Rediscovering Vitality, Peacefulness, and Connection

Adapted from a presentation by the Myositis Support Group at the Hospital for Special Surgery

The following is an adaptation of a presentation delivered by Richard P. Brown, MD, and contains references to material from his book, “The Healing Power of the Breath,” co-authored with Patricia L. Gerbarg, M.D.

Dr. Brown discussed the effects of stress on inflammation, pain, illness, healing, and energy. He also explained how the use of breathing, gentle movement, and meditation may be of help.

Dr. Brown began by asking the group what they would like to learn this evening. Answers included:

  • How to cope with a body that is less mobile
  • How to reduce depression
  • How to feel better naturally and not require so much medication
  • How to achieve substantial reduction of all symptoms
  • How to feel less demoralized

How Proper Breathing May be Helpful

Dr. Brown emphasized that the practice of breathing and the exercises that followed are not intended as a substitute for medical treatment. Before undertaking any additional treatment, patients must consult with their physicians.

Dr. Brown began with a simple explanation of how stress is produced in the body and some of the negative effects on the stress response system.

Any change causes a stress response. The type of stress response depends on the degree or nature of the stressor. Small amounts of stress can be good for us, as it can provide quick bursts of energy for survival, increase memory function, and lower sensitivity to pain. The autonomic nervous system is the part of the brain that controls the stress response. Common responses to stress are:

  • increased heart rate
  • faster breathing
  • shivering and sweating, which can change body temperature

These messages are then sent to our organs and glands by the sympathetic and parasympathetic nervous systems, which offset each other. Most of the time, our systems do not require a strong stress response, and when the stress system is activated, it tends to stay this way until the body relaxes.

When the body is subjected to stress, it uses up more energy. When stress becomes unmanageable, there are negative effects on your emotional and physical health. This can range from excess worry and difficulty sleeping to anxiety, obsessive thinking, irritability, and when one is stressed for prolonged periods of time, muscle aches. In trying to cope with stress, the body produces increased adrenaline and cortisol and reacts in other ways that can not only burn more energy, but may increase inflammation.

The longer you are exposed to stressors, the greater the chance that the stress-response system is overtaxed. This can lead to depression, chronic fatigue, feelings of being overwhelmed and helpless, and to the progression of physical illnesses.

Feeling stressed can also affect breathing, making it more rapid or shallow. This can leave the individual feeling more anxious and with a decreased energy level. One way to change these patterns is to initiate different breathing techniques.
Dr. Brown and his colleague, Dr. Patricia Gerbarg, have developed a technique known as Total Breath. This is a combination of Coherent Breathing, Resistance Breathing, and Breath Moving. This technique is a way to achieve greater, healthier balance by activating the healing and recharging parts of the nervous system and quieting the defensive and energy-burning parts. According to Dr. Brown the effects of Coherent Breathing are aided by Resistance Breathing and Breath Moving. The different kinds of breathing are described below in further detail. The entire practice should take about 20 minutes.

Dr. Brown suggested using Resistance Breathing at the beginning of a 20-minute breathing practice, continuing until the throat muscles tire. After stopping Resistance Breathing, continue Coherent Breathing (described below) for the remainder of the practice time.* The overall goal of this type of breathing is to reduce stress and increase energy.

Dr. Brown noted that some people with myositis have issues with their throat and with swallowing. He strongly emphasized the need for patients to consult with their doctors before doing this type of breathing.

For those who are able to use the technique, Dr. Brown said, in order to achieve success, daily practice is advised. If done correctly, this practice may help reduce stress within 3-9 months.

Dr. Brown further described how the different types of breathing work.

Coherent Breathing

Activity in the parasympathetic nervous system (the healing and calming part of our nervous system) can be measured by using the natural fluctuations in heart rate associated with breathing to calculate heart rate variability (HRV). HRV is the difference in the number of heartbeats between breathing in and breathing out. You will notice that the heart beats faster when breathing in. HRV changes with the overall rate of breathing. Through scientific studies and observation, experts have determined that changing the rate and pattern of breathing changes HRV. [1, 2] Low HRV is a sign that something is a sign that the body is overstressed. Therefore, increasing HRV by altering rates and patterns of breathing is associated with a healthier cardiovascular system and a more balanced and resilient stress-response system, which may result in less wear on the body. With Coherent Breathing, you are breathing at a rate of five breaths per minute. Slowing the breath increases the HRV; optimal HRV depends on factors such as gender, stress level, mood, and overall fitness level.

Resistance Breathing

  • Once Coherent Breathing has been mastered, Resistance Breathing can begin.
  • Resistance Breathing, or Ocean Breathing, enhances Coherent Breathing by creating resistance to the flow of air. By slightly increasing pressure in the lungs, stimulating the nervous system that helps to soothe and re-energize the body (parasympathetic)*
  • Singing and chanting are two forms of this type of breathing.

Breath Moving

  • In a practice common to many mind-body traditions, Breath Moving requires use of the imagination to “move” breath and awareness to different parts of the body.
  • This is a way to improve circulation of energy through the nervous system, thus improving blood flow.
  • Dr. Brown discussed how Breath Moving adds to Coherent Breathing and Resistance Breathing by helping the mind stay focused.
  • It may be difficult for some people, such as those who have asthma, to do Coherent Breathing alone.
  • Breath Moving helps open the airways. Once this happens, it may be possible to slow the breath rate gradually.

Dr. Brown provided the following example:

  • Breathe in and imagine you are moving the breath to the top of your head.
  • As you breathe out, imagine that you are moving the breath to your sit bones and the base of your spine.
  • Each time you breathe in, move the breath to the top of your head.
  • Each time you breathe out, move the breath to the base of your spine.
  • Repeat 10 times.

It is important to be aware that some people get more energized by Breath Moving, while others become calmer and more relaxed. For those who become energized, it would be advisable not to use this type of breathing before bedtime. Instead, use only the Coherent Breathing and Resistance Breathing.

Dr. Brown led the group in a series of breathing exercises that lasted for about 10 minutes, as well as a meditation that also lasted for approximately 10 minutes.

Because many people hold a great deal of tension in our upper bodies, especially when we sit at the computer for long periods of time, he instructed the group in wrist rolls and shoulder rolls, as well as arm stretching and head rolls, while using resistance breathing.

The following resources provide additional information about reducing stress through breathing:


1. Brown RP and Gerbarg PL. (2012). The Healing Power of the Breath. (Boston, Shambhala).
2. Brown RP, Muench F, Gerbarg PL. Breathing practices for treatment of psychiatric and stress-related medical conditions. In Complementary and Integrative Therapies for Psychiatric Disorders, Edited by Phillip R. Muskin, Patricia L. Gerbarg, and Richard P. Brown. Psychiatric Clinics of North America. March 2013, 36(1):121-140.

* Please note that links to other sites, including those of HSS Web Site sponsors, are provided for informational purposes and do not constitute endorsements or recommendations by HSS or its faculty of those sites, or the information, materials, products or services contained on or accessible through the sites, and users’ access and use of such sites, including information, material, products and services on those sites, is solely at the risk of the users. The Hospital for Special Surgery is not responsible for information provided on any site to which it is linked.

Learn more about the Myositis Support Group


Richard P. Brown, MD

Associate Clinical Professor
Department of Psychiatry
Columbia University College of Physicians and Surgeons

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Summary completed by Suzan Fischbein, LCSW
Coordinator, Myositis Support Group at HSS

Edited by Nancy Novick

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