Breathing Techniques for the Mind

By Jessica Tranchina, PT, DPT – September 1, 2021

The market is flooded with books and classes claiming “breathwork” can help with mental health, anxiety and even pain. But are experts convinced?

Breathwork practitioners report surges in interest, YouTube and Instagram stories are teeming with breathing courses and publishers clearly agree it’s a topic worth exploring. Books called “Breathe Well, The Power of Breathwork,” ”The Breathing Book,” “Breathing for Warriors,” “Breath: The New Science of a Lost Art” by James Nestor, “Exhale” by Richie Bostock, AKA The Breath Guy, and “The Wim Hof Method” by Wim Hof have all even been published recently.

This surge in interest in breathing is confusing to some. Sure, a bit of deep breathing at the end of a yoga class feels good, and many of us use simple breathing exercises to help us relax, but most of us manage our 23,000 or so breaths per day without pause for thought, never mind instruction. So, are advocates right that breathwork has a long list of physical and mental health benefits? 

Well, for starters, there is good-quality evidence to support the use of breathing exercises for asthma. A randomized controlled trial published in 2018 found that quality of life ratings were higher in UK asthma patients who underwent training in deep, slow, nasal and diaphragm breathing. Guidelines used by doctors in the UK state that breathing exercises can help reduce asthma symptoms.

Reducing Pain and Anxiety

Many of those who turn to breathing exercises do so to deal with stress or anxiety. The NHS website suggests these can be alleviated through short sessions of deep belly breathing. 

One study found that anxiety levels dropped in a group of medical students who underwent a six-week course of pranayama breathing exercises, while no change was seen in a control group. The pranayama group also saw increases in their heart rate variability (HRV). When we breathe in, our heart beats momentarily faster to speed the flow of oxygen around the body. When we breathe out, our heart slows down. HRV is the difference between these two rates, and higher HRV is seen as a marker of the body’s resilience and flexibility in response to outside stimuli.

A study published in 2017 found that a group of 20 Beijing-based IT workers had lower levels of the stress hormone cortisol in their saliva after undergoing eight weeks of deep, diaphragm breathing sessions – a change not seen in a control group. Italian researchers who reviewed 15 previous studies found slowing breathing promoted short-term increases in HRV, increased comfort and relaxation and reduced anxiety.

Scientists don’t know exactly how slow, deep breathing promotes relaxation. However, many believe its ability to increase HRV is a key factor. HRV is controlled by the autonomic nervous system, which regulates subconscious bodily processes including breathing rate and blood pressure. It is subdivided into the sympathetic nervous system, which triggers “fight or flight” responses such as increased heart rate and blood pressure, and the parasympathetic nervous system, which triggers “rest and digest” responses.

Parasympathetic responses are controlled by the vagus nerve that sends signals back and forth between the brain and different parts of the body. The higher a person’s HRV, the greater the strength of their vagal response to stimuli, and the quicker their bodies can activate parasympathetic responses to stress.

When psychologist Roderik Gerritsen of Leiden University in the Netherlands reviewed physical and mental health benefits associated with contemplative activities, he concluded that their common focus on breathing reduced stress by increasing parasympathetic nervous system activity. Gerritsen has explained before saying, “By slowing the breathing down, your heart rate goes down, you stimulate your vagus nerve and you’re telling your body it doesn’t have to respond to any immediate threats.”

Managing Pain

Breathing routines are also used to manage pain. A study involving 48 healthy volunteers published in January found that deep breathing reduces pain caused by heat, especially at rates of about six breaths per minute. Other research linked breathing exercises to reduced heart rates and blood pressure in cardiovascular disease patients.

There are many animal and short-term laboratory human studies that show breathing slowly and deeply triggers changes in the body linked to healthy outcomes. 

Italian physician Luciano Bernardi has shown that breath-control training helped chronic heart failure patients to significantly reduce their breathing rate as well as increase the amount of time they could exercise. Bernardi reported saying, “A month after the study, the benefits were still present, and we found that most had continued the practice. Like any other training, if you continue to do it, you maintain the benefits, and if you stop, after a while, you lose them.”

Here are just a few of dozens of breathing techniques and some of my own personal favorites:

Box Breathing

Also known as four-square breathing, box breathing is very simple to learn and practice. It goes like this:

  1. Exhale to a count of four.
  2. Hold your lungs empty for a four count.
  3. Inhale to a count of four.
  4. Hold air in your lungs for a four count.
  5. Exhale and begin the pattern anew.

Personally, I do at least four rounds to achieve complete decompression and relaxation.

4-7-8 Breathing

The 4-7-8 breathing exercise, also called the relaxing breath, acts as a natural tranquilizer for the nervous system. At first, it’s best to perform the exercise seated with your back straight. Once you become more familiar with the breathing exercise, however, you can perform it while lying in bed:

  1. Place and keep the tip of your tongue against the ridge of tissue behind your upper front teeth for the duration of the exercise.
  2. Completely exhale through your mouth, making a whoosh sound.
  3. Close your mouth and inhale quietly through your nose to a mental count of four.
  4. Hold your breath for a count of seven.
  5. Exhale completely through your mouth, making a whoosh sound to a count of eight.

Lion’s Breath

Lion’s breath, or simhasana in Sanskrit, is another helpful deep breathing practice during which you stick out your tongue and roar like a lion. It can help relax the muscles in your face and jaw, alleviate stress and improve cardiovascular functions.

The exercise is best performed in a comfortable, seated position, leaning forward slightly with your hands on your knees or the floor.

  1. Spread your fingers as wide as possible.
  2. Inhale through your nose.
  3. Open your mouth wide, stick out your tongue and stretch it down toward your chin.
  4. Exhale forcefully, carrying the breath across the root of your tongue.
  5. While exhaling, make a “ha” sound that comes from deep within your abdomen.
  6. Breathe normally for a few moments.
  7. Repeat the lion’s breath up to seven times.

Wim Hof Method

Cycles of controlled hyper-ventilation, extended exhalations and breath-holding, combined with exposure to cold and meditation, are designed to trigger positive immune system changes. I recommend this breathing technique to be performed with a trained professional.

To make deep breathing work for you, it’s essential to listen to your body and be mindful of how anxiety is impacting your everyday life. If after practicing deep breathing you still feel severe anxiety, consider consulting a mental health professional or medical doctor for assessment and recommendations for treatment. If you have a lung condition like COPD or asthma, or you’re experiencing pain or difficulty breathing, speak with your healthcare provider before trying any type of breathing exercise.


About the Author

Jessica Tranchina, PT, DPT, is a co-founder of Generator Athlete Lab and has been an athlete her whole life. As the creator of the Generator Method, Tranchina works to help guide others to better performance and recovery. She is passionate about bringing the active community of Austin together from all fitness levels and athletic backgrounds. She is the owner of PRIMO Performance and Rehabilitation, started in Austin in 2010, where her expertise and unique skill set have been established as one of the best in her field. NASM-CPT, A.R.T Certified Provider, CKTP.


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