Take a deep breath? Why the most common advice can backfire
Everywhere I have ever looked for advice for medical fears, the first and often only advice is: take a deep breath.
While no doubt it’s given with the best of intentions, this advice makes me cringe. If I am able to make one change in the world, let it be this.
When your stomach drops and your heart races as you sit in the clinic waiting room, should you take deep belly breaths?
Tldr; Probably not.
Here’s why
Deep breathing makes sense when we’re physically exerting ourselves.
But deep breathing (when our body doesn’t require it) can contribute to triggering our body’s sympathetic (fight or flight) response. Not only is this the opposite of the intended calming effect, but if you’re already scared witless, you are already breathing a bit faster than usual. Faster + deeper = a lot more breathing happening than normal. It’s safe to assume that your body’s fight-or-flight response is already turned on, and adrenaline was already making your hands cold and your mouth dry. That’s because adrenaline causes blood to surge to our muscles in our extremities. That’s totally where we want it if we are about to run, jump, hide, or fight.
But here’s the problem - we’re not running or fighting (in fact, we’re usually trying to be very, very still). And so, that blood that rushed to our limbs? Now it’s just hanging out, potentially pooling. No wonder if we feel even more woozy, unwell, and lightheaded.
Hypocapnia: Noun.
A state of reduced carbon dioxide (CO₂) in the blood, typically caused by hyperventilation (breathing too fast or too deep).
When we breathe deeper or faster than our body’s metabolism requires, we exhale carbon dioxide at a faster rate, as well. It may sound strange, but we need a certain amount of carbon dioxide in our blood. At reduced levels, cerebral blood vessels constrict, causing even less blood flow to the brain. Less blood flow = more symptoms of dizziness, visual changes, tingling, feelings of un-reality, and a racing heart.
If you’re already frightened, these increased symptoms might feel like evidence of your worst fears: that you’re out of control, that the fear is too much, or that something bad is going to happen.
While hypocapnia does not fully explain why fainting can happen, it might be a factor.
The tragic thing is, the more we panic and feel loopy, the more we might desperately take deep breaths. After all, so many people have told us to! When that doesn’t work, or backfires, we may feel like we are totally out of control, overwhelmed, and betrayed by our bodies.
What to try instead:
Slow breathing. You can try counting the breath if that helps you slow down. You can imagine breathing through a straw if that helps you slow down the inhale, and you can purse your lips to “blow” and slow down the exhale.
If you notice that fear is causing you to breathe too quickly or deeply, you can practice a one-second hold at the top of the breath (after the inhale) and a one-second hold at the bottom of the breath (after the exhale). You can gradually increase the hold time from one second to two (or more) if you feel comfortable doing so.
It may feel counterintuitive to slow, and even stop, breathing when so much conventional “wisdom” tells us the opposite. But the next time someone tells you to “take a deep breath”, you can tell them that deep breathing is for blowing out birthday candles. Slow and steady wins the day.
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References:
Bentley, T. G. K., D’Andrea-Penna, G., Rakic, M., Arce, N., LaFaille, M., Berman, R., Cooley, K., & Sprimont, P. (2023). Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature. Brain Sciences, 13(12), 1612. https://doi.org/10.3390/brainsci13121612
Immink, R. V., Pott, F. C., Secher, N. H., & van Lieshout, J. J. (2014). Hyperventilation, cerebral perfusion, and syncope. Journal of Applied Physiology, 116(7), 844–851. https://doi.org/10.1152/japplphysiol.00637.2013
Schüttler, D., et al. (2020). “Effect of Hyperventilation on Periodic Repolarization Dynamics.” Frontiers in Physiology, 11, 542183. https://doi.org/10.3389/fphys.2020.542183
Tipton, M. J., Harper, A., Paton, J. F. R., & Costello, J. T. (2017). The human ventilatory response to stress: rate or depth?. The Journal of physiology, 595(17), 5729–5752. https://doi.org/10.1113/JP274596
Zhang, Z., Guo, Q., & Wang, E. (2019). Hyperventilation in neurological patients: from physiology to outcome evidence. Current opinion in anaesthesiology, 32(5), 568–573. https://doi.org/10.1097/ACO.0000000000000764
