Breathwork contraindications — who should take care, and why

Contraindications for deeper breathwork practices

The following conditions warrant caution or contraindication for deeper, activating breathwork (Territory 3 and 4 practices — extended conscious connected sessions). Always consult with a healthcare provider if you are unsure.

Cardiovascular conditions

Heart disease, significant high blood pressure, history of heart attack, arrhythmia, aneurysm. Deeper breathwork significantly alters heart rate and blood pressure. Anyone with cardiovascular conditions should consult their doctor before any deeper session and should only work with a facilitator who has been informed of their medical history.

Respiratory conditions

Severe asthma, COPD, or other significant respiratory conditions. Gentle diaphragmatic breathing may be beneficial and should be practised gently. Intense breathwork with significant breathing pattern changes is contraindicated.

Neurological conditions

Epilepsy and seizure disorders. The altered states and physiological changes of deeper breathwork can lower seizure threshold. This is a clear contraindication for intense practices.

Psychiatric conditions — requiring careful assessment, not blanket avoidance

Active psychosis or schizophrenia. Bipolar disorder, particularly during manic or hypomanic phases. Severe dissociative disorders or active dissociation. These conditions do not make breathwork impossible, but they require specialist assessment and a highly experienced facilitator who understands these presentations. The altered states of deeper breathwork can intensify existing dysregulation in ways that are not therapeutic without the right container and expertise.

Pregnancy

Deeper breathwork, breath retention practices, and activating practices are contraindicated during pregnancy. Gentle, functional breathing is safe and often beneficial — but should be adapted and ideally guided by a practitioner who works with pregnant clients.

Recent surgery, injury, or significant physical illness

Anyone in acute physical recovery should not practise intense breathwork. The physiological demands of deeper practices are not appropriate during this period.

Active trauma crisis

Someone currently experiencing acute trauma crisis — in a state of significant dissociation, emotional flooding, or outside their window of tolerance — should not enter deeper breathwork. Gentle calming practices may help restore regulation. Deeper work should wait until a baseline of stability has been re-established.

Medication considerations

Certain medications — particularly those affecting blood pressure, heart rhythm, or psychiatric stability — interact with the physiological changes of breathwork. Anyone on significant medication should consult their prescribing doctor before beginning any deeper practice.

Recreational substances

Deeper breathwork should never be combined with alcohol or recreational substances.

What to do instead

If any of the above applies to you, this does not mean breathwork is closed to you. It means:

Start with gentle, functional practices. The extended exhale, box breathing, and coherent breathing are safe for most people and genuinely powerful in their own right. Many people work with these practices for years and find them sufficient for their nervous system and healing goals.

Work with a healthcare provider. If you have a significant medical condition and want to explore deeper breathwork, discuss it with your doctor first. A letter of clearance is something reputable facilitators will ask for in some cases.

Find a facilitator who takes health intake seriously. Any breathwork facilitator who does not conduct a thorough health intake before a deeper session is not operating to the standard of care that this work requires. A good facilitator will ask about your health history, current mental health, medications, and lived experience — and will adapt or decline to work with you if the conditions are not right.

Consider timing. Some contraindications are situational rather than permanent. Someone in acute crisis may not be appropriate for deeper work now but may be in six months, with the right support in place. The seasons of readiness matter.

A note on gentle functional breathwork

The contraindications above apply primarily to deeper, activating, extended practices. Gentle functional breathwork — the extended exhale, box breathing, physiological sigh, coherent breathing at a slow pace — has a much shorter contraindication list:

• Avoid breath retention if you have cardiovascular or respiratory conditions
• Do not practise any breathwork if you are feeling acutely unwell
• Go gently if you are pregnant, and stay with slow nasal breathing
• If any practice increases rather than decreases anxiety, slow down or stop

Beyond these, gentle functional breathwork is one of the most universally accessible self-regulation tools available. It is safe, evidence-supported, and appropriate for most people in most circumstances.

Why this page exists

This page exists because safety matters more than enthusiasm.

Breathwork is genuinely powerful — and in the wrong conditions, or for the wrong person at the wrong time, that power can be destabilising rather than healing. The contraindications above apply primarily to deeper, activating practices.

This is not a page designed to frighten you away from breathwork. It is a page designed to help you approach it wisely — and to understand why a skilled, trauma-informed facilitator will always ask about your health history before a deeper session.

Safety and loving awareness are not restrictions on breathwork. They are its foundation.

This page is educational information, not medical advice. If anything here might apply to you, please consult your healthcare provider before beginning any deeper practice.