Panic and Breathing

DEEP BREATHING MAY NOT HELP ANXIETY OR PANIC

Negate that advice to take a deep breath to calm yourself down and here is why…

Yoga instructors unknowingly encourage their students to breathe more. This is evident when breathing can be heard during asanas. Ironically, the more air breathed during light physical movements, the less oxygen that is delivered to the tissues. Breathing should never be heard during rest. Breathing should never be ‘hard’.

Patrick McKeown

Often when people are having moments of panic, advice is given, such as: “take a deep breath”. Given the large body of research that shows yogic breathing techniques, such as pranayama, can reduce anxiety (Saoji et al., 2019), it can be easy to interpret breathing as a cure-all for anxiety. However, subtleties in science are essential to consider when advising a friend or a patient to “take a deep breath” to calm down. The advice may cause more harm than good in some cases.

Firstly, let us consider the purpose of breathing techniques used within meditation practices. Breathing is not an end in itself; instead, it is a means to an end. The purpose of meditation is to lessen the activity of the mind and reduce the occurrence of time-travelling thoughts (those of the past and future) in preference towards thoughts that are more mindful towards the present (Bishop et al., 2004). Breath is ever-present and inescapable; therefore, focusing on the breath often brings the mind’s attention toward a direct experience. The breath can be a guide inwards to deeper states of meditation. As the meditator reaches the higher brain wave frequency of samadhi, they naturally let go of technique and all breath control, as the breath becomes very subtle, barely audible and noticeable to feel or even see.

For this reason, giving simplistic advice such as “take a deep breath” to calm down can be misleading. The individual in panic mode may be also well acquainted with the breath as a sign of an oncoming panic attack. They attempt to take a deep and get frustrated in their inability to do so, even further exacerbating symptoms. Their frustration may lead to further negative thoughts of self-judgment that further exaggerate the panic attack. All of this is counter to the intention of the advice to be sure; one must be aware that direction, when given in the wrong way, can cause more harm than good.

The second important thing to consider is how the breath takes place. The speed, duration, depth, and ratio of inhale/exhale are all important physiologic factors influencing how the breath affects the body and mind. An example of this is the existence of respiratory sinus arrhythmia (RSA). When we inhale and exhale, many changes of pressure and structure occur within the chest cavity. The diaphragm contracts and recedes downwards during inhalation, opening space below the heart. The diaphragmatic contraction decreases the pressure surrounding the heart, allowing the heart to encompass a larger area within the chest. Keep in mind that the body is constantly attempting to achieve homeostatic balance, so this change in pressure in the heart leads to an increased heart rate to compensate for the decreased blood flow. Respiratory sinus arrhythmia (RSA) refers to this phenomenon where heart rate increases during inhalation and decreases during exhalation. When someone is in panic mode, the goal is to slow down the heart and bring breathing under control. The simple advice of “take a deep breath” can be misleading. Upon hearing this advice, the individual could take an incredibly quick and robust inhale, unfortunately raising the heart rate even more! Therefore, though perhaps grounded in good intentions, the advice can be harmful.

All of this is not to say breathing is not a suitable solution for our health, anxiety, or panic. On the contrary, slow and long extended breathing using the diaphragm is particularly beneficial. Nonetheless, clarity on advice and technique is essential for those in a moment of panic or suffering from general anxiety. Often, if the breath is a trigger for panic or angst, the focus can be shifted by using sound on the exhale which naturally prolongs the breath and increases Nitric Oxide, a vasodilator (read more on humming or bumble bee breath).

Watch the following videos with Patrick McKeown here on breathing for stress, anxiety, and panic for more information. For teachers looking to find ways to express these teachings, read Celia’s interview with Patrick McKeown on why deep breathing during yoga may not be the ideal approach and how we can change our teaching instructions to help students, rather than harm.

Students should be encouraged to breathe light and soft so that breathing cannot be heard during asanas. The traditional Chinese art of Taoism succinctly describes ideal breathing as ‘so smooth that the fine hairs within the nostrils remain motionless’. True health and inner peace occur when breathing is quiet, effortless, soft, through the nose, diaphragmatic, rhythmic, and gently paused on the exhale. This is how human beings naturally breathed until the comforts of modern life changed everything.

Patrick McKeown

It is no surprise that masters have taught these techniques carefully over the ages. They are mighty and have much influence over the body and mind. One must be careful in their choice of words to provide the right message to follow the correct path.