By Gunnel Minett

According to news media lately, the British National Health Service (NHS*) is struggling to provide help for people with mental problems. In particular after severe lockdowns during Covid, there has been a sharp increase of people in need of help, among them most worryingly perhaps are children and teenagers. There is so much drugs can do to help with depression and anxiety. But alternatives such as talking therapy are potentially far more time consuming and consequently more expensive, and in many cases too expensive.

A new line of treatment for psychological illness, such as depression, addiction, anxiety etc., that is starting to appear as an alternative, is psychedelic drug induced psychotherapy. The drug used are in particular Psilocybin, Ketamine, MDM or LSD. So far it has shown to be a good alternative to conventional therapies. But as with all drugs, there may be unwanted side-effects that outweigh the positives of the therapy. And the sessions, although only a few may be needed, usually stretch over a whole day.

Good Alternatives

There is however another alternative that is less tested, but so far has proven to have effects very similar to those of psychedelic drugs, This alternative is known under the generic term of Breathwork. Breathwork comprises a number of different techniques, such as Yoga Pranayama, Chi Gong and other ancient techniques and also modern techniques such as Holotropic Breathwork or Consciously Connected Breathwork. What they have in common is that they are conscious, deliberate alterations of the normal breathing pattern. This can be done in a number of ways. In Yoga practices there are a range of breathing patterns, aimed at increasing or decreasing the flow of the breath, thereby increasing or decreasing body activation. Results here range from energising the body to mindfulness and a meditative state. 

The modern Breathwork techniques, Holotropic or Conscious Connected Breathwork have been used successfully in psychotherapy since the 1970’s. In comparison with psychedelic psychotherapy they produce very similar results, where it can be sufficient to obtain great changes for the client*.* Holotropic Breathwork was actually developed by Stan Grof, following his work with LSD induced psychotherapy. When the use of LSD in psychotherapy was banned in USA, he tried to mimic the effects that LSD has on his clients, with focus on the breathing in combination with provocative music. 

One of the absolute benefits with all forms of Breathwork therapy is that it is completely free of side effects. If the therapy is conducted by an experienced therapist the increased breathing exercise will leave the client feeling refreshed and re-energised after their session. The worst that tends to happen is that the client struggles to follow the breathing pattern and ends up having a nap instead.

Why is Breathwork not used as an option by NHS?

There are a number of reasons why Breathwork isn’t used as part of the healthcare programmes in NHS. One is very straight forward. To be approved as a NHS practice requires clinical tests that are difficult to conduct with a technique such as Breathwork. Unlike conventional drug based psychotherapy were the focus is more on finding the right drug to help the patient, in Breathwork the right interaction between therapist and client is essential. Breathwork relies on both the breathing pattern being done is such a way that opens up the client’s inner world enough to achieve deep healing and on the ability of the therapist’s ability to help the client to understand the experiences. So apart from being experienced enough to guide the breathing pattern, the therapist needs to be qualified to deal with their client’s psychological problems. 

This combination of psychology and physiology makes it difficult to valuate the technique. In normal circumstances clinical trials are constructed in such a way that they minimise the influence of the people involved in the test. But in Breathwork the therapist/client interaction plays an important role that can’t be ignored. In many ways it goes against the whole basis of modern science that is based on the assumption that valid results have to be achieved independently of the people involved. Tests conducted without this kind of stringency will be dismissed, in a similar way to drug trials, where the placebo effect is dismissed even when it can be as high as with the potent drug. (Placebo effect is where trust in the doctor’s promise plays a significant role in the healing effect). In the case of testing Breathwork it means that NHS would need to re-evaluate their criteria for how they judge the outcome of a specific therapy.

Another problem for NHS would be that it relies heavily on short, swift solutions that minimise the time spent on each patient. A Breathwork session usually requires around two hours in total (one for the breathing and another hour for talking therapy before and after the breathing. This kind of time frame would require far more resources allocated in the current situation. But as with the test results, this too is more a question of a re-think rather than a re-allocation of money. 

Breathwork can easily be conducted in groups. After an initial individual session where the needs of the client is evaluated, many can be referred to group sessions.There are no fixed limits to how big such a group could be, but a ratio of one therapist to five clients is known to work well. It has also been proven that group sessions add an effect that can be very supportive for the individual client. Despite the fact that each person has their individual problem, to breathe together with a group of people tend to create a group effect that supports each individual. This applies both to the actual breathing pattern and the sharing or discussions of each individual problem. Although most people with psychological problem tend to see them as different or unique, or even worse than others, in comparison this is often shown not to be true. In a similar way to AA meetings, it can be very helpful to simply hear the live stories. In many cases it will be sufficient to hear other similar stories to help a person getting positive insights to their own situation.

The Therapeutic Framework  

As mentioned, Breathwork is not just about changing the breathing pattern. Instead the breathing can be seen as the ‘tool’ to open up to change. And although the therapist’s input before and after the breathing session is essential, many of the changes are initiated by ‘insights’ obtained during the breathing. And as with psychedelic therapy, Breathwork tends to trigger brain plasticity. A difference here is that with a drug inducing the session, it may be more difficult to control the reaction than it is with a guided breathing session. In Breathwork the ‘challenge’ for the therapist is to create a safe enough space for the clients to be able to maintain a relaxed and open breathing pattern even when their inner defences react to fear or resistance that may contribute to the psychological problem they need help with. And in a similar way to psychedelic therapy, if the client can remain open to experiences that their inner defence usually would try to block, strong and instantaneous changes usually will take place.  

Breathwork is based on a theoretical framework that means that we are able to overcome many of our psychological problems ourselves if we are able to understand how and why they occur. Rather than identifying and labelling problems to link them with the suitable drug treatment, the aim in Breathwork is to explain how the human psyche works and how problems occur. In some cases a simple explanation of how the brain works may be sufficient to provide the client with a tool to help them change their behaviour to a more positive one that will help them overcome their problem. And as with addiction and depression, there may be a part of self-medication involved in their problem. In the case of addition it is usually more obvious that the substance or behaviour that is addictive stems from attempts to control the inner world. The same may apply also in depression, where the problem may not be in the depression itself but rather lack of understanding the source of the depression. In both cases, understanding the behaviour plats a major role in the healing process.

There are other cases where brain plasticity may play a major role. In religious experiences, a person can have a life-changing experience once and change their whole outlook on life as a result of it, just like in psychedelic drugs and Breathwork. In Breathwork it is not clear exactly what takes place and why it happens since there haven’t been enough research area yet. But there is a massive amount of anecdotal evidence to support this. 

After 50 years of development of Breathwork as part of psychotherapy there is finally more research being done into the potential of Breathwork as a tool for healing. Som universities in Britain are already working on ways to understand the effects of Breathwork and how to integrate Breathwork with other forms of therapeutic help. Once the hurdles of testing and quantifying are overcome, it will hopefully become a well used tool, that is guaranteed to be without side-effects. If or when it becomes mainstream, it may also be something to teach children in schools as a preventative tool to give their brains some free time and chance to self-heal.

*NHS, the British Healthcare Service, is the focus of this article, but there are similar considerations taking place in other countries around the world. 

**The preferred terminology in Breathwork is to use the word client rather than patient, to fit in better with the overall understanding of psychological ill health.

Keywords; breathwork, psychotherapy, hospital care, psychedelic drugs, depression, addiction, anxiety