Diaphragmatic Breathing, Relaxation, Biofeedback, & Distraction Techniques

Diaphragmatic Breathing, Relaxation, Biofeedback, & Distraction Techniques

Diaphragmatic breathing, relaxation, biofeedback, & distraction are all important strategies for (1) pushing up the parasympathetic (”rest & digest”) nervous system & (2) controlling and reducing pain and/or symptoms.  As noted in previous blog entries, pushing up the parasympathetic nervous system automatically pulls down the sympathetic (’fight or flight”) nervous system (like a pulley system).  Kids who are chronically ill have fight or flight responses that are in overdrive.  By pushing up the “rest & digest” part of the nervous system, you slow down your heart rate, lower your blood pressure, and open up your blood vessels for better blood flow to all parts of body, thereby improving circulation, reducing brain fog, and helping digestion.  These techniques are also useful in helping control and reduce many pain or symptom signals in the brain.  Diaphragmatic breathing is especially useful in controlling nausea.

Diaphragmatic Breathing:

Diaphragmatic breathing is deep/slow breathing, instead of shallow/rapid breathing.  With shallow/rapid breathing or “chest” breathing, you are only filling 30% of your lung capacity.  Our bodies are not equipt for shallow/rapid breathing.  This means, in order to chest breathe, we have to use our shoulder, chest, back, and neck muscles to do it.  This causes extra muscle tension & fatigue in those areas (where many of us feel stress!).  Our bodies are really designed for deep/slow diaphragmatic breathing.  Ever notice a sleeping baby breathe … with its tummy going up and down slowly??  That’s how our bodies are designed to breathe.  Diaphragmatic breathing fills 80% of lung capacity!

How do you do diaphragmatic breathing?  You pretend that you are filling a balloon in your stomach (keeping your chest still) & breathe in and out slowly.  

Diaphragmatic breathing is important because it helps push up the parasympathetic nervous system (”rest & digest”) & thereby bringing down the overtaxed sympathetic nervous system (”fight or flight”).  When kids’ have autonomic dysfunction, their “fight or flight” response is in overdrive causing increased adrenaline & other hormones, increased heart rate, increased blood pressure, increased anxiety, blood vessels constriction, and blood transfer to big muscles, halt of digestion, increased sensitivity to pain, and decreased immune system.  This is called the “stress response” and is designed to help us in survive in very stressful or dangerous situations.  With dysautonomia, even regular stress can cause this same “stress response”.  Staying more relaxed during activities & day will help with fatigue & pain.  Diaphragmatic breathing slows down your heart rate, lowers your blood pressure, and opens up your blood vessels for better blood flow.

Chemistry Behind Diaphragmatic Breathing: 

Red blood cells pick up oxygen molecules in lungs and carry them throughout body.  On the flip side, they pick up carbon dioxide “waste” molecules for elimination.  With shallow breathing, the red blood cells pick up oxygen molecules with a “sticky bonds” instead of a regular bonds.  Because these bond are “sticky”, the RBCs cannot properly distribute the oxygen molecules throughout the body or, on the flip side, pick up carbon dioxide for waste elimination.  On the other hand, with diaphragmatic breathing, there is proper bonding between RBCs and oxygen molecules.  This means better oxygenation of body leading to less fatigue & inflammation.

Mayo Study on Effects of Diaphragmatic Breathing: 

Two groups of people – Group 1 = normal health & Group 2 = POTS patients.  For both groups, the study involved taking baseline measurements (heart rate, blood pressure, & breathing rate), then subjecting all participants to a stressor (in this case, they used a cold pressure test … kind of like sticking your hand in an ice bucket), then taking those same measurements again, then removing the stressor and taking final set of measurements.  For Group 1 (normal health), all participants were at a “normal” baseline level, then their measurements (heart rate, blood pressure, breathing rate) all spiked under the stressor, then returned to “normal” baseline upon removal of the stressor.  For Group 2 (POTS patients), their baseline measurements were all elevated (compared to Group 1), then spiked from there with stressor, and came down upon removal of stressor … but only to their previous baseline (which was MUCH higher initially than the normal health participants.  This is further evidence of POTS patients’ bodies being in a constant state of “stress response”.  THEN BOTH GROUPS WERE ASKED TO DO DIAPHRAGMATIC BREATHING 3X PER DAY FOR 10 MIN FOR A TOTAL OF 2 WEEKS.  Then they were all retested again for baseline/stressor/baseline.  Results?  Both groups benefitted, but was what remarkable is that Group 2′s baselines started much lower than before and didn’t go as high under stress.  Remarkable.  The diaphragmatic breathing had decreased their baseline & stressor readings by pushing up their parasympathetic nervous systems thereby decreasing their chronic “stress response”.

Here at the PPRC, they teach us to breathe through our noses only because they want them to be able to utilize breathing in a stealth manner as a relaxation (or anti-nausea or other symptom) technique, even if surrounded by other people (for example, at school or a social activity).

Daily Dose of Diaphragmatic Breathing: 

3x per day for 10 min (or cumulative total of 30 min per day).  The breathing can be done while performing other activities as well … doesn’t have to be a quiet, devoted sit-down.  Grab 5 min here and 5 min there to get to your 30 min goal per day.

See video for more info: “Anxiety & Stress Relief with Diaphragmatic Breathing” – https://www.youtube.com/watch?v=pKZCGVSxmas (19:52 min).


Pain causes stress and stress intensifies pain.  The PPRC teaches us coping strategies to break the pain/stress cycle.  Relaxation reduces muscle tension, reduces anxiety, & allows a person to feel refreshed.  We learn several relaxation techniques including progressive muscle relaxation (where we tighten up muscles throughout our body and then relax them), guided imagery relaxation, meditation, and positive self-talk.  Relaxation is the key to controlling symptoms and decreasing the “pain/symptom” areas of the brain.

Please see the following videos:


We learn biofeedback through the aid of different computerized programs/instruments.  These instruments are used to measure our heart rates, breathing rates, and muscle tension.  We learn how to control these predominately involuntary processes through controlled deep breathing and relaxation.  (We also do daily biofeedback, so we can see results in our heart rate and brainwaves on a monitor while we practice our breathing.)  We learn how to relax & breathe so that we can practice those techniques while performing daily activities.


Distraction is a good way to get people’s focus away from their pain and/or symptoms.  There was a study at Mayo where people’s brains were scanned as a baseline.  Then the participants were put under a cold pressure test (as a stressor) and rescanned.  The doctors were able to see and measure the areas of the brain affected by stress/pain.  Then, while still enduring the cold pressure test, the participants were given flashcard tests that required them to pay attention, think, and answer questions … for the whole deck.  After the deck was finished, the patients’ brains were scanned for a third time.  Remarkably, although still enduring the cold pressure test, those pain/stress areas of the brain were greatly decreased with distraction!  Bottom line, when people talk about or focus on their pain/symptoms, those areas of the brain flare up.  With distraction (of any sort … including just normal functioning during the day), those pain/symptom areas of the brain can be greatly reduced.

MRI examples of focusing on pain: “How Your Brain Can Control Pain” – https://www.youtube.com/watch?v=oq6YKqSzEUw (1:30 min).

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