Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist 

Anxiety and the Breath

When our mind perceives danger, we begin to breathe rapidly and shallowly from our upper lungs in preparation for physical exertion. This style of breathing is normal when we are running or fighting, but if our bodies are idle, this style of breathing can lead to hyperventilation, or breathing more than is necessary.


When hyperventilating, we are dumping out carbon dioxide, which lowers the carbon dioxide levels in our blood, which leads to symptoms such as:

  • Dizziness
  • Shortness of breath
  • Chest pain
  • Lump in throat
  • Tingling in extremities
  • Nausea
  • Confusion

These breathing patterns can further contribute to uncomfortable symptoms of anxiety, which can lead to anxious thoughts about the symptoms, which can then lead to more anxiety.


In addition, when we experience chronic stress, we may be consistently hyperventilating on a small scale, leaving our bodies vulnerable to a panic attack. 


A study by Meuret et al (2011) showed that for those who experienced "out of the blue" panic attacks, significant changes in their breathing and heart rate occurred a full hour before their panic attack, and that these symptoms were largely outside of conscious awareness.


Wilhelm and Trabert (2011) also showed that individuals with panic disorder evidenced instability in measures of respiration even at rest. These findings point to the importance of stabilizing respiration in those who suffer from panic attacks. 


Because of the relationship between breathing and anxiety, many treatments for anxiety disorders involve breathing retraining. Breathing retraining refers to teaching clients how to breathe from their diaphragm, or from their bellies, vs their chest.


Breathing retraining also involves learning how to slow the breath cycle to about 6 breaths per minute, or 10-second breaths. Often, this can be done by imagining breathing through the nose (smelling the flowers) and then breathing out through pursed lips (blowing out the candles) and imagining that you are breathing into your belly, filling up a balloon that expands and pushes up your belly.


There have been mixed findings regarding the efficacy of breathing retraining in the treatment of panic disorder. This may be because "correct" breathing becomes another source of anxiety or the breathing is used as a way to stop or control a panic attack that has already been triggered.


The key to treating panic disorder is learning to tolerate the uncomfortable physical symptoms associated with anxiety and to learn that they are not harmful, can be tolerated, and will pass.


Therefore, when implementing this strategy, it is important to use it as a preventative measure that decreases overall physiological arousal to reduce the likelihood of panic attacks, but once a panic attack is triggered, the breathing should be used as way of sitting with the anxiety and allowing it to pass. 


Click here for more information about breathing and anxiety.

Click here for more information regarding breathing retraining