Life of Breath - Kate Binnie

Exploring the logic of respiration

Music & Mindful Yoga Therapist Kate Binnie joined Life of Breath as a researcher in January 2018. She writes:

I am delighted and honoured to be officially part of the LoB team at Bristol!

How I found LoB

I stumbled across LoB nearly 3 years ago when working as a music therapist in a hospice in Oxfordshire.  Previous to this, I’d discovered in my clinical practice that using aspects of yoga (which I teach) – particularly breath and body awareness (often known as mindfulness which are aspects of yoga known as dhyana and dhurana) – seemed to quickly help patients to down-regulate urgent bodily sensations and emotions such as pain, breathlessness and anxiety. Moreover, simply sitting and breathing in an intentional way with patients who were very unwell, sometimes with their families at the bedside, enabled a calm, direct, often non-verbal connection that was literally held in the breath. This allowed a spaciousness to what could sometimes be a fraught time for families leading up to their loved one’s death, and it supported not only the creation of music, but also of important conversations; the giving and receiving of forgiveness, thank you’s, I love you’s and goodbyes.

Kate Binnie with a patient

I began to read around and although I found some relevant literature and science, there seemed to be a gap. So I applied to the Cicely Saunders Institute at King’s College London to do an MSc in palliative care, and was lucky enough to receive a scholarship from the Samuel Sebba Foundation to study part time around my clinical job. During this period, I was encouraged by Dr Sara Booth whose work in setting up a Breathlessness Intervention Service in Cambridge and researching the experiences of patients with breathlessness in advanced disease was an important inspiration and provided an evidence-base from which I hoped to expand and extrapolate. Sara told me to read a book, Illness by Prof Havi Carel, and my copy was quickly covered in underscores, exclamation marks and excited scribblings. I had to get in touch with Havi. Here was someone saying – so eloquently – what I had been stumbling towards in my work and thoughts for some years. The importance of phenomenology. Of really seeing the ill person (as a person, not as an illness) and of the possibility of flourishing in the face of change, loss and death. Of the terror and invisibility of breathlessness as a symptom that I had seen over and again in the hospice, made worse by an almost institutional nihilism because breathlessness as a symptom is impossible to “fix”.

What I’m doing now at Life of Breath

Since meeting Havi and the team at Bristol I’ve attended and contributed at meetings and conferences in Bristol and Durham, and collaborated with various team members on creative and academic projects (and written several blogs about my work). I am now being supervised by Prof Gene Feder to update and publish some of the assignments from the MSc which relate to the LoB project. Firstly a systematic review assessing the effectiveness of yoga interventions for anxiety in cancer patients. Interestingly, yoga interventions that used breath only seemed to be just as effective for anxiety as those that included asana (postures) and meditation. Secondly, I hope to publish my thesis, which is a narrative synthesis of the evidence for yoga and pain outcomes and experiences across advanced disease. Again, the evidence synthesised here across qualitative studies show that patients (from diagnosis up to those receiving palliative care) found breath and breathing practices to be the most useful, effective and calming aspects of their yoga practice for coping not just with physical pain but for reframing and alleviating their mental, relational and spiritual suffering.  In palliative care we call this “total pain” relief.

What I hope to do next

Building on the work I’ve done, I am hoping to do a Phd. With Gene Feder’s support, I am writing a proposal for application later this year. I’d like to pull together the evidence for yoga-based interventions and breathlessness, understand what mechanisms and mediating factors are at play (particularly in terms of the neurophysiology & neuropsychology) and develop and test an intervention for patients with refractory breathlessness in advanced disease.  Part of this might be to develop technology that can be used directly by patients – in a very simple way I have already been doing this by making voice and audio recordings for isolated patients who then practice with these at home if they are beginning to feel anxious and unmanageably breathless. In several cases patients report that they used the recording instead of calling 111 or 999 and therefore didn’t go into hospital (which for many isolated & breathless patients is a weekly occurrence especially at weekends). This is something I think warrants further exploration. I am also keen to work with carers; if a breathless patient has someone living with them at home, can they learn simple techniques to support their loved one at times of exacerbation – and might this reduce admissions? It’s often a kind of “catching” panic between dyads that reinforces the cycle of anxiety that may lead to the 999 call. The bi-directional link between emotions and breathing is undisputed, what I want to do is systematically design and test a mode of self and co-support that may empower patients and families living with this uniquely frightening symptom (struggling for breath is struggling for life). One man with advanced COPD I saw recently told me that he calls 999 when the breathlessness takes over because “Just seeing the ambulance drawing up outside makes me feel better…. I feel safer.  Then they always have to take me in even though my oxygen sats are ok and I’m usually fine again by the time they’ve talked me down”.

The final strand is teaching professionals working in settings where patients are routinely breathless and anxious (cardio-thoracic wards, oncology, neurology, emergency departments, paediatric wards etc) to use simple breath-body-mind techniques. I already run study days about this in Oxford and at the Centre for Palliative Care in Worcester. My hypothesis is that learning these skills can improve care and enable staff to confidently and compassionately support patients at times of panic and heightened unpleasant sensation.  When someone is frightened, in pain, not-knowing-what-lies-ahead… this presents a kind of trauma which is always accompanied by a change in breathing (faster, shallower, held, or tight). By co-regulating the breath (smooth, long, waves of breath with plenty of space around the exhalation) there is an almost immediate down-regulation of the nervous system; the body relaxes, in the brain the limbic system (fight/flight/freeze) is soothed, the cerebral cortex (observing, reflecting) can function again… This allows for better communication and the building of therapeutic relationship, compliance during procedures, and sets the scene for healing which is optimised when we are in balance.  

Breath is the bridge which connects life to consciousness, which unites your body to your thoughts. Whenever your mind becomes scattered, use your breath as the means to take hold of your mind again.”  (Thich Nhat Hanh)

Closing thoughts

I called this blog “Exploring the Logic of Respiration” after reading a book I happened to pick up in a shop without looking for it. As so often happens, it seemed to press itself into my hand. 

Attention: Beyond Mindfulness by Gay Watson (Reaktion 2017) explores the philosophical and psycho-spiritual origins of attention-based practices and how they work. In this book Watson discusses how Eastern (particularly Chinese and Japanese) art expresses the Taoist philosophy and practice of generative emptiness… being emerging out of non-being, a perpetual unfolding of occurrence.  She goes on to say that Chinese thought and art is structured therefore by a Logic of Respiration (based on the continual rhythms of inspiration and expiration) rather than the logic of perception (taken by Greek and subsequent Western thought and art). There is nothing solid or fixed to this rhythmic flow which attentional/meditative practices including yoga encourage us to tune us into – revealing (so they say) the nature of reality.   But this is difficult!  This might not be the reality we would like or that which science demands – that of certainty, knowing and quantifying. The yogis call this Avidya – the misconception that things are or can be fixed.  What I find interesting is that my path seems to have been borne out of personal and clinical practice and its fruits (attention to breath, body, mind and the creative flow that may arise from this) and yet I now find myself seeking to prove it works!    

All I do know is that being with patients towards the end of life, listening to their stories and thoughts as they try to come to terms with what is happening, what has happened and what is to come – breathing with them, allowing space –  the rhythms of this respiratory logic seem to come closer and closer like the sound of waves breaking on the shore, just over the sand dunes, ceaselessly.

“At the edge of the ocean”

I have heard this music before

saith the body

(Mary Oliver)

Kate Binnie

Kate is a music therapist and mindful yoga teacher with an MSc in palliative care. She is a research associate with the Life of Breath team, researching the application of body-mind interventions for breathlessness and anxiety in advanced disease.

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