The Healing Role of Breathwork for Depression

based on the Polyvagal Theory

WilfriedEhrmann

Inthisarticle,Iwilldescribethevisceralbackgroundofdepressionfordeepeningtheunderstanding
oftherolewhichconsciousbreathingcanplayinhealingthisdisease.Thevariousreasonsofitinthe
personalhistoryofpeoplewillnotbecoveredhere.

Whatcanwelearnfromthepolyvagaltheory?
Thepolyvagaltheory,discoveredanddevelopedbyStephenW.Porges,professorforpsychiatryin
Chicago,addsanimportantviewpointtoourideasofthefunctioninganddysfunctioningofhumans.
Traditionally,wedividetheautonomousnervoussystemintotwobranches,thesympathicusandthe
parasympathicus.Thenewinsightisthatthevagus(thetenthcranialnerve),themainoperatorof
theparasympatheticalnervoussystem,hassplitupintotwodifferentsystems.Thefirstone,which
wesharewiththereptils,istheclassicalparasympathicus,responsibleforrelaxationandrecoveryas
wellasforfreezingandtotalshutdowninatraumaticexperience.Thesecond,newone,alsocalled
thesmartvagusormyelenatedvagus,whichcanonlybefoundinmammals,isconnectedtoour
functioninginsociallife.Itcontrolsthesympathicusbykeepingthebreathingrateandconsequently
therateoftheheartbeatatamodestrhythm.Italsocontrolsallthemusclesinourvocalorgans,ear
andfaceandinthiswayalloursocialexpressions.

Ournormalstateoffunctioningisregulatedbythesmartvagus(PorgescallsthisstatetheSystem
SocialEngagement=SSE)andallowsustocommunicateandinteractandhelpsusespeciallyto
performoptimallyasparentswithbabiesandinfants.Butanykindofinhibitingtheflowofthesmart
vagussystem,thatisanykindofstressdiminishesourabilitytofunctionopenandeasyin
communicationandsocialinteraction.Assoonaswecomeunderpressure,thesympathicus
graduallyormomentarilytakesover,asthesethreestatesofthenervoussystemworkina
hierarchicalorder.Whenwelosethisstateduetochallengefromoutsideorinside,weslipintothe
sympatheticstate,whichisrunbythefightorflightmechanism.Itallowsthemaximumof
mobilizationandisusesthestresssystemofourbody.Westarttointensifyourbreathingandour
heartbeat.Inthisstate,ourabilitytocommunicateisdrasticallyreduced.Forexample,themuscles
inourmiddleearneedarelaxedstatetobeabletolistentothespecificfrequenciesofhuman
voices.Inthestressstate,ourearsswitchtolistentodeepfrequenciessowedonothearproperly
whatotherpeoplewanttotellus.

Incaseofextremedanger,whenthefightorflightmechanismturnsouttobeuseless,theancient
parasympathicusisturnedonandweenterintoastateofimmobilizationandfreeze.Dissociationis
awayinthisstatetostaypartlyconsciousinthemidstofterror.Welosethecontacttoourbodyand
itsfearandpainandenterintoarealmoflightnessandpeace.
 Polyvagaltheoryanddepression
First,wetrytodeepenourunderstandingofdepressionbylookingattheviscerallevelwiththehelp
ofthepolyvagaltheory.Mentaldisorderslikedepressionareprimarilybasedonmalfunctionsofthe
vegetativenervoussystem.Sympatheticandparasympatheticstatesareprevalentwhilethestatesof
thesmartvagusarereduced.Inthecaseofdepression,apermanentlevelofstresskeepstheperson
inongoingunrestandnervousagitationwhileaswellbeingunabletoactinadeterminedway.
Depressivepersonsoftenfeelalackofdriveandmotivationandareunabletorelaxontheother
hand.Theirsleepisoftentoolongbutnotrefreshing.Stresspatternshavebeenobservedinthe
brainsofdepressivepeopleatsleep,whilethedreamphasesarereduced.

Sointhecaseofdepression,thesmartvagussystemisunabletocopewiththesympatheticbranch
ofthenervoussystem.Afterstressfulexperiences,thesmartvagusshouldapplythevagalbrake
whichcontrolsthesympathicusbyreducingtheheartrateandnormalizingthebreathingpattern.
Buttraumaticexperiencescandamageorblockthefunctioningofthisbrakeandtheactivitiesofthe
sympathicuscannotbestoppedwhennolongerneeded.Sothewholebodystaysinastateofover
activationandimbalance.

Insteadofthesmartvagus,itistheparasympathicus,whichreplacestheoveractivesympathicus
whenitsresourcesaredepleted.Thedepressivepersonfallsintoapathy.Inthecaseofabipolar
distortion,thephaseofmania(overactivesympathicus)changesintothephaseoflowenergy,
flattenedemotionsandthoughtsofselfdevaluation(parasympathicus).Ithasbeenmeasuredthat
peoplewithdepressionshowalowvagaltonewhichindicatesamalfunctioningofthevagalbrake.

Ontheotherhand,thealwayspresentsympathicusinhibitsaproperfunctioningofthe
parasympathicuswhichisresponsibleforrelaxationandregeneration.

Dominatedbythemutualinhibitionofsympathicusandparasympathicus,thedepressivepersonis
unabletousethesmartvagussystem.Theconsequencesarethereductionofsociallife,the
disabilitytofeelempathetictowardsotherpeopleandthecenteringononesownsufferingand
agonizingselfdevaluation.

Breathingasawaytohealdepression
Aswehaveseen,therhythmsofheartbeatandbreathingarethekeyfunctionsoftheautonomous
nervoussystem.Botharecontrolledbythevagus.Thesmartvagusisactivewhenthebreathingis
relaxedandcalm,thesympathicusrunsthebreathingwhenweareunderstress:wetakeshortand
shallowbreaths.Learningtoimproveourbreathingmeanslearningtouseourvagalbrake.
Depressivepeopleusuallyneedtochangetwoaspectsoftheirbreathing:

1) Thestrengtheningoftheinhaletoexpandthecapacityofthelungsandoftheoxygen
metabolism.Astrongerinbreathalsosymbolizesmoreselfesteemandtrustinoneself.

2) Therelaxationmainlyoftheoutbreath.Thisworksasaneffectivebrakeforthesympathicus.
Wecannotbeinastaterunbythesympathicusandbreatheinarelaxedway.Sowefindour
waybacktonormalfunctioningbyrelaxingthebreathing.Arelaxedoutbreathsymbolizes
acceptinglifeasitisandtrustingwhatevercomes.

Breaththerapymeansthatwehavetoresolveallobstacleswhichareinthewayofadeepenedand
relaxedbreathingsuppressedfeelingsandblockedemotions.Thetraumaswhichcausedthelossof
thevagalbrakehavetobeaccessedandhealed.Thiscanbealongandtediousway.Butwithevery
strongandrelaxedbreath,agoodstepistakentowardsrecovery.Inanyphaseofthehealing
process,theclientcanusethebreathingtoovercomethemiseriesofdepressionindailyandnightly
life.

Astherapists,weprovideadditionalhelpbybuildingupasupportiverelationshipwhichisbasedon
honestexchangeandclearcommunication.Breathingfreelyourselves,weshowempathyandtrust
intheclient`sinnateresources.Thuswestabilizetheworkofthesmartvagusandhelpourclientsto
regaintheirwaytothefreeflowofbreathingandtothefreeflowoflife.

References:

StephenW.Porges:ThePolyvagalTheory:NeurophysiologicalFoundationsofEmotions,Attachment,
Communication,andSelfRegulation.WWNorton&Co2011(German:DiePolyvagalTheorie.
NeurophysiologischeGrundlagenderTherapie.Paderborn:Junfermann2010)

JoeGriffin&IvanTyrell:HumanGivens:ANewApproachtoEmotionalHealthandClearThinking.
HumanGivensPublishingLtd2004