Slow Rhythmic Breathing as Effective Method Supporting

Psychotherapy Process of Trauma and Claustrophobia in

Head and Neck Cancer Patients.
Alicja Heyda, Agata Bieleń, Krzysztof Składowski,
Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
Contact: alicja.heyda@io.gliwice.pl
Introduction and Goal
Mental health problems and somatic diseases often result in the weaker activity of the Tab.1 Polyvagal chart presenting the Polyvagal Theory by prof. Stephen Porges
vagus nerve. Reduced vagal tone measured by RSA and/or HRV is present in depression,
anxiety disorder, behavioural disorders, attachment disorder, trauma/PTSD, related to in-
creased mortality in cardiovascular diseases, diabetes, several cancer types and other so-
matic diseases. Slow rhythmic breathing (SRB) of 6 breaths per minute, (0.10Hz) is known
for its beneficial effects on increasing vagal tone, regulating the peripheral nervous
system through vagus nerve stimulation, improving respiratory and circulatory efficiency,
oxygenation and reducing hypertension (numerous works by Tharion et al., Bernardi et.al,
Rosenberg et al.)
In the context of Polyvagal Theory which sets light on contemporary understanding of
trauma, when a person practices 6 breaths per minute, is simultaneously setting a healthy
vagal tone. The patient changes his/her psychosomatic state from
freeze/numbness/trauma phase (dorsal vagal part of the parasympathetic nervous
system) or fight or flight state (sympathetic NS) towards social engagement phase, safe
green zone of activation of the parasympathetic ventral part of the vagus nerve (see fig.1)
Head and neck cancer (HNC) and its treatment very often cause facial disfigurement, fa-
tigue, pain, speech problems, and depression. The goal of this study is to evaluate how
SRB affected heavily distressed HNC patients, whose trauma could have prevented them
(https://www.rubyjowalker.com/PVchart_200706.jpg Walker, 2017)
from completing cancer treatment.

Method
Eight HNC patients aged 54-76 undergoing radical radiotherapy or chemo-radiotherapy
started psychotherapy with SRB as an adjunct bodywork intervention after they reported
claustrophobia (6), depression (5) or/and anxiety (3), preventing them from
starting/completing cancer treatment. Patients had 15-30 minutes of slow breathing ses-
sions day by day followed by a free verbal expression (median=5 sessions; min 2-max 16).
Results
Underlying traumas included: accidents in the coal mine (3), at the martial arts training (1),
cumulative trauma of being a long-term (>10y) caregiver of ill relative (2), post-operative
PTSD (1), and life-threatening abduction (1). All patients completed the cancer treatment
and all reported significant clinical improvement: reduction of radiotherapy related pain
(3/8pts), claustrophobia (6/6pts), and anxiety (8/8pts) after a median of 2 sessions (min
2-max 10). Four patients made significant lifestyle changes (see tab.2)

Tab 2. Detailed information about the patients and their outcomes after slow breathwork sessions.

Patient's No. of sessions until

age at the No. of clinical improvement
time of Treatment breathwork of claustrophobic Results of breathwork as a single
treatment Sex type Symptoms and their context Notable trauma (s) sessions symptoms practice or as a part of therapy

67 m multiple Long term sleeping disorders, severe depression Prolonged, ongoing 24/7 care during the last 10 4 1 No claustrophobia, immediately
surgeries, lasting more than 5 years years over elderly disabled parents, with the regulated sleep pattern, less
radiotherapy only occasional help of other family members sadness and resignation, positive
without holidays and normal sleep at night. re-evaluation of personal life.

64 m surgery, Claustrophobia and panic attack during the first
radiotherapy attempt at cancer treatment in a different
hospital a year earlier. Treatment interrupted.
Depression during the last 12 months before
the treatment at National Cancer Center in
Gliwice.
Separated from juvenile mother as a toddler, 2 2 No claustrophobic symptoms, less
almost drowning in the swamp as 7 years old depression, de-traumatisation,
child, numerous bike accidents, finding a existential positive re-evaluation.
family member who had committed suicide, a
smothering accident at the martial arts
training 2 years before cancer onset.

69 m reconstructive Claustrophobia- first noted during radiotherapy
surgery, mask fitting procedure. Depression after 1st
radiotherapy stage of cancer treatment - 8 hours-long
operation, prolonged complicated stay at
Surgery Clinic. Constant pain.
Traumatised after being immobilised for days
after surgery, the experience of extreme
loneliness and helplessness without being
able to move, speak, swallow and breathe
freely.
8 2 No claustrophobia, reduction of
pain, fear of pain and body tension,
existential positive re-evaluation.

76 f induction Claustrophobia during diagnostic procedures 20 years of 24/7 care of a disabled, blind 6 3 No claustrophobic symptoms,
chemotherapy, before cancer treatment, long-lasting husband who had amputated limbs, without better sleep, less depressed
radio- depression. holidays, sleeping at night and any help from
chemotherapy others.

57 m induction High level of anxiety while being hospitalised Multiple accidents followed by losing 3 1 Quitted smoking, less bodily
chemotherapy, without the possibility to leave the room during consciousness and other threatening tension, no anxiety symptoms,
radio- intensified oral mucositis. related to situations at the coal mine. comfortable breathing despite
chemotherapy radiotherapy. Long-term (20 years) addiction COPD and pneumonia.
to alcohol - 10 years of sobriety. Addiction to
smoking cigarettes- 30 pack-years before
treatment. COPD and pneumonia during
radiotherapy.

54 m surgery, Claustrophobia in small closed spaces before Accidentally smothered and fainted in the 16 10 No claustrophobia, pain reduction,
radiotherapy the treatment, during the mask-fitting crowded lift at the coal mine. less general anxiety.
procedure and at the beginning of radiotherapy.

60 m induction Claustrophobia, first noted during magnetic 10 years before the treatment - beaten and 6 2 Complete reduction of claustropho-
chemotherapy, resonance procedures before cancer treatment, kidnapped into the woods during an armed bic symptoms, complete pain
radio- later during mask-fitting procedure. gangster assault, left alone with tied hands, reduction during intensive radio-
chemotherapy managed to run away. therapy, de-traumatisation.

63 m radiotherapy Claustrophobia during mask-fitting and at the Accidentally smothered several times in the 1 1 No claustrophobic symptoms.
beginning of radiotherapy. crowded lift at the coal mine.

Conclusion
SRB effectively reduced symptoms of claustrophobia, anxiety, and pain and enabled the patients to complete cancer treatment.
The method proved to be an effective adjunct to psychotherapy process of traumatized HNC patients.