BREATHING PRACTICES FOR TREATMENT OF PSYCHIATRIC AND STRESS-RELATED MEDICAL CONDITIONS
Breathing practices have been used for centuries in various cultures and mindfulness-based practices, such as Yoga, Tai Chi and Qi Gong, as a vital means of promoting physical and mental wellbeing. In recent decades, there has been increasing scientific interest in the use of such practices as a (cheap and freely available) treatment for psychiatric and stress-related medical conditions.
Physicians Dr Richard P. Brown MD, and Dr Patricia L. Gerbarg MD, have made the application of breathing techniques to clinical practice, and to aiding traumatised survivors of natural disasters, their life’s work, founding the Body Breath Mind Foundation. In this paper, published in 2013 in the journal Psychiatric Clinics of North America, they review numerous academic studies looking at many techniques and their potential benefits. Here, I give a brief overview of a few key techniques discussed in their paper, and provide links to other research studies that give further insight into the mechanisms at work in our bodies.
Diaphragmatic breathing
One of the most well-known breathing practices is diaphragmatic breathing. Also known as belly breathing, involves taking slow, deep breaths, focusing on filling the lungs from the bottom up, and exhaling slowly. It is used to use full lung capacity and create more oxygen flow in the body. We are all born with the innate knowledge of how to fully engage the diaphragm to take deep, nourishing breaths. Think of small children. You’ll see that they use their whole bodies. Everything expands in all directions on their little frames, their bellies bulging without any self-consciousness at all. This is because they are breathing ‘diaphragmatically.’ However, as we get older, we lose it. This is due to a combination of things, particularly stress.
Stress stimulates our sympathetic (activating) nervous system, preparing us to take some kind of defensive action, whether that’s to ‘fight’ or ‘flee’. If our ‘stress mode’ doesn’t switch off, because we can’t escape a threat like money problems, that work issue or the state of world affairs, and our brain is still perceiving a threat, over time our abdomen tightens like a belt, making it harder for our diaphragm to move downwards fully to initiate the inhale. So, we develop a habit of shallow, chesty breathing, sometimes we even holding our breath without realising. And the faster and more irregularly we breathe, the more the energy needs of our heart muscle increase and our heart rate goes up, activating the sympathetic nervous system yet further and sustaining a state of hyper-arousal.
We can unknowingly support this process by strapping waistlines into tight clothes, or sucking our bellies in self-consciously, to fit narrow ideals of perfection. Moreover, our increasingly sedentary lifestyles, which involve large amounts of time sitting – on sofas, in cars or at desks in offices - have a hugely negative impact on our posture, closing in the front body, compressing the chest and reducing the capacity of the respiratory muscles to function well, and of the lungs to fully expand. I often start with re-training diaphragmatic breathing when working with private clients or preparing guests for our retreats.
Diaphragmatic breathing helps slow the heart rate and lower blood pressure, decreasing the levels of stress hormones in the body, decreasing symptoms of anxiety and depression and supporting more robust immune system function, so that we are less prone to colds and other illnesses. A 2018 study co-authored by Harvard’s Benson Henry Institute for Mind-Body Medicine (where the mechanism of our ‘fight or flight’ response was first discovered over half a century earlier) and the Beth Israel Deaconess Medical Center at Massachusetts General Hospital revealed what may be happening at a deeper, molecular level. The investigators identified changes in genes and biological pathways linked to immune system regulation, metabolism, inflammatory markers, cardiovascular system development and circadian rhythm in people who reduced their blood pressure after an eight-week ‘relaxation response’ training. At the core of this training was diaphragmatic breathing coupled with mindfulness meditation. First described more than four decades ago by Herbert Benson, MD, former Director Emeritus of the Benson Henry Institute (he passed away, in early 2022, leaving an extraordinary legacy in healing research), the relaxation response is characterised by a set of measurable changes to the body, including decreased respiration rate and heart rate, all of which can be induced by mind-body techniques. This study shows that such practices can have such a profound impact that they change the way our genes express, and the physiological impact of these changes was as significant as the researchers would expect to see in a pharmacologic intervention.
coherent breathing
Coherent or resonant breathing is another widely studied technique. It involves increasing the length of inhalation and exhalation and making them of equal length, usually a 5 count in breath and a 5 count out-breath. This is more slowly than most people breathe, and it has the effect of reducing the activity of our autominc nervous system, which controls involuntary vital functions including heart rate, blood pressure, digestive processes and respiration. This has a calming effect overall on our body-mind. Professors Brown and Gerbarg have found through their own research that coherent breathing not only signifcantly reduced anxiety and depression - even with just 5-10 mins of this breathing exercise per day; it also helped survivors of 9/11 with ‘ground glass lungs’ - which can lead to respiratory disease and has no known cure - achieve significant improvements in their condition. They detail many of their techniques and research findings in their book, Th Healing Power of the Breath, which I’ve listed on my Books page.
alternate nostril breathing
Numerous studies, such as this one published in Medical Science Monitor in 2013, have also shown that alternate nostril breathing, drawn from the Yoga tradition, is an effective way to reduce blood pressure in individuals with hypertension. Hypertension is a common condition that affects millions of people worldwide (including my mother) and left untreated can lead to a number of serious health complications, including heart disease, stroke and kidney failure. Another study published in 2018 in the International Journal of Yoga, found that even 100 otherwise healthy young male participants, after practicing alternate nostril breathing for 12 weeks, had lower blood pressure and heart rate readings and also reported significantly lower levels of stress.
The technique involves inhaling and exhaling through one nostril at a time, switching back and forth between the left and right nostrils. It balances activity between the left and right brain hemispheres and thus promotes greater ease and harmony in body-mind functioning, such as improving the way our heart and lungs work together to ensure we’re getting enough oxygen for vital processes. Moreover, it is a simple and inexpensive intervention (free, once people know how to do it).
ratio breathing
Another valuable breathing practice for calming our system is ratio breathing with extended exhalations. This technique involves, for example, breathing in for a count of 4, and exhaling for a count of 6 or 8. Extending the exhalation stimulates the parasympathetic (rest and digest) nervous system, bringing the heart rate down and making relaxation more accessible. I use this often in my teaching, and I find the counting helps my clients to develop their concentration by keeping their awareness anchored into the present moment (instead of ruminating on the past or worrying about the future).
‘Box breathing’ or ‘square breathing’ - inhaling for a count of four, holding the breath for a count of four, exhaling for a count of four, and holding the breath again for a count of four before starting the cycle again - can also help to slow down the breath and bring a sense of calm, presence and focus to the mind.
Everyone's body is different and what works for one person may not work for another. It's important to consult with a qualified Yoga professional and/or medical professional before starting any new breathing practice, and individuals with hypertension should continue to take any prescribed medications and follow their doctor's recommendations for managing the condition.
