Experimenting with Biofeedback: Reconnecting with Breath to Manage Stress

The mark is one hundred and seventy beats per minute (bpm). As I step off the elliptical, the only remaining sound is my pulse. I sit down cross-legged and begin to focus on my breathing. With each measured inhale through the nose, the heartbeat grows faster and louder in my ears; on exhalation through my mouth it softens and slows. Gradually, the sound of my heartbeat fades away entirely and all that’s left is the key mantra: soft belly.

Soft belly breathing is as simple as it sounds: slow, deep breaths that focus on keeping the belly soft. This breathing technique takes advantage of two systems: the sympathetic and parasympathetic nervous systems.

You may have heard of these systems; autonomic refers to bodily functions that can take place without conscious thought, like breathing or digestion. The sympathetic nervous system is our “fight or flight” process—elevated pulse and breath rate, a rush of adrenaline that primes us to act here and now. The parasympathetic system is our “rest and digest” process that results in lowered vital signs, for example, the feeling you get while in a food coma as the body rebuilds and rehabilitates.

Like many of you, I have stressors in my life that are out of my control. I’m a medical student who began my career during a certain pandemic, routinely studying eight or more hours daily, and that is scratching the surface. My peers and I are taught to practice empathy for our patients and self-care to avoid burnout, but are also told that we are expected to miss holidays, weddings, family gatherings, and more in the same breath. I know that I will be entering a workforce that is by many accounts, fragmented and warped. Setting aside basics such as accessibility, affordability, and balanced quality of care, the weight of human life held in my hands over 50+ hour weeks should be daunting to anyone, no matter how “prepared” I may be from school. Furthermore, and much to the world’s chagrin, diseases and illnesses don’t take vacation days.

I wanted tools to cope with stress that focused on three key points: they could be performed anywhere with few to no accessory items, they could be performed in fairly short periods of time, and they cost little to nothing. Should the tools prove effective for myself, I would then be able to recommend them to others without having to worry too much about accessibility issues. This had to be something that was as sustainable as it was available.

The following trial is my attempt to gain just a little more control over my autonomic system so that I am better equipped to manage stress. We have some control over certain processes—most people can hold their breath to some extent or force themselves to breathe more rapidly, but the body will override these behaviors if they jeopardize our health. No matter how long you hold your breath, you will eventually be forced to resume breathing to continue, well, living.

Thankfully, I live in the era of technology, which grants me access to an important tool: biofeedback. Biofeedback refers to techniques designed to help better understand and control some of these physiologic processes, and classically involves the use of technology. Do you or someone you know have a smartwatch that measures your heart rate? That’s biofeedback. I can certainly tell when my breathing and pulse are high, but concrete numbers provide an excellent means of gauging how my autonomic nervous system is doing. They also allow me to make nice visuals in the form of data charts.

Over a fifteen-day period, I used the gym’s elliptical machine to quickly work my pulse up to 170bpm, and then performed a controlled breathing technique for five minutes to simulate the effect of recovering from a stressful situation and activate the sympathetic nervous system. I used a device called a pulse oximeter to record my heart rate, which is relatively inexpensive (compared to a fancy smartwatch). I performed three trials daily. In a fully relaxed situation without any exercise or other active stressors, my true resting heart rate is around sixty beats per minute. Here’s how my results turned out:

I assure you that the most surprised party here was myself. It was exciting to see real progress on a near-daily basis, let alone over a two-week period. Looking down and seeing a lower heart rate than the previous attempt provided a boost to my self-esteem and reaffirmed my ability to influence my well-being. Even on the rare occasions where I didn’t improve the following day, I could usually attribute it to factors outside of my control, like a fellow who decided that bringing their speaker to a public gym was an appropriate display of etiquette. If nothing else, I can tell you that the appropriate environment also plays an important role in letting the parasympathetic system do its work; loud music does not make for such an environment for me personally.

It’s important to stress here (pun intended) that these results shouldn’t just be taken as fact. This was performed on me, by myself, in an uncontrolled environment, using a reading that fluctuates from second to second. All I have to show for it is an apparent pattern of increased autonomic control and a subjective account that it truly did make me feel better. My workout routine following the drill felt more focused, and I found myself taking more moments throughout the day to take a few seconds of slow, deep breaths to rest my eyes and reorganize my thoughts.

Roughly six weeks after beginning to practice soft belly breathing, I took the USMLE Step 1, an eight-hour exam that determined whether or not I could proceed further in my medical education. It would be no exaggeration to say that awareness of my breath helped me push the limits of my mental stamina.

I highly recommend that you try soft belly breathing out for yourself. There are a number of more scientifically sound articles out there, and a near-endless number of anecdotal stories from people using this technique in their everyday lives. You don’t have to be at the gym, using fancy gadgets. You can make the technique your own. Whether as a quick respite from work, a weapon to reset the mind, or simply another way to bring about a mindful moment, I hope you too can use one of the most fundamental aspects of life – our breath – to enrich your life.

Acknowledgements

I wrote this article after participating in an eight-week online mind-body skills group, based on the model by the Center for Mind-Body Medicine, facilitated by Dr. Jessica Singh, founder of Sukhayu Wellness, during which a number of techniques for physical and mental wellness were explored that included the soft belly breathing that I chose to discuss here. I found the program to be a breath of fresh air, quite literally, amidst the hustle and bustle of daily life.

Many thanks to Dr. Jessica Singh, who led each session and then helped me conceptualize and edit this article. Each meeting was filled with attention to detail and a caring heart, and I am most grateful for the mentorship I received.