Breath Without Assumption
THE CLASSICAL ASSUMPTION: shallow or restricted breath signals held emotion; deepening the breath releases it.
THE DISABILITY QUESTION: what if deeper breathing isn’t physically possible, or isn’t actually useful?
Where breathwork can misfire
Respiratory disease, posture, pain, neuromuscular conditions, medication, and autonomic differences can all shape breath directly, alongside spinal cord injuries affecting the diaphragm, ventilator use, and anxiety about breath itself after a medical crisis. “Just breathe deeper” can range from unhelpful to actively distressing to physically impossible. Restricted breath is not automatically repressed emotion. Sometimes breath is just breath, shaped by a body’s actual respiratory reality — and a disability-informed therapist should never assume deeper means healthier.
You might recognise this
“I’ve been asked to take a deep breath in a body that genuinely can’t take a deep breath, and had to explain why every single time.” “Focusing on my breath makes me anxious because of my history with ventilation, not less anxious.” “My breath is shallow because of my condition, full stop, not because I’m holding something back emotionally.” “I ground through sound because breath was taken away from me as a safe focus a long time ago.”
Breath awareness is optional. Some clients find breathing focus frightening or irritating, for entirely legitimate reasons.
A lived scene · fictional teaching example
A therapist, working with a client who has a spinal cord injury affecting her breathing, opens a session the way she opens most: “let’s start with a few deep breaths.” The client goes quiet, then explains that her breath capacity is permanently reduced, and that instructions like this one, however well meant, tend to make her feel worse rather than settled — a reminder of what changed, not a route to calm. The therapist asks what she’d rather use instead. The client suggests sound: a low hum she can produce reliably, which she’s found more grounding than any breath focus ever was. From then on, sessions open with a few moments of that hum instead. Nothing about the psychological aim of the opening ritual — settling, arriving, becoming present — was lost in the substitution.
What might happen in therapy
Let’s start with a few deep breaths.
My capacity is permanently reduced. That instruction makes me feel worse, not settled.
Thank you for telling me. What would you rather use to settle in instead?
A low hum, maybe. I can do that reliably.
Let’s open with that from now on.
A process to try: Notice · Ask · Differentiate · Experiment · Check · Choose
- Notice. Breath is shallow, restricted, or simply present as it is.
- Ask. What breathing pattern feels available and non-straining right now — not “can we deepen this?”
- Differentiate. Respiratory condition? Posture? Pain? Medication? Anxiety about breath itself? A genuinely neutral pattern?
- Experiment. If breath is a comfortable focus, work with it exactly as it is. If not, offer sound, touch, or stillness instead.
- Check. Did the chosen focus actually settle, unsettle, or do nothing noticeable?
- Choose. Continue, switch channel, or set the whole exercise down.
Mine — Yours — Ours — System
Is breath actually a safe, useful focus for me, or has it become a source of anxiety in its own right?
Has a practitioner assumed deep breathing is available to me without asking first?
Can we choose the focus together, and can I say no to breath work without it becoming a struggle between us?
Does this practice assume unimpaired respiratory function as the default?
Where this concept can help
Building genuine regulatory alternatives to breath-focused work for clients where breath is medically limited, distressing, or simply not a useful focus — without losing the underlying psychological aim of the exercise.
Where interpretation should stop
When restricted or shallow breath has a known respiratory, neurological, or medical cause; when a client’s discomfort with breath focus, for whatever reason, is pushed past rather than respected.
For therapists
Always ask before introducing breathwork whether breath is a comfortable, accessible, and safe focus for this specific client. Have an equally valid alternative regulatory tool ready if the answer is no.
Evidence and status
Breath-based regulation has some research support: a 2023 meta-analysis of 12 trials found breathwork associated with lower self-reported stress than control conditions, and its authors call the evidence preliminary (Fincham et al., 2023). It does not help everyone, and it can be unsuitable or distressing for some people, including some with respiratory conditions or trauma histories. The specific disability cautions and alternatives offered here are a Disability in Psychotherapy clinical reconstruction.
A question worth carrying
Is breath actually the right channel for this person, right now — or is there a more accessible route to the same regulatory goal?
You may also want to explore
Grounding Without Standing · Medical Trauma & Body Ownership · Disability-Informed Body Psychotherapy
From the inside
Breath, in different lungs and bodies
For people with cystic fibrosis, breath is effortful, and airway clearance can take hours each day. Instructions to “breathe deeply” may trigger coughing or fatigue. Noticing breath without changing it, or not focusing on breath at all, may be kinder.
With POTS, slow breathing can sometimes help, but a racing heart is a physical symptom, not just anxiety. With Parkinson’s, soft voice and shallow breath may come together; voice work, rather than breathwork, may be what the person wants.
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Research finding
Fincham, G. W. et al. (2023), “Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials”, Scientific Reports, 13. doi:10.1038/s41598-022-27247-y. 12 trials, 785 adults; the authors describe the evidence as preliminary.
Our framework
The disability reconstruction on this page is this site’s own synthesis, as described under Evidence and status above. It has not been formally tested.
Fictional example
The lived scene and therapy dialogue on this page are constructed for learning. The people in them are not real.
Last reviewed: October 2026.
How to cite this page: Donaghey, C. (2026). Breath Without Assumption. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/body-psychotherapy-disability-lens/disability-informed-body-psychotherapy/breath-without-assumption/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with extra permissions for teaching, supervision and therapy. Credit the site. See Reusing This Material.