Anxiety and Supplemental Breathing Therapy

What’s Happening

Most people take breathing for granted, but for those who suffer from anxiety, practicing abdominal breathing can be an important technique to help get symptoms under control. Older adults, in particular, may find it helpful to practice deep and slow breathing (also called DSB) to manage the effects of physiological stress and anxiety, according to a consensus published in Nature.

The researchers found that even 5 minutes spent practicing a breathing exercise with shorter inhalations and longer exhalations can bring about positive changes for people of all ages by achieving a heart rate variability (HRV) that reflects a balance between the sympathetic and parasympathetic nervous systems. This type of breathing also activates the vagus nerve, which can be calming. Further, the team discovered that older adults had more measurable improvement than their younger counterparts.

Why It’s Noteworthy

Anxiety in older adults has been linked to a number of medical conditions, including chronic diseases, declining cognition, and mental health problems. DSB offers a simple and inexpensive technique to address anxiety attacks in the aging population.

Reports & Perspectives

  • An article in Frontiers in Human Neuroscience looks at the promise of stimulating the vagal nerve (also called vagus nerve) using guided breathing exercises to bring about mental health benefits.
  • Science Daily reports on the formation of a study exploring the benefits of deep breathing exercises that activate the vagus nerve; the researchers hypothesize that in addition to reduced stress and other mental health benefits, they may find that this practice also leads to sustained reductions in blood pressure.
  • The American College of Allergy, Asthma and Immunology provides a guide for practitioners on breathing techniques to help patients reduce stress —while also managing physical ailments such as asthma.
  • @NIH_NCCIH (National Center for Complementary and Integrative Health) says: “Relaxation techniques are practices such as progressive relaxation, guided imagery, and deep breathing. Research shows these may be helpful in managing a variety of health conditions, including being useful for older adults with anxiety.”
  • @AcupunctureCT (acupuncturist) shares: “Deep, Slow Breathing: An Antidote to Our Age of Anxiety? | Discover Magazine”
  • @cognitive_hw (nutrition and lifestyle program) tweets: “Walking, hiking, dancing, & running around, along with motion & air in combination with deep breathing techniques & meditation will release anxiety & stress that might be ailing you. All of these factors will bring your quality of sleep to the next level, allowing you to rest.”

In Practice

Depression Higher in People with Disabilities: How Working Can Help

What’s Happening

Researchers recently took a close at the connection between four types of disabilities (congenital physical-internal, physical external, mental, speech) and depression among people living in South Korea. The findings, which appeared in Nature, reveal key differences in the depression prevalence based on disability type. For instance, individuals with congenital physical-internal disabilities as well as those with a mental disability caused by an accident had a higher risk of exhibiting symptoms of depression than people with other types of disabilities.

In addition, work seemed to play a significant role in addressing depression. For people who had a physical-external disability, speech disability, or mental disability, having regular employment reduced their risk of depressive symptoms. Those with a physical-internal disability needed the ability to work to keep depression at bay.

Why It’s Noteworthy

The findings call attention to the need for treatment strategies and policies that are specifically geared to different disabilities to be most effective.

Reports & Perspectives

  • An earlier study in PLoS One found that gender also impacts the risk of depression in people with physical disabilities; women with physical disabilities demonstrated a higher likelihood of experiencing depression than their male counterparts.
  • Medicine included a research piece on the factors associated with depression in people with disabilities, such as having a grade 1 disability or experiencing impairment affecting daily living, as well as diabetes and hyperlipidemia.
  • @JrnlEnvirOccMed (Journal of Occupational and Environmental Medicine) tweets: “An Open Trial of the Effectiveness, Program Usage, and User Experience of Internet-based Cognitive Behavioural Therapy for Mixed Anxiety and Depression for Healthcare Workers on Disability Leave …”
  • @DisabilityFed (national support organization) tweets: “43% of people with disabilities report depression, 3x higher than national average. 37.5% of disabled people at risk of poverty, also 3x higher. See a pattern here?”
  • @spinalinjuries (Spinal Injuries Association) shares: “According to the @mentalhealth research it suggests that levels of depression are typically higher in people living a disability…”

In Practice

Psychodynamic Therapy Best Served Remotely

What’s Happening

Psychodynamic therapy puts the relationship between patient and therapist at the center of the problem being addressed and strives to uncover what lies at the root of the problem. When the COVID-19 pandemic pushed the bulk of therapeutic sessions online, this patient-therapist interaction changed.

Gordon et al recently conducted an international survey of practitioners from 56 countries and regions. As part of this effort, the results of which were published in Psychodynamic Psychiatry, they asked respondents to rank six key factors related to psychodynamic therapy (the unconscious mind, collective unconscious psyche, defense mechanism, psychosexual development, and psychosocial development).

They found that both patient and therapist characteristics (eg, the therapist’s skill and warmth, the patient’s motivation and insight) are the most important variable impacting the relationship, regardless of treatment setting.

Another study led by Douglas H. Ingram, MD, also published in Psychodynamic Psychiatry, explored the use of delivering psychodynamic therapy via online or via phone in the United States. Specifically, Dr. Ingram looked at how the virtual setting changes some of the therapy dynamics, such as a reduced perception of empathy from the therapist, which may hamper the patient’s desire to self-disclose sensitive information, as well as session timeliness. Once again, the findings reinforced that virtual therapy sessions are effective. (More best practices for teletherapy with Dr. Ingram in our Psy-Q challenge below.)

Why It’s Noteworthy

Both studies demonstrate the benefits of using teletherapy to continue psychodynamic therapy even after life returns to “normal.

Reports & Perspectives

  • A related study examined the importance of separating the addicted patient from their illness, while focusing on the need to celebrate the person’s uniqueness and also emphasizing the relationship with the practitioner to get optimal results. They concluded that, with visits occurring remotely during the pandemic, therapists need to find new ways to preserve this relationship.
  • An opinion piece in Frontiers in Psychology looked at the value of using psychodynamic therapy to help people deal with the stress of loss during COVID-19.
  • The American Psychological Association, Inc. shared advice for clinicians on how to adapt to using telehealth services fulltime to provide psychodynamic therapy during COVID-19.
  • A survey of Australian therapists found that many of them had reservations about providing therapy via phone at the start of the pandemic; however, the researchers also discovered that those providing psychodynamic therapy using a phone call had a more positive experience with this format than their counterparts providing other therapy forms.
  • The American Journal of Psychiatry takes a close look at performing therapy at a distance and offers some recommendations for clinicians.
  • @Drkatliang (psychiatry fellow) tweets: “I have made profound headway with one of my psychodynamic therapy patients over Zoom during the pandemic. In person before [the] pandemic we spent a year in standstill. Interpret that. Not great for everyone but there is still learning and good patient care happening.”
  • @Summersrpa (psychiatrist) tweets: “Psychodynamic therapy in the time of coronavirus. We need reality about the pandemic but a ‘community of soft denial’ to continue the therapy. Interesting interview with French psychoanalyst.”
  • @aidangcw (clinical psychologist) shares: “Folks often talk abt “teletherapy” as if it’s a singular thing, when in-person therapy isn’t just one thing. This article is interesting in its analysis of the pros and cons of teletherapy from a psychodynamic perspective.”

In Practice

Psy-Q Challenge

What’s the best way to provide psychodynamic therapy remotely? Douglas H. Ingram, MD, answers.

Get the Answer
Last Updated: Oct 14, 2021