“just relax. Take a deep breath.” The single worst piece of advice dispensed when you’re feeling anxious, overwhelmed, worked up, etc. And just overall pretty unhelpful in the moment.
The first part of the phrase – let’s face it, kind of irredeemable. But the second part actually may have some truth to it. We know that breathing is essential to life. And for the most part, we don’t have to think about it. It’s happens automatically since it’s controlled by the autonomic nervous system. Since respiration is controlled by the autonomic nervous system, stimulation of the sympathetic nervous system due to anxiety triggers physical responses that include elevated heart rate, tense muscles, and shallow, rapid breathing. In contrast, diaphragmatic breathing stimulates the parasympathetic nervous system, which reduces anxiety levels. ( 2 )
When we take breathing off auto-pilot and focus on the breath is when the magic happens and there can be real relaxation and stress-relief benefits. This type of breathing – deep, focused, mindful, intentional – is often referred to as diaphragmatic breathing. Diaphragmatic breathing is a breathing technique that uses the contraction of the diaphragm muscle to move air downward into the body, which increases diaphragm length and breathing efficiency and facilitates more efficient exhalation. ( 2 )
And it even has some science to it. In one study, forty participants were randomly assigned to either a breathing intervention group or a control group. The breathing group received intensive training for 20 sessions over a span of 8 weeks. ( 1 ) To accurately quantify stress response, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the breathing group showed:
- a significant decrease in negative affect after intervention
- an increased sustained attention after training, compared to baseline.
- significantly lower cortisol level after training, while the control group showed no significant change in cortisol levels.
In sum, this study demonstrated that diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. ( 1 )
In another study, 46 participants were divided randomly into a diaphragmatic breathing group and a control group. To quantify stress response, the study tracked skin conductivity, peripheral temperature (peripheral blood flow), heart rate, and breathing rate. There was a statistically significant difference in peripheral temperature between the two groups, with a lower anxiety level in the experimental group than in the control group. Secondly, there were statistically significant differences between the two groups in terms of average heart rate and breathing rate. Both rates were lower in the experimental group than in the control group. These results show that after the 8-week diaphragmatic breathing relaxation training, the experimental group made significant progress in reducing anxiety as measured by skin conductivity, heart rate, and breathing rate. ( 2 )
The above study results were confirmed in a systematic review study, which examined three studies (one of which is covered above – 1 ). All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 after implementation of a diaphragmatic breathing intervention. ( 4 ) Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress. ( 4 )
Beyond just stress-relief, diaphragmatic breathing has been shown to improve vital capacity in patients with asthma, functional status with heart failure, and in those with chronic obstructive pulmonary disease ( 2 ). It has even been suggested exercise to reduce the levels of pain associated with migraines and with surgery recover. ( 2 )
It can even help with heartburn symptoms! One study (albeit a small study of only 15 participants which has generalizability limitations) found that 80% of patients in the treatment group significantly reduced belching frequency compared with 19% in control subjects, as well as significantly reduced symptoms of GERD. And the benefits lasted long after the intervention, with changes being sustained at 4 months after treatment. ( 3 )
The list goes on and on, but considering I use deep breathing so much in yoga I figure let’s end it on this one. One study found and improvement with balance with diaphragmatic breathing. In the study, improvement was noted in number of single-leg stance balance errors, and tandem stance balance errors with diaphragmatic breathing. This study indicated that promotion of a costal-diaphragmatic breathing pattern may be associated with improvement in balance ( 5 ).
Okay, okay so yeah we get it. It not only feels good but has some clinically cool benefits.
Let’s get into how to do it.
Diaphragmatic Breathing Exercise
- Lie on your back on a flat surface or in bed, with your knees bent and your head supported (a pillow under your knees feels wonderful on the low spine if you have low back issues)
- Place one hand on your upper chest and the other just below your rib cage.
- Breathe in slowly through your nose (~3 seconds) so that your abdomen expands against your hand. The hand on your chest should remain as still as possible.
- Purse your lips (as if about to drink through a straw), engage your core muscles, press gently on your stomach and exhale for ~3 seconds. Let the stomach fall inward during the exhale and continue to keep the hand on your upper chest as still as possible.
- Repeat for about 5 minutes.
For best results perform 3-4 times a day. It’s important to practice these techniques when you’re already feeling well so you have them in your arsenal when things start to go a bit haywire. And by scheduling them throughout your day, it allows the mind a rest and is a great mental re-set.
( 1 ) Ma. X., Yue, Z-Q., Gong, Z-Q., Zhang, H., Duan, N-Y., Shi, Y-T., Wei, G-X., & Li, Y-F. The effect of diaphragmatic breathing on attention, negative affect, and stress in healthy adults. Frontiers in Psychology, 8(874). 10.3389/fpsyg.2017.00874. eCollection 2017
( 2 ) Chen, Y-F., Huang, X-Y., Chien, C-H., & Cheng, J-F. (2017). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspectives in Psychiatric Care, 53. 329-336.
( 3 ) Ong, A, M-L., Chua, L, T-T., Khor, C, J-L., … & Wang, Y-T. (2018). Diaphragmatic breathing reduces belching and proton pump inhibitor refractory gastroesophageal reflux symtoms. Clinical Gastroenterology and Hepatology, 16 (3), 407-416.
( 4 ) Hopper, S., Murray, S.L., Ferrara, L.R., & Singleton, J.K. (2019). Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults. JBI Evidence Synthesis, 17(9), 1855-1876.
( 5 ) Stephens, R.J., Haas, M., Moore, W.L., Emmil, J.R., Sipress, J.A. & Williams, A. (2017). Effects of diaphragmatic breathing patterns on balance: A preliminary clinical trial. Journal of Manipulative and Physiological Therapeutics, 40(3), 169-175.