Perfect Breathing

Breath Retraining, the Vagus Nerve, and Depression with Dr. Fred Muench

Dr. Fred Muench is a clinical psychologist who served on the team that developed the Helicor StressEraser bio-feedback device for breath-based stress reduction, as well as the Breath Pacer application for the iPhone. Dr. Muench offers a unique perspective into the science and application of conscious breathing, with some startling revelations on the profound effects breathing has on depression, anxiety and hypertension.


Perfect Breath: What was it that initially sparked your interest in the breath and its applications to health and wellness?

Fred Muench: I went to school for clinical psychology and during my training I realized that every patient intervention uses a stress management technique even if it is just as an adjunct. Whether it was a chronic population on an in-patient ward, schizophrenics, depressives, anxiety cases, it didn’t matter, there was always some form of stress management that was a part of the treatment.

There was also the mindfulness revolution of the early nineties which occurred while I was in grad school. So we started hearing more and more about it. And I came to realize that in every one of these interventions the common or even primary mechanism was breath control and although there were different techniques and forms – alternate nostril breathing, different counts and ratios -  it was ultimately about slow deep breathing.

After I graduated I was working at Columbia doing process research into the mechanisms of change in people. We were looking at social support, stimulus control techniques, and at people changing their environments, and it became clear that stress reduction was a key part of how people changed their behavior. Whether it was engaging in physical activity, stress reduction methods like meditation or breath retraining - stress reduction techniques were an excellent predictor of outcome. So I started focusing on breathwork more and more as time went on.

At that time Helicor was looking for a director of clinical research, focused on psycho-physiology and what happens to the body as people are breathing. That led me full force into this entire world of biofeedback, breath retraining, and stress reduction.

Since leaving Helicor, I’ve been working on applications like the Breath Pacer for the iPhone, as well as other applications and phones as well.


PB: During the research, studies, and investigations that you’ve conducted, what has surprised you the most?

FM: My perception, and I think that of the general public as well, was that breathing techniques help with stress arousal and anxiety and stress-related conditions, which is all true. What shocked me was the powerful effect of breath retraining on the symptoms of depression!

What I found so interesting was that when you have an anxious or hyper-tense population, what you are dealing with is sympathetic nervous system (the fight or flight system) over-arousal. Breath retraining reduces sympathetic nervous system over arousal and increases para-sympathetic nervous system activity – the relax, recuperate, regenerate system –which calms you down.

With depressives the problem seems to be under arousal. Low skin conductance, low heart-rate variability (HRV), and reduced low-frequency HRV. These are all indicators of depression. The whole body is under-aroused – it can’t get moving. Proper breathing seems to bring balance to the body. It is not a one way intervention, but brings the body into to equilibrium so it can work. Breath retraining increases skin conductance and increases low-frequency HRV. Typically people think these are not great outcomes. But in depressives that is exactly what you want.

Perhaps one of the most important outcomes is increased vagal nerve tone. The vagus nerve is the primary pacifying nerve in the body. Increased vagus nerve tone activates parts of the body that need activating and quells the parts that need to be relaxed. That was what really took me by surprise - the powerful effects on depressives. The effects are so significant they make any drug look like a placebo. The effect sizes are either large or very large and that is compared to active treatment not placebo. Compared to active relaxation treatments that don’t utilize breath retraining as an active component, it is extremely powerful. Unfortunately these outcomes have not been widely publicized which is a shame.


PB: What is the connection between the breath and the vagus nerve? How does the breath impact vagus function?

FM: The breath’s effects on the vagus occur primarily during exhalation. During exhalation your heart rate decelerates and during that period of deceleration the vagus becomes active. Shallow, rapid breathing patterns inhibit the vagus because the period of vagal activity is too short and the nerve does not have time to pacify the other nerves that it touches. It really is a simple mechanism. By slowing down your breathing you create more vagal activity, accentuating its relaxing and regenerating effects. With bio-feedback devices (such as StressEraser) you can train yourself to keep the heart-rate deceleration for as long as possible, maximizing its benefits.


PB: What do you see as the main benefits of using biofeedback technologies like StressEraser, and Breath Pacer?

FM: There is a difference in the function and value between StressEraser and Breath Pacer. The Breath Pacer is a simple metronome, while the StressEraser is actually a biofeedback device. Both of these devices make breath retraining accessible to those who don’t know about it or have difficulty performing the activity.

I’ve been quite surprised at how many people are oblivious to the effects of their breath - who don’t understand the concept of slowing down their breath, or are chest breathers. These technologies provide them with a window into the power of breath.

I personally found that I was easily distracted doing breathwork and discovered that the external focus provided by the device was very helpful, especially on the subway. I’ll just close my eyes and use the audio component to guide my breathing and do 20 minutes of breathwork on the way to the office. It does help you to stay focused, and when your mind wanders, StressEraser has the added benefit showing you the breaks in the waves so you can see what is happening. The down side is that some people are very anxious and get even more stressed out seeing their physiology being tracked on the device. For those people the simple metronome function of the Breath Pacer might be a better place to start.

The ultimate goal however is to encourage people to practice focusing on their breath. Where they take it from there is up to them. The physiological effects of just focusing on breath are so powerful, that alone would be sufficient, but if they graduate into integrating other practices such as mindfulness, yoga, or meditation, that is even better.


PB: What are the benefits of specific practices, such as alternate nostril breathing? How do these practices differ from simple slow, deep breathing?

FM: In terms of research, there is currently much more anecdotal evidence. Studies that have been done don’t seem to have good control groups. However, there seems to be the suggestion that alternate nostril breathing, for example, helps to lateralize the brain (emphasize one hemisphere over the other), activate certain regions of the brain, and perhaps affect visual acuity as well. But as I said there is not enough solid research yet to know the specific impacts of these different types of breathing.

It is the same with breath holding. A lot of practices use it. Clearly you see heart-rate deceleration during breath holding and I think taking slow inhales with long holding before the exhale helps - particularly in situations where you are dealing with anxiety in the moment. But I don’t know of specific research regarding breath holding.

That is why I focused on autonomic balance where breathing is in synchronicity with your heart rate.. That is what we’ve done with Breath Pacer. People enter their height which indicates how the blood flows through body, which helps determine the proper breath rate to create that autonomic balance.

That is my focus because we can see it happening. As a researcher, I just want to look at the empirical information. We know that around 6 breaths per minute, you get the autonomic balance.

PB: What do you recommend for people wanting to get started with breathwork?

FM: There are two things: The technology can help them get started focusing on their breathing and help guide them, but I would recommend that they take 2 hours out of their life to either join a yoga class, or a qi gong class - anything with the experience of guided training.

What I’ve learned it that it is a lot harder than I thought it was to teach proper breathing.

Some people are chest breathers and no amount of technology will change that. Get some sort of professional help, a video, a book, anything that will help you understand the fundamentals of the practice. You can breate 6 breaths per minute from your chest, but you’ll probably hyperventilating after 3 minutes and decide that it is a bunch of garbage. Some people get it right away, but some people need help. If you are having difficulty, get help.


PB: How has this knowledge, how have these techniques changed your life? How are you using them?

FM: That is a great question - especially now that I have kids. I have lots of opportunities! It has made a huge impact in terms of my personal emotional reactivity. I can come to work much more balanced, and I always know that I have it up my sleeve.

As I was learning and integrating it into my life, I found that I was using it as a crutch rather than a preventative measure. For example I’d get into a situation - like going to a last-minute meeting – where I was feeling anxious and using the breathing and feeling like it wasn’t working. Now it is a part of daily routine. I use it mostly on the train for 20 minutes on my way in to the office and also on the way home and I feel much more even-keeled. I can walk in the door and my kids will jump on me and I don’t need that 5 minutes or so to decompress and get settled. I can go right to engaging with my family because I’ve had that time to myself. Where everyone else on the subway just seems annoyed, I seem to have found a measure of peace, and finding peace on a NY subway - in and of itself - is more than anyone can ask!


PB: That is a quite an accomplishment!

FM: In terms of clinical practice, I’m not seeing patients any more, but I integrated it into my practice by showing patients how to use the techniques preventatively, trying to get them to realize that it is a very important tool - not your only tool - but a very important tool that can help you function throughout the day. It’s tool that I’ve integrated into my life and recommend that other do as well.

The best thing though is people calling the company and telling us that this has changed their life. “I’m a better, nicer person.” “I can’t tell you what you’ve done for my life.” “I’m more mellow, I don’t react to situations.” It is a glorious feeling and it really makes your day.

Don Campbell and Al Lee are the authors of Perfect Breathing: Transform Your Life One Breath At A Time (Sterling Publishing/2008) and write, speak, train, and blog tirelessly on the subject. Discover more ways you can improve your health, performance, and wellbeing at Reach them at info [at] perfectbreathing [dot] com or call 1-8... (toll free)