Atlas›Domain X · Body, movement, breath & physical›Guide 166
Guide X-166

Integrative breathwork

Jacquelyn Small1970Austin, Texas, United States
A 28 · L 51 · M 2112 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Integrative Breathwork lineage attributed to Jacquelyn Small (Eupsychia, Inc., Austin, Texas), as described by her student Lorraine Meyer (Integrative Breathwork Florida). Other organisations that use the same or a similar name are listed below and kept separate. Published descriptions of the method's own procedure are thin, so sections 2 and 4 describe the session only at the level the sources give. The psychotherapist's role (screening, consent, preparation, integration, referral) is written in full, and much of it is marked [synthesis].

What the sources say it is. Jacquelyn Small is described by her publisher as a "pioneer in the transpersonal or spiritual approach" to treating addiction. She is also named as former director of training for the Texas Commission on Alcoholism and co-director of Eupsychia, Inc., "a training and certification institute" bridging "traditional and transformational psychologies" [source: Penguin Random House author page]. A 2002 radio programme page calls her "a pioneer of spiritual psychology" and "founder and director of Eupsychia Institute in Austin, Texas" [source: New Dimensions, programme 2954, 19 Jul 2002]. A 2016 news report of workshops in Belize says the technique was developed by Small in the 1970s, after she worked with a psychiatrist studying people with addictive patterns. The report says it combines yoga-style breathing variations with music chosen to carry the session, much as a film score does, and that it can bring up stored memories and emotions [source: Channel5 Belize, 4 Feb 2016]. Eupsychia, Inc. holds a US trademark filing for "Psychospiritual Integration", covering transpersonal group methods said to heal past trauma and awaken "spiritual insight and creativity" [source: Justia trademark record]. How Integrative Breathwork fits within that framework is [uncertain: not verified].

Core idea of change (as attributed). In this lineage, conscious, intensified breathing with evocative music is said to bring stored memories and feelings into awareness. These are then integrated within a transpersonal or spiritual frame [source: Channel5 Belize]. The spiritual aims belong to the school's framework. They are not established fact.

Same or similar name, different organisations (keep these distinct):

  • Inspiration Consciousness School (Jessica Dibb, Baltimore area). Dibb's approach draws on "Integrative Breathwork", psychodynamic principles and the Enneagram. She founded a "1200+ hour Breathwork and Psychospiritual Facilitation Program", co-directs the Global Professional Breathwork Alliance (GPBA) and chairs its Ethics Committee. She wrote Breathwork and Psychotherapy: Clinical Applications for Healing and Transformation (W. W. Norton, 2025) [source: Omega teacher page; New Books Network; MIT Press Bookstore listing]. Whether her lineage includes Small is [uncertain: not verified].
  • Integrative Breathwork (online community and 7-month training on Mighty Networks), co-founded by Steph Magenta and Dr Rae Riedel. No link to Small is stated [source: integrative-breath.mn.co].
  • Akademie für Integrative Atemtherapie / Academy for Integrative Breath Therapy (Bergisch Gladbach, Germany; founded 2018 by Gerdi Schulte and Maria Faust). This is a GPBA Certified School. It combines humanistic psychology and bodywork with "conscious connected breathing" and other techniques [source: GPBA member pages].
  • Integrative Breathwork Therapy (IBT). This is a "three component breathwork model" reviewed by Lalande, Bambling, King and Lowe (2011) in the Journal of Contemporary Psychotherapy. The review describes support as resting largely on anecdotal clinical evidence [source: IFP NYU summary; Mandala library record]. The three components and the model's developer are [uncertain: not verified].
  • Tilke Platteel-Deur, The Art of Integrative Therapy (Verlag Der Rheinländer, 2011), presents "Integrative Breathwork" as a way to deepen psychotherapy [source: bookseller listing]. Its relationship to Small is [uncertain: not verified].

Before referring a client, ask the facilitator which school they trained in. The method's content and safety culture vary by school.

Intensity class and cross-reference. Published descriptions place Integrative Breathwork among the conscious connected or intensified breathing methods, in the same broad family as Holotropic Breathwork (see the Domain VII Holotropic Breathwork guide). These methods can cause hyperventilation effects and intense emotional and altered states. This guide gives no breathing rates, round counts, session lengths or breath-holding timings as instructions.

Health claims. Practitioners have claimed that oxygen "nurtures us and heals us" and that participants feel "lighter" [source: Channel5 Belize; Lorraine Meyer quoted]. These are testimonials. No controlled study of the Small lineage is reported [uncertain: not verified]. Integrative Breathwork is not a treatment for any physical disease. Clients should never change asthma, blood-pressure, psychiatric or other medicines because of breathwork. The GPBA standards say breathworkers "should not advise" anyone to change, stop or taper medication [source: GPBA Ethical Standards 2026, 4.1.9].

2. Framework

Format as published. Facilitator-led group workshops and individual sessions are described. Participants breathe consciously, in yoga-derived variations, to a music programme, and memories and emotions may surface [source: Channel5 Belize]. Eupsychia is described as a training and certification institute [source: Penguin Random House]. Its curriculum, levels, hours and certification criteria are [uncertain: not verified]. The typical number of sessions, criteria for progressing, and whether Eupsychia required participants to be in psychotherapy are [uncertain: not verified].

Phase structure for a psychotherapist working alongside a facilitator [synthesis, informed by GPBA standards]:

  1. Clarify and screen. Identify which school the facilitator belongs to. Then screen the client medically and psychologically.
    • Goal: a safe yes, no or not-yet decision.
    • Criterion to move on: no unmanaged contraindication, medical clearance where indicated, and capacity to consent [source: GPBA 4.1.2–4.1.8, 4.3.4].
  2. Prepare and consent. Give information about likely effects and risks. Agree any touch boundaries in advance, and confirm that the client knows they can withdraw at any time [source: GPBA 2.5, 4.3.1–4.3.3, 4.3.5].
    • Criterion to move on: the client can say in their own words what may happen, how to stop, and who to contact afterwards [synthesis].
  3. Session (trained facilitator only). The breathwork itself is led by someone trained in the school's method. A psychotherapist without that training does not lead it [source: GPBA 1.4, 2.8].
  4. Immediate aftercare and grounding. The goal is to return the client to ordinary functioning before they leave. Breathworkers are asked to "create a supportive space" for processing [source: GPBA 4.2.3].
    • Criterion: the client is oriented, steady and has a safe way home [synthesis].
  5. Integration in psychotherapy. Over the following sessions, work with what emerged. The aim is "skilful integration into everyday life" [source: GPBA 7].
    • Criterion to continue with further breathwork: the client is stable, functioning, and integrating rather than flooding [synthesis].
  6. Review and ending. Decide together whether to continue, pause or stop.
    • Stop if adverse effects persist, if dissociation, psychotic or manic symptoms or suicidality emerge, or if the client is using sessions to avoid daily-life work [synthesis].

Who may deliver it. Leading breathwork sessions needs training in the specific school. There is no government regulation of breathwork. The GPBA is a professional alliance, not a regulator. It sets ethical standards, certifies schools that have "taught the required curriculum" and graduated practitioners for at least two years, and uses a restorative-justice model for complaints [source: GPBA Ethical Standards 2026; GPBA Professionalism page]. Whether Eupsychia or the Small lineage is GPBA-affiliated is [uncertain: not verified]. GPBA asks breathworkers to have specific training and experience before working with people with mental-health challenges [source: GPBA 4.2.8].

3. Guiding principles

  • Name the school. Several unrelated groups use "Integrative" in their name. In practice, ask who trained the facilitator, for how long, and under which standards [source: section 1 sources].
  • Safety screening comes before the experience. Screen for cardiovascular and respiratory conditions, epilepsy, psychosis, pregnancy, medications and suicidality before any session [source: GPBA 4.1.2–4.1.8].
  • Informed, revocable consent. The client can stop the breathing, the music, the touch or the whole session at any moment, and knows how to signal this [source: GPBA 2.5, 4.3.3].
  • Capacity first. Do not proceed if the client is under legal age, intoxicated or not mentally competent to consent [source: GPBA 4.3.4].
  • Stay within your training. A psychotherapist without breathwork training screens, prepares and integrates, and does not lead the breathing [source: GPBA 1.4; UKCP Code item 23; APA Code 2.01].
  • Collaborate. Respect the client's other medical and psychotherapeutic care and coordinate with those professionals, with consent [source: GPBA 4.1.4].
  • Never sexual; touch only by agreement. Any touch is explained in advance, agreed and stoppable. Sexual or inappropriate touch is never acceptable, even if the client invites it [source: GPBA 2.5, 4.4.1.2–4.4.1.3; USABP Code VIII].
  • Attribute the spiritual frame. Transpersonal and spiritual explanations belong to the school's framework. Offer them as the school's view and let the client hold their own meaning [source: Penguin Random House; Justia record; synthesis].
  • Treat emerging material as experience, not proof. Memories or images that surface in altered states are explored for meaning. They are not taken as verified history [synthesis, consistent with memory-research cautions].
  • No medical promises. No cure claims, and no advice on medication [source: GPBA 4.1.9, 8.1.5].
  • Integration matters as much as the session. Plan time for integration after every intense session [source: GPBA 4.2.3, 7].

4. Intervention inventory

The published sources describe the session itself only in outline (conscious breathing in yoga-derived variations, with music, bringing up memories and emotions). No step-by-step Integrative Breathwork protocol from Small or Eupsychia is given here; that is [uncertain: not verified]. The inventory therefore covers:

  • the psychotherapist's own interventions around the session (4.1–4.4 and 4.6–4.12);
  • a descriptive account of the facilitator-led session (4.5).

4.1 Clarifying which "Integrative" school and vetting the facilitator

  • Purpose: to make sure the client goes to a trained facilitator whose method, safety culture and complaints route are known. Use it whenever a client mentions "Integrative Breathwork" or asks for a referral.
  • Steps:
    1. Ask which organisation trained the facilitator: Eupsychia or the Small lineage, Inspiration Consciousness School, the Magenta and Riedel training, the German Akademie, or another. See section 1.
    2. Ask about length of training, supervision, ethical code and insurance. GPBA standards expect breathworkers to be "properly licensed, insured and indemnified" for their location [source: GPBA 2.8].
    3. Ask what screening they do, whether they use touch, and how they handle emergencies.
    4. Ask how complaints are handled. GPBA members must explain complaint routes [source: GPBA 2.12].
    5. With the client's written consent, agree how you and the facilitator will share information [source: GPBA 4.1.4].
  • Example language (illustrative): "Several different groups use the name 'Integrative Breathwork'. Could you find out where your facilitator trained? Then we can check how they screen people and what happens if a session gets intense."
  • Watch for:
    • Vague answers about training.
    • No intake form.
    • Promises of cures.
    • Pressure to keep breathing through distress.
    • Discouraging the client from medical or psychological care.
    • Pressure to sign up for further sessions straight away.
    It is working if you get a named school, a code of ethics and a clear screening and emergency plan.

4.2 Medical and psychological screening (contraindications)

  • Purpose: to identify people for whom intensified breathing is unsafe or needs medical clearance or adaptation. Screen before any first session and again whenever health changes.
  • Steps:
    1. Ask about physical conditions. GPBA lists conditions that call for adaptation or referral to a more experienced breathworker, including cardiovascular, respiratory, epilepsy and psychosis [source: GPBA 4.1.2–4.1.3]. Also ask about [synthesis, consistent with the cautions published for intense breathwork]:
      • high or uncontrolled blood pressure;
      • glaucoma or retinal detachment;
      • recent surgery or injury;
      • asthma or COPD;
      • osteoporosis, if vigorous movement may occur.
    2. Seizures. A client with a seizure history must be told that breathwork "can lower the seizure threshold" [source: GPBA 4.3.2].
    3. Pregnancy. Ask whether the client is or could be pregnant [source: GPBA 4.1.7].
    4. Medications. Record current medications [source: GPBA 4.1.8]. Do not advise any change to them [source: GPBA 4.1.9].
    5. Mental health. Ask about:
      • suicidal thoughts or self-harm, at registration "and throughout" the process [source: GPBA 4.1.6];
      • psychosis, bipolar disorder, severe PTSD, dissociative disorders and panic disorder [synthesis].
    6. Substances. Check current substance use, and any recent psychedelic experience [source: GPBA 4.3.4, 7.1.6].
    7. Decide and refer. Where any of these applies, refer the client to their physician for clearance, or advise against the method and offer gentler alternatives [synthesis]. Record emergency contact details [source: GPBA 4.1.5].
    8. Water and driving. Tell the client never to practise intensified or connected breathing, or breath-holding, in or near water (bath, pool, open water) or while driving. Hyperventilation can cause loss of consciousness, and near water this can mean shallow-water blackout [synthesis; general breath-safety guidance].
  • Example language (illustrative): "This kind of breathing changes your blood chemistry for a while. It can make you dizzy, tingly or very emotional. So I'd like to go through some health questions first. Some of them, like heart conditions, epilepsy or pregnancy, mean checking with your doctor before going ahead."
  • Watch for:
    • Minimising symptoms in order to qualify.
    • Recent hospital admission or a change in medication.
    • Active suicidality.
    • Recent psychotic or manic symptoms.
    • Current heavy substance use.
    It is working if every listed item has been asked and documented, and any clearance is in writing.

4.3 Informed consent, including a touch agreement

  • Purpose: to make consent informed, specific and revocable, especially where the facilitator may use hands-on contact. Use it before the first session and update it as things change.
  • Steps:
    1. Explain the likely effects:
      • tingling, dizziness and muscle cramping or stiffening of the hands and face (tetany) from over-breathing [synthesis; tetany is reported in the closely related Holotropic Breathwork, see Shrink Rap Radio #372];
      • strong emotion, memories and altered states [source: Channel5 Belize].
    2. Explain the benefits as claimed, the risks and contraindications, and the right to withdraw at any time [source: GPBA 4.3.1–4.3.3].
    3. Find out whether the facilitator uses touch. Agree boundaries in advance: where touch may and may not happen, and how the client says no or stop [source: GPBA 2.5].
    4. State plainly that sexual or genital touch never occurs in any form [source: GPBA 4.4.1.2; USABP VIII].
    5. Recommend a written, signed and dated consent form [source: GPBA 4.3.5].
    6. Recheck consent before every session [source: GPBA 7.1.2]. Consent can change mid-session [source: USABP VIII.3–4].
  • Example language (illustrative): "You are in charge the whole time. If you want to slow down, return to ordinary breathing, or not be touched, you can say so or use your agreed signal, and that will be respected straight away."
  • Watch for:
    • Consent given in an over-compliant way.
    • A trauma history involving touch.
    • Difficulty saying no.
    • Facilitators who discourage stopping.
    It is working if the client can repeat back how to stop and what touch they have agreed to.

4.4 Preparation and intention-setting

  • Purpose: to reduce fear and give the experience a frame the client chooses. Use it in the session or sessions before the breathwork [synthesis].
  • Steps:
    1. Explore what the client hopes for and fears.
    2. Help them frame a simple, non-pressured intention, without a required outcome.
    3. Rehearse grounding skills they can use if they feel overwhelmed, such as feeling the feet or back on the floor, opening the eyes, or naming objects in the room.
    4. Plan practical arrangements: someone to accompany them home, no driving straight afterwards if they feel unsteady, and a quiet rest of the day.
    5. Book an integration session soon after.
  • Example language (illustrative): "You don't need to make anything happen. Whatever comes, or doesn't come, we'll look at together afterwards."
  • Watch for:
    • Expectations of dramatic breakthroughs or of "releasing" trauma in one session.
    • Reasons to pace more slowly.
    It is working if the client has realistic expectations, grounding skills they have practised, and a plan for aftercare.

4.5 The facilitator-led Integrative Breathwork session (descriptive only)

  • Purpose: in the school's framework, to bring stored memories and feelings into awareness for transpersonal integration [source: Channel5 Belize; Penguin Random House]. A trained facilitator delivers it. A psychotherapist delivers it only with that training.
  • What is published:
    • Participants breathe consciously, using variations derived from yoga, while a music programme supports the arc of the session [source: Channel5 Belize].
    • Sessions may be held in groups or individually [source: Channel5 Belize].
    • Other schools using the name describe "conscious connected breathing" combined with humanistic and body-based methods [source: GPBA member page, Akademie für Integrative Atemtherapie].
    • Breathing pattern, pacing, length, use of partners or "sitters", artwork, and closing circle for the Small lineage are [uncertain: not verified]. Do not assume they match Holotropic Breathwork; see Domain VII for that method's published structure. One US practitioner-directory listing headed "Integrative Breathwork" (San Antonio, Texas) describes group sessions in which participants work in pairs, taking turns as "breathers" and "sitters", with accelerated breathing, evocative music and bodywork, supervised by trained facilitators. It names neither Small nor Eupsychia, so whether this reflects the Small lineage is [uncertain: secondary, unverified] [source: SACRD directory listing].
  • Example language (illustrative, for preparing the client): "From what's published, you'll lie down and breathe more fully than usual, with music, and the facilitator will be with you. If it gets too much, slowing to normal breathing is always allowed."
  • Watch for: the warning signs listed in 4.6. Also watch for facilitators who encourage continuing through chest pain, faintness or panic. It is working if the client experiences the session as safe and stoppable, and leaves oriented.

4.6 Recognising and responding to over-breathing effects and acute distress

  • Purpose: to recognise when intensified breathing is causing physical or psychological harm, and to stop or modify it. This is relevant to facilitators, and to a psychotherapist who is present or who sees the client soon afterwards.
  • Steps [synthesis unless cited]:
    1. Know the signs of hyperventilation and low carbon dioxide (hypocapnia):
      • light-headedness and dizziness;
      • tingling around the mouth and in the hands;
      • muscle stiffening or cramping of the hands, the "claws" described in the related Holotropic Breathwork [source: Shrink Rap Radio #372];
      • panic, and a feeling of being unable to get enough air.
    2. If these signs are distressing, invite the client to return to slow, ordinary breathing through the nose, open their eyes and feel their support.
    3. Stop the session and get medical help for any of the following:
      • chest pain or palpitations;
      • fainting, or a seizure;
      • severe headache;
      • visual disturbance;
      • breathing difficulty that does not settle.
    4. For overwhelming emotion, dissociation or panic:
      • lower the stimulation by slowing the breath and asking for the music to be lowered;
      • offer orientation to the here and now;
      • stay with the client.
    5. Afterwards, document what happened and review whether the client should continue.
  • Example language (illustrative): "Let your breath go back to its own pace. Open your eyes if you like. Feel the floor under you. You're here, in this room, and you're safe. We can stop here."
  • Watch for: the difference between expected, passing sensations and red-flag symptoms. Watch too for clients who push on in order to please the facilitator. It is working if the symptoms settle once ordinary breathing returns and the client is oriented.

4.7 Grounding and immediate aftercare

  • Purpose: to help the client return to ordinary functioning before leaving. Use it at the end of every session. Breathworkers are asked to "create a supportive space" to process [source: GPBA 4.2.3].
  • Steps [synthesis]:
    1. Allow unhurried rest time.
    2. Check orientation: name, place, how they are getting home.
    3. Check body state: steadiness, any lingering tingling or cramping.
    4. Invite brief putting-into-words or drawing, without pushing for interpretation.
    5. Offer water and something to eat.
    6. Advise against driving until they feel fully steady.
    7. Give a contact route for the next 24–48 hours and the date of the integration session.
    8. Advise a quiet rest of the day, and remind them never to repeat intensified breathing alone in or near water.
  • Example language (illustrative): "Before you go, let's check how you're landing. What do you notice in your body right now? How are you getting home?"
  • Watch for:
    • Spaciness that persists.
    • Elation that tips into agitation.
    • Numbness, or a flat, shut-down state.
    • Wanting to make big life decisions immediately.
    It is working if the client is oriented, steady, and leaves with a plan.

4.8 Integration sessions in psychotherapy

  • Purpose: to make sense of what emerged and connect it to daily life and therapy goals. GPBA describes integration into "everyday life" as a core aim [source: GPBA 7]. Schedule within a few days of each session, and as often as needed after that [synthesis].
  • Steps [synthesis]:
    1. Ask for an account of the experience in the client's own words and sequence.
    2. Track the body sensations and emotions that remain.
    3. Explore meanings the client offers. If they use the school's transpersonal language, reflect it as their own or the school's framework, not as fact.
    4. Link themes to the presenting problem and current relationships.
    5. Identify one small, concrete daily-life step that follows from the experience.
    6. Review whether to continue with breathwork, pause, or stop.
  • Example language (illustrative): "What stays with you most from the session? … When you say it felt like something opened, what is different now in how you see this?"
  • Watch for:
    • Material that remains raw and intrusive.
    • Sleep disturbance.
    • Spiritual bypassing, meaning using spiritual experience to avoid ordinary difficulties.
    • Growing reliance on sessions to feel well.
    It is working if the client can hold the experience calmly, find meaning in it, and act on it in daily life.

4.9 Working with memories and images that emerge (birth, early trauma, "past lives")

  • Purpose: to respect what is experienced without turning it into unverified history. Use it whenever a client reports newly "recovered" memories or transpersonal images after breathwork.
  • Steps [synthesis]:
    1. Validate the experience as real experience.
    2. Explain that memory is reconstructive, and that altered states and suggestion can shape vivid images. Their accuracy cannot be known from vividness alone.
    3. Explore the emotional meaning and present-day relevance rather than establishing "what happened".
    4. Avoid leading questions and confirming interpretations.
    5. Do not encourage confronting family members or taking legal action on the basis of breathwork images alone.
    6. Where trauma memories emerge with PTSD symptoms, move to evidence-based trauma treatment and reconsider whether to continue intense breathwork.
  • Example language (illustrative): "That image clearly carries a lot of feeling. We can't know from the session whether it happened just like that, but we can look at what it means to you and what it is touching in your life now."
  • Watch for:
    • Rapid certainty about new abuse memories.
    • A facilitator or group that interprets images for the client.
    • Increasing distress.
    It is working if the client holds their own meaning, remains open about questions of fact, and functions better.

4.10 Addiction-recovery context

  • Purpose: Small's work is described as a transpersonal or spiritual approach to addiction treatment [source: Penguin Random House], and the technique is said to have been developed while working with people with addictive patterns [source: Channel5 Belize]. Use this when a client in recovery wants to take part.
  • Steps [synthesis]:
    1. Confirm stable sobriety and the client's current recovery supports.
    2. Check that the client is not intoxicated on the day [source: GPBA 4.3.4].
    3. Coordinate with the addiction treatment team, with consent [source: GPBA 4.1.4].
    4. Present breathwork as an addition to established recovery work, not a substitute for it.
    5. Watch for breathwork being used to chase intense states.
  • Example language (illustrative): "Let's make sure this sits alongside your recovery plan, not instead of it. Who else on your team should know you're doing this?"
  • Watch for:
    • Cravings or relapse after intense sessions.
    • Seeking out ever more sessions.
    • Combining breathwork with substances.
    It is working if recovery remains stable and insights are taken into recovery work.

4.11 Brief breath awareness within ordinary psychotherapy sessions

  • Purpose: to bring gentle attention to the breath as a grounding and awareness tool, at low intensity, as distinct from the intense session. Dibb's 2025 book presents methods to "incorporate breathwork into therapeutic sessions" [source: MIT Press Bookstore listing]; its specific procedures are [uncertain: not verified]. What follows is [synthesis].
  • Steps:
    1. Ask permission to try a short exercise.
    2. Invite the client to notice their natural breath without changing it: where they feel it, and its rhythm.
    3. If they wish, invite a slightly slower, softer exhale, without forcing and without any counts or holds.
    4. Ask what they noticed.
    5. Stop at once if they feel dizziness, tingling or rising panic.
    6. For structured paced-breathing protocols, see the Domain X guides on slow-paced and resonance breathing.
  • Example language (illustrative): "Just notice your breath as it is, without changing anything. Where do you feel it most? … What happens when you simply notice it?"
  • Watch for:
    • Breath focus that increases anxiety, which is common in panic and trauma; offer an external focus instead.
    • Breath control being used as a safety behaviour.
    It is working if the client feels steadier and more present.

4.12 Recognising adverse effects, referral and passing on concerns

  • Purpose: to respond when breathwork causes harm, or when a facilitator's conduct is a concern.
  • Steps:
    1. Assess adverse effects. Ask about persistent anxiety, depersonalisation, sleep disturbance, mood elevation, psychotic symptoms, suicidality, and physical symptoms.
    2. Refer by urgency. Send the client to medical or psychiatric care as urgency requires [synthesis].
    3. Raise concerns about conduct. Use the facilitator's school complaint process and, for GPBA members, the GPBA ethics process [source: GPBA 2.12, 8.1.11].
    4. Report illegal acts. Report sexual misconduct or other illegal acts to the authorities. GPBA channels are in addition to that, not instead of it [source: GPBA 5.1].
    5. Keep records and get advice. Document what happened, and consult your own supervisor and professional code [source: UKCP item 24; BPS 3.2(iv)].
  • Example language (illustrative): "What you're describing since the session matters, and I'd like us to take it seriously. I'd suggest we pause the breathwork and get you checked by your doctor."
  • Watch for: clients who blame themselves for not "doing it right", and a facilitator who brushes off concerns. It is working if the client is safe and supported, and the concern has been formally raised.

5. Handling problems

The published sources for Integrative Breathwork do not address most of these problems. Unless a source is cited, the guidance below is [synthesis].

  • The client's facilitator cannot name their training or code of ethics.
    • Explain your concern without disparaging the facilitator.
    • Suggest a GPBA-certified school, or another practitioner with transparent training. GPBA's school certification is described in section 2 [source: GPBA Professionalism page].
    • Example (illustrative): "I'd feel more confident if we knew how they were trained and how they handle difficult sessions."
  • Overwhelm during or after a session (flooding, panic, dissociation).
    • Use the grounding steps in 4.6 and 4.7.
    • Pause further breathwork.
    • Move to stabilisation and window-of-tolerance work before considering any return.
    • If PTSD symptoms are aggravated, offer evidence-based trauma treatment.
  • Panic disorder and fear of bodily sensations.
    • Hyperventilation sensations can trigger panic.
    • For clients with panic disorder, intense breathwork is usually not the place to start.
    • Interoceptive exposure within CBT is a structured, consented alternative; see the CBT guides.
  • Persisting physical symptoms (palpitations, chest pain, headache, visual change, seizure).
    • Refer to a doctor.
    • Do not resume until the client has medical clearance.
    • Remind the client of the GPBA warning that breathwork "can lower the seizure threshold" [source: GPBA 4.3.2].
  • Emerging psychotic, manic or severe dissociative symptoms.
    • Stop breathwork.
    • Arrange psychiatric assessment.
    • Inform the facilitator, with consent.
  • Suicidal thoughts after a session.
    • Carry out a standard risk assessment and safety planning.
    • Increase contact.
    • Breathworkers are expected to give opportunities to disclose suicidal thoughts "throughout" the process [source: GPBA 4.1.6].
  • "Stuck" client (nothing happens, or frustration at not having a breakthrough).
    • Normalise variation between sessions.
    • Remove performance pressure.
    • Explore what the wish for a breakthrough is about.
    • Consider whether breathwork suits this client at all. Do not intensify breathing to force an experience.
  • Resistance or reluctance to take part.
    • Treat it as information. The client may be protecting something important.
    • Respect a no without persuading. Consent must be free [source: GPBA 4.3.3].
  • Non-adherence to aftercare (driving straight away, practising intensified breathing alone, or doing it in the bath).
    • Revisit the safety reasons plainly, including the risk of fainting in or near water.
    • Agree a concrete plan.
    • If unsafe practice continues, advise against further sessions.
  • Over-reliance on sessions (chasing intense states, or doing workshop after workshop).
    • Explore what the sessions are giving the client.
    • Build everyday regulation skills.
    • Space out sessions.
    • In addiction recovery, take this up with the recovery team (see 4.10).
  • Spiritual framing taken as fact, or conflict with the client's beliefs.
    • Present transpersonal concepts as the school's framework [source: Penguin Random House; Justia record].
    • Respect the client's own religious or secular worldview.
    • Never require a belief.
  • Recovered memories leading to family confrontation.
    • Slow down.
    • Apply 4.9.
    • Advise against acting on breathwork images alone.
    • Get consultation.
  • Rupture with the therapist (for example, the client feels the therapist doubts their experience).
    • Acknowledge it.
    • Separate the validity of the experience from questions about historical fact.
    • Repair openly.
    • Example (illustrative): "I'm not doubting that this was powerful for you. I want us to understand it carefully together."
  • Touch concerns or misconduct by a facilitator.
    • Believe and support the client.
    • Help them raise the concern through the school and GPBA channels [source: GPBA 2.12].
    • Report sexual misconduct or other illegal acts to the authorities [source: GPBA 5.1].
    • Reassure the client that sexual or inappropriate touch is never acceptable, even when invited [source: GPBA 4.4.1.2].
  • A psychotherapist asked to lead the breathing.
    • Do so only after completing a school's facilitator training, with the right insurance, and only if your professional code permits it.
    • Codes require you to offer only methods you are adequately trained in [source: UKCP item 23; APA 2.01].
    • Combining psychotherapy with hands-on contact needs training and a code that allows it [source: USABP VIII; EABP Principle 7].
  • Medication questions.
    • Do not advise changes.
    • Refer to the prescriber [source: GPBA 4.1.9].

Sources

Web sources:

Books and articles cited:

  • Dibb, J. (2025). Breathwork and Psychotherapy: Clinical Applications for Healing and Transformation. W. W. Norton. Contents beyond the publisher's description: [uncertain: not verified].
  • Lalande, L., Bambling, M., King, R., & Lowe, R. (2011). Breathwork: An additional treatment option for depression and anxiety? Journal of Contemporary Psychotherapy, 42(2), 113–119. DOI 10.1007/s10879-011-9180-6. Full text: [uncertain: not verified].
  • Platteel-Deur, T. (2011). The Art of Integrative Therapy. Verlag Der Rheinländer.
  • Small, J. (1991). Awakening in Time. Bantam. A review describes a programme built on the seven chakras and a plan of meditation, inner work, study and service, with guided-imagery exercises; it mentions no breathwork [source: Kirkus Reviews]. Small, J. Becoming a Practical Mystic (Hazelden, 1995) and Psyche's Seeds: The 12 Sacred Principles of Soul Based Psychology (Tarcher/Putnam, 2002) [source: New Dimensions programme page]. Also listed on the publisher's author page: Becoming Naturally Therapeutic; Transformation: The Therapists of the Future; dates and any breathwork content [uncertain: not verified].

Gaps: no primary Eupsychia or Jacquelyn Small description of the Integrative Breathwork procedure, training curriculum or certification requirements is available to cite; these remain [uncertain: not verified]. Small's books and interviews, as publishers and reviewers describe them, concern transpersonal or "spiritual psychology" in general rather than the breathwork procedure. The sources for this modality are thin.

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