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Authors: Charles W. Hoge M.D.

BOOK: B0038M1ADS EBOK
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Contrary to popular belief, there is no "correct" or "incorrect" way to
breathe. Your body naturally breathes at the rate and depth that is most
efficient based on your level of exertion and oxygen needs. However, if
you know how to monitor yourself, you may discover that there are times
when breathing is initiated more in the chest and other times when it's initiated lower in the abdomen. Air can come in and out of the lungs because
of the actions of muscles in the chest, including those between each of
the ribs (intercostal muscles). Air can also come in and out of the lungs
because of the diaphragm beneath the lungs contracting downward into
the abdomen. You can experience both types of breathing. If you breathe
fully in through your nose with the idea of filling tip your upper chest
completely, you'll mostly be using the muscles in your chest to breathe. If
instead you breathe fully in through your nose but think of the air filling up your abdomen first, you'll probably be breathing lower down using the
diaphragm. You can employ both types of breathing simultaneously by initiating the breath down in the abdomen and then expanding up into the
chest. Sighing is one way for the body to increase the amount of air that
is exchanged, and generally uses both the diaphragm and chest muscles.

It's common advice to "take a deep breath" when we experience anxiety, stress, or anger. This may seem like good advice, because breathing
can become rapid and shallow (hyperventilation) when there is anxiety,
and hyperventilation itself can increase the level of anxiety. However, the
advice to "take a deep breath" isn't that simple, and most of the time people who give this advice don't understand exactly what this means. There
are various ways that you can take a deep breath. You can breathe deeply
into your chest or use your diaphragm to expand your abdomen. You can
also experience rapid shallow breathing as a result of anxiety but think that
you're already breathing deeply because the chest muscles are working so
hard. Hyperventilation feels like deep breathing, and therefore being told
that you should "take a deep breath" when you're already hyperventilating
isn't sensible. You may get more out of smacking the person who's giving
you this advice.

Better advice during times of stress is to "take a deep breath low in your
abdomen," which is more specific than "take a deep breath." Anytime anyone pisses you off, you can take a deep breath low in your abdomen. If you
start feeling anxious standing in a line, take a deep breath low in your abdomen. If traffic is snarled, take a deep breath low in your abdomen. If your
boss or coworker comes up with some stupid plan that they think is fabulous
but you know won't work, take a deep breath low in your abdomen.

Taking a deep breath from the abdomen, which is also called diaphragmatic breathing, is simple to do just relax your abdomen and let the breath
naturally expand it.

Here's how it works in a nutshell:

Start with sitting in a relaxed posture and place your feet on the floor.
You may first want to release any muscle tension, as described in chapter 4,
skill 3. Feel the weight of your body in the chair. (You can also lie on your
back, and feel the weight of your body pushing against the bed or floor.) Breathe in and out through your nose in a relaxed manner. Do this for
at least a minute or two. Now place your hands one on top of the other
on your abdomen and observe how it expands outward as you breathe in,
slightly separating your hands apart. You may notice that after taking in
a deep breath, you let it out over a slightly longer period than it took to
bring the air in; relaxation occurs as you exhale. Diaphragmatic breathing
simply means breathing slower and deeper from lower down in your abdomen, using your diaphragm to initiate the breath. But don't turn it into
work. Let the abdomen naturally expand (get rounder) without forcing it.
Don't push the abdomen out. Just let it expand on its own like air filling a
balloon. You can also watch someone sleeping, especially a child, to get an
idea of how this works.

It's best to practice breathing in a slower, deeper, lower, more natural
"diaphragmatic" way at times when you're relaxed instead of waiting for
those times when you become anxious. Once you've practiced this when
you're relaxed, it'll be easier to do when you're tense or anxious.

Breathing isn't something you need to control. You can simply notice
your breathing when you're relaxed without trying to change it in any way.
All that's important is to observe or notice your breathing and be aware
of whether you're initiating your breaths from deep in the abdomen or
higher up in the chest. Get used to noticing this. As you become more
practiced at observing your breathing when relaxed, then you'll be able
to shift into this "noticing" mode during times when you feel stressed or
anxious. This will make it easier to catch yourself breathing high up in
your chest when you get anxious and shift to slower, deeper breathing to
control your level of anxiety.

If you still have a difficult time doing the diaphragmatic breathing
after the above description (or I haven't explained it well enough), try
this exercise. Sit in a chair (you can stand or kneel if you like, but sitting
is more comfortable), and imagine that you're holding a 9mm pistol (or
another caliber of your choice). Now slowly raise the weapon and point it
at the center of an object some distance away (use a neutral object, not a
real or imaginary person). Do the actual motion with your arms, and concentrate on the target through the sights on your imaginary weapon with every intention of hitting it squarely. Now, very slowly release one round
off by squeezing your trigger finger as you would in real life. Don't do
this half-assed; do this just as if you had a real weapon in hand. Continue
to hold the position and prepare for a second round. Now notice where
you're breathing. Is your body still? In all likelihood you're breathing
more quietly from down in your lower abdomen to minimize the amount
of movement. You may stop breathing for a moment when you release
the round, but otherwise, you'll probably find that you're breathing in a
slower, more relaxed manner.

If you still find it difficult to do diaphragmatic breathing, have no worries. All you need is to become aware of your breathing without trying to
change anything. Simply learning to notice your breathing without changing it can be enough to reduce anxiety levels.

SKILL 6: IMPROVE YOUR FOCUS AND ATTENTION
THROUGH MEDITATION AND MINDFULNESS

Meditation, or the practice of being mindful, is an important warrior skill
that can help with concentration, focus, attention, confidence building,
and letting go of thoughts and feelings that may be fueling anger or anxiety or interfering with your happiness. Many books have been written
about meditation, both as part of religious traditions and as secular practices to improve health and well-being. The term mindfulness has become
popular in recent years, and is rapidly becoming part of mainstream medical treatment for depression, anxiety, pain, coping with chronic illness,
and other medical problems.

What is mindfulness? It's turning your attention to the present moment
without judgment, without goals, and without attachment to what's happening. It involves observing what's going on, quieting the mind, creating
a sense of space, and allowing the mind to take a break from the usual
chatter that characterizes mental processes involved in day-to-day activities-things like worrying about what needs to be done, keeping to-do lists
straight in your head, worrying about something at work, or feeling anxious. Mindfulness means being present to what's in the "here and now," rather than thinking about what occurred in the past, or what may happen
in the future. You can be mindful, or present in the moment, doing almost
any activity.

The practice of meditation is one way to become more mindful, and
can be very helpful in controlling anxiety, reducing worry, decreasing the
feeling of being revved up, and improving confidence, focus, and attention. Meditation provides insight into how your mind works. There are two
main types of meditation practices: 1) focused meditation, where you focus
your mind on something; and 2) open awareness meditation, which involves
observing or witnessing whatever is going on in the present moment without a specific focus. Meditation can be done sitting, lying, standing, or
walking, but the most common posture is sitting. The simplest posture for
meditation is to sit comfortably in a chair with your feet flat on the floor,
arms in your lap (or on armrests), and your spine supported in such a way
that it's as erect as possible. You can also sit cross-legged on the floor with
your butt raised up on a cushion and your legs and feet resting against the
floor. The cushion under you helps to lift the spine into a more comfortable upright posture. You can position your hands face up, one on top of
the other in your lap, facedown with your forearms resting on your knees,
or a combination of these two positions, with one hand in your lap and the
other over a knee. It's good to practice meditation with your eyes open as
well as closed. The time that you allow for meditation is entirely up to you,
but doing a specific practice-for example, twenty minutes several times
a week, or five to ten minutes every day-does help to make it become a
routine skill that you incorporate into your daily life.

A) Focused meditation: A common focused meditation is to observe your
breathing as it moves in and out. Close your mouth and breathe through
your nose. Whenever your mind wanders, as it's prone to do, bring it back
to the breath. The only goal is to keep your attention on your breathing
and gently bring it back whenever you become distracted or your thoughts
wander. You can silently say "inhale-exhale" or "in-out" if you want, but
this isn't necessary. Don't get upset with yourself when your mind wanders,
because that's exactly what the mind does, and one of the key skills is to become aware of how your mind works and allow whatever happens to
occur without judgment.

You can also put an object in front of you to focus on, such as a picture, a bowl of water, a candle, a rock, a flower, or anything (even a roll
of toilet paper). Alternatively, you can repeat a word, phrase, or sound (a
mantra) out loud or in your head. First Sergeant Schindler's "frequency,
intensity, duration" exercise is a sort of mantra that helps him to be mindful during stressful experiences or situations that may lead to anger. It
helps him to be present with his feelings and not immediately act on those
feelings. The goal, again, is simply to find something that you feel comfortable paying attention to. Whenever your mind wanders, just bring it back
to the object of awareness. An example of mantra meditation is to select a
sound/word like "Om," or any phrase that is meaningful to you. Initially
say it out loud, and then gradually make it softer and softer until you're
only repeating it in your mind. For all subsequent practice the word or
phrase is repeated silently. To do this, gently "toss" the word or phrase into
your mind. When it gradually fades away, gently repeat it. Don't focus or
concentrate too much on it; make it as effortless and easy as possible. An
example of a walking meditation is to walk slowly in a circle in a small area
or outside in a larger area and keep your focus and attention on each step.

B) Open awareness: This practice involves observing whatever is going
on in the present moment, in an open manner, without judgment, and
without attaching to what's happening. For example, sit comfortably with
your eyes open but not focused on anything particular. Allow all sounds,
images, thoughts, feelings, and sensations that you become aware of to
exist, but don't dwell on them, don't think about them, don't hold on
to them, and don't follow them. Thoughts may come up like, "I have so
much I have to do today" or "Oh, I forgot that I still have that thing to take
care of," or "What was I thinking when I said that?", or "I better not be
late," or "That really pissed me off." When thoughts like these arise, just
allow them to pass on, like they are part of a movie reel or a branch floating by on a river. You're not trying to eliminate thoughts or have a "blank
mind," nor are you engaging with them in some active way; instead, just allow your thoughts to exist on their own and remain in an open state of
consciousness or awareness. Don't follow a thought on to the next one, or
the one after that. Just let each thought pass. The same is true for feelings,
or anything else that occurs during the time of your meditation. If you feel
worry or anxiety, let it pass. If your phone rings, let it ring. If there is noise
outside, that's okay; notice it, but don't dwell on it. There is no goal, other
than to allow everything to exist as it is now without trying to change it
and without judgment. Similar to the focused meditation, when your mind
wanders off into a string of thoughts, then consciously let go of that line of
thinking and just bring your attention back to the moment.

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