I was 24 years old when I realized I had never learned to breathe.

It was 1994, and I was sitting in one of my first hatha yoga classes being guided through a breath awareness practice by my first yoga teacher Simone. She said, “Notice your breath….where do you connect with your breath in your body?”

Through this exercise I realized how shallow my normal breathing was and that it filled my chest without reaching the bottom of my lungs.

At that moment it hit me, “Maybe I’ve never really taken a deep breath!”

By that point I had been experiencing depression and anxiety for more than 5 years. I wondered if there was a connection between how I was breathing and my mental health symptoms.

From that first breath awareness practice taught by Simone, breathing practices (including the one I share in this blog) have played a significant role in learning to work with my own mental health symptoms.

Our mood affects how we breathe

There is no doubt that how we feel affects how we breathe. The most obvious example of this is when we are anxious or in panic. Think back to a time when you were really anxious or worried. What was your breath pattern like? Was it smooth and deep or shallow and choppy? Of course, for most people, the latter pattern would go along with anxiety.

In fact, research done by Philippot and Blairy identified distinct breathing patterns for four of our core emotions (joy, anger, fear, and sadness). In their 2010 study entitled “Respiratory Feedback in the Generation of Emotions,” the researchers had participants evoke different emotions through the use of memory and fantasy and then monitored and analyzed qualities of their breath patterns, including speed, location in the lungs and breath amplitude. Through this observation they found specific and distinct breath patterns associated with different emotions.

This study confirms what most of us know intuitively, how we feel emotionally affects us physically, down to how we breathe.

But how we breathe can also affect our moods

The second part of that study is where things get more interesting.

Here, they took a second group of volunteers and told them they were participating in a study looking at the cardiovascular impact of breathing styles. They then taught them to breathe in the four distinct breath patterns identified in the first part of the study. What they found was that, in most cases, they could reliably evoke the anticipated emotional response.

So if people who were not sad spent 15 minutes breathing in a “sad” breath pattern, they would begin to feel sad. If they spent 15 minutes breathing in an “anxious” breath pattern…you guessed it, they would begin to feel anxious. 

Imagine if you breathed in a “sad” or “anxious” breath pattern for months or years. Do you think this would lead to you feeling depressed or anxious?

What this study shows is what Yoga has been teaching for thousands of years.

One of the fastest ways to change how you feel is to change how you breathe. In yoga tradition, breath training is called “Pranayama” (which means “to expand and direct energy or lifeforce”), and is used to calm the body and regulate the mind.  

In their book “The Healing Power of Breath,” Integrative psychiatrists Drs. Richard Brown and Patricia Gerbarg state,

“By voluntarily changing the rate, depth, and pattern of breathing, we can change the messages being sent from the body’s respiratory system to the brain. In this way, breathing techniques provide a portal to the autonomic communication network through which we can, by changing our breathing patterns, send specific messages to the brain using the language of the body, a language the brain understands and to which it responds. Messages from the respiratory system have rapid, powerful effects on major brain centers involved in thought, emotion, and behavior.”

Most often, people who are depressed breathe in a shallow and uneven way, often punctuated with sighs. The recommendation to lessen sadness and promote joy, based on the research cited above, is to “breathe and exhale slowly and deeply through the nose; your breathing is very regular and your ribcage relaxed.”

What’s your breath pattern like?

One of the first things I have my clients do in our work together is to become aware of their their own typical breathing pattern.

I ask them to place one hand on their chest and and one hand on their belly just above the their belly button and notice which hand is moving out more.

If it’s the hand on their chest that moves out more, it’s an indication that their breath is shallow (this method of breathing is often referred to as “thoracic breathing.”)

If the hand on their belly is moving out more, it’s an indication that their breaths are deeper and fuller as breath is filling to the bottom part of their lungs.

There is clear indication that a deeper breath pattern is connected to mental health while shallow chest breathing is correlated with symptoms like depression and anxiety. Don’t be alarmed if your habitual breath pattern is shallow. This can be changed with practice.

In addition, I ask clients to notice a few other things that will give us information about the habitual breath patterns, including:

  • Are your inhales and exhales even, or is one longer than the other?
  • Are there pauses between the inhalation and exhalation or is the breath smooth?
  • Is your breath rate fast or slow?

These questions help you to understand whether your breath pattern is supportive of the condition you are working with (i.e. depression).

How breath influences mind

A regular practice of slow and steady deep breathing is one of the fastest ways of changing  how you think and feel. As few as three slow steady deep breaths that reach the lower quadrants of the lungs can shift mind and mood.

Belly Breathing (breathing deep into the lungs) triggers what stress management expert Dr. Herbert Benson calls the “Relaxation Response” which is the opposite of the fight/fight state.

In more technical terms, activating the “Relaxation Response” through breath turns on the parasympathetic branch of the nervous system, which communicates to the brain that you are “safe and OK.” The feeling of safety sets the stage for mental wellness. Dr. Benson has done decades of research which has shown that regular stress management practice (including deep breathing) helps many health problems including fibromyalgia, gastrointestinal ailments, insomnia, hypertension, anxiety and depressive disorders.

A breathing practice for depression or anxiety

One of the best breathing practices for depression is called the Three-Part Breath. It’s a mainstay of yoga and helps to create a state of alertness while at the same time activating the “Relaxation Response.”

It’s best done with an even inhalation and exhalation when you have a low energy depression. If you have more of an anxious depression it’s best to do the practice with an exhale twice as long as the inhale (for instance inhaling to a count of 3 and exhaling to a count of 6). By lengthening your exhalation you will enhance the calming effect of the practice.

To practice:

Begin in a comfortable seated position with the spine upright. Inhale the breath through the nose into the bottom of the lungs (so the belly expands). It may  help to put a hand on the abdomen to guide the breath.

Practice this first part a few times to get the hang of it. Allow the breath to become smooth as you notice your abdomen expanding with the inhale and contracting with the exhale.

When you have the first part down, inhale the first third of the breath into the bottom of the lungs as described above, and then inhale the second third into the middle part of the lungs so that the ribcage expands. Practice to get these first two parts down.

Once you do, place one hand on your upper chest, and inhale as you did above, then add the final third part of the breath into the top of the lungs.

What you are looking for is expansion of the belly first, then the expansion of the ribs and finally the lifting of your chest.

After the full inhalation, slowly release the breath and allow the upper chest to lower first, then as the ribs contract and as you complete the exhale, draw your abdomen back toward your spine, completely emptying the bottom of your lungs.

At the beginning, practice for 5-10 minutes.

It’s important to remember that breathing practices are most effective when practiced as part of the system from which they were born. This system of self-exploration is  called Hatha Yoga, which includes postures, breathing practices, systematic relaxation and meditation.

If you find 3-part breathing helpful, see if you can find a Hatha Yoga class in your community.  

An integrative approach to treat depression and anxiety

It’s unlikely that breathing practices alone will be all that’s needed to address you mood issues.

It’s more typical that breathwork would be part of a broader therapeutic effort that might includes modalities such as psychotherapy, nutrition, exercise, bodywork, neurofeedback, functional medicine testing or others.

It’s about finding the right combination of tools that help you.

If you enjoyed this article and would like to learn more about integrative approaches to depression (including yoga tools, nutrition, and functional medicine), take a look at my website.

In good (mental) health,

Dr. Josh


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