Stress and the Art of Breathing

Think you know how to breathe? Try this simple test: Sit or stand wherever you are and take a deep breath. Then let it out. What expanded more as you inhaled, your chest or your belly? If the answer is your chest, you’re a “chest breather,” and like most people you’re doing it all wrong. You may also be putting your health in jeopardy.

The technique is so powerful that physician James Gordon teaches it to nearly every patient he sees, from people with advanced cancer to those crippled by arthritis to schoolchildren struggling with attention deficit disorder. He’s taught it to refugees in war-torn Kosovo, to anxiety-plagued medical students at Georgetown University and to hundreds of health professionals who have attended his workshops on mind-body-spirit medicine.

“Slow, deep breathing is probably the single best anti-stress medicine we have,” says Gordon, a clinical professor of psychiatry at the Georgetown University School of Medicine and director of the Center for Mind-Body Medicine in the District of Columbia. “When you bring air down into the lower portion of the lungs, where oxygen exchange is most efficient, everything changes. Heart rate slows, blood pressure decreases, muscles relax, anxiety eases and the mind calms. Breathing this way also gives people a sense of control over their body and their emotions that is extremely therapeutic.”

A Nation of ‘Chest Breathers’

Obviously, everyone alive knows how to breathe. But Gordon and other experts in the emerging field of mind-body medicine, say that few people in Western, industrialized society know how to breathe correctly. Taught to suck in our guts and puff out our chests, we’re bombarded with a constant barrage of stress, which causes muscles to tense and respiration rate to increase.

As a result, we’ve become a nation of shallow “chest breathers,” who primarily use the middle and upper portions of the lungs. Few people--other than musicians, singers and some athletes--are even aware that the abdomen should expand during inhalation to provide the optimum amount of oxygen needed to nourish all the cells in the body.

“Look around your office, and you’ll see so little movement in people’s bellies that it’s a wonder they’re actually alive,” Gordon says. “Then watch a baby breathe, and you’ll see the belly go up and down, deep and slow.” With age, most people shift from this healthy abdominal breathing to shallow chest breathing, he says. This strains the lungs, which must move faster to ensure adequate oxygen flow, and taxes the heart, which is forced to speed up to provide enough blood for oxygen transport. The result is a vicious cycle, where stress prompts shallow breathing, which in turn creates more stress.

“The simplest and most powerful technique for protecting your health is breathing,” says Andrew Weil, director of the Program in Integrative Medicine and clinical professor of internal medicine at the University of Arizona in Tucson. Weil teaches “breath work” to all his patients. “I have seen breath control alone achieve remarkable results: lowering blood pressure, ending heart arrhythmias, improving long-standing patterns of poor digestion, increasing blood circulation throughout the body, decreasing anxiety and allowing people to get off addictive anti-anxiety drugs and improving sleep and energy cycles.”

New Focus on Alternative Therapies

There is little scientific research documenting the healing power of breathing, in part because its practice is so new in Western medicine. And unlike drugs or devices, breathing has no manufacturer who must sponsor studies to support its use.

Increased interest in studying the effects of nontraditional healing therapies such as relaxation breathing led to the founding in 1991 of the Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine, at the National Institutes of Health. As a result, more medical scientists are beginning to examine the health impact of a variety of mind-body therapies such as meditation, guided imagery and Eastern exercises--yoga, tai chi and qi gong--which typically incorporate focused breathing.

One of the few studies to examine a clinical application of yoga “belly breathing” found that menopausal women who learned the technique were able to reduce the frequency of hot flashes by about 50%.

“The average breathing rate is 15 to 16 cycles [inhaling and exhaling] per minute,” says Robert Freedman, a professor of psychiatry and behavioral neurosciences at Wayne State University School of Medicine in Detroit. “But with training, women can slow their breathing down to seven or eight cycles per minute, which can significantly reduce the frequency and intensity of hot flashes.”

Deep diaphragmatic breathing and other mind-body techniques can also significantly reduce symptoms of severe PMS as well as anxiety, depression and other forms of emotional distress, according to research by Alice Domar, an assistant professor of medicine at Harvard Medical School and director of the Mind/Body Center for Women’s Health.

To teach the technique, Domar has patients make a fist and squeeze it tight.

“Then I ask them what happens to their breath, and they realize that they’ve stopped breathing,” she says. “When we get anxious, we tend to hold our breath or breathe shallowly.” Domar then shows patients how to breathe deeply into the abdomen, a process most women tell her runs counter to the “hold in your stomach” breathing they’ve done all their adult lives.

Domar’s favorite stress-reduction technique is a short version of this breath-focus exercise, which she calls a “mini-relaxation,” or “mini.”

“You can do a mini when you’re stuck in traffic, at a boring meeting, whenever you look at a clock or any time you pick up a phone,” she says. “I have patients who do minis 100 times a day.” Minis are also helpful for people with medical conditions, who can do deep breathing when they’re having an IV started or undergoing chemotherapy.

Pamela Peeke, an assistant clinical professor of medicine at the University of Maryland, incorporates breath work into her practice, in part by getting her patients to exercise.

“It’s very hard to walk and take little panicked breaths,” says Peeke, who frequently takes patients out for a “walk and talk.”

In our stressed-out world, the fight-or-flight response that kept our ancestors alive has turned into a “stew and chew,” contends Peeke, who studied the connection between stress and fat at the National Institutes of Health. If no physical response occurs after stress revs the body up for battle, chronically elevated levels of stress hormones stimulate appetite and encourage fat cells deep inside the abdomen to store what she calls “toxic weight.”

For this reason, Peeke says, “I’m an absolute crazy person about getting people to move.” She encourages Eastern movements, such as yoga and tai chi, which rely on taking deep abdominal breaths. But she particularly urges patients to do aerobic activity to help neutralize the effects of stress.

“When people learn to breathe properly, they can calm themselves,” she says. “Then the stew doesn’t have to turn into a chew.”

A Technique With Many Applications

In hospitals, breathing techniques once were taught only to women for use during childbirth. Today, some hospitals have begun teaching relaxation breathing to patients of both sexes and all ages being treated for a wide range of conditions. At the Washington Hospital Center in the District of Columbia, nurse Julie Oliver incorporates breath work into support groups she leads, including one for people with congestive heart failure and another for parents of babies in the neonatal intensive care unit.

“Using the breath to quiet the body can be very powerful,” says Oliver, who is clinical manager of the hospital’s guided imagery program.

“Babies, especially premature babies, can sense how the mother and father feel,” Oliver says. “If the parents go in full of muscle tension and start jiggling the baby, the baby gets too stimulated, and the staff may need to tell the parents to back away, which adds to everyone’s stress.”

Oliver had a chance to practice what she preaches recently, when her newborn stayed in intensive care for three days of observation.

“I was so anxious to see Joseph, I found myself getting all wound up,” she recalls.

So Oliver took a minute to do several relaxation breaths, combined with positive thoughts.

“I was able to go in and take Joseph in my arms in a much quieter state of mind,” she says.

Conscious breathing also was a part of her delivery.

“Focused breathing pulls your attention away from pain and what’s going on in your body,” says Oliver, who teaches the technique to heart patients about to undergo procedures in the cardiac catheterization lab. She also teaches breathing to staffers.

“It’s an ideal form of stress reduction,” she says, “because it doesn’t take any time away from work, and you can do it anywhere.”