Stress reduction, insomnia prevention, emotion control, improved attention — certain breathing techniques can make life better. But where do you start?
By Christophe André
As
newborns, we enter the world by inhaling. In leaving, we exhale. (In
fact, in many languages the word “exhale” is synonymous with “dying.”)
Breathing is so central to life that it is no wonder humankind long ago
noted its value not only to survival but to the functioning of the body
and mind and began controlling it to improve well-being.
As
early as the first millennium B.C., both the Tao religion of China and
Hinduism placed importance on a “vital principle” that flows through the
body, a kind of energy or internal breath, and viewed respiration as
one of its manifestations. The Chinese call this energy qi, and Hindus
call it prana (one of the key concepts of yoga).
A
little later, in the West, the Greek term pneuma and the Hebrew term
rûah referred both to the breath and to the divine presence. In Latin
languages, spiritus is at the root of both “spirit” and “respiration.”
Recommendations
for how to modulate breathing and influence health and mind appeared
centuries ago as well. Pranayama (“breath retention”) yoga was the first
doctrine to build a theory around respiratory control, holding that
controlled breathing was a way to increase longevity.
In
more modern times, German psychiatrist Johannes Heinrich Schultz
developed “autogenic training” in the 1920s as a method of relaxation.
The approach is based partly on slow and deep breathing and is probably
still the best-known breathing technique for relaxation in the West
today. The contemporary forms of mindfulness meditation also emphasize
breathing-based exercises.
In
fact, every relaxation, calming or meditation technique relies on
breathing, which may be the lowest common denominator in all the
approaches to calming the body and mind. Research into basic
physiology and into the effects of applying breath-control methods lends
credence to the value of monitoring and regulating our inhalations and
exhalations.
Yoga
and meditation have inspired many of the breathing exercises used
today. The benefits of controlled respiration were first theoretically
posited centuries ago by the practitioners of pranayama yoga. Credit:
Getty Images
Mind under the Influence
Even
a rudimentary understanding of physiology helps to explain why
controlled breathing can induce relaxation. Everyone knows that emotions
affect the body. When you are happy, for instance, the corners of your
mouth turn up automatically, and the edges of your eyes crinkle in a
characteristic expression. Similarly, when you are feeling calm and
safe, at rest, or engaged in a pleasant social exchange, your breathing
slows and deepens. You are under the influence of the parasympathetic
nervous system, which produces a relaxing effect. Conversely, when you
are feeling frightened, in pain, or tense and uncomfortable, your
breathing speeds up and becomes shallower. The sympathetic nervous
system, which is responsible for the body’s various reactions to stress,
is now activated. Less well known is that the effects also occur in the
opposite direction: the state of the body affects emotions. Studies
show that when your face smiles, your brain reacts in kind — you
experience more pleasant emotions. Breathing, in particular, has a
special power over the mind.
This
power is evident in patients who have breathing difficulties. When
these difficulties are sporadic and acute, they can trigger panic
attacks; when they are chronic, they often induce a more muted anxiety.
It is estimated that more than 60 percent of people with chronic
obstructive pulmonary disease (COPD) have anxiety or depressive
disorders. These disorders probably stem in part from concerns about the
consequences of the disease (what could be more distressing than
struggling to breathe?), but purely mechanical factors may contribute as
well: the difficulty these patients experience often leads to faster
breathing, which does not necessarily improve the quality of their
oxygen supply but can aggravate their physical discomfort and anxiety.
Rapid
breathing can contribute to and exacerbates panic attacks through a
vicious circle: fear triggers faster breathing, which increases fear. In
2005 Georg Alpers, now at the University of Mannheim in Germany, and
his colleagues observed significant and unconscious hyperventilation
when people who had a driving phobia took their vehicles on the highway
(where they might not be able to pull over if they become agitated).
Whether
anxiety derives from breathing problems or other causes, it can be
eased by a number of breathing techniques derived from traditional
Eastern approaches (see “Six Techniques for Relieving Stress”). For
example, “follow your breath,” an exercise that focuses attention on
breathing, is one of the first steps in mindfulness meditation, whereas
alternate nostril breathing comes from yoga. Combining reassuring
thoughts with breathing is an approach incorporated into sophrology, a
technique that emphasizes harmony of body and mind and that borrows
exercises from many approaches, including yoga and mindfulness.
Overall,
research shows that these techniques reduce anxiety, although the
anxiety does not disappear completely. Breathing better is a tool, not a
panacea. Some methods have been validated by clinical studies; others
have not. But all of those I describe in this article apply principles
that have been proved effective. They aim to slow, deepen or facilitate
breathing, and they use breathing as a focal point or a metronome to
distract attention from negative thoughts.
Spotlight on Cardiac Coherence
A
close look at one popular technique — cardiac coherence — offers more
detail about the ways that breathing exercises promote relaxation. With
the help of biofeedback, the approach attempts to coordinate breathing
with heart rate, slowing and steadying breathing to slow and stabilize
the heartbeat.
The
method was developed based on the understanding that slow, deep
breathing increases the activity of the vagus nerve, a part of
parasympathetic nervous system; the vagus nerve controls and also
measures the activity of many internal organs. When the vagus nerve is
stimulated, calmness pervades the body: the heart rate slows and becomes
regular; blood pressure decreases; muscles relax. When the vagus nerve
informs the brain of these changes, it, too, relaxes, increasing
feelings of peacefulness. Thus, the technique works through both
neurobiological and psychological mechanisms.
Cardiac
coherence’s stabilization of the heartbeat can dampen anxiety
powerfully. Conversely, patients with overactive heartbeats are
sometimes misdiagnosed as victims of panic attacks because their racing
heartbeat affects their mind.
A
typical cardiac coherence exercise involves inhaling for five seconds,
then exhaling for the same amount of time (for a 10-second respiratory
cycle). Biofeedback devices make it possible to observe on a screen how
this deep, regular breathing slows and stabilizes the beats. (The space
between two heartbeats on the display is never exactly the same, but it
becomes increasingly more consistent with this technique.) Several
studies have confirmed the anxiety-diminishing effect of these devices,
although the equipment probably has more influence on the motivation to
do the exercises (“It makes it seem serious, real”) than on the
physiological mechanisms themselves. Simply applying slow breathing with
the same conviction and rigor could well give the same result.
Some
versions of cardiac coherence recommend spending more time on exhaling
than on inhaling (for example, six and four seconds). Indeed, your heart
rate increases slightly when you inhale and decreases when you exhale:
drawing out the second phase probably exerts a quieting effect on the
heart and, by extension, on the brain. This possibility remains to be
confirmed by clinical studies, however.
Other
work suggests that the emotional impact of the breathing done in
cardiac coherence and various other kinds of exercises stems not only
from effects on the periphery — on the parasympathetic nervous
system — but also from effects on the central nervous system. Breathing
may well act directly on the brain itself.
In
2017, for instance, Mark Krasnow of Stanford University and his
colleagues showed in mice that a group of neurons that regulates
respiratory rhythms (the pre-Bötzinger complex in the brain stem)
controls some of the activity of the locus coeruleus, a region involved
in attention, wakefulness and anxiety. Breathing techniques may
influence this seat of emotions by modulating the activity of the
pre-Bötzinger complex.
Beyond
any direct effects produced by slowed breathing, the attention given to
inhaling and exhaling may play a role in the brain’s response. In 2016
Anselm Doll and his colleagues, all then at the Technical University of
Munich, showed that this attentional focus eases stress and negative
emotions, in particular by activating the dorsomedial prefrontal cortex,
a regulatory area of the brain, and by reducing activity in the
amygdala, which is involved in these emotions.
In
addition, paying attention to breathing causes most people to slow it
down and to deepen it, which as I have mentioned, is soothing. Cognitive
resources are limited, and so when individuals concentrate on
breathing, they are not thinking about their worries. Those who practice
mindfulness learn to notice when their attention drifts away from
breathing and goes back to their concerns, and they train themselves to
return periodically to their breathing. This refocusing has a relaxing
effect on anyone and helps to combat ruminative thinking in people who
have anxiety or depression, especially those who are particularly prone
to negative thoughts that run in a loop.
When to Use Breathing Techniques
What
is the best time to apply slow-breathing techniques? One is during
occasional episodes of stress — for example, before taking an exam,
competing in a sporting event or even attending a routine meeting at
work. In 2017 Ashwin Kamath of Manipal University in India and his
colleagues studied stage fright before a public speaking engagement. The
participants, all medical students, spent 15 minutes doing alternate
nostril breathing — that is, slowly inhaling through one nostril and
exhaling through the other by applying finger pressure to the side of
the nose not being used. Compared with members of the control group,
participants experienced somewhat less stress when speaking publicly.
These
exercises may also help when insomnia strikes. In 2012 Suzanne M.
Bertisch of Harvard Medical School and her colleagues reported, based on
survey data, that more than 20 percent of American insomniacs do these
breathing exercises to sleep better. They may be on to something. In
2015 Cheryl Yang and her team at National Yang-Ming University in Taiwan
showed that 20 minutes of slow breathing exercises (six respiration
cycles per minute) before going to bed significantly improves sleep.
Insomniac participants went to sleep faster, woke up less frequently in
the night and went back to sleep faster when they did wake up. On
average, it took them only 10 minutes to fall asleep, almost three times
faster than normal. The investigators attributed the results both to
the calming mediated by the parasympathetic system and to the relaxing
effect of focused breathing.
But
respiratory techniques do not work only for acute stresses or sleep
problems; they can also relieve chronic anxiety. They are particularly
effective in people with psychiatric disorders such as phobias,
depression and post-traumatic stress disorder. In 2015 Stefania Doria
and her colleagues at Fatebenefratelli e Oftalmico Hospital in Milan,
Italy, offered 10 training sessions of two hours each, spread out over
two weeks, to 69 patients with anxiety or depressive disorders. The
training included a varied set of breathing techniques (such as
abdominal breathing, acceleration and deceleration of rhythm, and
alternate nostril breathing.), combined with some yoga stretches. The
researchers observed a significant decrease in symptoms at the end of
the protocol. Even better, improvement was maintained two and six months
later, with follow-up sessions just once a week and some home practice
during this period.
Breathing
exercises also help to counter the accumulation of minor physical
tension associated with stress. Therapists recommend doing them
regularly during the day, during breaks or at moments of transition
between two activities: you simply stop to adjust your posture and allow
yourself a few minutes of quiet breathing. Therapists often suggest the
“365 method”: at least three times a day, breathe at a rhythm of six
cycles per minute (five seconds inhaling, five seconds exhaling) for
five minutes. And do it every day, 365 days a year. Some studies even
suggest that, in addition to providing immediate relief, regular
breathing exercises can make people less vulnerable to stress, by
permanently modifying brain circuits. In a practice that may seem counter-intuitive, however, counselors may encourage some anxious
patients to breathe rapidly instead of slowly, as part of an effort to
train them to cope with their anxieties (see box “Inhale for Panic!”).
But
why confine breathing techniques to negative emotions? It is also worth
applying them during pleasurable moments, to take the time to
appreciate and remember them. In short, one can pause and breathe for
enjoyment as well as to calm down.
365: The name given to a common technique recommended by therapists to counter accumulated stress: at least three times a day, breathe six times per minute (inhaling for five seconds and exhaling for five seconds each time) for five minutes. Repeat all 365 days of the year.
Open Questions
Tradition
and experience encourage the use of respiratory-control techniques, and
scientific studies increasingly suggest that it is a good idea.
Nevertheless, further research is still needed, particularly given that
some studies lack control groups. One exception stands out: focusing on
breathing often is not a good idea for people having a panic attack that
stems from anxiety over their physical state (also known as
interoceptive anxiety). In this case, focusing on physiology, such as
muscle tension or breathing, may actually amplify panic (“Now that I’m
paying attention to it, my breathing doesn’t seem regular. Am I choking?
What will happen if I suddenly stop breathing?”) For these people,
breathing techniques should be tested and practiced under the
supervision of a therapist.
Otherwise,
considering how often everyone experiences emotional discomfort in
their everyday life and its negative consequences on health, we would
all do well to regularly pay attention to the way we breathe. Start with
brief periods of conscious, quiet breathing several times a day.
Breathing is like solar energy for powering relaxation: it’s a way to
regulate emotions that is free, always accessible, inexhaustible and
easy to use.
In
fact, I am mystified that controlled breathing is not recommended and
practiced more widely. Perhaps it is perceived as too simple,
commonplace and obvious to be a remedy. Faced with the complexity of
negotiating the ups and downs of human life, many people may assume that
simple solutions cannot be effective.
Or
maybe we are intimidated by the sacred aspect of breathing, by its
connection to life and, especially, to death. In the 1869 novel The Man
Who Laughs, Victor Hugo wrote: “Generations are puffs of breath, that
pass away. Man respires, aspires, and expires.” Ultimately, we don’t
like to think that we are nothing more than “puffs of breath.”
Six Techniques for Relieving Stress
Here
are some commonly used breathing techniques. Five to10 minutes of
exercise can relieve sporadic stress and even fend off panic attacks.
More regular practice can lower the daily levels of anxiety.
Stand Up Straight
Posture
is important for breathing: hold yourself straight, without stiffness,
shoulders back, sitting or standing. This body posture facilitates the
free play of the respiratory muscles (of the diaphragm and between the
ribs). Good posture enables your body to breathe properly on its own.
Follow Your Breath*
Simply
observe your respiratory movements: be aware of each inhalation and
exhalation. Focus on the sensations you feel as air passes through your
nose and throat or on the movements of your chest and belly. When you
feel your thoughts drift (which is natural), redirect your attention to
your breath.
Abdominal Breathing
Breathe
“through your stomach” as much as possible: start by inflating your
belly by inhaling, as if to fill it with air, then swell your chest; as
you exhale, first “empty” your stomach, then your chest. This type of
breathing is easier to observe and test while lying down, with one hand
on your stomach.
Rhythmic Breathing
Near
the end of each inhalation, pause briefly while mentally counting “1,
2, 3” and holding the air before exhaling. This counting while not
breathing can also be done after exhaling or between each inhalation or
exhalation. It is often recommended for anxious patients to calm anxiety
attacks because it induces a beneficial slowing of the breathing rate.
Alternate Nostrils*
Breathe
in and out slowly through one nostril, holding the other one closed
using your finger; then reverse and continue by alternating regularly.
There are many variations of this exercise — for example, inhaling
through one nostril and exhaling through the other. Research suggests
that what is most important, aside from slowing the breathing rhythm, is
breathing through the nose, which is somewhat more soothing than
breathing through your mouth.
Think Reassuring Thoughts While Breathing
With
each breath, think soothing thoughts (“I am inhaling calm”). With each
exhalation, imagine that you are expelling your fears and worries (“I am
exhaling stress”).
*Technique validated by clinical studies.
Inhale for Panic!
Whereas
slow breathing soothes, overly rapid breathing can induce feelings of
stress and anxiety. This phenomenon is used in behavioural therapy
sessions to train anxious patients to confront their emotions directly.
By deliberately hyperventilating, patients artificially trigger an
unpleasant anxiety, which they get accustomed to feeling and learn to
put in perspective. This technique also enables them to see that poor
breathing habits amplify their fear.
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