Breathing to Relieve Stress - How It Works & Exercises to Try

Stress is the process through which environmental demands result in detrimental outcomes to a person's physical and/or mental health and it is a global epidemic. In 2011, the World Health Organization developed guidelines to support primary care providers in the care of their patients who experience stress. [1] 

In 2016, a global assessment conducted by the World Health Organization recognized that sources of stress varied internationally and identified that 350 million people were affected by stress worldwide. [1]

A stressful experience encompasses both a physiological and psychological response.

Physiologically, stress activates the sympathetic nervous system through the secretion of cortisol [2] which causes an increase in the respiratory rate, heart rate and systolic blood pressure. The stress response can be immediate or delayed, acute or long term. Psychological stress also activates the sympathetic nervous system and is pro-inflammatory which leads to the development of mental and physical disease states. [2]

Stress is a major risk factor for the development of many chronic diseases, both physiological (e.g. cancer and cardiovascular disease) and psychological (e.g. anxiety and depression). [3]

In work and college environments, stress can lead to the development of cardiovascular disease, hypertension, depression, anxiety, social dysfunction, drug and alcohol abuse, and in extreme cases can result in death. [4]

The International Labor Organization's 2016 report on workplace stress identified that global workplace stress is only beginning to be quantified. [5]

In the United States, the cost of stress to employers has been reported to be over 300 billion. 

The overall financial burden of stress reported globally is staggering. [1]

The high costs of stress is well documented. In a study investigating anxiety and depression by the World Health Organization, the estimated cost of treatment worldwide from 2016 to 2030 using psychosocial counselling and medication is 141 billion. [6] 

Identifying evidence-based stress reduction interventions that are low cost, easy to use and can be self-administered is essential to the overall treatment and management of this global health issue.

How to Breathe to Relieve Stress?

Deep breathing is a simple yet powerful relaxation technique. It’s easy to learn, can be practiced almost anywhere, and provides an expedient method to get your stress levels in check. Deep breathing is the cornerstone of many other relaxation practices and is one of the best ways to lower stress in the body.

Deep breathing sends a message to your brain to calm down and relax.

The brain responds by sending this message to your body. The physiological responses that occur when you are stressed, such as increased heart rate, respiration rate, and high blood pressure, all decrease as you breathe deeply to relax.

Tips to practice deep belly breathing:

• Sit comfortably with your back straight. Put one hand on your chest and the other on your stomach.
• Breathe in through your nose. The hand on your stomach should rise. The hand on your chest should move very little.
• Exhale through your mouth, expelling as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.
• Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count slowly as you exhale.

If you are struggling breathing from your abdomen while sitting up, try lying down. Put a small book on your stomach, and breathe so that the book rises as you inhale and falls as you exhale.

Stress-Relieving Breathing Exercises to Try

Alternate nostril breathing:

Alternate nostril breathing, known as nadi shodhana pranayama in Sanskrit, is a breathing practice for relaxation. Alternate nostril breathing has been shown to enhance cardiovascular function and to lower heart rate. Nadi shodhana is best practiced on an empty stomach. Avoid the practice if you’re feeling sick or congested. Keep your breath smooth and even throughout the practice.

Here's how to do it:

• Choose a comfortable seated position.
• Lift up your right hand toward your nose, pressing your first and middle fingers down toward your palm and leaving your other fingers extended.
• After an exhale, use your right thumb to gently close your right nostril.
  Inhale through your left nostril and then close your left nostril with your right pinky and ring fingers.
• Release your thumb and exhale out through your right nostril.
• Inhale through your right nostril and then close this nostril.
• Release your fingers to open your left nostril and exhale through this side.
• This is one cycle.
• Continue this breathing pattern for up to 5 minutes.
• Finish your session with an exhale on the left side.

Buteyko Breathing technique - The Control Pause:

• After a relaxed exhale, hold your breath.
• Use your index finger and thumb to plug your nose.
• Retain your breath until you feel the urge to breathe, which may include an involuntary movement of your diaphragm, and then inhale.
• Breathe normally for at least 10 seconds.
• Repeat several times.

The Conscious Breathing Anchor:

• Inhale for 3 seconds through the nose
• Exhale for 6 seconds through the nose

Decongest the Nose:

• Pinch both nostrils shut and exhale through the mouth
• Hold breath and try to keep mind off breath holding.  
• Keep going, keep holding. When feel need to breath, take slow and controlled breath in through nose
• Do this a few more cycles

Box breathing:

• Navy seals use this technique to stay calm and focused in intense situations.
• Inhale to count of 4 secs, hold for 4 secs, exhale for 4 secs, hold for 4 secs
• Repeat

4-7-8 breathing:

• This is another exercise that also uses belly breathing to help you relax.  This can be performed either sitting or lying down.
• To start, put one hand on your belly and the other on your chest as in the belly breathing exercise.
• Take a deep, slow breath from your belly, and silently count to 4 as you breathe in.
• Hold your breath, and silently count from 1 to 7.
• Breathe out completely as you silently count from 1 to 8. Try to get all the air out of your lungs by the time you count to 8.
• Repeat 3 to 7 times or until you feel calm.
• Notice how you feel at the end of the exercise.

Roll breathing:
Roll breathing helps you to develop full use of your lungs and to focus on the rhythm of your breathing.

It can be performed in any position. It is best to lie on your back with your knees bent while you are learning this technique.

• Put your left hand on your belly and your right hand on your chest. Notice how your hands move as you breathe in and out.
• Practice filling your lower lungs by breathing so that your "belly" (left) hand goes up when you inhale and your "chest" (right) hand remains still. Always breathe in through your nose and breathe out through your mouth. Do this 8-10 times.
• After filling and emptying your lower lungs 8 to 10 times, add the second step to your breathing: inhale first into your lower lungs as before, and then continue inhaling into your upper chest. Breathe slowly and regularly. As you do so, your right hand will rise and your left hand will fall a little as your belly falls.
• As you exhale slowly through your mouth, make a quiet, whooshing sound as first your left hand and then your right-hand fall. As you exhale, feel the tension leaving your body as you become more and more relaxed.
• Take about 3-5 minutes and practice breathing in and out in this way. Notice that the movement of your belly and chest rises and falls like the motion of rolling waves.
• Notice how you feel at the end of the exercise.
• Practice roll breathing daily for several weeks until you can do it almost anywhere. You can use it as an instant relaxation tool anytime you need one.

Morning breathing:

• Try this exercise when you first get up in the morning to relieve muscle stiffness and clear clogged breathing passages. Then use it throughout the day to relieve back tension.
• From a standing position, bend forward from the waist with your knees slightly bent, letting your arms dangle close to the floor.
• As you inhale slowly and deeply, return to a standing position by rolling up slowing, lifting your head last.
• Hold your breath for just a few seconds in this standing position.
• Exhale slowly as you return to the original position, bending forward from the waist.
• Notice how you feel at the end of the exercise

Why Does Deep Breathing Relieve Stress?

Your autonomic nervous system, which controls involuntary actions like heart rate and digestion, is split into two parts. There is one part, the sympathetic nervous system, which controls your fight-or-flight response.

The other part, the parasympathetic nervous system, controls your rest-and-relax response. While both parts of your nervous system are always active, deep breathing can help quiet your sympathetic nervous system and therefore reduce feelings of stress or anxiety.

Breathing exercises reduce stress by increasing oxygen exchange, which reduces your blood pressure, slows the heart, and releases any tension held in the abdomen. These physical changes also benefit your mental state - concentrating on your breath can bring you into the present, in a state of mindfulness.

When a person is relaxed, they breathe through their nose in a slow, even and gentle way. Deliberately copying a relaxed breathing pattern seems to calm the nervous system that controls the body’s involuntary functions.

Controlled deep breathing can cause physiological changes that include:

• Lowered blood pressure and heart rate
• Reduced levels of stress hormones (i.e., cortisol) in the blood
• Reduced lactic acid build-up in muscle tissue
• Balanced levels of oxygen and carbon dioxide in the blood
• Improved immune system functioning
• Increased physical energy
• Increased feelings of calm and wellbeing

A likely mechanism of action is that voluntary slow deep breathing functionally resets the autonomic nervous system through stretch-induced inhibitory signals and hyperpolarization currents spread through both neural and non-neural tissue.

This synchronizes neural elements in the heart, lungs, limbic system and cortex.

During inspiration, stretching of lung tissue produces inhibitory signals by action of slowly adapting stretch receptors and hyperpolarization current by action of fibroblasts. Both inhibitory impulses and hyperpolarization current are known to synchronize neural elements leading to the alteration of the nervous system and decreased metabolic activity indicative of the parasympathetic state. [7]

The evidence to date indicates that deep breathing may decrease physiological stress as measured by blood pressure, respiration and cortisol levels, and also decrease psychological stress.

Given the potential benefits of deep breathing for physiological and psychological stress reduction, ongoing research is needed to continue to establish the evidence base for this self-administered, low-cost and non-pharmacologic intervention. [8]

References:
1.    Prüss-Ustün A, W.J., Corvalán C, Bos R, Neira M. global assessment of the burden of disease from environmental risks. in World Health Organization: Preventing disease through healthy environments. 2016.
2.    Muscatell, K.A. and N.I. Eisenberger, A Social Neuroscience Perspective on Stress and Health. Soc Personal Psychol Compass, 2012. 6(12): p. 890-904.
3.    Cooper CL, D.P., O’Driscoll MP.  , What is stress?, in Organizational stress: A review and critique of theory, research, and applications. 2001, Sage: Thousand Oaks, CA.
4.    Perciavalle, V., et al., The role of deep breathing on stress. Neurol Sci, 2017. 38(3): p. 451-458.
5.    Organization., I.L. Workplace stress: A collective challenge. 2016.
6.    Organization., W.H. Investing in treatment for depression and anxiety leads to fourfold return. 2016.
7.    Jerath, R., et al., Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses, 2006. 67(3): p. 566-71.
8.    Hopper, S.I., et al., Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review. JBI Database System Rev Implement Rep, 2019. 17(9): p. 1855-1876.