The effects of coherent breathing on mental well-being
In today’s society, with its fast paced and high pressured nature, along with the impact of Covid-19, there has never been a time when stress and anxiety levels have been so high in the general population. According to a study in 2020, ‘due to COVID-19, mental health illnesses including anxiety, depression, stress, and sleep disorder have become prevalent problems across the world. People who are under high risk of infection, stress, and burnout can develop common mental health problems such as anxiety, depression, and fear (Bao et al. 2020; Tanhan 2020).’(1) Living in a digital age undoubtedly has its benefits but also provides a near constant source of stimulus. It can be hard to escape the bombardment of information, much of it negative, and allows less time to spend on activities that are known to boost mental wellbeing, such as fostering social connections in the real world and spending time outdoors in nature. Covid-19 has introduced a host of anxieties that many will not have experienced before, such as living with the constant fear of illness, livelihoods being threatened in an unprecedented manner and the lack of social contact for months on end, of which the negative effects on mental health are well documented. Indeed, it is this lack of certainty over so many parts of life that has no doubt exacerbated anxiety amongst those who suffer from anxiety at a clinical level and even those not generally of an anxious disposition. This essay aims to explore the effects of stress and anxiety on the nervous system and whether a breathing practice, known as coherent breathing, can have a positive impact on the physiological functioning of the body, thereby boosting mental wellbeing.
In order to understand the effects of stress and anxiety on the body, we must look to the nervous system. There are two main branches to the central nervous system: the autonomic nervous system and the somatic nervous system. The autonomic nervous system (ANS) is responsible for functions over which we have very little conscious control such as metabolism, heart rate, blood pressure, and endocrine function. The somatic nervous system, on the other hand, allows for conscious control of skeletal muscles, used for such activities as walking, talking and eating. The ANS consists of two components: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), and all body systems and organs receive instructions from both. SNS is the ‘fight or flight' part of our nervous system and accelerates the body, while the PNS is the 'rest and digest’ component that allows us to slow down.(2)
The effects of stress and anxiety on the body in the short term include increased heart rate, rapid breathing, contraction of the muscles and raised blood pressure. This happens when the body’s SNS is activated and is designed to protect us from danger. Once the immediate danger has passed, the PNS should immediately activate to counter the physiological effects of the SNS and bring the body back into balance by reducing the heart rate and blood pressure, relaxing the muscles and slowing the breathing. From an evolutionary perspective, humans were designed to spend only short periods of time in the SNS in order to protect them from immediate danger, after which the PNS would automatically activate, triggering the restoration of physiological balance. However, due to modern lifestyle, where we are almost permanently ‘switched on’, many of us are now spending the vast majority of time living predominantly in the SNS despite not actively being in danger. This results in our bodies residing in a permanent state of stress which can lead to chronic ailments, inflammation and ultimately disease if left unaddressed.
The quickest and most effective way to activate the PNS, bringing the body back into a state of relaxation, is through attention to the breath. When we are anxious our breathing becomes short and shallow and is generally concentrated in the upper chest area. We also tend to breathe in and out through the mouth so by consciously breathing deeply and slowly through the nose, we can draw the breath down to the diaphragm, which has an immediate calming effect on the body’s vital organs. As the diaphragm expands it massages organs such as the liver, small intestine, stomach, pancreas and heart, which in turn has positive effects on all physiological functions ranging from blood flow and circulation to digestion and immunity. These reactions in the body, along with the release of endorphins and oxygenation to the brain, have a direct impact on our mental state, elevating our mood and helping to alleviate feelings of stress and anxiety.
Manipulation of the breath is not a new concept, having been utilised for thousands of years in practices such as yoga. Pranayama, the practice of controlling and regulating the breath in order to allow prana, or ‘vital life force’, to move freely throughout the body, is referenced in some of the earliest Indian scriptures, such as Patanjali’s Yoga Sutras. Pranayama was traditionally practised in order to prepare the mind and body for meditation and ultimately achieve Samadhi, a state of eternal bliss. It remains a fundamental part of yogic teaching to this day, although the focus of pranayama in the West is now often centred around the physical and mental benefits of breathing practices such as Sama Vritti (equal breathing) and Nadi Shodhana (alternate nostril breathing), rather than achieving spiritual enlightenment. According to Swami Niranjanananda Saraswati (Prana and Pranayama, 2016), ‘the yogic renaissance witnessed in the last few decades has made asana and pranayama into household terms, but the essence and depth of these practices remain unexplored for most practitioners.’(3)
The physical and mental effects of pranayama are discussed on a more practical level in the Hatha Yoga Pradipika. In his commentary of the text, Swami Muktibodhananda explains that ‘Prana and mind are intricately linked. Fluctuation of one means fluctuation of the other. When either the prana or mind becomes balanced, the other is steadied.’ He continues, ‘Hatha Yoga says let the mind be, concentrate on the autonomic body functions and vital energy, and the mind will become quiet by itself. When the nervous impulses are steady and rhythmic, the brain functions are regulated and the brain waves become rhythmic.'(4) As practices such as yoga have become more popular in the West, so have such breathing practices as a means to improving health and wellbeing. Breathwork has gained a great deal of attention in the last few years as more studies have shown the positive effects of breathing practices on the regulation of the ANS and in the treatment of stress and anxiety related conditions. One of these such practices is known as coherent breathing.
Coherent breathing is a technique involving deep and rhythmical breathing through the nostrils at a rate of around five breaths per minute, equating to an inhalation of six followed by an equal exhalation of six. This form of breathing has been proven to have certain balancing effects on the ANS, thus providing the practitioner with a sense of calm and relaxation both mentally and physiologically. When we breathe in, the SNS is activated and when we breathe out, the PNS comes into force and it is this focus on the equal inhalation and exhalation that has a particularly balancing effect on the nervous system. Many of us breathe at a rate of 15-20 breaths per minute so by reducing this to a rate of five achieves emotional and physiological coherence.(5) Importantly, diaphragmatic breathing also stimulates the vagus nerve which is responsible for activating the PNS.
The vagus nerve, also known as the ‘wandering nerve’, is the longest of the 12 cranial nerves and runs from the brainstem through to the abdomen via the neck, heart and lungs. Its four key functions are sensory (from the throat, heart, lungs and abdomen), special sensory (providing taste sensations behind the tongue), motor ( providing movement functions for the muscles in the neck responsible for swallowing and speech) and parasympathetic (responsible for the digestive tract, respiration and heart rate functioning).(6) The vagus nerve also carries sensory information from the internal organs back to the brain. It controls many of the internal organs and when stimulated, heart rate slows, blood pressure decreases and muscles relax. The brain is then informed of the physiological changes and the mind becomes calm and peaceful. Vagal tone (vagus nerve activity) reflects the ratio between sympathetic and parasympathetic signals and how well the vagus nerve is functioning. High vagal tone indicates a well functioning, balanced ANS and means that the body can return to a state of equilibrium fairly easily after encountering a stressful or fearful situation. It is associated with lower blood pressure, improved blood sugar regulation, improved digestion, reduced anxiety and reduced risk of stroke and cardiovascular disease. Furthermore, researchers have discovered a positive feedback loop involving increased vagal tone, positive emotional responses, and physical and mental well-being.(7) Low vagal tone, on the other hand, suggests that the vagus nerve is not functioning optimally and can lead to a heightened stress response, resulting in chronic disorders such as digestive issues and anxiety. There are various techniques that can help stimulate the vagus nerve and coherent breathing is one such practice, through its attention on focussed, slow, deep diaphragmatic breathing, thus activating the PNS and restoring balance in the body and mind.
Vagal tone can be measured by tracking certain biological processes such as heart rate, breathing rate and heart rate variability. When we breathe slowly and deeply, our heart rate patterns (Heart Rate Variability or HRV) can synchronise with our breathing to invoke a feeling of calmness. HRV peaks when breathing at a rate of about 6 breaths per minute, but this varies between individuals from 4-7 breaths per minute.(8) Heart rate variability refers to the variations in time between each of our heart beats. When we inhale our heart rate rises and when we exhale it slows down; however, the length of time between each beat varies, thus HRV is the range from our maximum heart rate to our minimum heart rate.(9) The body’s parasympathetic activity is directly reflected in HRV and a higher HRV equates to a stronger parasympathetic tone, meaning that the body can adapt to stressful situations more quickly and easily. This in turn results in lower stress and anxiety levels and better physical health. When stressful situations arise, the PNS in those with high HRV will activate more quickly and balance, both physiologically and mentally, will be restored more efficiently. Along with its association with better physical health, HRV is linked to performance, including the ability to self-regulate, inhibit negative thoughts and make objective decisions. Coherent breathing is one of the most effective ways of increasing HRV by quickly accessing the parasympathetic branch of the ANS and relaxing the body, which in turn, sends signals to the mind that all is well. It’s important to acknowledge that the nervous system cannot differentiate between real danger where one’s life is in jeopardy and perceived danger, which can be present in stressful situations such as a difficult encounter or argument. If we have strong vagal tone and high HRV the body is able to calm down more quickly and revert back to a state of relaxation. If our vagal tone is weak and we have low HVR our bodies will be stuck in a state of stress, with all of the accompanying physiological and emotional responses, such as a rapid heart rate and an anxious mind. According to one review of a 2003 study(10), harnessing the PNS through slow breathing ‘appears to be an effective means of maximising HRV and preserving autonomic function, both of which have been associated with decreased mortality in pathological states and longevity in the general population’.(11) In this review, Lehrer and Gevirtz suggest that diaphragmatic breathing is part of a feedback loop that improves vagal tone by stimulating the relaxation response of the PNS. It was also noted that people with a higher HRV (representing healthy vagal tone) showed lower biomarkers for stress, increased psychological and physical resilience, as well as better cognitive function.
In his groundbreaking work, The Polyvagal Theory, Stephen Porges suggests that the ANS is comprised of a third system response: the social engagement system, which is the ventral branch of the PNS and responsible for a mixture of activation and calming. The social engagement system helps us navigate relationships so whilst the SNS (mobilisation) and the dorsal branch of the PNS (immobilisation) systems are defence mechanisms designed to activate in an emergency, the social engagement system requires a sense of safety. An article in the Psychiatric Times notes that, ‘according to Porges, any stimulus that increases feelings of safety can recruit neural circuits that support the social engagement system and inhibit defensive limbic structures. Physiological states characterized by increased vagal influence on heart rate variability support social bonding.’(12) This indicates that mental wellbeing is sustained by optimal physiological states, and one way this can be achieved is through conscious, slow, diaphragmatic breathing.
Studies have shown that certain breathing practices can significantly improve symptoms of anxiety disorders. The same article goes on to explain that breathing practices focussed on slow breathing that increase vagal influence on heart rate variability ‘tend to induce calm, relaxed states.’ It suggests that coherent breathing is one of the most clinically useful practices ‘because it is easy to learn, safe for most people, and induces a mental state of emotional calmness with mental alertness and enhanced cognitive processing.’(13) Whilst this form of breathwork is considered safe for most people it is important to note that for some people with anxiety, attention to the breath in a prolonged manner could trigger anxious episodes and lead to panic attacks. In such cases a more simple breathing technique may be appropriate, such as gentle attention to the breath and some abdominal breathing. Indeed this breath awareness is a vital preliminary step to any breathing practice as the breath first needs to be lowered to the diaphragm to achieve, deeper, fuller breaths.
Whilst coherent breathing may not be suitable for everyone, practising diaphragmatic breathing with an emphasis on the equal inhalation and exhalation through the nostrils of around five breaths per minute, consistently over time, can lead to an optimally functioning nervous system and thereby better overall physical and mental health. Through its effectiveness on improving the functioning of the vagus nerve and increasing heart rate variability, coherent breathing can create an environment in which the PNS is able to override activation of the SNS with more ease. This enables the body to return to living predominantly in the PNS, its optimal natural default. As explored in this essay, those living with high levels of stress and anxiety can be particularly prone to living their lives with sympathetic dominance and for those individuals, coherent breathing can be particularly effective in restoring physiological and mental balance. By bringing attention to the breath, mental chatter can be reduced, thereby reducing anxious thought patterns. Consciously slowing the breathing can help activate the PNS and restore a feeling of calm, and deepening the breath allows the diaphragm to expand and relax, helping to lower anxiety levels. In addition to reduced symptoms of stress and anxiety, coherent breathing can also lead to reduced pain, more energy, improved sleep, reduced blood pressure, increased resilience and increased immunity, thereby improving not only one’s physical state but also boosting overall mental wellbeing.
Bibliography
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Prana and Pranayama, Swami Niranjanananda, Yoga Publications Trust, Munger, Bihar, India, 2016, p.1
Hatha Yoga Pradipika, Swami Muktibodhananda, Yoga Publications Trust, Munger, Bihar, India, 2013, p.150
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Lehrer P. M., Vaschillo E., Vaschillo B., Lu S. E., Eckberg D. L., Edelberg R., et al. . (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosom. Med. 65, 796–805. 10.1097/01.PSY.0000089200.81962.19
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