As more people seek help for their mental health, simple techniques that link mind and body are powerful alternatives to traditional talk therapy.
As the relentless energy of an increasingly crowded, ecologically degraded planet beset with global pandemics, political vitriol, economic uncertainty, and ever more people clamoring for limited resources seeps into modern consciousness, a simpler approach is slowly rewinding talk therapy. Borrowing and sometimes appropriating ancient practices like pranayama that originated with yogi masters in India, mental health therapists, physiologists, and physicians are turning to basic breathwork techniques to help individuals untangle trauma, ease depression and anxiety, lessen symptoms of chronic illness, and even explore the edges of human consciousness—often without spending a dollar or leaving home.
The “talking cure” is no longer sufficient to address what ails us. Exemplified by Freud’s work with his famed psychoanalysis patient, Anna O., it was a breakthrough that informed more than a century of mental health treatment. Anna O. dubbed it mental “chimney sweeping.” While talk therapy still prevails today, lots of new tools have emerged in the past decades, including pharmaceuticals and now a growing number of alternative practices, such as breathwork.
Controlled breathing techniques are designed to invoke a physical or psychological shift. Practitioners alter breath depth, speed, or frequency with an eye on calming the mind, releasing trauma stored in the body, finding focus and a spate of hoped-for results. You’re as likely to find controlled breathing techniques used in a therapist’s office as a biohacker’s seminar or a yoga retreat—where you might also find holotropic breathing, a type of controlled breathing that involves hyperventilating for minutes or hours. Practiced by everyone from adventurous thrill-seekers and longevity seekers to wellness practitioners, holotropic breathing is used to induce higher states of consciousness, if not actual hallucinations.
Since the days of Anna O. and her “talking cure,” mental health therapists and counselors have found that talking isn’t enough for everyone, and doesn’t always produce lasting change.
The doctor may be out, but breathwork is in.
Shifting focus from brain to body
In the United States, the 2008 Mental Health Parity and Addiction Equity Act compelled insurers to cover mental health therapies with fewer restrictions. As insurers began to offer that coverage, they placed heavy emphasis on short-term, evidence-based practices. This drove clinicians toward treatments like cognitive behavioral therapy that are strongly supported by research. And in 2022, the White House pointed to that same Parity Act, pressuring insurers to meet requirements that broadened mental health coverage to match coverage for physical conditions.
But unlike medical treatment for physical conditions, when it comes to mental health, scientists and clinicians alike have had trouble explaining exactly why therapy works—or doesn’t.
Vancouver therapist Niloufar Esmaeilpour has guided clients through trauma for a decade. Her early training included cognitive behavioral therapy, but she began incorporating breathwork and other somatic techniques that harness the mind-body connection four years ago. “I’ve been always interested in different ways that we can come back to ourselves,” she says. Plus, she was frustrated that cognitive behavioral therapy was working more like a Band-Aid than a cure. She felt that once the glue of therapy dissolved away, its benefits did, too.
Esmaeilpour also uses somatic experiencing, an alternative trauma-resolution method that mixes talk therapy (to recount traumatic memories) with observing bodily sensations that could represent trapped traumatic energy. Practitioners claim it eases people through reprocessing these memories by unearthing emotions and sensations connected to traumatic experiences, finally allowing people to process the experience. The goal is to decrease sensitivity to similar situations, real or perceived, and to de-power traumatic memories, allowing the mind and body to heal. Somatic experiencing focuses on clues from the body, like tension, a pounding pulse, or shallow breathing, to guide sessions.
“When we’re dysregulated, that’s a flooded response,” says Gina Martin, a professor of counseling and trauma specialist at the University of Wisconsin, Whitewater. “The counselor can recognize those symptoms of dysregulation and can help you get back [to baseline] through breathwork.” That can be as simple as pausing for the therapist and client to take a single breath together.
“There has to be a marriage of science and art when you’re working with humans.”
Martin recently penned a guide for therapists who want to incorporate breathwork into their practice. She doesn’t use hyperventilation techniques like holotropic breathing or specifically recommend them in her work. For one thing, Martin says, there’s the risk of people passing out. Also, they can be more difficult to master and more intense than techniques like box breathing that slow the respiratory rate.
But what about that lack of rigorous evidence for breathwork? It’s a question that plagues the mental health field as a whole, Martin says. Despite the merits of more evidence-based practices, “We have a lot of people who don’t get better,” she says. “It’s very standardized and it doesn’t work for everyone.” In other words, there aren’t always evidence-based answers for people who don’t get better with evidence-based practices. So many therapists have embraced techniques like breathwork that have even a smattering of research support.
“There has to be a marriage of science and art when you’re working with humans,” Martin says. “How do you quantify human emotion?” And whether breathwork as a standalone technique can resolve trauma, it’s a tool that can aid therapists. Observing someone’s breathing offers clues about difficult memories; places to pause the conversation or push it forward. “It can be a way to track the nervous system and see what needs to happen in a therapy session,” Esmaeilpour says.
Research advances the benefits of breathwork
Increasingly, scientists are pairing breathwork exercises with interventions to speed healing and stave off disease. So far, the strongest conclusion is a frustrating one: higher-quality research is needed. A meta-analysis in the journal Scientific Reports of 12 randomized-controlled trials of breathing techniques for stress reduction linked slow or fast techniques of breathwork to slightly lower stress levels, decreased depression, and gentler anxiety symptoms. But the researchers analyzing the studies also found that most were at moderate risk of bias, due to their design.
Controlled breathwork showed promise in another study published earlier this year by Stanford’s Huberman lab. Scientists reported that breathwork was more effective than mindfulness meditation in decreasing stress and boosting wellbeing. Researchers used three common types of breathwork: a type of drawn-out exhalation called cyclic sighing; box breathing, which is the alternation of inhalations and exhalations with equally long breath holds; and a type of hyperventilation that variably uses short and long exhalations. Cyclic sighing was the most effective at improving mood.
The measures of the Stanford study are apt: They define stress reduction not with qualitative self-reporting but with quantifiable biometrics, like lowering breathing and heart rates and increasing heart rate variability (a measure of the body’s ability to respond to stress)—meaning, these types of findings can help relieve symptoms of anxiety or PTSD, even if they’re not proven cures.
Meanwhile, scientists are applying breathwork to physical ailments, too. At the Oregon Health and Science University in Portland, a researcher studying the physical outcomes of yogic practices is currently working on clinical trials that examine the influence of yogic breathwork on sleep quality and, separately, CSF (cerebrospinal fluid) circulation. Elsewhere scientists are testing breathwork’s ability to prompt changes in addictive behavior, heart rate variability, and electrical activity in the brains of adults seeking help for cannabis use disorder.
Breathwork believers explore extremes
At the University of Sussex in England, research psychologist Guy Fincham is dedicated to unraveling cause-effect relationships between breathwork and health. Despite his experience at meditation retreats in places like India and Sri Lanka, hyperventilation techniques he learned later were the first thing to offer him relief from chronic fatigue syndrome (also known as myalgic encephalitis or ME/CFS). They became a window into other breathwork techniques, which he later mastered. (He is now a trained breathwork teacher.)
Some of the physiology is obvious. Slowing our breathing and observing our physical sensations gives a racing, ruminating mind something to focus on, and it can alleviate symptoms of anxiety and depression. This is not unique to breathwork, of course. It’s also a common benefit seen from mindfulness meditation, which is better studied. Early breathwork research, Fincham says, shows a small but validated effect. But he thinks studies that methodically seek to pair the many breathwork modalities with a host of human ailments will ultimately help medical providers learn to treat illness with more than a prescription pad.
“When I found out that there was a way of regaining control or what could be perceived as having some sense of control over my body, it seemed to help with these CFS relapses that I was having,” he says. Rapid breathing practices decrease carbon dioxide levels, causing blood vessels to the brain to constrict, which decreases oxygen to the brain. Ongoing research suggests this may lead to disinhibition of brain regions that process emotion and the internal sensations of the body, like heartbeat or thirst, Fincham says. He’s now pairing up with his institution’s school of psychology and its medical school to conduct more rigorous experiments to explain breathwork’s benefits.
Similar disinhibition happens with psychedelics, so proponents hope hyperventilation-based breathwork techniques could function as a low-barrier-to-entry method to induce extraordinary mental states. Of the half-dozen of these techniques, holotropic breathwork is among the first to wiggle its way into popular culture in the West.
“The interesting thing in psychedelic breathwork is that you’re in control of it.”
Unlike psychedelics such as psilocybin, MDMA, or LSD, “The interesting thing in psychedelic breathwork is that you’re in control of it,” Fincham says. “In the moment, you can decide whether you want to keep going or not.” When a participant stops breathing rapidly, the effect promptly dissipates. Given the mammoth challenges of psychedelic-assisted psychotherapy—access, legalization, regulation, potential cultural appropriation, adverse reactions, and more—breathwork alone would be far easier.
Whether it works is hard to say. A 2023 review compiled preliminary data from qualitative studies on meditation, yoga, holotropic breathwork, and shamanic drumming, noting improvements in mental health and wellbeing. Similarly, a 2022 case study tracked six women with childhood trauma who tried holotropic breathwork. They reported a host of improvements, from feeling more connected to having a better perspective on their past to simply feeling happier and more at ease. Most were interested in continuing the technique alongside other types of treatment. But these studies are more anecdotal than generalizable. For Fincham, a mixture of fast and slow breathing practices, plus CBT, proved beneficial.
It may be that breathwork is less about the specific method used and more about the outcome: an increase in mind-body awareness, and the ability to harness that awareness to alter our emotions or state of mind. Fincham believes that hyperventilation techniques are as likely to work as well as their non-hyperventilating counterparts, much as a religious scholar might argue there are many ways to seek the divine, yet only one ultimate truth.
For now, holotropic breathwork appears to be equal parts religion and research. Several of the participants in that six-person study reported re-experiencing their own birth and most claimed to have unlocked spiritual insights. Psychedelics have already hinted at similar outcomes: expanded mental states that create a host of creative, if inexplicable, experiences. Still unknown are the precise parallels between psychedelics, which were recently shown to boost psychological healing, and breathwork, whose potential is widely appreciated by therapists. Freud and “Anna O.” might be shocked by these methods, but after over a century of exploring the mind through words, perhaps another method for the “chimney sweeping” Anna O. described is on the horizon.