Teaching Breathing For Stress Management: The Most Significant Mistake & Why It Matters
One of the most common techniques therapists and coaches use to help clients relax is deep, slow breathing. But even when it works - and it sometimes makes things worse - you could be doing your clients a real disservice. That's because most people, when they try it, actually end up over-breathing. Over-breathing is also known as hyperventilation, which you'll know about in association with panic attacks. A classic panic attack is an extreme form of hyperventilation, but over-breathing can be mild as well. If your client is in extreme hyperventilation you'll know about it – they'll be gasping for breath – but you probably wouldn't recognise mild over-breathing.
I know this based on my experience with my own clients. I use a device (a capnometer) that can measure the degree of over-breathing. It's both an assessment tool and a biofeedback training device. Using it, I see a lot of people initially induce over-breathing when they try to relax.
The problem with over-breathing is that it reduces oxygen delivery to brain cells – so it's far from an optimal form of breathing. (Later in the article I'll explain how this happens.) Even when it apparently works as a relaxation technique, it's probably inducing a "spaced-out" kind of relaxation, maybe even slightly foggy-headed. It's because the brain is (somewhat paradoxically) getting less oxygen, and can't perform optimally.
Symptoms of over-breathing include anxiety and panic, shortness of breath, feeling light-headed or foggy-headed or faint. Over-breathing can easily turn into a habitual pattern - in which case it can be even harder to spot. Symptoms of chronic over-breathing include fatigue and depression.
How Over-Breathing Creates Problems
Breathing is essentially about efficiently delivering oxygen to cells and appropriately removing carbon dioxide – it's primarily a matter of chemistry. But much of what therapists know is to do with breathing mechanics – deep, slow abdominal breathing etc. But mechanics is secondary - in the first place optimal breathing means optimally delivering oxygen to cells, and particularly brain cells.
Again, over-breathing leads to less oxygen being delivered to brain cells. How?
The key to the regulation of breathing is carbon dioxide – not just a waste product, it serves and important function in the blood. Over-breathing causes the amount of carbon dioxide dissolved in the blood to fall, and in the short term this leads to two consequences. First, the haemoglobin in blood holds on more tightly to oxygen (actually because the blood is now more alkaline / less acidic). Second, blood vessels in the brain constrict. These two effects combine to reduce brain oxygen delivery.
Carbon dioxide actually builds up in the brain. Because the brain monitors carbon dioxide (rather than oxygen) this is what creates the feeling of shortness of breath. So you breathe more. But there's already plenty of oxygen in the blood, plus low carbon dioxide. It's just that the blood is not releasing its oxygen. The normal regulation of breathing has broken down and this creates a worsening spiral that can lead to a classic panic attack, where oxygen delivery to the brain can be reduced by as much as 60%. (In mild over-breathing this figure can be only 10 or 20%, and hard to recognise.)
If hyperventilation persists longer than a few hours the body will make compensations that will return blood acidity to normal - but these compensations are far from ideal and still leave the client with entrenched problems.
Stress & Over-breathing
Stress - even mild - typically leads to muscle tightness. When the breathing muscles are tight (the diaphragm in particular) we don't fully let the air out on exhalation and this leads to upper chest breathing. The diaphragm gets sort of locked up, and this can become habitual. Since the automatic brain circuits for breathing regulation link to the diaphragm, regulation doesn't work so well, and over-breathing is much more likely.
Probably over-breathing is (from an evolutionary perspective) a mechanism to prime the body for action - part of the fight-or-flight response.
Heart Coherence & Over-breathing
Another popular tool used by therapists and coaches for stress management training is HRV biofeedback or heart coherence biofeedback, which you can do using a device that can measure heart rate. Probably products from HeathMath are best known (e.g. Inner Balance, EmWave). Heart coherence, whilst also being related to positive emotion, is maximal with slow diaphragmatic breathing at about 6 breaths per minute.
Again, what I see is that a lot of clients will induce a degree of over-breathing in the process of trying to attain high heart coherence. I think what's happening is that they are "willing" coherence rather than allowing their body to express it - that is, they are breathing from their conscious, thinking, reasoning minds, which is not the part of the mind that truly knows how to breathe optimally.
Don't get me wrong, I think HRV biofeedback is an excellent tool. I use it myself in my stress resilience training programme, but I teach clients to optimise their brain oxygen supply first (in other words I teach them not to over-breathe) using capnometry biofeedback.
How To Teach Your Clients Optimal Breathing
I teach optimal breathing using capnometry biofeedback. A capnometer is a device that measures carbon dioxide in exhaled air (known to correlate to blood levels). It's the best way to objectively measure the degree of over-breathing - or conversely optimal breathing (in terms of optimal breathing chemistry).
Even if you don't want to go down the route of acquiring equipment of your own, I think it's very worthwhile to explain the pitfalls of over-breathing to your clients. I would say the key points to get across are:
- Over-breathing paradoxically starves the brain of oxygen.
- Mild over-breathing is largely unrecognised
- Two factors between them define your ventilation or air exchanged per minute, these are breathing rate (breaths per minute) and the size of each breath.
- To minimize ventilation and thus optimize oxygen delivery to brain cells, keep both variables low - so slow and gentle breathing. Perhaps above all clients should allow breathing to be gentle.
Benefits of Optimal Breathing
Because it optimizes oxygen delivery to brain cells, optimal breathing (chemistry) can boost any and all aspects of brain function. I find it can calm anxiety but also create a clearer focus, better concentration and sense of presence and self-possession.
THE STRESS RESILIENCE BLUEPRINT
I've created a summary statement of what everyone needs for effective stress management: how to work with anxiety, panic, irritability, fatigue, insomnia, brain fog, low mood and other stress-related symptoms.
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READ MORE ABOUT BIOFEEDBACK FOR STRESS MANAGEMENT
How To Manage Your Mind With Biofeedback & Mindfulness
Book by Glyn Blackett
- Underlying dynamics in stress & anxiety
- Science of the mind-body connection & how it can be applied
- Why breathing is at the heart of stress management
- Practical models for framing self-control challenges & solutions
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