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September 1, 2007

Breathe easy

Freaking out in meetings? There’s a machine that can help, says David Mattin

Presentations play a crucial role in Nick Janvier’s job. The 36-year-old NHS statistical analyst has long delivered talks to rooms full of colleagues. But in February last year that suddenly changed. As Janvier started a presentation he was overcome by anxiety so severe that his heart started to pound and his voice shook. He stumbled on for about a minute, but eventually had to ask a colleague to take over.

“I was completely gripped by panic,” he recalls. “I was sweating, and I lost any hold on my thoughts. I left the meeting feeling really bad about myself.”

According to the NHS, panic attacks affect one in ten of us, and 2 per cent of Britons will suffer frequent bouts known as panic disorder. In addition to the acute feeling of fear, attacks are characterised by rapid heartbeat, fast breathing and nausea, and while most last only a few minutes, they can continue for an hour or more. GPs faced with panic disorder will typically advise on a course of the talking treatment cognitive behavioural therapy, or may prescribe one of the family of depression and anxiety drugs known as selection serotonin reuptake inhibitors (SSRIs).

But Janvier found help in a drug-free noninvasive treatment called biofeedback. Here, patients are connected to instruments that measure heartbeat, muscle tension and breathing rate, and then display this information in an immediately accessible form, usually via graphs on a computer screen. Practitioners say that the experience can cause patients to learn a new level of control over their bodies, with therapeutic benefits for conditions from epilepsy to migraines and irritable bowel syndrome.

Janvier, who is single, says he suspects that stress in a personal relationship may have been part of the reason that he suddenly fell prey to the attacks. “A panic attack occurred again at the next big meeting, and the next.”

He heard about biofeedback through friends, and arrived for his first session with Glyn Blackett, of the York Biofeedback Centre, in June last year. The treatment dates back to work by psychologists and neuroscientists in the 1940s. “Biofeedback is based on a simple idea: learning control of the body,” says Blackett, a trained psychotherapist. “In anxiety cases by far the most useful physical parameter to concentrate on is the breath, and I focus solely on that. If patients can start to control the breath, they can halt the downward spiral into a panic attack.

The first appointment, then, was aimed at making Janvier aware of how his breathing changed during a panic attack. First, connecting him to a capnometer, a device that monitors breathing, Blackett induced a mild version of Janvier’s panic by asking him detailed questions about the attacks. Key information on his breathing was displayed on a screen next to him. “After a while Glyn asked me to look at the screen,” says Janiver, “and I was surprised to see how my breathing had become fast, shallow and erratic.”

“When we become anxious we tend to overbreathe,” Blackett says. “This usually takes the form of rapid, panting breath, and it is apparent in the amount of carbon dioxide we exhale.”

At his second session, Blackett focused on teaching Janvier to regain a healthy breathing pattern when he became anxious. “We revisited the attacks again, so that I started to overbreathe,” Janvier says. “Then Glyn told me to close my eyes and relax, and to find a comfortable, natural breath rhythm. That happened over a period of 10 or 15 minutes. When I opened my eyes, I saw on the screen how my breathing was very different; slow and gentle.”

With Blackett’s guidance, Janvier had achieved optimal breathing rate and depth. “The screen showed it very starkly; there was a clear relationship between my breathing and the way I felt,” he says. The following week, Blackett asked Janvier to use this new awareness to practise moving back and forth between an anxious state, in which he overbreathes, to a calm state, in which he breathes well, all the time using the screen to keep track of the relationship between his breath and feelings of panic.

Blackett says Janvier was a quick learner and after four sessions he was ready to start practising the strategy in his daily life, whenever he felt a panic attack coming. A typical programme of biofeedback might include between eight and ten sessions. “The central message, for me, was that breath was a handle on my anxiety,” says Janvier. “There had been no big work meetings during my four weeks with Glyn, but already at smaller, informal meetings I was able to get hold of my breath and to talk more cogently.

“It’s been a gradual process of building on small victories. But now in the big meetings I can control my breathing, and I’m able to get my points across; that’s the crucial difference. In smaller meetings I often forget my anxiety altogether.”

Getting the feedback

What is it? Patients are connected to instruments that measure heart rate, breathing rate and muscle tension, and display this information. Practitioners say the experience can help patients to learn a new awareness and control over the body. Biofeedback practitioners are not regulated by any organisation.

Who is it for? The NHS uses biofeedback to help incontinence patients to relearn control of their bowels and bladders. Practitioners say that the treatment can also help a wide range of conditions, including stress and anxiety, migraines, ADHD, epilepsy and asthma.

Cost Expect to pay between £35 and £55 for a one-hour session. An initial consultation at the York Biofeedback Centre is free.

Contact For information on Glyn Blackett, http://www.york-biofeedback.co.uk/ , 0845 4584517. Biofeedback Clinic, London (http://www.biofeedback%20clinic.org/ ); Changing States, High Wycombe (http://www.changingstates.co.uk/ , 01494 471762); Peak Mind, Swansea (http://www.peakmind.co.uk/ , 01792 828242).

WHAT’S THE EVIDENCE? DR TOBY MURCOTT

Can biofeedback treat panic attacks? While the evidence is limited it does suggest that the type of biofeedback that Nick Janvier received can help with anxiety. Researchers from Stanford University in the United States report that it has positive effects, and that these are sustained for 12 months.

Is it all about the breathing? Rapid or shallow breathing is often associated with anxiety and panic attacks. However, there is a theory that biofeedback works by allowing the patient to regain control of situations rather than by simply bringing breathing back to normal.

Does it have to measure carbon dioxide in your breath? No, there are a number of different types of biofeedback that measure different bodily functions. These include heart rate, blood pressure and direct measurements of brain activity. The key to biofeedback is to allow the patient to see how their actions affect their bodies in real time.

Is it safe? Biofeedback is not invasive and there are no reports of any adverse reactions. Anyone considering biofeedback should inform their GP.


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