Written by Milena Screm et al.

Co-authors are: Dr. Antonio Ceriello, endocrinologist and professor, University of Udine, Dr. Milena Screm, founder and manager, Insight school, Milan, Dr. Anna Ercoli, trainer, Dr. Roberto Da Ros, physician
This paper is from the proceedings of the conference “Scienze Complementari Integrate: percorsi comuni in medicina, psicologia e naturopatia” [“IntegratedComplementarySciences: Common Paths in Medicine, Psychology, and Naturopathy”] – Udine,September27-28th, 2002 (under the patronage of Comune di Udine, Regione Friuli Venezia Giulia, University of Udine, Chamber of Commerce of Udine, Associazione Industriali del Friuli V.G.)

Conscious circular breathing used in BreathWork is a breathing technique. To learn it initially requires the guidance of a professional teacher, who will instruct how to make our breathing full, free, and circular. The technique itself has countless definitions. BreathWork appears to be able to instantly generate a relaxing and stimulating energy, reducing stress and bringing mind, body and spirit back to a natural level of balance. It also appears to be effective against various physical disturbances and against neurotic and psychotic disturbances.

The BreathWork breathing technique is based on a consciously circular breathing pattern where the inhalation and exhalation is equally long and without intermediate pauses. This method, according to its originator (Leonard Orr/Rebirthing), should: ”repair the damage to your respiratory system caused by chronic hypoventilation, healing everything which is still unsolved with your father and your mother, balance your masculine and feminine sides, create the deserved quality of life”. There is however no explanation in scientific literature as to the mechanism through which these goals are achieved, and none of these effects can be estimated or accepted from a scientific point of view.

In this paper we will try to analyze the physiological features of breathing, looking for assumptions of scientific effectiveness of BreathWork.

Breathing represents an essential activity in life, the only semi-automatic vital function that as a rule occurs in an autonomous and unconscious way, but upon which we can act voluntarily to modify almost all its features: rate, rhythm, and depth. The main activity of breathing is the preservation of gas balance in the organism that occurs through the exchange of oxygen and carbon dioxide between inhaled air and blood. In achieving this balance, many structures are involved: lungs, respiratory tract, blood vessels, central and peripheral nervous systems, osteoarticular and muscular structures. Many muscles are mustered: internal and external intercostal muscles, diaphragm, vertebral muscles, sternocleidomastoid, and muscles of the abdominal wall. Some of these also carry out tasks for the maintaining of body posture. They play a role in achieving the muscle balance needed to maintain the body posture during the breathing cycle–which involves continuous oscillation of the subject’s barycentre. It is clearly evident how complex it is to control this activity, regulated by chemical, neural and mechanical stimuli, and integrated at a central and peripheral level. Also, the above mentioned breathing is the essential basis of cellular respiration, an essential process for the functioning and vitality of cells themselves, and a substrate for the generation of energy for the entire organism.

Chemical control
The chemical control has the task of continually measuring pH, PO2 of arterial blood and pH of brain interstitial fluid, in order to maintain a constant balance through nerve outputs and adequate ventilation. There are two receptor types in this system: receptors located at the carotid bifurcation, that send signals to the CNS through the ninth cranial nerve, and aortic arch receptors, from which signals reach the CNS and vagus nerve.

Hypercapnia is mainly detected from modifications of pH at cerebrospinal fluid level. Stimuli coming from receptors located at the ventral-lateral medulla are responsible of 80% of ventilation increase; the remaining 20% seems to be due to aortic and carotid chemoreceptors. Ventilation increases linearly as PCO2 rises, while it increases hyperbolically as PO2 drops. The reflex primed by chemoreceptors mediates the respiratory response, allowing the organism to adapt to various physical situations: physical activity, altitude, sleep, etc. This system is provided with plasticity: in chronic conditions, modifications are also created in the response to the stimuli, for example chronic hypoxia (occurring at high altitude or in cyanotic heart diseases) develops a reduced ventilatory response to the drop of oxygen level.

Neural control
The afferences originating from the respiratory apparatus are numerous, as well as the receptors coding for them: upper airways receptors, tracheobronchial receptors, slowly adapting pulmonary stretch receptors and rapidly adapting receptors, terminations of C fibers, chest wall receptors, muscle spindles, Golgi tendon organs. Afferences are then conveyed to the central nervous system through cranial nerves IX and X, reaching the medulla at the nuclei of ventral and dorsal respiratory group, which is located near the solitary nucleus. The solitary tract represents the main collector of impulses coming from nerves IX and X, which convey, as well as the afferences of the respiratory apparatus, also those of the main visceral, thoracic and abdominal organs, and those of arterial chemoreceptors. The dorsal respiratory group then, with its many connections with the nuclei of the solitary tract, represents the first stage of central processing not only of respiratory stimuli but also of integration of stimuli coming from the viscera. These connections explain the influence of visceral situations, e.g. pain, on respiratory activity.

A major afference comes from muscle spindles, Pacinian corpuscles and tendon organs terminations. Receptor structures responsible for these afferences are present in large amounts in intercostal muscles, to a lesser extent at the level of the diaphragm. The purpose of this great amount of afferences is the adaptation of respiratory volume. At spinal level, the reflex is amplified due to the firing of metamers adjacent to the one involved in the primary stimulus.

Descending pathways: the descending fibers of the cortex are divided in two groups, corticobulbar fibers going to the reticular formation, and corticospinal fibers going to the spinal cord. As regards the connection with the reticular formation little is known. This is no doubt interesting because of the involvement of many autonomic functions.

Neuromodulators and respiration
During the last 20 years many researches have investigated the role of endogenous opioids and other neuromodulators in regulating respiration. The basic assumption was the finding of a noticeable amount of endogenous opioids in the medulla, where the main centres of breathing integration and control are located. Research published in 1980 did not find variations in respiratory dynamics after infusion of naloxone, an opioid antagonist, compared with infusion of saline (1). These findings then excluded a primary role of endogenous opioids in the regulation of respiration. On the contrary, Waldrop et al showed in 1982 that muscle stimulation activates a sovraspinal mechanism capable of depressing respiration for long periods (2), and it has been shown that this action is mediated by endogenous opioids and GABA (3). The same group also shows that naloxone infusion, in laboratory animals, creates an increased respiratory rate, showing a chronic inhibiting effect on respiration by endogenous opioids (4).

Endogenous opioids inhibit respiration through a central mechanism, based on suppression of basic neural activity and on a reduced release of glutamate following inspiration (5). The other neuromediators involved in the regulation of respirations are: serotonin: it has a stimulating effect on respiration and is a regulator of rate. The stimulation of aortic baroreceptors causes a prolonged serotonin-mediated ventilatory response at central level (6). Through the increase of serotonin, the raphe nucleus increases the phrenic nerve firing rate; substance P: this neuromediator also has a stimulating effect on respiration; it shortens the duration of inspiration. It mediates the hyperventilatory response to hypoxia detected by the carotid chemoreceptors(7);
glutamate: stimulating effect; it increases the firing spikes of respiratory neurons (5);
GABA: inhibiting effect, like endogenous opioids.

Conscious breathing
Few studies have examined thoroughly the effects of control of respiration on the organism. Patwardhan et al have analyzed the variations of heart activity and arterial pressure in 10 subjects after 5 minutes of controlled breathing. The results show that the control of respiration reduces vagal influence on cardiovascular system, causing an increase of heart rate and arterial pressure. CO2 levels did not change significantly (8).

Croix St et al show that inspiratory muscle fatigue, achieved through forced inspirations, causes a time-dependent increase of sympathetic activity in lower limb muscles, with consequent vasoconstriction (9). This phenomenon has been subsequently ascribed to a metabolic reflex originating in diaphragm (10).
Another research by University of Missouri-Columbia, USA, takes into account the effect of circular breathing on heart activity mediated by autonomic nervous system. The results show that circular breathing alters the autonomic control of the heart, increasing the heart rate and reducing the variation of heart rate itself. We should remember that variations of heart rate are connected to modifications of respiration rate and to the modulation enacted by respiration on vagal activity (11).

Therapeutic hypotheses
Release of endogenous opioids during physical exercise
The release of endorphins during physical exercise has been demonstrated by numerous researches (13- 16, 18); also, daily training causes an increased production of endorphins compared to acute physical exercise, where the increase of endorphins is only due to an increased release of mediators. The intensity of physical exercise appears to be directly related to the production of endorphins; thus, the greater is the receptor stimulation, the greater are the afferences to the central nervous system and the release of endorphins (15, 16).

During BreathWork sessions many respiratory muscles are activated that are rarely used in normal respiration, and also the muscle strain is far lower compared to deep breathing. Therefore, a major stimulation reaches the central nervous system, coming mainly from the receptors of the various muscles involved in respiration, particularly from intercostal muscles where the concentration of receptors is far greater.

The intensity of these stimulations is no doubt far higher in comparison with normal breathing. This is due to the large number of receptors and to the inter- segmental phenomenon described above. BreathWork activity can be compared to an intense practice of physical exercise that releases remarkable amounts of endogenous opioids. This mechanism also explains the increasing effectiveness of continuous sessions, comparable to physical training.

Effects of endogenous opioids: physical and mental well-being, euphoria, muscle relaxation, higher pain threshold, increased effectiveness of immune system (14,15), alterations of menstruation (16), release of multiple hormones: growth hormone, ACTH, PRL, catecholamines,and cortisol(17,18).

Modification of blood gases during a BreathWork session

During a BreathWork session, it can be hypothesized that modifications of blood gases occur, when respiration is controlled by our will and not by chemoreceptors. In research by Patwardhan AR, CO2 did not change significantly between controlled and uncontrolled breathing, but the duration of the exercise was only 5 minutes. Variations of blood gases can naturally occur between physiological limits. The characteristics of our respiration (rate and depth of breathing), determines if oxygen and carbon dioxide levels increase or decrease.

The result of these alterations will be a major firing by the chemoreceptors detecting the anomaly. These impulses, aiming to restore the preexisting balance, cause the release of neuromediators; hypoxia causes the release of substance P, serotonin and glutamate (19), while hyperoxia reduces GABA levels (20). CO2 variations also have major consequences, such as the alteration of acid-base balance: hypocapnia alters the response of the sensory cortex increasing neuronal excitability, while hypercapnia causes the opposite effect (21).

Conscious breathing and childbirth

The only therapeutic application of conscious breathing in conventional medicine is labor analgesia. The effectiveness of such breathing techniques in reducing pain has been demonstrated using pain assessment scales. The mechanism of action is unknown – in this case, too, it can be hypothesized that opioids operate on descending pain control systems.

Conclusions: Currently, there is no scientific evidence for the effectiveness of BreathWork, though logical assumptions do exist for a rational explanation. Its effects on cellular respiration are even less predictable and hard to evaluate, though the improvement of gas exchange and the increase of oxygenation may create the needed substrate for a better cellular respiration.

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Glossary of Terms
PO2: oxygen pressure
HYPERCAPNIA: increase of carbon dioxide levels in the blood
PCO2: carbon dioxide pressure
CHEMOCEPTORS: receptor proteins responding to chemical stimuli
HYPOXIA: failed or reduced use of oxygen by tissues
C FIBERS: small diameter, unmyelinated nerve fibers
PACINIAN CORPUSCLES: receptor proteins
METAMERS: segments following each other which include functional units of one or more organs or organ systems RAPHE :integration center of nervous system
ACTH: an hormone released by hypophysis, acting on adrenal cortex
PRL: an hormone acting on secondary sex characteristics and milk-production
Dr. Antonio Ceriello, endocrinologist and professor, University of Udine Dr. Milena Screm, founder and manager, Insight school, Milan
Dr. Anna Ercoli, trainer
Dr. Roberto Da Ros, physician
From the proceedings of the conference “Scienze Complementari Integrate: percorsi comuni in medicina, psicologia e naturopatia” [“IntegratedComplementarySciences: Common Paths in Medicine, Psychology, and Naturopathy”] – Udine,September27-28th, 2002 (under the patronage of Comune di Udine, Regione Friuli Venezia Giulia, Universityof Udine, Chamber of Commerce of Udine, Associazione Industriali del Friuli V.G.)

Keywords; Conscious circular breathing, childbirth, GABA, blood gases, endogenous opioids, neuromodulators, hypercapnia, neural control, chemical control 

© Milena Screm 2014

More information for Milena Screm: http://www.insightformazione.it/chi-siamo/docenti-counselor-interni/milena-screm
Supervisor Counselor & BreathWorker
Founder and president INSIGHT School of BreathWork Counseling – Milan (Italy)
Author of fourteen books in psychology, published in Italy, France and Spain, among which we denote: “BreathWork” (1998), “Autogenic Training” (1989,2012), “Rebirthing & Water” (1994), “The history of Rebirthing” ( 1992 ), “Rebirthing, breathe for renewal”, the first book published in Italy on rebirthing (1989, 1993, 2011) http://www.insightformazione.it