Breathing to Control Anxiety

  “Anxiety disorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxiety disorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of these approaches has limitations. More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety.” (1)

  When you realize you are starting to breathe deeply at an excessive rate, inhaling and exhaling at a controlled pace can relieve you from experiencing a panic attack. Those individuals who have to deal with anxiety in their lives, find themselves having a long-term tendency for heavy breathing, which might cause several difficulties such as dyspnea and over-breathing.

  “Changes in breathing can be both the consequence of an increased level of anxiety as well as the source of threat experienced by the individual, which, in turn, leads to increased anxiety. Thus, assessing breathing might be a useful physiological marker of the level of anxiety but can also serve as an experimental tool to influence anxiety levels. The elucidation of the physiological mechanisms and neural pathways regulating breathing can help to better delineate how an emotional state emerges from the interaction between the body and the brain.” (2)

  Over-breathing is characterized by a bloated sensation, fast heart rhythm, dyspnea, chest discomfort, a sense of disbalance, extreme tiredness, trembling, difficulties with memory and loss of a sense of direction. Usually, it is recommended for people who suffer from numerous types of anxieties, such as panic disorders or social phobias, to try to maintain a regular breathing pattern ahead of taking on a stressful situation.

  “We have recently refined a previously proposed insular model of anxiety. The aim of this model is to integrate emerging neuroanatomy of interoception with a process focused formulation of anxiety to provide a novel heuristic for the development of assessments and interventions. In this model, we considered that anxiety is a result of an increased anticipatory response to the potential of aversive consequences, which manifests itself in enhanced anterior insular cortex processing. Specifically, when anxious individuals receive body signals they cannot easily differentiate between those, which are associated with potential aversive (or pleasant) consequences versus those, which are part of constantly ongoing and fluctuating interceptive afferents. As a consequence, these individuals imbue afferent interoceptive stimuli with motivational significance, i.e. an increased tendency to plan and act upon the reception of this input. Specifically, an internal body signal, e.g. an inspiratory breathing sensation, is associated with negative valence and linked to belief-based processes, e.g. “I am not getting enough air”, which results in an increased “fight/flight” response and potential withdrawal or avoidance behaviors. As a consequence of this noisy amplification, top-down modulatory brain areas such as the anterior cingulate, dorsolateral prefrontal cortex, and orbitofrontal cortex are engaged constantly to differentially amplify or attenuate signals that are predictive or not predictive of future states, respectively. This relative “overactivity” of cognitive control related brain areas is subjectively experienced as increased production of thoughts and associated beliefs, which provide prediction-enhancing propositions. Practically, these cognitive processes result in “worrying”, which is aimed at providing increased prediction accuracy. This model relies on the notion of “accurate” processing of interoceptive afferents in general and breathing in particular. However, it is unclear at what level inaccurate processing of interoceptive afferents occurs in anxious individuals.” (3)


  There are various breathing techniques to control anxiety.  Here, we are going to explain one of them. Prior to performing any procedure, this technique can be simpler to do, by following these steps:

  1.       Lie with your back on the ground
  2.       Form an angle of approximately 45° with your legs
  3.       Place your feet pressed to the ground
  4.       Bring one of your hands to your thorax
  5.       Bring the other hand to your midriff


  To be able to fully complete this technique outdoors, you first need to be capable of doing it laying down.  Then you can repeat it in a standing or sitting position. This will allow you to become skillful and perform this technique at any time and place without any difficulty.

  “Slow and deep breathing is efficient as it reduces the ventilation in the dead space of the lungs. Shallow breathing replenishes air only at the base of the lungs in contrast to deep breathing that replenishes the air in all parts of the lung. It decreases the effect of stress and strain on the body by shifting the balance of the autonomic system predominantly toward the parasympathetic system and improves the physical and mental health.” (4)

  “The main effects of slow breathing techniques cover autonomic and central nervous systems activities as well as the psychological status. Slow breathing techniques promote autonomic changes increasing Heart Rate Variability and Respiratory Sinus Arrhythmia paralleled by Central Nervous System (CNS) activity modifications. EEG studies show an increase in alpha and a decrease in theta power. Anatomically, the only available fMRI study highlights increased activity in cortical (e.g., prefrontal, motor, and parietal cortices) and subcortical (e.g., pons, thalamus, sub-parabrachial nucleus, periaqueductal gray, and hypothalamus) structures. Psychological/behavioral outputs related to the above mentioned changes are increased comfort, relaxation, pleasantness, vigor and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion.” (5)


The Breathing Technique Consists of the Following:


  1. Breathe in and retain air for a moment.
  2. Try to relax while exhaling
  3. Use your nose to breathe in air until the hand you previously put on your midriff starts moving upwards. Make sure the hand on your thorax has not moved substantially.
  4. Use your mouth to breathe out air until the hand on your midriff falls.
  5. Repeat the whole process again for a period of 5 minutes.


  Perform these steps whenever you feel that a panic attack is about to start, or when you begin to feel overcome with anxiety. You can also practice this by doing it regularly, for less than half an hour. The time can be distributed however, to suit whatever works best for you.

  “Breathing practice, also known as “diaphragmatic breathing” or “deep breathing,” is defined as an efficient integrative body–mind training for dealing with stress and psychosomatic conditions. Diaphragmatic breathing involves contraction of the diaphragm, expansion of the belly, and deepening of inhalation and exhalation, which consequently decreases the respiration frequency and maximizes the amount of blood gases. Benefits of diaphragmatic breathing have been investigated in association with meditation and ancient eastern religions (such as Buddhism) and martial arts.” (6)


Mindfulness, Another Type of Breathing?


  A study made by the Yeungnam University in South Korea, show the effectiveness of daily mindful breathing practices on test anxiety of university students. “A total of 36 participants were randomly assigned to one of three conditions: a training mindful breathing condition (n = 12), a training cognitive reappraisal condition (contrast group, n = 12), and a non-training condition (control group, n = 12). Each of the participants trained by themselves for 6 days after they had taken one session of education for mindful or cognitive reappraisal practices. They wrote their experiences on daily worksheets and sent it by mobile with taking pictures that were confirmed by the researcher. Before and after training, each of the participants completed a questionnaire to assess: test anxiety, positive thought, and positive affect. The results of the study showed that both mindful breathing practice and cognitive reappraisal practice yielded large effect sizes in reducing test anxiety. In addition, the mindful breathing condition scored significantly higher on positive thoughts than the cognitive reappraisal and control conditions. The findings of this study suggest that both daily mindful breathing and cognitive reappraisal practices were effective in reducing test anxiety; however, mindful breathing increased positive automatic thoughts to a greater extent than cognitive reappraisal.” (7)


Exactly, What is Mindfulness?


  “In the last decade there has been increased interest in ‘mindfulness’, with a growing number of clinicians demonstrating an enthusiasm to learn the techniques of mindfulness and to integrate them into their therapeutic work. The concept of mindfulness has its origins in many contemplative, cultural and philosophical traditions. Buddhism, for instance, contains extensive instructions on mindfulness principles and practice, but the training and practice of mindfulness can be effectively adopted by individuals in the absence of any particular philosophical, religious or cultural tradition or vocabulary. The scientific community first became seriously interested in the clinical applications of meditative and contemplative practices in the 1970s, particularly after some of the pioneering work of Herbert Benson on the ‘Relaxation Response’. In the Australian context, in the 1970s Ainslie Meares was among the first to bring meditation to the attention of clinicians and psychotherapists, particularly for its applications in pain control, anxiety and cancer management. In more recent times, the work of Jon Kabat-Zinn has brought attention to the clinical and psychotherapeutic applications of mindfulness.” (8)

  “Mindfulness is believed to be a natural psychological capacity capable of being enhanced by intentional practice, such as mindful breathing meditations delivered within mindfulness-based interventions (MBIs)–interventions which have been shown in meta-analyses to improve mental health and physical functioning. The formal practice of mindfulness meditation involves repeated placement of attention onto an object while alternately acknowledging and letting go of distracting thoughts and emotions. Objects of mindfulness practice can include the sensation of breathing; the sensation of walking; interoceptive and proprioceptive feedback about the body’s internal state, movement, and position; visual stimuli such a candle flame or running water; mental contents such as thoughts or feelings; or the quality of awareness itself. Such practices have been shown to increase the disposition to be mindful in everyday life, and to produce changes in neurocognitive function consistent with increased attentional control, emotion regulation, and self-awareness.” (9)



(1) Current Diagnosis and Treatment of Anxiety Disorders. Bystritsky, A, Khalsa, S.S, Cameron, M.E & Schiffman, J. Pharmacy and Therapeutics. 2013.

(2, 3) The breathing conundrum – interoceptive sensitivity and anxiety. Paulus, M.P. Depress Anxiety. 2013.

(4) Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters. Naik, G.S., Gaur, G.S. & Pal, G.K. International Journal of Yoga. 2018.;year=2018;volume=11;issue=1;spage=53;epage=58;aulast=Naik

(5) How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B. & Gemignani, A. Frontiers in Human Neuroscience.

(6) The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Xiao Ma, X., Yue, Z.Q., Gong, Z.Q., Zhang, H., Duan, N.Y., Shi, Y.T., Wei., G.X. & Li, Y.F. Frontiers in Psychology. 2017.

(7) The Effectiveness of Daily Mindful Breathing Practices on Test Anxiety of Students. Cho , H., Ryu, S., Noh, J. & Lee, J. Plos One. 2016.

(8) Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. Allen, N.B., Chambers, R.G. & Knight, W. The Australian and New Zealand Journal of Psychiatry. 2006.

(9) Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. Garland, L.E., Hanley, A.W., Goldin, P.R & Gross, J.J. Plos One. 2017.

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