an Introduction

Neglected Heads

 

 

We are all over-thinkers, every one of us, some of our countless thoughts are helpful. However, most of them are not, and because of this none of us are immune to the maladaptive emotions of anxiety, depression, and anger that this overthinking can trigger. These emotions are not pleasant. They can make us want to avoid doing the things we love, or they can lead us into doing things which we later regret.  When in the depths of them, they can leave us to think that there is something wrong with us, that we are not the same as other people, that we are stuck like this. This can cause us to not do anything about what we think and feel.

The tools that we use to accept and manage our thoughts and emotions determine how life is for us. No matter how smart we think we are, we have little to no control over the events that happen to us in life, and even if we did have this power it is not certain that we would be more fulfilled.

Learning how to deal with what goes on in us was never taught in school. It was left to us to find out for ourselves. In fact, worse than that many of us were given terrible advice: Fight your thoughts and reject your emotions.

Suppose we had the same lack of awareness and understanding about our diet, what do you think the health and economic outcomes of societies would be? There is, of course, a lot of rubbish food on the market now, but can you imagine what it would be like if we didn’t know about the consequences of excessive consumption of fat, sugar and salt? If we did not know about these things our health care systems could only serve in reacting to what they are being presented with.

This is exactly what is going on in mental health, we have a system that only serves to react to what is already happening. It is changing though, more and more people are taking personal charge of their mental health, which like diet requires some knowledge and continuous application.

Learn Buetyko breathing exercises and more to help you manage your thoughts and emotions 

If you are frequently in a poor mood, on this page we will explore the reasons why. We will then show you some Buteyko breathing exercises and cognitive techniques that we use in our online sessions. Understanding what is going on with us and having methods to deal with it strengthens our ability to cope better and carry on. This is our aim. Read, and if our approach resonates with you, then give the exercises a go, all you will need is a pen and paper.

 Events

 

 

 

When we are excessively anxious, sad or angry, in a state of heightened suffering, we are contending with one of two things.

The first is a major event that brings a threat or loss to us. An example could be the death of a loved one or losing a job. Events like these, if we are lucky, will be rare, but they will happen to us all at some point.

The second are more minor events that we experience often, examples could be; not having your messages replied to, being skipped in a queue, or may be internal; like remembering a past incident where you were slighted. These do not pose real threats to us, but if we are not aware of what is happening and don’t have any tools for dealing with these events they can trigger rigid thought patterns and negative emotions that snowball and consume our day. Even if we feel strongly that we are right, is it really such a good idea to let what has happened to have such power over us? Further, in the long run, if we are habitually driven by our maladaptive thoughts and emotions that are triggered during and after these frequent events, we could be setting ourselves up for chronic stress-related illness and poor immune system response (1.1, 1.2, 1.3).

Whether we are confronted with major or minor events there are things that we can do to ease the burden. Even if you think that your personality is fixed and there is little you can do to change how you react or deal with life’s difficulties. We would urge you to at least learn and practise our techniques. We say this because in the past 18 years we have helped a lot of people with a similar view.

The Uncontrollable Tapestry

 

 

 Think back to the first time that you played on a beach, petted a dog, saw snow, made friends, fell in love, became curious about something and started to learn about it. These moments in your life were out of your control, unplanned, they made you awestruck, brought you joy and contentedness. Emotions and events like these are what we always want. We attach ourselves to them, so much so that we do not want to deal with the other side of life’s eventualities. This makes these eventualities harder to live with when they come.

We will have experiences like failure, rejection, illness, death of a loved one, loneliness and so on and it may seem to us that we are hopelessly unprepared for them, or that they somehow signify how strong or weak we are. The thing is though, we are built for these experiences. They trigger our most primitive cognitive and biological functions. The suffering we go through are our primary negative emotions: anger, sadness and fear/anxiety. Most of us have been told from a young age not to feel these or banish them, then when we get older we are constantly told how bad they are for our health.

Being conditioned like this only makes us sad at ourselves for being sad, angry for being angry, and afraid of our fear.

 A  Balanced View

 

 

If our desired aim is to feel these feelings with less intensity and less often, then we need to first acknowledge that rejecting our feelings does not work. The old adage of “there is nothing to fear but fear itself” is nonsense. It is better for us to not be afraid of being afraid. Telling yourself not to feel a certain way or denying your feelings only puts extra pressure on you. You are demanding too much of yourself. This rethinking of emotions is the start to a process of becoming braver, more calm and comfortable with your feelings.

To rethink your beliefs about your feelings, be compassionate to yourself and rather than constantly fight a losing battle, try to accept them. However, it is hard to accept something that we have been habituated to view as being a problem.

Learn to foster a healthier, more flexible relationship with your feelings by finding coping statements that allow you to have a more balanced view of your emotions. Read the following statements, which of these makes you feel more comfortable in the moment? Memorise them. Use them in conjunction with the other exercises on this page.

Coping Statements for Anxiety

  • This feeling isn’t comfortable, but I can handle it.
  • By relaxing through these feelings I learn to face my fears.
  • I can feel anxious and still deal with this situation.
  • This is not a real emergency. I can slow down and think about what I need to do.
  • This feeling will pass.
  • By staying focused on my task my anxiety will decrease.
  • These are just thoughts – not reality.

Coping Statements for Fear – Preparing for Stress/Anxiety

  • I’ve done this before so I can do it again.
  • I’ll be glad I did it when this is over.
  • I’ll feel better when I am actually in the situation.
  • I’ll just do the best I can.
  • By facing my fears I can overcome them.
  • Whatever happens, happens. I can handle it.

Coping Statements for Feeling Overwhelmed

  • Stay focused on the present. What do I need to do right now?
  • It will soon be over.
  • It’s not the worst thing that could happen.
  • Step by step until it’s over.
  • I don’t need to eliminate stress, just keep it under control.
  • Once I label my stress from 1 to 10 I can watch it go down.
  • Take a breath.

Coping Statements for Panic

  • This isn’t dangerous.
  • I will just let my body pass through this.
  • I have survived panic attacks before and I will survive this as well.
  • Nothing serious is going to happen.
  • This will pass.

Coping Statements for Anger Management

  • It’s not worth getting mad about.
  • I won’t take this personally.
  • I am in charge, not my anger.
  • I am going to breathe slowly until I know what to do.
  • Getting angry isn’t going to help.
  • I can handle this and stay in control.
  • People aren’t against me – they’re for themselves.

Emotional Habituation Exercise

 

 

The modern human condition is one of constant thinking and planning. Yet when we find ourselves stuck in a moment, we don’t know what to do. The uncertainty of this for beings who like to be certain causes increased feelings of anxiety and hopelessness. Becoming familiar with and practising an exercise for these situations is therefore very useful. Our feelings will lessen, our reactions will be less extreme and we will be able to have our suffering pass sooner.

1. Name the emotion

Identify the primary emotion you are having. This is an emotion that is triggered in response to an external threat. Below is a heat map of these emotions with the warm colours showing areas of increased activity in the body.

Courtesy of: Proceedings of the National Academy of Sciences of the United States

2. Become familiar with your physiology

What is happening in your body? Here are some things that happen to us all when we experience these primary emotions. Which ones ring true for you? Make a note of them, so that you treat them as what they are: normal body responses. You may have:

  • An increase in heart rate and strength of the heartbeat, this enables blood and oxygen to be pumped around the body faster so you might feel like your heart is pounding.
  • A redistribution of blood from areas that aren’t as vital to those that are, such as away from skin, fingers and toes towards large vital organs. Your skin might look pale or you might feel cold, or there might be a feeling of numbness and tingling in your fingers and toes.
  • An increase in sweating causing the body to become more slippery, this helped primitive humans, by making it harder for a predator to grab, and also cooling the body, preventing it from overheating.
  • Widening of the pupils of the eyes lets in more light and enables you to better scan the environment for danger. You may notice blurred vision, spots before the eyes, or just a sense that the light is too bright.
  • Decreased activity of the digestive system allows more energy to be diverted to fight/flight systems. A decrease in salivation may leave you with a dry mouth and decreased activity in the digestive system may lead to feelings of nausea or a heavy stomach.
  • Muscle tension in preparation for fight/flight and results in subjective feelings of tension, sometimes resulting in aches and pains and trembling and shaking. The whole physical process is a comprehensive one that often leaves the individual feeling quite exhausted.
  • An increase in the rate and depth of breathing, known as hyperventilation. This dysfunctional over-breathing constricts blood vessels and reduces oxygen delivery due to the loss of carbon dioxide that occurs during increased exhalation. You may start to sigh, to yawn, or notice breathlessness, choking or smothering feelings, tightness and pain in the chest. This also reduces the oxygenated blood supply to the brain, and while not dangerous, you might feel dizziness, light-headedness, blurred vision, confusion, feelings of unreality and hot flushes.

Your Breath

 

 

Breathing is the one area that you have the power to affect real change when you experience anxiety/fear, anger or sadness. By correcting your breathing and stopping hyperventilation during periods when you feel overwhelmed, you will allow your brain and other vital organs to become oxygenated to their optimal levels. This is because hyperventilation causes carbon dioxide levels to drop, with each breath out you lose more, and when the level of carbon dioxide in your blood is low enough, oxygen in the bloodstream cannot be utilised (1).

If you remember your high school biology you will know that carbon dioxide reacts with water in the blood to form carbonic acid, an increase in CO2 results in a decrease in blood pH, resulting in hemoglobin proteins in the blood releasing their load of oxygen. Without CO2, oxygen remains bound to the hemoglobin protein (the Bohr Effect).

Hyperventilation is subtle – you might be breathing just a little more quickly over a long period of time, this is known as chronic hyperventilation. Stress disorders and chronic hyperventilation are proven to overlap (2). People who have chronic hyperventilation have consistently lower levels of carbon dioxide and thus lower levels of oxygen delivery (3). Many studies have shown this can impair thinking, alter levels of consciousness, cause depression and stir up anxiety. It is often thought of being a vicious cycle: over-breathing encourages anxiety and anxiety encourages over-breathing (4). This is why for some all it takes is a trigger like an anxious thought, a perceived insult or a painful memory and suddenly they’re feeling anxious, angry or down.

Stopping hyperventilation is key when we are feeling like this. And in the long term re-educating our breathing to eliminate chronic hyperventilation is the greatest tool we have of being able to respond to the continuous challenges that we face. This is what the Buteyko method and Buteykohead were created for.

In addition to addressing hyperventilation over the long term, it is also important to learn to control breathing during the early stages of heightened stress. A central feature of anxiety and anger is that the symptoms are cyclical, feeding back in on themselves and perpetuating the feeling. If symptoms continue, the increase in breathing volume serves to disturb blood gases further, reducing the delivery of oxygen to the brain and causing emotions to become even more intense (5,6).

While many breathing techniques aim to slow down breathing, the Buteyko method is the only breathing system that intentionally reduces breathing volume in order to create a tolerable need for air. In essence, the theory works like a vaccine – reducing breathing to create an air hunger is similar to giving the body a very small, controlled dose of symptoms, which can be a useful strategy to overcome moments of extreme stress and build resilience, which is key to being able to change the final piece of the puzzle.

To understand how the Buteyko method works and why some people develop chronic hyperventilation, you first need to know how our body reacts to levels of carbon dioxide (CO2) in the blood. Central chemoreceptors located in the brain (0.2 mm below the ventrolateral surface of the medulla in the retro trapezoid nucleus (RTN) inside the blood-brain barrier) monitor levels of CO2. They respond to increases in the partial pressure of CO2 by increasing the respiratory rate and depth of our breathing. Thus, CO2 serves as the stimulus for our breathing. Put simply, when CO2 levels rise we feel a need to breathe more. What is shown, however, is that central chemoreceptors can become hypersensitive to CO2 which results in feeling a need to breathe (air hunger) more often than necessary, thus causing chronic hyperventilation and poor oxygen delivery (7,8). It is worth noting there are many studies which show a correlation between stress disorders like anxiety and depression and hypersensitivity to CO2 (9,10,11,12).

The Control Pause

 

 

To measure how sensitive you are to carbon dioxide and thus how often you feel the need to breathe, a very simple breath hold test called the Control Pause (CP) can be used.

Your CP measures the length of time that you can comfortably hold your breath. It is not a maximum breath-hold test.

This is how to measure yours:

1. Close your mouth and take a small silent breath in and a small silent breath out through your nose.

2. After you breathe out hold your nose with your fingers to prevent air entering into your lungs.

4. Start the stopwatch below.

3. Hold your breath until you feel the first signs of an air hunger. You will notice your diaphragm involuntarily “jerking” or pushing downwards at about the same time.

5. Stop the stopwatch when this happens.

4. Release your nose and breathe in through it. Your inhalation after the breath-hold should be no larger than your
breath prior to taking the measurement. It should be calm and quiet.

What it means: A low CP time is under 25 seconds. The lower your C.P time, the more prone you will be to being triggered into extreme emotional states. This is because a low C.P signifies habituation to over-breathe at rest. It does take some practice before you become consistent in measuring your control pause. The measure is subjective because it is difficult to know what the first urge is. At first, it is very easy to push a little too hard and this is the case when the breath after taking the CP is greater than before. With practice, your control pause measurement will become more consistent.

The Buteyko method works by prescribing exercises that habituate the body to feeling an air hunger. With practice, these exercises will adjust your breathing to become slower and calmer. You will be able to clearly measure your progress because your CP will become higher.

Better Sleep

 

 

If you find yourself waking frequently at night. Don’t lose sleep over it. It’s common to wake. In fact, most people wake two or three times during the night. As teenagers or young children, sleep seemed to be a continuous period of relaxing oblivion that lasted between eight or nine hours, or even longer. However, that is not normal in adult sleep. Indeed, once we pass our teens, sleep tends to be lighter and awakenings during sleep more frequent. In most adults by the age of 40, it’s normal to wake 3-4 times per night. 

However, if you are frequently exhausted on waking or if you find yourself feeling drowsy during the day. It might be a good idea to look into how you are breathing at night: The next time you wake up at night, check your breathing rate; Is your breathing rapid? How many seconds are there between each breath? If you are finding that there is little to no pause between breaths, this may mean that you are hyperventilating, which usually accompanies periods of night time thinking or worrying.

Try to calm your breath and yourself by spacing your breaths out and breathing more lightly.

Calm your breath now and see how you feel. Then practise it at night.
1. Put one hand on your belly.
2. Close your mouth, breathe in and out through your nose. Do not be concerned if your nose is blocked, it will become clearer as you use it.
3. Look down and feel the rising of your belly as you breathe in, and see the falling of your belly as you breathe out. Do this for a while.
4. When you are ready, after you breathe out, hold your breath for 3 seconds, count it: 1, 2, 3 then breath in. Breathe out straight away and count again 1,2,3. Repeat this breathing pattern for at least a few minutes or until you feel calmer.

Doing Your Best

 

 

When we are afraid/anxious or depressed or angry we may think that we cannot cope with anything.

This reasoning is due to what we are telling ourselves to do and how we are asking ourselves to do it. We tend to lump our planned activities together and treat everything with a similar difficulty. This makes us unsure of our coping skills.

A good idea, therefore, is for you to sort the tasks that you need to complete into small manageable steps. Beginning with the easiest tasks and working your way up to the most challenging (you don’t actually have to carry out the tasks in that order).

When you schedule your tasks like this it gives you a sense of control over your day. Your day will seem less daunting when it is broken up. More importantly than this, you will become used to the idea, that even though you feel a particular way, you can carry on and get things done. Your feelings will not stop you. You will change the belief that you cannot cope when you are emotional. This is the aim. Complete this and the other exercises every day. Then over time, you will lessen the power that your emotions have over you. You will cease to be a slave to them. Your confidence in your coping skills will grow. It will get easier.

Graded Exposure Schedule Exercise

First, create a list (in no particular order) of all the tasks that you want to complete in your day and write down a percentage of how difficult you think they will be beside them.

  • 0: Perfectly relaxed
  • 25–50: Mild, you think you can do it but it will require effort
  • 51-65: Moderate, You think you will be distracted and that it will take a lot of persistence
  • 66-85: High, you think you will not be able to do, or that you really do not want to do it
  • 86-100: Extreme: The anxiety of it seems too overpowering and you feel that you need to avoid this

A Simple generic example, make yours as detailed as you want:

Exercise 80%

Video Conference for work 85%

Take a shower 0%

Make and eat breakfast 0%

Go for a walk outside 60%

Shop for groceries 80%

Read a book 40%

Make Lunch 50%

When your list is completed, create a table like this:

Graded Exposure Table

 Purpose

 

 

Getting out of the habit of rejecting your emotions, moving to accept them and carrying on will be made easier if you have a purpose to drive you. Many people have never thought about their purpose and this makes it hard for them during a time of crisis to become motivated. There is a lot of information out there about how to find your purpose. Much of it is very nuanced and lofty. Do not waste your time on this, for your purpose is the same as every other human being. Your job is to look after yourself so that you can look after others. When we say others, these could be people you love or anyone in need of your help or company. We know this on a fundamental level. We could expand on this further, however this may be something that is better for you to explore by yourself.

 

Meaning and Confusion

 

All that remains is the question of how do we look after ourselves. You already know about diet and exercise. If you don’t have an exercise routine our advice would be to start your day off with a walk and go from there. Walk as soon as you wake up in the morning, then at your own pace, you can speed up your walk. You do not have to jog or run, just see how you are and what you can do. To look after yourself and feel better, it helps if your day has some intrinsic value. We call this value meaning. We can gain meaning primarily by doing things that hold our attention. It is that simple. It is not about doing something for a social media post. It is about doing for the sake of doing. What can you do and get lost in doing it? Some people: cook, bake, lift weights, run, write, draw, read, grow or tend to plants, listen to music, play an instrument, paint, study, DIY.

It is also fine to just be comfortable and not do anything but watch your favourite series. However, if you do find yourself bored, try to keep away from untrustworthy news feeds, they only exist to bait you and keep you on their sites for as long as possible. They think nothing of spreading fear and confusion.

The pull of checking the news is alluring, we are after all afflicted with a negativity bias. This means two things: One, we are more sensitive to negative information than positive information, and two, negative stimuli activate the reward system in our brains. This served early humans well when they had little external stimulus and real predatory threats, but in modern times it has led many to become addicted to the never-ending anxiety that is being dished out by content creators. Ration the time you spend reading the news, challenge yourself in spending more time away. Do not worry that you will not know everything that is going on all the time. You do not need to. Check in with the people you are close to in your life. What is going on with them is more important.

What we have learnt so far

 

Life’s events, good and bad are beyond our control. This is fine.

Our thoughts and feelings are triggered by these events. Feelings like joy and pleasure are what we always want, however feelings like sadness and fear will be triggered by life’s events too. Unfortunately, we have been conditioned to reject these, which only makes these feelings more intense. To reduce the intensity of our emotions we can accept them, learn what they feel like. If we breathe in a way that stops us hyperventilating and allows oxygen to reach our brain, we will be calm sooner. If we look after ourselves and others and find activities that we can get lost in, our day will be more valuable.

Imagined Threats

 

 

When we are suffering from a real threat, what we do not need to do is place an extra load on ourselves in the form of self -created suffering, yet this is exactly what we will do, if we have no awareness of it. This is because self-created suffering seems no less real. Have you ever spent time getting angry, anxious or sad about something that has happened to you in the past or that you thought would happen to you in the future? Do you remember the last time that you were in a bad mood, what kind of predictions and opinions did you make about a situation or other people? After your stress subsided did they prove to be true? We can suffer for just about anything that we let ourselves suffer for. The slightest perceived insult can set us off. This kind of suffering is actually what we put ourselves through almost all of the time. We are so familiar with it, that we rarely question its authenticity. This kind of emotional turmoil, unlike the real thing, is completely within our power to control. We can reduce it or cut it out completely if we wish. 

Our Unhelpful Thoughts

 

 

If we begin to accept our emotions, work on reducing our breathing, the next step for us is to have a look at our thinking. This is where our self created suffering originates. To do this, it helps if you first get used to the idea, that you, along with me and everyone else is infallible. We are imperfect beings, so too are others. Therefore, it is wise for us to have some flexibility with ourselves and others.

Of course, on a certain level, this seems obvious, yet our thoughts are not often not flexible. They are prone to rigidity. Our assumptions are not treated as being assumptions.

This matters, because outside of real threats it is our thoughts, not the things that happen to us that trigger our anxiety, sadness and anger. The kind of thoughts that create these negative emotions fall into certain categories known as Thinking Errors, Unhelpful Thinking Styles or Cognitive Distortions (13,14,15). They come automatically in response to a perceived threat, or a memory and are outside of our awareness. When a person consistently uses these styles of thinking, they can often cause a great deal of emotional distress to themselves. This distress is completely avoidable when we learn to deal with it.

How to deal with it:

  1. Adapt the role as an impartial observer to your thoughts, accept them, they are separate to you
  2. Get to know the Cognitive Distortions you most commonly have (see below), write down some examples if you find this helps
  3. Catch yourself in the moment when you are starting to think in an unhelpful way
  4. Challenge the specific thought that you are having by looking for evidence that it matters and that it is completely true
  5. Introduce flexibility by coming up a more balanced alternative thought

With practice, you will be able to accept that your thoughts and shorten their duration and intensity. This method is rooted in a form of cognitive therapy that is shown to be as equal, if not more effective at treating depression, anxiety and anger than many prescribed drugs (16,17,18).

The next time you feel worried, angry or sad, take a pen and paper and answer these five questions: (write them down, as it is much more effective, you can throw the paper away when finished)

1. How do you feel and why?

E.g. I feel very anxious, I have to give a presentation tomorrow.

2. What are your thoughts?

E.g. I am thinking that I will be too nervous to do a good job, that I will mess it up and get fired.

3. What kind of thinking errors are your thoughts? (see below)

E.g. Filtering out the positive, catastrophizing

4. Could there be there any alternatives to your thinking?

E.g. Yes, the last time I did a presentation I forgot to include some things, but it was fine. I remembered to mention them in the review at the end. I was nervous, but I carried on. I coped.

5. Can you do anything now that will make it easier for you to cope?

E.g. I can read my notes and look at some possible questions and ways to elaborate my key points.

Mind Reading
We think we know for sure how another person views us. In reality, we do not know what is going with others. How people act and communicate is so complex, we cannot know for sure why others say or do the things they do.

All or Nothing Thinking
We see things as being black or white: That person is good or that person is bad. If only people were as simple as this. The reality is that we are so complex and our motivations change over time.

Filtering Out the Positive
We think only about the bad things from the past, the present or the future. This is known also as negative biasing. News media feeds this way of thinking and the next one too, actually all of them.

Catastrophising
We think things are much worse than they actually are. If we fall short on meeting our financial goals one month we may think, “I’m going to end up bankrupt.” If our loved ones are not returning our messages it is because they had an accident…

Personalisation
We personalise everything! If a friend doesn’t call us back, we assume, “She must be mad at me,” or if a co-worker is grumpy, we might conclude, “He doesn’t like me.”

Emotional Reasoning
Our emotions are not always based on reality or any kind of rational analysis, but we assume that our feelings are the best judge for thinking or acting a certain way.

Fortune Telling
When our emotions are strong we feel 100% sure that everything will happen exactly like we are thinking it will.

Overgeneralising
We take one particular event and make it a rule for all other similar events that follow.

False Ideals
We measure our life against someone else’s material success without recognising our own achievements.

 

Constant Mindfulness 

 

 

Mindfulness-Based Cognitive Therapy (MBCT)

Learn to use cognitive methods and mindfulness meditation as a way of recognising in the moment when negative thoughts are creeping up. The purpose is not to stop these thoughts from occurring, but to stop us from running with them. It is our spiralling thoughts which often triggers our anxiety, depression and anger.

To do this you can separate your thoughts and emotions from you and treat them as entities that can be observed without placing importance on them. The reasoning behind this practice is that when we are fearful or treat our thoughts and emotions as being heavy burdens, they tend to become magnified. Conversely, when we treat them passively, -when we are at peace with them- allowing them to come and go, they lose their power of us, our day does not become consumed by our heads.

When you continuously apply MBCT techniques you build a life-changing habit of being at peace with yourself and being able to carry on despite your thoughts.

For some video explainers and guided meditations that use Buteyko breathing techniques, click here. 

 Further Learning

 

 

How contented you feel in life relates directly to how well you manage your thoughts, emotions and behaviours. The tools and knowledge that let you address these are invaluable.

If you would like to learn more of these techniques and have one on one guidance applying them, then find out more about learning with us here.

References

 

(1.1) Journal of Psychosomatic Research: Going to the heart of the matter: do negative emotions cause coronary heart disease?

https://www.sciencedirect.com/science/article/abs/pii/S0022399999000914

(1.2) PNAS: Affective style and in vivo immune response: Neurobehavioral mechanisms

https://www.pnas.org/content/100/19/11148.short

(1.3) European Heart Journal: Inflammation, coagulation, and depressive symptomatology in cardiovascular disease-free people; the ATTICA study

https://academic.oup.com/eurheartj/article/25/6/492/494962

(2) Pathway Medicine: The Bohr Effect

http://www.pathwaymedicine.org/bohr-effect

(3) NHS UK Hyperventilation Syndrome

http://www.dchs.nhs.uk/assets/public/dchs/services_we_provide/service-directory/our-services/health-psychology/Information-sheets/stress&anxiety/Hyperventilation%20Syndrome.pdf

(4) U.S. National Library of Medicine Hyperventilation

https://medlineplus.gov/ency/article/003071.htm

(5) The Psychiatrist: Clinical and Therapeutic Journal

https://www.omicsonline.org/open-access/chronic-hyperventilation-hypocapnia-and-psychophysiological-dysregulation-106121.html

(6) Ley 1999; Ley and Timmons 1999; Brown and Gerbarg 2005

(7) Int J Psychophysiol. 2005 Nov-Dec;58(2-3):190-8. Epub 2005 Aug 30.Physiological markers for anxiety: panic disorder and phobias. Roth WT1. Meuret A , Wilhelm F, Ritz T, Roth W. (2008). “Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder.” J Psychiatric Research 42(7): 560-568. J Psychiatr Res. 2008 Jun;42(7):560-8. Epub 2007 Aug 3

(8) American Journal of Psychiatry: Carbon dioxide hypersensitivity, hyperventilation, and panic disorder

https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.150.8.1149

(9) Role of chemoreceptors in mediating dyspnea:Gordon F. Buchanan , George B. Richerson

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486073/

(10) Carbon Dioxide Sensitivity in Panic Anxiety: S W Woods, D S Charney, J Loke,W K Goodman, D E Redmond Jr, G R Heninger

https://pubmed.ncbi.nlm.nih.gov/3092780/

(11) Journal of Anxiety Disorders: Unexpected arousal, anxiety sensitivity, and their interaction on CO2-induced panic

https://labs.la.utexas.edu/telch/files/2014/10/Unexpected-arousal-anxiety-sensitivity-and-their-interaction.pdf

(12) Hypersensitivity to inhalation of carbon dioxide and panic attacks: Giampaolo Perna, Angela Gabriele, Daniela Caldirola, LauraBellodi

https://www.sciencedirect.com/science/article/abs/pii/016517819502723A

(13) Hyperventilation Challenge Test in Panic Disorder and Depression With Panic Attacks: A E Nardi, A M Valença, I Nascimento, W A Zin

https://pubmed.ncbi.nlm.nih.gov/11740975/

(14) Science Direct Journals and Books; Thinking Errors

https://www.sciencedirect.com/topics/psychology/thinking-error

(15) Beck, Aaron T. (1972). Depression; Causes and Treatment. Philadelphia: University of Pennsylvania Press

(16) Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms, Robert J. DeRubeis, Greg J. Siegle, and Steven D. Hollon

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/

(17) CBT Better Than Medication For Treating Social Anxiety Disorder, Evan Mayo-Wilson, DPhil, Johns Hopkins Bloomberg School of Public Health

https://www.psychiatryadvisor.com/home/topics/anxiety/cbt-better-than-medication-for-treating-social-anxiety-disorder/

(18) The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Stefan G. Hofmann, Ph.D., Anu Asnaani, M.A., Imke J.J. Vonk, M.A., Alice T. Sawyer, M.A., and Angela Fang, M.A.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/