Five Steps to Teaching Diaphragmatic Breathing

Step 1:  Observation

Observe patients’ breathing while they are seated for a minute or so.  It is helpful to have them place one hand on the abdomen and another on the chest. To reduce performance anxiety, you could have them close their eyes or distract them with a different activity to allow you to observe comfortably.

• Ask them to breathe normally, just as they would in their life outside the clinic.
• Observe the movements of the hands including whether there is more movement in the upper hand (chest) or the bottom hand (abdomen).
• Notice if their breathing rate is fast, slow or somewhere in between. Observe whether the breathing pattern is smooth or choppy.

Step 2: Education

The acronym DASS—Deep, Abdominal, Slow and Smooth—describes the goal pattern. If patient’s breathing pattern is shallow, fast or choppy consider discussing or demonstrating:

• The importance of the diaphragm muscle as the main muscle of breathing.
• Breathing as it relates to the sympathetic and parasympathetic nervous systems.
• What diaphragmatic breathing looks like (the provider can use DASS breathing to demonstrate to the patient).
• The role of stress, and how it can lead to shallow chest breathing.  Clinicians can acknowledge that pain (and its accompanying issues) are significant stressors and can influence their breathing patterns.
• Taking time with the exhalation assists in activating the quieting response mediated by the parasympathetic nervous system.