EMDR and Breathwork: Working With Trauma That Shows Up in the Body

For many people, trauma doesn’t show up primarily as a clear story in the mind. It shows up in the body. You might feel braced without knowing why, stuck in jaw tension or a tight chest, restless and keyed up, or strangely numb and far away. Even when life is “fine” on paper, the nervous system can behave as if the threat is still present. In that situation, it makes sense that a purely cognitive approach can sometimes feel like it’s missing the point. The body is already speaking. EMDR therapy is one of the best-supported trauma treatments we have, and it’s recommended in major clinical guidance for PTSD, including NICE in the UK and the World Health Organization. NICE guidance describes EMDR as a phased, manualised approach that is typically delivered over 8 to 12 sessions for adults, with careful preparation and self-calming strategies alongside trauma processing. Evidence syntheses also support EMDR’s effectiveness for PTSD symptoms: one meta-analysis of randomised controlled trials reported a moderate overall reduction in PTSD symptoms following EMDR (Hedges’ g around −0.66 across 22 studies). This matters, because it points to a real, measurable shift in symptoms for many people, not just a supportive conversation. At the same time, trauma processing is not simply an intellectual exercise. It involves memory, emotion, and physiology. When distress is strongly body-based, the first clinical task is often helping the person stay within their window of tolerance — not too flooded, not too shut down — so the brain can do the work of updating and integrating what happened. This is where breathwork, used carefully and clinically, can be genuinely useful. Breathwork is sometimes overhyped online, but slow, regulated breathing has a solid physiological rationale. Heart rate variability, often discussed as a marker of flexible nervous system regulation, is closely linked to breathing patterns. In the HRV biofeedback literature, maximum effects are commonly observed when breathing slows to around 0.1 Hz, which is roughly six breaths per minute. Put simply, slowing the breath can help shift the body out of fight-or-flight patterns and into a steadier, more regulated state, especially when the exhale is gently lengthened and the rhythm is comfortable rather than forced. When we look at the broader evidence on breathwork and mental health, the picture is encouraging but nuanced. A meta-analysis of randomised controlled trials (12 trials, 785 participants) found breathwork was associated with lower self-reported stress compared with controls, with a small-to-medium effect (Hedges’ g = −0.35). The same review reported similar effect sizes for anxiety (g = −0.32) and depression (g = −0.40). Those are not miracle numbers, but they are meaningful — particularly as a low-cost, low-tech intervention that can support regulation and resilience. There is also specific early research on breathing-based practices in trauma populations. For example, a small randomised controlled trial in U.S. veterans (n = 21) found a breathing-based meditation intervention was associated with medium-to-large between-group effects on PTSD outcomes, including a large effect on hyperarousal (with reported effect sizes over 1.0 in some comparisons). It’s a small study, so it doesn’t “prove” breathwork treats PTSD on its own, but it does support what many clinicians observe: changing respiration can change arousal, and arousal is often the gateway symptom that keeps trauma locked in place. It’s also important to be honest that not every breathing intervention outperforms placebo when tested rigorously. A large placebo-controlled coherent breathing trial reported improvements over time in both groups, without a measurable advantage for the coherent breathing condition over a well-designed breathwork placebo. That tells us something important: part of the benefit may come from attention, expectation, routine, and the act of practising something daily, not only from one specific breathing pattern. In therapy, that’s not a reason to dismiss breathwork — it’s a reason to use it thoughtfully, without grand claims, as one support among several. So how can breathwork and EMDR work together in a grounded, clinically responsible way? The simplest answer is that breathwork can support the conditions that make EMDR more tolerable and more effective, particularly for people whose trauma lives in tension, agitation, or shutdown. Before processing begins, guided breathing can help you arrive in your body and orient to safety. During processing, brief returns to a slow rhythm can help keep you within the window of tolerance when the nervous system starts to surge. After processing, breath can help consolidate, settle, and reduce the “EMDR hangover” some people feel when their brain and body have been doing deep work. In practice, this isn’t dramatic or forceful. It might look like two minutes of gentle down-regulation before starting, using a rhythm that feels natural and not breathless. It might involve tracking what changes when the exhale lengthens slightly, or noticing how the shoulders drop when the breath becomes steadier. The point isn’t to “breathe the trauma out”. The point is to create enough physiological stability that the mind can process without the body pulling the emergency brake. Breathwork also needs to be used with care. Some techniques — especially fast-paced breathing or anything that resembles hyperventilation — can increase dizziness, panic sensations, or dissociation in vulnerable people, and the research literature itself calls for caution and better reporting on adverse effects. If you have a history of panic, strong dissociation, significant medical issues, or trauma that quickly tips into overwhelm, breathing practices should be introduced slowly and collaboratively, with a therapist who understands pacing. When integrated well, breathwork doesn’t compete with EMDR. It supports it. EMDR helps the brain reprocess and update traumatic memory networks so the past stops intruding into the present. Breathwork helps the nervous system stay regulated enough to do that work safely, especially when symptoms are embodied. For people who live with tension, numbness, or agitation as their main “language” of trauma, bringing the breath into the therapeutic process can be a practical bridge between mind and body — not as a trend, but as a stabilising tool in service of real psychological change.