Breathing Techniques
Breath control is likely the most popular CAM technique patients naturally use when dealing with anxiety during their MRI exam. From personal experience, there have been countless numbers of patients who have said that breathing techniques was what helped them get them through their exam. My observation is supported by a study that evaluated interventions that patients used naturally to help reduce their stress during MRI2. Of all the impromptu interventions, 11% of patients used breathing techniques to help them relax during their MRI2. Likewise, in a study I conducted in 2014, 39% of participants said the breathing technique alone was the most effective in reducing their MRI anxiety compared to only 5% who felt aromatherapy alone was the most effective intervention20.
Before discussing breathing techniques, it is important to understand the different types of breathing. There are two types of breathing: metabolic and behavioral121. Behavioral breathing is controlled by the individual and can be influenced by both internal and external factors121. In metabolic breathing, the individual has no control as it is managed by the autonomic nervous system121. Although our emotions are governed by both metabolic and behavioral breathing, behavioral breathing is the basis of breathing techniques, and this relationship will be discussed in further detail in this section.
Breathing techniques, defined as eliciting a relaxation response through conscious breathing, have been found to be beneficial in reducing anxiety and was cited as a popular and effective self-regulation technique by MRI patients57,131. This relaxation response is elicited through the autonomic nervous system that consists of two parts, the parasympathetic nervous system (PNS) and sympathetic nervous system (SNS), which are responsible for the relaxation and stress responses, respectively57,132. The autonomic nervous system and neuroendocrine functions that control stress and relaxation responses can be positively influenced by controlled breathing57. One study suggested the nervous system response can be activated in less than five (5) minutes to help achieve a more relaxed state, making breathing techniques a viable way of dealing with anxiety in the fast-paced MRI environment57.
Breathing techniques reduce stress by increasing the amount of oxygen in the body while decreasing carbon dioxide57,132. The reduction of carbon dioxide is the basic reason breathing techniques are effective in activating the relaxation response57. When there is an excessive amount of carbon dioxide in the blood, the accumulation of lactic acid causes lactic acidosis, which aggravates symptoms of panic and anxiety, causing the patient to hyperventilate132. Almost every technologist has had a patient who has experienced hyperventilation from anxiety; thus, having a better understanding of these mechanisms are important and will be discussed in further detail at the end of this section.
Breathing techniques were found to decrease both physiological and psychological arousal during threatening situations as MRI exams are sometimes viewed25,72,133. Breathing techniques have also been shown to be effective in treating specific psychological disorders such as anxiety and panic attacks57,60. This is because, as stated above breathing techniques can have a calming effect both physiologically and psychologically25,57,133. Some studies have shown these techniques to help treat anxiety-related disorders in the MRI environment25,57,134. Two studies reported that breathing techniques aided in reducing symptoms associated with panic attacks and anxiety, which are often seen in MRI patients57,60,134,135. Breathing techniques are also believed to give a greater sense of control over their physical symptoms and catastrophic cognition or thoughts associated with panic attacks and anxiety, which are major contributing factors to MRI anxiety30,134.
There are several other studies that evaluated MRI anxiety and mentioned breathing techniques used by patients to self-regulate their emotions2,13,90. A qualitative study concluded that one of the major factors affecting anxious MRI patients was a lack of self-control, which breathing techniques may help patients regain30,134. With that being said, having patients with the ability to control their breathing is an important component in helping them regain self-control and reducing shortness of breath from anxiety or panic attacks.
Shortness of breath or hyperventilation is a common complaint of patients while in the MRI machine30. Hyperventilation is a breathing disorder associated with anxiety disorders commonly seen in the MRI department, such as claustrophobia and panic attacks. When a person suddenly feels anxious, there is a decrease in the amount of blood reaching the brain132. This reduction of oxygen to the brain causes neurocirculatory asthenia or air hunger132,136. Air hunger, also described as breathlessness, is when a person feels as though they are not getting enough air, causing them to breathe faster, setting the stage for hyperventilation132. It is unclear whether hyperventilation is the cause of anxiety or if anxiety causes it, but the reasons why it happens is not as important as knowing your patients don’t have much control over their breathing when experiencing anxiety-induced hyperventilation132. The best way for a technologist to understand how air hunger feels to their patient is to remember how they may have felt at some point during the COVID-19 pandemic when they were required to wear a mask for their entire shift. My personal experience with air hunger was during the beginning of the pandemic and I double-masked. In short, my hope is that if we as technologists have an idea of what a patient who experiences shortness of breath from anxiety, we will have a greater sense of empathy when a patient squeezes the call button saying they can’t breathe.
In summary, there are two types of breathing: metabolic, which is involuntary and controlled by the autonomic nervous system, and behavioral, which is both voluntary and involuntary121. Breathing techniques have been shown to be very effective in reducing anxiety and its physiological and psychological symptoms, making this the ultimate low-cost and easiest intervention for MRI anxiety20,25,72. This is because breathing is something we all do and use naturally when trying to regulate our emotions in any situation. In the case of hyperventilation, breathing techniques can increase oxygen while decreasing the amount of carbon dioxide in our bodies and, hence, its negative effects on anxiety.