Rethinking Breathwork

Why “Just Breathe Deeply” Might Be the Wrong Advice: Rethinking Breathwork in Mental Health

For decades, “take a deep breath” has been a go-to recommendation for calming down, managing anxiety, or easing distress. It’s often assumed that the deeper you breathe, the more relaxed you’ll feel. But recent findings in neuroscience and physiology suggest this well-meaning advice can sometimes backfire.

As a neuro-psychotherapist working at the intersection of science and mental health, I want to unpack why deep breathing isn’t always the answer, and offer more effective, evidence-based alternatives for managing stress through breath.

The Physiology of a Deep Breath—And Why It Can Be Counterproductive

When you take a deep inhalation, particularly one that is forceful or exaggerated, the pressure in your chest cavity drops. This negative intrathoracic pressure helps expand the lungs, yes—but it also reduces venous return to the heart. Since veins are passive vessels (they lack muscular walls like arteries), they rely on thoracic pressure changes and the diaphragm to move blood toward the heart.

The sudden drop in venous pressure can signal the heart—via stretch receptors and the sinoatrial (SA) node—that more blood is needed. In response, the heart compensates by increasing its rate and contractility, effectively ramping up sympathetic nervous system activity.

This can lead to:

• A faster heart rate,
• Heightened physiological arousal, and
• In some individuals, a worsening of anxiety or panic—exactly what the deep breathing was meant to fix.

So while deep breathing may be helpful in some contexts, it can paradoxically increase stress hormones and nervous system arousal when used improperly—particularly in already anxious or dysregulated individuals.

The Belly Breathing Mistake: When Technique Goes Wrong

Many therapeutic models teach diaphragmatic breathing, or “belly breathing,” as a way to engage the parasympathetic (rest-and-digest) system. When done correctly, this can be powerful. But here’s the catch: clients often misunderstand the technique.

Instead of engaging the diaphragm to generate deeper, slower breathing, they may:

• Force their belly outward in a mechanical way,
• Breathe quickly or shallowly,
• Focus only on moving the abdomen rather than improving actual tidal volume or gas exchange.

This mimicry can result in what I call “shallow belly breathing”—a movement pattern that looks like diaphragmatic breathing but lacks its physiological benefits. Worse, the shallow and fast breathing pattern can actually increase sympathetic tone, further exacerbating anxiety or dysregulation.

Breath, the Brain, and the Nervous System

To understand how breathwork affects our emotional and mental state, we need to look at the autonomic nervous system. The vagus nerve—a key player in the parasympathetic system—interfaces directly with the SA node in the heart and responds to patterns in breathing.

• Slow, extended exhalations activate the vagus nerve, slowing the heart rate and calming the nervous system.
• In contrast, rapid or effortful inhalations can signal threat or increase arousal, especially in a dysregulated system.

Thus, the structure and rhythm of the breath—not just its depth—determine whether it soothes or stimulates.

A More Effective Alternative: Cyclical Sighing

One of the most promising techniques supported by recent neuroscience is cyclical sighing, a method highlighted in a 2023 Stanford study co-authored by Dr. David Spiegel. It’s simple and highly effective:

1. Inhale fully through the nose, expanding the lungs naturally.
2. Take a second, short nasal inhale to “top up” the lungs.
3. Exhale slowly and fully through the mouth, longer than both inhales combined.

This pattern:

• Reopens collapsed alveoli in the lungs,
• Maximises oxygenation and carbon dioxide exchange,
• And most importantly, activates the parasympathetic response through the vagus nerve.

Unlike generic deep breathing, cyclical sighing emphasises exhalation, which is where the true calming effect lies.

The Takeaway for Therapists and Clients Alike

If breathwork is part of your practice—or your personal self-regulation toolkit—it’s time to move beyond the “just breathe deeply” mantra. While diaphragmatic breathing remains a valuable tool, it needs proper instruction and context.

In high-stress or anxious states, prioritising exhale-focused, structured breathing patterns like cyclical sighing may be:

• Faster-acting,
• More physiologically grounded, and
• Less likely to unintentionally trigger sympathetic arousal.

Breath as a Bridge

Breathing sits at the crossroads of body and mind, voluntary and involuntary systems. Understanding its mechanics is more than a technical detail—it’s a window into how neuroscience, physiology, and mental health deeply intertwine.

Let’s teach it that way.