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Breathwork: the main types and how to do it safely

BySafe Ceremonies

“Breathwork” covers almost any practice where you breathe on purpose in a particular way. At one end is a few minutes of slow breathing to calm down before a meeting. At the other is an hour or more of deep, fast breathing to loud music that can bring on strong emotions, tingling, cramping and experiences people compare to a psychedelic trip. Both get sold under the same word, so the first thing to find out about any session is which kind it is.

This guide sorts the main types into two families, explains what fast breathing does to your body, and covers who should be careful and what a safe session looks like.

The two families

Slow and paced breathing

These practices slow your breathing down, often to around five or six breaths a minute, or use a set rhythm. Examples include resonance or coherent breathing, box breathing (in, hold, out, hold, for equal counts), extended exhales, and many of the gentler pranayama practices from yoga. You stay fully alert and in control, and sessions are usually short.

This is the type with the most research behind it. A 2023 meta-analysis of randomised controlled trials found that breathwork lowered self-reported stress, anxiety and depression by a small to medium amount compared with control groups, and most of the studies it could use were of slow-paced breathing. The authors found few reported adverse events. The effects are modest, in the same range as many other relaxation practices.

Fast or high-ventilation breathing

These practices ask you to breathe more deeply and quickly than your body needs, for anywhere from a few minutes to a couple of hours. You’ll see them called conscious connected breathing, breathwork journeys, rebirthing, Holotropic Breathwork, transformational breath, or rounds of fast breathing followed by long breath holds, sometimes paired with cold plunges.

Researchers group these under the name high ventilation breathwork. A 2023 review describes them as producing “extraordinary changes in subjective experience” along with strong effects on the nervous system, and says the evidence for therapeutic use is still at the stage of needing rigorous testing. In the 2023 meta-analysis above, only two trials used fast breathing, and one reported side effects such as hot flushes, shortness of breath and sweating.

Fast breathwork is often what’s on offer at retreats and ceremony centers, sometimes as a “drug-free journey” before or between plant medicine ceremonies. It isn’t dangerous for most healthy adults in a well-run session, but it does need more care than slow breathing.

What fast breathing does to your body

When you breathe faster and deeper than you need to, you blow off carbon dioxide faster than your body makes it. That drop in carbon dioxide changes your blood chemistry, and it’s behind most of the physical effects people feel in a session.

MedlinePlus, the US National Library of Medicine’s health site, lists the symptoms of hyperventilation as feeling lightheaded, dizzy, weak or unable to think straight; numbness and tingling in the arms or around the mouth; muscle spasms in the hands and feet; and chest pain or a fast, pounding heartbeat. If you’ve heard people at a breathwork session describe their hands curling into “claws,” that’s what it is.

Some facilitators describe tingling and cramping as “energy moving” or “stuck emotions releasing.” You can hold whatever belief about it you like. What you should know is the physical cause, because it tells you what to try first: slow your breathing down. A facilitator who tells you to push through chest pain, or treats fainting as part of the process, is reading a medical warning sign as a spiritual one. Our guide on grounded or “woo woo” groups goes into why that matters.

Never near water, never at the wheel

This is the one rule with no exceptions. Hyperventilating or holding your breath before going underwater lowers your carbon dioxide, which delays the urge to come up for air. Oxygen can then drop far enough that you black out underwater without warning.

A report in the US Centers for Disease Control and Prevention’s MMWR looked at cases in New York State from 1988 to 2011 where otherwise healthy people lost consciousness underwater after deliberate breath-holding behaviors. All four of the people who died were experienced swimmers who had intentionally hyperventilated first. New York City now requires pools to post warnings that intentional hyperventilation and prolonged underwater breath-holding can be dangerous.

So never practise fast breathing or breath holds in a pool, the sea, a bath, a hot tub or a cold plunge, and never while driving or standing somewhere you could fall. If a retreat pairs breathwork with cold water, the breathing should be done lying down on dry land, and the plunge done afterwards, with normal breathing and someone watching.

Who should be careful

There’s no single official list for every type of breathwork. A clinical report on Holotropic Breathwork with about 11,000 psychiatric inpatients at a US community hospital, published by MAPS, screened out people with severe heart disease, severe musculoskeletal disorders, pregnancy and paranoid thinking, and recorded no adverse reactions over 12 years with that screening in place. Many fast-breathing facilitators use similar lists.

Talk to your doctor before fast breathwork, and tell the facilitator, if any of these apply:

  • Heart disease, a heart rhythm problem, or high blood pressure that isn’t well controlled.
  • A history of stroke, aneurysm, or fainting.
  • Epilepsy or a seizure disorder.
  • Pregnancy.
  • Asthma or another lung condition.
  • Recent surgery or injury, or a musculoskeletal problem that cramping could worsen.
  • Panic attacks. MedlinePlus lists anxiety and panic as common causes of hyperventilation, and some people find that deliberate overbreathing brings a panic attack on.
  • A history of psychosis, bipolar disorder, or a recent mental health crisis.
  • Any prescribed medicine you’re unsure about.

Slow breathing is gentle enough that most of these don’t rule it out, but if you have a heart or lung condition it’s still worth a word with your doctor.

What a safe fast-breathwork session looks like

  • You fill in a health form before you arrive, and someone reads it and follows up.
  • You breathe lying down or sitting supported, on a mat, away from hard edges.
  • There are enough staff to watch everyone. The hospital program in the MAPS report ran one facilitator for every four patients. Some groups pair participants so one breathes while the other sits with them.
  • The facilitator explains what you might feel, says plainly that you can slow down or stop at any time, and tells you what will happen if you feel unwell.
  • Touch or “bodywork,” such as pressing on tense muscles, is offered only with consent agreed beforehand.
  • There’s time at the end to rest, drink water, eat something and talk about the experience.
  • Nobody is hurried out to drive home while still dizzy.

Strong feelings and old memories

Fast breathwork can bring up intense emotion: crying, shouting, laughing, fear, grief, or memories you hadn’t thought about in years. Some people find this valuable. For others, especially people with trauma, it can be overwhelming, and unlike a psychedelic you can bring it to an end by changing how you breathe.

That’s worth remembering in the moment. You never have to keep going to “get through” something. Slowing your breath, opening your eyes, sitting up and putting your feet on the floor are the simplest ways to come back. If difficult feelings carry on in the days afterwards, our guides on integration and difficult experiences cover what to do.

Questions to ask before you book

  • Is this slow breathing, fast breathing, breath holds, or a mix?
  • How long is the breathing part, and how intense?
  • What health conditions do you screen for, and who reads the form?
  • How many staff will be in the room, and what training do they have?
  • Is any touch or bodywork involved? How do you ask for consent?
  • Is anything else part of the session, such as cold water, cacao or a substance?
  • What do you do if someone faints, has chest pain or panics?
  • What support is there afterwards?

A careful facilitator will be glad you asked. If the answers are vague, or you’re told the breath “knows what you need” in place of a straight answer about screening and emergencies, take that seriously.

More guides

Reviews from people who’ve been to a session can tell you how intense it was, how many staff were in the room and how the facilitator handled anyone who struggled. You can search the Safe Ceremonies listings for breathwork, and for related practices such as yoga.

Sources

Photo: Ocean Sunset by JJ Skys the Limit, CC0 1.0.

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