Anxiety issues are becoming progressively more pervasive in contemporary society. The daily stresses of our fast-paced ways of living have placed these issues in the forefront of mental health. The widespread impact of these issues is indicated by the various coping strategies available to those who need them. Popping pills does not hold the appeal for everyone, so they tend to opt for a more natural way of managing their anxiety. These include a varied assortment from meditation to gardening. However, as logical as it sounds, taking deep breaths to calm down is often overlooked. Strong scientific evidence has shown that it can actually help to dampen the 'fight or flight' response system while improving the functions of cognitive tasks. This has led to scientists suggesting its use in the self-management of anxiety.

The main point of this discussion is to consider how effective these breathing exercises are and if they could indeed be used to self-manage anxiety. Meditative and non-meditative breathing techniques can be a convenient, practical, and inexpensive solution for those dealing with anxiety issues. I aim to discuss this topic as the use and demand for psychological therapies are increasing, and the wait for these services can be rather long. Also, research will be conducted into current treatments for anxiety, which could support the use of non-meditative breathing techniques. Overall, it has been the rise of mental illness that has made 'anxiety management' the go-to choice of the populace. I feel that for many individuals, a mental health issue such as anxiety can be camouflaged and pushed to the side. However, there are methods for the self-management of anxiety that require the average anxiety sufferer to put in little effort and time.

Significance of Anxiety Management

In today’s day and age, effective stress management and anxiety management is indeed an independent branch of studies in itself. In a stressful world, it is no surprise that anxiety disorders, which are characterized by numerous phenomenological and emotional impairments, have increased exponentially. As many as one in four individuals can expect to be diagnosed with an anxiety disorder at some point in their lifetime. When one is aware of the growing volume of professional suicide, the high prevalence of untreated cases, and the substance abuse problems that co-occur with anxiety, some suggest that the numbers might be even higher. Anxiety disorders are likely to co-occur with other physical health problems including heart disease, high blood pressure, high cholesterol, and hormonal fluctuations, which can lead to osteoporosis. Therefore, the treatment of anxiety is of utmost priority.

The primary goal of treating anxiety is the promotion of mental health. Scaled exposure to competition is a slow process. There is no proven one-size-fits-all therapy, but counseling and anxiety management techniques, like deep breathing and muscle relaxation, sometimes help alleviate symptoms of anxiety. Developing a strong foundation of coping skills is critical. Muscle relaxation and physical exertion are ways to unwind, especially unconscious concerns, as shifting emphasis away from your concerns towards your values, while deep breathing can affect unconscious anxiety and boost well-being.

Rationale for Using Breathing Exercises

Rationale for Using Breathing Exercises in the Management of Anxiety

Breathing exercises are frequently recommended as an antidote to sudden feelings of panic and anxiety. The argument is that controlled breathing will have a calming effect that counteracts the physiological symptoms associated with anxiety, resulting in a decreased feeling of panic or worry. One of the advantages of breathing exercises is their ease of use, and more and more people are being encouraged to try them. It is, nevertheless, unknown if these techniques are genuinely beneficial. Research has shown that there does appear to be something to this hypothesis. Experiments with patients who were diagnosed with anxiety revealed that they experienced a significant reduction in anxiety symptoms after performing several breathing exercises: it is small enough to be performed regularly throughout the day and discreetly enough to be performed in public if needed, but it is also effective for almost anyone. Breathing exercises not only have the capacity to improve physiological tension and anxiety symptoms acutely but also appear to improve the general psychological state with repeated practice.

If the bodily sensations of a short sharp breath or, conversely, a long deep breath can so influence the subjective perception of our emotional state and act, at least for a short time, to counteract feelings of panic and anxiety, this raises the question: how are these processes able to exert such an effect on our emotions? In this model, a slow deep breath activates the sino-aortic baroreflex which, acting through the autonomic parasympathetic nervous system, leads to a lowering and stabilizing of the heart rate and induces broader effects on other body systems. Regular practice of this technique is likely to have long-lasting benefits for both physiological dysregulation and feelings of anxiety as, with repeated practice, it will make the body more easily 'relaxable'.

Understanding Anxiety

Anxiety is a broad level of experience. Although people often think of anxiety in general terms, it actually represents the umbrella term for a number of disorders. A few examples of these would include panic disorder, generalized anxiety disorder, social anxiety disorder, and depression. The presence of anxiety and related disorders often leads to symptoms that people find unpleasant and distressing. Because of this, people often cite anxiety as the reason for seeking therapy. There are also a number of non-therapy and anti-anxiety practices in which people partake. People who experience anxiety emphasize the need for broader knowledge and understanding regarding locations, caregivers, and treatment options. An estimated 31.1% of U.S. adults experience an anxiety disorder at some time in their lives. A reported 52.3% of people discontinue anxiety therapy due to unmanageability or symptoms.

Statistics show that the number of people dealing with symptoms is high. Although symbolic treatments for anxiety are numerous, etiology may be lessening due to treatment. This is concerning due to the way that anxiety reduces quality of life and management of day-to-day activities. Research has even led to the development of exponential costs linked directly to anxiety. Today, intensive study in the field is focused on the usefulness of a combined approach, consisting of traditional and drug therapy, in the effort to dampen the suffering of patients with anxiety and related disorders.

Definition and Types of Anxiety Disorders

Anxiety is described as "the anticipation of future danger that dominates an individual's thoughts and feelings." This anticipation can be in response to a wide range of stimuli, such as social situations, an object, or a potential event. There are seven recognized anxiety disorders: separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, and substance-/medication-induced anxiety disorder. Anxiety symptoms also commonly coexist with other mental health disorders such as depressive disorders and other medical conditions. In this chapter, we focus on three particularly prevalent and burdensome anxiety disorders: generalized anxiety disorder, panic disorder, and obsessive–compulsive disorder.

Anxiety disorders are diagnosed based on specific clinical criteria accompanied by impairment in social, occupational, and other routines of daily living. The symptoms of an anxiety disorder can differ based on its type. For instance, some individuals with anxiety disorders may experience intense, repeated episodes of panic or become overwhelmed by intrusive thoughts they cannot escape. Still, people with generalized anxiety disorder or social anxiety disorder may be consumed with feelings of worry, fear, and a lack of self-esteem. These different presentations of anxiety disorders highlight the challenges in diagnosing and treating them. If left unmanaged, anxiety disorders can be extremely debilitating. Prevalence rates of anxiety disorders are known to differ by type and can also show great variability across different countries and socioeconomic strata. For example, the 12-month prevalence of panic disorder has been found to be higher in high-income countries when compared to low- and middle-income territories. That being said, the 12-month prevalence of generalized anxiety disorder does not appear to differ much across countries, ranging from 0.4% to 1.5%. If left untreated, the complex manifestations of anxiety can bring about a considerable burden to individual and societal functioning. Consequently, anxiety disorders are directly associated with indirect costs related to lost productivity, reduced social and occupational functioning, and increased rates of comorbid mental and physical health conditions.

Impact of Anxiety on Physical and Mental Health

Symptoms of anxiety

Common symptoms of anxiety include psychological symptoms such as unease and fear, emotional symptoms such as irritability and restlessness, and physical symptoms such as increased heart rate, muscle tension, and fatigue. Chronic anxiety can lead to more physiological effects such as gastrointestinal pain, chest pain, headaches, trouble breathing, and shakiness. Health issues that emerge from chronic anxiety include hypertension and cardiovascular events, as anxiety can place strain on the heart. Weakened immunity can also occur due to the higher level of the stress hormone cortisol, living within those with chronic anxiety. Once immunity has decreased, these individuals are more likely to become ill from ailments in addition to taking a longer recovery time. Mental health is also impacted by chronic anxiety, as depression can arise from continuously low moods. This leads to an impaired ability to think, concentrate, and remember, which can create a decrease in productivity at school and/or work alongside experiencing social issues. Decreased cognitive functioning is emotional, as anxiety drains brain performance; the brain requires restraint to think.

Significance of using breathing exercises to manage anxiety

In order to flourish in life, the ability to use breathing exercises to manage anxiety problems is very helpful. In order to reduce how symptoms of anxiety impact the body’s stress response system, which causes physical symptoms to occur, breathing exercises can offer immediate relief. Breathing exercises are able to calm the individual with anxiety in addition to regulating heart rate to promote relaxation, making it easier to reduce fear. Moreover, if the individual has a panic attack, they can physically respond to symptoms nearly immediately. The alleviation of tension and muscular fatigue through breathing exercises also lessens the degree of “mind chatter” these individuals have. This can aid sleep onset and help them to have a day that is more productive. Effective chronic anxiety management is not only supposed to produce immediate relief but also to prevent chronic physical health systems from developing. The theory is that by assisting with respiratory function, they will be of significant benefit.

The Role of Breathing in Anxiety Management

In the previous section, we considered some alternative ways to manage physical and psychological symptoms of anxiety. We now shift our attention from activities that engage the mind to those that focus on the mind, with an emphasis on breathing practices. By providing a comprehensive understanding of the physiological processes that occur when we breathe and how breath control can be used as a tool to shift our emotional states, we draw a connection from the body to the mind when evaluating effective anxiety management techniques.

We have considered some cognitive activities that people find helpful in reducing anxiety. We will now focus on activities that are centered on the mind, specifically breathing exercises. When we pay attention to the way we are breathing, we can harness this cycle to shift our emotional state. Most adults take approximately 12 to 18 breaths per minute, while the healthy adult respiratory rate is 7 to 9 breaths per minute to support optimal carbon dioxide levels in the blood, which are necessary for all cellular processes. Carbohydrates, fats, and proteins in our food are ultimately oxidized through cellular respiration to support growth, movement, body temperature regulation, and other physiological functions. The final products of respiration are carbon dioxide and water, and oxygen is taken up from the outside to break down nutrients in metabolism. Since we need oxygen to generate energy and ensure our body's basic cellular function, correct breathing is essential for all humans. Breath regulation is linked to the autonomic nervous system. This system comprises the sympathetic and parasympathetic nervous systems and regulates unconscious functions including heart rate, digestion, respiratory rate, and perspiration. The sympathetic nervous system prompts our body into the "fight or flight" survival response, increasing heart rate and causing other physiological changes by releasing adrenaline and other stress hormones. Conversely, the parasympathetic nervous system is our body's "rest and digest" response, slowing heart rate and allowing physical rest and recovery. By breathing consciously, in a certain way and at a slower rate, we have the power to tap into the parasympathetic nervous system and send "rest" signals to the brain. In contrast, shallow, rapid breathing sends "stress" signals to the brain, which is apparent when people are anxious or have a panic attack. Making breath regulation a daily habit liberates individuals from feeling consistently stressed, anxious, or trapped in a state of fight, flight, or freeze.

Physiological Mechanisms of Breathing

Altogether, breathing is the primary role of the respiratory system. With each inhaled breath, oxygen enters the bloodstream, where it circulates throughout the body and is utilized by the cells to produce energy. Simultaneously, carbon dioxide is removed from the bloodstream via exhalation. In controlling the body's level of oxygen, carbon dioxide, and internal environment, the respiratory control center regulates breathing rate and depth via autonomic activity. As a result, breathing plays a substantial role in the maintenance of homeostasis by controlling levels of pH, oxygen, and carbon dioxide in the body.

Research suggests a link between different patterns of breathing and changes in the body's stress responses. While short, shallow breaths may trigger this mechanism, complete, intentional breaths to the depth of the diaphragm reset the parasympathetic nervous system responses by reducing heart rate and blood pressure, thus helping to counteract the body's negative autonomic responses characteristic of the fight-or-flight response. By engaging the diaphragm through deep breathing, individuals tap into the parasympathetic nervous system's ability to calm the body's stress responses, lower their signs of arousal, and elicit feelings of serenity. This shows that breathing techniques can be used to induce a relaxation response, smooth muscle tension, and help manage feelings of anxiety by calming down the bodily processes that occur during panic. Overall, the physiological mechanisms behind such phenomena as relaxation and state of calm can be explained through respiratory breathing techniques.

Link Between Breathing and Anxiety

Physically, there is only a small area of the brain that deals with breathing or anxiety. Two different conditions that have no apparent connection, yet they influence each other. Shallow, accelerated breathing has often been found to trigger anxiety. Might it also be the other way around, that is, that intense anxiety results in fast breathing which in turn leads to hyperventilation? Several studies support this thesis. The onset of an anxiety attack is accompanied by a quicker and shallower rate of inhalation and exhalation. Accompanying complaints often include dizziness, trembling, rapid heartbeat, and numb fingers and toes. Those affected often feel like they are struggling for breath. A kind of “positive feedback” occurs between rapid breathing and anxiety, both of which mutually exacerbate each other. It is important to recognize, though, that intensively increased breathing instabilities only contribute to the onset of anxiety disorders in combination with other risk factors.

Even when anxiety arises almost “physiologically,” such as prior to speaking in public, a racing heart, shaking hands, or heavy perspiration are the results. If the level of subject matter knowledge and experience are the deciding factors when it comes to who is going to do well, anxiety-driven symptoms appear to be somewhat irrational. Hyperventilation leads to a condition of “respiratory alkalosis,” a feeling of breathlessness, dizziness, and paresthesia. Over tens of thousands of years, animals, just like humans, have learned to take deeper and more frequent breaths. With shallow quick breathing, corresponding areas of the brain are activated, which initiate stronger emotions in us. The pathway goes the other way around, too. We can influence which areas of the brain are activated by our breathing patterns, for example, through slow conscious breathing.

Types of Breathing Exercises

One of the most important strategies in managing anxiety is resetting the breathing pattern to bring increased balance to both the body and mind. There are several types of breathing exercises that can be done to facilitate this management strategy and offer an improved sense of relaxation. Below are a number of these breathing exercises with descriptions on how to practice them.

Diaphragmatic Breathing: shown to elicit calming and relaxation responses. Inhaling through the nose, pushing the belly out like a balloon, rather than expanding the chest. Exhaling through the mouth, releasing the air from the belly first, followed by the chest. In this exercise, one simply focuses on breathing into the belly by demonstrating the movements. This can be done sitting, lying down, or standing. - Box Breathing: a type of breathing exercise that can help both to increase relaxation and reduce tension. Both inhales and exhales of this technique are done through the nose. Initial practice of this exercise involves a 4-step process of inhaling for 4 seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding it for 4 seconds, all done for a few minutes. Over time, as one becomes more comfortable, tools such as counting, an app, emotive video, calming visual, or the use of soothing music can be included. - 4-7-8 Breathing Technique: has shown to be a valuable breathing exercise for managing anxiety. Inhaling for four seconds, holding the breath for seven seconds, and exhaling for eight seconds, repeating this exercise a few times for a couple of minutes. In this breathing exercise, the tongue is placed against the roof of the mouth. One should breathe out forcefully through the mouth and allow the air to make a whooshing sound. The exhale should take twice as long as the inhale. It is recommended to practice this exercise at least two times a day.

Diaphragmatic Breathing

Diaphragmatic breathing, also known as belly breathing or abdominal breathing, is a deep breathing technique that focuses on engaging the diaphragm. As we breathe in, the diaphragm muscle contracts downwards to create a vacuum in the chest, which can then draw air into the lungs. When we breathe out, the diaphragm relaxes upwards, and we can then exhale air out of our lungs more easily. To practice diaphragmatic breathing, you will breathe in through your nose and out through your mouth, keeping your chest relatively still as your diaphragm and abdomen are engaged in the breathing process. This allows for deeper and more complete breaths. Engaging the diaphragm triggers a relaxation response in both the body and mind.

Physiologically, diaphragmatic or belly breathing is known to stimulate the relaxation response in the body. It allows more air to be drawn into the lungs with each breath, ensuring optimal oxygenation of the body. It also helps to take the body out of the "fight or flight" stress response towards the sleep or relaxation response. Diaphragmatic breathing is especially good at "resetting" the body after it has been exposed to stress, shock, or anxiety. Conversely, shallow breathing tends to freeze the body in the stress response. Psychologically, deep breathing helps to lessen feelings of fear and anxiety, as evidenced by the accounts of patients and individuals who practice it. Some studies suggest that deep breathing can help improve acting students’ sense of calmness before a performance and decrease individuals’ self-rated assessments of stress in various real-life situations.

Box Breathing

Box breathing is a simple breathing technique in which the breath is held in phases after inhalation, during exhalation, and at the close of each cycle. When this technique is practiced, inhalation, holding, exhalation, and the second holding phase all occur in succession; it creates a "box" pattern and each part lasts for the same amount of time. This is an effective technique for the advantages of box breathing: the psychological benefits that come with it. It can be practiced whenever needed and only takes a few minutes of one’s time. Step by Step Instructions: 1. Inhale deeply for a count of four seconds. 2. After inhalation, hold the breath for a count of four seconds. 3. Slowly and steadily exhale for a count of four seconds. 4. After exhalation, hold the breath again for a count of four seconds. 5. Repeat the whole sequence as desired. Box breathing can improve concentration, reduce stress, and decrease feelings of anxiety. It also calms the sympathetic nervous system and engages the parasympathetic system, lessens pain, and controls fear. Practicing box breathing regularly can contribute to overall emotional and physical well-being, and it is useful for managing fears and illnesses, both mental and physical. For example, non-standard situations like public speaking, medical exams, and sports can all cause a significant feeling of anxiety in people. Box breathing relaxes the nervous system and mind enough to prepare individuals for these events. Box breathing intrinsically heightens the mind’s focus, decreases anxiety, and stills the monkey mind. The process changes the parasympathetic nervous system into rest mode on the second inhale. All of these effects can greatly improve wellness.

4-7-8 Technique

The 4-7-8 technique is a shortened version of a traditional yoga practice of breathing exercises known as pranayama. The aim of the exercise is to promote relaxation and manage anxiety. It is based on a breathing pattern that repeats the following sequence of actions: Breathe in for 4 seconds; Hold the breath for 7 seconds; Breathe out for 8 seconds. As the exercise uses a specific breathing pattern, it is convenient to time the seconds by either counting in your head or using a watch or timer that shows the seconds. The following instructions are recommended to use this technique in a safe and effective way: 1. Begin by expelling all the air from your lungs with a strong expiration. You can create a whooshing noise when blowing out the air. 2. Breathe in quietly through the nose while mentally counting up to four. 3. Hold the breath in while you count to seven. 4. Exhale forcefully and completely when you count to eight. 5. Repeat steps 2 to 4 three more times. The slower than normal breathing rate helps relax by acting on the parasympathetic system, where the heart rate is slowed and so is digestion. Deep breathing is linked to the generation of tranquilizing peptides that reduce anxiety. In addition to the proposed physiological mechanisms, anecdotal evidence suggests that the 4-7-8 breathing technique can help calm the mind and reduce anxiety levels relatively quickly. A small amount of academic and clinical research also suggests that it may be effective in managing anxiety and promoting better relaxation. This particular technique is convenient to practice on a daily basis as it is time efficient, takes only a few minutes, and is flexible to do anywhere. It is less likely to cause lightheadedness and can also help people get to sleep, which may be particularly useful if you find anxious thoughts interfere with your sleep.

Benefits of Breathing Exercises for Anxiety

Studies have found that doing breathing exercises once or twice a day has positive effects on anxiety. Proponents garner extensive benefits from using these exercises. One study found that after practicing these exercises for a total of six weeks, individuals with elevated anxiety experienced a myriad of positive impacts. In-patients with a diagnosed anxiety disorder found that after a full three months of practicing Sitali breathing exercises, they showed reduced levels of anxiety while their cognitive and physiological abilities seemed to function better. Practicing breathing exercises reduced heart rate and salivary cortisol while also increasing heart rate variability in patients.

The objective of this series of breathing exercises, a combination of some of the oldest breathing exercises into one routine, is to reduce anxiety and achieve a state of relaxation. Many find that they can block out negative feelings and thoughts while doing the exercises. More benefits of practicing these exercises include reducing physical sensations of restlessness and tension, creating an environment that promotes mental focus and alertness, and can even be used to prevent further escalation of anxiety symptoms. Breathing exercises have been found to significantly reduce salivary cortisol, the hormone that is part of our fight-or-flight response and helps promote anxiety, as well as improve heart rate variability.

Reduction in Stress Hormones

One way through which breathing exercises assist in decreasing anxiety and increasing relaxation is by reducing stress hormones. Cortisol is known as a stress hormone. By regulating blood pressure and combining with insulin, it has a plethora of effects on the body. Prolonged stress and anxiety have been shown to cause raised cortisol levels, leading to a range of health issues. If not addressed, high cortisol can result in the raising of blood sugar levels and the storing of fat in the abdomen, which is linked to a range of health disorders such as obesity, diabetes, heart disease, and mood swings, among other things. Certain stress-relieving practices can aid by stimulating the body’s relaxation response, which short circuits ordinary stress reactions in the body. This step aids in the restoration of the body’s equilibrium and assists in the regulation of stress hormone levels.

When we engage in slow, deep breathing and other relaxation exercises, the body activates the parasympathetic response, which aids the body in returning to its normal state. Breathing regulates the reaction of the nervous system, lowers stress hormones, and promotes the development of controlled breathing practices. In addition, certain breathing practice routines, such as alternate nostril breathing or belly breathing, have immediate beneficial results. The trainee breathes out more slowly, suggesting that the exercise improves respiratory function, but the specific mechanism that led to cortisol levels falling is unclear. Soon after attempting the practices, people reported a reduction of anxiety, and cortisol levels fell significantly. Breathing practices have been shown to help regulate cortisol. One laboratory study indicated that alternate nostril breathing reduced cortisol levels in anxiety-ridden dental students. In another report, a group that spent two hours per day performing yoga practices regulated their daily cortisol levels and eliminated high cortisol levels in the evening. Regular observers at this class say they encountered improved morale, less anxiety, and better sleep patterns as a result.

Improved Focus and Clarity

A byproduct of anxiety, particularly surrounding work or maintaining a heavy workload, might be the inability to think clearly. In practical terms, stress and anxiety can impact cognitive function, resulting in reduced productivity and an increased likelihood of mistakes. This may directly impact one’s ability to perform, particularly if the individual is involved in work or study that requires mental clarity. Breathing exercises, therefore, can greatly ease one’s ability to develop a task-oriented focus, ultimately serving to heighten productivity.

Breathing exercises are a way to calm and clear the mind, focusing attention on the sensation of air passing in and out of your nostrils. Even brief periods of these exercises can serve to maintain focus and cognitive function. The integration of such exercises into the morning routine might, therefore, establish a clarity of mind that can be sustained throughout the day. A common anti-stress measure might focus on calming the physical systems – relaxing the muscles, releasing muscle tension – an effective stress management technique that leaves the workings of the mind in disarray. In this case, though, focusing and calming the thoughts can eventually result in the physical effects of stress dissipating. Therefore, while the target of the exercise is mental, with a more focused mind, the physiological response can be significantly reduced as well. Consequently, if mental clarity is a priority, breathing may be the perfect first step.

While there are occasional commercial testimonies of a connection between breathwork and mental acuity – some call meditation "no less than the ultimate mental training" – there is little research on the physical or mental effects of such a practice. What is known is that the process of inner focus meditation has the benefits of increased mental stamina, increased concentration, improved levels of relaxation, and cognitive enhancement. Exercises that force consciousness remain to be explored in depth as a tool for mental improvement. How one can go about it is almost as varied as the methods of relaxation: any spare moment, work breaks, and awkward waiting can be ideal for a moment’s mental centering. Furthermore, researchers have found that breathing exercises are an effective part of improved focus and concentration. A study showed that a yoga-based breathing program led to an increased level of attention, which amounted to a practical cost saving. In more complex environments, too, the researchers can be effective. A program including yoga-based breathing exercises in a psychiatric clinic reduced anxiety and improved quality of life for more than 70 percent of the participants. Moreover, there are other ways of chilling next to breathing.