Breathwork: Types, Benefits, and Why Breath Holds Aren’t Always Benign

Breathwork has become increasingly popular in therapeutic, wellness, and performance spaces. From trauma therapy to yoga studios and corporate wellbeing programmes, conscious breathing practices are often described as a powerful route to emotional regulation, physical health, and psychological insight.

However, not all breathwork techniques affect the body in the same way. Some approaches; particularly those involving intentional breath holds; carry physiological risks that are often poorly understood or inadequately screened for. This blog explores the main types of breathwork, the benefits they can offer, and-critically-the biology of breath holds, why they can be problematic, and how similar (or better) results can be achieved without breath retention.

The Main Types of Breathwork

1. Slow, Regulated Breathing

(e.g. coherent breathing, resonance breathing, 4-6 breathing)

This approach focuses on slow, steady nasal breathing-typically around 5-6 breaths per minute.

Benefits

• Improves heart rate variability (HRV)

• Enhances vagal tone

• Reduces anxiety and stress

• Supports emotional regulation and sleep

• Well tolerated by most nervous systems

Biology
Slow breathing increases parasympathetic (vagal) activity via the baroreflex and vagus nerve, improving autonomic balance without stressing oxygen or carbon dioxide levels.

2. Conscious Connected Breathwork (CCB)

(continuous breathing with no pause between inhale and exhale)

Often used therapeutically, this style involves a smooth, rhythmic breath-usually through the mouth-without intentional holds.

Benefits

• Facilitates emotional processing

• Increases interoceptive awareness

• Can access altered states safely when well held

• Supports trauma processing when titrated

Biology
CCB gently alters CO₂ tolerance and autonomic arousal while maintaining flow. When paced and grounded, it avoids the abrupt physiological shifts associated with breath holding.

3. Yogic Breathing (Pranayama - selected practices)

Some pranayama practices are regulating, while others involve breath retention.

Benefits

• Improved respiratory efficiency

• Enhanced attention and body awareness

• Cultural and spiritual significance

Caution
Traditional pranayama with holds was historically taught 1-to-1, often after years of preparation-something often lost in modern group settings.

4. Breathwork with Intentional Holds

(e.g. Wim Hof Method, box breathing with long holds, hypoxic training)

These methods deliberately include breath retention, either after inhale or exhale.

Reported benefits

• Increased stress tolerance

• Feelings of clarity or euphoria

• Sense of control or resilience

However, these effects come with significant physiological stress, which is often misunderstood.

What’s Actually Happening During Breath Holds?

When you hold your breath, several key biological processes occur:

1. Carbon Dioxide (CO₂) Rises

The urge to breathe is driven more by rising CO₂ than falling oxygen. Breath holds rapidly increase CO₂, triggering:

• Air hunger

• Sympathetic nervous system activation

• Increased heart rate and blood pressure

2. Oxygen Levels Fall

Prolonged holds can lead to hypoxia, particularly risky for individuals with:

• Cardiovascular disease

• Respiratory conditions

• Trauma histories

• Panic disorder

• Dysautonomia

• Pregnancy

3. Sympathetic Nervous System Dominance

Breath holding activates a stress response, not vagal tone. Any calm or euphoria afterward is often due to:

• Post-stress rebound

• Endorphin release

• Relief following threat resolution

This is not the same as regulated nervous-system safety.

Why Breath Holds Can Be Risky-Especially in Therapeutic Spaces

Breath retention can:

• Trigger panic or dissociation

• Exacerbate trauma responses

• Reduce cerebral blood flow

• Cause dizziness or fainting

• Increase seizure risk in vulnerable individuals

• Stress the cardiovascular system

Importantly, many people drawn to breathwork are already living with anxiety, trauma, chronic stress, or autonomic dysregulation-exactly the populations for whom breath holds may be contraindicated.

There is also a false assumption that discomfort equals healing. In nervous-system work, safety-not stress-is what creates lasting regulation.

Getting the Same (or Better) Results Without Breath Holds

The benefits often attributed to breath-hold practices-clarity, calm, emotional release, resilience-can be achieved without inducing hypoxia or CO₂ overload.

Evidence-based alternatives include:

• Slow, rhythmic breathing

Optimises vagal tone and HRV without triggering threat responses.

• Extended exhales (no holds)

Lengthening the exhale naturally engages the parasympathetic nervous system.

• Conscious connected breathing (without retention)

Allows emotional processing while maintaining physiological safety.

• Nasal breathing

Improves nitric oxide production, oxygen utilisation, and autonomic balance.

• Titration and pacing

Especially crucial in trauma-informed and clinical settings.

These approaches support regulation rather than endurance, which is key for long-term nervous-system health.

A Trauma-Informed Perspective

From a trauma and autonomic nervous system lens, breathwork should:

• Increase choice and agency

• Support interoception without overwhelm

• Build capacity gradually

• Avoid replicating states of suffocation, panic, or loss of control

Breath holds can inadvertently mirror traumatic physiological states. For some nervous systems, this reinforces threat rather than resolves it.

Final Thoughts

Breathwork is a powerful tool-but power requires responsibility. Techniques involving breath retention are not inherently benign, and their widespread use without screening, education, or clinical understanding is concerning.

The good news?
You do not need to hold your breath to heal your nervous system.

Gentle, science-aligned breathwork can create profound change-safely, sustainably, and inclusively.

References

• Lehrer, P., Vaschillo, E., & Vaschillo, B. (2000). Resonant frequency biofeedback training to increase cardiac variability. Applied Psychophysiology and Biofeedback.

• Porges, S. W. (2011). The Polyvagal Theory. Norton.

• Jerath, R., et al. (2015). Physiology of long pranayamic  breathing. Medical Hypotheses.

• Courtney, R. (2009). Buteyko Breathing Method.

• Bernardi, L., et al. (2001). Effect of breathing rate on oxygen saturation and autonomic modulation. Clinical Science.

• Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart–brain connection. Neuroscience & Biobehavioural Reviews.

• Van der Kolk, B. (2014). The Body Keeps the Score. Viking.