Diaphragmatic breathing

Domain X · Body, movement, breath & physical

What it is

Diaphragmatic ("tummy", "low" or "abdominal") breathing is a way of breathing at rest in which the diaphragm does most of the work: the lower ribs and belly move gently outwards on the in-breath, the upper chest and shoulders stay quiet, breathing goes in and out through the nose, and the breath is…

Format

• Typical dose and format. In psychotherapy it is usually taught in one session and refined over two to four further sessions, a few minutes each time, within a wider treatment. An NHS BPD physiotherapy first appointment lasts about 45 minutes and combines detailed history, observation of the…

Who practises it, and how they are trained or regulated

• Stage 0: Screening and decision. Goal: decide whether breathing work is safe and useful, and in what role. Rule out or refer physical causes of breathlessness and chest symptoms; screen for BPD features; decide whether in this case breathing is a general regulation skill, a BPD retraining aid alongside physiotherapy, or something to leave out (for example during exposure-based panic treatment). Move on when medical…
• Coping-skill version (breathing retraining included, as in some CBT panic packages and in BPD physiotherapy): breathing is used during early exposure or acute episodes, then faded.
• Version followed: the low, nose-based, diaphragm-led "breathing re-education" taught in UK NHS respiratory and physiotherapy leaflets for breathing pattern disorder (BPD, also called dysfunctional breathing or hyperventilation syndrome), adapted for psychotherapy as a coping and regulation skill inside CBT for anxiety and panic. Where CBT panic protocols differ (breathing retraining included, as in Craske and…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• a plan built entirely on breathing to stop panic (revisit 4.15). Working when the client can describe their plan without prompting.
• sessions becoming breathing classes; the client performing for the therapist. Working when the client needs less coaching each time.
• relaxation-induced anxiety in some clients (keep eyes open, short spells). Working when visible shoulder lift on the in-breath lessens.
• breath-holding on effort, rushed speech without pauses. Working when the client notices and corrects upper-chest breathing in daily life.
• air hunger turning into panic (move to 4.13 or 4.15); compulsive sighing. Working when air hunger becomes less frequent and less alarming.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.