Mindfulness Of Breathing
And Contemporary Breathwork Techniques


Dr. Joy Mann (1)

Keywords: Breathwork; Conscious Breathing Techniques; Therapeutic Breathwork; meditation; Rebirthing Breathwork; psychotherapy.

Joy, Many Thanks from Althealth for this article - Mike

This paper takes a meditation case history and proposes that the problem could have been treated more efficiently through the use of Conscious Breathing Techniques. (2) My position is that knowledge of meditation practice and technique enhances therapeutic Breathwork, and knowledge of therapeutic Breathwork techniques makes meditation more effective.

1. A meditation case history

Mark Epstein, in his book, Thoughts without a Thinker: psychotherapy from a Buddhist perspective, contains a meditation case history that demonstrates some very basic features of Breathwork meditation. (3) The first is that the breath is not a neutral object. Joe, a participant during a meditation retreat, "(finds) himself quite fearful of watching his breath(as) it felt dangerous and made him anxious." It takes three full days before Joe is able to concentrate on his breath again. We see from this that observing the breath has profound psychological consequences. This is hardly surprising as observing the breath is observing the process of consciousness itself.

The second feature is the close connection between Breathwork meditation and bodywork. The next stage in Joes Breathwork meditation was a peak experience "immediately followed by the feeling of an iron band constraining his abdomen, hurting him and restricting his breath." These feelings were so intense and unpleasant that meditation could not help Joe through them in any way: "No amount of attention, no change in position, no associated thoughts or feelings, no advice from his teachers seemed to affect the intensity of the sensations."

The third feature is the close connection between Breathwork meditation and both primal therapy and regression therapy. Joe finally stopped fighting his process. He stopped trying to induce the suggested meditative altered states of consciousness and he stopped trying to please his meditation teachers. Instead he surrendered to what was happening. Lying in one position and overcome by sadness, he "sobbed and shook for several hours." Eventually he remembered a traumatic childhood incident during which he had hidden from his raging father in the closet with his mouth filled with rags. This was when he had learned to hold his breath and to "bind all of his fear and rage and despair in the muscles of his abdomen."

In spite of the evidence which he cites, and despite his own observation (quoted above) that Joes unpleasant sensations could not be alleviated through any advice whatever from his meditation teachers, Epstein nevertheless asserts the efficacy of meditation, claiming that Joes realisation came through the meditative state rather than through therapy. He does, however, add this proviso, "(Joes) years of therapy obviously helped him see the experience through in a way that many other such traumatised people could not."

There is a gentle way of working with the breath therapeutically that would have brought Joe through his problem probably in one or two hours.

2. npnasati and psychotherapy

Joe's experience was evoked in the context of the Buddhist meditation on the breath, npnasati.. This practice concerns much more than the awareness of breathing. It shows the Buddhists using the breath in order to attain non-ordinary states of consciousness. If we analyse the sequence in the text, we see that the basic requirement is to have sufficient concentration to be able, for an extended period, to breathe with awareness.

The Anapanasati Sutta

The traditional Vipassana exercise of putting our attention on the breath is described like this in the pali Buddhist sutras. The Buddha says,

There is one dhamma, Monks, which when developed and practised frequently is very fruitful and deserves great praise. What is this one dhamma It is mindfulness of breathing. And how, Monks, is mindfulness of breathing developed How does it become very fruitful and deserving of great praise when practised frequently

This is how. A monk goes into the forest or to the foot of a tree or to an uninhabited place and sits with his legs crossed, and with his body erect he generates mindfulness and being mindful he breathes in and being mindful he breathes out.

As he breathes in a long breath he recognises that he is breathing in a long breath; as he breathes out a long breath, he recognises that he is breathing out a long breath. As he breathes in a short breath he recognises that he is breathing in a short breath; as he breathes out a short breath, he recognises that he is breathing out a short breath.

He trains himself to breath in experiencing his whole body and to breath out experiencing his whole body. He trains himself to breath in calming bodily activity and to breath out calming bodily activity.

He trains himself to breath in experiencing joy and to breath out experiencing joy; to breath in experiencing happiness and to breath out experiencing happiness.

He trains himself to breath in experiencing mental activity and to breath out experiencing mental activity; to breath in calming mental activity and to breath out calming mental activity; to breath in experiencing mind and to breath out experiencing mind.

He trains himself to breath in pleasing the mind, and to breath out pleasing the mind; to breath in concentrating the mind and to breath out concentrating the mind; to breath in releasing the mind and to breath out releasing the mind.

He trains himself to breath in observing impermanence and to breath out observing impermanence; to breath in observing freedom from passion and to breath out observing freedom from passion; to breath in observing cessation and to breath out observing cessation; to breath in observing renunciation and to breath out observing renunciation. (4)


The exercises begin with putting attention on the duration of one's breath. I think that everyone who has tried meditation will agree that it is impossible to be aware of the duration of one's breath without also becoming aware of its rhythm, the quantity of air one is inhaling and exhaling, the way the air is flowing into and out of the body and the movement of and feelings in the body as the air flows in and out of it. There is also awareness of whether the breath is easy or blocked and where it may be blocked. We are thus immediately in the realm of today's breath and body therapies and indeed Joes case history shows that comparable experiences will be evoked. Watching the breath can indeed feel fearful and dangerous and induce anxiety. Many traumatic situations result in the habit of holding or blocking the free flow of ones breathing.(5)

The next part of the exercise too has similarities with today's breath and body therapies. It uses the breath to experience the whole body. Experiencing the whole body may bring up various physical tensions such as the feelings of restricted or obstructed breathing or tension in the abdomen that came up in Joes case. As Epstein says, "Joe's story illustrates the power of meditation to focus us in on the places in our bodies where fear has taken hold." The exercise then goes on to using the breath to calm bodily activity. It is difficult to calm bodily activity without becoming aware of where the bodily activity is agitated, and working through psychotherapeutically the causes of the agitation. Epstein describes these as "the internalised remnants of chronic defensive reactions, fossilised within the body out of reach of our usual awareness." In the case history, Joes breath was constrained by the feeling of an iron band around his abdomen and this problem had to be worked through to the point of catharsis. As Epstein says, "when there has been a specific trauma, there is often a specific focal point in the body that needs to be experienced." This is classically the language and the process of body therapy.

The text then passes to using the breath to cultivate the particular emotional states of joy, and happiness. We read in the texts that the mind of someone who is happy is concentrated. (6) The purposeful cultivation of joy and happiness is likely to evoke the awareness of their absence, and also the experience of their opposites, sorrow and suffering, as well as emotions such as passion, hatred and delusion (7) which are considered particularly dangerous and harmful in the Buddhist texts. (8) Joy and happiness become possible when we have resolved enough of our life's suffering and when we have attained some degree of freedom from our intense emotions, hatreds and wrong ideas.

In this exercise, being able to produce states of joy and happiness at will, supported by the breath, is a prerequisite for confronting the mind. Only then does the meditator have enough concentration to use the breath to focus awareness upon experiencing mental activity, i.e. to become conscious of what is happening in her/his mind. Experiencing mental activity is what happens in every psychotherapy, unfortunately without the preparation of being able to enter stages of joy and happiness at will. The meditation continues with using the breath to calm mental activity. This includes purifying the mind by getting rid of certain hindrances which can be regarded as negative thought patterns, among them covetousness for the world, ill-will, apathy, agitation, regret and doubt. (9) Working through these mental states is also part of today's psychotherapies.

The breath is then used to experience mind: this is a state of being able to watch the mind without becoming involved with its multiple processes. This peaceful state cannot come about unless practitioners have worked through and integrated many of their life's problems. Otherwise, as is well known in psychotherapy, these keep coming up.

The next stage is to please the mind, keeping it contented and peaceful, so that it is possible to concentrate the mind, and release the mind. Then follows using the breath to observe impermanence, freedom from passion, cessation and renunciation.

All of these exercises and the states of consciousness that they induce are supported and energised by the breath. For most parts of this exercise, and certainly for practitioners on all but the highest levels, this is, in today's terms, psychotherapy using the breath as the means to gain access to the unconscious.

3. Rebirthing Breathwork and Meditation

The use of connected breathing techniques in personal and spiritual development was developed by Leonard Orr and Sondra Ray in 1977 as Rebirthing (Breathwork). (10) If you spend a moment observing your breathing you will notice that there is a pause between the inhale and the exhale, and again between the exhale and the inhale. Traditionally Rebirthing Breathwork is taught as strong and rapid connected breathing in the top of the chest, the pause between inhale and exhale being avoided. This is what I will mean when I refer to Rebirthing Breathwork in what follows. Hyperventilation is often connected with Rebirthing Breathwork, not always justifiably. (11) Rebirthing Breathwork got its name because its method of breathing frequently caused clients to relive their birth trauma. In fact, Rebirthing Breathwork is a powerful psychotherapy and brings up the same material as psychoanalysis. (12) The breath is the "royal expressway" to the unconscious. Rebirthing Breathwork goes further than psychoanalysis, however: Breathwork induces transpersonal experiences as the Buddhist text on awareness of the breathing shows.

There are certain common problems between practitioners of meditation and clients in Rebirthing Breathwork, usually called rebirthees. In Rebirthing Breathwork, as in meditation, there are people who can just do it. Rebirthing Breathwork and meditation work for these clients. They have good concentration and awareness. They cope with the experiences that come up, remain stable, integrate what happens and make good progress. There are people who can neither meditate nor do Rebirthing Breathwork. In meditation, they have insufficient concentration: their minds wander, they daydream or they fall asleep. (13) In this way they escape the experiences that meditation may induce. Another outcome for meditators who have insufficient awareness is that they become very rigid in their minds and bodies through fighting out of their consciousness with sheer will-power the experiences they cannot integrate. These meditators hold on to the meditation object with grim determination which they mistake for concentration. In Rebirthing Breathwork there is a second person present, so mind-wandering and daydreaming are more difficult, although clients do sometimes fall asleep.(12) Further, there is a witness there to draw the clients attention to rigid body holding. Rebirthing Breathwork clients may also suffer from tetany, a temporary painful paralysis of the hands and sometimes of the mouth, too, during sessions. Tetany is said to be caused by hyperventilation. (15) Hyperventilation forces into consciousness painful experiences, or evokes non-ordinary states of consciousness, that the client may not be ready to integrate. This accounts for the hysteria frequently present in groups where hyperventilation is practised. Tetany is the psyche's way of preventing this abuse from taking place.

Both meditation and Rebirthing Breathwork can bring up extreme experiences. These may be traumatic memories, ecstatic states, and other altered states of consciousness. (16) The incident in the present case history is an example of a traumatic event evoked through meditation. When the foundation of personal development is insufficient for the integration of these experiences, various more or less serious problems may ensue. The strong ecstatic experiences can cause people without a solid foundation to lose contact with reality and to become flippy. There are many examples in the Buddhist texts of people who wanted to out-Buddha the Buddha, imagining they knew more than he did. One Sarabha claimed that he gave up being a follower of the Buddha for the reason that he understood the Buddha's teaching. The Buddha challenged Sarabha to repeat this claim in his presence. Sarabha could not, and so his claim was exposed as false. (17) Contemporary meditators, too, may come to believe that they are enlightened, boast about it and start playing the "Teacher." (18) In Rebirthing Breathwork, practitioners may take up various types of rather odd religious beliefs (belief in the possibility of physical immortality is frequent) (19) or fall into other types of unrealistic beliefs or superstitious thought. (20)

These are the main kinds of outcome that I noticed both with meditation and Rebirthing Breathwork. These outcomes are not mutually exclusive. Many clients will go beyond tetany after a number of sessions and be able to open up and integrate the material that comes up. Many meditators and rebirthees who have spent some time being unrealistic will become realistic. With confidence and knowledge, people who have sought safety in rigid defences become more flexible.

4. Meditation influences Rebirthing Breathwork

My experience with Vipassana meditation, the Buddhist breathing exercises, (21) and my study of Buddhist Texts influenced my practice of Rebirthing Breathwork, and eventually I came to an adaptation which I now call Conscious Breathing Techniques. This is a six part structure for using the breath in therapy and for personal and spiritual development. The structure is:

part 1. Awareness Work with the Breath and Analytical Breathwork;
part 2. Introduction to Independent Breathwork;
part 3. Inducing Conscious Connected Breathing;
part 4. Working the Breath;
part 5. Advanced Energy Work with the Breath;
part 6. Advanced Awareness work with the Breath. (22)

This influence was not systematic except for one point: as in the exercises the breath is used as a support for awareness and the cultivation of specific states of consciousness.

5. Conscious Breathing Techniques influence meditation

I will briefly describe the various stages of the structure and relate them to the experiences Joe went through in his meditation practice to show hypothetically how Conscious Breathing Techniques could contribute to a more effective practice of meditation.

Many people do not naturally have basic awareness and have to learn it. The Buddha says, "the practice of mindfulness of breathing in and out is not for one who is careless in mindfulness or inattentive." (23) So the first step in working with the breath is to teach awareness and analysis. The one leads to the other.

In Joe's case history, his fearfulness of watching his breath could have been treated through awareness in the following way: When Joe feels an iron band around his stomach, he can be encouraged to breath into that area and to use his breath to explore the iron band. In other words, to increase his awareness of the situation he describes and to explore it with his awareness. The realisation and consequent release usually come very quickly. In this case, it was some days before the meditator realised that, "all of his fear and rage and despair in the muscles of his abdomen, (and) the iron band around his diaphragm was the feeling that resulted from his sobbing and holding his breath, (stifling his reactions so as not to set off his father), with his diaphragm rising and falling until it cramped."

Joe's fear could also have been treated analytically through the use of precisely relevant questions or instructions while he was attending to his breathing, e.g. "Tell me about this fear of watching your breath," or "What is your relationship with your breath", or "Do you often have feelings of tension in your abdomen" or "Tell me about feelings of tension in your abdomen." Again, one would expect the client to come rather quickly to realise that he had a habit of holding his breath, and to connect that to his father's treatment of him and possibly to other traumatic events. Joe's fidgeting could be similarly treated with awareness and analysis. Here the technique would either be to avoid it or to enhance it. In order to avoid it the instruction would be, "Be aware of your urge to fidget, but do not do it. Just keep connected to your breath and be aware of this urge." In order to enhance it the instruction would be "Fidget consciously. Make the movements your body wants to make. Really go into this, and all the time remain connected to your breathing." Here I would expect that after very few minutes Joes body would have ended up repeating the position in the cupboard. Whatever the instructions, the breathing is at all times the anchor, the source of grounding, the support for mindfulness. In both awareness work with the breath and analytical breathwork, clients remain grounded in their breathing, speaking only on their out-breath, so that their conscious breathing continues to energise their process. Both methods: awareness work and analysis, would be likely to result in catharsis, understanding and integration.

The second step of the structure is the Introduction to Independent Breathwork. This happens when clients are aware of what is happening in their minds and bodies and can concentrate on it. With regard to our hypothetical treatment of Joes case history: if he had been capable of this level of conscious breathwork, he would spontaneously have had his attention on his bodily feelings and have been able to keep it there. He would have known how to observe these feelings, analyse them and integrate what he discovered as he worked. It is easy for the trained breathworker to support a client in such a situation if the client can work at this level. Good accompaniment would have helped Joe to move through his fear of his breath and to integration of the traumatic event that caused it. Many Conscious breathing techniques that facilitate discharge of tension are available. In this situation one possibility is to invite the client to breathe into the area of tension and to release the tension on the out breath.

Effective meditation depends on competence in these first two stages of Conscious Breathwork.

Inducing Conscious Connected Breathing is the third part of this structured way of doing Breathwork. This means inviting the client to breath in such a way that pauses between in- and out-, and out- and in-breaths are eliminated. This is done once clients have a good foundation: i.e. they are grounded, their self-awareness is good, their awareness of their body is good, and their self-esteem is good. Then they are ready to integrate stronger experiences. Connected breathing is more likely to lead to trance states although it will not necessarily do so. It will certainly lead to strong experiences and that is why it should only be induced with clients who have already developed a sufficiently solid foundation to be able to integrate these. Connected breathing may be proposed, but it should never be imposed. Connected breathing is not hyperventilation.

From the case history, it seems possible that Joe was in a breathing trance: it seems that his breath was breathing him into an experience and holding him there. He could not get out of the process or shake it off, but had to work it through. Augmented breathing (see 4 below) and connected breathing give energy to such a process. Although what has to be gone through may be unpleasant, the support of the breathworker makes it easier and gives ongoing guidance. In this process, what might have happened to Joe if he had been working at this level is an intensification of the feeling of choking over a short period (usually only minutes) followed by the realisation of its cause and a discharge of the tension held through childhood.

The fourth stage is Working the Breath. Rebirthing Breathwork is also called "conscious connected breathing" as the in-breath and the out-breath are connected and form a continuous cycle. It is unfortunately often associated with rapid breathing in the upper chest area which is an unnecessarily limiting way of using connected breathing. Conscious connected breathing can take any form and rhythm and can be focussed on any body zone. Working the Breath means any rhythm of consciously connected breathing intentionally undertaken and worked purposefully and with discipline like a physical exercise. This consciously augmented breathing is not to be confused with hyperventilation (24) which I categorically exclude from my practice: there is nothing meditative or conscious in hyperventilation.

When working the breath, the goals for the session are discussed and an appropriate rhythm of breathing and part of the body where the breath should happen is proposed. There is an agreement between client and therapist that if what has been proposed does not happen, whatever is happening will be honoured, as the true practice of awareness in meditation demands (and which, incidentally, does not seem to have been proposed by Joes meditation teachers). The breath is an honest guide on the path of development.

This way of breathing induces intense emotional experiences, regressions and higher states of consciousness. When we have learned to contain ourselves and can integrate strong experiences, we are ready to work with the consciously connected breath without fear. We are ready to play with our breath and have adventures with it. Breathwork consciously undertaken, in strength and not through an overwhelming upsurgence of the unconscious, can lead to shamanic experiences at this stage. Stanislav Grof's Holotropic BreathworkJ belongs in this part of this structure.

Epsteins account of Joes case history does not say what kind of breathing took place at which stage, and so I cannot comment on it in this part of the structure.

parts 5 and 6 are not relevant to Joes case history. In Advanced Energy Work with the Breath advanced practitioners use their breath to purposefully clear out from their energy-field their aura and chakras unproductive thoughts, habits and attitudes, unnecessary influences, old relationship problems and tendencies towards relationship problems, and the energy left over from past life problems and experiences. These clients are able to practise all the parts of the npnasati exercise. Advanced awareness work with the breath is meditation. A client who has reached this stage no longer needs to be accompanied by a therapist.

6. Accompanied Meditation

Conscious Breathing techniques are a form of meditation for two, which is how David Brazier describes his Zen Therapy. (25) The therapist holds the space, helps the client to keep her/his attention on what is happening, and supports the client through difficult experiences.

This form of "supported meditation" is an effective therapeutic method which surely has its uses in the teaching and practice of meditation. It would certainly prevent meditators from getting lost in their process for long periods of time, as happened to Joe.

1. This paper was presented at the conference The psychology of Awakening: Buddhism, Science and psychotherapy, Dartington Hall, November 1996 and first published in Watson et al. The only changes I have made are: 1. to add the Anapanasati sutta and the subheadings in that section. I have had to leave out the diacritical marks in the transliterated pali through publishing constraints. 2. To replace Rebirthing with Rebirthing Breathwork. This avoids confusion with other completely unrelated techniques that call themselves Rebirthing.
2. Mann, 1994, 1995, 1997.
3. See Epstein, 1995, pp. 168-170 and my review, Mann, 1997.i.
4. Majjhima-Nikaya III. pp.82f. London : pali Text Society, 1977. My translation.
5. Boadella, 1994, Conway, 1994, proskauer, 1994.
6. Joy Mann, 1995(i).
7. raga, dosa, moha.
8. Joy Mann, 1995.ii, Brazier, 1995.
9. abhijjha loke, vyapada, thana, middha, uddhacca, kukkucca, vicikiccha. Mann, 1995(i).
10. Orr & Ray, 1983.
11. Mann, 1995.
12. Mann, 1994, 1995.
13. Engler, 1984:33.
14. Taylor, p.81-83.
15. See Albery, 1985:84-120; Karl Raab, 1992:155-167.
16. Engler, 1984:26; Mann, 1997.
17. Anguttara Nikaya, I 187, see Mann, 1996.
18. Engler, 1984:33, 37.
19. Mann, 1995, 1996.i, 1997.
20. See Albery, p.68f and elsewhere: Mann, 1995.
21. Mann, 1995.
22. Mann, 1995, 1997 and forthcoming, The Breathwork process: Varieties of Breathwork Experience; From Rebirthing Breathwork Through Conscious Breathing Techniques to Shamanic Breathwork and Breathwork Meditation.
23. Majjhima Nikaya III, 84.
24. Taylor and Mann, 1999.
25. Brazier, 1995:61.


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(1995) Rebirthing - Is it Marvelous or Terrible' The Therapist : Journal of the European Therapy Studies Institute, Spring 1995.

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(1999), Dialogue on Hyperventilation between Kylea Taylor and Joy Mann. In The Healing Breath: A Journal of Breathwork practice, psychology and Spirituality, Vol. 1, No.2, May 1999.

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For further information about Breathwork of all kinds, contact the International Breathwork Foundation at

About the Author

Joy Mann has a degree in psychology and a phD in Buddhist psychology. She has practised Vipassana meditation since 1965, taught by Dhiravamsa. She was trained in Spiritual Therapy by Hans Mensink and Tilke platteel-Deur in Holland, 1986-1988. She had her own school of personal and spiritual development in Switzerland between 1989-1995. She is the founder and Editor-in-Chief of the peer-review internet journal The Healing Breath: a Journal of Breathwork practice, psychology and Spirituality available through She has written numerous articles, on Buddhist psychology, Breathwork and the relationship between them, as well as textual studies on the Theravada Buddhist literature in pali. She is the author of Soul Therapy (North Atlantic Books, Berkeley, CA, 1997), a discerning persons guide to personal and spiritual development, which has been translated into Spanish; the shamanovel The Way of the Breath freely available at; and The Breathwork process: From Rebirthing Breathwork through Conscious Breathing Techniques to Shamanic Breathwork and Breathwork Meditation (forthcoming, 2003).

She was a founder member of the International Breathwork Foundation ( and its Newsletter Editor between 1997-2001. She is a major influence in establishing professionalism and professional standards on every level in Breathwork.

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