Cyclic sighing

Domain X · Body, movement, breath & physical · 2023

What it is

Cyclic sighing is a short, low-intensity, exhale-emphasised breathing exercise built on the shape of a natural sigh: two inhalations in a row (the second one topping up the lungs), followed by a slow, complete exhalation, repeated continuously for a few minutes. In the Stanford trial it was one of…

Format

• Format: self-administered at home, remote study, instruction delivered by pre-recorded video sent a few days before starting, plus daily text reminders.
• Dose: 5 minutes per day, timed with a timer, for 28 days.

Who practises it, and how they are trained or regulated

• Criteria for moving on or stopping: unpleasant hyperventilation-type symptoms, panic, or worsening of a breathing complaint mean stopping and reassessing, not pushing through (section 4.1).
• Scope for psychotherapists. This is a self-administered breathing exercise that a trained psychotherapist may teach within their competence as a coping and self-regulation skill. It is not a treatment for any physical disease, it is not a substitute for respiratory physiotherapy where a breathing pattern disorder is present, and clients must never change asthma or other medication because of it.

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 any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• 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?
• 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

• ratings that worsen after practice (review technique or stop); a focus on numbers that increases monitoring of anxious symptoms. Working if: the client can see a pattern in their own ratings.
• expectations of a cure; catastrophic beliefs about breathing ("if I don't breathe right I'll suffocate"), which are worth noting for later cognitive work. Working if: the client can describe the…
• breathing faster to "do it right"; a forceful or gasping second inhale; forcing the exhale until strained; raised shoulders; light-headedness or tingling (slow down, make the inhales smaller, or…
• pressure to keep going when it brings no benefit; a wish to "step up" to more intense breathwork, which needs separate screening and qualified instruction. Working if: the client has an informed,…
• use as an escape from every flicker of anxiety (see 4.7); rapid repeated sighs that tip into over-breathing. Working if: a few breaths take the edge off and the client carries on with the activity…

Problems the guide addresses

• Evidence status (to explain to clients and colleagues)
• The psychotherapist's role

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.