Anxiety and Panic Attacks In Emphysema/ Chronic Obstructive Pulmonary Diseases (COPD)

Vijai P. Sharma, Ph.D., psychologist

Chapter 8

Calming the Breath, Mind and Body for Anxiety and Panic Control

  1. Steps to Calm Your Breathing: slowing and steadying and bringing the breath back to normal
  2. Steps to Calm Your Mind: Replace "Hot thoughts" with "Cool thoughts"
  3. Steps to Calm Your Body: Reduce Muscle Tension, Prevent Further Release of Stress Hormones Including Adrenaline and Cortisol and Slow Down Your Heart

    Bonus Exercise: Visualization for Health Enhancement

This Chapter explains how you can calm your breathing, mind and the body. Breath is the "master skill" to our calming and controlling strategy. It's important that you utilize these steps in any order that works best for you.

Note: I have numbered the steps as 1, 2 and 3, but you don't have to follow them in that order. Actually, you might be working on all of them simultaneously.


Breath is the "master skill" to our calming and controlling strategy. Calming the breath is absolutely the first step! As breathing slows down and exhalation becomes more complete and efficient, the body automatically begins to calm down. In order to control your catastrophic thoughts, change your thoughts right when you get the correct breathing started.

Begin Pursed-Lip Breathing (PLB): The moment you notice the first signs of your breathing or heartbeat speeding up even though you are not exerting, start the PLB. The goal of doing PLB is to slow your breathing and get the excess air out of your lungs so you can breathe more easily.

Blow your breath out slowly while trying to maintain consistent flow of breath.

Do not blow your breath out too hard or fast as that could make you more anxious or jittery.

Don't blow your breath out too long as that could force you to breathe in abruptly or rapidly.

Maintain slow, soft and rhythmical breathing out and in. Gradually make your exhalation longer than inhalation. Longer exhalation helps to make more room in the lungs so your inhalation can become slow and steady. Refer to PLB instructions to make sure you do it correctly. Do PLB regularly so you can get really good it and can use it effectively when you need it.

Gently and lightly contract abdominal muscles during PLB: If you prefer and only if it feels comfortable, slightly pull in or press in your solar plexus muscles while exhaling. Don't squeeze the solar plexus too hard, be gentle and slightly engage them as you exhale.

You don't need to make any deliberate effort to inflate your belly muscles while inhaling. All you have to do is this: During inhalation, allow the abdominal muscles and lower ribs to do their own work. Abdomen and lower ribs will expand during inhalation. However, remain somewhat passive and relaxed during inhalation.

Pace your breathing through mental counting: Count silently in your head while exhaling and inhaling. For example, exhaling 1-2-3-4-5-6 inhaling 1-2-3-4 taking approximately one second for each number.

Notice that in the above example, I have given the count from 1 to 6 for exhalation but only 1 to 4 for inhalation. Through this example I want to point out that exhaling longer than inhaling is more desirable. However, when you are hyperventilating, you might be inhaling longer than exhaling. Be patient. First equalize your inhalation an exhalation and slowly work towards making your exhalation longer than inhalation.

Focus on a neutral object: Focus on something other than your panic, preferably something neutral such as the pattern on the wall, your knee caps, fabric or yarn of your clothes or anything that's there which you can look at. Continue to gaze at it. You may even focus at a "body anchor." For example. bend your thumb and cover it with your index and middle finger. Bring you mind to it, press it and feel the sensation of pressure and touch. Breathe into your hand. The goal here is to provide yourself a neutral object or point for focusing so you can take your mind off the source of your anxiety. It's a form of healthy mental distraction.


Superimpose "cool thoughts" on "hot thoughts." Catastrophic thoughts are euphemistically called "hot thoughts." Calming and assuring thoughts are called "cool thoughts."

Catastrophic thoughts such as, "I'll die of suffocation," pump adrenaline and create excessive heat in the body. Cool thoughts such as, "PLB will help calm you down and prevent further pumping of adrenaline in the body.

Such thoughts are automatic. At first you may not be aware of them. However, when you begin to pay attention to them and start recording them right away, you learn to easily and quickly identify them. At first, you may keep on thinking those thoughts for a while before you realize you had been thinking them. But, over a period of time, you can really get good in "catching them" as soon as those thoughts cross your mind.

People tend to offer advice in the negative such as, "Don't think negative thoughts." But that's hard to do when you are huffing and puffing and panicky thoughts are storming through your mind and gaining momentum. Don't try to fight those thoughts. Just keep throwing cool thoughts at the hot thoughts like you would throw sand at fire to put it out.

"Throw" cool thoughts over hot thoughts faster and in larger numbers. If you can't think of several cool thoughts, repeat one that you like most over and over again like you would repeat a positive affirmation or incantation.

To get you started, we have provided a list of hot thoughts and cool thoughts from which you can select the ones you like. Please review the list provided towards the end of this chapter.

Flash comforting "pictures" in your mind's eye: Clinical analysis of the accounts given by panic attack patients shows that while thinking catastrophic thoughts, some patients also see catastrophic pictures in their mind's eye. For example, the catastrophic pictures may consist of ambulance rushing to the hospital or the person lying in the bed at the intensive care unit or collapsing during a heart attack and being revived.

These pictures may be like quick flashes and may disappear before you become conscious of them. Whether you draw such catastrophic pictures in your mind or not, it would still be helpful to flash positive pictures in your mind.

Examples of positive pictures: Picture yourself walking, talking and laughing with your best friend; walking at the lake or the beach; standing in the middle of a spring garden or forest; looking at the flowers and fluttering butterflies; listening to the chirping of birds and smelling that sweet fragrance of flowers.

In the above examples of positive pictures, I have given examples of involving various sensory modalities. I did so because many psychologists recommend utilizing multiple sensory modalities (seeing, hearing, smelling, touching, feeling it in the body, etc.). More senses you can involve while imagining an experience, the more "real" it can feel to you. The more real it feels, the greater the physical and mental benefits you might receive.


Inhale relaxation and exhale tension: As you inhale, imagine your mind and body are becoming relaxed. As you exhale, imagine all the tension and anxious thoughts from the top are exiting out through your toes. Just say to yourself, "I inhale relaxation into me. I exhale tension out of me."

Release the muscle tension: Let your whole body become soft and loose. Let go of the muscle tension. Pay special attention to relaxing your face, neck, head and shoulders,

Towards the end of this chapter, there is a brief relaxation exercise that you may practice regularly and daily, preferably two or three times a day as a maintenance therapy. Here are three good reasons why you want to include such a practice in your daily routine:

1. The more you practice, the more it will sharpen your skill to relax.

2. Such a regular practice will also "nip in the bud" many future panic attacks or anxiety episodes.

The more practice you have under your belt, the more it will serve you when you need it most. You might be able to control a panic attack more quickly and bring your breathing back to your normal.

Examples of catastrophic thoughts or also known as "hot thoughts"

Given exactly the same level of breathlessness, the perceived level of threat may vary significantly from one person to another. One person may look at it as an unpleasant experience, but the other may view it as a matter of life and death. When your breathing problem escalates, an accurate or objective thought can be, "I am having trouble breathing." But you may view it as a catastrophe and your catastrophic thought may be something like "I will die of suffocation." Such a thought is likely to set off the "alarm."

"I can die of suffocation before anyone notices it."
"My heart can stop before I can get to the hospital."
"My breathing could get out of control"
"I am going crazy!"
"I'm losing control!"
"I'm losing my mind!"
"I won't make it to the hospital!"
"What will happen now?"
"I have totally lost control!"
I can't (or won't be able to) stop it ever!"

Examples of calming thoughts or "cool thoughts."

"People do get breathless and they come out of it."
"I have been breathless before and I survived it."
"I can get over it."
"Others also have had them (breathless episodes) and they have lived."
"My breathing is slowing down"
"I am having trouble breathing but I'm calming down."
"I have started PLB (Pursed lip breathing). It will help me to get the excess air out of my lungs"
"By slowing down my breathing and PLB, I will feel lot better."
"I am claming down."
"It will blow over in just a few minutes."
"I can handle it because I have handled it before."
"I am becoming calm and steady."

Write down your "Hot thoughts"

Write Down the "Cool Thoughts" that you like and can work for you

How would you Calm Your Breath?

How would you Calm your Body

Bonus Exercise-- Visualization for Health Enhancement

Use images that are vivid, strong, and meaningful for you. You can create any image you like. It doesn't have to be a medically accurate image. If you feel good when you hold an image in your mind, that's the right imagery for you. Adhere to your medical treatment and make use of inner powers of healing. Imagination or visualization of a positive and healing imagery is like adding condiments to your food. Be creative in your imagination.

Note, we don't really know if visualization helps with symptom control or not. But visualization has been utilized by many cancer patients. There are many patients who claim that visualization definitely helped them. It has great psychological value because it empowers the visualizing patients and satisfies them with the sense of doing something for themselves. I recommend it and I regularly do it for my own benefit.

Visualization should be done every day after you have relaxed the body and calmed the mind. For clogged arteries, imagine a miniature "Roto Rooter" truck cleaning out your clogged pipes. Breathe and visualize the gunk that was there in your blood or was sticking to the wall of your arteries is draining down and coming out through your toes. You may even visualize a pool of black tar liquid collecting near your feet that you drained out with your out breath.

To support your immune function, create such pictures in your mind that support, stimulate and strengthen your immune function. For example, imagine your immune cells are multiplying to make your immune system more effective and efficient. Your immune cells are removing or swallowing the infected cells.

If you feel your airways have been tightening and constricting such as happens in asthma, imagine that the tiny elastic rubber bands that were wrapped around your airways and were constricting them have begun to loosen up. The inflammation inside the walls of the airways is reducing. Airways are becoming more open, etc.

To support your lung health, sit or lie down. Make yourself relaxed. As you exhale, feel all the stale and poor quality air is leaving your lungs and the lungs are becoming healthy and pink in color. As you inhale, feel pure air and light is entering your lungs making your lungs white and energized.

Continue to Chapter 9

Return to Chapter 7

Copyright 2008, Mind Publications 
Posted August 2008


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