Voluntary Control of Respiration Patterns, In: A Clinical Guide to the Treatment of the Human Stress Response

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Citation

Everly, G.S., Lating, J.M. (2019). Voluntary Control of Respiration Patterns. In: A Clinical Guide to the Treatment of the Human Stress Response. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9098-6_15

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Note: You can share anything you want from these 411s—the more sharing the better. But this is my attempt to condense the findings into a bite-sized wisdom nugget:

A chapter in “A Clinical Guide to the Treatment of the Human Stress Response” found that controlled diaphragmatic breathing is one of the most effective methods for reducing excessive stress. They concluded: “Any clinician treating patients who manifest excessive stress syndromes should consider controlled respiration as a potentially suitable intervention for virtually all patients.”

4 Fundamentals

 

1. Essential Background Material

 

  • Breath control is one of the oldest and most effective methods of reducing stress, having been used for thousands of years to induce a state of calm.

  • From a clinical standpoint, they present three very general types of breathing:

    • Clavicle: Shallow “vertical” breathing where the shoulders move up and down, and the chest moves slightly.

    • Thoracic: Greater expansion of the rib cage followed by vertical movement of the shoulders. 

    • Diaphragmatic: The deepest form of breathing, relying primarily on the diaphragm, resulting in the greatest blood oxygenation.  A full diaphragmatic breath fills the belly, expands the ribcage, and finally, the shoulders move slightly.

  • Although all three patterns are essential to understand, diaphragmatic breathing is generally regarded as the most effective for reducing stress, so that’s what this book chapter focuses on.

  • In their words: “Any clinician treating patients who manifest excessive stress syndromes should consider controlled respiration as a potentially suitable intervention for virtually all patients.”  The rest of this will look at why that’s so.

 

 

2. What Did this Research Do?

 

This is a book chapter, so it’s not a formal research study.  It’s more of a broad overview of how diaphragmatic breathing can help reduce stress. 

 

It has three main parts: “Mechanisms of Action,” “Clinical Research,” and “How to Implement.”  Let’s look at the key points from each of these.

 

 

3. What Were the Major Findings?

 

Mechanisms of Action

 

  • In general, diaphragmatic breathing works by reducing the activity of the sympathetic (fight-or-flight) branch of the nervous system and increasing the action of the parasympathetic (rest-and-digest) branch.

  • This is accompanied by reduced activity in the amygdala, which helps calm the mind.

  • Moreover, longer exhalations typically associated with diaphragmatic breathing play a key role in eliciting the relaxation response and reducing activity in the amygdala and hippocampus (the latter portion potentially being significant in organizing emotional responses and for learning and memory).

  • Additionally, diaphragmatic breathing may activate stretch receptors in the lungs that reduce metabolism and increase parasympathetic dominance.

  • Lastly, aside from pure physiological mechanisms, breath control may give people a sense of agency and provide a means of controlling obsessive thought patterns.

 

That all sounds pretty awesome.  Let’s now look at what clinical research has shown.

 

Clinical Research

 

They describe around 10 general findings on slow diaphragmatic breathing.  Some key themes and results include:

  • Slow diaphragmatic breathing can reduce arousal and skin conductance (meaning less sympathetic activity) in subjects about to receive mild electric shocks.

  • It can reduce both psychological and physiological (as measured by cortisol) stress.

  • It can reduce performance stress and anxiety, such as that associated with test taking.

  • It has been shown to help with panic disorder and PTSD.

  • It can help with reducing asthma symptoms in both children and adults.

  • It can decrease the severity of motion sickness symptoms.

 

  

4. Why Do These Results Matter?

 

These findings are significant because they show that diaphragmatic breathing is versatile, helping many conditions related to excessive stress.  Moreover, it’s simple to learn and can be applied to a wide range of conditions.

 

Here, it’s important to point out the only potential side effect of deep breathing: unintentional hyperventilation.  When instructed to “take a deep breath,” people often interpret this as taking a big breath and overbreathe.  Additionally, they often compensate by taking much bigger breaths if they are breathing slower than usual.

 

Thus, they suggest that careful attention be taken to ensure people breathe deeply and slowly without hyperventilation.  Symptoms of hyperventilation to look out for include dizziness, chest pain, feelings of suffocation, and a racing heart, among many others.

 

However, this is relatively easy to overcome, making diaphragmatic breathing an excellent first-line treatment for stress.  This brings us back to the quote from earlier: “Any clinician treating patients who manifest excessive stress syndromes should consider controlled respiration as a potentially suitable intervention for virtually all patients.”

 

 

 

1 Big Takeaway

 

Controlled diaphragmatic breathing is one of the simplest and most effective methods for reducing excessive stress that can be easily taught and safely used in essentially any condition or setting.

 

 

 

1 Practical Application

 

The authors provide several easy exercises that any clinician can implement.  Most reduce breathing to 6.5-10 breaths a minute, faster than we usually discuss here.  However, when dealing with people experiencing excessive stress, starting at these slightly faster rates may be helping because slower speeds might feel too challenging.  This would then cause additional stress associated with the exercise itself, which is not what we want.

 

The general instructions they provide are:

 

  1. Inhale through the nose to the point of fullness that doesn’t cause strain (generally 2-3 seconds)

  2. Pause the breath (typically 1-2 seconds).  If the air feels like it “bursts out” after the pause, then it was too long.

  3. Exhale steadily and smoothly through the mouth or nose (generally 2-4 seconds).

  4. Pause slightly, ensuring the next inhale occurs quietly and smoothly (1-2 seconds max).

 

If you’re a breathing coach, consider using these straightforward guidelines when you work with people with excessive stress 🙏