Our brain controls our breathing largely without conscious awareness.
We shower, watch football, listen to music, and sleep while our respiratory system functions in the background to keep us alive and kicking.
However, the rhythmic pattern of unconscious inhalations and exhalations is not always efficient to meet the demands of our everyday experiences. For example, we often over-breathe in response to stress or under-breathe during sleep.
But it only takes a moment to bring our breath to conscious awareness. The human ability to take control of our breath is one of the most powerful tools we have to optimize health. By using our breath, we are able to purposely regulate our brain and bodily states and adjust to our environment.
Learning breathing techniques that are effective for our particular body and mind requires practice. The fundamentals of strong breathwork practice begins by mastering diaphragmatic breathing.
Diaphragmatic breathing is a deep-breathing technique that focuses on active contraction of the diaphragm. We inhale slowly and deeply through the nose using the diaphragm, which has the effect of raising the abdomen with minimal movement of the upper chest (Hamasaki, 2020).
The rhythmic pattern of slow and deep inhalation followed by equally timed exhalations improves respiration rate and oxygen saturation, associated with improvement in physical and psychological wellness (Hamasaki, 2020). It brings balance to the autonomic nervous system by triggering a parasympathetic response (Hamasaki, 2020).
In order to learn diaphragmatic breathing and ultimately use it to improve anxiety, we need to know a little about the mechanics of the diaphragm and the neuroscience of respiration.
Structure and function of the diaphragm
The diaphragm is the primary muscle of respiration, accounting for approximately 70% of the range of a typical inhalation and exhalation in a restful state (Helmy et al., 2021).
Structurally, the diaphragm is a large sheet of muscle and tendon located directly under the lungs and above the liver. It spans the ribcage and separates our thoracic cavity (cardiovascular and respiratory systems) from our abdominal cavity (digestive and reproductive systems). Imagine the diaphragm as a double dome-shaped parachute that contracts and relaxes rhythmically with our breath.
Functionally, the diaphragm is the main muscle of respiration. Our lungs do not function independently and require muscles to make them work. When we inhale, the diaphragm contracts and flattens allowing the lungs to expand and abdomen to rise. When we exhale, the diaphragm relaxes and returns to a double-dome shape, expelling air from the lungs.
Contraction of the diaphragm has important non-respiratory functions as well. We use our diaphragm to vomit, lift heavy objects, laugh, hiccup, and push babies through the birth canal. Dysfunction of the diaphragm is related to a wide-range of respiratory symptoms, exercise intolerance, and sleep-disordered breathing (Dubé & Dres, 2016).
Diaphragm - 3D Medical Animation
This 3D video demonstrates how the diaphragm flattens and relaxes with each inhalation and exhalation. Notice how the diaphragm connects to the lower ribs, sternum, and spine. See the lower ribs expand on inhalation, allowing more room for the lungs to expand.
Diaphragmatic breathing is fundamental to all breathwork
As with any new technique or practice, mastering the fundamentals provides a solid foundation for achieving success as we add complexity to the technique. A solid breathwork practice begins with mastering diaphragmatic breathing.
The goal is to get to a place where diaphragmatic breathing is second nature and occurs with little conscious effort. At that point, we can comfortably add variation to our breathwork techniques to improve our sleep, motivation, and learning and reduce stress.
Diaphragmatic breathing & relaxation
The vagus nerve passes through the diaphragm. The duration and intensity of our inhalations and exhalations can stimulate the vagus nerve to activate a parasympathetic response, resulting in feelings of relaxation.
The shift to parasympathetic dominance by vagus nerve activity is one potential mechanism to explain how controlled breathing practices may relieve symptoms and promote feelings of relaxation. Particularly in conditions exacerbated by stress, including anxiety, depression, post-traumatic stress disorder, and chronic pain (Brown & Gerbarg, 2005; Gerritsen & Band, 2018; Streeter et al., 2012).
Diaphragmatic vs. Chest Breathing: A Diagram
Since the lungs do not work on their own, we need to recruit our muscles for respiration. The difference between diaphragmatic breathing and chest breathing is simply the muscles we choose to use.
Diaphragmatic breathing
Diaphragmatic breathing requires active control of the diaphragm. Focus attention on this sheet of muscle during inhalation in order to fully expand the lungs and allow oxygen to enter our bloodstream and tissues. Chest expansion is kept at a minimum.
Noticeable abdominal expansion is produced naturally as the diaphragm presses down on the contents of the abdomen. We often call this “belly breathing”; however, air is going into the lungs, not the abdomen.
Exhalation is a passive process as the diaphragm relaxes and returns to a dome-shape, lowering the abdomen. Variations of diaphragmatic breathing can involve controlled exhalation that varies in duration and resistance, using active control of the lip and nasal cavity.
Chest breathing
Chest breathing is produced when we use muscles in the upper chest area and sometimes non-respiratory muscles of the shoulders, neck, and back when we inhale (Bradley & Esformes, 2014). Noticeable upper chest movement is produced when we use these muscles.
Inhalation during chest breathing is shallow and limits thoracic space for lung expansion, ultimately reducing the amount of oxygen entering our body and increasing levels of carbon dioxide. Rapid chest breathing increases activity of the sympathetic nervous system, resulting in what feels like a stress response.
Panel 1: With chest breathing, the muscles in the back, shoulders, and neck are recruited during inhalation, with noticeable chest expansion and partial lung expansion.
Panel 2: With diaphragmatic breathing, the diaphragm is recruited during inhalation. It contracts and flattens, allowing the abdomen to rise and creating space for the lungs to expand completely.
Diaphragmatic breathing is fundamental to ancient practices of yoga, tai chi and mind–body practices.
Although the state of scientific research on breathwork and diaphragmatic breathing is in its infancy, evidence for the effectiveness of diaphragmatic breathing to improve physical and mental health is strengthening. Several studies show the enormous potential of diaphragmatic breathing exercises to improve a wide range of symptoms in clinical and nonclinical populations.
Continued improvement in research methodology and identification of mechanisms will provide evidence-based directions to its therapeutic potential.
1. Slow breathing shows a system-wide benefit
A review of the physiological effects of slow breathing (about six breaths per minute) in healthy adults shows improvement across respiratory, cardiovascular, cardiorespiratory, and autonomic nervous system functions (Russo et al., 2017).
This system-wide effect of slow breathing demonstrates its potential to improve cardiovascular, respiratory, and digestive system health, as well as nervous system regulation separately and as an integrated system. Of interest to mental health is the impact of slow breathing on the autonomic nervous system through improved vagal activity and a shift to parasympathetic dominance (Russo et al., 2017).
A meta-analysis of 13 studies of 665 participants with high blood pressure found that regular diaphragmatic breathing practice at six to 10 breaths per minute improved blood pressure in prehypertensive and hypertensive individuals (Yau & Loke, 2021).
Benefits to heart rate variability, quality of life, and anxiety were also found. Based on these findings, the authors concluded that four weeks of twice daily diaphragmatic breathing at a rate of less than 10 breaths (or six breaths) per minute for 10 minutes was effective (Yau & Loke, 2021).
3. Slow breathwork improves perceived stress
A meta-analysis of 12 randomized controlled trials with a total of 758 participants showed that deliberate, slow breathwork practices (but not fast breathwork) improved perceived stress in nonclinical samples (Fincham et al., 2023). The effect was not significant in clinical mental or physical health samples.
Slow breathwork significantly reduced stress when taught in a group setting or individual setting and when delivery was in-person, remote, or a combination of the two (Fincham et al., 2023).
A randomized control group study showed that diaphragmatic breathing reduced cortisol levels after 20 sessions of controlled breathwork. The 30-minute intervention occurred over an eight-week period and included 15 minutes of rested breathing followed by 15 minutes of diaphragmatic breathing (Ma et al., 2017).
The intervention group showed significant improvement in sustained attention and a decrease in negative affect compared to baseline (Ma et al., 2017).
5. Diaphragmatic breathing reduces anxiety levels
An experimental study of healthy adults showed that diaphragmatic breathing intervention reduced self-reported anxiety levels and physiological indicators of anxiety, including average heart rate and breathing rate (Chen et al., 2017).
The intervention group completed an eight-week diaphragmatic breathing relaxation program and practiced twice a day at home (Chen et al., 2017).
6. Diaphragmatic breathing app improves emotion regulation in veterans with PTSD
In this experimental study (Wallace et al., 2022), veterans experiencing post-traumatic stress disorder (PTSD) and traumatic brain injury used a smartwatch app intervention for four weeks. The app included diaphragmatic breathing techniques and other stress management tools.
Veterans in the experimental group experienced a significant increase in meeting emotion regulation goals they set for themselves compared to the control group (Wallace et al., 2022).
7. Diaphragmatic breathing improves fetal attachment in pregnant women with gestational diabetes
In this randomized controlled study (Fışkın & Şahin, 2018), women with gestational diabetes practiced diaphragmatic breathing for five minutes each day for 30 days. Self-reported fetal attachment significantly increased after 30 days in women in the experimental group.
Women also experienced a decrease in self-reported stress, anxiety, and depression. The hypothesized mechanism of improved attachment is that increases in fetal movement during diaphragmatic breathing improves mother–child bonding.
How to Do Diaphragmatic Breathing: 4 Steps
A strong diaphragmatic breathing practice can prepare us with the fundamentals of healthy breathing.
From here, a personalized toolkit of breathwork practices can be built that meets the specific challenges your clients face each day.
Guide your clients with the following steps:
Step 1. Body position
Lie on your back in a comfortable position free from distraction. Place one hand on your chest. Place the other hand on your abdomen.
Step 2. Notice your breath and body
Without trying to control your breath consciously, take notice of the rise and fall of your hands, the duration of your exhalations and inhalations, and how you are using your nose and mouth to breathe.
Step 3. Inhalation
Inhale deeply through your nose into your abdomen and laterally into the lower rib cage and back toward the spine. Imagine expanding the entire surface area and perimeter of the dome shape of the diaphragm to make room for your expanding lungs. Notice how the hand on your abdomen raises higher than the hand on your chest.
Step 4. Exhalation
Take time to exhale passively through the nose and relax the diaphragm. Repeat steps three and four for a duration of five minutes.
Variations and helpful tips
If you find it difficult to notice the rise and fall of your abdomen, try a few breaths lying on your stomach. You may more easily feel the sensation of pressure of your rising abdomen against the surface you are lying on.
Imagine your breath as a balloon that gently inflates and deflates with each inhalation and exhalation.
Add a brief pause at the top of each inhalation and the end of each exhalation.
Increase the duration of your inhales compared to exhales (e.g., four-second inhale followed by six-second exhale).
At the end of each exhalation, actively press your abdomen against your spine to empty your lungs completely.
6 Best Exercises, Handouts, and Worksheets
Think of breathwork as consciously controlling our breath using different rhythmic patterns designed to change our physiological, emotional, and cognitive states in a specific way.
Patterns are created by deliberately adjusting the ratio of inhales to exhales, adding breath holds, and adding resistance to the breath with various configurations of our lips, tongue, and nasal cavity.
1. Square breathing
In this square-breathing exercise, equalize the ratio of inhales, pauses, and exhales with this beginner’s exercise for overall relaxation.
Quickly break the cycle of anxiety with the physiological sigh exercise led by Andrew Huberman. Just one physiological sigh can decrease anxiety in the moment. A daily five-minute practice of cyclic sighs is shown to decrease stress for 24 hours (Balban et al., 2023).
Reduce anxiety and stress with the physiological sigh
5. The Power of Breath
The Power of Breath is a comprehensive handout from the US Department of Veterans Affairs to teach diaphragmatic breathing to clients. It includes the science of breathwork for various clinical populations, evaluation, homework, and trouble-shooting.
6. Prepare for sleep
Try this relaxing breathwork exercise with a 4–7–8 technique described by Andrew Weil. Inhale for four counts, hold for seven, and exhale for eight.
How to perform the 4-7-8 breathing exercise
3 Meditation Scripts to Manage Anxiety
Meditation scripts can be recited live during a session or recorded for later use. Record yourself or have your client record themselves reciting the script. Save the script as an audio file on a smartphone or tablet. Clients can listen to the audio recording when they need to reduce feelings of anxiety or manage an anxiety-provoking experience.
1. Meditation for working with difficulties
This general six-minute script from the Mindful Awareness Research Center at UCLA can be used for working through any difficult emotion or troubling body sensation.
2. Soften, sooth, allow
This script from Palouse Mindfulness is based on mindfulness-based stress reduction practice. It can be used to work through experiences of stress and anxiety that are often felt in the body.
3. Soothing anxiety with breath awareness
This script from Mindfulness Exercises combines meditation and breath awareness to reduce feelings of anxiety. The worksheet format is ideal for documenting meditative practice.
Best Apps to Improve Your Breathing
The best way to build a strong breathwork practice is consistent practice and reliable data. Apps are invaluable for beginners and for anyone who wants to fine-tune their breathwork or combine it with other mind–body practices.
Each app offers personalization for your specific mental/physical needs, useful notifications to improve practice, free and paid content, quick evidence-based education, visual/haptic/auditory guidance, and compatibility with iOS and Android devices.
Breathwrk
Choose the brain or body state you want to experience right now: calm, nighttime, energizing, performance, or health.
Select one or more breathwork practices to get you there. Many practices are under five minutes. It also includes a free beginners program.
Unique exercises: Habit formation, Breathing for Pain, Pregnancy & Labor, COVID Support, High Altitude Training, Brain Fog, Pre-Meeting Jitters
Practices are highly experiential, with a focus on active meditation, music-immersive practices, and positive wisdom from experts in breathwork, somatic release therapy, and physiotherapy.
The app is designed for transformative experiences rooted in ancient practices alongside modern science. Try the Beginners Journey with a seven-day free trial.
Up sessions – practices to start your engine (energizing)
Down sessions – practices to land (calming)
All around sessions – long haul journeys (emotional release)
Calm offers a holistic mind–body experience that includes breathing exercises, music and sounds for focus, and meditations. Calm has it all.
Unique content: “Slow the Swirl in Your Mind” grounding exercise, “Managing Overwhelm” meditation, “Crossing Ireland by Train” with Cillian Murphy sleep story, and “Train Your Mind” with LeBron James
Help your clients prevent burnout, handle stressors, and achieve a healthy, sustainable work-life balance with these 17 Stress & Burnout Prevention Exercises [PDF].
If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.
A Take-Home Message
The diaphragm is the engine of respiration and a powerful muscle we can engage to actively regulate our nervous system. Diaphragmatic breathing is a technique almost anyone can use — anytime, anywhere — to activate a parasympathetic response and return to a state of calm.
Whatever your health goals, a breathwork practice grounded in diaphragmatic breathing is a flexible tool to change your physiology.
Active control over the patterns of our breath has the effect of shifting our mental and physical state to meet the unpredictable demands of our moment-to-moment experiences.
Regular practice can improve the quality of our sleep, our general response to stress, and our cardiovascular health.
Diaphragmatic breathing allows you to actively control your respiration in a rhythmic pattern that reduces stress, increases calm, and improves overall wellbeing.
What is the difference between belly breathing and diaphragmatic breathing?
These terms are used interchangeably since belly rising is an effect of diaphragmatic breathing. It is anatomically impossible to breathe into your belly. You can only breathe into your lungs.
What is diaphragmatic breathing in Pilates?
Diaphragmatic breathing differs from Pilates breathing. Pilates breathing is deep breathing with simultaneous contraction of the abdomen and pelvic floor. Diaphragmatic breathing is deep breathing that results in a natural rise and fall of the abdomen.
References
Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell ReportsMedicine, 4(1).
Bradley, H., & Esformes, J. (2014). Breathing pattern disorders and functional movement. International Journal of Sports Physical Therapy, 9(1), 28–39.
Brown, R. P. ,& Gerbarg, P. L. (2005). Sudarshan kriya yogic breathing in the treatment of stress, anxiety, and depression: Part I—neurophysiologic model. The Journal of Alternative and Complementary Medicine, 11(1), 189–201.
Chen, Y. F., Huang, X. Y., Chien, C. H., & Cheng, J. F. (2017). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspectives in Psychiatric Care, 53(4).
Dubé, B. P., & Dres, M. (2016). Diaphragm dysfunction: Diagnostic approaches and management strategies. Journal of Clinical Medicine, 5(12).
Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1).
Fışkın, G., & Şahin, N.H. (2018). Effect of diaphragmatic breathing exercise on psychological parameters in gestational diabetes: A randomised controlled trial. European Journal of Integrative Medicine, 23, 50–56.
Gerritsen, R. J. S., & Band, G. P. H. (2018). Breath of life: The respiratory vagal stimulation model of contemplative activity. Frontiers in Human Neuroscience, 12.
Hamasaki, H. (2020). Effects of diaphragmatic breathing on health: A narrative review. Medicines, 7(10).
Helmy, M. A., Magdy Milad, L., Osman, S. H., Ali, M. A., & Hasanin, A. (2021). Diaphragmatic excursion: A possible key player for predicting successful weaning in patients with severe COVID-19. Anaesthesia, Critical Care & Pain Medicine, 40(3).
Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., & Li, Y. F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8.
Russo, M. A., Santarelli, D. M., & O’Rourke, D. (2017). The physiological effects of slow breathing in the healthy human. Breathe, 13(4), 298–309.
Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5).
Wallace, T., Morris, J. T., Glickstein, R., Anderson, R. K., & Gore, R. K. (2022). Implementation of a mobile technology-supported diaphragmatic breathing intervention in military mTBI with PTSD. The Journal of Head Trauma Rehabilitation, 37(3), 152–161.
Yau, K. K., & Loke, A. Y. (2021). Effects of diaphragmatic deep breathing exercises on prehypertensive or hypertensive adults: A literature review. Complementary Therapies in Clinical Practice, 43.
About the author
Jessica is a developmental scientist with a background in neurocognitive research and sociocultural theory. As co-founder of The Urban Chalkboard Play Cafe in Indiana, her applied work focuses on the cognitive, social, and mental health benefits of children's play.
Our brain controls our breathing largely without conscious awareness.
A strong diaphragmatic breathing practice can prepare us with the fundamentals of healthy breathing.
