By Christine Saari, MA, C-IAYT
You get things done. You keep the wheels turning. You show up, even when your chest is tight, your thoughts are spinning, and your body is begging for rest. You are holding it all together and from the outside, it looks like you are thriving.
But inside, it is a different story. While it’s not a diagnosis, high functioning anxiety is often invisible from the outside. Those experiencing it typically continue to meet deadlines, care for others, and maintain outward composure, even while internally managing persistent tension, disrupted sleep, or chronic physiological activation. This experience is common, especially among high-achieving women, and the strategies offered to support it often fall short.
Why Traditional Anxiety Treatment May Not Be Enough
Most anxiety treatments rely on top-down methods. These include cognitive approaches such as reframing, exposure, and structured behavioral strategies, which are often used in talk therapy. Top-down approaches can be effective when the nervous system is flexible enough to support reflection and insight. However, they often miss a core element: the state of the body itself. If the autonomic nervous system remains in a chronic stress response, cognitive strategies can feel inaccessible or ineffective.
The Science Behind Yoga for High Functioning Anxiety: Bottom-Up Regulation
Instead of the top-down, cognitive approach to anxiety, bottom-up regulation refers to managing your emotional state that starts with bodily sensations rather than your thoughts. Bottom-up regulation focuses on noticing and influencing your physical experiences. Recent advances in neuroscience have brought increased attention to bottom-up regulation, particularly in how breath, interoception, and somatic awareness impact autonomic nervous system function and emotional resilience (Balban et al., 2023; Farb et al., 2015; Khalsa et al., 2018; Lehrer et al., 2003). In this article, we’ll focus on the role that interoception plays in a balanced nervous system response.
What is Interoception?
Interoception refers to the ability to sense what is happening inside the body, such as heart rate, breathing, or hunger. Interoception is closely tied to how we recognize and regulate emotions. This means that practices which build awareness of internal sensations, like breathwork or mindful movement, can directly support nervous system balance and reduce anxiety by helping the body feel safer and more regulated from the inside out.
Interoception plays a central role in nervous system regulation and emotional health. Farb et al. (2013) showed that focusing on the breath activates specific brain regions involved in internal sensory awareness, distinct from those used to process the external world. When interoceptive pathways are strengthened, the body more accurately detects its own state, and the brain becomes more responsive to cues of safety. For individuals managing anxiety symptoms that seem to come out of nowhere, such as a tight chest, fluttery stomach, or constricted throat, building interoceptive awareness helps decode those sensations and creates a clearer path back to nervous system regulation.
As this internal awareness grows, the body becomes more receptive to change. It becomes easier to balance the nervous system and access the rest-and-digest, parasympathetic nervous system state. Interoception is not just a personal skill; it is also a clinical tool. This is why more mental health professionals are turning to yoga therapy as a structured, body-based method for supporting nervous system regulation.
Using Breathwork To Facilitate Interoception and Nervous System REgulation
The breath is the best tool we have for nervous system regulation. In fact, a growing body of research highlights how slow, patterned breathing influences vagal tone and heart rate variability. These are both markers of nervous system resilience and adaptability. For example, a 2023 study by Balban and colleagues found that structured breath practices with extended exhalation were more effective at reducing anxiety than mindfulness meditation. Similarly, Lehrer et al. (2003) demonstrated that slow breathing could measurably increase heart rate variability, offering both immediate and long-term benefits for autonomic nervous system regulation.
In practice, this means that carefully designed breathing techniques can serve as a bridge between the physiological stress response and the psychological experience of anxiety. In this way, using the breath to help manage anxiety becomes a feedback loop. As interoception skills increase, you are better able to notice symptoms of anxiety. Practicing breathwork helps to regulate the nervous system, and you are better able to sense when you have calmed down. You start to get better at noticing anxiety symptoms sooner, and in turn can use breathwork to self-regulate.
One of these carefully designed breathing techniques used in yoga therapy is 4:0:6:2 Ratio Breathing, and that’s the breathing practice we will explore further in this article.
A Breathing Practice for High Functioning Anxiety: 4:0:6:2 Ratio Breathing
This technique establishes a regulated breath rhythm that encourages parasympathetic activation through a prolonged exhalation and gentle breath retention. 4:0:6:2 Ratio Breathing can be used when the system is moderately activated. For example, it can be used during anticipatory anxiety or post-activation recovery. It’s a quick way to get ready for or respond to stressful situations throughout the day.
Instructions:
- Begin by observing the natural breath without changing it.
- Direct awareness to the area around the navel. Encourage abdominal movement, allowing the belly to expand gently with each inhale and soften on the exhale.
- Once this pattern feels natural, begin inhaling for a count of 4 and exhaling for a count of 6.
- When comfortable, introduce a brief pause after the exhale, holding the breath out for 2 counts.
- Continue this pattern (inhale 4, exhale 6, hold out 2) for several minutes.
- Afterward, release the technique and return to natural breathing. Note any changes in body or mind.
How 4:0:6:2 Ratio Breathing Works For High Functioning Anxiety
This breath pattern works by extending the exhale, which stimulates the vagus nerve and helps deactivate the sympathetic stress response. The gentle pause after the exhale introduces a moment of stillness that supports nervous system balance without overwhelming it. This pause also helps rebuild tolerance to carbon dioxide (CO₂), which often becomes disrupted with chronic stress.
When CO₂ sensitivity is high, the body may misinterpret normal levels of CO₂ as a threat, triggering symptoms like throat tightness, air hunger, chest constriction, or a fluttery nervous stomach. These responses may occur even when nothing outwardly stressful is happening.
By gradually restoring balance to this internal chemistry, the 4:0:6:2 Ratio Breath practice begins to send a different message to the brain: it’s safe to settle.
Breath practices like 4:0:6:2 Ratio Breathing not only help rebalance the body’s chemistry, they also shift where attention is directed. Rather than focusing outward or trying to control symptoms, this practice invites gentle attention inward. This is a part of interoceptive awareness: the ability to notice and interpret internal signals such as breath rhythm, heart rate, gut sensation, or tension in the throat or chest.
Yoga Therapy as a Personalized Anxiety Treatment Approach
Clinicians are increasingly recognizing the value of bottom-up care, including breathwork and yoga-based practices that build awareness of the body and internal states. At ClinicAlly Trained, for instance, mental health professionals are incorporating yoga therapy tools into their work, applying evidence-based techniques that start with the body and support nervous system flexibility.
Yoga therapy’s strength lies in its adaptability. Unlike generalized group yoga classes, which may emphasize intensity or stillness prematurely, private yoga therapy tailors techniques to how symptoms present for each individual. This includes movement practices that release hyperarousal, breathing techniques that settle activation, and meditation methods chosen specifically for the client’s nervous system. The goal is not to bypass cognitive processing, but to make it possible by establishing a foundation of physiological safety first.
Why Nervous System Regulation Should Come First in Anxiety Care
As anxiety care continues to evolve, the integration of body-based modalities offers a needed complement to existing treatment models. High-functioning individuals often appear well-regulated, even when internal resources are depleted. Yoga therapy provides a framework to reconnect with those resources, not by adding more effort, but by shifting the strategy altogether.
Next Steps
At Yoga Therapy Associates, our team of certified yoga therapists offer private yoga therapy in-person in Connecticut, and virtually, nationwide. We specialize in mental health, including high functioning anxiety. Our focus is on efficacy, and most of our clients experience relief in four sessions or less. Learn more about private yoga therapy, or book your intake session. You can also contact us or schedule a confidential, complimentary phone consultation. We’d love to hear from you.
References
- Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
- Farb, N. A., Segal, Z. V., & Anderson, A. K. (2015). Attentional modulation of primary interoceptive and exteroceptive cortices. Cerebral Cortex, 23(1), 114–126. https://doi.org/10.1093/cercor/bhr385
- Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., … & Zucker, N. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
- Lehrer, P. M., Vaschillo, E., Vaschillo, B., Lu, S. E., Eckberg, D. L., Edelberg, R., Shih, W. J., Lin, Y., Kuusela, T. A., Tahvanainen, K. U., & Hamer, R. M. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805. https://doi.org/10.1097/01.PSY.0000089200.81962.19
