At a recent NCIM webinar, NHS GP and NCIM Integrative Medicine practitioner Dr Erica McNabb with special interests in mind-body medicine and post-traumatic recovery, shared the idea that one of the most powerful tools we have for transforming our physical and emotional health is something we already do roughly 20,000 times a day, often without giving it a moment’s thought. And that tool is the breath.

Dr McNabb’s own journey into breathwork began not in a textbook but in a hospital bed. A colon cancer diagnosis at the age of 23, right at the end of medical school, gave her a perspective that few clinicians have: she became the patient rather than the doctor. The treatment she received saved her life, but it didn’t heal her. There was a gap, she found, between being cured and being whole again, and the Western biomedical model had little to offer for that second part of the journey. That gap is what sent her looking elsewhere, and what she found was breathwork.

Breathing is the only automatic process we can consciously override. Most of what keeps us alive runs entirely outside our control. We don’t choose our heart rate, our digestion, or our hormone levels. But breathing sits in a strange and useful middle ground: it happens automatically, yet we are one of the very few mammals able to deliberately override it. We can speed it up, slow it down, hold it, or redirect it, and in doing so, we can send entirely different messages to the brain and nervous system.

Breathwork as a Therapeutic Tool

If breath can influence the nervous system, and the nervous system shapes how we feel, think, and heal, then breath becomes a lever we can pull on purpose.

Breathwork isn’t one practice; it’s a spectrum, and different techniques serve different goals. Three ways to use the breath:

1. Optimising oxygenation and performance
This is the territory of athletes and performance coaches. The basic principle is that nasal, diaphragmatic breathing delivers air more efficiently to the alveoli at the base of the lungs, where the real work of gas exchange happens. Breathe shallowly into the chest, and a large portion of lung capacity barely gets used. Breathe deeply into the belly through the nose, and oxygen reaches the mitochondria, the cellular engines that produce the energy the body needs to function and perform. Techniques like graduated breath-holding, used by endurance athletes, train the body to tolerate higher carbon dioxide levels, which in turn helps red blood cells release oxygen more readily to working muscles.

2. Stress reduction and nervous system regulation.
This is where heart rate variability (HRV) comes in. A resilient nervous system can shift smoothly between sympathetic activation (“fight or flight”) and parasympathetic rest (“rest and digest”). Slow, deep, belly-led breathing, particularly with a longer exhale than inhale, engages the vagus nerve and nudges the body toward that calmer parasympathetic state. Research from the HeartMath Institute has shown that “coherent breathing”, inhaling and exhaling for matched counts, produces a smoother, more regulated heart rhythm almost immediately, with knock-on benefits for blood pressure and cardiovascular health more broadly.

3. Emotional processing and connection to self.
This third category is the one Dr McNabb focuses on most in her own clinical work, and it’s the one with the richest, strangest implications. The idea is that emotional experiences, particularly traumatic ones, don’t just live in the mind. They can be stored physically in the body, an idea popularised by trauma researchers Bessel van der Kolk and Gabor Maté, and increasingly supported by emerging science. The tissue most implicated in this storage is fascia: the connective web that wraps around every organ, muscle, and nerve in the body. The diaphragm sits at the centre of this fascial network, meaning that deep, deliberate breathing doesn’t just move air, it moves fascia, and may help release patterns of tension and emotion that have been held in the body, sometimes for years.

What Happens During Conscious Connected Breathwork

The umbrella term for breathwork aimed at emotional release is conscious connected breathing (CCB). It covers well-known methods like the Wim Hof Technique and holotropic breathwork, the latter developed during the psychedelic research era of the 1960s as practitioners searched for ways to access altered states of consciousness without substances.

What these practices share is a breathing pattern with no pause between inhale and exhale, sustained long enough to shift brainwave activity from our usual alert beta state down into the deeper, more meditative alpha, theta, and even delta states, the same brainwave territory associated with psychedelic experiences. Combined with mild under-oxygenation of the brain from the rapid breathing pattern, this can produce something like a small altered state, sometimes accompanied by crying, laughing, vivid memories, or a felt sense of releasing something long held.

It’s powerful, but it isn’t gentle, and it isn’t for everyone. Dr McNabb was candid about this during the webinar: conscious connected breathwork is contraindicated for people with epilepsy, certain arrhythmias, or psychosis, and approached with real caution in cases of poorly controlled or brittle asthma.

But perhaps the most important point from the session wasn’t about technique at all. It was about how breathwork is held and delivered.

There’s a growing trend, visible all over social media, toward breathwork as a tool for big, dramatic emotional releases. But pushing someone into intense emotional processing before their nervous system is ready for it risks something close to the opposite of healing: re-traumatisation rather than relief.

A more careful approach uses concepts borrowed from somatic trauma therapy: pendulation, gently moving in and out of activation rather than diving straight in, and titration, building tolerance gradually rather than all at once. In practice, this means a lot of groundwork happens before any conscious connected breathing is introduced: helping a person understand their own nervous system, building their capacity to shift between stress and calm, and making sure they always feel in control of the process. The goal isn’t the most intense experience possible. It’s expanding what a person can tolerate and integrate safely.

This is also why breathwork is sometimes described as a “bottom-up” therapy, as distinct from “top-down” approaches like traditional talk therapy. Top-down work starts with the thinking brain: examining experiences, identifying patterns, talking things through. Bottom-up work starts with the body: physical sensation, movement, breath. For trauma in particular, where the body sometimes holds material the conscious mind can’t easily access or articulate, working from the body up can reach places that talking alone doesn’t.

A Simple Place to Start with Breathwork

Not every breath practice needs to be intense to be useful. One of the simplest tools shared in the session is sometimes called the “cooling breath”: rolling the tongue (or, for those who can’t, lightly resting the top and bottom teeth together with the lips parted), breathing in slowly through the mouth as if sipping through a straw, and exhaling gently through the nose, with the exhale slightly longer than the inhale. It’s an easy, accessible way to engage the parasympathetic nervous system in real time, wherever you happen to be.

That, in many ways, is the broader takeaway. Breathwork doesn’t require special equipment, a retreat, or even much time. It requires noticing, more often, how you’re breathing right now, and remembering that you have more influence over how you feel than you might think, one breath at a time.