• Karla Benzl, M.D.

Three Proven Breathing Techniques to Counteract Stress

Updated: Nov 5, 2020

Stress is an inevitable part of life. However, there are ways to cope. Your biggest allies when it comes to stress management include healthy diet, good sleep, exercise, social connection, meditation, and spiritual practices. All are equally important for well-being. Ideally, they should be practiced consistently during times of stress, as well as times of calm. If you are currently limited in time and resources, however, I recommend starting with breathing exercises. They are relatively simple to do and require minimal resources. Breathing practices are ancient techniques used by many cultures to help calm the mind. Not surprisingly, modern day research supports the use of such practices for conditions like anxiety , depression, insomnia, and PTSD. (2) Other benefits associated with breathing practices include: increased ability to bond with others, decreased BP, decreased HR, increased heart rate variability, and decreased levels of stress hormones.(2,3,4,5)

Before exploring different breathing techniques, I will explain why they work. This involves understanding some basic physiology (feel free to skip this part and go straight to the exercises listed below). The autonomic nervous system plays a role in our response to stress. It is a part of the nervous system that involuntarily regulates important processes such as breathing, temperature control, and digestion. The autonomic nervous system can further be divided into the sympathetic branch and the parasympathetic branch. The sympathetic branch activates the body. For example, it increases heart rate, raises blood pressure, and stimulates the release of energy. When the mind perceives stress, the sympathetic nervous system becomes active, preparing the body for “fight or flight” by triggering the release of stress hormones such as adrenaline. When the sympathetic nervous system activates, blood is shunted to the large muscles of the arms and legs, the heart starts pumping harder and faster, the pupils dilate, and sweating occurs. The parasympathetic nervous system, on the other hand, stimulates digestion, lowers blood pressure, decreases heart rate, and allows for restoration and rebuilding of organs. The parasympathetic nervous system allows normal bodily processes to function, and is associated with the phrase “rest and digest.” Imbalances of the autonomic nervous system are associated with prolonged stress, anxiety, insomnia, and PTSD (post-traumatic stress disorders). In such conditions, the sympathetic branch is in overdrive.

Restoring balance to the nervous system is vital to counteracting stress. You can do this by actively engaging the parasympathetic nervous system through your breath.

The following paragraphs will outline three different techniques to slow down the breath. I recommend practicing these techniques regularly. Many of these techniques can be practiced on the go, but should also be done routinely, for at least 15 minutes, once or twice a day. Commit to 3 months to see optimal results.

1) Consciously counting the breath is a helpful technique to slow down your breathing. This involves timing your inhalations and exhalations. A popular counting sequence involves breathing in for 4 seconds, holding the breath for 7 seconds, and then exhaling for 8 seconds. This allows you to adjust your rate of breathing to the actual metabolic demands of the body, as breathing too fast paradoxically leads to less oxygen delivery to your cells.(5) You can practice this technique wherever you are. It can be helpful for those who are prone to panic attacks, since it will counteract hyperventilation. Lengthening the exhalation relative to the inhalation helps activate the parasympathetic nervous system.(2) Another effective sequence is 4-4-6-2 (4 seconds on the inhalation, 4 second pause, 6 second exhalation, 4 second pause).

2) Diaphragmatic breathing refers to bellying breathing, and is a way to deepen the breath by filling the lungs to capacity. The length of inhalations and exhalations can be equal, or timed to follow a counting sequence as mentioned above. To learn how to do diaphragmatic breathing, you can start by lying on your back and placing a pillow on your abdomen. As you breathe in, expand your abdomen to allow your lungs more space to draw in air. You should notice the pillow rise and fall with each inhalation and exhalation. Try this for several minutes daily, until you are able to practice diaphragmatic breathing without the pillow. This technique has been shown to lower cortisol, a stress hormone. It has also been shown to increase melatonin, the hormone responsible for inducing sleep (and is also a potent antioxidant).(6)

3) Alternate nostril breathing (ANB) involves breathing in through one nostril, pausing, and then exhaling through the opposite nostril. Breathing unilaterally through the right nostril activates the sympathetic nervous system, and breathing unilaterally through the left nostril activates the parasympathetic nervous system. The goal of this practice is to balance the the nervous system. In one study, patients who were randomized to practice ANB had lower perceived stress scores, lower blood pressure, and decreased heart rate when pre and post-intervention measurements were taken. They were instructed to practice ANB for 30 mins once a day, 5 days a week, for 12 weeks.(1) Follow these steps to practice ANB:

· Sit up straight and soften the abdomen.

· Cover your right nostril with your right thumb

· Inhale through the left nostril while slowly counting to 6 seconds.

· Hold your breath while counting to 6.

· Cover your left nostril with your right ring finger, and uncover the right nostril.

· Exhale through the right nostril for 6 seconds.

· Inhale through your right nostril for 6 seconds

· Hold the breath in for another 6 seconds.

· Repeat two or three more rounds. Note that some people use a longer interval, such as 10 seconds.

As you practice these techniques, you will notice that your breathing influences how you feel, and vice versa. You may notice when feeling stressed, that your breathing becomes rapid and shallow, therefore contributing to sensations such as shortness of breath, dizziness, and/or tingling in the extremities. On the other hand, when you are calm and relaxed, you will notice that your breathing is deep and slow. This type of breathing sends feedback to the brain that all is well. When you are conscious of your breath, you will have more control over how your body responds to stress.

This article has been adapted for children: https://www.resiliencykids.com/post/3-ways-to-teach-breathing-techniques-to-kids

Works Cited:

1. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time. Int J Yoga. 2014 Jan;7(1):60-5.

2. Brown RP, Gerbarg PL, Muench F. Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatr Clin North Am. 2013 Mar;36(1):121-40. doi: 10.1016/j.psc.2013.01.001.

3. Gerbarg PL, Muskin PR, Brown RP. Complementary and Integrative Treatments in Psychiatric Practice 1st Edition. 241-248.

4. Martarelli D, Cocchioni M, Scuri S, Pompei P. Diaphragmatic breathing reduces exercise-induced oxidative stress. Evid Based Complement Alternat Med. 2011;2011:932430. doi: 10.1093/ecam/nep169. Epub 2011 Feb 10.

5. McKay M, Zuercher-White E. Overcoming Panic Disorder and Agoraphobia- Therapist Protocol (Best Practices for Therapy. Therapist Protocol) Paperback – May 1, 1999

6. Sunil NaikG, Gaur GS, Pal GK. Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters Int J Yoga. 2018 Jan-Apr; 11(1): 53–58.

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