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Writer's pictureDr Thomas Italiano

Manage Your Stress with 3 Breathing Techniques



Type the word stress into Google and you will obtain a stunning 1,23 billion results in just above a second. This six letter word is part of our daily vocabulary and, in theory, it needs no presentation. Most people would agree that stress is toxic and detrimental for our physical and mental health. However, as it is easy to acknowledge that we might feel stressed or we have high stress levels, explaining what we mean by that is not so obvious. In psychology, stress is commonly defined as “a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilise”. And, in life, the demands perceived as excessive can indeed be endless. They might be small but eventually compound: work (performance, deadlines, interactions with a boss or colleagues and so on), relationships (unmet expectations, arguments, sulking), family and children (from calls to parents to nappies and school runs). As “normal stress sources” were not enough, we are currently experiencing a pandemic affecting the whole planet. A huge threat to our well-being, it has forced us in unfamiliar and


restrictive routines, and raised uncertainty on many fronts. For most of us stress levels have gone up. How does stress work? The physiology and psychology of stress go hand in hand.

The autonomic nervous system (ANS), is divided into the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), and is responsible for activating a “fight or flight” response. When we perceive a threat, our brain will send signals to different organs and elicit changes to prepare us to deal with it, either by running away or approaching what’s dangerous. Our heart rate will increase, our breathing will be shallower, and our digestive system will halt. The process involves the release of adrenaline, norepinephrine and cortisol. Subjectively, it is an uncomfortable, often unpleasant feeling of tension and agitation. Such physiological arousal is normal and healthy, as long as it is temporary. It can occur dozens of times every day, often in ways so subtle that we do not notice them. Stress “activates” us, it motivates us to solve problems and act on the stressors. Unfortunately, when we live in a chronic state of stress, there will be a price to pay. It can fuel anxiety and depression, contribute to chronic inflammation and correlated conditions (diabetics, arthritis, heart problems). It can also maintain negative behavioural habits such as over-drinking, over-eating and smoking, which in turn cause obesity and cancer. What we experience as threatening or stressful is, in most cases, subjective. Whether apparently trivial triggers (I forgot to send that birthday card! I’ve gained 5 pounds!) or more life-changing ones (Will my job be available after furlough? Will I be able to keep myself safe?), our are emotional, mental and physical responses depend on many variables. At the risk of being over-simplistic, the main factors involved in this equation are: the meaning we give to the threat, our (perceived) ability to deal with it and the (perceived) support available. In the long run, dealing better with stress requires growth in awareness of our triggers and changing our auto-piloted responses; psychological therapy is likely to be the best route to those objectives (full disclaimer: I am a psychologist!). Nevertheless, our breathing can offer an immediate and powerful effect on our stress levels. It is free, easy and can be done anywhere. BREATHING


Breathing is the only function of our ANS that we can easily and intentionally influence. When we modify our breathing, we can send signals to our brain that activate specific neural circuits and counteract the stress ones. Specifically, when we engage with diaphragmatic breathing, we activate our PNS through the vagus nerve. This changes both our feelings, with a rapid sense of calm, and our physiology, with a lower heart rate, improved digestion and progressively, lower body inflammation. Adopting diaphragmatic breathing is easy but requires some practice; if new to it, the best way of practising involves lying down and placing one hand on the upper chest and one on the stomach, by the navel. When we engage the diaphragm, the first hand should remain still, while the second should move with each breath. It will not take long before we can use the diaphragm in any circumstance.


Breathing protocols with an emphasis on inhaling – inhaling longer than exhaling - will generate arousal, that can be experienced as stress; conversely, protocols emphasising exhaling will generate calm.

Three specific patterns of breathing, easy to adopt, are particularly efficient in the activation of the PNS. The first two are more effective if the whole respiration is done through the nose. Box Breathing, designed by Mark Divine, a Navy SEAL commander; this breath-work is reported to optimise levels of alertness and concentration with calm. It consists of using a regular rhythm and breath length during the process:

1. Start with inhaling steadily and slowly. 2. Then hold the breath. 3. Slowly exhale. 4. Hold for again, before inhaling.

Each of these steps should last four seconds, which creates a comfortable pace for most people. 4-7-8 breathing, a breath-work for relaxation, reported to be effective in inducing calm and facilitating sleep. In this case, inhale for four seconds, hold for seven and slowly exhale for eight seconds. Should these intervals feel too long, it is possible to adopt halved durations (e.g. 2-2.5-4 seconds). Double Inhale breathing: A calming pattern, consisting of inhaling twice in a row (through the nose) and exhaling slowly though the mouth. Dr Andrew Huberman, a Stanford neuroscientist, explains that this pattern rapidly affects the ratio of oxygen and carbon dioxide in the bloodstream, and lungs and activates the sighing neurons that have a fast and direct route to our PSN. A different breathing technique deserves a special mention, as it is intriguing the scientific community for the benefits, both physiological and emotional, that it reportedly induce. It is incorporated in the Wim Hof Method (WHM). Wim Hof, also known as “The Iceman”, is a Dutch extreme athlete who holds more than 20 Guinness World Records. Wim has developed a method that encompasses breathing exercises, meditation and cold exposure. Although the cold exposure has attracted media and celebrity attention, Wim’s breathing is in itself a powerful technique to reach both mental quietness and alertness.

Wim’s breath-work includes controlled hyperventilation and breath retention. Paradoxically, the hyperventilation is a breathing pattern that occurs when we experience anxiety or panic. It increases the oxygen saturation levels and can produce some light-headedness and buzzing ears. The breath retention will re-adjust the body chemistry and the balance between oxygen and carbon-dioxide, in a way that many “Hoffers”, enthusiastic method practitioners, experience as “relaxing and energising”. Although there has been very limited scientific research on the effects of this method on mental health, anecdotal evidence suggests that WHM adepts benefit in both physical and mental health, reporting lower levels of stress, anxiety and depression.

Ultimately, there is no quick fix for stress or anxiety and, aiming for “control” is often a counterproductive stance. Yet, acknowledging that stress and anxiety are part of life does not mean resigning to these feelings. We can actively practise stress management and using breathing protocols is a step in that direction.

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