Deep breathing: A “simplistic” technique with many benefits
Deep breathing (or abdominal breathing, diaphragmatic breathing, belly breathing, rhythmic breathing, mindful breathing) is a tool that can achieve a sense of deep relaxation after only a few minutes. It is a simple, cost-effective, and readily available technique with very few adverse effects that can be done by a person of any age. It is flexible and can be carried out in a variety of different ways. It can be used on its own or combined with other relaxation exercises (e.g., visualization, progressive muscle relaxation).
Use it when you are faced with a stressful situation, or as a way to prevent your body from accumulating excess stress and its negative effects.
What happens during deep breathing?
Deep breathing optimizes the use of the diaphragm – the main muscle of breathing. It is a dome-shaped muscle located just below your lungs. During breathing exercises, emphasis is placed on using your abdomen rather than your chest for breathing. When you breathe with your chest, breathing is shallow and air is only drawn into the top of the lungs. But when you inhale using your diaphragm, breathing is deeper, and you draw air all the way down into the bottom of your lungs. During exhalation, the diaphragm returns to its dome-like shape – effectively emptying the lungs of air.
How can slow, deep breathing make us feel relaxed?
Breathing is closely related to our nervous system. When we are stressed, the sympathetic nervous system (“flight-or-fight”) is triggered. This includes many physiological changes, including an increase in heart and respiration rate. In contrast, the parasympathetic nervous system (“rest-and-digest”) brings about opposite effects, thus making us feel relaxed. A key component of this relaxation system is the vagus nerve, whose activity is controlled by respiration. If we breathe in a certain way (slowly with longer exhalations), we can directly activate this nerve. This inhibits the flight-or-fight stress response and shifts the body into a calm state (The proposed mechanisms underlying deep breathing and relaxation are quite complex and fascinating – readers interested in the detailed physiology are referred to the article of Gerritsen & Band, 2018, see in reference list).
Are there benefits?
Studies show that breathing exercises benefit both physical and mental health. For example, deep breathing can strengthen your diaphragm, lower stress levels; improve attention, decision-making and mood; promote feelings of being in control; provide pain relief; lower cortisol and adrenal levels; increase antioxidant markers; lower oxidative stress and free radicals; and lower blood pressure. Thus, breathing can be a reliable way to bring your anxious body back to baseline before you act. Furthermore, it is often a part of treatment plans for various medical and psychological conditions.
If you practice this style of breathing for longer periods (i.e., for at least a month), you will begin to retrain yourself to breathe from your abdomen consistently and naturally, while focusing on your daily activities. This can then produce an overall feeling of relaxation on an ongoing basis and an increased ability to better deal with stress in the future.
Is there a “right way” to breathe?
An online search of deep breathing will reveal various breathing techniques. They may differ, for example, by the pattern of inhalations and exhalations. Whereas some sources encourage that your exhale be longer than your inhale (skewed pattern), others report that your in-breath and out-breath can be of equal length (symmetrical pattern). A recent research study (2019) found that both these patterns can increase vagal nerve activity, with the skewed pattern having the added benefit of improving decision-making as well. Several other studies conclude that when you extend your exhale, you can maximize relaxation effects.
Numerous other variations have also been proposed (e.g., pausing after inhalation and/or exhalation; oral vs nasal breathing; tongue placement; saying a relaxing word to yourself upon inhalation/exhaling). Examples of variations include the 4-7-8 technique; pursed lips method; unilateral nostril breathing; and loaded breathing.
Although more research is needed, it has been proposed that different deep breathing techniques may have different effects on physiological systems –thus be more or less effective in specific conditions or diseases. Therefore, the most important part when starting breath work is to experiment with different approaches and find one that works for you. Regardless of the specific technique you choose, follow some general guidelines to improve the efficiency of the exercise (see below).
That being said, based on the latest research and my own personal experience, I’m going to describe the technique of diaphragmatic breathing using extended exhalations.
Are there any contraindications for deep breathing?
Diaphragmatic breathing is not always helpful as a standalone treatment. For people with anxiety disorders or similar conditions, this tool could temporarily increase your feelings of anxiety, as you might feel the technique isn’t working. If this happens, rather try different coping techniques to ease your anxiety, or talk to your psychologist/doctor about combining breathing techniques with other treatment strategies.
People diagnosed with medical conditions affecting the respiratory system, such as asthma or chronic obstructive pulmonary disease (COPD), should first consult with their doctor before attempting deep breathing exercises. However, seeing as respiratory patients are often also taught how to breathe more effectively, these techniques may not always be contraindicated for these patients.
Patients who fear panic attacks and who are undergoing exposure-related treatments are also discouraged from using deep breathing when they sense panic related symptoms. These patients could use breathing as a general relaxation strategy, but if they use it to counter panic symptoms, then their fears that these symptoms are dangerous are maintained.
Deep diaphragmatic breathing:
General principles:
| Practice at times when you are not feeling stressed | The more you practice when you are feeling calm, the easier it is at times when you’re anxious. You will learn how it feels to switch your body from anxious mode to relaxation mode |
| Find a quiet place | You can even do it at a regular time every day so that it becomes a habit. |
| Be comfortable | You can do this exercise seated, standing up or lying down. If you are tired, rather do it straight up, as deep breathing while lying down can cause you to fall asleep (Unless that was the goal!).
Breathing should never be painful! If you are feeling too restless to remain seated, do this exercise while walking: Synchronize your steps and breathing (e.g., Breathe in for 3 steps, breathe out for 3 steps). |
| Eyes | Close your eyes or keep them open while staring at the floor slightly ahead of you. |
| Hands | Place your one hand on your belly (just below your ribcage) and the other hand on your chest |
| Practice for at least 5 minutes | If you are unable to practice for the full time, start practising for 1 minute a day. Gradually add a minute to your time after 1 – 2 weeks until you reach 5 mins a day |
| Slowly (6 breaths per minute) | The typical breathing rate in humans is 10 – 20 breaths per minute.
Slow breathing will be anything less than 10 breaths per minute. Aim for 1 breath every 10 seconds (or 6 breaths per minute). If desired, breathe even slower (be careful for light-headedness). If it is a bit challenging to breathe so slowly, start with 10 breaths per minute, and gradually reduce the number of breaths to a comfortable pace. This may take several weeks of practice. |
| Inhalation | Breathe in slowly through your nose. Feel how your belly fills up with air like a balloon.
Your hand on your belly should rise up (if you’re lying down) or outwards (if you’re sitting). |
| Exhalation | Breathe out slowly through your nose or mouth.
Empty your lungs as completely as possible. Your hand on your belly should go back down. Recommended: When breathing out through your mouth, purse your lips as if blowing out candles on a cake Recommended: Your exhale should be longer than your inhale. Choose a ratio that is comfortable. For example: · Breathe in for 3 counts, breathe out for 7 counts; or · Breathe in for 4 counts, breathe out for 8 counts |
| Shoulders, chest, and ribcage | These should remain relatively still as you inhale and exhale (I.e., your hand on your chest should barely move) |
| Stop wandering thoughts | Try to be fully present in the moment, rather than chasing after worrying thoughts.
For example: · You can focus on the sound and physical sensation of your breathing. · You can count each breath as you exhale. · You can visualize a peaceful scene or memory. · Write down your worry on a piece of paper and attend to it after the exercise |
| Do not try to relax | Don’t pressure yourself, judge your performance or worry about the outcome of this technique.
Stop focusing on if it’s working. If you’re constantly monitoring your anxiety, it can override the relaxing response. Just let go and follow each step of the exercise. |
| Apply it to stressful situations | Once you feel proficient in this technique, apply it in stressful situations |
Step-by-step instructions:
Please read the general principles of diaphragmatic breathing (see above) before starting this exercise.
- Sit or lie down in a comfortable position.
- Inhale slowly through your nose for 4 counts
- Exhale slowly through pursed lips. Gradually lengthen the exhale.
For example: Start by breathing out for 4 counts. After each minute, increase the number of counts that you exhale until you reach a ratio of 4 counts of in-breath and 6 counts of out-breath
4 counts in, 4 counts out…
4 counts in, 5 counts out…
4 counts in, 6 counts out…
- After the exercise, return to your normal breathing.
It didn’t work when I tried it…
People may report that they’ve tried deep breathing and it didn’t work. Deep breathing is just one of many coping tools, and some people might not prefer it. There are also certain contexts or conditions in which breathing could be less successful. However, most of the time its limited success can be attributed to one/more of the following reasons:
- Not distinguishing diaphragmatic breathing from chest breathing.
- Not following the general principles for deep breathing.
- Not practicing during non-stressful times.
- Only using it at stressful times.
- Engaging in anxious thoughts while breathing.
- Not breathing long enough.
If you suspect that any of these reasons may be a culprit, I encourage you to try again. You may be pleasantly surprised!
References and Further Reading
Books and Websites:
Bergland, C. (2019). Longer exhalations are an easy way to hack your vagus nerve: Respiratory vagus nerve stimulation (rvns) counteracts fight-or-flight stress. Retrieved from https://www.psychologytoday.com/za/blog/the-athletes-way/201905/longer-exhalations-are-easy-way-hack-your-vagus-nerve
Bourne, E. J. (1995). The anxiety & phobia workbook (2nd Ed.). New Habinger Publications, Inc. Oakland, CA.
Gillihan, S. J. (2019). How to reduce anxiety with every breath: Use these five principles to calm your nervous system. Retrieved from https://www.psychologytoday.com/za/blog/think-act-be/201910/how-reduce-anxiety-every-breath
Grande, D. (2021). The Simplest Stress Management Skill: How to do it and why it works. Retrieved from https://www.psychologytoday.com/us/blog/in-it-together/202107/the-simplest-stress-management-skill
Leahy, R. L., & Holland, S. J. (2000). Treatment plans and interventions for depression and anxiety disorders. The Guilford Press: New York, NY.
Wei, Marlynn. (2022). This Slow-Breathing Exercise Can Reduce Stress and Anxiety. Retrieved from https://www.psychologytoday.com/us/blog/urban-survival/202204/slow-breathing-exercise-can-reduce-stress-and-anxiety
Journal articles:
De Couck, M., Caers, R., Muscha, L., Fliegaufe, J., Giangrecoe, A., Gidron, Y. (2019). How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. International Journal of Psychophysiology, 139, 1–9.
Drigas, A., & Mitsea, E. (2022). Conscious breathing: A powerful tool for physical & neuropsychological regulation. The role of mobile apps. Technium Social Sciences Journal, 28, 135-158.
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), 1–25.
Gholamrezaei, A., Van Diest, I., Aziz, Q., Vlaeyen, J. W. S., & Van Oudenhove, L. (2021). Psychophysiological responses to various slow, deep breathing techniques. Psychophysiology, 58 (e13712).
Hopper, S. I., Murray, S. L., Ferrara, L. R., & Singleton, J. K. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database of Systematic Reviews and Implementation Reports, 17(9), 1855-1876.
Laborde, S., Allen, M. S., Borges, U., Dosseville, F., Hosang, T. J., Iskra, M., Mosley, E., Salvotti, C., Spolverato, L., Zammit, N., & Javelle, F. (2021). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience and Biobehavioral Reviews, 138, 104711.
Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Scientific Reports, 11(1), 19267.
Russo M. A., Santarelli D.M., O’Rourke D. (2017). The physiological effects of slow breathing in the healthy human. Breathe, 13, 298–309.
Van Diest I., Verstappen K., Aubert A. E., Widjaja D., Vansteenwegen D., & Vlemincx, E. (2014). Inhalation/Exhalation ratio modulates the effect of slow breathing on heart rate variability and relaxation. Applied Psychophysiology and Biofeedback, 39(3-4), 171-80.
Vierra, J., Boonla, O., & Prasertsri, P. (2022). Effects of sleep deprivation and 4-7-8 breathing control on heart rate variability, blood pressure, blood glucose, and endothelial function in healthy young adults. Physiological Reports, 10(e15389).
