve never heard of anyone fully recovering without psychological guidance and support.

Common treatment issues in all eating disorders include: body image, shame, self-esteem, anxiety, perfectionism, relationships, and value systems. None of the key psychological causes are about food. 

9. Social Forces 

We live in a culture of rampant weight bias, patriarchy, racism, classism, homophobia, and other social problems. The inequities are vast. All eating disorders occur in a socio-political context. 

White privilege translates to the fact that Caucasians typically have greater access to resources than do people whose skin is not white. 

Another form of privilege is thin privilege. Just because of their (highly desirable and socially sanctioned) thin body size, some people have greater access to resources and less discrimination than people deemed to be in a body that isn’t thin or that doesn’t meet the cultural ideal. 

All eating disorders are affected by culture and the associated stereotypes, biases, and discrimination. 

10. Myth city

Myths abound. 

Common ones are that all eating disorders are: 

just a phase

a way to get attention

a lifestyle choice

about vanity

forever; once you have one, you have one for life

One thing I’ve learned from 25 years of working in the field of eating disorders is that recovery is ABSOLUTELY possible and a worthy investment of time, energy, and other resources. 

I know in my heart that full recovery is possible.

I also know that not everyone recovers.  

(Access to and participation in effective treatment is more challenging depending on location.  Telehealth has helped to level the playing field a bit.)

One of the things I remind people of is that recovery is one of THE hardest things. Blood, sweat, and tears don’t even come close to describing the physical and emotional pain of recovery. 

Recovery is also one of THE most rewarding things in life. 

I have yet to hear anyone say they wish they still had an eating disorder.

I do hear the opposite. Something like “I had no idea how much happier life could be without an eating disorder.” 

Suffering from an eating disorder is like living in prison. There is no freedom, but a lot of darkness. It sucks. 

You are worthy of nourishment — physically, emotionally, relationally, and beyond. Reclaim eating as a source of pleasure and your body as the wonderland it is.

Dr Elayne Daniels is a Yale-trained clinical psychologist in private practice. She specializes in the treatment of people with eating disorders using innovative and empirically based methods. Humor and connection are central to her treatment approach. You can contact her here.

Highly sensitive woman practicing self-care with her dog on a trail.

Highly Sensitive People (aka HSPs) feel the world deeply. They are born with a nervous system wired to be super attuned and responsive. 

If you are a highly sensitive person, self-care is critical because everyday life can be draining. You need self-care to refuel so you can make best use of the unique gifts of being an HSP.  

The trait isn’t super common, but it’s not an anomaly either. About 15 to 20 percent of the population is born with High Sensitivity, with an equal male to female ratio. 

High sensitivity comes with advantages and disadvantages, benefits and bummers. 

Feeling, thinking, and living with intensity adds depth and meaning. Kind of like living in a world of bright colors and beautiful sounds, delicious flavors and appealing textures.The natural capacity for affinity and soulful connection is interwoven into the trait.

Intensity can also lead to a sense of ‘too much-ness.’ And generate angst that something’s wrong with you. That you are ‘too much’ . But you’re not. 

If there were such a thing as a ‘muchness continuum’, you would be just right. Because you are just right. 

You’re uniquely you, and your perception of the world is what makes you so extraordinary.

Productivity, swift decision making, and a fast pace are highly valued and praised in modern-day. These aren’t the innate traits of highly sensitive people like you.  

And thriving in an environment that isn’t necessarily nurturing doesn’t just automatically happen. But it can be learned, which is great because highly sensitive person self-care is critical to overall health and wellbeing. 

Thriving as an HSP takes effort and psychological strength. And you’re up for the challenge, once you educate yourself on the trait.

You can create the kind of environment for yourself that is conducive to growth, as long as you understand the highly sensitive trait. Discovering how to accept, embrace, and enjoy the kind of person you are translates to having a rich, meaningful life. 

Let’s use a flower analogy. Consider orchids. They require a supportive environment to grow and blossom. Air temperature, amount of sunlight and water, location, and other features of the environment have to be within a particular range for the flowers to blossom. 

Orchids are sensitive to the care they receive and have an exceptional capacity to grow and blossom under favorable conditions. They wither in an environment that does not support their needs. Orchids are not the everyday kind of flower or plant sold in flower shops. 

In the world of flowers, highly sensitive people would be orchids. 

In contrast, consider dandelions. They grow in nearly any kind of environment. They proliferate regardless of the amount of water, sun, shade, or care they receive. Their roots are deep in the ground, so deep that even yanking at them has little effect. 

Dandelions are hardy and easily endure variations in weather, soil, and temperature. They even grow through rocks and concrete! Dandelions are common and symbolically represent the 80 percent of people who are not HSPs. 

Btw, the high sensitivity trait has been documented in over 100 species of animals including chimpanzees, deer, horses, birds, cats and dogs. 

For humans, expression of the high sensitivity gene shows up in four areas. Within the four domains are features that can be enriching or overwhelming. 

Knowing about the four categories can help you embrace being a highly sensitive person and understand why self-care is so necessary. 

For a highly sensitive person, self-care takes more effort than it does for everyone else. Here is why: 

  1. Depth of Processing. HSPs process things deeply. You reflect more often and intensely on the ways of the world, including your own internal workings, relationships, and decision making. You make connections in your mind that other people respond to by saying they never thought
  2. Overstimulation. HSPs’ senses respond intensely and easily. Certain smells, sounds, or textures are overwhelming to you – sometimes in good ways and sometimes in yucky ones.

    Crowds, bright lights, and loud noises can also be overwhelming – usually in the negative sense of the word. They can activate your ‘fight or flight’ response. As a result, you’re likely among the first in certain environments to feel overstimulated. Excessive stimulation can be one of the hardest aspects of high sensitivity to manage. As long as you can access a calm or just calmer environment to recalibrate, you will  regain your equilibrium. 
  3. Empathy/Emotional responsiveness. HSPs feel deeply. So, you probably tend to worry, be sentimental, and may even be known as  ‘intense.’ HSPs can easily worry about the health and welfare of those they believe to be less fortunate. We can become sentimental when we see a flower that reminds us of a loved one. And our emotions can exude from us, causing others to think we are intense. 
  4. Sensory sensitivity. HSPs notice details and nuance. The moment-to-moment changes of a setting sun, a subtle shift in facial expression, or the sound of the wind as it picks up speed are all things you naturally notice. Your senses are highly attuned, and your experience of life is much richer than it is for many others. 

For the highly sensitive person, self-care is absolutely essential. 

The kind of self-care I am talking about goes beyond bubble baths and pedicures. Immersing yourself or your feet in warm, sudsy water may be lovely, but not what the doctor ordered. (Maybe it depends on if the doctor has the high sensitivity trait lol.)

The particular form of self-care is individual to you. 

Here are some refreshing ideas for a highly sensitive person to consider:  

Make time in your day to spend a few moments in solitude, in a quiet, calm space. This can be especially helpful on days you have experienced a loud event, conflict, or busy-ness that has left you feeling exhausted. Give yourself time and space to reset.

Getting enough restful sleep is critical for an HSP to recalibrate, replenish, and renew. If you have a difficult time getting the sleep you know you need, here is a helpful guide you may want to check out. 

Let your natural creativity guide you toward other ways to practice self care. Make your own special go-to “coping container” or box. Decorate it in a way that makes you smile. Maybe incorporate decoupage, stickers, sparkles, or doodles. 

To take it a step further, fill the container with sensory faves.  Invite your favorite senses to the party!  Hello cinnamon (smell), velvet (touch) swatch, Tibetan bells (sound), mint (taste), and favorite photo (sight). Awwww! If you are highly sensitive, reading the suggestions may automatically cause a smile and warm feeling inside. 

Have fun creating your container and choosing the contents. Allow for whimsy and nostalgia. The collection provides relief when you are looking for a quick (or not)  dose of comfort. 

You can always change the contents of the collection at any time to keep it extra interesting. Or keep it the same if you prefer consistency and knowing what to expect. 

Making sure you are well hydrated is another self-care must. The same goes for nourishment. Eating enough, including foods you enjoy, keeps your body satisfied and energized. 

Stable blood sugar and hydration help HSPs put their best foot forward.  Eat a snack in between meals to fend away irritability, brain fog, and feeling out of it. Have a snack with you so that fuel is there when you need it. Keep a water bottle handy for easy go-to sips of water. 

Compassion toward living things comes naturally for HSPs.  Self compassion is not as automatic. A tender relationship with yourself softens how you speak with and care for yourself. 

Treat yourself as you would a friend or a beloved. Maybe even refer to yourself with a pet name, such as “Sweetheart” or an empowering image like “Rockstar”. Or even a silly or superhero name to add light heartedness. 

In any given situation you may need ‘extra’. Extra time, space, or comfort, for example. Trust that what you need is valid. Because it is. 

If you are a highly sensitive person, self-care is critical to thriving.  

Familiarize yourself with the four areas that comprise the gift of being a highly sensitive person. Honor and appreciate what you know to be true about yourself.  Be open to and curious about what helps you be you- with all your splendor, wonderful quirks, and ways of being in the world. 

Doing so will help you to discover, affirm, and prioritize whatever your orchid needs to thrive.  

I’m Dr. Elayne Daniels, a psychotherapist, and I specialize in working with highly sensitive people. To learn more about my work, visit HSP page. If you’re in the Canton, MA area and are interested in working with me, you can contact me here.