The Importance of Providing Accurate Belly Breathing Instructions

At some point in nearly every therapist's career, they will instruct a client to practice belly breathing. It is a cornerstone of anxiety management, a staple of the coping skills toolkit, and a technique so widely taught that it has become almost reflexive.

And at some point in nearly every therapist's career, they will watch a client do something with that instruction that was not what they had in mind.

This article is about that moment.

What You Said

"I want you to breathe into your belly. Let it expand. Don't force it — just let the air go all the way down."

You have said this hundreds of times. It has always worked. You have never once considered that it might require further clarification.

What They Heard

"Push your stomach out as far as it will go. Hold it there. Make it look like you have swallowed something large and round. Maintain eye contact."

The client is now sitting across from you with their abdomen fully extended, cheeks puffed, expression one of intense concentration and mild defiance. They are breathing. Technically. You cannot fault the effort.

The Therapist's Internal Experience at This Moment

• —A brief pause in which you process what you are seeing.
• —A second, longer pause in which you decide how to respond.
• —A third pause in which you consider whether this is, technically, correct. (It is not. But it is also not entirely wrong.)
• —A quiet internal note to revise your instructions going forward.
• —A decision to write this down later. Possibly for a website.

A Brief History of Ambiguous Breathing Instructions

The phrase "breathe into your belly" is, if you think about it for more than four seconds, anatomically confusing. Air does not go into your belly. Your belly does not have lungs. What we mean, of course, is diaphragmatic breathing — the diaphragm descends, the abdomen rises, the chest stays relatively still.

What the client in the photograph understood is that the belly should be involved, prominently, and with commitment. He is not wrong about the belly. He is wrong about almost everything else.

Revised Instructions (Field-Tested)

• —Place one hand on your chest and one hand on your stomach. The stomach hand should move. The chest hand should not move very much. If both hands are moving dramatically, we need to talk.
• —Inhale slowly through your nose. You are not inflating a balloon. You are not preparing to hold your breath underwater. You are simply breathing, with intention.
• —Your belly will naturally rise as your diaphragm descends. This is not a performance. You do not need to assist it manually.
• —Exhale slowly. Through your mouth, if that feels natural. Through your nose, if you prefer. Not through your cheeks, which should remain in their usual position on your face.
• —Repeat. You should feel calmer. If you feel like you are auditioning for something, we have gone off track.

A Note to Clients

If you have ever done belly breathing in a therapy session and your therapist got very quiet and then said "good, yes, that's — yes" in a tone that suggested mild uncertainty, this article may be about you. That is okay. You were trying. The effort counts. The technique needs work.

Your therapist went home and revised their instructions. You made them a better clinician. This is, in its own way, therapeutic progress.