The Psychology of Breathing

When Breathing Feels Difficult – Understanding the Mind–Body Connection

Breathing can be seen as the way the body processes emotion. Gasps, sighs, feeling as though our breath has been taken away for joyful or shocking reasons, these are all examples of varied responses to human life experiences and environment. The triggers and physical sensations of this will be felt differently by different people.

Why Breathlessness Can Feel So Frightening

Through my work with people living with severe asthma, long Covid and other respiratory conditions, as well as those experiencing panic attacks, I have seen how deeply breathing is connected to our sense of safety and being alive. When breathing becomes difficult, it can feel frightening and can bring us face to face with feelings of vulnerability or even mortality. It can also be hugely disruptive to the activities of daily life and this can have consequences for confidence, state of mind and relationships.

Someone having panic attacks and feeling short of breath may feel just as much at risk as someone having a life-threatening asthma attack or heart attack. Panic attacks can feel frightening and physically intense, but they are not usually harmful in themselves. Understanding the mechanisms behind why this happens and being able to label it as panic or a stress response and not physically harmful is a first step.

The body’s alarm system is designed to trigger the highest state of alert when we struggle to breathe, regardless of whether the cause of the sensations is medical danger or an accumulation of stress that has pushed the body and breathing pattern into hyperventilation.

Support for People Experiencing Breathing Difficulties

For loved ones, it can be challenging to witness the intense suffering that comes with such symptoms and sometimes specific psychological support for both the person experiencing breathing difficulties and their loved ones is helpful. Often the most effective approach is to understand the biological processes and mind-body interconnections.

For someone who has breathing symptoms where the factors driving symptoms are hard to unpick, working with a respiratory physician and/or respiratory physiotherapist and psychologist can often be helpful in disentangling the driving factors and developing a tailored plan.

It is natural to feel anxious when struggling to breathe and whatever the original causes of breathlessness, there is a common escalating vicious cycle of physical sensations driving panic and tension, which can drive further breathlessness and chest tightening.

Calming the Body Through Gentle Breathing

I have learnt that across different conditions psychology tools, psychological therapy and building an in-depth understanding of vicious cycles can increase a sense of knowledge and power, which can enable application of tools to calm the physiological and emotional processes.

• Gentle, calming diaphragmatic breathing where your stomach rises and falls and your chest stays still (you could put one hand on your chest and one on your stomach) can send the brain messages of  ‘I am safe’, ‘I am ok’, and this can be a helpful strategy to soothe stress and panic.
• Avoid big breaths as this can further drive patterns of tension and hyperventilation but aim for a quiet, gentle breathing pattern.
• You could also try box breathing, where you imagine drawing each side of a box as you inhale, hold, exhale, hold.

Grounding Techniques for Breathlessness and Panic

For some people with breathing conditions or intense breathlessness, a focus on breathing can drive further panic so strategies focusing on grounding can be most helpful. The best approach is to understand what happens for you and then tailor approach accordingly.

Here are a few examples: