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A Practitioner's Guide to Breathwork in Clinical Mental Health Counseling
Abstract
Breathwork techniques and therapies offer a set of practical interventions for clinical mental health counselors (CMHCs) and are viable methods for integrating physiological sensitivities in treatment by way of the relaxation response. We discuss an organizing framework of breathwork practices and identify three broad categories of breathwork within the field: deep relaxation breathing, mindfulness breathwork, and yogic breathing. Each style is distinct in how it is applied and in the specific respiratory patterns that users are instructed to use. We also aim to elaborate the physiological effects, clinical research outcomes, and applicability of breathwork for treating mental illness. Overall, research findings indicate that breathwork may be efficacious for treating anxiety, depression, and posttraumatic stress disorder. Despite preliminary evidence for breathwork's efficacy for treating common psychological distress, more research is needed to evaluate its utility for treating a wider range of mental illness. CMHCs are encouraged to incorporate breathwork techniques in their clinical treatment programs but must appraise the value of each technique individually.
... Mental health benefits of these practices for people with severe mental illness have also been identified, including yoga in schizophrenia [21] and major depressive disorder [22], and pranayama [23] and chanting [24] for post-traumatic stress disorder. Authors of other studies have recommended the use of breathwork [25,26] and yoga [27,28] as either standalone or adjunctive mental health interventions. ...
... For example, in a qualitative study, psychologists identified the need for a guideline for using alternative interventions (including some sensorimotor R/S practices) in mental health [38], this study however did not specifically focus on sensorimotor R/S practices. Some studies have provided guiding information on integrating some R/S practices, such as breathwork [25], in mental health counselling. Others noted ethical considerations of integrating yoga in psychotherapeutic interventions [47]. ...
... The flight and fight response may aid temporarily, but for repetitive stress it is important to follow a set of skills that are validated for use (Aideyan et al. 2020). Health care workers are more prone to psychological and physiological stress that lead to sleep disturbances, memory loss, poor reactivity, harming patients and even suicide (Hersch et al. 2016). ...
https://pressto.amu.edu.pl/index.php/eip/article/view/39021
... (2) This breathing technique is relatively easy to learn and quick to practice on one's own [56]. Therefore, it is advantageous as a remote self-management practice that is expected to be more potent than simply deep breathing and more accessible compared to other emotionally activating breathwork interventions that need to be practiced in a specific setting under the supervision of a trained therapist or facilitator [42][43][44][45][172][173][174][175]. (3) Millions of people around the world already engage in this breathing practice on their own 2 , but comparably little scientific research has tested its safety and efficacy. ...
Due to the persistent, costly, and complex nature of chronic low back pain (cLBP), nonpharmacological self-management approaches rooted in the biopsychosocial model of pain are
of great interest to develop and test. Respiration is a vital physiological function that is also bidirectionally related to other body systems (e.g., nervous, cardiovascular), pain, and psychological processes (e.g., stress, emotions). Therefore, breathing practices may be promising self-management strategies for chronic pain. Research has shown that conscious connected breathing, a technique where there is no pause between inhalation and exhalation, combined with periods of breath retention can influence pain-related mechanisms (e.g., inflammation). However, this breathing practice has never been
examined for its impact on chronic pain symptoms. The primary aim of this randomized pilot study was to test the feasibility and
acceptability of a 5-day conscious connected breathing with breath retention intervention compared to a deep breathing sham control intervention for adults with cLBP. Participants included 24 adults with cLBP between 18-65 years. Both interventions were described as Breathing and Attention Training and neither was depicted as the active intervention in order to reduce possible expectancy and placebo effects common in pain research. We found it was feasible to recruit, randomize, and retain participants and that both interventions were acceptable, satisfying, and helpful. Although underpowered, preliminary clinical results will
be presented. As the study design was feasible and the interventions were acceptable, a larger trial is needed to test the efficacy and mechanisms of this breathing self-management practice.
... (2) This breathing technique is relatively easy to learn and quick to practice on one's own [56]. Therefore, it is advantageous as a remote self-management practice that is expected to be more potent than simply deep breathing and more accessible compared to other emotionally activating breathwork interventions that need to be practiced in a specific setting under the supervision of a trained therapist or facilitator [42][43][44][45][172][173][174][175]. (3) Millions of people around the world already engage in this breathing practice on their own 2 , but comparably little scientific research has tested its safety and efficacy. ...
Background
Chronic pain is a major source of human suffering, and chronic low back pain (cLBP) is among the most prevalent, costly, and disabling of pain conditions. Due to the significant personal and societal burden and the complex and recurring nature of cLBP, self-management approaches that can be practiced at home are highly relevant to develop and test. The respiratory system is one of the most integrated systems of the body, and breathing is bidirectionally related with stress, emotion, and pain. Thus, the widespread physiological and psychological impact of breathing practices and breathwork interventions hold substantial promise as possible self-management strategies for chronic pain. The primary aim of the current randomized pilot study is to test the feasibility and acceptability of a conscious connected breathing with breath retention intervention compared to a sham control condition.
Methods
The rationale and procedures for testing a 5-day conscious connected breathing with breath retention intervention, compared to a deep breathing sham control intervention, in 24 adults (18–65 years) with cLBP is described. Both interventions will be delivered using standardized audio recordings and practiced over 5 days (two times in-person and three times at-home), and both are described as Breathing and Attention Training to reduce possible expectancy and placebo effects common in pain research. The primary outcomes for this study are feasibility and acceptability. Feasibility will be evaluated by determining rates of participant recruitment, adherence, retention, and study assessment completion, and acceptability will be evaluated by assessing participants’ satisfaction and helpfulness of the intervention. We will also measure other clinical pain, psychological, behavioral, and physiological variables that are planned to be included in a follow-up randomized controlled trial.
Discussion
This will be the first study to examine the effects of a conscious connected breathing with breath retention intervention for individuals with chronic pain. The successful completion of this smaller-scale pilot study will provide data regarding the feasibility and acceptability to conduct a subsequent trial testing the efficacy of this breathing self-management practice for adults with cLBP.
Trial registration
Clinicaltrials.gov, identifier NCT04740710 . Registered on 5 February 2021.
... Guided Respiration Mindfulness Therapy is a newly introduced clinical model of breathwork that is gaining recognition in mental health practice. For example, Aideyan et al. (2020) offer a practitioners' guide to breathwork for clinical mental health counselors and draw attention to GRMT as an emerging practice option. Historically, while breathwork practice with some comparable features to GRMT first gained popularity in America during the 1970s on the fringe of self-development and experiential psychotherapy, its growth and acceptance has until recently remained constrained by the lack of a clearly specified approach, no standardized training process, and neglect of research to provide an evidence base, among other concerns. ...
Guided respiration mindfulness therapy (GRMT) is a clinical model of breathwork that has shown promise as a treatment for depression, anxiety, and stress. This study examined the effectiveness of GRMT as a holistically oriented intervention for reducing psychological distress in nurses. Sixty-two nurses were assigned to either five sessions of GRMT or 5 sessions of a mindfulness-based intervention (MBI) comparison condition which were conducted over 5 weeks. A no-treatment control was also included. Session-by-session change in depression, anxiety, and stress, along with change in mindfulness and self-compassion were assessed. Multilevel analysis showed GRMT resulted in statistically significant reductions in overall psychological distress, anxiety, and stress levels, as well as significant increases in mindfulness and self-compassion with large to very large effect sizes. On all measures, GRMT performed better than the comparison MBI intervention which showed no significant effect on stress levels. Results suggest that GRMT can provide nurses with an effective group intervention for reducing stress, and increasing mindfulness and self-compassion which are foundational elements of self-care for the holistic nurse.
The traumatized client may enter the mental health counseling suffering from the neurobiological effects of psychological trauma. This exposure has a detrimental impact on the brain’s functioning levels and functional connectivity of the white matter that runs between the frontal lobe, and the striatal areas of the brain, and altering the homeostasis of the client’s physical body through symptoms of anxiety. The stress causes the body to activate its survival mechanisms and may lead to acute stress responses or Post-Traumatic Stress Disorder (PTSD) symptomology. We examine the concepts and techniques of mindfulness as a clinically sound approach for relieving and reducing the long-term negative effects of this activation of this neurologically focused survival mechanism. This article explores approaches to building resiliency through enhancing neuroplasticity and examining how neuronal activation may alter the neurophysiological response to stress. Coupling this, specific mindfulness activities will be reviewed for effectiveness.
Psychosocial risk factors significantly contribute to the morbidity and mortality of patients with cardiovascular disorders. The present study explored the anxiety and depression status of patients with coronary artery disease and evaluated the effect of deep breathing exercise on these psychosocial variables as well as physiological variables like heart rate variability and blood pressure. A randomized control design was adopted for the study. Out of 65 clients eligible for the study, 45 were selected based on inclusion criteria. Patient were trained in Deep breathing exercise (DBE)for 2-3 days, were instructed to practice the exercise twice a day for 10 min for a period of 2 weeks, further instructed to come for follow up to cardiac OPD after 2 weeks. The study findings revealed that majority of the cardiac patients were anxious 39 (86.66%), 23(57.5%) had mild depression and 3(7.5%) were with severe depression. Fischer's exact test revealed a significant association between depression and occupation (p=0.051), monthly income (p=0.031) and co morbid disease (p=0.006, p<0.05). Karl Pearson's correlation coefficient revealed significant positive correlation between anxiety and depression i.e. (r = 0.414, p <0.01). DBE was found to be effective in reducing anxiety and diastolic BP of clients with CAD. But there was no significant reduction in HR, SBP and depression after the intervention.
The need for effective population mental health promotion approaches is urgent as mental health concerns are escalating globally and current allopathic treatment regimens are insufficient to bring people towards the state of mental well-being (citation). Successfully alleviating stress has the potential to promote wellbeing and prevent illness. Worldwide, yoga is gaining popularity as an accessible, acceptable and cost-effective practice for mind and body. People are turning to yoga for mental health improvement because of preferences for: self-treatment as opposed to clinical intervention; perceived greater efficacy than medication; fewer side effects; lack of response to medication. Yoga has minimal side effects and is cost-effective in comparison with pharmacological treatments and psychotherapy. Yoga’s added benefit is that it improves physical fitness and encourages self-reliance. In this brief article we discuss the evidence for yoga as a form of mental health promotion, illness prevention and treatment for depression.
The present study examined the effectiveness of daily mindful breathing practices on test anxiety of university students. A total of 36 participants were randomly assigned to one of three conditions: a training mindful breathing condition (n = 12), a training cognitive reappraisal condition (contrast group, n = 12), and a non-training condition (control group, n = 12). Each of the participants trained by themselves for 6 days after they had taken one session of education for mindful or cognitive reappraisal practices. They wrote their experiences on daily worksheets and sent it by mobile with taking pictures that were confirmed by the researcher. Before and after training, each of the participants completed a questionnaire to assess: test anxiety, positive thought, and positive affect. The results of the study showed that both mindful breathing practice and cognitive reappraisal practice yielded large effect sizes in reducing test anxiety. In addition, the mindful breathing condition scored significantly higher on positive thoughts than the cognitive reappraisal and control conditions. The findings of this study suggest that both daily mindful breathing and cognitive reappraisal practices were effective in reducing test anxiety; however, mindful breathing increased positive automatic thoughts to a greater extent than cognitive reappraisal.
In this exploratory study of the relationship between characteristics of breathing and 3 common psychological issues (i.e., symptoms of anxiety, alexithymia, and depression), 79 college-age adults were examined using self-report, rater observation, and physiological measures. Results indicated significant positive relationships between dysfunctional breath characteristics and symptoms of both anxiety and alexithymia. A significant positive correlation was found between self-reported symptoms of dysfunctional breathing and symptoms of depression, but no significant relationships existed between symptoms of depression and either rater-observed breath characteristics or physiological measures. © 2016 by the American Counseling Association. All rights reserved.
Background:
Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use.
Methods:
We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication.
Results:
In total, 140 case-control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = -0.583) with a large effect for psychotic disorders (Hedges g = -0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics.
Limitations:
Study quality significantly moderated effect sizes in case-control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings.
Conclusion:
Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk.
Over the past two decades, the theoretical basis and application of psychotherapy has been undergoing a paradigm shift from a focus on higher cortical/cognitive processes to a new and growing appreciation of affective phenomena as the locus of behaviour change. The move has been prompted by breakthroughs in neuroscience that show bottom-up, left-hemisphere neural processes to underpin behaviour, validat-ing affectively focused clinical practices. This paper examines the theoretical basis of this paradigm shift, with an emphasis on Klaus Grawe's consistency theory as central to its early description, and identifies the specific neural underpinnings for an effective clinical application of psychotherapy as established by contemporary neuroscience.
PURPOSE: High dental anxiety is pervasive and associated with treatment avoidance and poor oral health. Ideally, anxiety reduction techniques should be easy to use, low in cost, non-pharmacological, comfortable, and effective. This study compared the effectiveness of two self-taught anxiety reduction techniques--breathing and focused attention--with a control group. METHODS: Anxiety was assessed in 272 adult private dental practice patients with a modified dental anxiety scale-revised. Frequency of oral health care visits in the last 10 years to all dentists, including the current dentist, was collected. Immediately prior to the dental procedure, participants in the two experimental groups were given written instructions outlining the respective anxiety reduction technique they were to use. Efficacy of technique was assessed by subjective comparison to anxiety during previous oral health treatment. Participants also listed techniques that they believed to be effective for anxiety reduction. RESULTS: Twenty-six participants (9.56%) scored high in dental anxiety. High anxiety was associated with infrequent oral health care visits. Compared to the recall of anxiety experienced during prior treatment, there were no significant differences in anxiety between breathing, focusing, and control groups. But there was a trend toward decreased anxiety overall. Controls who reported infrequent visits and use of their own anxiety reduction technique showed significantly reduced anxiety. CONCLUSION: Dental patients employ numerous strategies for anxiety reduction. Anxiety reduction techniques not yet practiced may place unwanted expectations on patients. It is suggested that oral health care practitioners be aware of the patient's preferred technique for coping with anxiety and encourage them to use self-help techniques.
Baroreceptor stimulation yields antinociceptive effects. In this study, baroreceptors were stimulated by a respiratory maneuver, with the effect of this manipulation on pain perception subsequently measured.
Thirty-eight healthy participants were instructed to inhale slowly (control condition) and to hold the air in lungs after a deep inhalation (experimental condition). It was expected that breath-holding would increases blood pressure (BP) and thus stimulate the baroreceptors, which in turn would reduce pain perception. Pain was induced by pressure algometry on the nail of the left-index finger, at three different pressure intensities, and quantified by visual analogue scales. Heart rate (HR) and BP were continuously recorded.
Pain perception was lower when pain pressure was administered during the breath-holding phase versus the slow inhalation phase, regardless of the pressure intensity. During breath-holding, a rapid increase in BP and decrease in HR were observed, demonstrating activation of the baroreceptor reflex.
Pain perception is reduced when painful stimulation is applied during breath-holding immediately following a deep inhalation. These results suggest that a simple and easy-to-perform respiratory maneuver could be used to reduce acute pain perception.
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Current research reveals that trauma often cannot be resolved solely through interventions that utilize left-brain functions, such as those used in traditional talk therapy. Because trauma is actually something that happens deep in the core of the brain and the body, the most effective treatment approaches integrate traditional therapy modalities with those that focus on calming the nervous system such as yoga, mindfulness, imagery, expressive arts, and eye movement desensitization and reprocessing. This paper will focus on synthesizing current information on traumatic stress, the neurobiology of trauma, and evidence-based, body-integrative interventions provided within the framework of the Collaborative Change Model (CCM) (Barrett in The systemic treatment of incest. Taylor & Francis, Bristol, 1989; Treating complex trauma: a relational blueprint for collaboration and change. Rutledge, New York, 2014). Through the framework of the CCM, this paper will provide clinicians with an understanding of how and when to engage clients in body-mind approaches, how to help clients learn to recognize when they are in fight, flight, or freeze response patterns, and how to develop skills for managing emotional dysregulation. A detailed case study will be provided to illustrate this integrative approach in the treatment of trauma.