Expert Commentary

Help With Anxiety - An Exercise in Breathing Regulation for Patients

Philip Muskin, MD


Professor of Clinical Psychiatry: Columbia University
Chief of Service: Consultation-Liaison Psychiatry,
New York-Presbyterian Hospital/Columbia University Medical Center
New York, NY


When patients are breathing with rhythm and regularity, their heart rate synchronizes with respiration. Respiration aids in circulation, facilitating venous blood flow during inhalation and arterial flow during exhalation, heart emphasis shifting from right to left with each cycle of respiration. This synchrony results in a blood wave that enters the lungs during inhalation and exits the lungs during exhalation.


Often, in patients with anxiety or depressive disorders, the stress patients feel from the disorder results in sympathetic nerve signals from the brain that can cause irregular and increased heart rate.  Teaching patients to breath regularly and rhythmically can help overcome this heart rate variability, and can help them feel less anxious.  Here, Dr Muskin describes some simple, easy-to-master breathing exercises with the aid of a prerecorded clock and chime to teach your patients.  A CD with the tones is available to purchase from COHERENCE; read the resource by Drs Brown and Gerbarg (right).



1. Coherent breathing. Available at

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