Palliative care I Dyspnea

Psychotherapy

Fear of suffocation is the most frequently mentioned fear in patients receiving palliative care, apart from the fear of pain. Dyspnea is usually closely associated with anxiety. In the context of multimodal treatment of anxiety, we can use all the possibilities of psychotherapy and bring relief. In particular, relaxation and breathing techniques have proven to be useful in treating dyspnea.

Therapeutic approach

In psychotherapy, the prerequisite is to form a trusting, reliable alliance, so that the patients’ “look into the abyss” and their path at the edge of this abyss can successfully proceed. The mental stability of the therapist offers the patient the possibility to temporarily hold on to him inwardly (“I”-support function).

In a first step the patient learns that her fears and the associated emotional agitation can be reduced by her power of thinking and judgement. This happens, for example, in

  •  guided relaxation and imagination exercises.

In addition, the patient practices strengthening her own power of thought as it affects her life of soul. A wealth of exercises and different forms of meditation are available for this purpose, which can first be experienced under therapeutic guidance and then patiently practiced by the patient.

  • the LIT anthroposophic training program by Harald Haas and Theodor Hundhammer (1),
  • the six qualities according to Rudolf Steiner (2),
  • the review of the day (3, p. 87).

are important tools. Here patients practice guiding their own thoughts, a process which enables them to experience what it takes to control their thoughts and feelings.

Verses and meditations can be added to these exercises. The therapist should be familiar with their content to be able to provide the patient with effective assistance.

Meditations that have worked well

Many patients suffering from dyspnea, with agitation and fear, experience help through the following meditation. The therapist should familiarize himself with what it means and give the patient guidance:

I bear calm within myself,
I bear within myself
The forces which strengthen me.
I want to fill myself
With the warmth of these forces,
I want to pervade myself
With the power of my will.
And I want to feel
How calm spreads
Through all my being
When I strengthen myself
To find calm as
The force within me
Through the power of my striving.

Rudolf Steiner (4, p. 179, translated by Christian von Arnim)

The following meditation can be recommended in cases of fearful helplessness:

Victorious spirit
Flame through the faintness
of hesitant souls.
Burn up ego’s self-craving,
Ignite compassion,
So that selflessness,
the life-stream of mankind
Wells up as the source
of spirit’s rebirth.

Rudolf Steiner (4, p. 73)

The following is suitable when relatives want to send helpful thoughts to a patient:

Spirit of your soul, working guardian,
May your wings bring
Our souls’ praying love
To the person in the spheres entrusted to you
That united with your power
Our petition helping shine
On the soul that it lovingly seeks.

Rudolf Steiner (5)

When patients are undergoing existential battle with their disease, a short meditation by Rudolf Steiner can engender a special source of strength:

You spirit of my life, protective companion,
Be goodness of heart in my willing,
Be human love in my feeling,
Be light of truth in my thinking.

Rudolf Steiner (4, p. 190 and 180)

This meditation is titled “In danger of death”. The date of its origin and the person who asked for it are unknown. The meditation addresses the angel of the human being, who carries and can guide the “I” and bestow strength in thinking, feeling and willing. Then those qualities can arise and be promoted which we admire in many patients in palliative medicine: a wise view of life as the light of truth in thinking, which no longer only illuminates the personal, but recognizes new perspectives; human love that no longer develops egocentrically, but is directed towards its surroundings, and finally a goodness of heart that can almost be perceived as a power to bless. In such inner developments, something angel-related appears as the fruit of the confrontation with the disease, which can carry the individuality into the future either in this or a later destiny (6).

1 Haas H, Hundhammer T. Selbsterziehung und der achtgliedrige Pfad – ein Gruppenprogramm. Der Merkurstab 2013;66(6):496–506.

2 Steiner R. Die Nebenübungen. Sechs Schritte zur Selbsterziehung. 5th ed. Dornach: Rudolf Steiner Verlag; 2016. English alternative on the same topic: Steiner R, Baydur A (ed.). Six steps in self-development. The 'supplementary exercises'. Rudolf Steiner Press, London 2010.

3 Steiner R. Seelenübungen mit Wort- und Sinnbild-Meditationen. GA 267. 2nd ed. Dornach: Rudolf Steiner Verlag; 2001. English translation: Steiner R, Barton M (translator). Soul exercises. Word and symbol meditations. Herndon: Steiner Books; 2014.   

4 Steiner R. Mantrische Sprüche. Seelenübungen II. GA 268. Dornach: Rudolf Steiner Verlag; 1999. English translation: Steiner R. Mantric sayings. Meditations 1903–1925. Great Barrington: Steiner Books; 2015. Translated by Dana L. Fleming and Christopher Bamford.

5 Steiner R. Der Tod – die andere Seite des Lebens. Wie helfen wir den Verstorbenen? Worte und Sprüche. 3rd ed. Dornach: Rudolf Steiner Verlag; 2000. English alternative on the same topic: Steiner R, Barton M (transl.). Meditations for the dead. Connecting to those who have died. London: Rudolf Steiner Press; 2018.

6 Girke M. Palliativmedizin. Der Merkurstab 2017;70(5):416-423.