Purposefully controlling your breathing by using a device to guide you for slowing your breathing rate while also keeping it very regular is a surprisingly powerful strategy to improve both your feeling of wellbeing and your health. Using a smart phone, you can download a free app that is simple to use. If you are already sure that you want to try this strategy, and you have no desire to read about the research behind it, you should skip this introduction and go directly to: “Using a paced breathing strategy” below.
When brain scanning images are recorded while research subjects are doing this type of breathing, beneficial changes in brain structure are observed. Brain areas and pathways which are known to enhance emotional control and to better balance the body’s metabolic processes show increased activity, power, and connectivity. As neuroscientists have learned to expect from these changes in brain structure and function, research subjects often have decreased anxiety, improved depression, less insomnia, lower blood pressure and blood sugar, and even decreasing joint pain for people with rheumatoid arthritis.
I first became aware of the value of this self-healing strategy as I was reviewing the research examining the health benefits of using what is called heart rate variability biofeedback (HRVBF). We are most familiar with heart rate measurements from automated blood pressure monitors or the output of an electrocardiogram (EKG). In the heart rate value from these devices, though, only the average heart rate is reported, and they do not report much information about the rapidly changing beat-to-beat variations in heart rate that are always present. However, if a careful statistical analysis of these instantaneous beat-to-beat changes in heart rate are performed, a measure called heart rate variability (HRV) can be derived. Research has shown that measurements of HRV are remarkably powerful in predicting both the presence of many kinds of disease as well as the likelihood that these diseases will develop in the future. Extensive research has also shown that when using HRV as a biofeedback technique, HRVBF is a very effective treatment for a wide range of disease conditions.
As I explored this technology further, I found that the research scientists studying HRVBF have shown that certain slow and carefully timed breathing rates have very powerful and beneficial effects on regulatory areas of the brain previously shown to be important to our health and our feelings of wellbeing. Furthermore, researchers reported that precisely controlled slow breathing rates often produce benefits comparable to those found with the use of HRVBF, but without the need to use HRVBF devices. This means that many of the health improvements are due to just slowing down the breathing rate and keeping the pattern very regular and even. This is why smart phone apps designed to help control your breathing pattern are so useful.
Why is the precise timing provided by the use of smart phone apps so important? The researchers who have explored this question have found that very regular breathing rates set up a state of resonance with various neurological and metabolic processes in the human brain and body. They have found that slow and very regular breathing calms your nervous system by decreasing the excitability of sympathetic “fight or flight” pathways and lowering the blood levels of the stress hormones that are produced when this system is chronically activated. While these beneficial effects are most potent during the breathing sessions, they also carry over into the rest of your day and slowly accumulate in their effects. This means that these carefully paced breathing sessions will be most useful if used every day, and with continued use, the improvements should slowly increase over time. While you may or may not feel immediate benefits during these sessions, to be able to determine if they are producing long term benefits will require at least several weeks of continued use.
Since there are no risks involved in making use of these free apps and the research shows this strategy is remarkably powerful, I have begun to teach this self-healing strategy to some of my patients. I have usually recommended its use to help with insomnia, anxiety, and hypertension, but as noted above, there are many other medical problems that will be likely to improve. I can report that most of my patients who have used it for at least several weeks have reported benefits, and a few have reported dramatic improvements.
For those readers who are interested, references for some of the research reports on which these recommendations are based will be found at the end of this article. Next, I will provide some guidance to help you use this strategy most effectively.
Using a paced breathing strategy
Developing a daily habit of using paced breathing sessions is likely to increase your feelings of comfort, relaxation, and confidence, while decreasing feelings of chronic stress, anger or confusion. In addition, research has also shown that problems like chronic pain, elevated blood pressure, insomnia, anxiety, and abnormal blood sugar can sometimes show long term improvement when using carefully paced breathing sessions for extended periods of time.
One of the best ways to use this technique is to download a free app on a smartphone and use it to follow a precise, pre-selected breathing pattern. An app called “Breathly” works well if you have either an iphone or an android phone. As mentioned earlier, research shows that precise timing is important to develop a powerful state of resonance between your breath rate, your heart rhythm, and the activity within important regulatory centers of your brain. Over time, the resonance induced during breathing sessions will increase the power of the areas of your brain which calm your nerves and will decrease the activity of other areas involved in chronic stress.
Once you have a good app downloaded, you should find the “custom settings” screen where you can set your inhale and exhale durations as well as any breath holds you may want to include. If you are new to this, I recommend starting with 5 seconds inhale, 5 seconds exhale, and no holds. This will mean you will be breathing 6 times a minute, about half of the usual rate of our breathing when we are at rest. Next, find the option that allows you to customize the total duration for each breathing session. You might want to start by finding two times during your day to use this strategy and set the total time for 5 minutes per session.
Paced breathing apps usually use graphics that give visual cues to guide your inhalation, your exhalation, and any holds you select. They also usually have sound cues that can be left on or turned off, as you prefer. The Breathly app uses a graphic of a ball that expands to time your inhalation, remains stationary during holds, and shrinks for your exhalation.
I have found that when people first try to use a controlled breathing app, they often inhale and exhale too quickly. If needed, a simple way to learn to slow down your inhalation rate is to purse your lips and suck in air as if you were sucking a thick liquid through a thin straw. In a similar fashion, you can learn to exhale slowly by pursing your lips and steadily blowing out a very small stream of air. After a little practice, you will get used to breathing slowly enough and should no longer need to purse your lips.
Besides demonstrating that a strategy of using very regular and carefully timed breathing sessions is important, research studies also show that slower rates are usually more powerful in their beneficial effects compared to faster rates. It is the total duration of each breath that produces the important frequency that determines this power. For example, if you set 5 seconds for inhale, 2 seconds as a hold between your inhale and exhale, and 5 seconds for exhale, the key number would then be a total of 12 seconds per breath. To achieve slower rates from a longer breathing cycle, once you have become completely comfortable with your current settings, add a second to either the inhalation time, the exhalation time or one of the hold spots, whatever you think will be best for you. In this way, you can easily add time to the breath cycle of your sessions when you want to slow them further.
Another very potent means of increasing the self-healing power of carefully paced slow breathing sessions, once you are very familiar with doing them with an app, is to add a brief affirmation to repeat to yourself during each breathing cycle. Just create very positive and good feeling statements about yourself that you will repeat. Or, as an alternative, you might use a short prayer phrase from the Bible, or other sacred text, that feels particularly good to you as you say it. The same statement or phrase might either be repeated with each breath, or you could go through go through a list of these, one at a time, with each new breath.
There may be times when it is not practical for you to open an app to guide a slow breathing session. Once you are familiar with it using the timer provided by an app, you can count out the breath cycle silently in your head. I say to myself “one thousand one, one thousand two” etc. While this is not as effective as a precisely timed session, it can still be very useful as a calming strategy if you realize you are feeling stressed at a time during which opening an app is not an option. Besides helping us to feel better quickly, using controlled breathing to stop stressful thoughts improves our ability to function with our work, and minimizes the residual damage to our nervous system and body that stress can cause.
Another very useful time to use a mental counting strategy without opening the app is if you awaken in the middle of the night and your mind will not shut off and allow you to get back to sleep. Doing a mentally counted breathing session should stop the intrusive thinking process within a few breaths, allowing you to fall back asleep. If, however, unpleasant thoughts persist even while concentrating on your breathing, try increasing the length of the breathing intervals further since this takes more of your attention and will be better at interrupting the train of thoughts that are disrupting your sleep.
Once you have gotten comfortable using this strategy, you may notice yourself becoming a little calmer and more composed immediately after each session. But even if each session doesn’t provide a noticeable benefit, you should still find that improvements will slowly accrue over time as you continue using this self-healing strategy. It is likely that your emotional set point (the way you are feeling when not much is going on), will slowly but steadily move towards a feeling of greater wellbeing. You should use it daily for at least a month to see if you notice these improvements.
Given their beneficial and well-demonstrated impact on the structure of the human brain, the continued use of carefully paced breathing sessions should also lead to improvements in your physical health. This is a very effective way to purposefully employ your brain’s natural plasticity to improve your life.
References
Here are two review articles that analyze the results from research studies showing heart rate variability biofeedback is effective in treating both psychological and physical illnesses:
Gervitz R, The Promise of Heart Rate Variability Biofeedback: Evidence-Based Applications, Biofeedback 2013; 41:110-120
Lehrer P, Kaur K, et al, Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis. Appl Psychophysiol Biofeedback 2020; 45:109-129
This is a review article from 2013 which concludes that breathwork strategies are not only effective in treating anxiety, depression and insomnia, they also result in brain structural changes of a more beneficial balance between the sympathetic and parasympathetic systems:
Zaccaro A, Piarulli A, et al, How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physical Correlates of Slow Breathing. Frontiers in Human Neuroscience 2018; 12:1-16
Here are three review article, all published in 2023, demonstrating that breathwork interventions are effective in treating anxiety, depression and elevated blood pressure:
Banushi B, Brendle M, et al, Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sci 2023; 13:1-22
Fincham GW, Strauss C, et al, Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomized-Controlled Trials. Nature 2023; 13:432-446
Herawati I, Mat Ludin AF, et al, Breathing Exercise for Hypertensive Patients: A Scoping Review. Front Physio 2023; 10:1-16
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