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While not a stand-alone treatment for anxiety disorders, breathing exercises can indeed play an important role in managing anxiety. What do you need to know?

We often take breathing for granted. It is, after all, a natural act that just happens. But if you suffer from an anxiety disorder and have experienced hyperventilation (overbreathing), it can feel like a life or death matter for a few minutes and have big physiological effects.

Anxiety and panic attacks make you feel like you're facing a great danger or threat, and if you add the hard physical work that is hyperventilating, it can cause symptoms like dizziness, confusion, blurred vision, increased heart rate, numbness in extremities, and of course breathlessness.

It's important to understand that respiration is the only physiological system that is both under autonomic and voluntary control, and this is where breathing exercises make their appearance as a therapeutic option.

Breathing training and anxiety

Breathing exercises are widely used techniques that focus on counteracting the nervous system arousal that comes with chronic anxiety. They can benefit you not only if you have a diagnosed anxiety disorder, but also if you're simply looking for a relaxation technique to face any stressful situation.

In the treatment of Generalized Anxiety Disorder (GAD) and Panic Disorder (PD), breathing exercises should be taught as coping mechanisms when worries or highly demanding situations take place and an anxious response may occur. These are included in the part of the treatment that handles psychoeducation and frequent monitoring of anxiety symptoms, which must be taken as therapeutic priorities instead of just auxiliary measures.

Breathing exercises teach and help you to reduce shallow chest breathing that comes with chronic hyperventilation. Learning to breathe properly through specific techniques has a dual purpose:

  • It prevents an imbalance between oxygen intake and carbon dioxide levels to take place (with the following negative physical sensations)
  • It induces a subjective state of relaxation and calm, promoting a feeling of self-control.

What breathing exercises can you use?

Diaphragmatic breathing

The basic principle of this exercise is the manipulation of breath movements to turn chest expansion into abdominal expansion when breathing, contributing to a physiological immediate response of decreased oxygen consumption, heart rate and blood pressure. This technique can be taught by a professional, but it can also be independently learned through audio or video platforms that explain how to pace breathing into slower and deeper breaths, which ultimately leads to a state of relaxation. It needs to be practiced for a couple of minutes several times a day, or as needed, to see short-term benefits.

Pursed-lip breathing

This is a fantastic technique for symptomatic relief of acute shortness of breath because of anxiety. It's practiced by focusing on achieving active expiration through pursed lips, prolonging the exhalation phase and ultimately reducing respiratory frequency and preventing hyperventilation.

Yogic breath regulation (pranayama)

Breath regulation is an integral part of the ancient practice of yoga. Various yoga breathing exercises with available scientific evidence include modifications in the pace of breathing, manipulation of the nostrils, chanting of humming sounds and retention of breath, among others. Some that are easily done and require little training are:

  • Alternate nostril breathing (Nadishodhana/Nadishuddi). Using the right thumb, close the right nostril and inhale through the left nostril. Then, close the left nostril and exhale through right nostril, inhaling through the same side and following subsequently through the opposite nostril. This is one round and it can be repeated as desired.
  • Bellow's breath (Bastrika). This is performed by inhaling and exhaling quickly and forcefully without straining by flapping the abdomen. For better results, it should be practiced up to 100 breaths.
  • Uninostril breathing (Suryanuloma Viloma and Chandranuloma Viloma). Both inhalation and exhalation should be done through the same nostril, closing the other one and without altering the pace of breathing.
  • Kapalabhati. Sitting in a relaxing environment, with a straight back and neck, this is done by inhaling through both nostrils and exhaling rapidly by flapping the abdomen during each exhalation at a pace of 60 and up to 120 breaths per minute.
  • Psychic breath (Ujjayi). Inhaling and exhaling through the nose at a normal pace, and being aware of the passage of air through the throat during the practice, one must produce a light snoring sound.
  • Active expiration. This exercise is about contracting the abdominal muscles as much as it can be done to increase pressure during expiration and push all the air out of the lungs. This focused exhalation will eventually lengthen the exhalation and draw more air in through inspiration.

Can anyone use breathing exercises?

Breathing training can be a great measure if you're dealing with an anxiety disorder. Not only is your breath the safest of all places to focus your awareness, but it can also literally dissolve stress. The only relative contraindication of these techniques is for people with medical conditions affecting the respiratory system (Chronic Obstructive Pulmonary Disease, asthma), who should consult with their physician first. However, is not always contraindicated since it can also be part of pulmonary rehabilitation programs.

One of the greatest advantages of breathing exercises is that they can be done anywhere, at any time, and with zero cost. If you want to start practicing them but don't know how, just begin by paying attention to your breath on a daily basis, observing it without trying to change it, and as you progress, practice the exercises as previously shown.

  • Photo courtesy of SteadyHealth
  • rc.rcjournal.com/content/59/2/209.full
  •  https://books.google.es/books?hl=es&lr=&id=W1rLL2BYPqgC&oi=fnd&pg=PA166&dq=breathing+exercises+for+anxiety&ots=27_BIf8vnt&sig=dAglGrs7jU3uzwIOMpKZDNWJ3TM#v=onepage&q=breathing%20exercises%20for%20anxiety&f=false
  •  http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.851.7680&rep=rep1&type=pdf
  •  https://academic.oup.com/painmedicine/article/13/2/215/1936333
  •  https://reader.elsevier.com/reader/sd/pii/S0975947617303224?token=FDA7BE05FA749FD5FEBF05989A75952072000DF732EA171A1EF4F882341A74BD82FAA35686BD7901770BE2AC8938967B
  •  ​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018827/

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