Conscious connected breathing

1. Introduction

Version followed: the generic technique as defined by the Global Professional Breathwork Alliance (GPBA) 2026 Ethical Standards and its Professional Training Standards (ratified 2003). Read this together with the school-specific guides for exact methods: 160 Rebirthing-breathwork (Orr), 161 Vivation (Leonard), 162 Transformational breath (Kravitz), 163 Clarity breathwork, 164 Shamanic breathwork (Star Wolf), 165 Biodynamic breathwork (Tonkov), 166 Integrative breathwork and 168 SOMA breath (Naik). 167 Wim Hof method is a separate method with its own guide. For Holotropic Breathwork, see the Domain VII guide 002 Holotropic breathwork.

What it is. Conscious connected breathing is not a single therapy or a school of its own. It is a breathing pattern that many schools share. The GPBA defines it as a pattern in which the breather "intentionally connects the inhale with the exhale without any pauses" (6.3). It defines Conscious Connected Breathwork (CCB) as a field of practice that combines this pattern with "body-mind techniques" (6.4). Schools differ in whether breathing goes through the nose or the mouth, how full or fast it is, whether it is done lying down or with movement, music, sound, affirmations or hands-on work, and in their theory of what happens. These differences are covered in guides 160 to 168 and are not proceduralised here. [source: GPBA 2026 Ethical Standards 6.1 to 6.4]

How change is thought to happen. In the GPBA's account, breathwork "can help participants to access expanded states of consciousness". Those states "can bring strong emotions, memories and unresolved traumas to awareness" so that they can be processed and integrated into daily life (Section 7). Individual schools add their own explanations, such as release of "birth trauma", energy, spiritual awakening or shamanic journeying. These belong to the school and are not established facts. [source: GPBA 2026 s.7] Connected breathing, especially when it is fuller or faster than needed, can also lead to over-breathing. Medical sources describe over-breathing as lowering carbon dioxide (hypocapnia) and producing respiratory alkalosis. Their effects include narrowing of brain blood vessels, light-headedness, tingling, and in some people carpopedal spasm (tetany) (see Section 3). Many of the bodily experiences participants report overlap with these physiological effects. [source: Krishnaprasadh & Sharma, StatPearls Hypocarbia 2026; Sur & Hashmi, StatPearls Alkalosis 2024] [synthesis: the link between reported experiences and hypocapnia is an inference]

Not to be confused with coercive "rebirthing". Rebirthing-Breathwork, developed by Leonard Orr in the 1970s, is mainly a breathing technique. It is distinct from the restraint-based "rebirthing" attachment-therapy variant in which a 10-year-old girl died in Colorado in 2000. In that case two social workers and two assistants restrained her while simulating a birth, and they were convicted of reckless child abuse resulting in death. Colorado then passed a 2001 law prohibiting the technique known as rebirthing, which the BMJ report describes as banning active restraint in all psychotherapies. Conscious connected breathing never involves restraint or wrapping a person. For the harm account, see Domain XVI. [source: Josefson, BMJ 2001; Colorado Session Laws 2001 ch. 129]

Evidence status. Fincham, Montero-Marin, Strauss and Cavanagh (2023) published a meta-analysis of randomised controlled trials of breathwork in general. For self-reported stress (12 RCTs, 785 adults) they found a small-to-medium effect favouring breathwork over controls (g = -0.35). They found similar small-to-medium effects for anxiety and depressive symptoms. They judged most trials at moderate risk of bias. Most trials studied slow or diaphragmatic techniques and Sudarshan Kriya Yoga rather than conscious connected breathing, and only six focused mainly on fast-paced breathing. Fincham commented that the safety of fast-paced breathing needs more study and that breathwork "may help some but not others". A review of high-ventilation breathwork by Fincham and colleagues (2023, Neuroscience and Biobehavioral Reviews) describes the benefits for trauma-related, affective and somatic disorders as putative and calls for rigorous clinical testing. An uncontrolled study of 20 healthy adults (Bahi et al., 2024, Current Psychology) reported reduced negative mood and altered-state scores after one connected-breathing session. Conscious connected breathing is not an established treatment for any mental or physical disease, and clients should never be told to change asthma or other medicines because of it (GPBA 4.1.9). [source: Fincham et al. 2023 Sci Rep; PsyPost 2023 report; Fincham et al. 2023 NBR abstract; Bahi et al. 2024; GPBA 2026]

2. Framework

Who may lead sessions. No government regulation of breathwork facilitators was found [uncertain: not verified]. The GPBA is a voluntary international professional association. It certifies four levels:

an "Ethically Compliant Breathworker": at least 50 hours over 9 months, including 8 hours of ethics;
an Ethically Compliant Breathwork Programme, to the same minimum;
a "Professional Breathwork Practitioner": 400 hours over at least 2 years, including 8 hours of ethics and supervised in-person client work;
a Professional Breathwork School, which provides that 400-hour training.

Its training standards require trainees to guide supervised sessions with peers and to take at least three clients through 10 sessions each. Trainers must have practised for at least 2.5 years. [source: GPBA Training Standards; GPBA 2026 s.6.5 to 6.8]

Leading conscious connected breathing sessions needs facilitator training from a school, on top of psychotherapy training. Healthcare professionals must also follow their own professional codes (GPBA 7.1.3). A psychotherapist without that training has a different role: screening, referral, preparation, integration and monitoring for adverse effects (see 4.13 to 4.15). [source: GPBA 2026; synthesis]

Curriculum a trained facilitator is expected to have covered. The GPBA's nine training units include:

client suitability and contraindications;
anatomy and physiology of breathing, and medical conditions and medication effects relevant to safety;
breathing analysis;
stages of a session, integration, touch, movement and verbal interventions;
the range of experiences, including tetany;
counselling and knowing when to refer;
presenting issues such as dissociation and spiritual crisis;
transference and boundaries.

[source: GPBA Training Standards, Section 11]

Phases of a course (generic; schools vary):

Screening and assessment. Goal: decide whether connected breathing is suitable, needs adjustment or needs referral. Move on only when screening is complete, any doubts have been discussed with the client's physician or therapist, and no contraindication stands. [source: GPBA 4.1.2 to 4.1.8; Omega Institute Holotropic Breathwork medical form]
Preparation and informed consent. Goal: the client understands possible effects, agrees in writing, and agrees any touch and the stop signals. Move on only with signed, dated consent and confirmed capacity (adult, competent, not under the influence of substances). [source: GPBA 4.3, 7.1.2]
Breathing sessions. Individual or group, in person or online (online work must comply with the law in both locations, GPBA 5.3). A session usually has the following arc, which is described here without timings: arrival and intention; settling and starting the connected pattern; a phase in which sensations, emotions or memories may build and release; completion, with a return to natural breathing and rest; and verbal integration before leaving. Session length and frequency follow the school's training and are not given here. [source: GPBA Training Standards Unit 5, "stages of a session"; synthesis for the arc wording]
Integration. Goal: make sense of material that emerged and link it to the client's life and therapy goals, without treating altered-state content as literal history. This happens after each session and between sessions, often in psychotherapy. [source: GPBA s.7]
Review and ending. Goal: decide whether to continue, pause or stop, judged against agreed goals and any adverse effects. A 10-session series appears in the GPBA's trainee practicum requirements. It is a training standard, not a prescribed treatment course. [source: GPBA Training Standards s.6; synthesis]

Criteria for pausing or stopping [synthesis drawn from GPBA 4.1 and 4.2 and the medical sources]:

a new or worsening medical condition, or a pregnancy;
a seizure, fainting, or chest pain during a session;
re-experiencing or dissociation that does not settle with grounding;
emerging psychosis, mania or suicidality;
the client becoming dependent on sessions or on the facilitator;
the client withdrawing consent, at any time and without needing to explain.

3. Guiding principles

Screen every time. Ask about health at registration and before each session, because conditions change. [GPBA 4.1.2, 4.1.6, 8.1.13]
Contraindications are taken seriously. Medical and professional sources name the following, for which the practice is ruled out, adapted, or done only after medical clearance:
- cardiovascular disease, past heart attack, and severe or uncontrolled high blood pressure;
- epilepsy (the GPBA notes breathwork can lower the seizure threshold, and that a seizure may affect a person's legal eligibility to drive);
- pregnancy or trying to conceive;
- recent surgery, fractures or injuries;
- glaucoma and retinal detachment;
- osteoporosis (where there is vigorous movement);
- acute infectious illness;
- asthma (participants bring their inhaler) and other respiratory conditions;
- neurological conditions;
- severe mental illness, psychosis, schizophrenia, bipolar disorder, complex trauma, and psychiatric hospitalisation;
- self-harm or suicidal thoughts;
- medications, especially those affecting bleeding or the central nervous system;
- substance use.
Practical meaning: a "yes" on screening means a conversation and, where relevant, a referral or clearance, not an automatic go-ahead. [GPBA 4.1.2 to 4.1.8, 4.3.2, 7.1; Omega Institute form]
Know the physiology. Over-breathing lowers PaCO2 (hypocapnia), which causes respiratory alkalosis and narrows brain blood vessels. Medical sources list these effects:
- light-headedness, dizziness and confusion;
- tingling and numbness;
- carpopedal spasm (positive Trousseau and Chvostek signs);
- chest tightness or pain, nausea and fatigue;
- syncope;
- in severe cases, seizures, arrhythmias and reduced coronary perfusion.
Hyperventilation from anxiety or pain can mimic serious illness, and pulmonary embolism should be ruled out before hyperventilation is put down to anxiety. Seek emergency care for a seizure, altered mental state, blue lips, severe weakness or loss of consciousness. Practical meaning: the facilitator must recognise these signs, know when they are expected and when they are an emergency, and be trained in CPR. [StatPearls Hypocarbia; StatPearls Alkalosis; Cleveland Clinic; GPBA 4.1.5]
Do not use paper-bag rebreathing. StatPearls says it is no longer recommended because it has been associated with adverse outcomes, including increased mortality. A Cleveland Clinic patient page still mentions trying it, so the sources conflict [uncertain]. Practical meaning: slow, natural breathing and reassurance, never a bag. [StatPearls Hypocarbia; Cleveland Clinic]
Never in or near water, never while driving or operating machinery. Practical meaning: light-headedness, fainting or a seizure can be fatal in water or at the wheel. Client home practice must not include these settings, and clients should not drive until fully clear after a session. [synthesis from the medical sources and GPBA 4.3.2]
No rates, rounds or durations from this guide. Practical meaning: pace, depth and length follow the facilitator's school training, adjusted down for each client. A psychotherapist does not improvise intensity.
Consent is ongoing and revocable. Practical meaning: explain every added element (touch, movement, sound, affirmations, coaching) before using it. Get consent before each session, and make sure the client knows they can stop at any moment without judgement. [GPBA 2.5, 4.3.3]
Touch only by agreement, and never sexual. Practical meaning: agree before the session where and how the client may be touched, and check during it. Sexual conduct is prohibited even if a participant invites it. [GPBA 2.5, 4.4.1.2; USABP VIII; EABP Principle 7]
Stay within competence. Teach and facilitate only at the level of your training, and train before taking on new populations or techniques. Work with serious mental health problems or with children only with the specific training. [GPBA 1.1 to 1.3, 4.2.8, 4.2.9]
Anchor the client in their own experience. Keep participants anchored in their own breathing and inner experience, not in their relationship with the facilitator, because transference and countertransference are amplified. [GPBA s.7]
Integration is part of the method, not an extra. Practical meaning: build in time and support to process intense emotional release. [GPBA 4.2.3, s.7]
Attribute beliefs; do not impose them. Practical meaning: present a school's ideas about birth trauma, past lives, energy or spirit as that school's view. Respect the client's own beliefs and their other medical, psychotherapeutic or Indigenous care. [GPBA 4.1.4, 4.2.4, 8.1.2]
Respect lineage and culture. Credit where a practice comes from. Do not trademark or claim Indigenous or traditional practices, and describe borrowed ceremonial elements only as their communities describe them. [GPBA 2.8, 3.7, 5.4]
Make honest claims. Give realistic information about benefits, with no exaggerated outcomes and no medical advice from unqualified people. [GPBA 2.8, 8.1.5]

[source for section: GPBA 2026 Ethical Standards; GPBA Training Standards; StatPearls; Cleveland Clinic; Omega Institute form; touch codes as cited]

4. Intervention inventory

This is a generic inventory. Interventions 4.4 to 4.12 are carried out only by someone trained as a facilitator in a school (see Section 2). Interventions 4.1 to 4.3 and 4.13 to 4.16 are within a psychotherapist's role whether or not they facilitate. The techniques specific to each school are in guides 160 to 168, and Holotropic Breathwork is in Domain VII guide 002.

4.1 Intake screening (medical and psychological)

Purpose: to find contraindications and conditions that need adjustment, referral or medical clearance before any connected breathing. Use it at registration, and update it before every session. [source: GPBA 4.1.2 to 4.1.8, 4.1.6; Omega Institute form]
Steps:
1. Use a written health questionnaire. Then go over it in person, asking open questions about each "yes".
2. Ask about each area the sources name:
  - heart disease and past heart attack, and blood pressure;
  - epilepsy and seizures;
  - pregnancy or trying to conceive;
  - recent surgery, fractures or injuries;
  - glaucoma and retinal detachment;
  - osteoporosis;
  - acute or infectious illness;
  - asthma and other respiratory or neurological conditions;
  - medical and psychiatric hospitalisation;
  - psychosis, schizophrenia and bipolar disorder;
  - complex trauma and dissociation;
  - self-harm and suicidal thoughts;
  - current therapy;
  - current medications (especially anticoagulants and drugs acting on the central nervous system);
  - substance use.
3. Ask clients with asthma to bring their inhaler, and anyone with a prescribed EpiPen to bring it.
4. Where there is any doubt, ask the client to consult their physician or therapist and to share the answer before booking.
5. Decide whether to proceed, adapt (for example a gentler, non-connected breathing practice), refer to a more experienced breathworker, or decline. Record the decision and the reasons.
6. Do not advise changing, stopping or tapering any prescribed medicine.
7. Where available, use a validated breathing-pattern screening measure as published by its authors, such as the Nijmegen Questionnaire, to identify a pre-existing tendency to over-breathe [uncertain: not verified].
Example language (illustrative): "Before we decide whether this kind of breathing is right for you, I need to go through some health questions. Some are about your heart, eyes, pregnancy and seizures, because the breathing changes your blood chemistry and blood flow. A 'yes' doesn't automatically rule you out. It means we talk it through, and sometimes check with your doctor."
Watch for:
- minimising ("it's only mild");
- a recent change in medication;
- history of panic disorder, which can be triggered by the sensations of over-breathing;
- pressure to skip screening because of a booked retreat or group.
It is working when the client discloses openly and accepts adjustments or referral without feeling judged.

4.2 Informed consent conversation and written consent

Purpose: to make sure the client knows the benefits, risks, contraindications and possible effects, and can say no or stop at any time. Do this before the first session, and reconfirm before each session. [source: GPBA 4.3.1 to 4.3.5, 7.1.2]
Steps:
1. In plain language, explain what the client may feel during or after a session: light-headedness, tingling, emotional release, tetany (cramping, often of the hands), and memories resurfacing.
2. For anyone with a seizure history, explain that breathwork can lower the seizure threshold, and that a seizure may affect legal eligibility to drive.
3. Explain that the client can withdraw consent at any moment without judgement.
4. Confirm capacity: legal age, mental competence, and not under the influence of substances. If capacity is in doubt, do not proceed.
5. Get signed, dated written consent and store it under data-protection law. Get separate written consent for any filming.
6. Say plainly that this is not a treatment for any physical disease and that outcomes vary.
Example language (illustrative): "Most people feel some tingling or light-headedness, and some get tight, cramping hands. Strong feelings or memories can come up. None of that means you have to keep going. You can open your eyes, breathe normally and stop at any point, and I won't ask you to justify it."
Watch for:
- consent given to please the facilitator or the group;
- the client not taking in the information (check by asking them to say it back);
- intoxication or recent psychedelic use.
It is working when the client can describe the risks and the stop signal in their own words.

4.3 Agreeing touch and other added elements

Purpose: many schools add hands-on pressure, "bodywork", movement, sound, affirmations or coaching. Each needs explicit, specific prior agreement. [source: GPBA 2.5; USABP Code VIII; EABP Principle 7]
Steps:
1. List the elements you might use and explain the purpose of each.
2. For touch, agree which body areas are acceptable (never genital or breast areas, and never sexual), the type of contact, and a clear stop word or gesture.
3. Record what was agreed. The USABP recommends written consent for touch and periodic re-checking, because early consent may not reveal problems the client is not yet aware of.
4. Re-check verbally just before any touch during a session, using a short, yes-or-no question.
5. Psychotherapists: combine psychotherapy and hands-on work only if your own profession's code permits it and you hold the training. Mainstream codes (for example BACP, UKCP and APA) contain no explicit touch provision, but they prohibit sexual contact and require you to stay within your competence. Body-psychotherapy codes (USABP, EABP) regulate touch directly.
Example language (illustrative): "Sometimes I might place a hand on your shoulder or the top of your chest to help you notice where you're holding. That's only if you're comfortable. Where would be okay, and where is off limits? If you raise your hand or say 'stop', I'll take my hand away at once."
Watch for:
- freezing or a too-quick yes, especially in clients with a history of abuse;
- changes in the breath or body at the moment of contact.
It is working when the client uses the stop signal freely and reports feeling in control.

4.4 Preparing the setting and emergency readiness (facilitator)

Purpose: to provide physical safety and readiness for seizures, fainting or panic. [source: GPBA 4.1.1, 4.1.5]
Steps:
1. Choose a private, ventilated, accessible and clean space, with a mat or bed, cushions, blankets, water and tissues.
2. Keep emergency contacts and know local emergency procedures. The facilitator holds current CPR training.
3. Never run sessions in or near water (baths, pools, hot tubs) or in a vehicle.
4. In groups, follow your school's standard for the number of trained assistants [uncertain: not verified].
5. Never facilitate while under the influence of any substance (GPBA 7.1.1).
Example language (illustrative): "Your inhaler is by your mat. If you feel faint or unwell, raise a hand and someone will come to you."
Watch for: hazards around the floor space; clients arriving unwell; the facilitator's own fatigue. It is working when there are no avoidable hazards and the client knows how to call for help.

4.5 Briefing and setting an intention

Purpose: to give clear instructions and discuss possible experiences in advance, and to orient the session toward the client's goals. [source: GPBA 4.2.2]
Steps:
1. Recap the stop signal and the touch agreement.
2. Invite the client to set an intention in their own words. Accept "no particular intention" as well.
3. Explain the pattern in descriptive terms: breathing in and out joined in a continuous circle, without pausing between breaths, as the school teaches it (GPBA 6.3).
4. Explain that the client can make the breath gentler, or return to natural breathing, whenever they choose.
Example language (illustrative): "Is there anything you'd like to bring to today's session, or anything you'd like to be more aware of? It's fine just to see what comes."
Watch for: intentions framed as dramatic breakthroughs, or expectations of recovering a specific memory (address these gently; see 4.13). It is working when the intention is realistic and the client has no outstanding questions.

4.6 Guiding the connected breathing pattern (facilitator)

Purpose: to help the client establish the circular, unbroken pattern their school uses. [source: GPBA 6.3; GPBA Training Standards Unit 5 "breathing cycles"]
Steps (descriptive only; no rate, depth, round count or duration is given here):
1. Help the client settle into a comfortable position.
2. Invite awareness of the natural breath first.
3. Guide the joining of inhale and exhale so that there is no pause between them, following the school's method for nose or mouth breathing and for how full the breath is.
4. Cue relaxation of the exhale rather than forcing it, where the school teaches this [uncertain: not verified].
5. Calibrate to each client, and err toward less intensity in people with any screening concern.
6. Do not add breath-holds unless the school's method includes them. If it does, they are taught only by that school's trained facilitators, and this guide gives no timings.
Example language (illustrative): "Let the in-breath flow straight into the out-breath, like a circle, with no gap. You don't need to push. If it starts to feel like too much, make it softer, or just breathe normally for a while."
Watch for:
- strained or forced breathing;
- escalating speed;
- breath-holding;
- early signs of over-breathing: light-headedness, tingling around the mouth or in the hands.
It is working when the breath is continuous, the client feels in charge of the intensity, and sensations stay tolerable.

4.7 Presence, tracking and verbal support during the breathing phase (facilitator)

Purpose: to stay present, monitor the client's physical reactions, and support the client without directing their experience. [source: GPBA 4.1.10; Training Standards Unit 5 "verbal interventions", "staying present"; GPBA s.7]
Steps:
1. Sit nearby, attentive but not intrusive.
2. Track breathing, colour, facial expression, hands, movement and signs of dissociation.
3. Use brief, non-leading prompts that bring the client back to their own breathing and inner experience.
4. Do not interpret, suggest content or bring in your own beliefs during the session.
5. Note what happens so it can be integrated afterwards.
Example language (illustrative): "Stay with your breath." "You're safe here; let it move through." "What are you noticing right now?" (asked only if the client is speaking)
Watch for:
- leading suggestions ("Is that your birth?");
- your own emotional reactions (countertransference);
- the client becoming focused on you rather than on their own experience.
It is working when the client stays oriented and can report later what they experienced.

4.8 Responding to light-headedness, tingling and tetany (facilitator)

Purpose: to recognise and manage the expected effects of over-breathing, and to tell them apart from medical emergencies. [source: StatPearls Hypocarbia; StatPearls Alkalosis; Cleveland Clinic; GPBA 4.3.2, 4.1.5]
Steps:
1. When tingling, light-headedness or cramping of the hands or mouth appears, reassure the client that these are known effects of breathing changes.
2. Invite them to soften the breath, relax the exhale, or return to natural, unforced breathing until the sensations settle.
3. Do not use paper-bag rebreathing.
4. Stop the session if any of these occur: fainting; a seizure; chest pain; an irregular or racing heartbeat the client is worried about; confusion that does not clear; blue lips; severe weakness.
5. In those cases follow emergency procedures. Call emergency services for a seizure, loss of consciousness, altered mental state or blue colour.
6. Afterwards, make sure the client does not drive until fully clear, and record the event.
Example language (illustrative): "That tightness in your hands is a common reaction to the breathing. Let the breath slow down and go back to normal. Good. Just let your hands rest; it will ease."
Watch for:
- panic escalating because of the sensations (see 4.9 and Section 5);
- symptoms that do not ease once ordinary breathing returns;
- symptoms out of proportion to the breathing, which can point to another medical cause.
It is working when sensations ease with softer breathing and the client stays calm and oriented.

4.9 Supporting emotional release and re-experiencing (facilitator)

Purpose: to hold intense emotion, sound, movement or memory when it arises, and to keep it tolerable and later workable. [source: GPBA 4.2.3, s.7; Training Standards Unit 5 "recognizing emotions in the breath", "range of experiences"]
Steps:
1. Allow crying, sound or movement within safe limits. Protect the client's head and body from hard surfaces.
2. Offer brief reassurance and reminders of where they are.
3. If distress escalates beyond the client's window of tolerance, invite them to open their eyes, return to natural breathing, feel the floor, and name things in the room. Then pause the connected pattern.
4. Do not push the client to "go deeper" against their wishes.
5. Note the content for integration, and do not interpret it during the session.
Example language (illustrative): "Let it come. You're here in this room with me, and you're safe. If you'd like to step back from it, open your eyes and let your breathing go back to normal. You decide."
Watch for:
- flashbacks with loss of orientation;
- dissociation (glazed eyes, no response, numbness);
- self-injurious movement;
- a client who stops responding to their name.
It is working when release is followed by settling and the client stays reachable. If grounding does not restore orientation, stop the session and treat it as an adverse reaction (4.15). [synthesis for grounding steps]

4.10 Optional hands-on support (facilitator with school training only)

Purpose: some schools use pressure points, light holding or bodywork to support release or awareness. These are used only where the school trains them, and only within the agreement made in 4.3. [source: GPBA 2.5, Training Standards Unit 5 "touch"; school detail in guides 160 to 168]
Steps:
1. Confirm consent just before touching.
2. Use only the agreed areas and types of contact.
3. Remove your hand at once if the client says stop or signals stop, or if their breath or body suggests distress.
4. Never touch genital or breast areas, and never touch in a sexual way, even if invited. GPBA 4.4.1.2 prohibits sexual conduct of any kind, including inappropriate touch.
5. Use a chaperone or a second facilitator where appropriate.
6. Document what touch was used.
Example language (illustrative): "I'm going to put my hand on your shoulder now, as we agreed. Is that still okay?"
Watch for:
- a startle or freeze response;
- erotic feelings in either person (GPBA 4.4.1.1 warns that heightened "life-force energy" can amplify sexual energy; this is the GPBA's framing);
- dependency on being touched.
It is working when touch helps the client feel supported, and is reported afterwards as wanted and respectful.

4.11 Completion, rest and grounding

Purpose: to bring the client back from the active breathing into ordinary breathing and rest, and to make sure they are oriented before talking or leaving. [source: GPBA Training Standards Unit 5 "stages of a session"; synthesis for steps]
Steps:
1. Signal the end of the active phase and invite natural, unforced breathing.
2. Allow a period of rest lying down, covered if the client is cold.
3. Invite slow sitting up, feeling the feet on the floor, sipping water, and looking around the room.
4. Check orientation (name, place, how they feel).
5. Check for lingering dizziness, tingling or emotional flooding.
Example language (illustrative): "Let your breathing find its own rhythm now. There's nothing to do. When you're ready, roll onto your side and come up slowly. Notice your feet on the floor and look around the room."
Watch for: standing up too fast (light-headedness or fainting); persistent spaciness; the client wanting to leave abruptly. It is working when the client is oriented and steady and their breathing is ordinary.

4.12 Post-session safety check before leaving

Purpose: to make sure the client leaves safely. [source: GPBA 4.3.2, 4.1.6; synthesis]
Steps:
1. Ask about physical state, mood and any thoughts of self-harm.
2. Advise against driving, swimming, bathing in deep water, or operating machinery until fully clear. After any seizure, follow medical advice and local law on driving.
3. Give the client contacts for between-session support.
4. Suggest gentle self-care: rest, food and water.
5. Agree when integration will happen.
Example language (illustrative): "How are you feeling in your body and in yourself? Please don't drive until you feel completely clear. Some people feel tender or tired later today or tomorrow. Here's how to reach me."
Watch for: new suicidal thoughts; confusion; the client being alone after a very intense session. It is working when the client has a clear and safe plan for the rest of the day.

4.13 Integration in psychotherapy (psychotherapist's core role)

Purpose: to help the client process and make sense of what emerged and link it to daily life and therapy goals, as the GPBA's call for "nuanced and skilful integration" describes. This is the main contribution of a psychotherapist, whether or not they also facilitate. [source: GPBA s.7, 4.2.3]
Steps:
1. Invite a free description of the session: sensations, images, emotions and memories.
2. Explore meaning collaboratively, and link it to current relationships, patterns and goals.
3. Treat images of birth, past lives, spirits or ancestral scenes as meaningful experiences, not as verified events. The idea of reliving birth trauma or past lives belongs to particular schools (see 160 to 166).
4. Do not use breathwork content as evidence about historical abuse or other events. Vivid, emotional altered-state material can feel certain without being accurate, and suggestion can shape it [synthesis; uncertain: not verified against specific memory research].
5. Pace trauma-related material using your usual trauma-informed methods.
6. Encourage writing, drawing or quiet reflection between sessions where the client finds it helpful.
Example language (illustrative): "You saw yourself as a very small baby, frightened and alone. What does that image say about how you feel in your life now? We don't need to decide whether it actually happened. Let's look at what it means to you."
Watch for:
- the client building a fixed new story of their past from a session;
- the client confronting family on the basis of breathwork imagery;
- spiritual inflation or grandiosity;
- prolonged destabilisation.
It is working when the client has more understanding, choice and steadiness in daily life.

4.14 Referral, preparation and collaboration (psychotherapist not facilitating)

Purpose: to decide whether a client should try conscious connected breathing, find a suitably trained facilitator, prepare the client, and coordinate care. [source: GPBA 1.4, 4.1.4, 4.4.4; GPBA certification levels 6.5 to 6.8; EABP 6.b]
Steps:
1. Screen first (4.1). Discourage it if contraindications exist or the client is currently unstable.
2. Help the client check a facilitator's training: the school, the hours, and whether it meets GPBA certification or an equivalent. Check their code of ethics, insurance, complaints route and screening practice.
3. Prepare the client: what to expect (4.2), their right to stop, touch boundaries (4.3), and that they need not disclose therapy material to the facilitator.
4. With the client's written consent, share relevant safety information with the facilitator.
5. Discuss with the client the implications of receiving similar services in parallel, to avoid confusion (EABP 6.b).
6. Schedule an integration session soon after the breathing session.
Example language (illustrative): "If you'd like to try this, let's find someone properly trained, ask what training they have and how they screen people, and plan time here afterwards to make sense of what comes up."
Watch for: facilitators who skip screening, promise cures or recovered memories, discourage medical care, or are vague about touch. It is working when the client goes in informed and comes back able to talk about it.

4.15 Recognising adverse effects and passing them on

Purpose: to identify physical or psychological harm after sessions and act on it. [source: GPBA 2.12, 4.1.5, 4.2.1; GPBA Process for Addressing Ethical Concerns (listed on the GPBA ethics page); StatPearls]
Steps:
1. After any session, ask about the following:
  - fainting, seizures, chest pain or injuries;
  - lasting anxiety or panic;
  - new panic attacks outside sessions;
  - insomnia;
  - depersonalisation;
  - intrusive memories;
  - manic or psychotic symptoms;
  - suicidal thoughts.
2. Refer to medical care for physical symptoms, and urgently for any emergency signs.
3. Use standard risk assessment for suicidality.
4. Refer for psychiatric assessment if there are signs of psychosis or mania.
5. With the client's consent, inform the facilitator. Support the client to raise ethical concerns through the facilitator's school or the GPBA complaints process.
6. Report criminal conduct or safeguarding issues as the law requires.
Example language (illustrative): "Since the session, have you noticed anything that worries you, such as panic, trouble sleeping, feeling unreal, or memories that keep intruding? I'd rather hear about it early."
Watch for: clients minimising harm out of loyalty to a group or facilitator. It is working when adverse effects are named early and the client gets appropriate care.

4.16 Substances and psychedelic integration

Purpose: to address substance use alongside breathwork. [source: GPBA 7.1.1 to 7.1.6]
Steps:
1. Assess capacity to consent before every session, because substances can impair it.
2. Do not run sessions with an intoxicated client.
3. For people who use substances regularly, seek supervision and record the client's acknowledgement of the possible effects.
4. If breathwork is used in psychedelic integration, ideally collaborate with a trained practitioner.
5. Psychotherapists also follow their own professional code and the law.
Example language (illustrative): "Have you taken anything today, including alcohol, cannabis or anything else? It affects how the breathing works for you and whether we can safely go ahead."
Watch for: combining breathwork with psychedelics outside a legal, supervised setting. It is working when sessions happen only with clear capacity.

5. Handling problems

Where a source is named, the guidance follows it. Everything else is marked [synthesis].

"Nothing happens" or the client feels stuck. Normalise the experience. Do not raise the intensity to force an effect. Explore expectations in integration: a quiet session is still a session. [synthesis] Do not encourage pushing past the facilitator's school-calibrated limits. [synthesis] Example (illustrative): "Some sessions are quiet. What did you notice, even if it was small?" Watch for the client blaming themselves or seeking ever stronger methods.
Panic triggered by the sensations. People with panic or anxiety disorders are at particular risk, because the sensations of over-breathing can mimic or trigger panic [source: StatPearls Hypocarbia]. Respond as follows:
- name the sensations as expected effects of the breathing;
- guide the client back to natural breathing and orient them to the room;
- stop the active phase.
In therapy, consider whether connected breathing suits this client at all, or whether gentler paced methods fit better. [synthesis] Example (illustrative): "This is your body reacting to the breathing, not danger. Breathe normally with me and look around the room." Watch for panic attacks recurring outside sessions; if so, pause and refer for assessment.
Overwhelm, flashback or dissociation. Stop the active pattern. Ground the client (eyes open, feet down, naming objects, their name, the date) and stay with them until they are oriented [synthesis]. Review suitability: clients with severe PTSD, dissociative disorders or complex trauma need adjustment or referral (GPBA 4.1.2). In psychotherapy, return to stabilisation work before considering further sessions. [synthesis]
Severe or persistent tetany, fainting or seizure. Stop the session. For cramping that eases with ordinary breathing, reassure and rest. For a seizure, loss of consciousness, altered mental state or blue lips, call emergency services. Never use a paper bag. Record the event, review screening, and get medical advice before any further session. [source: StatPearls; Cleveland Clinic; GPBA 4.1.5, 4.3.2]
Resistance or wish to stop. Respect it at once: withdrawing consent needs no explanation (GPBA 4.3.3). Explore the reason in therapy without pressure. Treat a client's "no" as information, not as resistance to be overcome. [synthesis]
Intensity-seeking or over-use. Some clients chase dramatic states or practise at home without support. Discuss the risks: unsupervised practice, water, driving, being alone with very intense material. Say that home practice of connected breathing should follow the facilitator's school guidance and screening, and should never take place in or near water or while driving. Steer daily self-regulation toward gentle methods. [synthesis] Watch for breathwork used to avoid feelings or relationships.
Non-adherence with integration. Clients who book sessions with an outside facilitator but skip integration sessions miss the part the GPBA calls essential (s.7). Agree a plan that ties breathing sessions to integration time. [synthesis]
Ruptures over touch. If a client felt touched without consent, or touched in a way they did not want, acknowledge it, apologise without defensiveness, revise or withdraw touch from the agreement, and offer the complaints route (GPBA 2.12). Sexual contact is never acceptable and is a reportable ethical breach (GPBA 4.4.1.2; USABP Code; APA Code 10.05). [source as cited; synthesis for repair steps]
Erotic transference or romantic feelings. The GPBA says romantic or sexual feelings must not be acted on in session. If a relationship is ever considered later, the participant must first be referred to an independent breathworker, and a period of reflection and independent supervision is recommended (4.4.1.3). Psychotherapists follow their own stricter codes on former clients (for example APA 10.08). Take it to supervision. [source: GPBA 4.4.1.3; APA Code]
Dependency on the facilitator or group. Transference is amplified in expanded states (GPBA s.7). Keep the client anchored in their own experience and space sessions out. Watch for group dynamics that discourage outside help. [source: GPBA s.7; synthesis]
"Recovered" birth, past-life or abuse memories. Do not confirm or deny them as history. Explore their meaning, and caution against acting on them, such as confronting family or making legal claims, on the basis of session imagery alone. Consult a memory-informed colleague if the client is distressed. [synthesis; uncertain: not verified against specific memory research]
Spiritual crisis or spiritual interpretations. Present spiritual frameworks as the client's or the school's views. Assess for psychosis or mania if there are grandiosity, sleeplessness or disorganisation, and refer urgently if present. The GPBA training curriculum names spiritual crisis as a presenting issue. [source: GPBA Training Standards Unit 8; synthesis]
Emerging suicidality. The GPBA requires opportunities to disclose self-harm or suicidal thoughts at registration and throughout (4.1.6). Use standard risk assessment and safety planning, and pause breathwork. [source: GPBA 4.1.6; synthesis]
Medication questions. Never advise changing, stopping or tapering medication (GPBA 4.1.9). Refer the client to their prescriber. Asthma inhalers stay available during sessions. [source: GPBA 4.1.8, 4.1.9]
A client wants a coercive or restraint-based "rebirthing". Decline, explain the difference from breath-based schools, and point to the Colorado case and law (Section 1; Domain XVI). [source: Josefson, BMJ 2001]
Misconduct by a facilitator. Support the client to report through the school's process or the GPBA's process for ethical concerns, and to the police where conduct is criminal. Keep careful notes. [source: GPBA 2.12, 5.1, 5.2]

Sources

Related guides: 160 to 168 (breathwork schools) in this family; 002 Holotropic breathwork (Domain VII); Domain XVI for the coercive restraint "rebirthing" harm account.

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