Stop – breathe – think

Conscious breathing can help anyone battling stress in the operating room, according to Stig Severinsen

Aidan Hanratty

Posted: Sunday, April 1, 2018

Image courtesy of Casper Tybjerg

The key to relaxation is in the exhalation. This was the main point made by freediving champion, Guinness World Record holder and expert in ‘Breatheology’, Stig Severinsen. He was speaking at a symposium “Keep Calm: Stress Management During Cataract Surgery” organised by the Young Ophthalmologists Committee as part of the 22nd ESCRS Winter Meeting in Belgrade, Serbia.

Severinsen has a background in biology (specifically marine biology and neuro-physiology) and medicine – his PhD was on inner ear hair cell regeneration on mammals and humans – and has gone from freediving and breath-holding to offering courses and lectures on efficient breathing and mental training. This is for anyone from Olympians and CEOs to Navy SEALs and sufferers of post-traumatic stress disorder.

As he writes in his book Breatheology: The Art of Conscious Breathing: “The ability to relax ‘on command’ and overcome or completely avoid stress and the accompanied improved mental control and confidence are gifts that help in all parts of life.” This is particularly relevant for cataract surgeons who may be placed under stress in their early surgeries.

Severinsen’s younger brother Martin is a cataract surgeon and a member of the Young Ophthalmologists Committee. Introducing his brother in Belgrade, he gave an example of a stressful situation that may arise in a cataract operation. While his trainee was performing a capsulorhexis, the patient started coughing. The trainee managed to keep a steady hand and Dr Severinsen helped him finish the procedure.

What would the elder Severinsen recommend in such a situation? “If you feel something’s going wrong, just stop what you’re doing. Sit Up. Breathe for a moment and just hold your breath for about two seconds, maybe five seconds.

“When we stop and when we hold our breath, even for a few seconds, the brain opens in a different way. When you have experience and you control your mind then you come up with a solution.” Speaking to EuroTimes after the event, he recommended the following: “Stop – Breathe – Think.”

Another tip he suggests is what he calls 1:2 breathing. This consists of exhaling for twice as long as you inhale. “You decide how long your inhale is, and then exhale through the mouth, but double the time. Feel what’s going on in your body.”

Methods like this help to activate the vagus nerve or 10th cranial nerve, which spreads out all over the body, connecting the brain to your heart, lungs, glands and more. “With the vagus nerve activation, there is more empathy, there is more collaboration, and you become more reflective and more open minded.”

In what may have been a first for an ESCRS Meeting, Severinsen invited the audience to stand up and partake in exercises to strengthen and improve breathing and breath holds. One was the sky stretch, which involves stretching one arm as high up above your head as possibly while breathing in, holding and then exhaling. Another involved breathing in, pulling your shoulders back, bending your knees and then reaching forward like a cat.

Delegates at the 22nd ESCRS Winter Meeting in Belgrade, Serbia, practise the sky stretch as instructed by Stig Severinsen

Vasilios F Diakonis MD, PhD, was part of the Young Ophthalmologists Committee that invited Severinsen to speak. For this Meeting he and the team wanted to host an unusual or “out-of-the-box” symposium, one that would still be relevant to young surgeons. “We make mistakes in surgery, we need to learn to correct our mistakes, we need to learn to prepare ourselves in order to decrease the mistakes we make etc., but at the same time besides skill and knowledge there is a physical component that most of us deal with, especially early in our carriers, which is stress during surgery.”

Having met Severinsen at the ESCRS Congress in Barcelona in 2015, he was a natural choice. “I believe that everyone in the audience enjoyed the talk as they performed exercises under Stig’s instructions, not a common phenomenon from a group of scientists during a scientific meeting.”

Severinsen spoke highly of the people he met in Belgrade, noting the high level of engagement and enthusiasm demonstrated by everyone during the breathing and relaxation exercises. His takeaway message was that doctors seemed to be willing to use breathing, meditation, mindfulness, imagery and relaxation as complementary ‘tools’ to improve both surgical results and a better and deeper connection with themselves, their team and even their patients.

“The mind is very difficult to control. That’s why we have stress. Stress leads to panic. Panic will always lead to bad decision making,” Severinsen said. “When the breath is calm, the mind too will become still.”