Can Breathing Exercises Help Reduce PTSD Symptoms or is That Just Woo-Woo Nonsense?

Summary: Yes, breathing exercises can help reduce PTSD symptoms. Using breathwork to help reduce mental health symptoms is data-driven and evidence-based. That’s not just woo-woo nonsense.

Key Points:

• Breathing exercises, sometimes called breathwork, are considered effective complementary therapeutic modes for the treatment of mental health disorders and general stress reduction.
• Previous research shows that consistent, structured breathing exercises can reduce anxiety symptoms over time.
• A new study compares the impact of mindful meditation with no specific breathing techniques to structured breathing exercises on symptoms of anxiety and PTSD.

The Role of Complementary and Alternative Therapies in Mental Health Treatment

Over the past several decades, the idea of using alternative approaches to improve mental health symptoms has gradually been accepted to the point that we can almost consider them mainstream. Mindfulness, meditation, and relaxation techniques are now known to effectively reduce stress, improve mood, improve emotion regulation, enhance cognition, improve sleep, and boost overall wellness and psychological wellbeing.

In fact, most mental health treatment programs include some form of the following in treatment plans for depression, anxiety, and other mood and behavioral disorders:

• Mindful meditation
• Self-guided progressive relaxation exercises
• Yoga
• Tai chi
• Breathing exercises

Nevertheless, there’s still a significant proportion of our general population who hear words like yoga or mindfulness or breathwork and respond with a perspective like this:

None of that woo-woo nonsense works.

However, a growing body of evidence in peer-reviewed scientific studies conducted from the 1970s to the present – that’s about 50 years of research – shows that these approaches, once considered by many a nonscientific waste of time and energy, are in fact reliable and effective methods for reducing stress, improving mood, and enhancing overall wellbeing.

Note the claims we avoid:

Yoga cures depression.

Meditation cures anxiety.

Breathwork cures PTSD.

We’ll observe that no one therapy cures any mental health disorder – not psychotherapy, not psychiatric medication, and not novel brain stimulation techniques, which means we can temper our expectations when we talk about mental health treatment. What we know is that an integrated, comprehensive approach to treatment works best. Plans that include a tailored mix of psychotherapy, medication when needed, lifestyle changes, and complementary supports – e.g. breathing exercises – offer the greatest likelihood of success.

When we refer to complementary or alternative approaches, we always mean in addition to standard best care practices, and never instead of established, evidence-based care guidelines for specific mental health disorders.

Breathing Exercises or Mindful Meditation for Anxiety and Arousal: New Study

In the recent study “Brief Structured Respiration Practices Enhance Mood and Reduce Physiological Arousal,” a group of researchers designed an experiment to compare the impact of mindful meditation compared to breathing exercises on symptoms associated with anxiety and other mental health disorders such as PTSD.

Here’s their summary description of the study:

“We report the results from a study of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month.”

The research team examined the following three breathing exercises/breath techniques:

1. Cyclic sighing, a technique that employs longer exhalations than inhalations
2. Box breathing, a technique that employs equal and even inhalations, equal and even breath retention (briefly holding breath), and equal and even exhalations.
3. Cyclic hyperventilation, a technique that employs longer retention, extended inhalation, and quick/rapid exhalation.

To assess the impact on symptoms associated with mental health disorders, the research team administered standard metrics that measure:

• Improvement in mood
• Improvement in anxiety
• Reduced physiological arousal, as measured by:
  • Respiratory rate
  • Heart rate
  • Heart rate variability

Improvements in mood and anxiety are associated with reduced symptoms in anxiety disorders such as PTSD and depressive disorders, while reductions in physiological arousal are associated with improvement in anxiety disorders, and specifically elevated anxiety associated with PTSD.

To collect data for analysis, researchers recruited 111 patients and divided them into four groups:

1. Mindful meditation group: engaged in mindful meditation exercises, with natural, uncontrolled breathing
2. Cyclic sighing group (see above)
3. Box breathing group (see above)
4. Cyclic hyperventilation/retention group (see above)

Each group engaged in at least 5 minutes of guided meditation of breathing sessions every day for a month. Researchers collected data on the following metrics before and after each daily session:

• State anxiety
• Positive affect
• Negative affect
• Resting heart rate
• Respiration rate
• Heart rate variability
• Sleep efficiency
• Hours of sleep
• Sleep score

Let’s take a look at what they found about whether breathing exercises can help reduce PTSD symptoms.

Breathing Exercises and Mindful Meditation: Real Treatment or Woo-Woo?

The breathing exercises the researchers examined in this study were definitely not woo-woo, and the results indicate they can function as real, effective treatment support for mental health disorders with symptoms associated with state anxiety, positive affect, and negative affect.

Here’s the conditions those symptoms are associated with:

State anxiety:

• Anxiety disorders
• PTSD
• Depression
• Schizophrenia
• OCD

Reductions in positive affect:

• Depressive disorders
• Anxiety disorders
• PTSD
• Bipolar disorder
• Schizophrenia

Increases in negative affect:

• Depressive disorders
• Anxiety disorders
• PTSD
• Bipolar disorder
• Schizophrenia

Here are the results for the impact of mindful meditation compared to breathing exercises for state anxiety, positive affect, and negative affect

Daily Mental Health Metrics: Results

State anxiety:

• Mindful meditation: reduction of 3.95 points avg/day
• Breathwork: reduction of 3.03 points avg/day
  • Sighing: – 3.85
  • Box: – 2.83
  • Cyclic: – 2.97

Positive affect:

• Mindful meditation: increase of 1.22 points avg/day
• Breathwork: overall increase of 1.91 points avg/day
  • Sighing: + 1.89
  • Box: + 1.84
  • Cyclic: + 1.97

Negative affect:

• Mindful meditation: reduction of 1.62 points avg/day
• Breathwork: reduction of 0.98 points avg/day
  • Sighing: – 1.48
  • Box: – 0.83
  • Cyclic: – 0.62

Those results tell a clear story. Meditation and breathwork can both improve mental health symptoms, with the specific breathing exercises showing advantage over mindful meditation for specific symptoms. Here’s how the study authors summarize these results:

“Both mindfulness meditation and breathwork groups showed significant reductions in state anxiety and negative affect and increases in positive affect. Overall, breathwork was more effective than mindfulness meditation in improving positive affect, an effect that got larger with more adherence to the protocol. Participants in the exhale-emphasized cyclic sighing group had the highest increase in positive affect.”

Next, let’s look at the outcomes for the physiological measures.

Breathing Exercises and Mindful Meditation: Impact on Physiological Measures

These metrics can indicate elevated anxiety, panic attacks, or the experience of hyperarousal, a core symptom of anxiety and anxiety disorders such as PTSD. Researchers recorded daily data on heart rate, respiration rate, heart rate variability, sleep efficiency, hours of sleep, and total sleep score.

Here’s what they found.

Daily Physiological Metrics: Results

Respiration rate:

• Mindful meditation: minor decrease
• Breathwork: significant decrease
  • Sighing: significant decrease
  • Box: moderate decrease
  • Cyclic: moderate decrease

No significant differences appeared between meditation and breathwork groups for resting heart rate, heart rate variability, sleep efficiency, hours of sleep, and sleep score.

While not as dramatic as the impact on mental health metrics, the impact on respiration is significant for patients with severe anxiety or PTSD. Here’s how the research team summarize these results:

“Cyclic sighing produced the highest daily improvement in positive affect as well as the highest reduction of respiratory rate, both significantly different from mindfulness meditation. The physiological and psychological effects of cyclic sighing appear to last over time.”

Key takeaways from the study include:

• Five minutes of breathwork and/or mindful meditation each day can reduce anxiety and enhance positive mood.
• Mindful meditation helps, but results show structured breathwork is mor effective in improving mood and reducing physiological arousal.
• Among the breathwork techniques examined, cyclic sighing showed the strongest impact on psychological, emotional, and physiological factors associated with mental health disorders

We’ll discuss these results and key takeaways below.

Empowering Patients With Practical Daily Tools

The importance of having a solid evidence base for breathwork in mental health treatment revolves around at least two factors.

First, once you learn breathing techniques, they’re yours forever. You don’t have to renew a prescription for breathwork, go to breathwork once a week or even once a month, or do anything but use what you learn when you need it. But learning breathing exercises does require attention, commitment, and work on the front end. All of the work is well worth it, because, like meditation or yoga, once you learn a breathwork technique – and we repeat – it’s yours forever.

Second, it’s efficient. Breathing exercises are easy to learn, easy to learn quickly, and easy to apply as soon as you learn them. The breath is connected to the body in an immediate way. The way you breath can instantly impact a wide range of physiological and psychological factors, which makes breathing exercises an essential –  but often overlooked – component of mental health treatment.

Breathing Exercises Help Reduce PTSD Symptoms: Mechanisms

In the study we discuss throughout this article, authors identify possible mechanisms whereby breathing exercises can help reduce PTSD symptoms and symptoms of other mental health disorders, including anxiety and PTSD. Here are the four primary mechanisms they propose explain the impact of breathing exercises on mental health symptoms.

Breathing Exercises, Internal States, and Mental Health

1. Impact on vagal nerve. Research indicates breathing techniques can have an impact on vagal nerve function, which itself can be “conceptualized as a marker of emotional control.” Therefore, the effect on the vagal nerve may be one pathway that breathing exercises impact state anxiety, positive affect, and negative affect.
2. Impact on interoception. Interoception refers to our ability to identify and assess our internal physical sensations, and understand the feedback our body provides us, 24/7, about our current internal state. Interoception plays a role in “…emotional experience, self-regulation, decision-making, and consciousness.” Enhanced interoception can improve awareness – and therefore enable management – of physical/somatic symptoms associated with diagnoses such as PTSD and other anxiety-related disorders.
3. Action on brain function. Being out of breath, i.e. breathlessness, can activate brain structures that generate emotion while simultaneously deactivating brain structures, including the prefrontal cortex, that regulate emotion. Learning to control breathing – transforming fast, panic breathing to slow, controlled breathing, for instance – may give patients the ability to regulate emotion by reactivating brain structures associated with emotion regulation.
4. Increased sense of control. For patients with disorders like PTSD, where physical symptoms associated with fear appear alongside or immediately precede emotions such as fear and worry, increased interoception combined with knowledge of effective breathing techniques can give an individual more effective and direct control over their internal states, both physical and emotional. This increased sense of control may play a role in mitigating negative affect, and enhancing positive affect, or preventing triggers from eliciting nonproductive, disruptive emotions.

When we understand breathing exercises and how they affect our bodies, brains, and emotions, it’s clear why they’re common in mental health treatment: they help us regulate our emotions via our bodies. They’re obviously not a cure, but rather, effective tools that patients can use to manage acute emotions in the moment. And, as the results of this study show, some breathing exercises become more powerful in increasing positive affect over time. That’s an important new finding that tells us that breathing exercises can become part of an effective long-term strategy for managing emotions and reducing psychological distress.