A Trauma Aware Approach to Breath Work

 

As mainstream society continues to jump on the breath work bandwagon it is very important we continue to prioritize safety and accessibility with regards to this practice. As a mental health therapist and mindfulness coach that works extensively with athletes, its important that I continue to break down the nuances of such an individualized and powerful practice. As someone who has experienced significant trauma, chronic anxiety and panic disorder in my life I know firsthand how challenging breath work can be.

I always want to acknowledge that in any setting I may be teaching breath work in, someone has probably experienced some level of trauma. More likely than, someone in the room really struggles with breath work and doesn’t feel safe feeling or accessing their breath let alone manipulating it. This blog is a complete break down of WHY this might be the case and HOW to get started with breath work in a safe and accessible way.

As Deb Dana says "The breath can be both a trigger and a resource". We have to feel safe enough to engage in breath work. Let's dive in. 

 

What is breath work?

We can’t talk about breath work without first acknowledging what the breath is. To breathe is to be alive and breathing is the most basic physiological process that is required for living. Pranayama, which is often used to refer to “breath work” is the one of the 8 limbs of yoga. Prana, means “life force”. Yama means “extension or control”. 

 The breath is automatic but we can also control it.

In order to control or manipulate it, we have to genuinely understand it. At a foundational sense, for me, breath work is simply about developing a relationship with our breath. Different pranayama techniques have different effects on the mind and body and its important to understand this as we come to any practice. 

Kristine Weber, in her Ebook The Subtle Secrets of Pranayama (2018)  states “Your breath is your lifeline, it is your ally, your friend, and your counselor. It is wise, and its intelligence maintains your very existence. Rather than “breath control” or “breath mastery” we can think about pranayama as breath exploration.” I think this is so beautiful and how we should all be coming to a breath work practice.

Breath work is NOT a competition or something to be forced. This practice begins with gaining awareness and moving towards exploration to find ways in which connecting with your own breath may serve and support you.

 

Basic Breath Anatomy

Breathing is a complex process that involves:

  • Diaphragm
  • Lungs
  • Nose, airways
  • Heart
  • Brain
  • Blood vessels
  • Intercostal muscles
  • Muscles of the neck, shoulders, back

 Your diaphragm is the main muscle in breathing which sits below the rib cage and above the stomach cavity. In short here is what happens when we breathe in and breath out anatomically:

Inhale: We breathe in. Air enters the nose and goes down in to the lungs which means our lungs inflate. As the lungs inflate our diaphragm contracts down (or flattens) creating an expansion at the belly.  

Exhale: We breathe out. Our lungs deflate as air exits the nose. As our lungs deflate our diaphragm will release back up (return to its natural shape)  and the belly will fall back down.  

Here is a simple picture for visual representation. Visuals can be helpful in seeing where the diaphragm is, what it looks like and how its sits inside the body : Breathing Mechanics

 

The Breath and Nervous System

Your breath is an automatic process that is controlled by your brain (medulla oblongata) and the autonomic nervous system (Ikeda et al, 2017). The autonomic nervous system (ANS) is a part of the peripheral nervous system and controls all involuntary or automatic processes like breathing, heart rate and digestion. 

When it comes to breathing, Your brain is always (automatically) adjusting your breath according to what is needed whether you are running from danger, working out at the gym, eating a meal or sitting at your desk reading a book (Novotny and Kravitz, 2017).  This is for our survival, safety and overall well being. 

The link between the breath and nervous system has been acknowledged from the beginning as seen in this verse from the Hatha Yoga Pradipika . “Respiration being disturbed, the mind becomes disturbed. By restraining respiration, the Yogi steadies the mind.” 

What we also know from much of the research on Polyvagal Theory, done by  Dr Stephen Porges, is that autonomic nervous system is a main influencer in how we think, feel and behave. The ANS is the controller of our lives. Therefore, breathing, because it is controlled by the ANS will have an intertwined relationship with how we think, feel and interact with the world around us.

 

The ANS

In order to understand more on breath work and the nervous system we need a short lesson in the Autonomic Nervous System.

The autonomic nervous system as 2 main branches, sympathetic and parasympathetic.

  • Sympathetic Nervous system = mobilization, fight, flight
  • Parasympathetic Nervous system = rest, digest, safety

*Please note: The parasympathetic nervous system technically has 2 pathways or branches based on Polyvagal theory (Dr. Stephen Porges).

  • Pathway 1 = Ventral Vagal which is that rest, digest, social connection and safety
  • Pathway 2 = Dorsal vagal which is shut down, freeze and immobilization

*Please note: When it comes to the nervous system we are never fully in 1 state or another (meaning 1 state is never “on” while the other state is “off”). Think of this as more of an influence and the state that has the influence is in control of our thoughts, feelings and actions. 

 

The Vagus Nerve, Heart and Lungs

The autonomic nervous system controls the breath through the inner workings of the vagus nerve.  The vagus nerve is the largest nerve (actually a bundle of nerves) in the body that travels from the brain down to the stomach. The vagus nerve is the main influencer of the autonomic nervous system and innervates and connects with the heart, diaphragm and lungs.

The vagus nerve connects the brain to the sinoatrial node (SA node) in the heart, which is the heart's natural pacemaker. Heart rate variability is the beat-to-beat variation in your heart rate and is directly related to your respiratory sinus arrhythmia (RSA) (Thompson et al, 2015). The RSA is a natural variation in heart rate that occurs during breathing.

During inhalation, the vagus nerve lets up on the SA node, heart rate increases slightly and you will have a more sympathetic influence on your nervous system.  During exhalation, the vagus nerve acts like a brake on the SA node, heart rate decreases, and you will have more parasympathetic influence on your nervous system. (Porges 1995, Dana 2020).

Cliff notes:

  • Inhale = heart rate increases , sympathetic influence
  • Exhale = heart rate decreases , parasympathetic influence

Manipulation of your inhale and exhale will inherently manipulate your heart rate. When your heart rate changes your body and mind change with it. The mind and body do not operate separately. If we manipulate one, we manipulate the other.

In addition to the vagus nerve and SA node, nerves from both your sympathetic and parasympathetic nervous system innervate and cover your airways and lungs (Mazzone and Canning, 2013).  It has been shown that many of the nerves that are a part of your parasympathetic system are located in the lower half of your lung lobes while more sympathetic nerves cover the top half of your lobes (Nestor, 2020).  This would suggest that breathing more deeply so that the lungs fully expand on your inhale would potentially engage these more parasympathetic nerves. 

Much talk around breath work is that it is “calming” and “soothing” because of this link to the parasympathetic nervous system state.

When we are in highly activated or distressful states (think panic or heightened anxiety) we are going to be in a more sympathetic nervous system state. Ideally, in these states the goal (in order to help ourselves navigate these experiences) is to gently and compassionately  “downregulate” our nervous system. Downregulating means shifting from a more sympathetic (activated, mobilized state) to a more ventral vagal parasympathetic nervous system, state (rest, digest, safety). The breath is ONE way that we can help ourselves out here but not THE only way.

The main take away here should be that breath work is very intimately connected to each individuals nervous system and therefore intimately connected to how we think, feel and behave. We are all different people with different lived experience and different nervous systems. The goal or intent behind breath work should never be to generically prescribe practices because no two people are the same.

 

Why can breath work be challenging?

As I just mentioned, breath work impacts everyone in unique and individual ways but I will repeat one more time because of its importance!

As you have read, the breath is intimately connected to your nervous system and therefore intimately connected to how you think, feel and behave as well as our sense of survival.

When we manipulate the breath we are manipulating our nervous system.

We need to understand the profound power and impact that the breath has on us as humans and our ability to navigate our lives and the world around us. We need to become FRIENDS with the breath so that our breath supports us and works for us not against us.

Breath work, at any level, is a mindfulness practice. Mindfulness practices can at times pose challenges for people, especially people who have lived through trauma. The rates of trauma in our society are extremely high and roughly 90% of the population has experienced trauma (Elliott 1997, Kilpatrick et al, 2013)

For many people, manipulating the breath in any way can feel very uncomfortable, unsafe and unsettling.  

Why?  David Treleaven , in his book Trauma Sensitive Mindfulness, states “when we ask someone with trauma to pay close, sustained attention to their internal world, we invite them into contact with traumatic stimuli – thoughts, images, memories, and physical sensations that may relate to a traumatic event.” (page 6).

Any breath work practice, regardless of its intention, has the ability to increase or exacerbate any of these symptoms which can often feel MORE activating (connected to that more sympathetic nervous system state).  This is why we cannot generically prescribe or claim that breath work is “calming”, “grounding”, or “safe”. For many people tuning in to the breath or manipulating the breath at any level feels the opposite.

If you have experienced (or are experiencing) trauma, post traumatic stress or heightened levels of anxiety or panic and breath work has been difficult for you, I want you to know that you are not alone. This makes complete sense.

If a breath work practice elicits any uncomfortable feelings, difficult memories or flashbacks, hypervigilance or a feeling of not being “okay”, remember that YOU are in charge. Breath work should never be forced. You are in control to stop the practice at any time.

It is always a good idea to consult your primary care provider or mental health clinician before starting or engaging in breath manipulation.

If you notice any symptoms including dizziness, light headedness, nausea, or increased heart rate, please stop immediately and consult a professional.

The last thing I will add is that we as a society are very focused (and prioritize) intellect, rationale and reason. We prioritize living our lives “in our heads” which often leaves us disconnected from the felt sense of our body.  Tuning in to our body and the process of breathing can be challenging for people even if you haven’t experienced trauma.

There is a difference between breath work being challenging and difficult at times and evoking or exacerbating harmful symptoms. Babette Rothschild (2010) shares that any work specifically concerning trauma must be to relieve not intensify suffering. 

But I also like this guideline for those who haven’t experienced significant trauma. If your practice is causing you MORE harm than support its time to pivot or make adjustments. This is why I am a huge advocate of working with a licensed or qualified professional. Its always a great rule of thumb to consult with your mental health or medical provider.

  

Potential contraindications for breath work

  • Medical: Heart conditions, asthma, emphysema, bronchitis, and other breathing problems, headaches, glaucoma, and cervical disc problems, vertigo, stroke, high blood pressure and any other cardio-vascular or neurologic conditions. Please consult your medical provider before breath work.
  • Mental health and psychological: Schizophrenia, dissociative conditions, history of trauma, PTSD, anxiety or panic disorders. Please consult your medical or mental health provider before engaging in breath work.
  • If you are pregnant please consult with your physician!

 

 

Now that you know the full scoop on breath work I encourage you to head over to Part 2 on my Blog, "Exploring Breath work: Where to Start?This blog will help you get started with breath work in a safe and accessible way!

 

Please download and read my full Breath Work Disclaimer HERE 

 

 

References: 

Weber, K . (2018), The subtle secrets of pranayama.  Subtle Yoga Health, LLC. Teacher Training. www.subtleyoga.com
Ikeda, K., Kawakami, K., Onimaru, H., Okada, Y., Yokota, S., Koshiya, N., Oku, Y., Iizuka, M., & Koizumi, H. (2017). The respiratory control mechanisms in the brainstem and spinal cord: integrative views of the neuroanatomy and neurophysiology. The journal of physiological sciences : JPS, 67(1), 45–62. https://doi.org/10.1007/s12576-016-0475-y Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368202/
Novotny, S. and Kravitz, L. (2017). The science of breathing.
https://www.unm.edu/~lkravitz/Article%20folder/Breathing.html
Dr. Stephen Porges
https://www.stephenporges.com
Thompson, M., Thompson, L., and Reid-Chung, A. (2015). Combining loreta z score neurofeedback with heart rate variability. Z Score Neurofeedback Clinical Applications.  Retrieved from: https://www.sciencedirect.com/book/9780128012918/z-score-neurofeedback , Chapter 8
Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications for our evolutionary heritage. A Polyvagal Theory. Phsycophysiology, 32 (4), 301-319
Dana, D. 2020. Polyvagal excercises for safety and connection. W.W. Norton & Company. New York, NY
Mazzone, S. B., & Canning, B. J. (2013). Autonomic neural control of the airways. Handbook of clinical neurology, 117, 215–228.https://doi.org/10.1016/B978-0-444-53491-0.00018-3
https://pubmed.ncbi.nlm.nih.gov/24095128/
Nestor, J. 2020. Breath. Riverhead books by Penguin Random House, New York.
Elliott, D. M. (1997). Traumatic events: Prevalence and delayed recall in the general population. Journal of Consulting and Clinical Psychology, 65(5), 811–820. https://doi.org/10.1037/0022-006X.65.5.811
Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of traumatic stress, 26(5), 537–547. https://doi.org/10.1002/jts.21848
Treleaven, D. (2018). Trauma sensitive mindfulness. Practices for safe and transformative healing. New York, NY. WW. Norton & Company
Rothschild, B (2010). 8 keys to safe trauma recovery: take charge strategies to empower your healing. New York, NY : Norton.
 
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