MAS Magazine: Don't Hold Your Breath

Talk for more than 5 minutes to Tania Clifton-Smith and you're suddenly aware that you are holding your breath, deep sighing to pull in more air or suckling in your tummy. Not good.

After 30 years of delving into the physiology and psychology of breathing, the expert physiotherapist knows plenty about what can go horribly wrong when we don’t breathe properly. The field has rapidly expanded from its early roots, focused on hyperventilation.

“There is still an academic debate about what it is called – breathing dysfunction, breathing pattern disorder or disordered breathing. It used to be called hyperventilation, when if you over-breathe then carbon dioxide drops with myriad effects on the nervous system, the cerebral arteries, the neurotransmitters,” Tania explains. “Breathing is an individualised, simple concept, but it is highly complex. We are starting to look at breathing beyond respiration.”

In a world where pop ‘science’ and instant mindfulness gurus are cottoning on to the effects of good – and poor – breathing on health, Tania is a self-confessed nerd on the science and evidence-based research in her rapidly expanding field. When she first discovered the speciality on her OE in the late 1980s in London, she spent every penny she earned going to conferences in Europe and the United States for the International Society for the Advancement of Respiratory Psychophysiology. The society’s roots in the early 1980s and ’90s brought together diverse professionals – physiologists, sleep researchers, anaesthetists, paediatricians, yoga researchers, respiratory physicians and physiologists – around the new field of ‘respiratory psychophysiology’. Already she was learning that there were more than just sensations of breathing.

“I was so blessed to meet such amazing people who had written a lot of the research,” she says. “In my most recent work [the dysfunctional breathing section of the severe asthma toolkit for the Australian Centre of Excellence in Severe Asthma] with allergy, asthma and clinical immunologist physician Mark Hew, I am so excited that we are talking about the nose, the lungs, the musculature and the nervous system as an integrated system, not each as a separate speciality and not just the function of respiration. We are starting to address the whole that is breathing and how this plays a part in respiration as well as many other functions.

“Breathing is the orchestra of the body,” she says. “In the private breathing clinic we get referrals from all the specialists – psychiatrists, physicians, gastroenterologists, cardiologists and neurologists.”

Tania started out with a physical education degree from the University of Otago before changing to physiotherapy in Auckland, where her early thought processes very much focused on bio-mechanics and movement. It wasn’t until she worked in a London clinic treating stress-related disorders, with clients who ranged from the rich and famous to refugee survivors of torture, that she realised that pain and chronic pain were about more than bio-mechanics.

“I had to figure that out for myself; it turns your thinking upside down. I was taught mechanics, but I hadn’t been taught that someone could be so stressed that they couldn’t feel my hands.”

When she returned to New Zealand, in 1991 she set up the first hyperventilation clinic at Middlemore Hospital, part of its chronic pain and stress management services. About her career, Tania is quick to credit amazing mentors – at Middlemore it was physiotherapist Mark Cranswick and rheumatologist and pain medicine specialist Mike Butler. But it was a workshop with Dinah Bradley, who had just published Hyperventilation Syndrome, that cemented her future.

“After her presentation I ran down the corridor after her, saying ‘I know this work’,” laughs Tania. “I came from a pain and musculoskeletal physiotherapy background, and Dinah came from a respiratory physiotherapy background. It was a perfect match to cover our professional scope of practice.”

The pair established the first independent breathing pattern disorders clinic in Australasia in 1999, evolving the internationally recognised BradCliff Breathing Method® from their successful drug-free treatment techniques. Spreading the word is a huge part of their ethos. As well as Dinah’s first book, the women have co-authored Dynamic Breathing (Random House New Zealand, 2008) and Breathe Stretch & Move for managing workplace stress and preventing injury (Random, 2002). Tania has also published

'When in doubt, breathe out', that's our company motto.

Bradcliff Breathing Method

The kids are all right

Train your children to notice when they are tense, talk about how they feel, then use their physical awareness to bring themselves back to calm.

Encourage your child to breath out (not in, hyperventilation just increases the tension) using belly breaths.

Self check – ask, “What is my mind telling me?” The nervous system can’t distinguish between real danger and what the mind is messaging (either anxiety about what might happen, or depression about what has happened). The body doesn’t know danger hasn’t happened; you have to
create that connection.

Complete the Nijmegen Questionnaire, a broad view of the symptoms associated with dysfunctional breathing patterns.

A score of over 23 out of 64 suggests a positive diagnosis of hyperventilation syndrome.

By Catherine Smith, MAS Magazine, Summer 2017/2018