Breath is our primary food.
Lorin Roche, Breath Taking
The breathing in and the breathing out are rice and barley
Atharvaveda (Zaehner, 1966)
Your heart speeds up a little when you inhale (SNS activation) and slows down when you exhale (PNS arousal).
Rick Hanson & Richard Mendius, Buddha’s Brain
Empty your mind before you fill your body.
Pavel Somov, Reinventing the Meal
We have a misconception about mindfulness. It’s partly rooted in the semantics of the word: Mindfulness is not a fullness of the mind; it’s an emptiness of the mind. A full mind can’t attend to anything – it’s already full (like that proverbial full cup that can take no more tea no matter how much you pour into it). A mindful mind is a mind that is empty enough to be filled with the here-and-now experience. So, if your client is to make a shift from mindless emotional eating to mindful emotional eating, they have to learn to empty their mind. Relaxation is one way to do it and that’s what this chapter is about. Relaxation is the first course of the mindful emotional meal (MEM). Relaxation is also connecting to one’s body. Mind empties itself by noticing the body around it. Read on to see exactly what I mean by all of this.
Chapter 2 is about your first experiential jumpstart step. It’s akin to popping the hood. You and your client are rolling up the sleeves and getting to the business of skill training. But, first, let’s recap. MEE starts off with a radical rethinking of emotional eating. Emotional eating is first de-pathologized and then re-instated as a legitimate and intuitive form of self-care, and as a potentially effective platform of coping and emotional self-regulation. And, following this humanistic reframing of the emotional eating, client is offered a clear clinical objective: “Our goal is not to eliminate emotional eating but to make it more mindful, more effective.” So, that’s the first order of business in this program of mindful emotional eating retraining. The second order of clinical business is relaxation training. Which is what this chapter is about.
Keep in mind, however, that while this chapter is about relaxation training only, relaxation training is not the only item on the agenda of the second session. To clarify, MEE is 4 sessions. The first session is psychoeducational. The second session is about relaxation training and training in choice-awareness and pattern interruption (see Chapter 3). So, before you proceed with relaxation training, at the outset of the second session, let your client know that you will spend the first half of the session on relaxation training and that you will be talking about choice awareness and pattern interruption in the latter part of the second session.
Each clinical population seems to benefit from a slightly different relaxation approach. While the basics are fundamentally the same, the specific behavioral packaging of how you get to a place of peace varies. In working with emotional eating clients, I favor the following types of relaxation techniques:
• Humming
• Mmm-ing
• Toning
• Sighing
• Pursed lips breathing
• Smelling
• Water drinking
• Touching lips
• Chewing gum
• Tongue locking/Jihva Bandha
• Pure Breath Focus/Anapanasati
This relaxation package for emotional eating utilizes the oronasal hardware of eating – that of the mouth and the nose, whereas the relaxation package for anger management, in contrast, works with the anatomical hardware of fighting (with the help of the “open your hand to open your mind” relaxation technique).
But customization of relaxation doesn’t stop there. Additionally, this particular relaxation package, as you will see in a moment, underscores the importance of tuning in to the sensations that accompany eating. In selecting these particular relaxation techniques, I was guided by the following criteria:
• Simplicity
• Multi-utility
• Packability
• Portability
These four elements assure the development of a relaxation habit.
Simplicity, in the case of relaxation training, has to do with bottom-up rather than the top-down route of emotional self-regulation. Guided imagery or decatastrophizing would be examples of a “top-down” route to self-regulation. Having your clients think about relaxing in order to relax – that would be top-down and top-down takes time. To relax through, say, guided imagery takes time and it places a certain amount of cognitive load on an otherwise resource-depleted mind. What we need is an intuitive relaxation shortcut that requires little or no analysis. What we need is a “bottom-up” relaxation shortcut. “Bottom-up” here means non-conceptual, non-central, and non-cognitive. In other words, “bottom-up” means peripheral: Changing the state of the body to change the state of the mind rather than working this connection in reverse.
Furthermore, we want to make maximum use – double use, if not triple use – out of any given relaxation pathway. For example, a mere act of drinking water 1) works to relax, 2) works to preload (for an earlier onset of fullness), 3) works as a convenient way to prime for the sensations of fullness (to promote awareness of satiety). That’s three utilities out of one method. Similarly, an act of conscious smelling 1) works to slow you down (which takes you off the mindless eating autopilot), 2) acts to relax you (since smelling is a form of conscious breathing), 3) serves as an essential aspect of savoring (which leverages the mindfulness process), 4) and allows you to preload as well (by creating a sense of fullness). That’s four utilities out of one relaxation activity. That’s some impressive multi-utility for you.
You know how when you pack for a trip you might stuff a pair of fresh socks into each one of your shoes. You do so to maximize space. Why not use the same kind of packing mentality when you go on a relaxation journey? So, by packability I mean the ability of one relaxation path to “fold into” another relaxation path so as to create a relaxation combo. Being able to do so is a kind of clinical origami, an art of folding multiple behaviors into one. For example, one of my relaxation combos involves a “noseful” of conscious smelling on the way in (as you inhale) and a foodgasmic “mmm-ful” of savoring on the way out (as you exhale). The details are to follow but at this point I only mean to illustrate that it pays to pack together (combine) various multi-utility relaxation paths into a kind of relaxation power-punch.
The marriage of multi-utility and packability results in portability. The end goal of relaxation training is to help your client develop a relaxation habit. Therefore, the relaxation technique needs to be portable, easy to use in public, and, preferably, as inconspicuous as possible. We don’t just stress-eat at home: There is a lot of emotional eating that happens in the work place. Thus, portability is essential. An intuitively simple, conceptually face valid, well-packaged, multi-use, portable relaxation combo is well positioned for conditioning and habit formation.
Effective habit-formation thrives on cues. The relaxation meme here is “Relaxation is the first course (of mindful emotional eating).” And “Empty your mind before you fill up your belly.” As you present all of the different relaxation shortcuts, keep reiterating this relaxation narrative that has been customized to the challenge of emotional eating. Merely saying “Relax.” isn’t enough. What we want to do, as clinicians, is to help our clients embrace a more integrated view of mindful emotional eating. By framing relaxation as the first course of the mindful emotional meal and by inviting your client to empty their mind with relaxation before they fill up their belly we help our clients develop a more methodical view of mindful emotional eating.
Before you present your client with this oronasal relaxation package it is important to clarify that we are not trying to trick ourselves out of emotional eating. We are not playing a game of postponement. Relaxation is to be viewed as a bonafide first course of the mindful emotional eating meal, not a substitute for it. Naturally, if your client feels after the first course of relaxation that they don’t need to eat to cope anymore, they don’t have to proceed. If they feel that they are experientially full, that they have lost their appetite for emotional eating, that they are good to go now, then so be it. But this should not in any way be a goal. And this is essential to reiterate. Relaxation-as-the-first-course should not be misused as relaxation-as-the-only-course.
Now let’s take a closer look at the different oronasal relaxation paths available to us. And then we’ll talk about how to combine these stand-alone relaxation shortcuts into simple, portable relaxation power-punches.
Taking a deep breath when stressed seems like age-old advice. But it’s frequently misapplied. Typically, when we, as clinicians, offer deep breathing as a relaxation technique, we place the emphasis on the in breath, on the inhalation phase of the breath cycle, on taking a deep breath. But that’s not really where the relaxation and stress-diffusing effect lies. The relaxing part of conscious breathing is on the back end of the breath cycle, in the prolongation of the out breath. How do you prolong the exhalation phase of the breath cycle? By taking a longer time to exhale (e.g. with the help of counting) or by narrowing the oronasal aperture through which you exhale (e.g. exhaling through your nose or pursed lips).
Did you know that humming and chanting doesn’t just feel good but actually does good? I wrote about this best-kept secret of relaxation training in my 2012 book, Reinventing the Meal:
Nasal humming (and chanting, for that matter) triggers the release of a substantial amount of nitric oxide (NO). What’s the significance of this? Louis Ignarro, distinguished professor of pharmacology at the UCLA School of Medicine and a 1998 Nobel Prize laureate for his discovery of the importance of nitric oxide, describes NO as “the body’s natural cardiovascular wonder drug” (2005, xiii). According to a report in the American Journal of Respiratory and Critical Care Medicine, “The paranasal sinuses are major producers of nitric oxide (NO).” The researchers hypothesized that “oscillating airflow produced by humming would enhance sinus ventilation and thereby increase nasal NO levels” (Weitzberg & Lundberg, 2002, 144). Indeed, their study found that humming increased nasal NO by a factor of fifteen when compared to quiet exhalation. Why is this of any relevance? Because nitric oxide release happens to both accompany and power up the relaxation effect. Here’s what the godfather of Western relaxation research, Herbert Benson, MD, had to say about nitric oxide in his book Relaxation Revolution: “Those practicing mind-body techniques [tend] to experience lower blood pressure, calmer brain activity, healthful emissions of nitric oxide in the body’s cells and other physical and emotional benefits” (Benson & Proctor, 2010, 22). Benson explains that “release of nitric oxide in the body’s cells ... serves as a vasodilator, an agent that expands blood vessels. This dilation process can be highly effective in reducing blood pressure” (129). He also explains that nitric oxide is “associated with good health, including antibacterial and antiviral responses and also beneficial changes in the cardiovascular system” (77).
I distinguish three types of nasal prolonged exhalation breathing: humming, mmm-ing, and moaning. I don’t recommend moaning but it serves as a good way to introduce mmm-ing.
You don’t have to use mental count to prolong exhalation. Frankly, the business of mental counting feels like a hassle. A simpler, more enjoyable, and more bottom-up (non-cognitive) way to prolong the out-breath is to hum it out. Invite your client to try to exhale several breaths through the nose while humming. Model it in session as part of relaxation training. Have a few “humfuls” to appreciate the subtle soothing vibration of humming. And invite your client to have a few humfuls before they have a few mouthfuls. Say:
“Next time you feel like you want to eat to cope, have a few humful breaths first. Fill up on relaxation. Humfuls first, mouthfuls second. Empty your mind with a few humfuls before you fill up your belly.”
Moaning needs no introduction. We moan in pain. We moan as we struggle and endure. Therefore, moaning has an affectively negative valence. And I do not recommend it as a relaxation path in the context of mindful emotional eating. Moaning is however very similar to mmm-ing in terms of its vocal execution so take a moment to moan for a moment or two, just as a warm-up for mmm-ing.
Mmm-ing as a mantra of gustatory enjoyment – a kind of “om” of mindful eating. Indeed, the sound “mmm” is the music of savoring, the sound of eating satisfaction associated with the so-called foodgasms, a celebration of gustatory pleasure (Somov, 2008). So, introduce this curious oronasal relaxation strategy to your emotional eating client and explain:
“You don’t have to wait until you have something in your mouth to “mmm” about. You can also amplify the pleasure of anticipation. And that’s where mmm-ing comes in as a double-use relaxation short-cut. Mmm-ing is a form of nasal prolongation of exhalation and a subjective amplification of eating satisfaction. Try mmm-ing now to see what I mean about the extended out-breath.”
Clinician, there is a good chance that your client might feel a bit self-conscious about making this arguably emotionally intimate sound in session. So, it’s best if you model some mmm-ing to demo the prolonged exhalation aspect of it. And then cap off the moment with the following recommendation:
“Before you eat to cope, mmm a little. Empty your mind with a bit of mmm-ing before you fill up your belly. Have a few mmm-fuls for your first course of relaxation. Prime yourself for eating pleasure to leverage more coping per calorie.”
Just like you can extend the exhalation phase of your breath cycle through nasal breathing, you can also prolong your breath by breathing out through your mouth. I distinguish three types of extending your out-breath orally – toning, sighing, and exhaling through pursed lips.
Don Campbell, the founder of the Institute of Music, Health and Education, says this about toning: “Toning balances brain waves, deepens the breath, reduces the heart rate and imparts a general sense of well-being” (2001, p. 93). Toning is elongation of vowels and thus, fundamentally, a form of prolonged exhalation. According to Campbell, toning ahhh evokes an immediate relaxation response, and toning om – the richest tonal phoneme – can even warm skin temperature (Amen, 1998). Daniel Amen, in his book Change Your Brain, Change Your Life, recommends toning for five minutes a day as a stress management tool. And I, in turn, recommend toning as yet another relaxation shortcut as part of the first course of mindful emotional eating. Invite your client to tone a few ahhhs or a few oms to fill up on relaxation before filling up on food.
Another oral way to extend the exhalation phase is sighing. Sighing is intuitive for the body. We sigh at a moment of emotional relief. But we don’t have to wait till some crisis or stressor is over in order for us to sigh in relief. You can sigh on demand. Invite your client to sigh a few times to see how it works. There is a kind of energetic but brief uptake of air and a prolonged exhalation through a loosely protruding mouth. There is a characteristic “wooh” sound to it. Or a more open “ahh” sound to it. The “wooh” takes longer than “ahh.” So, I recommend the “wooh” since it prolongs the out-breath better than “ahh.” Encourage your clients to experiment with issuing some preventive sighs of release as an intuitive relaxation shortcut. Say:
“Empty your mind with a few sighs of relief before you sit down to eat to cope. The more stress you relieve with sighing the less stress there is to cope with by eating.”
Breathing out through pursed lips is similar to sighing. The difference is that the oral aperture is more tightly controlled. When you sigh your lips are slack. When you breath out through pursed lips, lips are held more tightly, the opening of the mouth is narrower, and as a result the out-breath is even longer. Try to breathe out through pursed lips. Invite your client to empty his or her mind before eating with a few such breaths.
Smelling is the opposite of prolonged exhalation. Smelling is a long inhalation. When you take a purposeful whiff, you take a long draw of air. If we go with the theory about prolonged exhalation, then smelling in and of itself would seem counterproductive. A longer inhalation is arousing rather than calming. But there is a way for your client to use smelling as a way to relax before eating. And we have a good reason to try to take advantage of smelling: Much of the sensation of taste is powered by the nose rather than the tongue. And we are definitely interested in making an emotional eating episode richer in taste so as to hopefully keep it from being larger in calories. Furthermore, smelling has been indicated as a way to preload on fullness. Taking conscious nosefuls of the food’s aroma allows you to experience a sooner onset of fullness and, therefore, not overeat. So, we have many good reasons to incorporate smelling into the first course of relaxation. Encourage your client to combine nosefuls with mmm-fuls or with hum-fuls. The idea here is to take a long conscious noseful of food smells on the in-breath and mmm on the out-breath. That’s it. Try it to see what I mean. Tell your client:
“How about you practice this next time you sit down to eat to cope. Set out some food in front of you but before you eat, have a first course of relaxation by inhaling the smell and mmm-ing it out in satisfaction. In – the smell, out – the sound of fulfilling satisfaction.”
Your lungs and your stomach share the same portal. But your body is smart; it knows how to handle these two very different kinds of traffic – water and air. So, when you take a sip of any liquid your body pauses your breath to make sure that the liquid doesn’t do down the wrong pipe. Encourage your client to experiment with this. Tell them to drink a glass of water before they eat to cope and to notice how the body slows itself down by pausing the breath to accommodate a sip. Another rationale for drinking water as the first course of relaxation has to do with the fact that preloading on water facilitates a sooner onset of fullness. Additionally, research suggests that preloading by drinking just two eight-ounce glasses of water before a meal may help with weight-loss success (Davy et al., 2008). Another reason for drinking water to relax is that dehydration reduces the activity of nitric oxide synthase, an enzyme that converts the amino acid L-arginine into nitric oxide, that miracle molecule of relaxation; and hydration reverses this process (Bryan and Zand, 2010). Finally, mindfully drinking a glass of water allows you to experience the sensation of abdominal distention, i.e. the physiological signature of fullness. Therefore, drinking water not only relaxes and facilitates the onset of fullness through preloading, but it also primes your client’s mind for paying attention to the sensations of fullness.
So, what we have here is a bottom-up, NO-enhancing, filling, awareness-building, portable relaxation shortcut. After you present the rationale behind this relaxation shortcut, simply say:
“Next time you sit down to eat to cope, have a glass of water, take your time with it. Empty a glass of water to empty your mind.”
Also encourage your client to experiment with drinking warm water, drinking a warm glass of milk, or drinking a cup of something non-caffeinated. I would particularly like to highlight chamomile tea as a simple oronasal relaxation shortcut. I playfully call chamomile “calm-omile” because of its calming effects. So, bottoms up.
Rick Hanson and Richard Mendius, in their 2009 book, Buddha’s Brain, write: “Parasympathetic fibers are spread throughout your lips; thus, touching your lips stimulates the PNS. Touching your lips can also bring up soothing associations of eating or even of breastfeeding when you were a baby” (p. 82). Could this be the secret behind the good romantic kiss? Maybe. Definitely something to think about, right? But for our purposes, touching the lips seems like a perfect oronasal relaxation shortcut before eating. Encourage your client to try running his or her index finger along the track of their lips a few relaxing and self-soothing laps. Alternatively, you could have your client apply a few massaging rounds of flavored lip balm and sit for a few minutes in breath focus. And finally, a simple act of moistening the lips with the tongue can too serve as a way to stimulate the relaxing effect of the PNS.
Emotional eating is a form of self-pacification. And you can think of chewing gum as an adult pacifier. Chewing gum, particularly flavored gum, engages your oronasal apparatus, thus engaging the parasympathetic nervous system (PNS) and positioning you for relaxation. With this in mind, encourage your client to stock up on some of the modern-day intriguing chewing gum options. Invite them to relax with a few minutes of chewing gum before they eat to cope. As you know gum loses flavor relatively fast. After a couple of minutes the flavor is more or less gone and we feel kind of bummed out, but here it’s actually good news: The loss of gum’s flavor is a natural way to time the duration of relaxation.
Tongue lock is when you curl up the tip of your tongue to touch your palate and you keep it that way for a while. This kind of tongue lock is a part of yoga breath practices and is called jihva bandha. When used as part of a breathing meditation, jihva bandha can also involve a slight stretching of frenulum (which is the bridle that connects your tongue to the floor of your mouth). Try to curl up your tongue right now so that it not only touches the palate but curves back. Strain yourself a bit. The stretch you feel is your frenulum. Combine this tongue-lock with a noseful of smell as you inhale and with an mmm-ful out-breath as you exhale. Packing so much into a single breath cycle – a noseful, a tongue lock, and an mmm-ful is a sensation-rich experience. Tongue-lock is a potent concentration practice; it preoccupies the mind in doing so empties the mind of stress. If you do this for a minute or so, you will soon notice that there is some accumulation of saliva. Swallow it and re-lock yourself into this oronasal concentration combo for another moment or two.
Anapanasati is pure breath focus, mere awareness of breathing as it is. This has always made sense to me: The body knows how to breathe and it really needs no direction from you. The pranayama approach to breathing is about modifying, shaping, and changing your breathing rate. Anapanasati is simpler and harder than pranayama. Anapanasati is simple because there is nothing to do and it is hard because there is nothing to do. And we are not very good at doing nothing. But if your client can allow himself or herself to do nothing, they will likely find it rather liberating. So, simply instruct:
“When you sit down to eat to cope, take a couple of moments to simply notice your breath exactly as it is. There is nothing else required of you in this moment. Notice your breath to empty your mind before you proceed to fill up your belly.”
There are many different ways to combine these relaxation shortcuts. Here are a few that I like (in no particular order):
• a noseful (of smell) on the in-breath + a hum-ful (of self-soothing) on the out-breath
• a noseful (of smell) on the in-breath + an mmm-ful (of satisfaction) on the out-breath
• either of the above with a tongue lock
• a sip (of water) + a hum-ful (of self-soothing) on the out-breath (do this through a full glass of water)
• a sip (of water) + a wooh-like sigh (of relief) on the out-breath (do this through a full glass of water)
• a noseful (of smell) on the in-breath + toning -ee or -aa on the out-breath
• humming with a tongue lock
• mmm-ing with a tongue lock
• anapanasati/breath focus + jihva bandha/tongue lock
• drinking a glass of water punctuated with anapanasati/breath focus in between sips
Try all of these combos yourself before you offer them to your clients. Learn the lingo and the mechanics so that you can explain these novel oronasal maneuvers. If you don’t have much time, just go with the basics – some plain breath focus, maybe a humful or two, maybe a glass of water. Help your client play around with these ideas to develop a relaxation ritual of their own. And, of course, if you as a clinician have your own field-tested way of relaxation training, use it. The core idea here is not the “how” of relaxation but the mere fact of it as the first course of a mindful emotional eating meal.
A Power-Combo: Air + Water = First MEE Course
Encourage your client to have some air and to have some water. It doesn’t have to be either/or. Why air first and water second? We are just following the survival priorities, that’s all. An intuitive sequence. But of course, if you are using a combo (of sipping through a glass of water with humming or sighing or toning or mmm-ing in between) then the two become one. Insisting on both tactics (of breathing and drinking water) buys your client more time to wind down, allows them to preload (through smelling and with liquids), and helps them tune in to the eating apparatus.
Oronasal relaxation shortcuts prime the client’s mind to tune in to the olfactory and gustatory stimuli associated with eating and that is value-added. Relaxing in this oronasal manner (as opposed to, say, sitting in a massage chair or taking a shower or using some musculoskeletal relaxation sequence or some imagery) is meant to drive the client’s mind towards the process of mindful eating. These relaxation techniques recalibrate your client’s attention away from cognition back to sensation. Your client doesn’t want to think anymore. He or she is fried, beat, stressed. They are looking for a way to connect with their body and to find solace in the unambiguous richness of sensation. And that’s where the proposed relaxation package comes in – this particular kind of relaxation platform not only relaxes but also primes the mind for mindful eating. The idea here is not only to empty the mind of stress but to also awaken the mind to the oronasal landscape of eating sensations.
There are three issues here: one from clinician and two from clients. Since this book is primarily for clinicians, let’s tackle the clinical objection of time management first. A clinician might object: “Pavel, this is too much – too many relaxation skills to teach to the client.” Agreed, this is a big chapter, but it’s not that big of a job. 15 to 30 minutes max when you know what you are doing. You don’t have to present your client with all of these relaxation shortcuts. Just present a few, roll them into a relaxation power-punch and you are done. Maybe give your client a handout and homework to experiment with whatever strikes their fancy. That’s about it.
Now, the client on the other hand might challenge you with an oldie-but-goodie: “I don’t have time.” If so, simply counter this objection with: “Yes, you do: if you have time to cope by eating, you have time to relax. Take your time to relax before you eat to cope so as to not waste more time on mindless overeating.”
The client might also ask you to be more specific about how much time to spend on relaxation. What I usually say is: “The more time you take to relax, the less stress you have to cope with by eating.” But after explaining this inverted correlation, I paradoxically rush to add:
“But don’t spend too much time in relaxation, maybe 5 minutes tops – I don’t want for you to start feeling like you are trying to trick yourself out of emotional eating. Sure, if after a few minutes of relaxation you conclude that you no longer feel like eating to cope, then, naturally, you don’t have to. But if, after a few minutes of relaxation, you feel better but you still want to do some emotional eating, then there is no point in continuing to relax in the hope that you can dodge emotional eating altogether.”
There are many different ways of presenting this first experiential training step. Here are some general ways for framing this first behavioral step:
• Relaxation is the first course of the mindful emotional eating meal.
• First course of mindful emotional eating is to connect to your body with relaxation.
• Empty your mind with relaxation before you fill up your belly.
• First, empty your mind by connecting to your body. And then you can eat.
• Practice relaxation-as-the-first-course not only when you decided to eat to cope but any time you eat.
Use these ideas as clinical refrains as you introduce your client to the relaxation training. But also feel free to develop your own way of pitching relaxation to your emotional eating client. And make sure that your client gets the core rationale for why a mindful emotional eating episode should begin with relaxation. Keep reiterating that by reducing the amount of stress on the front end, before eating, your client will have less stress to cope with by eating. Relaxation-as-the-first-course positions your client to have a successful emotional eating experience. Relaxation-as-the first-course enables emotional eating in moderation.