Breath as a healing tool: How a yoga therapist might use pranayama

By J. J. Gormley

Pranayama, or breathwork, may seem really strange to beginning yogis, but it’s such a powerful tool—one of the key practices in yoga therapy, in fact—that it’s well worth exploring. Although yoga therapists take years of training to help them guide clients to use their breath for specific therapeutic goals, the practices themselves need not be intimidating at all.

Although more research is needed, a slower breath rate is generally considered to have positive effects on health (see this review study, for example). In my training programs, we learn to gently lengthen the breath by counting it in seconds. That can be less-than-relaxing for clients, though, so we might take a different approach, offering them something less cerebral to monitor when they start. We might have the client use phrases such as, “I am inhaling” (said silently on the inhale) and, “Now I’m exhaling” (on the exhale). To lengthen the breath, we can simply add words over time: “Now I’m exhaling longer,” and eventually, “Now I’m exhaling even longer still.”

Photo by Valeriia Bugaiova

Energetic effects

In yoga therapy, we can also use the breath to help clients shift their energetic state. We can think of energy as being more “up” or active (brahmana), more “down” or calm (langhana), or “even-keeled” or balanced (samana). Here are a few of the many possible ways we might use pranayama techniques to help a client change their state of energy.

Say the yoga therapist has a client who has been depressed, with very low energy, or perhaps has chronic fatigue syndrome. The yoga therapist might recommend increasing or expanding the breath, which could help uplift the person’s energy. We might ask them to do a practice similar to the length-monitoring one outlined above (“Now I’m exhaling…”), focusing on slowly making changes by focusing on one aspect of the breath at a time and pausing to notice the effects. Through processes like this, the breath should always feel at ease and not forced; the idea is to keep the breath smooth, relaxed, and easeful.

Maybe another client needs more calming, and not too uplifting of a practice; perhaps this person is more agitated or anxious. We would want to use the exhale, which helps to activate the parasympathetic nervous system (PNS). The PNS is the part of the nervous system that calms and quiets us—it is commonly called the rest and digest part of the nervous system (as opposed to the sympathetic nervous system, responsible for fight or flight). For the client who needs to activate the PNS to calm and quiet the nervous system, we might lengthen the exhale only, again gently and step by step. This type of practice could also be used, for example, with someone who has difficulty falling asleep.

Or perhaps the yoga therapist has a client who is too heated, as in menopause, so to help cool them we could give a pranayama technique such as sitali, in which the inhalation comes through the mouth, through a curled tongue as the head moves up. We might also suggest exhaling through alternate nostrils to further enhance the calming effect.

For a client who has sways in emotion, such as someone moving through grief, we would keep the inhale and exhale balanced. A good technique for this person would be ujjayi pranayama, known for bringing balance. Ujjayi is done by bringing a slight constriction to the throat, which slows the rate of breath.

Yoga therapists have many tools in their toolboxes—using breath in particular ways is just one of many. Even when we focus on working with the breath, simple movements could be involved. Linking movement with the breath is a useful starting point for many, not only helping clients to be present in the breath, but also allowing for easier pacing and bringing increased mindfulness. Pranayama or breath-focused practices usually are quite effective, as they help us directly affect the nervous system, which is such a large part of the healing process.

J. J. Gormley, MS, C-IAYT, is a yoga educator, yoga therapist, and nutritionist. She is the executive director of Surya Chandra Healing Yoga School and resides in Madison, Virginia.