Breathing Through the Panic
How Deep Diaphragmatic Breathing and Hypercapnic Training May Prevent Anxiety
In recent years, a growing body of research has spotlighted the decisive role of breathing interventions in mental health, especially concerning anxiety. While deep diaphragmatic breathing has long been lauded for calming the nervous system, hypercapnic training—exposure to elevated carbon dioxide (CO₂)—is emerging as a fascinating, albeit counterintuitive, strategy for increasing emotional resilience and reducing anxiety sensitivity.
But can breathing techniques truly help prevent anxious thoughts? Does repeated CO₂ exposure toughen the mind against panic and fear? Let’s explore the science behind these methods.
The Case for Deep Diaphragmatic Breathing
Diaphragmatic breathing, called belly breathing, activates the parasympathetic nervous system, which is responsible for the body’s rest-and-digest functions. When practiced regularly, this type of breathing slows the heart rate, lowers cortisol, and improves heart rate variability (HRV)—all linked to reduced anxiety.
A comprehensive review by Yohannes et al. (2017) demonstrated that breathing techniques effectively reduce anxiety and dyspnea in chronic obstructive pulmonary disease patients, suggesting broader applications for mental well-being.
Yohannes, A.M., Junkes-Cunha, M., Smith, J., & Watson, J. (2017). Management of dyspnea and anxiety in chronic obstructive pulmonary disease: A critical review. Journal of the American Medical Directors Association, 18(2), 109–114. Link
Hypercapnic Training: Anxiety Exposure Therapy for the Nervous System?
Hypercapnic training involves brief, controlled exposures to elevated CO₂ levels, which simulate the physical sensations of anxiety—racing heart, shortness of breath, and dizziness. But here’s the twist: repeated exposure desensitizes the brain to these sensations, reducing fear responses over time.
Key Findings from Scientific Research:
1. Hypercapnic resilience as a protective trait
Di Credico et al. (2022) found that baroreflex sensitivity (BRS) predicted resilience to anxiety induced by CO₂ exposure. Individuals with higher BRS showed lower anxiety responses.
Di Credico, C., Rosenberg, M., & Eastwood, P. (2022). Baroreflex sensitivity and anxiety during CO₂ exposure. Int. J. Psychophysiol. Link
2. CO₂ tolerance correlates with emotional toughness
A study by Battaglia (2002) revealed that those with heightened panic sensitivity had stronger reactions to hypercapnic challenges, implying a potential training window for anxiety-prone individuals. Battaglia, M. (2002). A cholinergic route for panic attacks. Molecular Psychiatry, 7, 284–286. PDF
3. Military resilience under CO₂ stress
Telch et al. (2012) assessed soldiers’ panic responses to a 35% CO₂ challenge and tracked their PTSD/anxiety symptoms post-deployment. Higher reactivity predicted vulnerability, suggesting CO₂ reactivity could serve as a diagnostic and training marker.
Telch, M.J., Rosenfield, D., & Lee, H.J. (2012). Reactivity to CO₂ challenge and later PTSD/anxiety in soldiers. JAMA Psychiatry, 69(12), 1161–1168. PDF
4. CART therapy and trait anxiety
A 2023 dissertation by Hasratian revealed that individuals undergoing Capnometry-Assisted Respiratory Training (CART), which modulates CO₂ levels, showed reductions in anxiety symptoms. Hasratian, A. (2023). CO₂ in Capnometry-Assisted Respiratory Training. SMU Dissertations. PDF
5. Physiological mechanisms—ventilatory adaptation
A recent paper by van der Schrier et al. (2022) explored how carbon dioxide tolerance reflects stress resilience, especially in older adults with diminished adaptive capacity.
⚖️ The Interplay: Breath Control and Anxiety Control
When diaphragmatic breathing is combined with graded exposure to CO₂, individuals may be training both the body’s autonomic response and the mind’s cognitive response to panic sensations.
This dual approach:
• Enhances interoceptive awareness (awareness of internal bodily sensations),
• Reduces anxiety sensitivity,
• Builds psychophysiological resilience.
Niedermeier et al. (2022) call this a form of psychological conditioning, likening it to how athletes train under pressure.
Where This Leads: We’re at the frontier of next-gen anxiety interventions. Traditional talk therapy and SSRIs aren’t the only tools in the mental health toolkit anymore. Breathwork and CO₂ exposure therapy represent low-cost, scalable, somatic interventions that could prevent and manage anxiety in resilient and at-risk populations alike.
Final Thoughts: If you’ve ever felt breathless from panic, the solution may be in… breathing itself but with precision, practice, and perhaps a puff of CO₂.
References:
1. Burtscher, J., Niedermeier, M., Hüfner, K., et al. (2022). The interplay of hypoxic and mental stress: Implications for anxiety. Neuroscience & Biobehavioral Reviews, 139, 104701. Link
2. Van der Schrier, R., van Velzen, M., & Roozekrans, M. (2022). CO₂ tolerability and toxicity in rat and man. Frontiers in Toxicology, 4, 1001709. PDF\
Di Credico et al., 2022 – International Journal of Psychophysiology
3. Battaglia, 2002 – Molecular Psychiatry PDF
4. Telch et al., 2012 – JAMA Psychiatry
5. Hasratian, 2023 – SMU Dissertation PDF
6. Van der Schrier et al., 2022 – Frontiers in Toxicology
7. Yohannes et al., 2017 – JAMDA
8. Drigas & Mitsea, 2022 – Technium Social Sciences Journal