Breathing Exercises for Stress, Anxiety & PTSD

I’ve been working on 3 articles about PTSD and the Healing Powers of the Breath. They are coming along, but I decided I first want to compile a bunch of actual exercises into a post and “Just Do It.” Do the exercises first and discuss the whole subject in depth later.

Briefly, the basic principle is:

Holding your breath, shortness of breath, constrained and tense breath, rapid breath = survival, fight/flight/freeze, activation of the nervous system, stress.

Natural, full, diaphragmatic breaths = opening up to life beyond survival, opening up to calmness, regulation of the nervous system, bringing about physical relaxation, improving health, being able to think.

For PTSD specifically, conscious breathing seems to act as a nervous system interrupter. The survival brain gets stuck in this pattern: stimulus in environment (trigger) leads to automatic response of autonomic nervous system (shallow breathing). Taking control of the breathing interrupts this circuitry and breaks the cycle.

Here’s a quote for ya: “Of all the various functions of our autonomic nervous systems, from heart beat, perspiration, hormonal release, gastrointestinal operation, neurotransmitter secretion, etc., the breath stands alone as the only subsystem the conscious mind can put into ‘manual override’ and so it is through manipulation of the breath that we can recalibrate the entire system.” (source)

Triggers can be maddening, so I’m thinking it would be a good idea to make a genuine effort to incorporate more of these breathing exercises into my life, especially when things get really bad.

Two Breathing Tests Prove I Suck at Breathing

Before getting into the exercises, I want to point out that there are tests online to measure how you are doing with your breathing.

As for myself, I breath shallow, relatively quick, tense breaths, even sometimes while I sleep. I’m pretty sure I suck very much at breathing.

First Breathing Test

Just to verify this, I took this breathing test and, indeed, according to the test my breathing pattern allows for an amount of oxygen in my system similar to that of a person with a serious physical disease.

To do the test: inhale and exhale as you normally do and then hold your breath. Time the number of seconds you are able to hold before experiencing discomfort. Begin breathing again the moment you can begin to breathe again in the same rhythm you were prior to counting. In other words, you resume breathing and stop counting the moment that, if you were to hold your breath beyond that point, you would feel discomfort and need to take in more air on your next in-breath than you take in during a normal in-breath. (This is not “extended pause length” in which you hold for as long as possible through low and medium discomfort)

In the video, the presenter Artour Rakhimov says, “Breath holding time can be as low as 5-7 seconds when people are severely sick.” 20-40 seconds is considered healthy.

My score was 11 on average. I did the test 15 times while alternating with removing my bra and putting it back on. There was a 2.75 second longer hold time with my bra off but results were a little erratic and probably not repeatable. Undoing my pants didn’t change anything though. I thought my clothes were restricting my breathing but really I just suck at breathing.

It seems that a score of 11 is not severely sick but somewhere on the verge of sick. Then it’s not my imagination, even according to science my breathing is “sick”. (I do have injuries including to my lungs but I didn’t think I was that bad off).

Second Breathing Test

Out of curiosity I took another, more comprehensive, breathing test (It has about 30 sections and produces a huge report that is emailed to you at the end). This longer test also indicated that I am really quite bad at breathing. Here are just two of the variables they measured:

Complete Breaths per minute at rest.

Your Answer: 14

“Your breathing rate is much faster than what we consider healthy. It is correlated with many illnesses and excessive stress. If you want to improve your correlations, then you must work at lowering your breath rate. The desired rate is 5-6.”

And I honestly thought I was breathing slowly during this test. 🙁

Even that previous presenter, Artour Rakhimov from the first test stated, “Sick people breath about 15-20 times per minute,” so at 14, I’m again at the very verge of “sick.”

(The “normal” breaths per minute seems to vary by expert, but 14 seems to generally be considered not ideal. “Medical textbooks suggest that the normal respiratory rate for adults is only 12 breaths per minute at rest. Older textbooks often provide lower values (e.g., 8-10 breaths per minute)… Don Campbell and Al Lee, authors of ‘Perfect Breathing: Transform Your Life One Breath at a Time,’ agree that 10 or fewer deeper, slower breaths per minute is best for overall health” (source))

Breathing Pause Extension.

Your Answer: 17

“Your extended pause length is far below what is recommended. A low score can be an indicator of health challenge and excessive stress. The absolute minimum score recommended is 45, although the desired score is 60. To improve your extended pause, it is absolutely necessary to take action.”

So, I obviously need to just stop whatever I’m doing and do some breathing exercises.

STOP and BREATHE.

Breathing Exercises

Exercises To Try When Anxious or Triggered…

1. Simple and Relaxing – Four In, Four Out Slow Belly Breathing

Source: Psychology Tools

Also Called: Relaxed Breathing, 4 Count Breathing, 4-1-4-1 Breathing

The following is from the Psychology Tools download.

“When we are anxious or threatened our breathing speeds up in order to get our body ready for danger. Relaxed breathing (sometimes called abdominal or diaphragmatic breathing) signals the body that it is safe to relax. Relaxed breathing is slower and deeper than normal breathing, and it happens lower in the body (the belly rather than the chest).

Instructions:

1. Make sure you are sitting or lying comfortably.
2. Close your eyes if you are comfortable doing so.
3. Breathe through your nose rather than your mouth if that is comfortable for you.
4. Deliberately slow your breathing down.
5. Breathe in to a count of 4
6. Pause for a moment
7. Breathe out to a count of 4
8. Pause
9. Repeat
10. Make sure that your breaths are smooth, steady, and continuous – not jerky; pay particular attention to your out-breath – make sure it is smooth and steady

Am I doing it right? What should I be paying attention to?

Relaxed breathing should be low down in the abdomen (belly), and not high in the chest. You can check this by putting one hand on your stomach and one on your chest Try to keep the top hand still, your breathing should only move the bottom hand Focus your attention on your breath – some people find it helpful to count in their head to begin with (”In … two … three … four … pause … Out … two … three … four … pause …”)

How long and how often?

Try breathing in a relaxed way for at least a few minutes at a time – it might take a few minutes for you to notice an effect. If you are comfortable, aim for 5-10 minutes Try to practice regularly – perhaps three times a day

Variations and troubleshooting

Find a slow breathing rhythm that is comfortable for you. Counting to 4 isn’t an absolute rule. Try 3 or 5. The important thing is that the breathing is slow and steady Some people find the sensation of relaxing to be unusual or uncomfortable at first but this normally passes with practice. Do persist and keep practicing.”

Remember: If stressed, say slowly to yourself while breathing from your relaxed belly: “One, Two, Three, Four, Pause. One, Two, Three, Four, Pause.” Repeat for a few minutes.

2. For When You’re Super Anxious And Need a Quick Solution – Whole Body Muscle Tensing and Relaxing

This exercise switches on the parasympathetic nervous system (“relaxing” nervous system) more quickly than the others. It’s also more impactful than the others because it engages all the muscles of the entire body. This powerful impact can help you “snap out of it!” even in tough situations.

I gather that this exercise is a relative of Progressive Muscle Relaxation. In Progressive Muscle Relaxation, you relax and tense each muscle group progressively and reach deeper and deeper states of relaxation as you go. That takes time though. This one is more of an emergency measure. I’m calling it “Whole Body Muscle Tensing and Relaxing” because you do it with your whole body system at once rather than progressively. Because you tense and relax your whole body it’s much faster. If you are facing anything that is anxiety provoking, like a meeting or public speaking for example, this one can be done quickly. If you have more time, you can do it over again several times, or instead do Progressive Muscle Relaxation.

Instructions:

1. Take a very deep breath in with your mouth open; fill your lungs up.
2. Hold your breath.
3. While holding your breath, tense muscles all over your body as tense as you can – face, fingers, toes, shoulders, stomach, butt, legs etc. – without injuring yourself (if you have a known issue go easy on that part of your body)
4. Count 5-10 seconds while holding your breath and keeping all muscles tense.
5. Then relax everything, let go of all the tension in your muscles and
6. Slowly let your breath out.

Here is a video about this exercise. If you want to skip the intro, this is where he begins the exercise.

Here is a guided meditation video for Progressive Muscle Relaxation – this would be great to listen to while falling asleep at night.

3. To Break Out of Being Triggered – 4-4-4-4 Breathing

This exercise is from Lieutenant Colonel Dave Grossman. Grossman has trained thousands of law enforcement personnel how to teach this exercise to trauma survivors. He has found that having a trauma survivor do this exercise immediately after the traumatic event helps their nervous system regulate around the experience and may stop the extreme cycles of PTSD from getting started in their body.

Instructions:

1. Breathe in while counting to 4. Make it a deep, belly breath.
2. Hold your Breath while counting to 4.
3. Breathe out while counting to 4.
4. Hold your Breath while counting to 4.
5. Do this sequence 2 more times.

This exercise, as I understand it, is specifically for breaking the threat response cycle in the nervous system. There is perception of an overwhelming threat and the system goes into freeze/flight/fight response. The autonomic nervous system is telling the breathing to become shallow and fast in order to respond to the threat.

Then you step in and by using your voluntary muscles to open and close the breathing deliberately, slowly, fully and deeply, you are using the somatic nervous system (voluntary moving muscles) to influence something that, when in a trauma response, is under the control of the autonomic nervous system. The breathing acts as the bridge between the two systems.

Eventually, by putting this bridge into action, you break the connection between the threat and the breathing.

Although Grossman explains this sequence of physiological events really well in his article in relation to 4-4-4-4- Breathing, which he calls Autogentic Breathing by the way, this applies to all breathing exercises with the same characteristics.

For example, slow breathing in general seems to allow people to slow their entire system (mind, emotions,body) down enough to integrate pieces of what happened to them that came too quickly for their system to process during the event.

Additionally, deep breathing in general seems to allow emotional release and processing of the energy stuck in the body from the trauma (people may, after a while of breathing, begin crying, tingling, feeling hot or cold, releasing energies from the trauma).

All of the natural responses to trauma – the fight/flight response to stimulus, the arrested and unmoving state of not processing anything and repression of the energies and emotions from the trauma – are normally held static inside the body indefinitely to wreak havoc. Breathing is able to get a whole slew of things un-stuck and moving.

One video mentioned that, in the case of using any deep, slow breathing exercise when you are triggered, you can actually think about what you fear – the trigger – as you slow your breath. That would be interesting to try. The idea is to try to disconnect the thought of the trigger from the automatic response of fight and flight in the nervous system.

Very similar to this one is:

4. To Train The Mind and Body To Find Peace – 4-6-4-6 Breathing

Source : Sonia Choquette

Instructions:

1. Breath in for a count of 4
2. Hold for a count of 6
3. Breathe out for a count of 4
4. Hold for a count of 6

Click here to jump to where Sonia gives the instructions for this exercise in the video.

I like how she said to envision it like a rectangle.

“The 4-6-4-6 breath trains the mind to be peaceful.” – Sonia

Exercises to Try for Deep Relaxation…

5. For Soothing The Nervous System – The Sigh

Source : Sonia Choquette

This one is very soothing and healing exercise that is like a balm for the nervous system.

Click here to go to where Sonia gives the instructions for this exercise in the video.

Instructions:

1. Breath in.
2. When you breath out, open your mouth and exhale the air with the sound of the air releasing, a soft sigh sound.
3. Relax your shoulders, neck and other muscles and let everything go.
4. Do 3 or 4 times, or however many times feel right.

“It’s like being wrapped in a warm blanket; it calms the nervous endings, it quiets the brain, it ground the body, it expands the lungs…” -Sonia

6. For Deep Relaxation – Buteyko Small Breath Holds

This one is so relaxing. I think this is one of the best exercises I’ve done so far for entering deep relaxation. I really felt the switch she describes into the “relaxing nervous system,” the parasympathetic nervous system.

Instructions:

1. With your mouth closed, take a small, but calm and relaxed, breath in.
2. Take a small breath out.
3. Block your nose.
4. Hold for a count of 5
5. Release
6. Gentle, soft breathing in-between sets
7. Tongue rests at the roof of the mouth; Teeth slightly apart; jaw relaxed; Drop shoulders; relax chest and belly; Relax facial muscles.

For some reason I find following along to her voice in the video more relaxing than doing it on my own.

(unfortunately the video about this technique was removed from Youtube.)

Dr. Mercola has an article about the Butekyo method. This looks like the same exercise:

Breathing Exercise to Quell Panic Attacks and Anxiety

Another breathing exercise that can help if you’re experiencing anxiety or panic attacks, or if you feel very stressed and your mind can’t stop racing is the following: Take a small breath into your nose; a small breath out; hold your nose for five seconds in order to hold your breath, and then release to resume breathing. Breathe normally for 10 seconds. Repeat the sequence: Small breath in through your nose; small breath out; hold your breath for five seconds, then let go and breathe normally for 10 seconds. This sequence helps retain and gently accumulate carbon dioxide, leading to calmer breathing and reduces anxiety. In other words, the urge to breathe will decline as you go into a more relaxed state.

Something very interesting noted in that article by Dr. Mercola, and the video that accompanies it, is that heavy breathing contributes to anxiety. Patrick McKeown (the gentleman in the video) explains that: Breathing heavier due to stress reduces carbon dioxide in the blood due to exhaling too much of it; the loss of C02 causes blood vessels to constrict. The main blood vessel to the brain can constrict up to 50% thereby reducing bloodflow to the brain. In response, the individual over-breathes more. It’s important to keep breathing calm and quiet when stressed – a deep breath that is very calm is completely different than a big breath that is stressed. His book is called “Anxiety Free.”

7. For Centering and Integrating the Past – Alternate Nostril Breathing (a kind of Pranayama/Yoga Breathing)

Source: Giovanni Dienstmann; This breathing exercise is also featured on realwarriors.com.

I had great results with this practice during my self-tracking experiment.

Actually, any breathing exercise that includes very slow breathing helps pull me into my center and helps my body to integrate past experiences.

Instructions:

1. Sit down on a chair
2. Close the right nostril with your right thumb. Then inhale slowly through your left nostril.
3. Then close the left nostril with your right index finger and open the right nostril by removing the right thumb. Exhale very slowly through the right nostril.
4. Then draw the air through the right nostril as long as you can do it with comfort and exhale through the left nostril by removing the right index finger
5. This is one round. Do 12 rounds.
6. Note that for this, breathing in and out should be as slow, soft, steady and long as possible. But don’t force.
   The alternate nostril breathing harmonizes the whole nervous system and balances the activity of both hemispheres of the brain.

I got the best results when doing it 3 times for a total of 36 rounds.

There are many versions of alternate nostril breathing. Here is another one:

“One method of alternate nostril breathing that is easy to understand (when written down like this) is to exhale and inhale from one nostril five times. Then, do five times with the other nostril. That is called a “round.” Doing three rounds is a complete practice. …There are a variety of different patterns of doing alternate nostril breathing (such as the five on each side method).
This physical act really does have an effect on the autonomic nervous system, and allows one to become “centered” in such a way that both nostrils are flowing smoothly. In this state, the mind is also quite relaxed.” (source)

8. To Slow Your Heart Rate & Blood Pressure – 4-7-8- Breathing (a kind of Pranayama/Yoga Breathing)

For any breathing exercise, when the exhale is longer than the inhale this slows the heart rate and lowers blood pressure. When you pause after inhaling it slows the heart rate. Divers do breathing exercises to control their heart rate.

Also, for any breathing exercise that involves counting, the counting itself can be calming as well because of focusing your mind on something simple and rhythmic, something other than what is causing the stress.

Instructions:

These instructions are quoted directly from the blog “Madly In Love With Life”:

“You can do this exercise standing, lying down, or sitting in a chair (keeping your back straight and both feet on the floor). You may keep your eyes open or closed. Count at a comfortable pace for yourself and don’t force anything.

1. Begin by exhaling all the air out through your mouth.
2. Curl the tip of your tongue up to touch the hard ridge behind your upper front teeth and hold it there for the duration of the exercise.
3. Close your mouth and inhale through your nose for a count of 4. Don’t force it, but take a good breath as this has to last for the next 15 counts.
4. Hold your breath for a count of 7.
5. Open your mouth and exhale through your mouth (still pressing the tip of your tongue to the hard ridge behind your upper front teeth) for a count of 8. You will make a sound as the air moves around your tongue. You may want to purse your lips if this helps you to direct the flow of your exhalation.
6. Repeat 4 times.

At the end of the last cycle, relax and notice how you feel. I always like to finish with an inner and outer smile, but that’s just me!”

Here is a good video of Dr. Andrew Weil teaching this breathing exercise:

Note: I think that physiologically, the thing that matters most when it comes to doing this exercise is making sure that you pause and that you keep your exhale longer than your inhale.

If you want you can do it to the yogic form that includes keeping the tongue to the roof of the mouth, counting 4-7-8, opening mouth to exhale and following the advice on how many times to do the exercise per session.

However, it’s also fine to experiment and find out what works for you. For example, you can place your tongue wherever it feels good to you, count to any numbers you feel like as long as you pause and have the exhale longer than the inhale, close your mouth if you like, and do it as many times as you feel like. Just make note of the results you get; you may find the traditional techniques work best for you or you may find that other ways of doing it work better for you.

Exercises for Achieving Optimal Day-to-day Breathing…

9. Follow Along To Learn What Optimal Everyday Breathing Feels Like

So far, the breathing exercises in this article have address various different goals in relation to relieving stress. These exercises, however, don’t necessarily help to optimize your normal daily breathing pattern. The following two exercises are designed to help train you to breathe healthfully all the time.

Breathing optimally in general is way more complex than I had imagined. It makes sense though because the respiratory system, respiratory medicine and pulmonology are complex areas of scientific study.

We’re supposed to be breathing from the diaphragm not the chest. We’re supposed to have relaxed bellies when breathing. No sucking in that tummy ladies; apparently you gotta let it all hang out if you want to breathe right.

At the same time, we must be careful not to “over-breathe” by switching too much emphasis on effortful overly deep breathing… I guess the idea here is to retrain  the muscles so that everything is balanced.

Follow along with this video and see if you can get the hang of it:

Remember: When you do this exercise, let your tummy go! Let it stick out there. Don’t hold back. Go for it. Unzip your pants! Have you ever seen a little kid naturally standing with their tummy sticking way out? Be that free. Kids know what it’s all about when it comes to breathing with an unrestricted belly.

Instructions:

1. Release muscle tension and allow your body to breath in and out in a smooth way at a regular pace.
2. Follow along with the animated breather in the video.
3. See if you can get through the video without voluntarily tightening / pulling in your stomach muscles. See if you can let all the air out of your lungs while letting the belly stay out a little and allowing your stomach muscles to do their own thing.
4. See if you can get through the video without letting your shoulders rise upwards but instead letting your ribs go out to the sides. See if you can allow your lungs to take in complete, full breaths while the shoulders stay relaxed.
5. As you follow along, relax more and more down into your lower belly, lower back, lower sides
6. The diaphragm, which is right under and a bit up into the rib cage, should be the central point of control, like a bellows.
7. Repeat if you need more practice.

This was really relaxing for me. I do get very confused sometimes during this exercise because I’ve been breathing wrong for so long; guess I need to practice this one!

There is a pretty detailed article about diaphragmatic breathing from the point of view of the yoga tradition here.

On that yoga website, they recommend doing diaphragmatic breathing without moving the upper chest or lower abdomen, and  just flaring the lower chest out.  The ultimate goal seems to be to have a tranquil and still belly and upper chest. The aim is to center the breathing in the diaphragm. When I try that I feel very peaceful but then get tired and lightheaded; I would need to practice to be able to do that without losing oxygen. I did like the “no pause” as it felt like an unbroken full circle, but the pause during breathing exercises feels peaceful and I guess it slows the heart and lowers blood pressure.

10. Train Your Body to Relearn How To Breathe

This is another exercise to help learn how to breath optimally during day-to-day life. I really love this one.

This is from Don Campbell, co-author of “Perfect Breathing: Transform Your Life One Breath at a Time.”

Instructions:

“Do this exercise five times a day and you’ll start thinking and performing better in no time:

1. Inhale deeply
2. Exhale with a short burst (as if blowing out a candle). This helps activate your diaphragm, which most people don’t use.
3. Exhale with a long, slow finish to empty the lungs. Breathlessness comes from not expelling enough CO2.
4. Inhale, filling your lungs from the bottom to the top, instead of taking short sips. Most use a third of their lung capacity.
5. Hold for a moment to allow oxygen to saturate the cells.
6. Exhale slowly and completely.
7. Repeat steps 4 through 6 for five minutes.”

(source)

I guess once your diaphragm learns how to be more activated, you then try to breathe without voluntarily tightening your stomach…

To Get Real Meditative with Your Breathing…

11.  Easy to Remember – Focused Attention on Sensation of Breath in Nose

This is something they teach in classes on Vipassana meditation.

Instructions:

1. Close your eyes. If closing your eyes makes you more anxious, leave them open. This will be different for everyone.
2. Pay attention to the sensation of your breath as it enters and exits your nose.
3. Stay focused on that sensation. Feel the temperature, the motion. Rest your attention there.

You can do this for as long as you want. You can do it for an hour if that’s what it takes to calm down.

This exercise is like the Felt Sense of the Nose.

This one is more subtle than the others. For me it works with low to medium level stress, mental confusion and racing thoughts. When I’m extremely triggered I need something more powerful. For some people, the act of focusing on the breath sound or sensation could be triggering if they heard or felt themselves breathing during a traumatic event, so this exercise would not be appropriate for them.

5 More Awesome Breathing Exercises from Yoga…

Here are some more exercises to check out:

Soham mantra – A relaxing and easy way to start a daily practice; after reading the instructions you can follow along with the video.

Two-to-one breathing – Exhaling twice as long as inhaling.

Spinal breath – Very relaxing active imagination exercise where you imagine a milky white flow of energy going from the top of your head to the bottom of your spine as you breathe. Expands breathing to encompass more of the body.

Walking breath – breathing coordinated with walking.

Deergha swasam (Complete Breath) – This is a vigorous breathing practice that energizes and invigorates the body.

Printable Handout

Click on the link below for a printable PDF of some of the exercises:

Breathing Exercises for Stress, Anxiety & PTSD

Here is an image file of the PDF file (note that print quality will be way better for the PDF):

Sudarshan Kriya and Practices (SK&P)

SK & P Include Breathing Exercises That Have Many Scientifically Documented Beneficial Effects…

Sudarshan Kriya is an entire system and I am assuming it’s best to get instruction from a trained teacher.

This particular breathing practice has been studied by some prominent researchers to discover the beneficial effects on our physiology.  For example: Dr. Richard Brown M.D., Associate Clinical Professor of Psychiatry at Columbia University, Stephen Porges, PhD (University of North Carolina at Chapel Hill), and Emma Seppala of Stanford University have all conducted research on SK&P. Seppala researched specifically the effects of these exercises on PTSD. She worked with Project Welcome Home Troops, an organization that teaches these breathing exercises during their Power Breath Meditation Workshop  for returning veterans.

They found that these breathing exercises have a host of beneficial effects on human physiology. This article discusses Seppala’s findings, and this article goes over the findings in relation to the vagus nerve.

It Breathes Me

Beware that although these exercises involve you controlling your breathing, the ultimate goal for developing good daily breathing is not to be forcing or controlling your breathing.

“…for optimal breathing to be reached and sustained the breathing mechanics must be developed to expand and contract in balance without force or resistance, even during sleep; especially during sleep.” (source)

“It Breathes Me.” I like this phrase. It’s from a random video I was watching. He said:

“Your breathing should self-regulate meaning it should determine its own rhythm… Your breathing should just happen… Above all avoid conscious and controlled breathing… add the formula, ‘It Breathes Me.'”

I like all the exercises, they are wonderful to break out of high stress breathing patterns. I guess the end goal though would be for the body to be balanced enough and calm enough that the breath naturally takes on a grounded, balanced and healthy rhythm without exerting any control over it. That, I expect, would take some time.

Happy breathing!

Stay tuned for the next post where I will be giving away a free coloring book page that will serve as beautiful reminder for you to BREATHE!

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Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.