Healthcare practitioners breathing deeply

By Bonnie Hutchinson

You wouldn’t think a medical research report in an academic journal and a story about a 1920s student of Japanese archery would have a common theme, but they do.

The common theme? Breathing.

As a healthcare practitioner, you know the first things to assess in a medical emergency are airway and breathing. If a patient can’t breathe, that’s a crisis.

Breathing gives us oxygen and oxygen gives us life. But oxygen is just one of benefits of breathing. It also affects brain functioning and behaviour. Turns out the way you breathe can impact fear, memory and even the ability to focus.

Useful for patients. Useful for healthcare practitioners.

Let’s begin with the medical research. We’ll get to the Japanese archery.


A study published in the Journal of Neuroscience showed that the rhythm of breathing creates electrical activity in the human brain. That electrical activity enhances emotional judgments and memory recall. The effects on behavior are different when you’re breathing in compared to when you’re breathing out. It also makes a difference whether you breathe through your nose or your mouth.

The study’s lead researcher Christina Zelano is an assistant professor of neurology at Northwestern University Feinberg School of Medicine. She says, “One of the major findings in this study is that there is a dramatic difference in brain activity in the amygdala and hippocampus during inhalation compared with exhalation.” She adds, “When you breathe in, we discovered you are stimulating neurons in the olfactory cortex, amygdala and hippocampus, all across the limbic system.”

Did you get all that? In case you didn’t, here’s a quick refresher.

• The olfactory cortex is part of the cerebral cortex and relates to your sense of smell.

• The amygdala is located near the hippocampus. It is responsible for the response and memory of emotions, especially fear. Basically, its job is to watch for possible danger and alert you by triggering fear responses.

• The hippocampus is part of the limbic system. It plays important roles to consolidate information from short-term memory to long-term memory. It also holds spatial memory that helps you navigate.

• The limbic system, loosely, is mid-brain. It supports many functions including emotion, behavior, motivation, long-term memory and smell. You might think of it as your emotional brain.


Northwestern scientists first discovered differences in brain activity while they studied seven patients with epilepsy. The patients were scheduled for brain surgery. A week before surgery, a surgeon implanted electrodes into the patients’ brains in order to identify the origin of their seizures.

This allowed scientists to acquire electro-physiological data directly from the patients’ brains. The recorded electrical signals showed that brain activity changed with the patients’ breathing. The activity occurred in limbic brain areas where emotions, memory and smells are processed.

This discovery led scientists to ask whether cognitive functions associated with these brain areas could be affected by breathing. In particular, scientists were interested in fear processing and memory.


The amygdala is strongly linked to emotional processing, especially fear-related emotions. So scientists asked about 60 subjects to make quick decisions on facial expressions while recording the subjects’ breathing. The subjects were shown pictures of faces that showed either fear or surprise. The subjects had to indicate, as quickly as they could, which emotion each face was expressing.

When the subjects looked at faces while they breathed in, they recognized the faces that expressed fear more quickly than when they looked at faces while they breathed out. This was not true for faces that expressed surprise. These effects decreased when subjects performed the same task while breathing through their mouths. In short, the effect applied only to fearful stimuli while breathing in through the nose.

In an experiment to assess memory function — which is tied to the hippocampus — the same subjects were shown pictures of objects on a computer screen and told to remember them. Later, the subjects were asked to recall those objects. Researchers found that recall was better if the subjects saw images while they were breathing in.


The researchers say the findings imply that rapid breathing may confer an advantage when someone is in a dangerous situation.

“If you are in a panic state, your breathing rhythm becomes faster,” Zelano said. “As a result you’ll spend proportionally more time inhaling than when in a calm state. Thus, our body’s innate response to fear with faster breathing could have a positive impact on brain function and result in faster response times to dangerous stimuli in the environment.”

This is useful information for healthcare practitioners. When under stress, consciously taking a few deep fast breaths through the nose can help your response time.

Another potential insight of the research is on the basic mechanisms of meditation or focused breathing. “When you inhale, you are in a sense synchronizing brain oscillations across the limbic network,” Zelano says.

And that takes us to a story about a 1920s student of Japanese Archery.

During the 1920s, Eugen Herrigel, a German professor, took a leap of faith and moved his entire family to Japan, in hopes of learning the Japanese tradition of Zen in Archery.

Herrigel planned to teach philosophy at the University of Tokyo and master the art of archery within a few years. He convinced the legendary Japanese archer, Master Kenzo Awa, to take him on as a pupil in the Japanese martial art of archery.

Four years later, Herrigel was fed up. He struggled to improve and was frustrated with the slow pace. He began to lose his focus and motivation. He grumbled to Master Kenzo that his stay at Japan was limited and time was running out.

The Master calmly replied, “The way to the goal is not to be measured! Of what importance are weeks, months, years?”
For those of us in twenty-first century North America, there is an answer to that question! However, Herrigel nodded and made a resolution that he’d stop worrying about his goals. He shifted his entire focus to practice instead.

Day in and day out for months, Herrigel would pick up his bow and arrow, and shoot. It didn’t matter how motivated he felt, or how badly he missed his targets, he’d still show up to practice.


Zanshin is a word used in Japanese martial arts to refer to a state of relaxed alertness. The literal translation of Zanshin means “the mind with no remainder.” It describes a state of mind when there is complete focus and awareness of the body.

During his early lessons with Master Kenzo, Herrigel struggled to achieve Zanshin. Each time he picked up the bow, he’d use considerable force to bend it, his hands would tremble, and he’d run out of breath.

One day Herrigel was drawing the bow in his usual fashion. Master Kenzo calmly said to him, “Relax! You cannot do it because you do not breathe right. If it is done properly, you will feel the shooting becoming easier every day.”

A few months later, Herrigel complained that he’d tried to stay focused and relaxed, but couldn’t do so. The Master replied, “That’s just the trouble, you make an effort to think about it. Concentrate entirely on your breathing, as if you had nothing else to do!”

After a year of trial and error, Herrigel finally learned how to stay focused, draw the bow and release it in a completely relaxed manner.

About a year later, during a spectacular ceremony in front of a large crowd, Herrigel tuned out all distractions and effortlessly executed on the test exercises that he’d practiced for five years.

A short distance away, Master Kenzo smiled like a proud father, walked up to Herrigel with a diploma and said to him, “You have now reached a stage where teacher and pupil are no longer two persons, but one. You can separate from me anytime you wish… I need not ask you to keep up your regular practicing.”


In his book Zen in the Art of Archery, Herrigel describes the details of his story and explains how Zanshin led to his significant improvement in archery:
“So that was it: not a technical trick I had tried in vain to pick up, but liberating breath-control with new and far-reaching possibilities.”

Herrigel didn’t focus on his goals or even his knowledge, he just focused on Zanshin. This enabled him to focus on the task at hand, despite any distractions. Herrigel’s key point: “The more one concentrates on breathing, the more the external stimuli fade into the background.”

From multiple sources including Zansin, we know that the more relaxed the state of our mind and body, the more likely we’ll stay focused, avoid distractions and achieve our goals in the process. And from the Northwestern University research, we know that breathing in through the nose taps into areas of our brain that help to quell fear and allow us to focus.

East and West, last century and this century, we see the value of focused breathing.


The mission of Hone Virtual Education is to help healthcare practitioners save lives by learning to perform at peak levels, capable of rapidly and correctly identifying diagnostic cues to enable correct clinical decisions.

Hone’s CUE Recognition virtual simulation training modules don’t specifically address your breathing pattern as a health practitioner. However, the downloadable training modules do help you develop other skills. The resulting increased ability and confidence help to foster something like the Zansin state of relaxed alertness that is so valuable in high-pressure situations.

To find out more, visit where you can…

• Learn more about Hone CUE Recognition virtual simulation training;
• Be notified of updates and launch dates;
• Apply to be a beta tester as new modules are developed for healthcare practitioners in high pressure environments.

Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. As an organizational and evaluation consultant, she’s worked with many healthcare and healthcare practitioner organizations. She’s bestselling author of Transitions: Pathways to the Life and World Your Soul Desires.

[1] Christina Zelano, Heidi Jiang, Guangyu Zhou, Nikita Arora, Stephan Schuele, Joshua Rosenow and Jay A. Gottfried, “Nasal Respiration Entrains Human Limbic Oscillations and Modulates Cognitive Function,” Journal of Neuroscience, December 6, 2016, 2016 doi:10.1523/JNEUROSCI.2586-16.2016.

[2] Marla Paul, Northwestern University, “Rhythm of Breathing Affects Memory and Fear,” Neuroscience News, December 7, 2016,

[3] (2016) identifies the amygdala image source as “public domain.” Used with thanks.

[4] Mayo Oshin, “How to Master the Art of Focus and Concentration from a Legendary Japanese Archer,” posted February 12 2019 on, Originally published at

[5] Eugen Herrigel and Daisetz T. Suzuki (1999), Zen in the Art of Archery, Vintage Books.

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