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Shortness of breath can be an indication of anxiety. It is one of the various physical symptoms that this emotional state can cause.

Shortness of breath associated with anxiety is often described as a subjective feeling of being unable to take a deep breath or feeling like there’s a tightness in the chest.During periods of heightened anxiety, the body’s stress response is activated, which can lead to rapid breathing or hyperventilation.

This may result in the sensation of not getting enough air, or feeling breathless.It is important to note that if you are experiencing shortness of breath, it is crucial to rule out other potential causes, as it can also be a symptom of various medical, as well as non-medical conditions.

Here are some common causes:

• Physical exertion: Engaging in strenuous physical activity or exercise can temporarily cause shortness of breath due to increased demand for oxygen.
• Asthma is a chronic condition characterised by inflammation and narrowing of the airways, leading to wheezing, coughing and shortness of breath.
• Chronic obstructive pulmonary disease (COPD), which includes conditions such as chronic bronchitis and emphysema, results in progressive airflow limitation and difficulty breathing.
• Respiratory infections, such as pneumonia or bronchitis, can lead to symptoms like coughing, wheezing and shortness of breath.
• Allergic reactions, particularly to environmental triggers like pollen, dust mites or pet dander, can cause respiratory symptoms, including shortness of breath.
• Anxiety and panic disorders, which, as mentioned earlier, can result in shortness of breath due to hyperventilation or a sense of breathlessness.
• Heart conditions, such as heart failure, coronary artery disease or arrhythmias, can cause fluid accumulation or reduced blood flow, leading to shortness of breath.
• Pulmonary embolisms occur when a blood clot travels to the lungs, causing a sudden blockage in the pulmonary arteries and resulting in breathing difficulties.
• Anaemia, characterised by a low red blood cell count (i.e. reduced haemoglobin levels), can lead to inadequate oxygen transport in the body, resulting in shortness of breath.
• Obesity can put pressure on the chest and lungs, making it more difficult to breathe, particularly during physical exertion.

How it manifests

Anxiety can cause shortness of breath through several mechanisms. When a person experiences anxiety, their body’s stress response is activated, leading to physiological changes that can impact breathing patterns. Here’s how anxiety can contribute to shortness of breath:

Hyperventilation

Anxiety can lead to hyperventilation, which is rapid and shallow breathing. During a state of anxiety, the body’s sympathetic nervous system is activated, triggering an increased respiratory or breathing rate.

This excessive and rapid breathing can disrupt the balance of oxygen and carbon dioxide in the body, leading to sensations of shortness of breath or feeling like you can’t take a deep breath.

Tension and tightness

Anxiety can cause muscle tension and tightness in the chest and upper body. This can restrict the movement of the ribcage and diaphragm, which are involved in the breathing process. As a result, it may feel like your breaths are shallow or constricted, leading to a sensation of breathlessness.

Heightened sensitivity

Anxiety can increase a person’s sensitivity to physical sensations. Normal fluctuations in breathing patterns or slight changes in respiration may be perceived as more significant or distressing when experiencing anxiety. This heightened sensitivity can amplify the perception of shortness of breath.

Hypervigilance

When anxious, individuals often become hyperaware of their bodily sensations, including their breathing. This constant focus on the breath can create a sense of breathlessness or difficulty breathing, even if there is no underlying respiratory issue.

> Panic attacks

In certain cases of anxiety, panic attacks can also occur. Panic attacks are intense episodes of anxiety characterised by a sudden surge of fear or dread. During a panic attack, individuals may experience rapid breathing or hyperventilation, leading to a feeling of breathlessness or a sense of suffocation.

Other symptoms of anxiety

Anxiety can present itself through a variety of symptoms, and individuals may experience a combination of these symptoms to varying degrees. Some key symptoms of anxiety include:

• Excessive worry: Persistent and excessive worry about everyday events, often accompanied by a sense of impending doom or catastrophe.
• Restlessness and irritability: Feeling on edge, restless or easily irritated.It can manifest as difficulty relaxing, feeling tense or being easily startled.
• Sleep problems: Trouble falling asleep, staying asleep, or having restless and unsatisfying sleep.Anxiety can also cause nightmares or vivid dreams.
• Physical symptoms: Physical manifestations such as rapid heartbeat, chest tightness, shortness of breath, trembling or shaking, sweating, dizziness, nausea, gastrointestinal issues (e.g. stomachaches, diarrhoea), headaches or muscle tension.
• Cognitive symptoms: Racing thoughts, difficulty concentrating or focusing, indecisiveness, overthinking, and experiencing intrusive or obsessive thoughts.
• Avoidance behaviour: Avoiding situations or places that trigger anxiety or induce feelings of fear or panic.This may lead to limitations in daily activities or social interactions.
• Social anxiety: Intense fear or discomfort in social situations, leading to avoidance of social gatherings, public speaking or interactions with strangers.
• Panic attacks: Sudden and intense episodes of fear or apprehension, accompanied by physical symptoms such as heart palpitations, chest pain, shortness of breath, trembling, sweating and a sense of impending doom.

Strategies for coping

If you are experiencing shortness of breath due to anxiety, there are several strategies you can try to help alleviate the symptoms:

Relaxation techniques

Practice relaxation techniques such as deep breathing exercises, progressive muscle relaxation or mindfulness meditation. These techniques can help calm your body and mind, reduce anxiety, and regulate your breathing pattern.

Diaphragmatic breathing

Practice diaphragmatic breathing, also known as belly breathing. This technique involves breathing deeply into your diaphragm, rather than shallowly into your chest. It helps promote a more relaxed and efficient breathing pattern.

Breathing exercises

Try specific breathing exercises designed to regulate and slow down your breathing. One example is the four-seven-eight breathing technique. This technique involves inhaling for a count of four, holding the breath for a count of seven, and exhaling slowly for a count of eight. Repeat this cycle several times to promote relaxation.

Grounding techniques

Engage in grounding techniques to help distract your mind from anxious thoughts and focus on the present moment. For example, you can name five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste.

Identify triggers

Pay attention to situations, thoughts or activities that trigger your anxiety and subsequent shortness of breath. By identifying these triggers, you can work on managing or avoiding them to reduce the likelihood of experiencing breathlessness.

Seek support

Consider seeking support from a mental health professional, such as a therapist or counsellor. They can help you develop coping strategies, provide guidance and offer techniques specific to your needs.

Engage in regular exercise

Regular physical activity can help reduce anxiety and improve overall well-being. Engaging in exercises like walking, jogging, yoga or swimming, can be beneficial for both your physical and mental health.

Practice self-care

Take care of yourself by engaging in activities that promote relaxation and self-soothing. This may include getting enough sleep, eating a balanced diet, engaging in hobbies, spending time with loved ones, or engaging in activities that bring you joy.

Managing anxiety can be a multifaceted approach that may involve various strategies. It’s important to note that everyone’s experience with anxiety is unique, and what works for one person may not work for another.

If anxiety persists and significantly interferes with your daily life, it is advisable to seek professional help from a mental health provider who can offer tailored guidance and support.

By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 25 Sep 2023