Breathwork became an extremely popular approach to mental health in recent years. It is sometimes used as a therapist resource on its own or as part of other approaches (e.g., mindfulness). But popular does not always equal effective. So does somatic breathwork work?
Intentional breathing has been used for centuries as a method to increase awareness of our surroundings, check in with ourselves when emotionally elevated, and relieve stress (via parasympathetic activation). But therapy has applied it to mental health difficulties like PTSD and anxiety.
As you can probably tell from our “wicked sweet” title, somatic breathwork’s effectiveness is actually a mixed bag. Research finds that certain types of breathwork are effective for general stress or anxiety, while others are not. Incorporating fast and slow breathing paces, using breathing sessions under 5 minutes, extensive practice (surprise), and long-term continued use all appeared effective. Therapist training and guided-breathing is important. Using only fast paces, sessions longer than 5 minutes, and group settings do not help.
These findings are helpful for understanding how to structure breathing exercises. And research finds evidence that breathing helps relieve general stress in the moment and even in the long-term. But what about trauma or high levels of anxiety? Research finds that breathwork does not provide long-term relief for those experiencing things like PTSD, anxiety, or depression.
Breathing appears to provide an in-the-moment skill that give clients a way to calm sympathetic nervous system reactivity in the moment. It may also provide a sense of efficacy over distress. But breathwork does not appear to relieve symptoms like trauma triggers, fight or flight response, hyperarousal, or anxiety over time. This is likely because it does not retrain the brain to respond differently to difficult situations that activate the individual, but that are not objectively harmful. For example, being in social situations.
Then is somatic breathwork mostly “just a band-aid” for things like trauma or anxiety? Potentially. But maybe that doesn’t matter: Luckily, we have therapist resources and methods shown to help people progressively experience fewer fight or flight reactions in response to trauma or anxiety triggers.
Extensive research consistently finds that both prolonged exposure therapy (PE) and cognitive processing therapy (CPT) are highly effective for PTSD. CPT appears particularly effective in cases of trauma and shame. Exposure for anxiety disorders is also highly effective.
These approaches help clients gain in-the-moment skills while also reducing symptoms over time. As an aside, breathwork is even built into some of these therapies (e.g., prolonged exposure). So these approaches actually help clients experience fewer triggers and less distress in the first place, and less need to stop and breath at all.
Contrary to some recent assertions, prolonged exposure does not harm or retraumatize clients. It simply leads them to approach fears they already are well-aware exist. EMDR also appears to be effective, but there is controversy that EMDR is merely a form of prolonged exposure. That is, it has a large prolonged exposure component built into it (plus eye movements).
Somatic breathwork is now a popular therapist resource for trauma and anxiety in therapy. It appears to help for general stress and mental wellness. But individuals experiencing trauma or high anxiety need breathwork forever in the absense of other approaches that retrain the brain to respond differently to trauma and anxiety triggers. Breathwork appears to work only in conjunction with those approaches that provide long-term relief.
*Also note analyses in linked studies demonstrating difficulties with quality and bias of studies finding efficacy for breathwork.
