The power of breathing for stress relief and wellness (and what to do and how to do it)

Breathing practices have surged in popularity in recent years, driven by a growing interest in holistic wellness and mindfulness techniques. With the increasing recognition of the interconnectedness between mind and body, people are turning to breathing exercises as accessible tools for managing stress, enhancing mental clarity, and promoting overall well-being. Influenced by ancient practices such as yoga and meditation, modern breathing techniques offer a practical and scientifically supported approach to reducing stress relaxation, improving focus, and regulating emotions. Breathing practices also have the advantage of being universally accessible, scalable, and cost-free. They are not limited by access to healthcare services, have no long-term side effects, and put potential treatment tools in the hands of the individual. In this article, we explore the emerging science behind several breathing practices and investigate their potential for health improvements and vitality.

How do breathing exercises actually work?

Breathing practices have been shown to positively affect the autonomic nervous system (the body's control system that manages things automatically, like breathing) and the brain; contributing to their stress-reducing benefits. These interventions facilitate increased parasympathetic tone (associated with states of calm), which offsets the heightened sympathetic activity (associated with stress and anxiety). Additionally, breathing practices can influence neural circuit dynamics, cognition, and mood through the process of synchronising the rhythm of breathing with the rhythm of brain activity (Ashhad et al., 2022). This synchronicity works both ways where altered respiratory patterns (such as changes in depth and frequency) can affect and be affected by different emotional and cognitive states (Masaoka et al., 1997; Sellakumar et al., 2015).

One of the main differentiators of common breathing techniques is the emphasis on the relative duration and intensity of inhales versus exhales (Balban et al., 2023). Exercises where you exhale longer than you inhale (and vice versa) will have different effects on the body. While in this article we will focus on a few select exercises, bear in mind that many exist that encompass these basic principles.

Nose vs. mouth breathing

Nasal breathing and mouth breathing represent two distinct respiratory patterns, each with unique physiological implications. Nasal breathing offers several advantages over mouth breathing. The nasal passages are equipped with hair-like structures (cilia) and mucous membranes, which serve to filter, warm, and humidify incoming air, thereby optimising respiratory function (Bustamante-Marin & Ostrowski, 2017). Nasal breathing also helps widen the blood vessels in the lungs (vasodilation) and improves how much oxygen the blood can absorb (Huberman, 2023). In contrast, mouth breathing bypasses these nasal mechanisms, leading to the inhalation of cooler, drier, and potentially unfiltered air. This may increase susceptibility to respiratory infections and exacerbate conditions such as asthma and allergies (Bustamante-Marin & Ostrowski, 2017). Additionally, nasal breathing promotes diaphragmatic engagement and optimal oxygen-carbon dioxide exchange, promoting a more efficient respiratory pattern and reducing the risk of over-breathing and associated respiratory alkalosis (Huberman, 2023). Overall, evidence suggests that nasal breathing has numerous physiological benefits compared to mouth breathing, underscoring the importance of adopting nasal breathing habits when possible for respiratory health.

Breathing for mood improvements and stress reduction

Breathing techniques have long been recognised as effective tools for stress reduction, supported by a wealth of evidence demonstrating their physiological and psychological benefits. Deep breathing exercises, which often emphasise a slow elongated exhale promote activation of the parasympathetic nervous system, leading to decreased heart rate, blood pressure, and muscle tension (Gerritsen & Band, 2018). These techniques enhance vagal tone, facilitating emotional regulation and stress resilience (Gerritsen & Band, 2018). Overall, evidence supports the efficacy of various breathing techniques and tools in alleviating stress and promoting emotional balance, highlighting their potential as accessible and cost-effective interventions for stress management. There exist many regulated breathing practices that can offer these effects, however, box breathing, cyclic hyperventilation, and cyclic sighing were found to be supported by robust evidence.

Box breathing

Box breathing, also known as "tactical breathing," involves inhaling, holding, and exhaling for equal amounts of time. Several studies support its effectiveness. Military personnel use box breathing for stress management and performance enhancement (Balban et al., 2023). It aids in concentration, focus, and lung function (Ahmed et al., 2021). Box breathing can also reduce stress, improve mood, alleviate symptoms of anxiety and panic, and decrease depression among chronic lower back pain patients (Huberman, 2023; Kim, 2008; Ahmed et al., 2021). Many healthy individuals experience chronic over-breathing during the day, under-breathing at night, and lack pauses between breaths (Huberman, 2023). Box breathing practice can address these issues and restore efficiency, and normal breathing patterns. When practiced in succession for a short period, these positive effects of box breathing can last throughout the day.

How do I practice box breathing?

The principle of this exercise is that the inhale, hold, exhale, hold should all be the same length (around 3 - 10 seconds each). The length of time should be challenging but manageable so choose a time that works for your current ability.

• Sit comfortably with your back straight.

• Inhale deeply through your nose for the count of your choice (3 - 10 seconds).

• Hold your breath for the same count.

• Exhale slowly and completely through your mouth for the same count.

• Hold your breath with your lungs empty for the same count.

• Repeat this pattern of breathing for 5 min, visualising a square as you inhale, hold, exhale, and hold again, then return to breathing normally.

As you improve, you will need to extend the length of the breaths.

Cyclic hyperventilation

Reflexively occurring “hyperventilation” has been linked with chronic anxiety and even panic, however, when practiced in a deliberate and controlled manner, hyperventilation is shown to have therapeutic effects (Meuret et al., 2005). Cyclic hyperventilation (CH) is a breathing technique characterised by alternating periods of inhales of longer duration and relatively greater intensity than exhales. CH works by triggering the release of adrenaline. When this is done intentionally during CH, it gives one the experience of maintaining a calm state with a lot of adrenaline in the body (as opposed to when it happens uncontrolled during life events). This is indicated to be important in helping people handle stress during life situations.

While understanding of how these specific inhale-exhale ratios influence autonomic activity and wellness is limited, cyclic hyperventilation has been studied in several contexts, including stress and depression reduction, and inflammatory response. One study suggests that CH may be a useful treatment for a variety of conditions associated with excessive or persistent inflammation; especially auto-immune diseases (Kox et al., 2014). Another study by Touskova et al (2022) found that depressive symptoms were reduced in participants. Finally, another study found cyclic hyperventilation to be associated with a significant decrease in perceived stress (Fincham et al., 2023). When practiced in succession for a short period, these positive effects of CH can last throughout the day.

*Individuals with certain medical conditions or panic disorders should consult a doctor before attempting cyclic hyperventilation to avoid potential adverse effects*

How do I practice cyclic hyperventilation?

• Sit comfortably in a chair or this can be practiced lying down.

• Inhale deeply (ideally through the nose but if that is not possible, inhale through the mouth) and then exhale passively through the mouth.

• Hold with the lungs empty for 15 seconds.

• Repeat steps 2 and 3, 25 - 30 times.

• Do a further 2 rounds of 25 - 30 breaths then return to breathing normally.

You can see a short demonstration of this exercise here:

https://www.youtube.com/shorts/TP-P0YukA94

Cyclic sighing

There is a long-known association between sighing and relief in both humans and animals. Various emotions, both positive and negative, prompt increased sighing. Studies indicate that sighing rates rise during moments of fear, desire, depression, and states of stress, aggression, or unpleasantness (Vlemincx et al., 2016). It's suggested that sighing acts as a psychophysiological reset, helping to restore the body's natural balance (homeostasis) both when it is disturbed. It follows that the practice of cyclic sighing, which is characterised by deep breaths followed by extended, relatively longer exhales, and has been associated with many positive effects. These include stress reduction, improvements, a lower resting heart rate, and resetting of the respiratory rate (Balban et al., 2023). This is a highly powerful technique, and it has been found that even one cyclical sigh has an immediate calming effect (Huberman, 2023). When cyclic sighing is practiced repeatedly for a short period, these positive effects can last throughout the day.

The study by Balban et al (2023) found cyclic sighing to be the most effective at improving mood and reducing respiratory rate compared to CH and box breathing.

How do I practice cyclic sighing?

• Sit down in a chair, or lie down if preferred.

• Inhale slowly, and once your lungs feel full, inhale again to maximally fill your lungs (the second inhale will likely be shorter in duration and smaller in volume than the first).

• Slowly and fully exhale all their breath through the mouth.

• Repeat this pattern of breathing for 5 minutes, then return to breathing normally.

Ideally, both inhales should be performed through the nose and the exhale through the mouth, but, if preferred, you can do the breathing entirely through the nose.

You can see a short demonstration here:

https://www.youtube.com/shorts/Sva2A9yXiM4

How long and often do I need to practice these exercises?

While a daily breathwork practice is best, practicing one or all of these exercises for 5 minutes each once or twice a week has been shown to make improvements in the parameters outlined.

In summary

Incorporating these evidence-based breathing exercises into daily practice can provide numerous physical, emotional, and cognitive benefits, contributing to overall health and well-being. There exist many breathing exercises that have been linked to positive effects, so you may want to explore alternative techniques and find the ones that resonate best with your preferences and needs. Consistency is important to see results and long-term benefits are usually observed after one month. However, you do not need to devote too much time in a day to practicing these breathing tools for them to be effective long-term. As research continues to uncover the profound physiological and psychological benefits of conscious breathing, its popularity is expected to continue growing as a fundamental pillar of self-care and health-promoting practices.

*Disclaimer*

The information presented in this article is for educational purposes only and is based on our interpretation of the current research. Individuals are recommended to consult with a qualified healthcare professionals or registered dietitians for personalised guidance and recommendations tailored to their individual needs and circumstances.

References

Ahmed, A., Devi, R. G., & Priya, A. J. (2021). Effect of box breathing technique on lung function test. Journal of Pharmaceutical Research International, 33(58A), 25–31. https://doi.org/10.9734/jpri/2021/v33i58A34085

Ashhad, S., Kam, K., Del Negro, C. A., & Feldman, J. L. (2022). Breathing rhythm and pattern and their influence on emotion. Annual Review of Neuroscience, 45, 223–247. https://doi.org/10.1146/annurev-neuro-090121-014424

Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports. Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895

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Fincham, G. W., Kartar, A., Uthaug, M. V., Anderson, B., Hall, L., Nagai, Y., Critchley, H., & Colasanti, A. (2023). High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications. Neuroscience and Biobehavioral Reviews, 155, 105453. https://doi.org/10.1016/j.neubiorev.2023.105453

Gerritsen, R. J. S., & Band, G. P. H. (2018). Breath of life: The respiratory vagal stimulation model of contemplative activity. Frontiers in Human Neuroscience, 12, 397. https://doi.org/10.3389/fnhum.2018.00397

Huberman, A. (2023, February 20). How to breathe correctly for optimal health, mood, learning and performance: Huberman lab podcast [Video file]. YouTube. https://www.hubermanlab.com/episode/how-to-breathe-correctly-for-optimal-health-mood-learning-and-performance

Kim, S. H. (2008). Power breathing: Breathe your way to inner power, stress reduction, performance enhancement, optimum health and fitness. Turtle Press.

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Petraskova Touskova, T., Bob, P., Bares, Z., Vanickova, Z., Nyvlt, D., & Raboch, J. (2022). A novel Wim Hof psychophysiological training program to reduce stress responses during an Antarctic expedition. Journal of International Medical Research, 50(4). http://doi.org/10.1177/03000605221089883

Sellakumar, G. K. (2015). Effect of slow-deep breathing exercise to reduce anxiety among adolescent school students in a selected higher secondary school in Coimbatore, India. Journal of Psychological and Educational Research (JPER), 23(1), 54-72.

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