From “breathwork recipes” to breathing techniques, many social media and health websites are recommending breathwork to reduce stress.

But breathwork is not new. Rather it is the latest in a long history of breathing techniques such as Pranayama from India and qigong from China. Such practices have been used for thousands of years to promote a healthy mind and body.

The benefits can be immediate and obvious. Try taking a deep breath in through your nose and exhaling slowly. Do you feel a little calmer?

So, what’s the difference between the breathing we do to keep us alive and breathwork?

Breathwork is about control

Breathwork is not the same as other mindfulness practices. While the latter focus on observing the breath, breathwork is about controlling inhalation and exhalation.

Normally, breathing happens automatically via messages from the brain, outside our conscious control. But we can control our breath, by directing the movement of our diaphragm and mouth.

The diaphragm is a large muscle that separates our thoracic (chest) and abdominal (belly) cavities. When the diaphragm contracts, it expands the thoracic cavity and pulls air into the lungs.

Controlling how deep, how often, how fast and through what (nose or mouth) we inhale is the crux of breathwork, from fire breathing to the humming bee breath.

Breathwork can calm or excite

Even small bits of breathwork can have physical and mental health benefits and complete the stress cycle to avoid burnout.

Calming breathwork includes diaphragmatic (belly) breathing, slow breathing, pausing between breaths, and specifically slowing down the exhale.

In diaphragmatic breathing, you consciously contract your diaphragm down into your abdomen to inhale. This pushes your belly outwards and makes your breathing deeper and slower.

You can also slow the breath by doing:

• box breathing (count to four for each of four steps: breathe in, hold, breathe out, hold), or
• coherent breathing (controlled slow breathing of five or six breaths per minute), or
• alternate nostril breathing (close the left nostril and breathe in slowly through the right nostril, then close the right nostril and breathe out slowly through the left nostril, then repeat the opposite way).

You can slow down the exhalation specifically by counting, humming or pursing your lips as you breathe out.

In contrast to these calming breathing practices, energising fast-paced breathwork increases arousal. For example, fire breathing (breathe in and out quickly, but not deeply, through your nose in a consistent rhythm) and Lion’s breath (breathe out through your mouth, stick your tongue out and make a strong “haa” sound).

What is happening in the body?

Deep and slow breathing, especially with a long exhale, is the best way to stimulate the vagus nerves. The vagus nerves pass through the diaphragm and are the main nerves of the parasympathetic nervous system.

Simulating the vagus nerves calms our sympathetic nervous system (fight or flight) stress response. This improves mood, lowers the stress hormone cortisol and helps to regulate emotions and responses. It also promotes more coordinated brain activity, improves immune function and reduces inflammation.

Taking deep, diaphragmatic breaths also has physical benefits. This improves blood flow, lung function and exercise performance, increases oxygen in the body, and strengthens the diaphragm.

Slow breathing reduces heart rate and blood pressure and increases heart rate variability (normal variation in time between heart beats). These are linked to better heart health.

Taking shallow, quick, rhythmic breaths in and out through your nose stimulates the sympathetic nervous system. Short-term, controlled activation of the stress response is healthy and develops resilience to stress.

Breathing in through the nose

We are designed to inhale through our nose, not our mouth. Inside our nose are lots of blood vessels, mucous glands and tiny hairs called cilia. These warm and humidify the air we breathe and filter out germs and toxins.

We want the air that reaches our airways and lungs to be clean and moist. Cold and dry air is irritating to our nose and throat, and we don’t want germs to get into the body.

Nasal breathing increases parasympathetic activity and releases nitric oxide, which improves airway dilation and lowers blood pressure.

Consistently breathing through our mouth is not healthy. It can lead to pollutants and infections reaching the lungs, snoring, sleep apnoea, and dental issues including cavities and jaw joint problems.

A free workout

Slow breathing – even short sessions at home – can reduce stress, anxiety and depression in the general population and among those with clinical depression or anxiety. Research on breathwork in helping post-traumatic stress disorder (PTSD) is also promising.

Diaphragmatic breathing to improve lung function and strengthen the diaphragm can improve breathing and exercise intolerance in chronic heart failure, chronic obstructive pulmonary disease and asthma. It can also improve exercise performance and reduce oxidative stress (an imbalance of more free radicals and/or less antioxidants, which can damage cells) after exercise.

A mind-body connection you can access any time

If you feel stressed or anxious, you might subconsciously take shallow, quick breaths, but this can make you feel more anxious. Deep diaphragmatic breaths through your nose and focusing on strong exhalations can help break this cycle and bring calm and mental clarity.

Just a few minutes a day of breathwork can improve your physical and mental health and wellbeing. Daily deep breathing exercises in the workplace reduce blood pressure and stress, which is important since burnout rates are high.

Bottom line: any conscious control of your breath throughout the day is positive.

So, next time you are waiting in a line, at traffic lights or for the kettle to boil, take a moment to focus on your breath. Breathe deeply into your belly through your nose, exhale slowly, and enjoy the benefits.

Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong and Judy Pickard, Senior Lecturer, Clinical Psychology, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Picture two people, both suffering from a serious mental illness requiring hospital admission. One was born in Australia, the other in Asia.

Hopefully, both could be treated on a voluntary basis, taking into account their individual needs, preferences and capacity to consent. If not, you might imagine they should be equally likely to receive treatment against their will (known colloquially as being “sectioned” or “scheduled”).

However, our research published in British Journal of Psychiatry Open suggests this is not the case.

In the largest study globally of its kind, we found Australians are more likely to be treated in hospital for their acute mental illness against their will if they are born overseas, speak a language other than English or are unemployed.

What we did and what we found

We examined more than 166,000 episodes of voluntary and involuntary psychiatric care in New South Wales public hospitals between 2016 and 2021. Most admissions (54%) included at least one day of involuntary care.

Being brought to hospital via legal means, such as by police or via a court order, was strongly linked to involuntary treatment.

While our study does not show why this is the case, it may be due to mental health laws. In NSW, which has similar laws to most jurisdictions in Australia, doctors may treat a person on an involuntary basis if they present with certain symptoms indicating serious mental illness (such as hallucinations and delusions) which cause them to require protection from serious harm, and there is no other less-restrictive care available. Someone who has been brought to hospital by police or the courts may be more likely to meet the legal requirement of requiring protection from serious harm.

The likelihood of involuntary care was also linked to someone’s diagnosis. A person with psychosis or organic brain diseases, such as dementia and delirium, were about four times as likely to be admitted involuntarily compared to someone with anxiety or adjustment disorders (conditions involving a severe reaction to stressors).

However, our data suggest non-clinical factors contribute to the decision to impose involuntary care.

Compared with people born in Australia, we found people born in Asia were 42% more likely to be treated involuntarily.

People born in Africa or the Middle East were 32% more likely to be treated this way.

Overall, people who spoke a language other than English were 11% more likely to receive involuntary treatment compared to those who spoke English as their first language.

Some international researchers have suggested higher rates of involuntary treatment seen in people born overseas might be due to higher rates of psychotic illness. But our research found a link between higher rates of involuntary care in people born overseas or who don’t speak English regardless of their diagnosis.

We don’t know why this is happening. It is likely to reflect a complex interplay of factors about both the people receiving treatment and the way services are provided to them.

People less likely to be treated involuntarily included those who hold private health insurance, and those referred through a community health centre or outpatients unit.

Our findings are in line with international studies. These show higher rates of involuntary treatment among people from Black and ethnic minority groups, and people living in areas of higher socioeconomic disadvantage.

A last resort? Or should we ban it?

Both the NSW and Australian mental health commissions have called involuntary psychiatric care an avoidable harm that should only be used as a last resort.

Despite this, one study found Australia’s rate of involuntary admissions has increased by 3.4% per year and it has one of the highest rates of involuntary admissions in the world.

Involuntary psychiatric treatment is also under increasing scrutiny globally.

When Australia signed up to the UN Convention on the Rights of Persons with Disabilities, it added a declaration noting it would allow for involuntary treatment of people with mental illness where such treatments are “necessary, as a last resort and subject to safeguards”.

However, the UN has rejected this, saying it is a fundamental human right “to be free from involuntary detention in a mental health facility and not to be forced to undergo mental health treatment”.

Others question if involuntary treatment could ever be removed entirely.

Where to from here?

Our research not only highlights concerns regarding how involuntary psychiatric treatment is implemented, it’s a first step towards decreasing its use. Without understanding how and when it is used it will be difficult to create effective interventions to reduce it.

But Australia is still a long way from significantly reducing involuntary treatment.

We need to provide more care options outside hospital, ones accessible to all Australians, including those born overseas, who don’t speak English, or who come from disadvantaged communities. This includes intervening early enough that people are supported to not become so unwell they end up being referred for treatment via police or the criminal justice system.

More broadly, we need to do more to reduce stigma surrounding mental illness and to ensure poverty and discrimination are tackled to help prevent more people becoming unwell in the first place.

Our study also shows we need to do more to respect the autonomy of someone with serious mental illness to choose if they are treated. That’s whether they are in NSW or other jurisdictions.

And legal reform is required to ensure more states and territories more fully reflect the principal that people who have the capacity to make such decisions should have the right to decline mental health treatment in the same way they would any other health care.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Amy Corderoy, Medical doctor and PhD candidate studying involuntary psychiatric treatment, School of Psychiatry, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.