Breathing occurs so automatically that we rarely think about it, yet given the obvious impact it has on our health (just try not breathing if you need a demonstration), it’s not unreasonable to wonder whether it might be a useful tool to improve our overall wellbeing. With that in mind, a range of techniques collectively known as “breathwork” have been gaining popularity in recent years.

Covering a broad spectrum of exercises that involve either speeding up or slowing down the breath, breathwork is beginning to catch the attention of researchers. And while we’re still waiting with baited breath for a large-scale clinical trial, the science behind the idea suggests it may be more than just hot air.

Breathe in, breathe out

“Breathing is incredibly intertwined with the way we process the world,” Dr Martha Nari Havenith, from the Ernst Strüngmann Institute for Neuroscience, told IFLScience. “It’s like a bridge between our mind and our body, between our brain and our autonomic nervous system [ANS].”

Indeed, it’s the ANS that provides the logic behind most breathwork exercises. Responsible for regulating involuntary physiological processes including respiration, this unconscious control center contains both the sympathetic and parasympathetic nervous systems.

Of these, the former is activated in times of stress and mobilizes our "fight or flight" response, which is characterized by faster breathing, increased heart rate, and the diversion of blood away from the prefrontal cortex of the brain and towards the muscles, priming us for action. All of this is combined with a surge in adrenaline, causing us to feel alert and on edge while also impairing our ability to stop and think logically.

Conversely, the parasympathetic system helps us enter a "rest and digest" state when we feel safe and relaxed. This involves slower breathing and an increase in blood flow to the gut and the parts of the brain responsible for complex thinking. 

“The breath has a massive effect on your sympathetic versus parasympathetic activity,” Havenith told us. “It's one of the dials you can turn to interface with your body.” 

In other words, consciously changing the rhythm of one’s breath may signal to the body a state of either relaxation or stress, thereby causing the ANS to alter its response. This, in turn, changes the way we feel and think, with major implications for the cardiovascular and immune systems.

Slow and steady

Numerous slow breathing exercises have been developed to help people overcome the mental and physiological problems associated with stress. These include methods such as diaphragmatic breathing, which involves taking consciously deep breaths into the belly as opposed to the shallower breaths many of us habitually take. 

According to a recent review study on the effectiveness of slow breathing techniques, “People with stress and anxiety disorders tend to chronically breathe faster and more erratically.” However, after noting a correlation between breathwork and reduced stress levels in participants with no major mental health issues, the authors conclude that “[with regular practice] respiration rate can become gradually slower, potentially translating into better health and mood, along with less autonomic activity.”

Another recent study found that US military veterans who practiced meditative breathing benefited from reductions in anxiety and other symptoms related to post-traumatic stress disorder. Meanwhile, inspiratory muscle strength training (IMST), which involves the use of a handheld device that makes it harder to inhale, has been linked to a significant drop in systolic blood pressure.

Though the biological processes behind these benefits haven’t been fully probed, it’s thought that breathing slower activates the vagus nerves, which are the main pathways for the parasympathetic nervous system. On a more nuanced level, research has shown that the activity of the ANS fluctuates as we breathe in and out.

For example, one study revealed how adrenaline production increases on the inhale and decreases on the exhale. Changing the way we breathe may therefore enable us to regulate our adrenaline levels, thereby providing a tool to either sharpen or blunt our focus and attention. Researchers have suggested that this may be useful in the treatment of conditions such as attention deficit hyperactivity disorder (ADHD) while also supporting cognition in older people.

Techniques such as 4-7-8 breathing - which involves inhaling for four seconds, holding for seven and exhaling for eight - are designed to ensure the outbreath exceeds the inbreath, thereby increasing parasympathetic activity. Further research has shown that heart rate increases as we inhale and decreases as we exhale, and that controlled breathing can therefore help to regulate heart rate variability. This has been linked to an array of potential benefits, including a reduction in amyloid proteins, which are associated with Alzheimer’s disease.

Picking up the pace

Given the obvious advantages that come with reduced stress levels, it seems somewhat counterintuitive to think that activating the sympathetic nervous system through faster breathing could also bring health benefits. However, high-intensity breathwork has been reported to facilitate mental health breakthroughs in a similar way to psychedelic drugs like psilocybin or ayahuasca.

This concept was first developed in the 1970s by a Czech psychiatrist named Stanislas Grof, who sought to use the breath as a tool to legally induce altered states of consciousness in his patients after psychedelics were outlawed. The technique he came up with is known as Holotropic Breathwork, and involves rapid, deep breathing in combination with other sensory stimuli such as trippy music.

Havenith uses the umbrella term "circular breathwork" to describe the various high-intensity breathing exercises that have been developed over the past few decades, all of which involve hyperventilation. Regarding the effects of these techniques, she explained to IFLScience that “we've done a couple of studies where we use exactly the same questionnaires as you would do for psychedelic or hypnotic states, and people come up with very similar scores. So it seems like you're entering a very similar state, just through a different door.”

“In terms of the physiology, what seems to be clear is that as your CO2 goes down - which it does when you're breathing intensely - your cerebral blood flow goes down too,” she says. “So your brain is getting massively less blood, and especially the decision making areas like the cortex.”

At the same time, “it seems that as the brain gets a bit overloaded, your serotonin system kicks into gear in a massive way. And then you get these altered states of consciousness.” Similarly, psychedelic drugs are known to produce their effects by binding to serotonin receptors in the brain, so there’s reason to believe that breathwork could be used therapeutically in lieu of mind-altering chemicals. It’s worth noting, however, that brain imaging studies on breathwork participants are yet to be conducted, which means we can’t say for sure how these exercises affect brain activity.

Another proponent of high-intensity breathwork is the somewhat controversial Wim Hof, also known as the Ice Man. Famous for his ability to withstand freezing temperatures, Hof has developed a protocol that combines fast-paced breathing exercises with cold exposure, and has gained large numbers of followers around the world.

Interest in the Wim Hof Method skyrocketed after a 2014 study found that participants who practiced the technique displayed lower levels of inflammation and an absence of flu-like symptoms when injected with a bacterial endotoxin. More recently, however, researchers have questioned the validity of these findings while also pointing out that Hof’s involvement in the study may compromise its integrity.

Nevertheless, Havenith says there’s reason to speculate that overstimulating the sympathetic nervous system through circular breathwork may have a hormesis effect, whereby exposure to increased levels of cortisol, adrenaline, and other markers of stress may actually improve one’s overall fitness. “In the long run, inflammation goes down and your immune system becomes more efficient,” she explains. “And that also helps with your mental state, because inflammation is one of the things that makes depression a lot worse.”

Breath of life or wasting your breath?

Despite all the buzz around breathwork, it’s important to come back to the fact that not all of the claims are scientifically proven. And while research is ongoing, the systematic review mentioned earlier concluded that most studies conducted over the past few years show indications of bias.

However, Havenith explains that “there are quite a few studies that show the clinical benefits of the more intense practices like Holotropic and consciously connected breathwork.” Admittedly, all of these studies are pretty small, although she says “they are reasonably well done and they're consistent with each other.” 

Highlighting some of the findings, Havenith told IFLScience that “depression goes down, anxiety goes down, self-awareness goes up. Death anxiety and PTSD, all of that stuff goes down.”

Considering how difficult some of these conditions are to treat - not to mention the fact that the air is free - the whole concept seems like a breath of fresh air. After all, you spend all day breathing anyway, so why not make it work for you?

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