Breathing, Music and Mental Wellbeing - Traveling Psychiatrist

When I published my posts about mental health and wellbeing, I did not include either breathing or music into the 10 key areas (of pillars) of mental wellbeing. I did, nonetheless, consider music (and music therapy) in the context of pleasurable activities (key area or pillar no 10).

But how about breathing?

On average, we breathe 16 times a minute, or 23,000 times a day. Over a lifetime, we take hundreds of millions of breaths. Yet, we barely think about breathing. Yoga (key area no 3), meditation and mindfulness (key area no 6) are practices that help bring our attention to our breathing. Deep breathing is actually an effective stress management tool, as it can bring a sense of calm.

Sophrology and breathing

I recently came across sophrology, “a structured method created to produce optimal health and well-being. It consists of a series of easy-to-do physical and mental exercises that, when practiced regularly, lead to a healthy, relaxed body and a calm, alert mind” (defined as such by the Sophrology Center Online). Sophrology combines traditional Eastern practices (such as yoga and meditation) with modern-day stress-management techniques often used by clinical psychologists in the treatment of anxiety disorders (such as body scans, visualizations, breathing techniques and other relaxation exercises).

COVID-19 and breathing

Amidst the COVID-19 pandemic, and whilst learning about sophrology, I have become more and more interested in this basic function of the human body, a function that we often take for granted. Unfortunately, in the most severe cases, the coronavirus can cause shortness of breath and compromise respiratory function. It can cause pneumonia (inflammation of the lungs) and subsequently acute respiratory distress syndrome (a type of respiratory failure and life-threatening condition where the lungs cannot provide the body’s vital organs) that can lead to death. In these cases, mechanical (or assisted) ventilation (artificial ventilation where mechanical means are used to assist or replace spontaneous breathing) is required to help patients get oxygen into the lungs and stay alive.

Reflecting on the current circumstances and the impact of the pandemic across the world, I have started paying closer attention to my own breathing, often pausing to take a few deep breaths to help me relax.

Wellbeing

At the same time, I have re-visited the 10 key areas (of pillars) of mental wellbeing, to help maximize our wellbeing and contribute to a happier and healthier life.

On a more personal level, whilst self-isolating, I have been spending a lot of time listening to music (especially my vinyl records). In fact, music has been one of my passions since childhood, but nowadays I often listen to it rather mindlessly, without paying particular attention to music and/or to lyrics.

In this post, I would like to bring breathing and music together. First, I am going to discuss why and how deep breathing can improve mental wellbeing. Then, I am going to discuss the benefits of music and music therapy. Last but not least, I am going to share my playlist with songs about breathing.

Wellbeing and breathing

As mentioned, deep breathing can bring a sense of calm and is often used as an effective stress management tool. In fact, sophrology and mindfulness-based therapies incorporate a number of different techniques and skills that can all contribute to stress reduction and improved mental wellbeing; breathing exercises are amongst those. Breathing consciously is also the essence of yoga and meditation.

So, how come a somatic (bodily) function can play such an important role in our mental health and wellbeing?

There are two main types of breathing: chest or costal breathing, and abdominal or diaphragmatic breathing. Breathing is regulated by the autonomic nervous system (ANS), the part of the nervous system that supplies many organs and subsequently regulates many bodily functions, such as respiration, digestion, blood pressure and heart rate. The sympathetic (SNS) and the parasympathetic nervous systems (PNS) are both parts of the ANS.

When we are calm and relaxed, we tend to use abdominal breathing, which is the more efficient of the two types. On the other hand, chest breathing takes over when we go into the fight-or-flight mode; this happens in response to actual or perceived danger. When we sense danger, the brain releases chemicals (such as adrenaline) that trigger the fight-or-flight response. This activates the SNS, which in turn prepares the body for fight or flight. Part of this fight-or-flight response involves switching from abdominal to chest breathing.

When we are stressed, the same thing happens. The SNS gets activated and we switch to chest breathing. This activation of the SNS is responsible for many of the physical sensations or symptoms that we experienced when stressed or anxious (i.e. fast and shallow breathing, heart beating faster and many others). So, even though this process can be useful when we face real and physical danger, it is not helpful in most of the situations that stress us out. Quite the opposite in fact, as the activation of the SNS also affects the way we think, feel and perceive the world around us (as a hostile environment), so we continue feeling stressed/anxious/angry.

Deep breathing

Deep breathing is a type of breathing exercise that helps strengthen the diaphragm; this is the main muscle of respiration and separates the thoracic cavity (which contains the lungs and the heart) from the abdominal cavity (containing the stomach, the bowel and other organs involved in digestion). Deep breathing de-activates the SNS and, at the same time, activates the PNS. This sends the signal to switch from chest breathing back to abdominal (or diaphragmatic) breathing. It also lowers heart rate and blood pressure. More importantly, it helps reduce stress/anxiety/anger. It therefore contributes to both physical and mental wellbeing.

Even though there are many variations of deep breathing, certain elements are common amongst these variations. First, we become conscious of our breathing and pay close attention to it. In fact, we focus all our attention on our breathing. Second, we take deep breaths, breathing all the way into the abdomen, and then breathing out. Third, we breathe slowly. The normal respiration rate for an adult at rest is 12 to 20 breaths per minute. When, we practice deep breathing, however, our respiratory rate slows down. To help us breathe slowly, we may count during inhalation and then during exhalation. Some experts recommend holding our breath between these two phases (inhalation/exhalation). Most recommend the exhalation to last longer than the inhalation. I personally don’t want to be too prescriptive. For me, the important thing is to take deep and slow breaths, and the rest will follow.

Music and wellbeing

I would now like to take a small break from deep breathing, and discuss about music and wellbeing.

Many research studies provide evidence in support of the beneficial role of music (classical, as well as some other types of music) on both physical and psychological symptoms. For example, a systematic review indicated that listening to music might have a beneficial effect on anxiety, pain and physiological parameters (such as blood pressure, heart rate, and -let’s not forget what we’ve been talking about- respiratory rate) in people with coronary heart disease. Another systematic review concluded that music interventions might have beneficial effects on anxiety, pain, fatigue, and quality of life in patients with cancer.

Music therapy

As a Psychiatrist, I am often interested in the effect that music has on our brain, and our mental health and wellbeing. The health benefits of listening to music are often seen in the context of music therapy. This is an umbrella term for evidence-based interventions that use music in a therapeutic context. There are two types of music therapy: receptive (listening to music), and active or expressive music therapy (playing or creating music). Music therapy has been evaluated in a number of different physical and mental conditions, including dementia, and the results are positive.

The ‘Mozart Effect’ refers to the positive effect that classical music has on cognitive skills. Researchers found that listening to the Sonata for Two Pianos in D major, K. 448 by Mozart improved spatial reasoning skills (part of the widely used Stanford-Binet IQ test). It is rather unclear whether this effect is specific to this particular piece of music or applies to classical music in general. Music composed by Yanni (‘Acroyali/Standing In Motion’) was also found to have a similar effect. It may be that the positive effect on cognitive abilities is mediated by musical patterns shared by Mozart’s and Yanni’s compositions.

Having said that, one doesn’t have to listen to a particular piece of music, or engage in music therapy, to reap the benefits of music. Simply listening to your favorite song, artist, album, or playlist can help lift your mood and make you feel better.

Music and breathing

Now, let’s combine music with breathing. Diaphragmatic breathing is widely considered essential for the best possible singing performance. It is also useful for wind instrumentalists, as it allows them to maximize the intake of air and minimize the number of breaths.

Personally, I have always enjoyed listening to music much more than playing musical instruments. Lately, whilst self-isolating, to lift my mood and make myself feel better, I have been listening to my favorite music, as well as practicing deep breathing (as part of sophrology exercises, yoga or meditation).

This is when I came up with the idea of compiling a playlist with some of my favorite songs about breathing. It features songs by some of my favorite artists and bands from all around the world, including Telepopmusik (from France), Tame Impala (from Australia), Faith Hill (whose album ‘Breathe‘ is one of my favorite albums of all time), Taylor Swift and Reba McEntire (from the US), Ronan Keating (from Ireland), Asgeir (from Iceland), Oscar and the Wolf (from Belgium), Florence and the Machine (from the UK), Astrid S and Ina Wroldsen (from Norway), and Maria Elena Kyriakou (the Greek Cypriot singer who represented Greece at the 2015 Eurovision Song Contest). Rather ironically, the song that was going to represent the UK at the Eurovision Song Contest this year is called ‘My Last Breath’. You can follow my playlist on YouTube or Spotify.