Why Deep Breathing Makes Anxiety Worse

Low Tide Blog · Breathwork & Anxiety

Why "Take A Deep Breath" is the Worst Advice You Can Give an Anxious Person

12 April 2026 · 14 minute read

You have heard it a thousand times. From therapists, from apps, from well-meaning friends, from your mother. You are anxious, overwhelmed, mid-spiral, and someone tells you to take a deep breath.

So you do. You suck in a big lungful of air. And you feel worse. Dizzier. Lighter in the head. Your chest tightens. Your hands tingle. Now you are anxious about the breathing on top of whatever you were already anxious about.

If this is you, there is nothing wrong with you. The advice is the problem, not your nervous system.

I say this as someone who lives with ADHD and spent years assuming breathwork was not for me because every technique I tried seemed to make things worse. It was not until I trained in the Buteyko method that I understood why, and why the solution is the exact opposite of what most people are told.

What actually happens when you "take a deep breath"

When someone is anxious or panicking, their breathing is already disrupted. It tends to be fast, shallow, and centred in the upper chest rather than the diaphragm. The sympathetic nervous system (fight or flight) is running the show. The standard advice assumes that taking a big, deep breath will counteract this by flooding the body with oxygen. The problem is that oxygen is not what your body is short on.

A clinical psychologist writing in Psychology Today explains that during hyperventilation, there is already too much oxygen in your system relative to the amount of carbon dioxide, and that taking a big gulp of air extends and exacerbates the hyperventilation cycle. You are not calming down. You are doubling down on the exact breathing pattern that is causing the symptoms.

This is not fringe science. Johns Hopkins Medicine states directly that the goal when treating hyperventilation is to raise the carbon dioxide level in the blood, and that to increase CO2, you need to take in less oxygen. That is why the old paper bag trick works. It recirculates CO2.

Someone telling you to take a deep breath during a panic attack is, with the best of intentions, telling you to do more of the thing that is making you panic.

The Bohr effect: the bit nobody explains

Here is where it gets interesting, and where most breathwork content on the internet falls short.

There is a well-established principle in respiratory physiology called the Bohr effect, first described in 1904 by Danish physiologist Christian Bohr. It describes how haemoglobin, the protein in your red blood cells that carries oxygen, adjusts its grip on oxygen based on the levels of carbon dioxide and pH in your blood.

In simple terms: when CO2 levels are adequate, haemoglobin releases oxygen to your tissues efficiently. When CO2 drops too low, as it does during hyperventilation or big deep breathing, haemoglobin holds onto its oxygen more tightly. Your blood is technically saturated with oxygen. But your cells, including your brain cells, are not getting as much of it delivered.

This is not a theory. It is textbook physiology. The StatPearls medical resource published by the National Library of Medicine confirms that the Bohr effect describes haemoglobin's lower affinity for oxygen release when CO2 is reduced and blood pH increases. A decrease in CO2 provokes an increase in pH, which results in haemoglobin picking up more oxygen and releasing less of it to tissues.

Read that again. More breathing can mean less oxygen where it counts.

This is the paradox that most "just breathe" advice completely ignores. The person gasping for air during a panic attack feels like they cannot get enough oxygen. But the sensation of air hunger is driven by CO2 sensitivity, not by an actual lack of oxygen. Published research on panic disorder by Meuret and Ritz (2010) in the International Journal of Psychophysiology confirms that clinical and experimental studies have linked reductions in CO2 levels (hypocapnia) to emotional states including overwhelming stress and panic, and that a wide range of patients with anxiety disorders have been found to have low CO2 values. Their oxygen saturation is almost certainly fine. Their CO2 is depleted. And every big breath depletes it further.

Why this hits differently if you have ADHD

This is where I stop talking in the abstract and start talking about what I see in my own life and in clients.

I want to be very clear about something before I go any further: mouth breathing does not cause ADHD. ADHD is a neurodevelopmental condition with strong genetic and neurological roots. It is not a breathing problem, and no amount of nasal breathing is going to rewire the dopaminergic pathways that make ADHD what it is. Anyone telling you otherwise is selling something.

What is true, and what the research does support, is that there is a significant overlap between ADHD and dysfunctional breathing patterns. People with ADHD are more likely to be chronic mouth breathers, and dysfunctional breathing appears to be more common in children with attention and sleep-related difficulties. Children with ADHD tend to have a higher incidence of allergic rhinitis and nasal congestion, and sleep-disordered breathing (including snoring and sleep apnoea) is associated with a meaningfully increased risk of attention and learning difficulties.

A point of honesty about the evidence here: specific percentage claims linking sleep-disordered breathing to ADHD diagnosis rates (for example, "40% of children with sleep disorders develop ADHD or a learning disability") are widely cited in Buteyko-adjacent literature but trace back to secondary sources rather than primary research. The Illidi et al. 2023 review in the European Journal of Applied Physiology (see sources below) explicitly calls out the practice of citing studies on allergic rhinitis to imply Buteyko reduces ADHD risk. I am not making that claim here, but you deserve to know the criticism exists.

The mechanism by which dysfunctional breathing can worsen existing ADHD symptoms is better understood than the old "less oxygen to the brain" framing suggests. Chronic overbreathing keeps CO2 levels low, and low CO2 triggers two separate but related problems in the brain at once.

First, reduced CO2 causes cerebral blood vessels to constrict, which reduces cerebral blood flow and decreases oxygen delivery to brain tissue. A clinical review on hyperventilation in neurological patients (Brian et al., 2019) confirms that hyperventilation causes cerebral vasoconstriction, reduces cerebral blood flow and volume, and decreases oxygen delivery. Separate research on the cerebrovascular effects of hyperventilation notes that after only two minutes of sustained hyperventilation, cerebral blood flow can drop to levels considered critically low for normal brain function.

Second, the resulting rise in blood pH, known as respiratory alkalosis, directly increases neuronal excitability by altering the behaviour of voltage-gated and ligand-gated ion channels in nerve cells. A study on hyperventilation and EEG activation (Kim et al., 2023) confirms that hyperventilation produces respiratory alkalosis and cerebral vasoconstriction, which together result in reduced cerebral blood flow, lower delivery of energy substrates to the brain, and increased neuronal excitability. A separate study on corticospinal excitability found that hypocapnia is independently associated with increased neuronal excitability in the motor cortex, even when cerebral blood flow changes are controlled for.

In plain English: the brain gets less fuel and becomes more jittery at the same time. Neurons become easier to excite, membrane stability decreases, and the whole system tilts toward overactivation. Add that to an ADHD nervous system that is already working harder than most to regulate attention and impulse control, and you have a physiological cocktail that makes fog, restlessness, and distractibility worse.

Buteyko will not cure your ADHD. But it might stop your breathing from making it louder.

What Buteyko does differently

The Buteyko method flips the standard advice on its head. Instead of breathing more, you learn to breathe less.

That sounds counterintuitive, and honestly, it felt counterintuitive the first time I tried it. The method involves gentle nasal breathing with a deliberately light, quiet, barely perceptible breath. No big inhales. No dramatic exhales. No forcing. The goal is to gradually increase your body's tolerance to carbon dioxide through reduced breathing volume and controlled breath holds. Buteyko's history and evidence goes deeper into the mechanism.

The key measurement in Buteyko is the Control Pause (sometimes called the BOLT score): the number of seconds you can comfortably hold your breath after a normal exhale before feeling the first urge to breathe. It is not a competition. You are not holding until you go blue. You are measuring how quickly your body panics at a small rise in CO2.

Most people who come to me for breathwork sessions score between 10 and 18 seconds on their first measurement. That is not a failure. That is information. It tells us exactly where to start and gives us something concrete to track over time. Each 5-second improvement tends to come with a noticeable reduction in symptoms.

Why this works for people who have given up on breathwork

Here is what I think makes Buteyko different from most breathwork modalities, and why it lands particularly well with neurodivergent clients.

First, it does not ask you to go inward in a way that feels unsafe. There is no eyes-closed "observe your inner landscape" instruction that leaves you trapped with your own spiralling thoughts. You are breathing through your nose, lightly, and paying attention to the sensation of air at your nostrils. It is external, tangible, and specific. For someone with ADHD whose brain treats silence like a vacuum that needs filling with catastrophic thoughts, that specificity is everything. Breathwork and mindfulness for neurodivergent minds goes deeper on this.

Second, it does not rely on big dramatic breaths that can trigger hyperventilation. The entire philosophy is less air, not more. For someone who has tried box breathing during a panic attack and felt worse, this is a fundamentally different experience.

Third, it gives you a number. The Control Pause is objective, trackable, and responds to practice. For an ADHD brain that thrives on concrete feedback and visible progress, that is not a small thing.

And fourth, the underlying physiological principles that Buteyko trades on (slow breathing, reduced volume, extended exhales, nasal breathing) show up consistently in evidence-based respiratory physiotherapy and clinical research. Gerbarg and Brown (2016) in Psychiatric Times describe how slow, controlled breathing techniques increase heart rate variability (a marker of vagal tone and parasympathetic function) and reduce stress markers. Extending, slowing, and holding respiration are considered vagal manoeuvres that stimulate the vagus nerve, which is your body's primary brake pedal for the stress response. Polyvagal theory and somatics explained covers the underlying nervous system framework.

The case against Buteyko (and why you should hear it)

If I am going to recommend this method, I owe you the counter-argument. And the counter-argument is not trivial.

The Buteyko method is not widely accepted in mainstream medicine. A thorough analysis published on Science-Based Medicine (Albietz, 2011) reviewed all available Buteyko studies on PubMed and found that of the three studies designed to test Buteyko's proposed mechanisms of action, none supported his theories. The five studies comparing Buteyko to a control for asthma treatment showed some reduction in medication use, but no change in participants' actual lung function. The author's conclusion was blunt: the evidence suggests Buteyko may alter a patient's perception of their symptoms and prevent overuse of medication, but does very little to change the underlying condition.

The Australian Government's Department of Health reached a similar conclusion in 2015, reviewing Buteyko as one of 17 alternative therapies and finding no clear evidence of effectiveness. A 2020 Cochrane review (Santino et al.) found that breathing exercises may have some positive impact on quality of life and hyperventilation symptoms in asthma, but rated the evidence as moderate to very low certainty.

A peer-reviewed paper in the European Journal of Applied Physiology (Illidi et al., 2023) went further, specifically warning that some Buteyko advocates associate the technique with loosely related research to imply benefits that have not been demonstrated. The paper explicitly called out the practice of citing studies on allergic rhinitis in children with ADHD to imply that Buteyko's nasal breathing focus can reduce ADHD risk, describing this as a claim currently lacking plausibility and evidence.

That is a fair criticism, and I take it seriously. I have tried to be careful in this article not to make that leap. What I have said is that dysfunctional breathing can worsen symptoms in someone who already has ADHD, not that fixing breathing will fix ADHD. Those are very different claims.

There are also legitimate concerns about Buteyko's origins. The method was developed in the Soviet Union in the 1950s by a single physician based on a personal revelation, not a controlled experiment. The original theoretical framework, that hyperventilation is the root cause of over 150 diseases, is an extraordinary claim that has never come close to being substantiated. Some of the more enthusiastic corners of the Buteyko community still promote claims about curing conditions ranging from diabetes to epilepsy, which is frankly irresponsible.

And there is a standardisation problem. Buteyko is not a single, codified protocol. Different practitioners teach it differently, which makes it extremely difficult to study rigorously. When a clinical trial tests "Buteyko," it is not always clear exactly what intervention was delivered, which muddies the evidence base further.

So why do I still use it?

Because I think there is a meaningful distinction between Buteyko's original theoretical framework (which is shaky) and the practical techniques themselves (which overlap substantially with evidence-based respiratory physiotherapy). Nasal breathing, reduced breathing volume, diaphragmatic engagement, and extended exhales are not Buteyko-exclusive ideas. They are components of breathing retraining that appear across mainstream respiratory medicine, yoga, and clinical psychology.

The Bohr effect is real, documented physiology. The relationship between CO2, cerebral blood flow, and neural excitability is well established in primary research (see the peer-reviewed sources below). The fact that hyperventilation depletes CO2 and produces anxiety symptoms is confirmed by Johns Hopkins, the Cleveland Clinic, and published research on panic disorder. The idea that slow, reduced breathing stimulates vagal tone is supported by clinical research. None of that is Buteyko-specific. What Buteyko provides is a structured, accessible framework for applying those principles, particularly the Control Pause as a feedback tool.

I do not teach Buteyko as a cure for anything. I teach it as a practical breathing retraining method.

In my experience and the experience of my clients, it helps with nervous system regulation, stress tolerance, and the specific frustration of finding that conventional breathwork advice makes things worse.

It is not a replacement for ADHD medication, therapy, or any other form of professional support. If you have ADHD, keep working with your GP or specialist. If you are on medication that works for you, keep taking it. Breathing better is a complement to those things, not a substitute.

You deserve to know both sides before you decide whether it is worth trying. I think it is. But I would rather you make that decision with your eyes open than have me gloss over the gaps.

Where to start if you are curious

Start by measuring your Control Pause first thing tomorrow morning. Sit upright, breathe normally through your nose for a minute or two, then after a gentle exhale, pinch your nose and time how long before you feel the first definite urge to breathe. Not how long you can endure. The first urge. Write it down.

Then breathe through your nose for the rest of the day, as much as you can. That is it. That is step one. No apps, no equipment, no commitment beyond paying attention to whether your mouth is open.

If you want to go further, I run breathwork sessions through Low Tide Calm, both in person in Wicklow and online for clients throughout the world. The programme is built specifically for people who find conventional breathwork inaccessible, with a particular focus on neurodivergent adults and people dealing with chronic stress or burnout. For between-session practice, the free Low Tide Calm app has a small set of guided options.

You do not need to be good at breathing. Nobody is good at breathing when they start. That is the whole point.

Cian O'Driscoll is a breathwork and mindfulness facilitator, reflexologist, and complementary therapist based in Wicklow, Ireland. He works with neurodivergent adults and burned-out, stressed humans through Low Tide Calm. To book a session or find out more, visit lowtidecalm.ie.

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Peer-reviewed research cited

Meuret, A.E. & Ritz, T. (2010). Hyperventilation in panic disorder and asthma: empirical evidence and clinical strategies. International Journal of Psychophysiology, 78(1), 68-79. View on PMC.

Brian, J.E. et al. (2019). Hyperventilation in neurological patients: from physiology to outcome evidence. Korean Journal of Anesthesiology. View on PMC.

Kim, J.A. et al. (2023). Optimum duration of hyperventilation during electroencephalography. Pediatric Neurology. View on PMC.

Rupp, T. et al. (2015). Corticospinal excitability is associated with hypocapnia but not changes in cerebral blood flow. The Journal of Physiology. View on PMC.

Illidi, C.R., Romer, L.M., Johnson, M.A., Williams, N.C., Rossiter, H.B., Casaburi, R., & Tiller, N.B. (2023). Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals. European Journal of Applied Physiology. View on PMC.

Santino, T.A. et al. (2020). Breathing exercises for adults with asthma. Cochrane Database of Systematic Reviews. View on Cochrane.

Benner, A. et al. (2023). Physiology, Bohr Effect. StatPearls, National Library of Medicine. View on NCBI.

Bohr, C., Hasselbalch, K., & Krogh, A. (1904). Concerning a biologically important relationship: the influence of the carbon dioxide content of blood on its oxygen binding. (Original paper describing the Bohr effect.)

Clinical and further reading

Johns Hopkins Medicine: Hyperventilation. Clinical patient education resource.

Cleveland Clinic: Hyperventilation Syndrome. Clinical patient education resource.

Gerbarg, P.L. & Brown, R.P. (2016). Neurobiology and Neurophysiology of Breath Practices in Psychiatric Care. Psychiatric Times. (Clinical review article.)

Albietz, J. (2011). Buteyko Breathing Technique: Nothing to Hyperventilate About. Science-Based Medicine. (Critical commentary.)

Psychology Today (2021). When "Take a Deep Breath" Can Be Bad Advice. Clinical commentary.

Bruton, A. & Thomas, M. (2005). The Buteyko breathing technique for asthma: A review. Complementary Therapies in Medicine.

Australian Government Department of Health (2015). Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance.