Leaflet 5: Thinking - Managing thoughts about breathlessness

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.

Breathlessness is a very common symptom in many long-term conditions such as COPD, heart failure, and cancer. It is normal to become breathless when we exercise or exert ourselves. However, there are times that breathlessness can feel uncomfortable or worrying.

How the brain responds to breathlessness

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. When this happens, the body is preparing itself to react and protect us. If we cross a road and notice a car coming towards us, it is the fight or flight response that helps us to get out of the way and avoid the car.

This is a very helpful response to help to protect us if we are in a dangerous situation or when there is an immediate threat. However, when this happens with day to day breathlessness, this response is less helpful.

The fight or flight is triggered when we sense a threat. This then stimulates the adrenal glands to produce adrenaline and release it into our blood. The adrenaline reaches the heart, lungs and muscles and causes the reactions needed to help us fight or flee a threat. When this is happening 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 imagining 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.

Our fight or flight response can also be triggered when we feel frightened or anxious. It is normal for us to experience some degree of anxiety from time to time. However, when anxiety is triggered by day to day breathlessness, which is normal for you, it can be less helpful.

Breathlessness and anxiety

Unhelpful thoughts about breathlessness can often lead to a 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 you can change the way you think and feel about breathlessness and learn to respond in a different way. 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 reassuring 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 how breathless 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.

Breathlessness can also make people feel angry, frustrated, or worried. It can be helpful to talk about how breathlessness makes you feel. This may also help those around you to understand a little more what you are experiencing and to the things that will help.

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

How can I control my anxiety?

• Recognise what triggers your anxiety and the first signs you notice.
• Use a technique that helps at the first sign of anxiety.
• Try to identify problems and address them one at a time.
• Learn a way of relaxing that works for you.
• Use a photo/ picture that helps you to think about relaxing thoughts.
• Talk about how you are feeling to a relative, friend or healthcare professional.

Thoughts about breathlessness can influence your feelings and actions. 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, then gently ask yourself, "What could I have done differently?"

• What feelings did you have?
• What physical symptoms did you notice?
• How did you respond in that situation?
• Is there an alternative or more helpful response to the situation?

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

Relaxation techniques and mindfulness can also help to manage the symptoms of anxiety. There are some techniques to try in Leaflet 6: Relaxation and mindfulness.

Having a plan of action

Many people find it helpful to have a plan of action written down to refer to. This action plan may be as simple as a few basic prompts to remind you what can be helpful. It can reassure you that you have had this feeling before and that you will recover your breathing.

Further information

For further help or advice contact the Breathlessness Intervention Service on 01223 274404 - 09:00 (9am) to 17:00 (5pm) Monday to Friday.