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When your heart is open and you feel present, relaxed, and safe, oxygen literally flows more freely to your heart and throughout the body.

With a relaxed mind and body you can breathe more deeply, increasing oxygen flow, stimulating the parasympathetic nervous system, and promoting a state of calmness. When in emotional distress, however, your body becomes constricted and tense, thereby taking in less oxygen and activating the sympathetic nervous system, also known as the “stress response.”

Given the inextricable link between mind and body, many therapists have embraced ways of incorporating breathing into the therapy process. Utilizing structured breathing exercises in session may be the most common way therapists do this. Learning how the breath can be used to shift your experience and bring about a sense of groundedness when needed can bring a sense of empowerment into your life.


One of the simplest and most accessible techniques is counting the breath.

For example, in a four-count breathing exercise, you inhale on a slow count of four, retain the breath for a slow count of four, and exhale for a slow count of four, repeating several times and pausing in between cycles for a few seconds as needed. As you get comfortable with this pattern, you can extend the count of the hold and the exhalation, breathing in for four counts, holding for seven counts, and breathing out for eight counts. Dr. Weil calls this the “four-seven-eight breath” or the “relaxing breath.” You can access detailed instructions on this exercise at this link.

Other breathing techniques used in session are less structured, with the emphasis on observing and allowing the breath to be as it is (long or short, deep or shallow, etc), without controlling it. In this approach, the breathing techniques are used to cultivate present-awareness, also known as mindfulness. Vietnamese monk Thich Nhat Hanh describes conscious breathing as serving as an “anchor” to the present moment, bringing the body and mind in alignment together to establish oneself “in the here and now.” Hahn delves into this concept in his classic book titled The Miracle of Mindfulness, nicely summarized in his article.

Using a Guided Meditation Practice

To give you a sense of how mindfulness techniques might be used in session, your therapist might choose to guide you through a mindfulness practice or simply ask you questions about your in-the-moment experience of your body sensations, your thoughts, or your emotions. A guided practice may start by your therapist inviting you to sit comfortably with eyes open or closed and turn your attention to your breathing; allowing yourself to feel your breath without controlling it; noticing the qualities of the experience in your mind and body. Hahn offers the following tool to focus on the mind on breathing, which could be helpful to practice with your therapist, or on your own:

“Breathing in, I know that I am breathing in.

Breathing out, I know that I am breathing out.”

When we arrive in the present moment, Hahn says, possibilities open to gain insight and discover new things. For many of us this simple task is quite challenging because, consciously or unconsciously, we may be avoiding painful feelings in our bodies and minds, or have developed patterns of avoidance to survive difficult times. Working with a therapist in conjunction with practicing mindful breathing, you can learn over time to stay in your body when confronting difficult feelings. You can also increase your capacity to tolerate challenging situations when they arise, rather than dissociating or running away from them.

Incorporating breathing and body awareness into our lives can help us to attune to our embodied experience rather than only to the reasoning of our minds. It can help us to cope with challenging experiences by offering a sense of grounding and an alignment of mind and body. While the mind and intellect are integral to our growth, our bodies and breath also offer tools and wisdom that can be used to help us on our healing journeys.

Parts of this article are taken from my thesis research on the integration of conscious breathing into psychotherapy. You can access the full paper here.


Mia Gutfreund is a Licensed Clinical Social Worker (LCSW) at Well Clinic in San Francisco. She has been providing clinical services to adults, adolescents, and families in San Francisco for over 10 years. In Mia’s words, “I believe in the psyche’s natural instinct to grow, and that the very struggles you face give us access to the wisdom that lives within you.”

»» Learn more about Mia and book an appointment today


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