Mental health and stress management have long been concerns for healthcare providers.1 The COVID-19 pandemic has further intensified these issues,2 highlighting the need for simple, accessible stress management techniques to protect healthcare providers' mental health and wellbeing.
In her recent paper published in The Journal of Interprofessional Education & Practice (March 2023), Dr. Jennifer L. Shaw-Metz from Drexel University explores breathwork as an easy and effective way for healthcare providers to combat stress.3
How does stress impact healthcare providers' wellbeing?
Healthcare workers face ongoing physical and psychological stressors in demanding work environments. Additional personal stressors, such as personal health concerns, family responsibilities, financial stress, overscheduled lifestyles, and lack of time for rest, exacerbate this pressure.4 Without proper relaxation, long-term effects of stress can lead to emotional dysregulation, anxiety, cardiovascular and cognitive problems, insomnia, fatigue, immune suppression, and permanent physiological changes.3
Healthcare providers' fast-paced and high-demand work environment does not allow for time-consuming and complicated stress management techniques. Instead, they need evidence-based, easy, and accessible strategies to combat stress in the moment of need.
“Repeated external stressors can lead to cognitive and emotional dysfunction, cardiovascular disease, immunocompromise, and can directly correlate to higher levels of burnout, attrition in the workplace, mental health, morbidity, mortality, and other concerns.”
What is the evidence behind breathwork?
Breathing techniques or breathwork activates the parasympathetic response, promoting relaxation and counteracting the negative effects of the fight-or-flight sympathetic state. This leads to immediate reductions in blood pressure, respiratory, and heart rates. Regular breathwork improves lung capacities, sleep quality, mood, and overall wellbeing.3
Evidence shows that breathwork can alleviate anxiety, depression, panic, PTSD symptoms, and aggressive behaviors while enhancing mental focus and clarity.5 Breathwork also enables restorative sleep crucial for cognitive performance, emotional regulation, and memory.6 Improving sleep quality is especially important for healthcare workers, as shift work disrupts natural sleep cycles, leading to health issues.
“Breathwork requires minimal education, no specialized skills, and can be utilized by anyone, in any setting, without equipment or cost.”
How to do breathwork?
Dr. Shaw-Metz highlighted three breathwork techniques in her paper:
Four Square Breathing or Box Breathing:7
- Inhale deeply for 4 seconds, hold the inhale for 4 seconds, exhale fully for 4 seconds, and hold the exhale for 4 seconds. Click here for a video demonstration.
- Practice multiple rounds, gradually increasing the time for each step.
4-7-8 Breathing Technique:8
- Begin with a full exhale through the mouth, making a whooshing sound. Inhale deeply through the nose to the count of 4, hold the breath to the count of 7, then exhale slowly through the mouth to the count of 8. Click here for a video demonstration.
- Keep the tip of the tongue touching the mucosa behind the top front teeth throughout the exercise.
- Practice multiple times daily, but not more than four cycles at any one time.
Diaphragmatic Breathing or Belly Breathing:9
- Place one hand on the chest and the other on the abdomen to monitor breathing movements. Slowly inhale a deep breath, expanding the belly while keeping the chest mostly still. Then, exhale slowly through pursed lips, allowing the belly to deflate. Click here for a video demonstration.
- Practice this technique as often as desired.
- Although a relaxed seated position or lying supine is optimal for this technique, it can be practiced in any position or location.
Breathwork can be practiced on its own or in conjunction with other stress management strategies, such as yoga, journaling, meditation, or art therapy.3 In either case, it can help healthcare providers manage stress and promote wellbeing.
Breathwork in action
Healthcare providers can integrate breathwork into their daily routines, starting with three sessions a day at convenient times. Flexibility and self-acceptance in practicing breathwork are crucial for developing a personalized wellness routine.
Breathwork can be adapted to healthcare providers' specific needs. For example:
- A busy nurse caring for an unstable patient might practice one round of 4-7-8 breathwork during moments at the computer or medication dispensary.
- A specialist having trouble falling asleep due to racing thoughts could practice three rounds of diaphragmatic breathwork while lying in bed.
- A physician preparing for a challenging conversation with a patient's family may practice box breathing just before entering the patient's room.
1. Hersch RK, et al. Applied Nursing Research. 2016;32:18-25.
2. Søvold LE, et al. Frontier in Public Health. 2021;9:679397.
3. Shaw-Metz JL. The Journal of Interprofessional Education & Practice. 2023;30:100594.
4. Lewandowska K, et al. International Journal of Environmental Research and Public Health. 2020;17(22):8409.
5. Aideyan B, et al. Journal of Mental Health Counseling. 2020;42(1):78-94.
6. Liu Y, et al. Sleep Medicine. 2021;78:8-14. doi:10.1016/j.sleep.2020.12.003
7. Norelli SK, et al. StatPearls Publishing; 2023. http://www.ncbi.nlm.nih.gov/books/NBK513238/
8. Weil, Andrew, 1995
9. Hamasaki H. Medicines. 2020;7(10):65.
