Breathwork: A Powerful Tool for Managing Stress (& Techniques to Use)

Briran Comly, M.S., OTR/L on Dec 07, 2022 in Mood and Feelings

Modern Day Stressors

Our hunter-gatherer ancestors would laugh at the stressors we experience on a frequent basis. Sitting in a beautiful and advanced machine amongst similar machines and “inching” ahead at a running pace? A waiter taking too long to write down your made-to-order food request you didn’t have to spend days hunting down? Missing a comma in a spreadsheet? Yes, these are our first-world problems, but they are still problems. They create the same stress response of high blood pressure and systemic inflammation throughout your body as that lion chasing our ancestors did.

Most of the time, these modern-day stressors are subtle. Even the act of checking our email leads 80% of us to hold our breath in what has been coined email apnea. But frustration with your boss, checking your email, and even not getting as many Instagram likes as you expected can lead up to a daunting cumulative effect with a huge impact on both your short- and long-term health.

The good news is that we have control over it. One way is to change our mindset, a topic we’ll get into another time. The other way is to use the breath.

Think of your stress or anxiety as the alarm to your home. When you walk in the door at the end of the day, you need to punch in the code or else the alarm will blare. Using that code is breathing. When you breathe in intentional ways, you can instantly reduce your stress and increase your parasympathetic (rest, digest, repair) nervous system.

Deep breathing brings deep thinking and

shallow breathing brings shallow thinking.

– Elsie Lincoln Benedict

The Perils of Chronic Stress

Stress is not intuitively a bad thing — but chronic stress is. Because it begins in your brain, it reaches every part of your body. Chronic stress can lead to:

  • Accelerated aging
  • Insomnia and other sleep problems
  • Weight gain
  • Hair loss
  • Skin issues such as acne, eczema, and rashes
  • Headaches
  • Anxiety
  • Depression
  • Reduced sexual desire and erectile dysfunction
  • Low energy
  • Osteoporosis
  • Worsened asthma symptoms
  • Infertility for both men and women
  • Lower sperm count, sperm motility, and an abnormal production
  • Decreased testosterone
  • Less muscle growth
  • Poor recovery from exercise
  • Muscle tension
  • Brain fog
  • Gastrointestinal dysfunction such as heartburn, constipation, bloating, and diarrhea
  • Difficulty with digestion and nutrient absorption
  • Weak immune system
  • Damaged blood vessels
  • High blood pressure
  • Type 2 diabetes
  • Heart attack
  • Stroke

Many people have had a level of chronic stress for so long that they think it is their baseline. It is so ingrained in who they are that not only do they not know anything else but they actually become less comfortable when they get into that more relaxed state.

We see these people every day, and there are no shortage of ways this stress presents. Given society’s love of productivity, there are positive ways of describing them: high achiever, hard charger, driven, quick talker, extremely organized, and “always on.” There are also the less socially-accepted ways of describing them: scattered, jittery, anxious, irritable, and impatient. These characteristics all fall under the umbrella of an elevated sympathetic nervous system or stress.

Of course, someone can have these traits at times and have a fully engaged and balanced parasympathetic nervous system at other times, but this is rare. The best way to tell if you are in a chronic state of stress is to check your heart rate variability (HRV). (The second best way might just be to ask your friends.) HRV is the most comprehensive, non-invasive biomarker and a great way to objectively measure your nervous system. I’ve written about the different ways to check your HRV, the benefits of checking it, and different ways to improve your HRV.

Fortunately, you can break this pattern and unlock the other side of your autonomic nervous system — the parasympathetic nervous system — through breathwork. Tapping into this rest and digest state can have incredible effects like the more obvious: improved sleep, lower blood pressure, and decreased anxiety and depression. It also has an impact on the less obvious: lower blood sugar, better sex drive, improved digestion, and the ability to grow muscles.

So start with one of the techniques below, try it for a few days then pick another one. Stick with what works for you and use it on a regular basis.


I don’t provide information on what position to be in when using these techniques. It’s typically recommended you do these in a cross-legged position in a non-distractible area, but don’t limit yourself to this. The more important thing is just practicing the techniques.

At the end of the instructions for each technique, it simply states “repeat.” A good rule of thumb is to shoot for 8-10 rounds of each technique unless otherwise stated. Some people feel the benefits after 5 rounds and others after 30 minutes. Use your discretion.

3 Breathwork Techniques for Stress Reduction

Extended Exhales

Your heart rate slightly increases with inspiration — stimulating your sympathetic nervous system — and decreases with expiration — stimulating your parasympathetic nervous system and the vagus nerve. When you exhale longer than you inhale, the parasympathetic response dominates the sympathetic and increases your vagal tone, resulting in a state of calmness.

Instruction: The only rule for this one is to exhale longer than you inhale. The best results are typically from exhaling 2-3 times longer than you inhale. For example, if you take a 4-second inhale, then you would exhale for 8-12 seconds. I like to do a 1:2 ratio with a pyramid approach where I gradually increase the inhale/exhale time by 1 second per rep, decrease by 1 second, then repeat (e.g. 4s-8s / 5s-10s / 6s-12s / 7s-14s / 8s-16s / 7s-14s / 6s-12s/5s-10s / 4s-8s…).

Inhale at a count of 4 seconds.

Exhale for 2-3x as long.


Science: Every time we inhale, we trigger the sympathetic nervous system. Every time we exhale, we inhibit it. A longer exhale therefore means that we are in a stressed state for less time. A group of researchers performed two studies and published them in the International Journal of Psychophysiology. The first study looked at slow breathing on HRV metrics. The second study looked at the relationship between decision-making and perceived stress on breathwork practices. They concluded that breathwork with longer exhales can significantly improve HRV metrics, decrease perceived stress, and improve decision-making skills.

When to do it: Use this technique when you need to activate your parasympathetic system such as when you are in a stressed or jittery state, having trouble focusing during meditation, or having trouble falling asleep (substitute sheep for seconds). You can also use this at work to help make better decisions.

Alternate Nostril Breathing

The name says it all. Alternate nostril breathing is a breathing practice commonly used in yoga. It involves breathing through one nostril by blocking the other and then switching back and forth.


Inhale and exhale slowly.

Use your thumb to close off your right nostril.

Inhale and exhale through the left nostril.

Close the left nostril with your middle finger of the same hand.

Inhale and exhale through the right nostril.


Science: One study had 25 male participants perform alternate nostril breathing for 15 minutes a day for six weeks and found significant improvement in parasympathetic tone. In a 2017 pilot study, researchers broke up medical students into two groups prior to a simulated public speaking test. One group sat in a quiet room for 15 minutes without instruction, and the other performed alternate nostril breathing. The breathwork group showed a trend toward lower anxiety; however, it was not statistically significant. Another study broke up 13 participants into three groups: quiet sitting, breath awareness, and alternate nostril breathing. Using an EEG, they found that performing alternate nostril breathing increased calmness, whereas sitting without instructions actually increased arousal.

When to do it: Use alternate nostril breathing to activate your parasympathetic nervous system for relaxation and stress reduction.

Bonus: Use this to clear out your airways and nasal cavity. If you are a mouth breather, this is a great exercise to overcome the “fear” your brain associates with nasal breathing due to an increase in pressure with nasal breathing vs. mouth breathing.

Resonance Breathing

Resonance breathing (aka coherent breathing) is a technique that synchronizes your breath to your heart rate. This breath rate varies by individual, and it can range from 4 to 7 breaths per minute. In James Nestor’s book Breath, he writes that all traditions practice some sort of prayer, chanting, or meditation at a rate of about 5.5 to 6 breaths per minute with common examples including yogic breathing and the Hail Mary. He writes, “The perfect breath is this: Breathe in for about 5.5 seconds, then exhale for 5.5 seconds. That’s 5.5 breaths a minute for a total of about 5.5 liters of air.”


Inhale to a count of 5.5 seconds slowly without force.

Exhale to a count of 5.5 seconds slowly without force.


Science: This study showed that 5.5 breaths per minute showed the best HRV measurements compared to 6 breaths per minute and compared to an inhale-to-exhale ratio of 4:6. In this study, researchers divided 95 participants into three groups: no instructions, pre-determined resonance breathing + 1 breath per minute, and a pre-determined standard resonance breathing. Interestingly, the researchers used Rosenthal’s HRV determination protocol to determine each participant's individual breathing rate, which ranged from 5-7 breaths per minute. There was an improvement in systolic blood pressure, HRV, and overall mood in the resonance breathing group as compared to both the group that took 1 extra breath a minute and the group that just sat there. 

Researchers in a 2019 study took a similar approach by studying resonance breathing and resonance breathing + 1 breath per minute on 10 participants. They reported that both breathing patterns “induced the same acute changes on the sympathetic nervous system and BP, with both breathing paradigms inducing similar changes in the pattern of sympathetic firing.”

When to do it: Use resonance breathing to activate your parasympathetic state and put you in a calm mindset. The above studies show that you can use it to lower your blood pressure and improve your mood as well. Sometimes I’ll use the Cardiac Coherence app (similar one for iOS) which uses audio (waves on the ocean) and visual (a moving cursor) cues as a pacer so that I can focus on the breath instead of the count.

What I Do

When I become stressed about something (that I don’t want to be stressed about), the first thing I try to do is recognize the trigger. What exactly put this stress into motion? Then I mentally sit with the symptoms of this, even if it is just for a few seconds. I tend to have more energy, less saliva in my mouth, and more blood flow to my head and face. Then I start to breathe to recenter myself. I weave all three of these breathwork techniques into my routine whether as a way to decrease stress or simply as “practice” when I’m not stressed.

My favorite go-to breathwork strategy is extended exhales. I use this frequently and, really, whenever I think about my breath (sometimes helped with a notification on my phone). I often use resonance breathing as a way to help center me in meditation when I’m losing focus.

In a short time, the saliva returns to my mouth, my heart rate trends downward, and I return to my baseline.


Stress is our body’s natural way of protecting us. Acutely, it helps to save our lives. Chronically, it can kill us. There are many ways chronic stress has an impact on our lives. One difficulty with this is recognizing stress. Many people are chronically stressed and totally unaware. Once you use tools to identify your stress, the next step is to manage it.

Enter breathwork. Breathing is our body’s natural stress-reliever, but few of us realize it and fewer use it in that way. Recognize your breath, and then use one of the three breathwork strategies above to become healthier. Studies have shown that these techniques improve calmness, HRV metrics, lower your blood pressure, improve your mood, and even improve your decision-making.

Take one out for a spin, commit to it every day for a week, and then try the next one. You’re breathing anyway. Might as well get some benefit out of it.

Briran Comly is a Occupational Therapist Website

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