Breathing Exercises for PTSD
Restore calm to a nervous system stuck in survival mode
PTSD keeps the nervous system locked in a hypervigilant state — the amygdala constantly signals danger, even when the environment is safe. The vagus nerve, which normally acts as a brake on this stress response, becomes underactive. Breathing exercises work for PTSD because they bypass cognitive processing and directly stimulate the vagus nerve, telling the brainstem 'you are safe' through a physiological channel the traumatized brain can't override.
The most important principle for PTSD breathwork is safety. Breath holds and rapid breathing can trigger flashbacks or panic in trauma survivors. Extended exhale techniques (where the exhale is longer than the inhale) are the safest starting point because they gently activate the parasympathetic system without any intense sensations. A simple 4-count inhale, 6-8 count exhale is often the best entry point.
Bessel van der Kolk, the leading trauma researcher and author of The Body Keeps the Score, emphasizes that trauma is stored in the body, not just the mind. Breathing exercises provide a somatic (body-based) pathway to regulation that talk therapy alone cannot access. The physiological sigh — a double inhale followed by a long exhale — is particularly effective because it's the body's natural reset mechanism, observable even in sleeping dogs.
Benefits
- Directly stimulates the vagus nerve — bypasses the overactive amygdala
- Extended exhales activate the parasympathetic 'safety' system without intensity
- Somatic regulation — reaches the body where trauma is stored (van der Kolk)
- The physiological sigh is the body's own natural de-escalation mechanism
- Zero risk of dependency — unlike medication, breathing works long-term without tolerance
Frequently Asked Questions
Are breathing exercises safe for PTSD?
Extended exhale techniques (inhale 4, exhale 6-8) and the physiological sigh are safe for most people with PTSD. Avoid breath holds, rapid breathing (Wim Hof, kapalabhati), and any technique that creates intense physical sensations — these can trigger flashbacks. Start gently and stop if you feel destabilized. Work with a trauma-informed therapist if possible.
Which breathing technique is best for PTSD?
Extended exhale breathing (4-count inhale, 6-8 count exhale) is the safest and most effective starting point. The physiological sigh (double inhale + long exhale) is effective for acute episodes. Coherence breathing builds long-term vagal tone. Avoid hyperventilation-based techniques entirely.
How does breathing help if my trauma isn't physical?
Trauma — whether physical, emotional, or psychological — creates the same nervous system dysregulation. The amygdala doesn't distinguish between types of threat. Breathing exercises regulate the autonomic nervous system regardless of the trauma type. The body's stress response is the target, not the specific traumatic memory.
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