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Stress Management for Health Course

Stress and the Role of Breathing


". . . diaphragmatic breathing is considered by many to be the simplest and most effective form of controlled respiration in the reduction of excessive stress."

(Dr George S. Everly M.D.)


It has been known for thousands of years that breathing has a powerful influence over our physiological and psychological well-being.  Some people may find it difficult to understand the link between the way we breathe and its effects on stress, as we have been breathing since the first moment we were born and take 20,000 breaths a day, so we must have been breathing correctly as we are still alive.  Yet research has shown that the way we breath can have a powerful effect on how stressed we feel.  When we suffer stress one of the changes brought about by the fight/flight response is to speed up the amount of breaths we take switching from slow, abdominal breathing to faster, shallower, stressful, chest breathing.  This is vital and healthy in the short term however if we are constantly triggering the fight/flight response we can begin to habitually breathe with our upper chest even though the stress may be over.  This style of breathing sends signals to the brain that we are under stress when we may not be.


Styles of Breathing


We have two basic styles of breathing:


1.          Relaxed Abdominal Breathing

2.          Stressed Chest Breathing


1.  Relaxed Abdominal Breathing


Relaxed abdominal breathing is a slow, calm style of breathing where we breathe mainly from our diaphragm/abdomen.    If you observe a child that is relaxed and happy and you will see that their abdomen moves out when they inhale and it deflates when they exhale.  There is very little movement in their chest.  Studies have shown that practicing this style of diaphragmatic breathing reduces muscle tension and anxiety levels within 60 seconds.  Abdominal, slow breathing stimulates the Parasympathetic (the relaxation) branch of the Autonomic Nervous System.


2.  Stressed Chest (Thoracic) Breathing


In this style of breathing it is mainly the chest that moves when we inhale/exhale while there is very little movement in the abdomen, and the breathing is shallow and fast.  Again observe a child who is distressed.  When they become upset their breathing switches from slow, abdominal, diaphragmatic breathing to mainly chest breathing that is fast and shallow.  Chest breathing stimulates the Sympathetic (the fight/flight) branch of the Autonomic Nervous System.


Fortunately, although breathing is controlled mainly by the Autonomic Nervous System, we can voluntarily influence our breathing and help to switch off the fight/flight response by changing our breathing style from fast, shallow chest breathing to breathe diaphragmatically at a slower rate.  By doing this we send signals to the brain that the threat is over and the parasympathetic part of the Autonomic Nervous system starts to reverse the biochemical and physiological changes brought about by the fight/flight response.  However, it must be remembered that diaphragmatic breathing is a skill that takes time to learn, but it is effective because it is impossible to be relaxed and stressed at the same time.


Guidelines for Relaxation Breathing


Learning diaphragmatic breathing does not take long, but like any other skill it will take practice.


        Practice several times a day for several minutes each time.


       One of the advantages of diaphragmatic breathing is that you can practice it at any time in any place and nobody will be aware that you are doing it.  It can be used when:

  On a bus or train travelling to work

  During break times at work

  Before and during a visit to the dentist or doctor

  In bed just before getting up or going to sleep

  During adverts on the TV

  Just before meals

  Before an interview or exams or giving a public talk

  During difficult, stressful meetings

  While waiting in a queue


       It is important not to take deep breaths.  A lot of confusion has been caused by using the term deep breathing.  Your inhalation should only be slightly deeper than your regular inhalation.  If you take deep breaths this will achieve the reverse of what you are trying to achieve.


       It is important to practise breathing correctly every day, several times a day, until it becomes automatic and not wait until you are in a stressful situation before using it.



Breathing Training Precautions


       If you find your breathing style is a factor in your stress and the breathing strategies outlined in this session dont resolve this, or you have a chronic health problem we recommend you consult a Chartered Physiotherapist who specialises in breathing retraining.  You can find such a physiotherapist at www.physiohypervent.org


       If you feel uncomfortable when practising diaphragmatic breathing you may be breathing too fast and or too deeply.  All you have to do is let your breathing go back to its normal pattern.  You cant change a habit of many years, overnight.


        There are certain medical conditions like neurological or cardiovascular problems which may be compensated for by rapid breathing, such as:



         High blood pressure

        Heart disease

        Recent surgery

        History of fainting

        Kidney disease


       Respiratory conditions/Emphysema


        Low blood pressure


If you have such a condition or any other chronic medical condition you should consult your GP before practicing these diaphragmatic breathing retraining exercises.


       A minority of people who suffer from panic attacks and panic disorder can be sensitive to breathing retraining and it can actually induce panic attacks in sensitive individuals, so if you suffer panic attacks or panic disorder, discuss this with your doctor before practicing breathing retraining.


How to Check We are Diaphragmatically Breathing


1.   Lie down on the bed or settee, place one hand (palm face down) on your chest and place the other hand (palm face down) on your abdomen (just below your ribcage).


2.   Breathe normally and notice which hand is moving most, ie the abdominal hand or the chest hand.


3.   If the hand on your abdomen is moving and the hand on your upper chest is still, you are using your diaphragm and breathing correctly.


4.   If your upper chest hand is moving more than the hand on your abdomen then you are breathing mainly with your chest and this is a form of stressful breathing.


5.   By checking in this way on a regular basis that you are diaphragmatically breathing it will ensure that the majority of your breathing is relaxed abdominal breathing and this will help to reduce stress.  If you are not diaphragmatically breathing then follow the instructions in Abdominal Breathing Exercise.


6.   You may find it initially difficult to breathe using your diaphragm.  Don't give up, keep practicing, you may have been breathing with your chest for some time and so it takes time for your body to relearn to use your diaphragm again.



Slow Diaphragmatic Breathing Exercise (To be practiced at home)


Once you have checked if you are diaphragmatically or chest breathing you can now go onto the slow, abdominal, diaphragmatic breathing exercise (1-2-3 breathing).  Please ensure that you have read the precautions and guidelines on breathing before commencing the exercise below.  Once you have learned the slow, abdominal breathing exercise at home you wont need to use your hands on your abdomen and you can then begin practicing using it in outside situations, like on the bus or train to work.


1.   Sit or lie down.


2.  Loosen any tight clothing; remove shoes, tie, glasses/contact lenses.


3.   Place the palms of your hands flat on your abdomen just beneath your rib cage, middle fingertips touching, at a point 2 - 3 inches above your navel.


4.   Close your eyes and start to focus your thoughts on your breathing.  Try not to think of anything but your breathing.  This helps distract stressful thoughts.  Thoughts will intrude so don't fight them; when thoughts come into your mind try to bring your focus of attention back to your breathing.  It is important not to worry how well you are doing but try to retain a passive attitude.


5.   Begin to inhale through your nose (not your mouth), feel the air flow through your nostrils.  Breathe in for a slow count of 1 . . . 2 . . . 3 . . ., then exhale to a slow count of 1 . . . 2 . . . 3 . . . This will give you a breathing rate of 10 breaths per minute.


6.   Try to imagine in your minds eye that there is a balloon in your abdomen, as you inhale the balloon expands and as you exhale the balloon deflates. 


7.   Do not take deep breaths.  When you inhale your fingertips on your abdomen should only slightly part, this will help to reduce the risk of over breathing.


8.   Start by practising for a few minutes per day and then over time build up to 5 minutes, twice daily.


9.   If you feel dizzy, stop the exercise and let your natural breathing rhythm take over; you are probably breathing too deeply and/or too quickly.




       Do not use this breathing technique while driving, operating machinery or where you need to concentrate for safety aspects.


       Do not stand up straight away after relaxing, open your eyes, wait for a few minutes and then stand up.


       Do not drive immediately after practising your breathing exercises.

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