Emotion reference sheet
A diaphragmatic breathing worksheet can be a helpful tool to help clients relieve stress, muscle tension, anxiety, and improve quality of life.
This article explains diaphragmatic breathing, its benefits, how it works, and includes a step-by-step breathing worksheet guide for practicing this effective relaxation technique.
We’ve also included a free downloadable diaphragmatic breathing worksheet to save to your electronic health record (EHR) and share with clients in your practice.
What is diaphragmatic breathing?
Diaphragmatic breathing is a relaxation technique that involves taking slow, deep breaths using the diaphragm—the large, dome-shaped muscle under your lungs. Also called belly breathing or deep breathing, diaphragmatic breathing activates the body’s relaxation response by engaging the diaphragm to draw air deep into the lungs, causing the abdomen to rise and fall rather than the upper chest.
Diaphragmatic breathing is commonly practiced in mindfulness, meditation, yoga, traditional martial arts, tai chi, and somatic practices. Therapists may use the diaphragmatic breathing worksheet as a mindfulness exercise, an emotional regulation or distress tolerance skill, or as part of cognitive behavioral therapy.
This breathing technique can affect the cardiovascular, gastrointestinal, and respiratory systems. It can lower heart rate, relieve stress, and reduce blood pressure. It can also improve physical health conditions.
Diaphragmatic breathing may be beneficial for people with:
Gastrointestinal conditions (GI), such as constipation or gastroesophageal reflux disease
Chronic pain
Chronic obstructive pulmonary disease (COPD)
Asthma
Acute or chronic stress
Migraine
Eating disorders
Chronic heart conditions
Hypertension
Diaphragmatic breathing is a complementary technique and is not a replacement for professional medical or mental health treatment. Individuals who have any of the conditions listed above, or who are unsure whether this exercise is appropriate for them, should consult with a qualified healthcare provider before beginning.
How to do diaphragmatic breathing
The diaphragmatic breathing worksheet guides clients through the following steps:
Find a comfortable place to sit or lie down, free from distraction. If lying down, you can place a pillow under your head and a bolster under your knees.
Take a moment to settle in.
Place one hand on your chest and one on your stomach, just below your ribs.
Inhale slowly through your nose for four to six seconds as the air fills your belly. While breathing, your abdomen should rise, and the hand on your chest should remain still.
Hold your breath for a couple of seconds.
Exhale slowly through pursed lips for about six to eight seconds, and feel your stomach gently contracting to its original position.
Repeat the exercise for five to 15 minutes.
As with any new skill, diaphragmatic breathing may initially feel strange. With practice, however, it will feel more comfortable and relaxing.
You can find these instructions in our free downloadable diaphragmatic breathing worksheet.
Does diaphragmatic breathing work?
Diaphragmatic breathing has been studied extensively.
Research suggests that this simple breathing technique may help to:
Reduce heart rate
Lower blood pressure
Activate the vagus nerve, shifting the body from the “fight or flight” sympathetic state to the parasympathetic state
Decrease levels of cortisol, the body’s stress hormone
Increase core muscle stability
Improve the ability to tolerate exercise
Help people with COPD strengthen their diaphragm, making breathing easier
Relieve pain
Alleviate symptoms of anxiety
Reduce muscle tension
Increase energy and motivation
Improve concentration
Improve gastrointestinal motility and reduce stress-related GI distress
Support healthy immune function by reducing chronic stress
Help to manage PTSD symptoms
Provide emotional regulation and strengthen distress tolerance skills
Improve respiratory function post-operatively
Increase blood oxygen levels
Enhance quality of life
Reduce the resurgence of migraine
Improve circulation and blood flow to extremities
How to use the diaphragmatic breathing worksheet
You can download and use the diaphragmatic breathing handout PDF in several ways.
For example, use it to provide psychoeducation on diaphragmatic breathing. You can also share the breathing worksheet with coworkers or supervisees.
Save the diaphragmatic breathing worksheet to your computer or EHR to download or send to clients when needed. Or, simply leave copies of the breathing worksheet in your waiting room.
Provide the breathing worksheet to the client to remind them of what you discussed during therapy. Then, ask the client to use the worksheet to practice diaphragmatic breathing between sessions and report their progress at their next therapy appointment.
You may also combine the diaphragmatic breathing worksheet with other mindfulness worksheets for group therapy.
Sources
Hamasaki H. (2020). Effects of Diaphragmatic Breathing on Health: A Narrative Review. Medicines (Basel, Switzerland).
Harvard Health Publishing. (2016). Learning diaphragmatic breathing. Harvard Medical School.
National Institutes of Health. (n.d.). Diaphragmatic breathing.
Johns Hopkins Medicine. (n.d.). Diaphragmatic breathing.
University of Michigan Health. (n.d.). Diaphragmatic breathing for GI patients.
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