Breathwork: A Drug-Free Approach to Managing Panic Attacks

By Christine Saari, MA, C-IAYT

Stress and anxiety have become more than just occasional nuisances—they’re constant companions for many of us. And for some, it’s not just a case of feeling a bit frazzled now and then; it’s full-blown panic attacks that can turn their lives upside down. Imagine feeling like you’re drowning in your own fear, your heart pounding so hard you can practically hear it in your ears, your breath coming in short, sharp gasps. It’s terrifying, right?

Panic disorder, affecting 1 to 3 percent of the population, not only inflicts immense personal suffering, but also strains our healthcare system significantly. Astonishingly, panic-related symptoms are behind up to 40 percent of emergency department visits for chest pain¹. Coupled with conditions like agoraphobia and depression, and the temptation to self-medicate, individuals grappling with panic disorder present complex challenges in primary care settings². 

However, breathwork offers a promising solution. With its low cost, accessibility, and rapid effectiveness, breathwork techniques provide a viable self-management strategy for panic disorder. This has the potential to reduce healthcare resource utilization while improving patient outcomes.

Main points: 

• Traditional treatments like medications and talk therapy may offer partial relief but often fail to address underlying physiological issues linked to panic attacks.
• Breathwork emerges as a promising alternative for managing panic attacks, tapping into the body’s innate capacities to promote relaxation and calmness.
• Yoga therapists specialize in addressing harmful breathing patterns and offer personalized interventions.
• It’s crucial to exercise caution with breathwork trends, as some techniques may exacerbate anxiety and trigger panic attacks.
• Individualized breathwork instruction is essential for safe and effective management of panic attacks.
• Breathwork influences various physiological mechanisms, including nervous system regulation, heart rate variability, vagus nerve stimulation, carbon dioxide levels, and brain activity, to alleviate panic attacks.
• Instructing individuals to change their breathing during panic attacks can exacerbate panic or fear, emphasizing the importance of gradual breathwork skill-building.

What Are Panic Attacks?

Panic disorder is characterized by recurrent panic attacks, which involve a sudden onset of intense fear or discomfort accompanied by physical symptoms such as palpitations, sweating, trembling, hyperventilation, shortness of breath, and chest pain³. These attacks typically last more than 10 minutes and occur unpredictably, interfering with normal activities. 

It’s not just the physical sensations that make panic attacks so daunting. There’s this whole other layer of emotional turmoil that comes with them. People might feel ashamed or embarrassed about their panic attacks. They might start avoiding certain situations or social gatherings because they’re terrified of having an attack in public, which can lead to feelings of isolation and loneliness. And let’s not forget about those sleepless nights, when panic attacks decide to pay a visit in the wee hours, robbing people of much-needed rest and leaving them feeling drained and defeated come morning.

Then there’s the impact on everyday life. Panic attacks can wreak havoc on a person’s ability to work, make decisions, or even leave the house. Simple tasks like grocery shopping or taking public transport can suddenly become monumental challenges. 

Standard Treatment for Panic Attacks Falls Short

Traditional treatments for panic attacks typically involve antidepressant medications, cognitive-behavioral therapy (CBT), and benzodiazepines⁴. Antidepressants like SSRIs and tricyclic antidepressants are often prescribed to alleviate panic symptoms and prevent future attacks. CBT equips patients with valuable coping strategies to manage panic symptoms and overcome avoidance behaviors. Although benzodiazepines offer short-term relief, they are less effective than antidepressants and CBT, and carry a risk of addictive dependence. 

The side effects of medications for panic attacks, like feeling dizzy, drowsy, or gaining weight, often make it hard for people to keep taking them⁵. Moreover, while talk therapy might offer partial relief, it often fails to address the underlying breathing issues linked to panic attacks. This leaves many people struggling with symptom management. 

Therefore, it’s no wonder that people are desperate for additional options. They’ve probably tried everything under the sun—medications, talk therapy, mindfulness apps… you name it. And while these things can help to some extent, for many people, their physical problems persist.

Breath Dysfunction in Panic Attacks 

Many people experiencing panic attacks have difficulty breathing properly, a problem often overlooked in traditional medical treatments. Their breathing tends to be shallow, rapid, and centered in the chest rather than the diaphragm or belly area. These breathing patterns not only worsen feelings of anxiety but can also trigger panic attacks. 

This issue of patterning goes beyond just breathing; it affects how the body moves, maintains balance, and regulates its internal functions. When breath patterns don’t work as they should, it disrupts the body’s natural equilibrium, leading to uncomfortable symptoms and overall health issues⁶. In the context of panic attacks, this dysfunctional breathing only intensifies symptoms, making it harder for the body to regain balance, and worsening both the physical and emotional impact of the attacks.

One study on breath dysfunction in people with panic attacks identified greater variability in the volume of air inhaled with each breath, as well as a distinct pattern of sighing breaths⁷. 

Notably, they found that these patterns appear resistant to cognitive techniques like CBT or talk therapy.

Applying Breathwork for Panic Attacks

It’s therefore no wonder that there’s been a noticeable shift in the mental health field towards recognizing the physical aspects of panic attacks. Mental health professionals are increasingly seeking training in complementary practices like breathwork to integrate into their practices, driven by an increasing understanding of the mind-body connection. 

Researchers emphasize the effectiveness of breathwork in managing symptoms of panic attacks, including hyperventilation, with ongoing efforts to understand how it can be applied in real-world settings^{(8, 9. 10, 11)}. However, establishing standardized protocols and frameworks for implementing breathwork therapies remains a work in progress¹². 

Beware of Dangerous Breathwork Trends

While many online resources, classes, and apps offer breathwork techniques, distinguishing evidence-based practices from trends poses a challenge. Some breathwork trends may carry serious potential health risks for people with panic disorder and other health conditions. In particular, breathing techniques involving hyperventilation and rapid deep breathing have been shown to increase anxiety in patients with panic disorder, and can even trigger panic attacks¹³. This underscores the need for caution and informed decision-making when choosing an appropriate breathwork technique.

Yoga therapists receive specialized training in assessing health conditions and contraindications, allowing them to pick a safe and appropriate breathwork technique based on a person’s complete health history. With this expertise, they offer evidence-based breathwork interventions to provide an outcome-based breathwork regimen targeting the symptoms most troubling to the client.

Individualized Breathwork is the Way to Go

Analysis of the research indicates the importance of individualized breathwork instruction over the one-size-fits-all-style instruction you are likely to find in group classes or on mindfulness apps¹⁴. Whether administered in-person, remotely, or both, individualized breathwork interventions were deemed safer and more effective in helping people manage their symptoms.

Not All Breathwork Approaches are Evidence-Based

As efforts to integrate breathwork into existing therapeutic approaches persist, the field is evolving towards evidence-based practices¹⁵. Within the biopsychosocial model, which considers biological, psychological, and social factors as interconnected influences on well-being, therapists are challenged to expand their toolboxes and integrate techniques that can shift a client’s biology. Evidence-based breathwork emerges as a promising tool within this model for addressing the physiological aspects of anxiety and promoting overall well-being¹⁶.

However, it’s crucial to implement integrative approaches to breathwork for mental health conditions with techniques informed by frameworks that align specific breathwork methods with corresponding desired outcomes. For example, 4-7-8 Breathing is contraindicated for clients with anxiety, yet many people receive well-intentioned yet uninformed advice to try this technique, often with adverse effects or suboptimal outcomes.

How Breathwork Alleviates Panic Attacks

Breathwork influences the body’s systems in several ways, providing a pathway to reduce or resolve panic attacks without the use of medication. Here are five key mechanisms through which breathwork affects the individual:

Regulating the Nervous System

By engaging in slow, deliberate breathing techniques, individuals can rebalance their autonomic nervous system, shifting from a state of heightened arousal to one of relaxation and calm^{(17, 18)}.

Enhancing Heart Rate Variability

Breathwork practices promote variability in heart rate, fostering adaptability and resilience in the cardiovascular system, crucial for managing stress and anxiety¹⁹.

Stimulating the Vagus Nerve

Deep breathing stimulates the vagus nerve, triggering a cascade of physiological responses that promote relaxation and counteract the body’s stress response²⁰.

Regulating Carbon Dioxide Levels

Controlled breathing increases carbon dioxide levels in the bloodstream, leading to vasodilation, muscle relaxation, and improved oxygen delivery to tissues, supporting recovery from panic disorder²¹. As people become more aware of their internal bodily sensations (interoception), they can better learn to adjust their carbon dioxide levels and respiration rates as instructed in breathwork, which ultimately leads to an improvement in panic disorder symptoms²².

Modulating Brain Activity

Breathwork influences brain activity, promoting neuroplasticity and enhancing brain regions associated with emotion regulation, attention, and self-awareness²³.

Yoga Therapists: Breathwork Specialists for Panic Attack Management

Yoga therapists specialize in tackling harmful patterns that disrupt healthy breathing and exacerbate panic attacks. Therapeutic breathwork, under their guidance, can significantly regulate the nervous system, improve heart health, and affect brain function. It’s a gradual process that requires skillbuilding, short daily home practice, monitoring, and support, with yoga therapists crafting personalized plans and tracking progress to ensure effectiveness. 

Unlike group classes, video demos, or one-time experiences, yoga therapists provide breathwork through an educational process. This empowers individuals to utilize breathwork effectively and safely, targeting their symptoms in an outcome-oriented manner.

Don’t Tell A Person Having a Panic Attack to Change Their Breathing

During panic attacks, instructing someone to change their breathing can sometimes intensify panic or fear, leading to feelings of loss of control²⁴. This is why yoga therapists approach breathwork skill-building gradually, starting with non-breathwork techniques such as focusing on sensations in the extremities to initiate a relaxation response. Then, attention is directed to the breath with cues like “notice that you are already breathing.” Observing the breath in a relaxed state can facilitate diaphragmatic breathing, marking the beginning of unwinding breath dysfunction patterns and initiating the development of a therapeutic breathwork practice. 

One study investigated the impact of different breathing instructions on individuals facing acute stress. Interestingly, while specific cues to alter breathing didn’t lead to significant relaxation, simply focusing on the breath without any directive brought relief²⁵. This highlights the significance of a gradual educational strategy for reshaping breath patterns in managing panic attacks, rather than relying on breath as an immediate solution to stop an attack.

Case studies have played a crucial role in showing how people deal with panic attacks as they begin to engage in breathwork practices²⁶. These studies showcase the use of introductory techniques such as Breath Counting Meditation, where people passively observe and count their breaths to trigger a relaxation response and alleviate symptoms of panic disorder gradually over time.

Yoga therapists understand that it’s not as simple as instructing someone to suddenly breathe differently, especially in the midst of a panic attack. If you’ve experienced distress when told to breathe slowly during a panic attack, consider working with a yoga therapist or a talk therapist with specialized training in therapeutic breathwork to explore alternative approaches for modifying your breathing patterns effectively.

Conclusion

Navigating panic attacks can be quite the challenge, especially when traditional treatments don’t fully resolve your symptoms. Yet, breathwork emerges as a game-changer in this arena. It taps into the body’s innate capacities, bringing about a sense of calm, steadiness, and mental clarity. With skilled yoga therapists as your allies, you’re not alone in this endeavor. They’ll be there to guide you through, helping you understand and refine your breathing techniques at your own pace. So, keep at it and know that a little breathwork can go a long way when practiced regularly — it’s your pathway to rediscovering peace and relief in your life.

About Us

Yoga Therapy Associates provides yoga therapy for individuals suffering from panic attacks, as well as other chronic physical and mental health conditions. Yoga Therapy Associates offers yoga therapy at four locations in Connecticut and nationwide via telehealth.

Are you interested in learning more about how yoga therapy can help you? It would be a pleasure to get to know you. Book a complimentary phone consultation today.

Breathwork Training for Mental Health Clinicians

Yoga Therapy Associates offers continuing education trainings for mental health clinicians in therapeutic breathwork. Learn more about our upcoming offerings.

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