A Trauma-Informed Lense of this technique.

A healthy body should be able to adjust from a state of stress to a state of calm within 20 minutes, or less, of being activated.  Learning how to shift from a stress response (sympathetic) to a healing response (parasympathetic) is perhaps one of the most powerful skills for maintaining body-mind health and interrupting stuck stress/trauma patterns.  

A resource that is always available, always necessary, and always free is your breath.  Learning to control the breath is the key.  Deep, diaphragmatic belly breathing helps to stimulate all sorts of responses in the body through an intricate network of nerves that tell the brain it is safe, able to de-armor and be at ease in the present moment.  When a body is more at ease there is greater capacity/tolerance to manage emotions and thoughts and greater control/less impulsive or reactionary behaviors. 

Breathwork and bodywork has been a non-negotiable foundation to not just my yoga practice but also my clinical therapy practice. Many moons ago traditional mental health practitioners gave me (and many yogis, perceived to be woo-woo or hippy dippy) a lot of crap about teaching clients about the importance of breath and embodiment work in the practice of mental health and trauma treatment. “What does the breath or body have to do with PTSD?”  “Everything, we would say!” 

Fast forward to today, we have a vastly growing field of body-based awareness and body-based psychotherapy.  The normalization of “bottom-up” protocols and evidence-based practices are inspiring a new era of healing care and trauma awareness.  Thank goodness there is a merging of old and new practices, mental health with physical health.  Somatic Psychology is no longer an underground approach from outside-the-box thinkers and therapists, but an emerging field with great credibility.  Like anything new and trending, there is the potential for misinformation.

One of the most common breathing activities used by ‘healers’, social workers, counselors, and educators is the box breath. This breath, when done correctly, is known to be highly effective for stress management.  Box breathing is a simple and predictable technique visualizing a box with four equal sides, inhale slowly through your nose while counting to four. Hold the breath for four counts then slowly exhale for four counts. Hold for four counts.

It is important to understand that certain breaths are potentially going to affect people with trauma (particularly complex trauma) differently than people who are experiencing acute stress.  Some things to consider with box breathing:

• Holding the breath is a common “freeze” response for many people, particularly children.  Breath retention does not feel safe, can be associated with a traumatic event (hiding in the closest and trying to be quiet to avoid abuse, or a soldier anticipating an explosion) and can prolong and reinforce a conditioned trauma-response instead of helping initiate a healing response. 
• Similarly, many victims experience asphyxiation/strangulation – a deliberate suspension of breath as a means of ultimate threat- a body memory easily activated when holding one’s breath.

• Many people ‘hold’ the breath with clenched posture; tight jaw, shoulders, constricted belly, pelvic floor – learning to hold the breath in a relaxed state takes a lot of body awareness and practice….and is extra difficult to learn in a moment of stress. People who are not well-practiced with basic diaphragmatic breathing have difficulty with breath retention.  In traditional Eastern practices, many schools of yoga suggest only retaining the breath after at least a year of basic breathing.

• Not all stress needs to be immediately ‘down regulated”.  Sometimes we need to release high levels of built-up stress/energy before we calm.  Discharging energy is essential for many ‘fight and flight’ responses.  (more on this soon).  Big, audible exhales can be more effective that holding/suppressing the rise of energy.

• Pay close attention to your client’s process of breathing when conducting box breath.  Look for signs of discomfort, fear, fidgeting, avoidance, ‘stuck’ energy. Don’t force. Always give alternatives and options.  Always psycho-educate about the brain and body and normalize a trauma response. When in doubt, ask about it makes them feel.  Let them know it might help some people, but it doesn’t mean it’s the right one for them (clients, particularly those victimized) want approval and avoid conflict/disappointing others.  

• Developing proficiency with basic breathing, postural awareness, and attunement to conditioned holding patterns is essential. 

• When beginning breathwork, start with equal ratio breath, same length in, same length out.  In through the nose, out through the nose (or mouth) but never breathe in through the mouth, this creates a stress response.

• Box breathing can help break through barriers. Teaching a new response to an old trigger is healing, but this requires a lot of training, and even more practice, in understanding titration, pendulation and the trauma vortex.  It requires a consistent therapeutic relationship with a trusted provider and a client who is not significantly detached from their own body and breath.

• As always, lived experience matters.  Establish regular breathwork practices and learn from your own process.  Practice breathing with clients every session, not just in a state of stress. 

Lots more learning and training tid-bits to come. 

Thank you for your service and care for community wellbeing.

Respectfully, Robin Afinowich