Transformational breath (Kravitz)

1. Introduction

Version followed: Transformational Breath® (TBr) as described in 2026 by the Transformational Breath Foundation's certified-school and course listings on the Global Professional Breathwork Alliance (GPBA) directory, supplemented by one certified practitioner's published research protocol (Wheble & Elcin 2025) and facilitator materials. The Foundation's own website is not used as a source here, and Judith Kravitz's book Breathe Deep, Laugh Loudly is named but its contents are not drawn on [uncertain].

Transformational Breath is a conscious connected breathwork method developed by Dr Judith Kravitz. She is an ordained minister who has worked with breath "as an agent of transformation and healing" since the late 1970s, and she founded the Transformational Breath Foundation in 1994, where she remains Executive Director [source: Omega teacher page]. The Foundation describes TBr as a breathing system that combines two core tools, Breathing Analysis and Bodymapping, supported by sound (toning), invocations, affirmations, movement and music. It reports that the method is taught in 56 countries and 12 languages [source: GPBA TBr profile; GPBA certified-school listing].

Core idea of change, as the school states it (attributed, not established fact): a full, connected, diaphragmatic breath opens "restrictive breathing patterns", and that opening is said to bring suppressed emotion and subconscious material to awareness for integration. The school also speaks of "energy blockages" opening and of physical, emotional and spiritual transformation [source: GPBA certified-school listing; facilitator handout, railwellbeinglive]. Energy, "frequency" and Higher-Self concepts belong to the school's own framework and are attributed to it here.

What this means for a psychotherapist. TBr is a facilitator-led method. Only people trained and certified through the Foundation's pathway lead sessions (see Framework). This guide covers two things: the method as the school publishes it, described without breathing rates, round counts, session durations or retention timings, and the psychotherapist's own role in screening, referral, preparation, collaboration and integration. A psychotherapist who also holds TBr facilitator certification may deliver the method, and the inventory gives the published session arc for that case. The hands-on Bodymapping element raises separate questions about touch and professional codes, covered in 3 and 4. Holotropic Breathwork and similar intense methods are covered in the Domain VII Holotropic Breathwork guide. Wim Hof breathing has its own guide (row 167).

Health claims, attributed. School materials claim benefits including enhanced lung capacity, toxin elimination, immune support, lower cortisol and better lung function (described as "Research shows", with no citation given), and help with anxiety, asthma, migraine, PTSD, insomnia, addiction and IBS [source: GPBA certified-school listing; railwellbeinglive handout]. One facilitator's handout states that TBr "is not a medical therapy and makes no claims to cure medical conditions" while also calling it safe and saying clients "can come to no harm" [source: railwellbeinglive handout]. That safety statement is contradicted by the cautions in the GPBA Ethical Standards and by the physical effects recorded in research (see Framework, safety). A certified facilitator has described TBr as "great for PTSD" [source: Northwest Military article]; this is a practitioner's claim. Independent evidence is very limited. In a small randomised exploratory trial, three TBr sessions with professional voice users showed no group-by-time or group effects against waitlist on psychological or physiological measures. Music-performance anxiety fell within the TBr group by the third session [source: Wheble & Elcin 2025]. TBr is not a treatment for any physical disease. Clients should never change asthma, blood-pressure, psychiatric or other medicines because of it [source: GPBA Ethical Standards 4.1.9].

2. Framework

Format. The method is delivered in individual sessions (in person or online) and in groups and workshops, including one-day retreats and multi-day residential events [source: GPBA TBr profile; railwellbeinglive handout; Northwest Military article]. The client lies on a mat. A certified facilitator guides throughout.

Session arc (the school's published sequence) [source: GPBA TBr profile; GPBA certified-school listing]:

The facilitator prepares the space and centres themselves.
Welcome and initial interview, including physical and medical conditions, so the session can be tailored.
The client sets an intention.
Breathing Analysis: the client breathes normally while the facilitator observes their natural pattern.
The facilitator demonstrates the technique.
The active breathing phase, with invocations and music, which the school calls "the core part of the session".
Techniques and adjustments: Bodymapping, affirmations, toning, movement.
Integration: the client returns to relaxed breathing.
Grounding and closing, including the offer of a drink.
Feedback and sharing.

One research protocol written by a certified TBr trainer followed the same order in compressed form: coaching to set an intention, an active phase of connected diaphragmatic breathing with music, a relaxation phase in which the practitioner recorded observations, and a short post-session interview. Components named were practitioner feedback on breathing, therapeutic touch, positive affirmations, toning, movement and breath-holding [source: Wheble & Elcin 2025]. Breath-holding is named here as published. No timings or counts are given, and none should be inferred.

Typical course. Session count is not fixed in the sources used here. The research protocol used three individual sessions spaced apart [source: Wheble & Elcin 2025]. Facilitator materials describe individual sessions, workshops and residential events, plus a short regular self-practice [source: railwellbeinglive handout]. Whether the Foundation itself recommends a standard number of sessions is not published in its listings [uncertain].

Criteria for moving on. The sources give no formal criteria between sessions. In TBr's own terms, the facilitator adapts each session to the client's observed breathing pattern "rather than following a fixed script" [source: GPBA Level 4B listing]. Suggested criteria for a psychotherapist's involvement [synthesis]: (a) begin only after screening and any needed medical clearance; (b) book further sessions only if the client recovered fully from the previous one (sleep, mood, no lingering derealisation or flashbacks) and can say what they took from it; (c) pause if new trauma material surfaces faster than it can be processed in therapy.

Facilitator training and certification [source: GPBA TBr profile; GPBA Level 4A and 4B listings]:

Transformational Breath® Essentials, Levels 1–3: the prerequisite experiential training.
Facilitator Foundations Course, Level 4A: online with live classes. It introduces Breathing Analysis™ and facilitation tools, covers presence and professional foundations, and is described as the move "from experiencing the method to learning how to offer it".
Advanced Facilitator Course, Level 4B: Breathing Analysis™, Bodymapping™, facilitation techniques, coaching skills, presence and intuition, ethics and personal work. It is described as a "pivotal stage" for Facilitator Interns working towards professional certification.
The full certification is described as 500 hours and CEU-recognised in the United States and Canada. Further options include Online Session Certifications, Advanced Breathing Analysis and continuing education.
The Level 4A and 4B listings name Breathing Analysis, Bodymapping, facilitation techniques, coaching skills, presence, intuition and ethics; they do not mention contraindication, screening or touch-consent training [source: GPBA Level 4A and 4B listings; uncertain: full syllabus not published].

Professional association. The Foundation's certified schools are listed by the GPBA. Its 2026 Ethical Standards cover consent, screening, scope, referral, integration and complaints [source: GPBA Ethical Standards]. No government regulation of TBr facilitators is known to this guide [uncertain]. Facilitator certification is not a licence to practise psychotherapy or medicine.

Physical safety, screening and contraindications.

The GPBA Ethical Standards say breathworkers should inform participants about conditions that breathwork may affect. They name "cardiovascular conditions, respiratory issues, epilepsy, psychosis", note that some conditions need adjustments, and say breathworkers should be aware of medicines that raise bleeding risk or act on the central nervous system (4.1.2, 4.1.8). Participants must be told the "potential benefits, risks, and contraindications" and any "physical, cognitive, or emotional effects" (4.3.1–4.3.2). Breathwork can lower the seizure threshold, which may affect a client's eligibility to drive (4.3.2). Participants should be able to disclose self-harm or suicidal thoughts at registration and throughout (4.1.6) [source: GPBA Ethical Standards].
One research protocol excluded people with severe depression or anxiety, current suicidal ideation, smoking, alcohol use above recommended limits, and regular use of beta-blockers, antihypertensives or inhaled asthma medication [source: Wheble & Elcin 2025].
A comparable energy-intensive breathwork school (Kripalu, not TBr) lists as contraindications: pregnancy; cardiovascular disease; personal or family history of aneurysm; epilepsy or seizure conditions; retinal detachment; recent injury or surgery; mental illness, trauma or current emotional issues that could be aggravated; untreated high blood pressure; conditions needing major medication, especially tranquillisers; and infectious conditions. People with asthma should bring their inhaler [source: Kripalu Transformative Breathwork information]. These are given as a reference point, not as TBr's own list.
The Foundation's published profile lists no contraindications; it says only that new clients have an initial interview about their physical and medical conditions [source: GPBA TBr profile]. Commonly cited further cautions for intense connected breathwork are glaucoma, bipolar disorder, severe PTSD or dissociation, panic disorder, and osteoporosis where there is vigorous movement [uncertain: secondary, not from a TBr source; treat as cautions needing medical or psychiatric clearance].
Over-breathing effects recorded in TBr sessions: paraesthesia or tetany (cramping and stiffness, typically in hands, feet or around the mouth) in a substantial minority of sessions, dizziness, and headache [source: Wheble & Elcin 2025]. Facilitator materials also mention dry mouth, numbness and tingling, as well as crying or laughing [source: railwellbeinglive handout]. These are generally attributed to low carbon dioxide from over-breathing (hypocapnia), which can also bring on or mimic panic [synthesis; uncertain: not verified].
Never practise connected or accelerated breathing, or any breath-holding, in or near water (bath, pool, open water) or while driving or operating machinery. Loss of consciousness in water can be fatal (shallow-water blackout) [synthesis].
Stop rules [synthesis, consistent with GPBA 2.5]: stop and return to relaxed natural breathing for chest pain, palpitations that do not settle, severe headache, visual disturbance, fainting or near-fainting, seizure signs, severe or escalating panic, or loss of contact with the present. Seek medical help where indicated.

3. Guiding principles

Principles the school states [source: GPBA TBr profile; GPBA certified-school listing; GPBA Level 4B listing; railwellbeinglive handout]:

Adapt to the individual breath, not a script. Breathing Analysis directs each session. Practical meaning: read what the client's breath shows before choosing any adjustment.
Intention frames the session. The client sets an intention before breathing. Practical meaning: the session has a purpose the client chose, which also anchors integration afterwards.
Stay with what arises. Clients are encouraged to stay with emotions and sensations rather than push them away. Practical meaning: allow tears or laughter, and coach the client back to the breath rather than stopping at the first discomfort. This must not override stop rules.
Breath, body, sound and words together. Bodymapping, toning, movement and affirmations support the breath. Practical meaning: each tool supports the breathing pattern and is not an add-on for its own sake.
Integration and grounding before leaving. Every session ends with relaxed breathing, grounding and sharing. Practical meaning: no client leaves while dizzy, flooded or disoriented.
Presence and the facilitator's own practice. Training stresses presence, intuition and the facilitator's ongoing personal work. Practical meaning: the facilitator's steadiness is part of the method.

Principles from professional ethics [source: GPBA Ethical Standards; USABP Code of Ethics; EABP Ethics Guidelines; APA Ethics Code; BACP and UKCP codes as listed in Sources]:

Informed consent includes risks. The client is told the possible physical, cognitive and emotional effects and the contraindications before the first session (GPBA 4.3). Practical meaning: no "you can come to no harm" framing.
Consent to touch before and during, with the right to stop. Consent covers boundaries around therapeutic touch, and the client may withdraw it at any time (GPBA 2.5). The client may refuse or end any touch at any time and consent is re-checked over time (USABP VIII.2–VIII.5). Practical meaning: ask before each touch, accept "no" without persuasion, and offer a touch-free session as a full option.
Never sexual touch. Genital or other sexual touch is "always inappropriate" (USABP), inappropriate touch is to be avoided even when the participant invites it (GPBA 4.4.1.2), and mainstream psychotherapy codes prohibit sexual contact with clients (e.g. APA 10.05; UKCP item 4; BACP 2018 para 34). Practical meaning: Bodymapping contact is never on breasts, genitals, buttocks or the inner thighs, and any doubt means no touch [synthesis on areas].
Stay within competence and certification. Breathworkers "must not provide advice or services for which they are not certified" (GPBA 1.4). Psychotherapy codes require practising only within training (UKCP item 23; APA 2.01). Practical meaning: a psychotherapist does not run TBr sessions or use Bodymapping without Foundation certification, and a facilitator does not do psychotherapy without that training.
Do not combine talk therapy and hands-on work by default. Mainstream codes contain no explicit touch provision, while body-psychotherapy codes regulate touch directly (USABP VIII; EABP Principle 7). Practical meaning: a psychotherapist adds touch only if their own profession's code allows it and they hold the training. Otherwise they refer and collaborate.
Never advise on medication. Breathworkers should not advise anyone to change, stop or taper prescribed medication (GPBA 4.1.9). Practical meaning: medication questions go to the prescriber.
Coordinate parallel care. Where a client receives similar services from another professional, the therapist considers the implications and discusses them with the client (EABP 6.b). Practical meaning: with the client's consent, agree roles with the facilitator.

4. Intervention inventory

There are three groups. A: the psychotherapist's tasks before referral or a session [mostly synthesis, anchored in GPBA standards]. B: the TBr session components as the school publishes them, delivered only by a Foundation-certified facilitator, including a psychotherapist who holds that certification. C: the psychotherapist's tasks after sessions. No breathing rates, round counts, session durations or retention timings are given anywhere in this guide.

A. Before: the psychotherapist's role

4.1 Deciding whether to suggest TBr, and referring

Purpose / when: the client is curious about breathwork, has tried it, or wants an experiential, emotion-releasing complement to talk therapy, and is stable enough for intense states [synthesis].
Steps: (1) Ask what the client hopes for, and correct any expectation of a cure, using the attributed claims and limited evidence in section 1. (2) Screen (4.2). (3) If TBr fits, point the client to Foundation-certified facilitators, for example via the GPBA member directory, and suggest they check the facilitator's certification level, touch policy and complaints route (GPBA 2.12) [source: GPBA TBr profile; GPBA Ethical Standards]. (4) With written consent, agree what will be shared between you and the facilitator (EABP 6.b). (5) Book a psychotherapy session soon after the breath session.
Example language (illustrative): "Transformational Breath can bring up strong feelings and body sensations. The research on it is still thin, so let's treat it as an experiment we look at together, not a cure. If you go ahead, I'd like us to meet soon afterwards to make sense of whatever came up."
Watch for: wanting TBr to bypass slow trauma work; pressure from a group or partner to attend; a facilitator who promises cures or says there are no risks. It is working when the client chooses freely and understands the risks.

4.2 Screening and medical clearance

Purpose / when: before any first session, and again if health or medication changes.
Steps: (1) Ask about the conditions in section 2: cardiovascular disease, blood pressure, aneurysm history, epilepsy or seizures, respiratory conditions including asthma, pregnancy, eye conditions (retinal detachment, glaucoma), recent injury or surgery, and medicines affecting bleeding or the central nervous system [source: GPBA Ethical Standards 4.1.2, 4.1.8; Kripalu information]. (2) Ask about psychosis, bipolar disorder, severe PTSD, dissociation, panic disorder, current suicidal ideation or self-harm, and substance use [source: GPBA 4.1.2, 4.1.6; Wheble & Elcin 2025; uncertain: bipolar disorder and dissociation are not named in these sources]. (3) Where any is present, the client gets clearance from their physician or psychiatrist before booking, and you tell the facilitator what the client consents to share. (4) For seizure history, the client also asks their doctor about driving implications (GPBA 4.3.2). (5) Record your decision.
Example language (illustrative): "Before you try this, I need to ask some health questions, because fast connected breathing affects the heart, blood pressure and nervous system. If anything applies, the next step is a conversation with your doctor, not a no."
Watch for: minimising symptoms in order to qualify; recent trauma disclosure or crisis; a recent or planned change in psychiatric medication. If there is current suicidal ideation, psychosis, mania or severe dissociation, defer [synthesis].

4.3 Preparation and informed consent about effects and touch

Purpose / when: after screening, before the first session.
Steps: (1) Describe the likely experience: open-mouth connected breathing; possible dry mouth, tingling, numbness, cramping (tetany), dizziness or headache; tears or laughter; strong emotion or memories [source: railwellbeinglive handout; Wheble & Elcin 2025]. (2) Explain that sessions may include hands-on Bodymapping, and help the client decide in advance whether they want touch, where they do not want it, and what signal they will use to stop. Touch-free is a full option (GPBA 2.5; USABP VIII.5). (3) Agree a stop signal, for example a raised hand, as in comparable schools [source: Kripalu information]. (4) Plan safe travel home: no driving if dizzy or emotionally flooded [synthesis]. (5) Remind the client never to practise the breath in or near water or while driving [synthesis].
Example language (illustrative): "You are in charge of your body the whole time. You can say no to touch before the session or in the middle of it, and the facilitator should stop straight away. You can also stop the breathing at any moment and go back to normal breathing."
Watch for: a trauma survivor who feels unable to say no. Rehearse saying it in session. Freeze responses may make a "yes" unreliable, so a touch-free first session may be wiser [synthesis].

B. The TBr session as published (certified facilitators only)

4.4 Preparing the space and centring

Purpose / when: before every session [source: GPBA TBr profile].
Steps: (1) Prepare a quiet, warm, private space with a mat, cushions, blanket, tissues and water. (2) Remove trip hazards. Make sure nobody is near water or due to drive straight after [synthesis]. (3) The facilitator centres themselves, which the school treats as part of presence.
Example language (illustrative): "Take your time settling. There's water and a blanket here, and nothing will start until you're ready."
Watch for: facilitator hurry or distraction. In groups, enough space and assistants to reach every breather [synthesis].

4.5 Welcome and initial interview

Purpose / when: first session, and briefly every session. It covers physical and medical conditions so the session can be tailored [source: GPBA TBr profile; GPBA 4.1.2, 4.3].
Steps: (1) Health interview using the conditions in 4.2. (2) Explain the risks and effects, and obtain consent, including consent to touch and its boundaries (GPBA 2.5, 4.3). (3) Ask about current stressors and emotional state, and invite disclosure of self-harm or suicidal thoughts (GPBA 4.1.6). (4) Record what was agreed.
Example language (illustrative): "Is there anything about your health, medication or how you've been feeling lately that I should know before we breathe?"
Watch for: new symptoms since the last session; a client arriving intoxicated or in crisis. Postpone if so [synthesis].

4.6 Setting an intention

Purpose / when: before breathing, to focus the session and anchor integration [source: GPBA TBr profile; Wheble & Elcin 2025].
Steps: (1) Ask what the client wants from this session. (2) Help them phrase it in a few positive, present-tense words that they own. (3) Note it for the feedback stage.
Example language (illustrative): "If this session could help with one thing, what would it be? Let's put it in your own words."
Watch for: intentions to recover hidden memories or to "get rid of" a person or feeling by force. Reframe these towards self-awareness or acceptance [synthesis; see 4.21 on memory].

4.7 Breathing Analysis

Purpose / when: at the start of each session, to read the client's natural breathing pattern and plan the session. It is one of the two core TBr tools and is taught at Levels 4A and 4B and in Advanced Breathing Analysis [source: GPBA TBr profile; GPBA Level 4A and 4B listings].
Steps (described generally): (1) The client lies on the mat and breathes normally. (2) The facilitator observes where the breath moves (chest, belly), whether it flows or pauses, and how the exhale is released. (3) The facilitator uses these observations to choose adjustments, such as Bodymapping, positioning, toning or affirmations. The detailed reading system belongs to the Foundation's training and is not published [uncertain].
Example language (illustrative): "For now, just breathe the way you normally do. I'm only watching how your breath moves, and there's nothing you need to get right."
Watch for: the client self-consciously changing their breath. Quick shallow chest breathing or breath-holding at rest may signal anxiety, which calls for a gentler session [synthesis].

4.8 Demonstrating and teaching the breath

Purpose / when: after Breathing Analysis [source: GPBA TBr profile].
Steps (described, no rates or counts): (1) The facilitator demonstrates the pattern. As published, it is an open-mouth breath [source: railwellbeinglive handout] that is diaphragmatic and uninterrupted, with inhale flowing into exhale and a relaxed, complete exhale rather than a forced one [source: Wheble & Elcin 2025]. (2) The client tries it with coaching. (3) The facilitator gives feedback on the breath [source: Wheble & Elcin 2025]. (4) The client is reminded they can return to normal breathing at any time.
Example language (illustrative): "Let the breath come in through an open mouth into your belly, and let it fall out without pushing. If anything feels too much, just go back to your ordinary breathing."
Watch for: forcing or pushing the exhale. A comparable school links tetany to forced exhalation and advises relaxing on the out-breath [source: Kripalu information]. Watch also for straining and for breathing faster than coached.

4.9 Active breathing phase with music and invocations

Purpose / when: the core of the session, during which material is said to surface for integration [source: GPBA certified-school listing].
Steps (described): (1) The client sustains the connected breath, with the facilitator's coaching, over music the school calls inspirational. (2) The facilitator speaks invocations, which belong to the school's spiritual framework and are attributed to it [source: GPBA TBr profile]. (3) The facilitator monitors continuously and uses the tools in 4.10–4.14 as the breath and the client's responses indicate. (4) When the client stops breathing actively, the facilitator moves to integration (4.15).
Example language (illustrative): "Keep the breath connected. Let whatever comes, come. You can cry, laugh or make sound. I'm right here."
Watch for: stop-rule signs (section 2); escalating panic; tetany causing distress; dissociation (glazed eyes, no response to voice); re-experiencing trauma without present-moment contact. In any of these, slow down, return to normal breathing, and ground the client (4.16) [synthesis]. Signs it is working, as the school describes them: emotional release followed by calm, and a freer, fuller breath [source: railwellbeinglive handout; GPBA listing].

4.10 Bodymapping (hands-on)

Purpose / when: one of the two core TBr tools. The facilitator adjusts the client's position and body to enhance the breathing pattern [source: GPBA certified-school listing]. A certified facilitator describes Bodymapping as using pressure points that are said to release stored emotions, combined with healing affirmations [source: Northwest Military article]. The research protocol records it as therapeutic touch [source: Wheble & Elcin 2025]. The stored-emotion account is the school's explanation, not established fact. Bodymapping is taught at Level 4B [source: GPBA Level 4B listing].
Steps (general terms only): (1) Touch is used only if consent was given beforehand and only within the agreed areas (GPBA 2.5). (2) Before each contact, the facilitator says what they are about to do and asks again; during contact they check in. (3) Contact is light to moderate pressure on non-intimate areas, or a change of position, guided by Breathing Analysis. The Foundation's specific point system is not published and is not reproduced here [uncertain]. (4) Pressure may be paired with an affirmation (4.11). (5) At "stop", a raised hand, pulling away or freezing, the facilitator removes their hands at once and offers a touch-free alternative. (6) Contact is never on the breasts, genitals, buttocks or inner thighs and never sexual in any way (USABP VIII; GPBA 4.4.1.2) [synthesis on areas]. (7) The facilitator documents consent and any changes to it (USABP VIII.1, VIII.3–4).
Example language (illustrative): "I'd like to place my hand lightly on your upper belly to help the breath move there. Is that OK? You can say stop at any time." Then, during contact: "Still OK?"
Watch for: startle, freeze, held breath or going quiet when touched, all of which can mean consent has lapsed even without words. Watch also for flashbacks linked to touch, or for pressure causing pain or bruising, particularly with anticoagulants or fragile bones [synthesis; GPBA 4.1.8]. A psychotherapist does not use Bodymapping unless they hold TBr certification and their own professional code permits touch (section 3).

4.11 Affirmations

Purpose / when: during the active phase, often paired with Bodymapping, to "reinforce positive beliefs" and, in the school's words, reprogram negative thought patterns [source: GPBA certified-school listing; Northwest Military article; Wheble & Elcin 2025].
Steps: (1) Draw on the client's intention and the themes that come up. (2) Offer a short, positive, present-tense statement for the client to repeat aloud or silently, or to simply hear. (3) Ask whether it fits, and change it or drop it if it does not.
Example language (illustrative): "Try this, and only if it feels true enough: 'It is safe for me to feel.' Change the words if they don't fit."
Watch for: affirmations that contradict reality, for example "I am safe" said to someone still at risk, or that shame the client. Watch also for a client who repeats an affirmation to please the facilitator. It is working when the client finds or reshapes words that ring true [synthesis].

4.12 Toning (sound)

Purpose / when: before and during sessions, to stimulate the breath and, in the school's terms, to improve energy flow and support integration [source: GPBA certified-school listing; Northwest Military article].
Steps (described): (1) The facilitator invites the client to make sustained vocal sound on the exhale, such as a hum or open vowel. (2) Sound can be used to release built-up tension or emotion, or to settle the client after intense breathing.
Example language (illustrative): "On the next out-breath, let a sound come out, any sound at all, as loud or as soft as you like."
Watch for: self-consciousness, especially in groups; sound that turns into screaming and dysregulation rather than release. If that happens, slow the breath and ground the client (4.16) [synthesis].

4.13 Movement

Purpose / when: before and during sessions to stimulate breathing, and during integration as relaxing "healing movements" [source: GPBA certified-school listing; Northwest Military article].
Steps (described): (1) The facilitator invites gentle, client-led movement such as shaking out the hands, rocking or stretching. (2) The facilitator keeps the space safe and watches for falls or knocks.
Example language (illustrative): "If your body wants to move, let it, gently. Your hands and feet can shake out the tingling."
Watch for: vigorous movement in clients with osteoporosis, joint problems, recent surgery or pregnancy [synthesis; Kripalu information]. Watch also for movement that becomes thrashing or a re-enactment of trauma; if so, slow down and ground.

4.14 Breath-holding (named as published)

Purpose / when: the research protocol lists breath-holding among the TBr components the facilitator may use [source: Wheble & Elcin 2025]. The Foundation's published listings do not describe its purpose or placement [uncertain].
Steps: none given. This guide gives no hold lengths, counts or instructions. Breath-holding is used only under a certified facilitator's direct supervision, and never in or near water, while driving, or by clients with cardiovascular, seizure, eye or pregnancy-related contraindications [synthesis].
Example language (illustrative): "If I suggest pausing the breath and it doesn't feel right, just keep breathing. That is always fine."
Watch for: light-headedness, fainting, chest discomfort, panic. Stop at once if any appear [synthesis].

4.15 Integration: return to relaxed breathing

Purpose / when: after the active phase, so that the experience settles and the body returns to baseline [source: GPBA TBr profile]. In the research protocol this is a relaxation phase during which the practitioner records observations [source: Wheble & Elcin 2025].
Steps: (1) Coach the client back to natural, relaxed breathing. (2) Let them rest quietly under a blanket. (3) Observe and note how they recover: tingling and tetany fading, colour, calm, responsiveness.
Example language (illustrative): "Let the breath go back to its own rhythm now. You don't need to do anything. Just rest and notice."
Watch for: symptoms that do not settle with relaxed breathing (see stop rules); continuing dissociation; distress returning when the client is left alone. It is working when the breath is easy, sensations are fading and the client can speak normally [synthesis].

4.16 Grounding and closing

Purpose / when: before the client gets up and leaves [source: GPBA TBr profile].
Steps: (1) Help the client sit up slowly. (2) Ground them: feet on the floor, eyes open, naming things in the room, the feel of the mat or chair [synthesis]. (3) Offer a drink, as the school does [source: GPBA TBr profile]. (4) Check they are oriented and safe to travel. If they are dizzy or emotionally flooded, they should not drive [synthesis; GPBA 4.3.2].
Example language (illustrative): "Before you stand up, press your feet into the floor and look around the room. Tell me three things you can see. Here's some water."
Watch for: unsteadiness, ongoing derealisation, tearfulness that escalates. Do not let the client leave until it has settled, and agree a contact plan [synthesis].

4.17 Feedback and sharing

Purpose / when: at the end of the session, to put the experience into words and link it to the intention [source: GPBA TBr profile]. In the research protocol this is a brief post-session interview [source: Wheble & Elcin 2025].
Steps: (1) Ask open questions about the client's experience. (2) Link it to their intention. (3) Provide integration support (GPBA 4.2.3). (4) Note anything that needs follow-up in psychotherapy, with the client's consent to share.
Example language (illustrative): "What stood out for you? Did anything connect to what you came in wanting?"
Watch for: the facilitator interpreting the client's material, such as "that was birth trauma" or "that was a past life". Facilitators should not offer psychological interpretation beyond their training (GPBA 1.4, 8.1.5). Refer material that needs it to the psychotherapist.

4.18 Group sessions and workshops

Purpose / when: group breathing sessions, one-day retreats and multi-day residential workshops [source: railwellbeinglive handout; Northwest Military article].
Steps: (1) Screen every participant individually (4.2, 4.5). (2) Have enough trained assistants to reach anyone who signals. (3) Agree the touch policy and stop signals in advance. (4) Give everyone individual integration and grounding before they leave [synthesis].
Example language (illustrative): "If you need someone at any point, raise your hand. A facilitator will come to you, and you can opt out of touch completely."
Watch for: contagion of intense emotion or sound; people pushing themselves to keep up; group pressure to accept touch or to share; residential settings that remove people from their usual support [synthesis].

4.19 Online sessions

Purpose / when: TBr offers Online Session Certifications for facilitators and online individual sessions [source: GPBA TBr profile; railwellbeinglive handout].
Steps: (1) Screen as usual, and record the client's address and an emergency contact. (2) Ask the client to set up lying down in a private space, away from water and not in a vehicle. (3) Agree what happens if the connection drops: the client returns to normal breathing, and the facilitator calls back or uses the emergency contact. Bodymapping is not possible online [synthesis].
Example language (illustrative): "If the call drops, go back to normal breathing and stay lying down. I'll call you back straight away."
Watch for: the facilitator not being able to see tetany, fainting or dissociation clearly on camera. Be more conservative with clients who have any risk factor [synthesis].

4.20 Self-practice

Purpose / when: one facilitator's handout recommends a short regular home practice [source: railwellbeinglive handout]. The Foundation's profile says regular practice calms the mind but publishes no self-practice protocol [source: GPBA TBr profile; uncertain].
Steps: learn any self-practice only from a certified facilitator. Practise lying or sitting somewhere safe, never in or near water and never while driving. Stop and return to normal breathing if dizziness or tingling builds. This guide sets no duration, frequency or targets [synthesis].
Example language (illustrative): "If your facilitator gave you a home practice, do it lying down somewhere safe, and stop whenever it feels like too much. There's no target to hit."
Watch for: solo practice being used to escape distress compulsively, or to chase intense states; and symptoms during practice. Review practice in therapy [synthesis].

C. After: the psychotherapist's role

4.21 Integrating session material in psychotherapy

Purpose / when: in the psychotherapy session after a breath session [synthesis; GPBA 4.2.3, 4.1.4 on working alongside psychotherapy].
Steps: (1) Start with the body and present state: sleep, mood, any lingering symptoms. (2) Invite the client's own account without leading questions. (3) Work with emotions, images and insights as the client's experience and meaning. (4) Treat apparent "memories" with care, especially of birth, early infancy or past lives. Do not confirm or build on them as historical fact, because altered states and suggestion can produce vivid but inaccurate recollections [synthesis; uncertain: secondary, unverified]. (5) Link insights to the goals of therapy and to everyday changes.
Example language (illustrative): "That image clearly carries a lot of feeling. We don't have to decide whether it literally happened. Let's look at what it means to you now."
Watch for: suggestions from facilitators or groups that hardened into beliefs about abuse or birth trauma; the client feeling they "failed" if nothing happened; idealisation of the facilitator. It is working when the client can hold the experience with curiosity and use it in daily life.

4.22 Grounding a client who arrives destabilised

Purpose / when: the client comes to therapy after a breath session dysregulated, with flashbacks, derealisation, insomnia or agitation [synthesis].
Steps: (1) Stabilise first: orient to the present, slow natural breathing (not the TBr pattern), sensory grounding. (2) Assess risk, including suicidal thoughts. (3) Postpone further breathwork until the client is stable. (4) With consent, tell the facilitator. (5) If symptoms persist or psychotic or manic features appear, refer for medical or psychiatric assessment.
Example language (illustrative): "Let's slow everything down. Feel the chair under you. You don't need to make sense of the session right now. First, let's get you steady."
Watch for: symptoms lasting days; panic attacks that started after the session; sleep loss with elevated mood. These are reasons for urgent review.

4.23 Recognising and passing on adverse effects

Purpose / when: physical or psychological harms during or after sessions, or concerns about a facilitator's conduct [synthesis].
Steps: (1) Ask routinely about physical symptoms (fainting, chest pain, seizure, injury) and psychological effects. (2) For medical symptoms, direct the client to medical care. (3) Help the client raise concerns with the facilitator. Breathworkers must provide information about complaints processes and must not retaliate against a complainant (GPBA 2.12), and the GPBA has a process for ethical concerns [source: GPBA Ethical Standards; GPBA ethics page]. (4) Any sexual or non-consensual touch is misconduct. Support the client in reporting it to the school, the GPBA and, where it is a crime, the police, in line with your own code and local law [synthesis].
Example language (illustrative): "What you describe shouldn't happen in a session. You have the right to make a complaint, and I can help you think about how."
Watch for: clients blaming themselves or minimising ("I said yes at the start"). Consent can be withdrawn at any time (GPBA 2.5).

4.24 Collaborating with the facilitator

Purpose / when: whenever a client in psychotherapy attends TBr [source: EABP 6.b; GPBA 4.1.4].
Steps: (1) Obtain written consent to share information. (2) Agree roles: the facilitator runs the breath sessions, and the psychotherapist holds diagnosis, risk and trauma processing. (3) Agree pacing and stop criteria, for example a pause if trauma symptoms rise. (4) Agree how each of you contacts the other after a difficult session.
Example language (illustrative), to the facilitator: "My client has asked me to share that they have a trauma history and prefer no touch. Could we agree that you'll let me know, with their consent, if a session gets very intense?"
Watch for: contradictory messages, such as the facilitator encouraging the client to stop therapy or medication (see GPBA 4.1.9), and splitting between providers.

5. Handling problems

The school's sources say little about problem-handling beyond staying with what arises and adapting to the individual. Unless a source is tagged, the guidance below is [synthesis].

"Nothing happened" / stuck client. Normalise this: the school says sensations may or may not occur [source: railwellbeinglive handout]. Explore any pressure to perform. Shift the intention from release to curiosity. Do not push intensity to get a result. Response (illustrative): "A quiet session is still information. What was it like to have nothing dramatic happen?"
Resistance to open-mouth breathing, sound or touch. Treat it as information about safety, not as resistance to be overcome. Offer graded choices: nose breathing until the client is ready, silent breathing, a touch-free session. Every element is optional (GPBA 2.5).
Tetany or tingling causing alarm. Prepare the client in advance (4.3). In the session, coach a relaxed rather than forced exhale [source: Kripalu information] and slow towards normal breathing. Reassure and stay close. If symptoms do not settle with relaxed breathing, or come with chest pain or fainting, stop and get medical help.
Panic or overwhelm during the active phase. Stop the connected breath and return to slow, natural breathing. Open the eyes, sit up if helpful, and orient to the room. Do not encourage the client to "breathe through it" if they are losing contact with the present. With clients who have panic disorder, discuss with their therapist beforehand whether intense breathwork fits the treatment plan, since over-breathing can mimic or bring on panic [uncertain: not verified].
Dissociation or trauma re-experiencing. Signs include a fixed stare, no response, sudden stillness, or speaking as if the trauma is happening now. Stop the active breath. Use the client's name, invite them to open their eyes, describe the present setting, remove any touch, and ground (4.16). Afterwards, review with the psychotherapist before any further session (4.22).
Flooding after the session (days of distress, insomnia, nightmares). Use stabilisation in therapy (4.22), assess risk, pause breathwork, and inform the facilitator with consent.
Emerging psychotic or manic symptoms. Stop breathwork. Arrange urgent psychiatric assessment. Do not frame the symptoms as "spiritual awakening", even though the school speaks of possible "profound spiritual awakenings" [source: GPBA certified-school listing].
Spiritual or energy interpretations. Respect the client's meaning, and treat the school's concepts of energy, frequency and Higher Self as the school's framework rather than fact. Help the client use what is meaningful without adopting interpretations that frighten or bind them.
"Recovered" memories of birth, abuse or past lives. Hold them as experiences, not established facts (4.21). Avoid decisions such as confronting or cutting off family based only on material from a breath session. Explore it over time in therapy.
Non-adherence with self-practice. There is no target to adhere to. Explore whether the practice helps. Stopping is a valid choice. Never frame missed practice as failure.
Overuse, or dependency on sessions or the facilitator. Look for compulsive self-practice, frequent sessions to escape distress, or idealisation of the facilitator. Name the pattern, return the focus to everyday coping, and space sessions further apart if the client continues.
Rupture around touch (the client felt touched without real consent, or touched in a way that felt wrong). Believe and validate the client. Consent can be withdrawn at any moment and the client had the right to stop (GPBA 2.5; USABP VIII.5). Explore what happened without minimising it. Support complaint routes (4.23). Sexual touch is always misconduct, whatever the rationale given.
Facilitator advises stopping medication or therapy. This conflicts with the GPBA standard that breathworkers should not advise changes to prescribed medication (4.1.9). Tell the client to keep taking medication unless their prescriber advises otherwise, and discuss whether to raise the issue with the facilitator or the GPBA.
Claims of safety or cure ("no harm can come", "great for PTSD"). Correct these gently, using the attributed claims and limited evidence in section 1 and the GPBA's own risk disclosures. Keep the client's choice to continue intact.
Rupture with the psychotherapist (the client feels the therapist disapproves of breathwork). Ask about it directly. Separate curiosity and safety concerns from judgement. Agree a shared safety plan rather than a ban.
Group-specific difficulties (another participant's intense sounds triggering the client, pressure to share). Arrange in advance where the client will lie, ear protection if wanted, permission to step out, and consent to pass on sharing.
Health changes between sessions (new pregnancy, new medication, cardiac or seizure event, eye surgery). Pause, re-screen and get clearance (4.2).
Water and driving. If the client mentions practising in the bath or pool, or while driving, address it straight away: stop, and explain the risk of losing consciousness.

Sources

Web sources:

Books and other references:

Kravitz, J. Breathe Deep, Laugh Loudly. Year given as 2007 in a secondary source; publisher and edition [uncertain]. Contents not drawn on in this guide.
The Transformational Breath Foundation's own website (transformationalbreathing.com, as linked from the Omega teacher page); not used as a source in this guide.
Cross-references: Domain VII Holotropic Breathwork guide (intense breathwork); row 167 Wim Hof Method.

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