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For most, going to the eye doctor is an annual event. But having been diagnosed with glaucoma, I have to visit my ophthalmologist every few months, who puts me through a series of tests to ensure my eyes are healthy.

One of them is the “tonometry” test, where she uses a device to push on my cornea and measure the pressure in my eyeball. I’ve gotten better at sitting calmly for this test over the years, but my tendency is to hold my breath. Because, you know, having someone poke your eyeball isn’t exactly the sort of thing that induces calm.

However, holding your breath apparently leads to a higher pressure reading (high pressure = bad), so she often reminds me to breathe while she administers this test.

Nowadays, the reminder to “just breathe” seems to be everywhere. When my wife and I went to childbirth classes, breathing was one of the skills we were taught. The guy in my online yoga app is often reminding me to breathe while yoga-ing. And heck, even my kids’ schools are teaching them to manage stress and strong emotions with breathing techniques.

Yet, “just breathe” seems so inadequate when you’re on stage, the lights are in your face, your heart is pounding, and your hands are shaky.

So is “just breathe” really valid advice? Or is it just one of those things that everyone says because it sounds like a good idea?

The fear-tension-pain cycle

Studies suggest that childbirth is a stressful, painful, and anxiety-inducing experience (though my wife asks “do we really need research to tell us this?”). And while easier said than done, one of the keys to a more positive labor and delivery experience is interrupting the “fear-tension-pain” cycle.

This is where anxiety creates tension, which increases pain, which causes more fear/anxiety, further increasing tension, heightening pain, etc. All of which can lead to the release of stress hormones, which can cause contractions to slow, lengthening the duration of labor, and increasing the risk of complications.

Breathing training

A pair of Turkish researchers randomly selected 70 pregnant women from a group who applied for admission to a university hospital for delivery of their baby.

Half of these women (the breathing group) received training and practice in several breathing techniques while in the early latent stage of labor. The other half (control group) received no special training.

And then, when the women entered the active phase of labor, those in the breathing group were coached through the breathing technique appropriate for that stage. The control group just proceeded with labor without any breathing coaching.

And when the women entered into the transition stage of labor, those in the breathing group were once again guided through a breathing technique specific to that stage. While those in the control group again proceeded with no coaching.


The researchers managed to get anxiety ratings at various points during labor (I know, right? That must have been great fun for everyone in the room…), which enabled them to measure the impact of the breathing exercises.

Everyone started off with about the same level of anxiety, and there wasn’t much of a change through the latent phase of labor.

But by the time they reached the late active phase, there was a significant difference in the participants’ anxiety. The breathing group scored a 38.88, compared with 43.20 for the control group (where 20-39 is slight anxiety and 40-59 is moderate anxiety).

Duration of labor?

The researchers also timed the length of each phase of labor, to see if breathing might help shorten their duration.

And indeed, there was a difference. The breathing group averaged 403.71 min in the latent phase, while the control group averaged 658.71 min. And in the active phase, it was 174 min for the breathing group, compared with 264.57 min for the control group. In the transition phase, the groups’ times were about the same (110.71 vs. 101.42).

The verdict?

The results of this study are intriguing and suggest that breathing can help with reducing anxiety during super stressful moments.

But it should be noted that since the women in the control group didn’t receive any special coaching or attention, the comparison may not be quite fair. Because it’s possible that the mere presence of the breathing coach during labor, and the extra attention these women received, could also have played a role in reducing their anxiety.

Then again, other studies – from test anxiety to vocal performance suggest that breathing can reduce anxiety related to performance.

But why is this? How does breathing affect our stress response?

The mouse that could not sigh

A team of researchers at Stanford ran some studies on mice, in which they aimed to isolate various types of nerve cells in an area of our brain1 thought to control breathing. Or our “breathing pacemaker,” as some have called it.

Essentially, the researchers bioengineered mice in such a way that they could “delete” specific subtypes of neurons. The idea being, if you wiped out one type of neuronal subtype, and the mice no longer sighed – but continued to yawn, gasp, etc., you probably found the subtype that controlled sighing.

After successfully identifying the subset of neurons that regulated sighing, they moved on to another subtype of neurons to find out what type of breathing that might control.

But after eliminating these neurons in a new set of mice, nothing happened. These mice continued to engage in their full repertoire of breathing skills.

Totally “meh”

But after a few days, the researchers noticed that this group of mice were strangely calm. While most mice get excited and sniff around when you put them in a new environment, these mice spent less time exploring their surroundings, and more time sitting around and grooming themselves.

Furthermore, while the mice continued to employ a full range of breathing types, the ratio of fast to slow breathing had shifted. Like in meditation or yoga practice, the more chilled-out mice were doing a lot more slow breathing, and less fast breathing.

The researchers puzzled over this for a while, did some more testing, and concluded that this set of neurons is not so much involved in regulating breathing, but in monitoring breathing and communicating with a structure in the brainstem2 that serves as the arousal center of the brain. Essentially, keeping tabs on our breathing patterns, and using that as a cue to let the rest of the brain know if it should be on high alert or not.

In other words, slow, easy, deep breathing isn’t just a sign that you’re calm, but something you can consciously do to actively promote a more relaxed state.

Take action

Umm…so what now? Do we just breathe, and that’s it?

Well, not exactly. Learning how to calm down via diaphragmatic or “belly” breathing is a skill that involves technique, and thus requires a bit of practice.

For instance, one tip I recently received from a former airline pilot (who in turn learned it from a Navy SEAL buddy of his) was that we sometimes focus too much on inhaling and taking in deep breaths. Instead, it can often be more helpful to focus on breathing out and getting rid of old air. As in, when you get to the end of a breath, gently push the rest of the air out, and let your lungs naturally fill themselves back up with fresh air. Like the “choo-choo-train” breathing technique described here at 1:03.

Fortunately, there are a ton of breathing videos on YouTube, that will walk you through the ins and outs of breathing. But for now, try this short TED talk with a guided breathing session beginning at 1:45 to get started:

Breath - five minutes can change your life @TED

Or if you just want to read about a few simple breathing exercises, there are three at the end of this short NY Times article:

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing @NY Times

After all, with exams/auditions/holiday travel right around the corner, there will be plenty of opportunities to practice these breathing techniques when you feel your stress level rising!


  1. The pre-Bötzinger complex, to be exact.
  2. (the locus coeruleus)

About Noa Kageyama, Ph.D.

Performance psychologist and Juilliard alumnus & faculty member Noa Kageyama teaches musicians how to beat performance anxiety and play their best under pressure through live classes, coachings, and an online home-study course. Based in NYC, he is married to a terrific pianist, has two hilarious kids, and is a wee bit obsessed with technology and all things Apple.

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