Breathwork: benefits, step-by-step techniques and safety

Breathwork is an umbrella term for practices where you pay attention to your breathing and change it on purpose: slower, deeper, with a longer exhale or, in some styles, much faster.

It helps to split it into two families. Slow, gentle techniques (diaphragmatic breathing, box breathing, paced breathing at about six breaths a minute, a longer exhale) aim to slow you down and help you feel calm. Intense styles use rapid, deep breathing for minutes at a time, sometimes followed by long breath-holds. They share a name, but not the same risks.

Breathwork overlaps with meditation, and the two are often practiced together: in meditation the breath is usually something you watch; in breathwork you also change it.

“Belly breathing” is the base of most breathwork techniques. The NIH’s National Center for Complementary and Integrative Health (NCCIH) describes it as taking slow, deep breaths.

Box breathing has four equal counts, like the four sides of a square. Keep the holds gentle: holding your breath should never hurt or leave you gasping.

Reviews of slow breathing define it as fewer than 10 breaths a minute. An easy way to get to about six:

Making the exhale longer than the inhale is another simple technique. One studied version is the “cyclic sigh”:

The evidence is promising but small, and it has limits. Here is what has been published:

• Stress. A 2023 meta-analysis in *Scientific Reports* (Fincham and colleagues) pooled 12 randomized trials and found breathwork was linked with lower self-reported stress than control groups, a small-to-medium effect. Most trials had a moderate risk of bias, and the authors warn that the hype around breathwork runs ahead of the evidence.
• Relaxation. A 2018 review in *Frontiers in Human Neuroscience* (Zaccaro and colleagues) found across 15 studies that breathing slowly, at fewer than 10 breaths a minute, was linked with higher heart rate variability and with people feeling more relaxed. None were randomized trials, and the groups were small.
• Blood pressure. A 2019 meta-analysis (Chaddha and colleagues) of 17 trials in adults whose blood pressure was above the normal range found that slow breathing for at least 5 minutes, several days a week for 4 weeks or more, lowered systolic pressure by about 5.6 mmHg and diastolic by about 3 mmHg on average, with results that varied a lot between studies. The studies had short follow-up and a high risk of bias (NCCIH), so the long-term effect is unknown.
• Mood. A 2023 trial in *Cell Reports Medicine* (Balban and colleagues) found that 5 minutes a day of cyclic sighing for a month improved mood more than mindfulness meditation. It compared practices with each other, not with doing nothing.

The bottom line: slow breathing may help you feel calmer, and gentle techniques are generally considered safe for healthy people (NCCIH), though a few people find them uncomfortable. It is not a treatment for any disease. If you have high blood pressure, don’t stop your medicines on your own: breathwork adds to your plan, it doesn’t replace it.

Some breathwork styles ask you to breathe fast and deep for several minutes, then hold your breath for as long as you can. In practice, that is hyperventilation: it lowers the carbon dioxide in your blood.

According to MedlinePlus, overbreathing can make you feel lightheaded, dizzy, weak or unable to think straight, and cause numbness and tingling in the arms or around the mouth, spasms in the hands and feet, and chest pain or a fast, pounding heartbeat. MedlinePlus also notes that fast breathing can trigger seizures in people with seizure disorders. And a CDC report on swimmers explains that hyperventilating or holding your breath before going underwater delays the urge to come up for air, and low oxygen can then make you black out underwater.

According to the NCCIH, relaxation techniques in general, gentle ones included, are considered safe for healthy people, but people occasionally report unpleasant experiences such as increased anxiety, intrusive thoughts or a fear of losing control. Intense styles can also bring up strong emotions.

Short, regular sessions are easier to keep up. In the trials above, people practiced about 5 minutes a day, or at least 5 minutes several days a week.

To see how movement and meditation sessions fit a retreat week, read our guide to yoga and meditation retreats.

If you have a heart condition, high blood pressure, epilepsy, a pregnancy or a recent surgery and want to know whether a technique is safe for you, you can book an online visit with Dr. Diana Nieves Castro, a general practice physician licensed in Puerto Rico. Video visits are only for people who are physically in Puerto Rico.