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Thinking - Managing thoughts about breathlessness (Leaflet 5)

Patient information

The information given below is designed to help you manage your stable long-term breathlessness. If your breathing is getting worse, or you are experiencing breathlessness as a new feeling, it is important to seek medical advice from your GP.

How the brain responds to breathlessness

We become breathless when we exercise or when we over exert ourselves and it is quite normal to experience breathlessness from time to time. Breathlessness is a very common symptom in long-term conditions such as COPD, heart failure, and cancer.

The fight or flight response

Sometimes, sudden and unusual breathlessness can be a sign that something is wrong. Our brain responds to this by triggering our survival or ‘fight or flight’ response to manage whatever is going on. This is a very helpful response to help to protect us if we are in a dangerous situation. However, when we are not in a dangerous situation, such as being breathlessness due to a long-term condition, this response is less helpful.

It is normal for our bodies to experience some degree of anxiety. When this happens, the body is preparing itself to react (known as ‘fight or flight’). Imagine that you are crossing a road, when you notice a car coming towards you. It is the fight or flight response that helps you to get out of the way. So some feelings of anxiety are useful.

When we become anxious, the eyes and ears sense a threat and alert our brain. This then stimulates the adrenal glands to produce adrenaline and release it into our blood. It reaches the heart, lungs, and muscles and causes the reactions needed to help us fight or flee.

Because of your body responding like this when you feel anxious, you might experience some of the following:

Body

Tensed muscles, rapid heartbeat, difficulties breathing, chest pains, sweating, dizziness, nausea, dry mouth, blurred vision, or the need to go to the toilet.

Thoughts

Unhelpful thinking such as imaging the worst, worrying about looking foolish, worrying about ‘going mad’.

Actions

Avoiding situations or people which make you feel anxious, poor concentration, aggression, irritability, sleep problems.

Breathlessness and anxiety

Unhelpful thoughts about breathlessness can often lead to a vicious cycle of anxiety and avoidance, as described in Leaflet 1. When anxiety begins to affect life to an extent that you are experiencing unpleasant symptoms regularly, and unable to do what you want to do, it is helpful to understand the reasons why this is happening, so that you are able to manage these symptoms.

The good thing is that whilst you might not be able to change what is happening in your heart or lungs, you can change the way you think and feel about breathlessness and change behaviours. This, in turn, can help you to do more of the things you would like to do, and feel more in control of breathlessness when it happens.

One person who used the Service said “I’m in control of what’s happening to me, you

know, how I feel mentally, not necessarily physically all the time, but certainly mentally I’ve got a much different attitude”.

Some people find it re-assuring to know that usual day-to-day breathlessness on exertion is not harmful. There are ways to manage breathlessness which help you to recover more quickly, or help you not to get so breathless.

Common thoughts about breathlessness

Feeling breathless, or seeing someone you care about being breathless, can be very unpleasant and frightening. If you have had any past frightening experiences of breathlessness, this can also impact on the level of breathlessness you are feeling now. Understanding why breathlessness happens, how the body responds and how you can control these responses can be a very useful way of managing your breathlessness. Talking through your thoughts to help you to understand your body’s response can help you to manage your breathlessness.

Breathlessness can also make people feel angry, frustrated, or worried. How does breathlessness make you feel? It is very helpful to talk about how breathlessness makes you feel. This will also help those around you to understand a little more what you are experiencing and will also enable people to help.

Here are some common thoughts or “misperceptions” which people often have about breathlessness with an explanation which may help to relieve some concerns.

Non-urgent advice: Common thought or "misperception"

"I need more oxygen"

Breathlessness is not always related to the level of oxygen in your blood, and oxygen does not always relieve breathlessness. Using the fan and practising relaxed tummy breathing will help your breathing.

“I won’t be able to get my breath back”

Making yourself moderately breathlessness by being active is not usually harmful and you will recover your breathing.

“I’m going to pass out”

If you become extremely breathless, you tend to breathe more quickly and shallowly. This is a very inefficient way of breathing and can make you feel light-headed. Practising relaxed tummy breathing can prevent this from happening.

“I’m going to have a stroke or heart attack”

The fight or flight response can cause your heart to beat faster, tightness in your chest and other symptoms. Understanding the body’s response to breathlessness and anxiety can help to take away these worrying thoughts.

How can I control my anxiety?

  • recognise what triggers your anxiety
  • mention how you are feeling to health care professionals
  • try to identify problems and address them one at a time
  • try not to worry about future events, concentrate on the present
  • learn a way of relaxing that works for you
  • use a photo / picture that helps you to think about relaxing thoughts

Thoughts about breathlessness can influence how you feel and behave. Your response to a situation also impacts on how you think and feel. It can be helpful to think about a situation where you felt anxious. Think about what thoughts were going through your mind.

  • What feelings did you have?
  • What physical symptoms did you notice?
  • How did you behave in that situation?
  • Then gently ask yourself what could I have done differently?
  • Is there an alternative and more realistic thought or response to the situation?

Talking these situations through with a health care professional can help you to change your responses to situations. This can help you to feel less anxious and less breathless.

Relaxation techniques can help to manage the physical symptoms of anxiety. There are some techniques to try in our relaxation guide.

Having a plan of action

Many people find it helpful to have a plan of action written down to refer to in times of breathlessness, particularly if you have feelings of anxiety of panic. This action plan may be as simple as a few basic prompts to remind you what to do. It can re-assure you that you have had this feeling before and that you will recover your breathing.

Non-urgent advice: Action Plan for breathlessness

I have had this feeling before

I know it will go away soon

Information:

I am going to lean forward

I am going to use my fan

Focus on gently breathing out

I can do this – I am doing it now

I don’t need to be frightened – I am OK

Further information

For further help or advice contact the Breathlessness Intervention Service on 01223 274404 - 09:00 to 17:00 Monday to Friday.

We are smoke-free

Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.

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https://www.cuh.nhs.uk/contact-us/contact-enquiries/