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Anxiety

Why “Take a Deep Breath” Is Bad Advice

Two reasons deep breathing makes anxiety worse, and what to do instead.

Key points

  • Therapists and well-meaning friends often say to "take a deep breath," but breathing deeply worsens cognitive and physiological anxiety.
  • Breathing slowly (not deeply), using slow breathing at the right time, and practicing slow breathing regularly will provide more relief.
  • When having an anxiety attack, it's best to do grounding work to get one's thoughts under control first, before breath work.

It’s 8:58 a.m. and I’ve signed into the testing center to take the Examination for Professional Practice in Psychology (EPPP), a daunting standardized test that decides whether you can be licensed as a psychologist or not. To say I’m nervous would be the understatement of the century.

Given the decade of yoga training I’d accumulated at that point, I had a great plan: I would slip into the bathroom right before the test began and take some good old-fashioned deep breaths. In, 2, 3, 4, pause, 2, 3, 4, out, 2, 3…you get the idea.

It didn’t work, though. Instead, I felt shakier. My heart raced. I couldn’t even find my breath, because it was so erratic. Was I doing it wrong? Am I screwed? I walked back into the testing room, my body still a-jitter.

Well-meaning yogis, therapists, counselors, and mindfulness teachers—even parents, now that today’s culture is so mindfulness-informed—have told us for years that deep breathing is the cure to all our anxiety-related ills.

Teens (and a lot of grown-ups) hate it. They are ready to tell me in Therapy Session 1, “Don’t tell me to take a deep breath, because it doesn’t work.” Many times, my own kids have screamed, “I don’t want to take a breath!” mid-tantrum. As I pushed out my second child, in the middle of my awesome breath practice, an L&D nurse told me “Stop that! You’re wasting all your energy!” At some point, I stopped fighting them on it and got curious about why.

As far as I can tell, there’s at least two reasons why this advice is misguided.

1. Cognition (Your Thoughts)

The breath is often used as a beginning anchor for mindfulness students, but not because it has special powers: It’s just always with you. Training yourself to return to the breath over and over can help distance us from distracting thoughts. But for some of us, particularly when we are already in a state of physiological panic, overfocusing on the breath can lead to spiraling thoughts upon thoughts.

Focus on the breath can be an anxiety trigger for some and lead to panic attacks, due to the judgments and thoughts that pile on as you think about how you should be able to do it, how you’re doing it wrong, how you can’t even do breathing right, and so on. When you’re calm and still and say, mid-meditation, that’s perfectly fine, because you can observe those thoughts without getting attached to them. But in the middle of a freak-out, it’s more likely you’ll get hooked by the thoughts and carried away into panic-town.

2. Physiology (Your Nervous System)

One of the most terrifying signs of a panic attack is feeling like you can’t catch your breath. Hyperventilation (i.e., breathing heavily when stressed or panicking) means you’re exhaling too much carbon dioxide. There’s too much, not too little, oxygen in your system, in relation to the amount of CO2. A relative drop in CO2 makes you feel dizzy, lightheaded, and faint.

“Taking a deep breath,” especially a quick one, is essentially extending and exacerbating the hyperventilation cycle. If you’re having a panic attack, or feel close to it, taking a big gulp of even more O2 is the very last thing you should do, because it will tip the scales again in favor of less CO2. With that big gulp of air, you’re pumping even more oxygen.

Ever seen someone hand a panicked person a brown paper bag? Breathing into and out of that paper bag helps balance the ratio. That’s why it works.

As a further illustration, in the Bikram yoga tradition, Kapalbhati, AKA breath of fire, requires using quick, successive, and deep exhales to stimulate the sympathetic nervous system. That’s the exact wrong half of the autonomic nervous system you want to activate if you’re having an anxiety attack! The sympathetic nervous system revs us up and further prepares us for danger. Fire breath is considered an activating or energizing breath exercise, not a relaxing one.

That’s not to say all breathwork is doomed, though. The breath is a tool and can be used in many ways. Some types of breathing exercises definitely improve stress and anxiety. Just cross out “deep” and insert some other modifiers.

Julia Strait, 2011
Breathing: You're Doing It Wrong :)
Source: Julia Strait, 2011

How to Get Breathwork to Work for You:

If you’re using the breath as a calming device, make sure you:

1. In the middle of an anxiety attack, practice grounding first, then onto the breath.

Grounding skills will help get your thoughts under control and bring you back to the room. (Remember it’s the spiraling thoughts that cause trouble in the first place!)

As you do this, monitor how distressed (freaked out) you feel. You can use any scale, but 1-10 (10 being the most freaked out ever) works well. As you do your grounding skills, wait till you’re a 3 or 4 out of 10 on the distress scale, not a 9 or 10.

When you’ve allowed your O2/CO2 ratios and your autonomic nervous system to calm down a bit, you can more safely start with more relaxed breathing.

Slow breathing works well as a regular preventive practice, or as a method of stilling an already-still mind even further, but it’s not good at the height of a crisis. Once you are grounded and have some distance from those pesky thoughts about thinking and breathing, you can move to #2.

2. Breathe slowly, not deeply. Fast, deep, irregular breathing is what leads to hyperventilation.

Try to get it slower each time, breathing in for 3 seconds and out for 4 seconds, then in for 3 and out for 5, and so on, rather than starting with 3 counts of in-breath and 8 counts of out-breath. Lengthen the exhale to activate the parasympathetic nervous system, but gradually. Taking shortcuts will backfire.

3. Practice regular, slow breathing when you are not in a crisis. Think of it like flossing…for your nervous system.

Get your mind and body used to discriminating between “I’m breathing slowly and regularly” (i.e., relaxed) and “I’m breathing quickly and deeply” (i.e., panicked). Get familiar with the feeling of transitioning from one to the other and improve the fluency with which you can switch back and forth (i.e., physiological flexibility, which is related to Heart Rate Variability or HRV).

This is where most of the evidence for the effectiveness of breathing protocols on anxiety comes from, by the way (example). Participants are typically asked to practice breathing techniques daily, not just in the throes of panic. And from what we’ve talked about so far, you can see why.

With these modifications, you have yourself a relaxation toolbox that will be much more effective, and less frustrating, than trying to deep breathe your way out of a DEFCON 1 emotional crisis.

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