Transcription
The more irregular a heart is, the healthier the person is because it has greater adaptability. There is this capacity for great oscillation between the sympathetic and parasympathetic, between action and rest, and someone who has great resilience of the autonomic nervous system. And so, this is what we seek to do, to increase by training our autonomic nervous system as we would train a muscle. Uh, the state we call cardiac coherence, and I don't like that word because it medicalizes the subject and it keeps the heart, which is only the marker. Uh, the training will be done in small moments for everyday life. So, having a few minutes a day, 15-20 minutes a day, it's simply taking time for breathing. Hello, welcome to Dialogue. I am Fabrice Middal, an enthusiastic philosopher who likes to share his enthusiasms with you, author of many books including "Am I Hypersensitive?" and the latest, "How Not to Let the World Fall Apart: 19 Lessons for Resistance." For over 35 years, I have been practicing meditation, and reflecting on what breath, respiration, is essential. And I have always experienced that depending on how I breathe, it changes my emotional state and my mind. So, for a long time, I have enjoyed reading books on this subject, and generally, I am almost always disappointed because I find that breathing is spoken of as something mechanical, technical, without truly showing the links to the state of being, in a completely non-instrumental way, but in a way of listening. I believe that what is central is that it is not about manipulating our breathing as we manipulate too many things today, but about rediscovering its breadth, its depth, and its power. It has such a profound impact on our health. And to talk about all this, I have invited Dr. David Hoard for his new book. You will see, it will be fascinating, even if I tell you right away, we don't always agree with Dr. Hoard. Well, you will form your own opinion and tell me what you think. Hello, Doctor. Hello. How does a doctor become so passionately involved in breathing? Understanding breaths and understanding the link between breaths, health, and emotional state. It didn't happen all at once, it happened gradually with a bit of chance or synchronicity. Given that my mother tongue is English, one day I was asked to translate an explanatory notice for breathing guidance software that recorded heart rate. This was at the end of the 90s. And so, I received the software, which was a prototype, and where the person was connected to an ear sensor, and we could see what could be modified in the heart rate with breathing. That's how the spark happened. But yes, because it was a discovery for me to see the importance of breathing, and I am passionate about physiology. In what I have written, there is not a single line, not a single paragraph that is not supported by a study, a publication. So, I try to be very scientific while being very Cartesian and a doctor. And so, it surprised me to see that breathing had a direct effect on heart rate. But then again, it's not a direct effect on heart rate. It's a direct effect on our autonomic nervous system, which is our system of adaptation to the environment. We have an involuntary autonomic system that we cannot modify by will. For example, heart rate, sleep-wake rhythms, you cannot modify them by will. There is an automatic function, which is breathing, where there is a certain part of modification that we can make by will. And what is called heart rate variability interested me greatly. There are an enormous number of publications on this, 20,000 on this adaptation system, which is always involved in all health disorders. I don't necessarily want to talk about illness, but any health disorder is always accompanied by an imbalance in our adaptation system, which is called the autonomic nervous system. And it has two branches. The branch that prepares for action, flight or fight. This is how we adapt. We are animals. We adapt through animation, movement, distancing ourselves from danger, and then there is the branch called the flight or fight branch, also called the orthosympathetic, and then an antagonistic branch for repair after preparation, which puts us at rest, relaxation, and in fact, health is a balance between two forces. A force of energy expenditure, energy towards the outside, and a force of restoration, of recovery. And what is interesting is that breathing, having a direct action on the autonomic nervous system, has a direct action on health. So, that's the starting point. For example, this software showed what cardiologists had known for a long time, which is called respiratory sinus arrhythmia, that every time we inhale, the heart accelerates. Even now, every time you inhale, even automatically, your heart accelerates, and every time, every time you exhale, the heart slows down. It's the only thing the software showed: that in a normal state, the heart accelerates and slows down, and that by taking some control over breathing, we have a small means to subtly influence the autonomic nervous system and bring it back to the center. So, that's the starting point, and it's the starting point of what is called cardiac coherence. And I don't like the term, I have never used this term because it means nothing to the common person, or even to doctors. At best, it would have been called cardiorespiratory coherence. That would have been simpler. And so, I became very interested in this. The book we are talking about is the 8th or 9th. So, the first ones were mainly devoted to cardiac coherence. Then I said to myself, now it's been 25 years that I have been teaching, training health professionals in respiratory consultation practices, and I said to myself, maybe it's time to step out of this physiological niche a bit. And I'm not talking about medical, because I would like to demedicalize cardiac coherence to move upwards a bit. And what is above cardiac coherence, or cardiorespiratory coherence as I would like to call it? Well, breathing. It so happens that 2 years ago, I had a rather significant accident with multiple fractures, which forced me to stay in bed for 6 months. For me, being hyperactive, it was terrible. Fortunately, I had reading, and I read, and I wanted to get interested, but it had already been several years, I wanted to get interested in all these respiratory techniques which are very often the gateway to ancestral practices, to health practices, not necessarily medical or scientific, which are the gateway. For example, for meditation, we often start with breathing. For yoga, we often start with breathing. Athletes, often breathing, singers, actors. Breathing is already a tool that we use to enter into an activity that is healthy or beneficial for health. And so, I started reading books on breathing in the field of health, well-being, and wellness. And I wanted to know what the common points were. What are the common points? How does it work? And always bring it back to physiology. I need to understand. I don't like talking about something I don't understand, or I don't talk about it in general. And this allowed me to understand how certain yoga postures worked, always with my physiological basis. And that's why, little by little, I have accumulated, and for some time now, accumulated all these notions. Why do we breathe up and down? Why do we start with yoga, from the ground upwards, for the sun salutation? Trying to find the common points, and I started taking notes, and these are hundreds of pages of notes, which made me want to compile them into a book that would first give the general principles that I found to be common to all these practices. So, that's the accidental basis of medical translation or translation for software, how a doctor fell into the magic potion of breathing. So. Can we start by describing, as you do, because in essence your book is very much about, well, we talk about evidence, and step by step, and you simply start by describing how we breathe and what is the singularity of inhalation and exhalation. And that's the starting point, and it's almost the only one, the first one we enter through, because it's easy, because it's measurable, and we can, it's the respiratory rate. The respiratory rate per minute is already known. I mean, when we slow down our breathing, we enter a state of calm. So, there's the respiratory rate, and slow breaths tend to be calming. But then there's something else. There's this aspect that every time I inhale, I activate the orthosympathetic system and I activate the adrenaline system. Every time I exhale, I activate the antagonistic parasympathetic system, which activates, for example, acetylcholine, which is the hormone antagonistic to adrenaline. Because what is important, I think, to say is that your work is not to manipulate the breath like this, but to start from what is already happening. So, your work is already, but what happens when we inhale? What are you doing? We will first start by seeing what happens when we inhale. What happens during exhalation? Pay a little more attention to what is happening, because it is from there that we will be able to have levers for movement. Yes, exactly. And I realized that it's not just that. For example, when we have a more clavicular, upper chest breathing, at the clavicular or apical level, we activate the orthosympathetic system. To recall, the orthosympathetic system, SOS, is the danger system. When we have central breathing, rather than outward, we activate both the sympathetic and parasympathetic. Visceral abdominal, sub-diaphragmatic breathing, we have parasympathetic activity. So, we are talking about the locations of respiratory volumes. So, you're going very fast. I'll try to recap. Yes, absolutely. Because what you're saying is not what we sometimes hear, like this is good breathing, this is bad breathing. You're saying that breathing high up has a meaning, a function, breathing in the middle has a function, breathing in the belly has a function, and so by understanding the function of each, we can see what we want to do. So, it's much less dogmatic, because generally, you know, you have to breathe from the belly. No, no, that's not your point at all. It's about describing. So, I want to make sure we cover this, if you're willing, very, very simply, because for you it's very obvious, but I'd like us to take it very simply. Okay. So, what happens when I breathe up high? Up high, we activate, the heart accelerates because it's the proof, it's the visual and measurable manifestation that we are activating the orthosympathetic system. So, we see the heart accelerate, we can see by how much, and when we breathe, when we breathe in the middle, we have activation of the sympathetic and parasympathetic. So, why do we breathe? What's the advantage of breathing high up? Well, breathing high up doesn't have many advantages. It doesn't have many advantages because in today's world, in our environment, which is rather stressful, upper breathing is the breathing of stressed people in general. They are already naturally stressed. We see it very quickly, the shoulders go up and down, breathing here. As soon as we ask them to do a breathing exercise, they choke. They only know how to inhale, they don't know how to exhale, they don't know how to breathe out. So, we suggest going down. So, we prefer to suggest, in our very stressful and anxiety-provoking environment, we prefer to suggest lower breathing in such cases. But that's not all, because we can continue. We can continue, for example, with movements. A movement, for example, with the arms. I'm careful not to knock anything over. As soon as a movement starts from the center of the body and goes outwards, we stimulate the sympathetic. As soon as a movement brings us closer inwards, we stimulate the parasympathetic. And indeed, even at the level of body language, it's extremely interesting because the parasympathetic nervous system is also a system that promotes social connection, which causes a very specific hormone to be secreted. I always stick to the physiological explanation, which causes oxytocin to be secreted in particular, which is a very parasympathetic hormone. So, doing this activates the parasympathetic, doing this activates the sympathetic. Moving from bottom to top activates the sympathetic. And these are all things I discovered over time. But here too, in fact, all breathing practices, whatever they are, use the same levers, as you said. I like to talk about it a bit like a remote control. We have a remote control, there are several buttons that we activate. The first is the duration of breathing. The second is, for example, the inhalation-exhalation ratio. Not necessarily in seconds, but in time. I will inhale for 5 seconds, exhale for 5 seconds. We equalize the autonomic nervous system. We put ourselves in a neutral state, and we can go even further if we add mental imagery. A calming, gentle mental image will activate the parasympathetic. And so, I have cataloged a bit everything that has been published as reinforcing factors for breathing, to make them into recipes where we mix ingredients. So, there are all these ingredients that modify our physiology with the goal of bringing it back to the center, strengthening it, returning to neutral, because in medicine, we have what is called homeostasis. Homeostasis is the ability to keep the internal environment stable, a stable internal environment in the face of an unstable environment, to return to the center. And so, the goal of these breathing practices, initially, is to re-center, to return to the center. Someone who is very stressed has a sympathetic system, they are in sympathetic dominance, a lot of cortisol from stress, with undesirable effects in the medium to long term, on sleep, on a whole set of signs, symptoms, and we try to bring these people back to the center with breathing. But on the other hand, we have people who are parasympathetic dominant, with fatigue, depression in particular, and we try to bring them back to the center. And so, it's about using it to calm some people, to stimulate others. So, through breathing, I can act on my nervous system in a completely customized way when I understand the principles you've mentioned. So, the length, inhalation and exhalation don't have the same function, their duration, where I breathe, if I link it to body movements, and I can use images that help me inhabit breathing differently. Then we can add affirmations. I didn't want to use the word mantra, but it's the same thing. We can add mental affirmations. And so, these are the basic ingredients. And then, precisely through, I'm talking about 30 practical exercises. I called them breaths, it's an action that is mainly there to illustrate what can be done. And my goal in this book is to provide the basic ingredients that work, and then to invite readers, people, to look for what suits them, but also to try to experiment by combining them based on what they feel. Because I talk about feelings, it's not a medical book, I don't talk about symptoms, I don't talk about illness, I talk about worries or feelings. We can adapt it to feel better, and again, at no point do I make a therapeutic claim or anything else, and I never do that, it's to feel better. So, that's a bit of the basis of this book. The perspective that drives you in this book is to make us more familiar with our breathing to find within each of us what is right. So, in a very subtle way, throughout the book, there is a real concern to avoid what is almost always present when talking about breathing, a slightly too technical aspect. I'm a bit bothered because often when we talk about breathing, it feels like I have to control my breathing, that it's a technique. So, it's very subtle, but your book, that's why I wanted to invite you, because I said, finally, someone who talks about breathing with this flexibility, this very subtle flexibility, you always say it's not about following a technique, it's about inhabiting a certain modality. So, for example, you even said it very quickly earlier, it's not necessarily about counting seconds, it's about finding the rhythms that we can feel ourselves. So, in many places, by using images, by saying this, by relying solely on external cues, we can end up distancing ourselves from ourselves. And generally, that's how breathing is often presented. I did exercises when I was a young teacher. I was losing my voice. I went to see a voice specialist, I did breathing exercises. Still, I felt like I had to follow something like an external technical form that I had to follow. And so, by reading, this is not at all what I learned, this is not at all what I see in most books. That it's really about re-inhabiting one's breathing, understanding its different principles. So, we become much more active in understanding. Absolutely. And it is, of course, for example, if we want to practice equalizing the inspiratory and expiratory time, it's one of the basic exercises. I mean, we will, at the beginning, do a mental count, but then we don't care if it's seconds or not. It's just that the same duration, because it's really the duration spent inhaling that will activate the orthosympathetic system during that same duration, and the duration, so if we count to three, going up and down, it's the same thing, that's enough. But it is sometimes simpler to start with a breathing guide, because I am sometimes told, people talk to me about cardiac coherence, it's the ball that goes up and down, because most breathing guides are like that, but I am for autonomy, for being able to do without these external guides in two or three weeks. So, it's occasional. And again, there are no dogmas, there is no good or bad breathing, it's about going gently. It's about returning to the center, because there is a dimension we haven't seen yet, which is the emotional dimension. All emotions, without exception, are conveyed and manifested, embodied by the autonomic nervous system. There are emotions, the sympathetic dominant polarity, those that make the heart rate accelerate. These are fear, anger, disgust, surprise, joy. And I'm not talking about the valence of the emotion, since joy accelerates the heart rate. It's sympathetic dominant. So, there are all emotions, and then there are emotions in parasympathetic polarity: shame, shame, sadness, for example, which are messages of movement and motion, and moving outwards, of movement to return to the center, fear to make me flee, anger to make me fight, and all this to move away from danger, to move away from dangers. And so, emotions are entirely conveyed by the autonomic nervous system, and so here, it's not just what I call a physiological re-centering, and what interested me is that all this can be shown, and yes, we can use equipment, and I use it only for demonstration, to show people what we can achieve with breathing, and to show it on biofeedback, which is equipment for heart rate feedback. I use heart rate simply to show that we have the power to return to the center. To return to the center to get rid of the equipment as soon as possible. And as a nutritionist by training and specialty, I quickly realized that purely dietary management was doomed to failure and didn't work. Cognitive restriction doesn't work in the medium to long term. And that's why, from the beginning of my practice as a nutritionist, I became interested in emotions and food, to the point of no longer prescribing restrictive diets. And it's not that I don't believe in it or anything, but I think it's not the best way to manage eating disorders. And here, emotion also comes into play. And the practices with my patients, my clients, were truly about working on breathing within this emotional framework. Within this emotional framework. So, I read your book and I said to myself, wow, finally something inspiring, because we enter into the rhythm of breathing. But then, I was completely taken aback that you, that you, that you said you came from cardiac coherence, which for me is truly, I don't know how, for me, completely negative. I advise people against cardiac coherence. I find it abominable because you don't know it in what I find, I find that it's the, for me, that's it, that's a bit of the, I said to myself, but it's the opposite of your book. Cardiac coherence is, I am something, I instrumentalize my breathing, I am cut off from my feelings, and I advise against it, I find that I, I find that it's very mysterious to me, what I read. When you say, by relying solely on external cues, we can end up distancing ourselves from ourselves. Too much guidance can dissociate us from real feelings. We follow the imposed rhythm without really listening to ourselves. I feel that cardiac coherence, moreover, you mentioned the problem of the term, the usage, which is indeed, it's, you know, I'm stressed, I'll follow this ball to calm myself down. I find that it's not a human relationship with life, and I find that, and I find that what I liked about your book is that we start with images, with life, with rhythm, and I find this general mechanization of everything. We live in a world where human beings are increasingly mechanized. Following a ball that goes up and down. I tried to do it. I found it completely anxiety-provoking to the highest degree. I felt it drove me crazy because I find it dehumanizing. So, I'm a bit hypersensitive, so I'm very sensitive to that. I find it a very profound dehumanization of the human being. So, I was, I was taken aback, but you said it a bit earlier, in this book, it's as if you entered another dimension. So, maybe it helped you, but in any case, in the experience of your book, it has nothing to do with cardiac coherence. We are in another world than cardiac coherence. Cardiac coherence is part of that world. Breathing is only, cardiac coherence is just a small country. But cardiac coherence, compared to what you do in this book, at least for me, they are two different worlds. That is, as much as cardiac coherence, for all the reasons I've given, I'm struck that we live in an increasingly mechanized world. The relationship with the human being is mechanized. I mechanize myself, and therefore the relationship with my breath becomes mechanized. I don't believe that a mechanical relationship with my breath can help me in the long term. It might help me in the short term, but fundamentally, it doesn't help me in the long term. And when I talk to friends who are psychiatrists who do cardiac coherence, I tell them, but in the end, it becomes emotional avoidance. People do this to avoid feeling their emotions and to calm down. So, for me, they say, "Yes, at first it calms them down." But I say, "Yes, but then it becomes a trap." And they all end up saying, "Yes, but okay, but at first, you have to start somewhere." Imagine, you shouldn't start with something that isn't healthy at its root, since it doesn't start from the integrity of the human being, and it gives the illusion that I will try to avoid my emotions by trying to calm myself down. Now, we are in a fascinating area. So, you, I must say, I warned you beforehand that I would ask you this question. I told you, I'm inviting you, but for me, I can't not address this question. So, I wanted to ask you if you were ready to talk about it. Ah yes, because you were perfectly ready to talk about it. So, I've been waiting for this question for 25 years because I want to tell people that it's not my usual habit to, you know, to enter into profound disagreement with a guest I invite. I really try to be at the service of the people I invite, but for me, this question is very important, very important. So, I told you I wasn't going to defend cardiac coherence because that's not the subject. We could revisit it if you want, but you should know, and I'm returning to emotions, because, to emotions, the state we call cardiac coherence, I don't like that word because it medicalizes the subject and it keeps the heart, which is only the marker. So, which is only the marker of the autonomic nervous system. But that's what it's called in French. My friend David Servan-Schreiber coined this term in his first book, "Healing," in 2003. And in English, the term cardiac coherence is not used. We use HRV training, heart rate variability training. We try to modify heart rate over a short period to return to the center, and we can use equipment to see the results. I seek, my patients, I no longer have patients, but the people I train and have trained to free themselves from this equipment as soon as possible. This equipment is used for demonstration, for understanding and explaining. When we can show what we can do, and because it's measurable, and health can be measured. We have a health marker called the amplitude of heart rate variability. It's a recognized health marker since the 1950s, which shows that the more irregular a heart is, the healthier the person is because it has greater adaptability. There is this capacity for great oscillation between the sympathetic and parasympathetic, between action and rest, and someone who has great resilience of the autonomic nervous system. And so, this is what we seek to do, to increase by training our autonomic nervous system as we would train a muscle. But the training, the training will be done in small moments for everyday life. So, having a few minutes a day, 15-20 minutes a day of a little training. And at the base of this training, the simplest, and I ask people to start with this, is simply to take time for breathing with a posture, because we haven't talked about postures. Postures are also important. So, a rather vertical posture, sitting or standing, where we equalize the inspiratory and expiratory time. And just that, we are in the domain of cardiac resonance, which would be internal, physical, which would be more accurate. It's where the fluctuation becomes periodic, meaning we truly have an acceleration-deceleration, acceleration-deceleration, which gives the greatest amplitude of heart rate variability, which is the best health marker we have. And so, the goal is to have short practice sessions where we push a little. I like the idea of a swing. For example, there's a swing or a pendulum. If we want to maintain the movement of a pendulum or a swing, we can't push at just any moment. We have to wait for it to come back, and the length of the string, the swing, will determine the speed of the moment it returns. So, we push when it comes back. We push when it comes back. And if we want to maintain a pendulum, we do the same. We can't go faster, we can't go slower. It so happens that the autonomic nervous system is an oscillating, oscillatory, vibrating system, like all physiology. And the autonomic nervous system has what is called a resonance frequency, meaning a frequency of oscillation like any balance wheel, any pendulum, which is that if we let it return, it will always oscillate at the same speed. The autonomic nervous system has a natural oscillation frequency, measured. Now, there are thousands of studies on this, of 0.1 Hz, but it's easier to say 6 per minute. If we push the autonomic nervous system by exhaling, the heart will slow down, and as if we wanted to bring the swing back by inhaling for 5 seconds, that makes 6 per minute. 5 seconds of inhalation, 5 seconds of exhalation, that makes 10 seconds, that makes 6 per minute. We have the greatest oscillation of the autonomic nervous system. That's where the seconds come into play. But this is only to show, and so we will try with breathing, and here I am only talking about the inhalation-exhalation ratio, and for years I only did that, until this accident made me open up to the fact that there are also other things that can be added. We will make our system oscillate at its optimal healing frequency too. Why did you say that the question I asked you, you had been waiting for it for 25 years? Because no one has ever told me that cardiac coherence, I advise against it. And that's why I also like to understand your point of view, and for me, it's interesting. For me, it's dehumanizing. Yes, but I understand because it cuts me off from my experience. I am doing something, and I am no longer paying attention to what I feel. I am conforming to something. Second, I am using this to try to calm myself down. So, to not. That's how it's presented everywhere. That's how all doctors do it today. That's how it's recommended everywhere, on all sites. We see it. Calm down. Do coherence. So, this leads to experiential and emotional avoidance, which is one of the major problems of our time today. People want to be efficient, effective, and calm, instead of encountering their difficulties, inhabiting them, and transforming them. And thirdly, in cardiac coherence, there is no deep experience of the emotion I am feeling, that I accept, that I recognize in order to transform it. So, in your book, it's the opposite. In this book, it's the opposite. All emotions are taken into account, and you show how breathing is not a way to avoid them, but a way to inhabit them differently. And so, for me, this book is the antipode of what is presented. It's the antipode because I do exactly the same thing all the time. I have to follow the ball that goes up and down. So, it's something mechanical. That's really it, fundamentally, I am also presented, and this is where the meditator in me and the philosopher come in. I am presented with a machine as a model of breathing, a ball that goes up and down in exactly the same way. For me, this is part of a very profound dehumanization. And what I found fascinating in your book is the exact opposite. And you talk about the water mirror for looping thoughts, rumination, the inner compass for a decision in suspense. So, this is a complete re-humanization. I'm delighted to hear it. It's the alliance, loss of self-confidence. And so, for you, breathing truly becomes not something I have to do, but almost the mirror of my being, in which I, in meditation, we often say that the breath is what best links the body and the mind, and through the breath, I can act on my body and my mind, it's the passage. And so, I find that your book connects with a very profound spiritual knowledge that is very forgotten, because we are entirely caught up in a technical model.
As I said. So that's what I found fascinating about your work. Even if I see that you are a bit like Monsieur Jourdan. You have what you do is a bit like Jourdan doing prose without knowing it. Ah, absolutely. I have the impression that you discovered this in your work, but that you touched upon something even vaster perhaps than you thought.
So, I completely agree with you. I did not expect the beneficial effects it brought. I did not expect to find so many coincidences in practices, and now when I see any health practice, if it uses breathing, I can finally understand why we would, for example, take breathing pauses, suspensions, and I like to understand, and I realize that with breathing, we touch man in his integrity. That.
And where I disagree with you is the fact that we dehumanize ourselves. But you must know, and here you are right about emotions. When we are in a state of cardiac coherence, this state has a physiological definition of cardiac coherence that no one knows because it is too complicated to explain. It is the periodic fluctuation of heart rate.
So already writing a book "Lose Weight Through Cardiac Coherence" is complicated, but "Lose Weight Through the Periodic Fluctuation of Heart Rate" you won't sell a single one. So it's complicated, there's always a problem with the words we've put on cardiac coherence. And on the other hand, when we are in this state of so-called coherence, of sympatho-vagal neutrality, because the vagus nerve is the parasympathetic, this state of sympatho-vagal neutrality, we are in, and there are quite a few works on this, in emotional weightlessness. I'm not saying we are in a state. Emotion is an experience, and I'm not saying emotion is absent, but we are in a state where the body does not produce emotion. Emotion is a message of change. Emotion is perceived when there is a notion of danger in particular. There is an emotion which is a movement to escape danger or to approach what is favorable. And so it is a movement of, not escaping, but finding ways to escape this danger. And once the danger has passed and the energy required for it has been repaired, we are in a state of emotional weightlessness. That is to say, there is no longer an alarm message at that moment. And in this state of cardiac coherence, it's not that we escape emotion, we trigger a state of emotional weightlessness in the face of the conditions, the environment around us that generated it.
And here, for example, I trained pilots of the French Air Force at Mont-de-Marsan, at the Mont-de-Marsan base, by training them in flight simulators to be able to remain in this state of cardiac coherence despite danger messages in their helmets or on their instruments, to serve as a way to gain distance. In the beginning, when we implemented this with David Sérang Schrebert, because we were associated for about ten years for the training, we implemented the first trainings, we had created a small group of doctors because in fact, I didn't know where I was going. I didn't know what I was doing. I discovered this. Nothing had been published on this at the time. And so we did a mini-study, of course, among ourselves with about a dozen doctors for 2 years, of people who regularly practiced breathing, I'll say at a fixed frequency, and the feedback we got with open-ended questions. We asked our clients, our patients to note what has changed since you have been practicing cardiac coherence, because that's the term used. Well, in open-ended questions, the most frequently cited physiological phenomenon, and it's not a multiple-choice question, it's really: "I sleep better already," and that's the manifestation of reduced stress because stress, cortisol, prevents sleep. And the second, from a feeling perspective, the two words that were mentioned were "taking distance" and "letting go." With these moments of return to this weightlessness, I like to call it emotional weightlessness. I like to compare it a bit to a roller coaster. It goes up, it goes up, it goes up. And at one point, before going down, there is this moment of emotional weightlessness, and we can return to the center emotionally. We can put ourselves in this state of weightlessness several times a day, not to try to avoid emotions, but to learn to live with them and to, I won't use the term desensitization, to make them less, how to say, less difficult for the body. And so it's more of a desensitization work that we do gently.
And what is important is that this technique, 5 seconds, 5 seconds, when we do it, I like, I prefer to use with patients, with the people I guide, a personal guidance. So already, I want to put myself in cardiac coherence, and I no longer use the breathing guide, for decades. So, and guided with a, I just, we inhale and we exhale, and really as if we were following a sinusoid, a wave, and all of that, there's nothing of a mechanism that goes up and down.
And can we do one of your exercises? Is there one you want to do? Well, we'll take, we'll take the stress or the base. Perhaps the base, because the base is in the domain of stress, because this book, for me, is to show, because if I had only used inhale, exhale, the report, well, that already exists in a book called "365." So, I had to give everything we can do and add to make the exercises interesting and different. And here is the chronic stress base, and I'll let you guide us.
So, in this case, I'm not going into the physiological details, but I first ask the person to sit up straight. I'll do it like this. Everyone can do it at the same time as they listen to us. Sit up straight and simply, we'll start with our eyes open. You look at me, and you will simply follow my hand, and I will do it with you, and I will explain why we do this. What I call synchronous breathing is crucial. So, we will inhale. I'm not even asking you to count because I will count for you. So, I'll do it with my left hand. Inhale, and exhale. We inhale, and exhale. Here, I inhale for four or five counts, and what's important, I exhale for four or five counts. Continue like this. Inhale, and exhale. I will ask you to lower the tension as if you wanted to have an expansion of the chest and abdomen on the inhale, and as if you were simply letting the muscles tighten. So, an active inhale. You will activate the muscles to inhale, and there's no need to inflate them excessively, just inhale and let go, and exhale without activating a muscle. We try to use the elasticity of the ribs. We inhale, and we let it deflate on its own. We inhale, and we let it deflate on its own. This little exercise in 10 to 20 seconds, that is to say, in one or two breaths, leads to this physiological re-centering, this emotional weightlessness, and there is an effect, and it is measurable, and that's what interests me in this practice. There is a measurable effect. There aren't too many parameters we can measure, but one parameter we can measure is the cortisol level, for example. An exercise practiced for a few minutes, I don't know, 3 to 5 minutes, has an effect on residual cortisol for several hours. And cortisol is not the enemy, and it's the enemy when there's too much of it. And precisely, we're not trying to be anti-cortisol. Quite the opposite, it's cortisol that woke me up this morning. It's thanks to cortisol that I get up in the morning. And so this exercise has shown its benefits in the area of stress. This little exercise that we did together, it wasn't long enough to have an effect, but if we had done it for 5 minutes, that is to say, about 30 breaths. About 30 breaths have a residual physiological effect that has been measured by several components in cortisol, and also in DHA, which is an increase in DHA, which is the antagonist of cortisol, and so we rebalanced this system for about 3 to 4 hours. This explains why, in breathing practice, we equalize breathing time, we put breathing time at the center. But and here we used what I call the base. I didn't add mantras, affirmations, I didn't add mental imagery. It's because it's based on regular, repeated practice, since the duration is a few hours. So, we start with a practice, I'll say for how long will I have to do it? Well, I'll say it's a routine practice, it's a lifestyle practice, a hygiene of life. If we want medium to long-term effects, we practice daily, but I don't want to say three times a day, with ten breaths per minute for 5 minutes. It's a mnemonic technique I found to interest people in practicing. And here, and here I'm not talking about cardiac coherence, but I'm always circling around pushing the autonomic nervous system, pushing my physiology, pushing my emotions to make them oscillate as widely as possible. But we can also, and the other exercises, there are exercises. I'm tired in the morning, for example. We can do another one, or here I propose one. I would like to do one where we see the whole richness, that is to say, with visualizations and everything, but perhaps we could do, I don't know, I like it, I find it quite good, perhaps to find the balance with the others. We could do one of the, we come to a relational conflict, for example, the weave.
So, I propose we do the weave. So, it's in the weave 230. Well, it's sure this book was made for that, to officially do the whole thing. So, the weave, the weave is because I started from the image of a crumpled fabric. So, the names, I gave them to increase, to increase the imagination. I think it's good if you guide it, we can take our time and go ahead with the phrases you recommend, the images. I find it precious.
So, in this exercise, there is a central re-centering. So, so this is because I experienced a conflict. So, I'm not well, I'm angry with someone. It's a bit like that in the case where you are exactly, so something is not going well. And here, I generally ask for a hand near the heart. So, there is also the focus, because I haven't talked about intention, attention, there are many other things we could add.
So, it's sure that when I'm with someone, it's much more intuitive for me than following a plan. And the phase of inspiration. So, here it's the same, we'll use an equalization. Here, I'm putting 4 counts. It's a breath, I'm not trying to slow it down too much. It's a slightly faster breath that we'll use. We are in the range of natural breaths which are between 9 and 25 per minute. So, that is to say, I will breathe for 4 counts, and I like to add, well, it's a breath of about, about 8 to 9 per minute, and what you will find is that each time I do the same thing. But in fact, we always do the same thing. We always do the same thing. We will inhale with mental imagery, and we will exhale. And here, I'm asking for a slightly faster breath. And in mental imagery, I don't remember what I put anymore because then I have to reread them, some I wrote them 2 years ago. That, the image. Yes. Yes, that's what I like. A crumpled fabric placed on a table. Each inhale makes the fabric ripple. I, a fabric that ripples in the wind gently. So, so we will inhale. Here it's a bit faster, but we always equalize the inhalation and exhalation time. We will inhale like a fabric floating in the wind, and exhale with a truly central breath. Central breathing will activate both the sympathetic and parasympathetic. At the same time, we are not forcing the vagal nerve here. It's really, it's sure that it's not spectacular, and at the base, we always do the same thing. And that's why I wanted to dress it up to give it a bit more visual substance. And this example, there are other examples where we will rather, perhaps, perhaps with this exercise, you can read the phrases you recommend. Yes, absolutely. Yes, it's true. So, we see, we really see, because we have the image of the fabric rising and falling. You said that you specified that the breathing took place in the middle of the body. We put our hand on the heart. Absolutely. That brings the weave, it was, it was 230, and you have all this work on the phrases which is very beautiful. Yes.
So, I have, there are five phrases each time. Five affirmations to measure. And we don't read all five. I mean, each time we repeat the same one. We choose one. "I cannot fix everything, but I can fix myself." And it's in quotes, I give the explanation that accepting my limits opens the path to healing. "I can be at peace even without agreement." Inner peace does not depend on others, even without agreement from others. "This link hurt me, it can also teach me." Each wound carries a lesson to be welcomed. "I open a space, not a wound, it is with openness, healing, my breath connects me to what is alive." So, we take one, we take one, and for a few minutes, I do this breathing, I see the fabric, and I repeat this phrase to myself internally. "Even without agreement, I can be at peace." All of this is in mental affirmation. Yes.
I think we understand better. I find that this exercise, and here I completely agree, we are not at all in cardiac coherence, even if at the base it re-establishes, it gains more scope, it gains more, and here we see, there is a whole scope that is reintegrated into it with the phrase. And the reason I did this is following the previous book, called "Coherence Kid," because I was asked if we can do cardiac coherence in children, and of course, we can practice cardiac coherence in children. And I contacted teachers, people who work with children, who do either yoga at school, meditation techniques at school, or breathing practices at school, and asked them to share the exercises they do. And with children, it's especially a teacher in Quebec, because I was living in Quebec at the time, 7 or 8 years ago, who had invented a whole series of exercises with a story behind them to make them interesting. There was, for example, the imaginary orchestra, that is to say, an accordion.
Ah, and she's the one who gave you the idea to make this book like this? The book for children has 47 exercises, with a story behind them to interest children. Otherwise, I... And it's always with bodily accompaniment. For example, there's the butterfly, we create, and this brings us back to the hand on the heart. With the other hand, we make a butterfly. We make our butterflies breathe. We don't pay attention to the seconds at all. We all make our butterflies breathe at the same time. That's it. And there's the imaginary menagerie with the elephant and its trunk, with the eagle. Each time, there are movements starting from the center of the body outwards on the inhale, returning inwards, starting from the center on the inhale, returning to the center on the exhale. And that made me want to imagine and create exercises for adults to make them tangible and not just a ball going up and down. And here, I completely agree with you, and that's the goal. But the goal is not just that, the goal is to show the whole range of what we can do while doing practically the same thing, but by dressing it up with mental imagery, with a good... Yes, it becomes much more alive. But yes, we re-inhabit it. What I find beautiful is that by doing these different exercises, it's like revelation stops being something a bit foreign that we have to follow, but we re-inhabit it, and in fact, we realize that we are very cut off from the richness of our breathing. And here, for example, several exercises in the area of pain. I have quite a few pain centers that use this resonance breathing. I don't use the term cardiac resonance coherence in the area of pain. Pain is also a message that the body sends me, a message of suffering. And depending on whether, for example, inflammatory pain, which is pain where we apply cold, for neurological pain, we would rather apply heat. Here too, we are always in the domain of sympathetic and parasympathetic system balances. And here, we will not have the same breathing if it is a sciatic type pain, dental pain which are neurological pain which are sympathetic dominant, as the exercises in inflammation where it is red, it is hot, it is swollen, it is inflamed. And so, we will act on the inhale-exhale ratio. If I want, for example, to wake up in the morning, there is the intellect, for example, I will do very short inhalations and exhalations. Long exhalation, short inhalation. If, on the contrary, you spoke of calming down through cardiac coherence, cardiac coherence is not a calming exercise. It's not relaxation, it's the opposite of relaxation. In relaxation, we put the entire nervous system to rest in total parasympathetic. That is to say, we shift the physiological cursor towards dominant parasympathetic. Here, what do we do? We re-center and activate the autonomic system to its maximum, at the center. And so, that's why when I see names like, where relaxation is in the term, and so on, I say they haven't really understood what we're doing with cardiac coherence, where we put ourselves in a state of neutrality.
I advise, I still do professional training, less than before. I still do professional training. I say one thing that should remain after this training: breathe with your patients, breathe with them. Start every consultation by saying, since this is the first time I'm seeing you today, I would like it if we see each other several times in consultation, I would like us to spend ten breaths, to synchronize our breaths. At the beginning of the consultation, I will breathe like we did earlier. You will breathe with me, and then we will follow our usual consultation. What does this little exercise, which I call synchronous breathing, do? It has transformed my practice as a general practitioner and my approach, particularly with cognitive and behavioral therapy practices. And so, this has transformed this singular dialogue, this therapeutic alliance that we have with patients. That is to say, I am in this state of emotional neutrality during this time, that is to say, I start, and then I move into a responsive emotional state. I mean, I return to these states, but I've set them to neutral, I've set them to zero. So, I start the consultation, the patient who was before, emotionally, it's over. I start the consultation in this state of neutrality. 10 breaths are enough to get into this state of neutrality, which can be seen when we do recordings with biofeedback. And then, I am in this state of emotional weightlessness. The person in front of me is also, because it's a reflex. You should know that no one can not be in this state of cardiac resonance. I will no longer use the term cardiac coherence with you. No one can not be in this state. It's a reflex that calls for the baroreflex. It's perfectly, it's perfectly explainable, and I do it in the training we inherited. All vertebrates have had this for 580 million years. Simply equalizing the inhalation time puts us in this physiological state of neutrality, which is a non-adaptive state. So, it's not a good state, we'll use a few minutes, a few seconds, just to return to the center, then we go back into real life, but we go back to neutral. And so, in the consultation, if we start it, I am at neutral, and it's here that I take distance, I am more open, I am more accepting, non-judgmental, since I am at neutrality. But my patient, who is in front of me, starts the consultation in this emotional safe space that we trigger with this state. And the therapeutic relationship, the therapeutic alliance also changes, because you should know that stress, and indeed in movement, in the sympathetic system, we have a tendency to push people away. I mean, it's pushing away, and the parasympathetic system is bringing closer, and indeed there is oxytocin, it's the most parasympathetic hormone. That is to say, it's called the hormone of attachment and love. It's really a bringing closer, and we are both in a state, including hormonal, including social, of neutrality, and it creates, well, what is called a safe space, a safe space also for the relationship. And this simple practice of synchronous breathing for 10 breaths, which is a minute and a half for 10 breaths at the beginning of a consultation, changes the life of the professional, the life of the patient. And I tell my patients, if there is one, to the people I train, it's a small practice. Start all your consultations with this breathing. It's like in those black and white spy movies where watches weren't electronic before going on a mission. Gentlemen, let's synchronize our watches. That's exactly what we're going to try to do before going on a mission. The mission is not to be at neutral. And I do not recommend any high-level athlete, for a 100-meter race, to do a breathing exercise like this. On the contrary, we seek the sympathetic system. And so, it's about using chosen moments in life where we put ourselves at rest. Because if we are not at rest, if there is muscular activity or mental activity, then we are in dominant sympathetic. So, we decide, I put myself in an upright position, we lose 30% of amplitude if we are lying down. We put ourselves in an upright position, we equalize the inhalation and exhalation time for about ten breaths, we can go. If we want it to have a beneficial effect in the long term, well, it has to last a bit longer. That's why I say a few minutes, but I don't even give a duration. Generally, a few minutes is enough, but then we go back into real life. So, there is no avoidance. And when we do training on stress, coping, it's avoidance that most people do. They avoid stressors so as not to be confronted with them anymore. It works because it works, because we suffer less. The problem is that there is never any attenuation through exposure. There is never any desensitization either. And there is one area where this practice works well, and that is precisely hypersensitivity. But that's another topic.
Thank you infinitely. It was truly fascinating to listen to you, to see someone who is so passionate. I was sincerely looking forward to coming. Not for cardiac coherence. I was looking forward to coming. I'm not trying to convince you. The cardiac coherence you're talking about is not the one I believe in. Listen, thank you infinitely, and in any case, I found your book very helpful. Thank you. Thank you. That's the goal, actually. Thank you for following this episode of Dialogue. It's truly a big thank you because it's truly precious that you've watched this episode until the end, that it speaks to you, that I do this for you. So, it's truly an exchange, and I am truly aware today that around Dialogue, there is truly a community of people for whom taking care of the world, taking care of oneself, taking care of others matters a lot. And it's truly wonderful to see that we are such a community. So, don't hesitate to share, to like. It may seem like nothing, but it's really very important. It's part of a kind of happy contagion that our world really needs. Well, I embrace you, and I thank you once again.