Now That Masks Are Coming Off: What I Learned about The Connection Between Wearing a Mask and Mental Health- Linda Thai

I have noticed that individuals with mental health issues/trauma histories struggle with wearing face masks, and here is how I came to this realization:

I saw an OSHA video going around a few weeks ago. A man was holding an oxygen-sensor next to his mouth and measuring oxygen levels, mask-off and then mask-on, to “prove” that wearing a mask was hazardous for your health.

The yoga teacher in me was like, “Hmmm, who the heck breathes through their mouth? Mouth-breathing jacks up the nervous system.”

That was when the somatic trauma therapist in me joined the dots about anti-mask wearing, mouth-breathing, mental health and trauma responses.

When we perceive danger, we mouth-breathe in, in order to rapidly oxygenate the body and to mobilize the active defenses of fight and flight (sympathetic arousal). Putting on a face mask can elicit the beginnings of sympathetic arousal in many individuals. Furthermore, mouth-breathing can be detrimental when wearing a face mask, as the body isn’t able to get enough oxygen, which can cause the body-brain to spin further into panic/rage/terror. Hence the OSHA video.

Mouth-breathing is common amongst individuals who experience anxiety or depression; have trauma histories; or experience other forms of mental illness or developmental disabilities.

Nose-breathing restores the body back into the parasympathetic branch of the autonomic nervous system (rest and digest, safety and connection), and keeps the prefrontal cortex online therefore able to discern the difference between uncomfortable and unsafe.

Individuals whose nervous systems are conditioned to correlate mouth-breathing (sympathetic arousal) with danger responses will abreact to mask-wearing.

And yes, mouth-breathing can be associated with sympathetic arousal in a good way – surprise, excitement, joy, awe and wonder. The ventral vagal branch of the parasympathetic nervous system mitigates this arousal (when developmentally co-regulated) creating a robust nervous system capable of tolerating the full range of positive emotions. However, for now, this is outside of the mask/no-mask conversation.

We get advised to wear masks, but no one has taken the time to explain to us how to breathe when wearing a mask.

I have been using the face mask as an intentional activation cue to breathe in-and-out through my nose and my nose only.

I do box breathing exercises when I’m feeling a little anxious. (Inhale for a count of four. Hold the breath for a count of four. Breath out for a count of four. Repeat four times.)

Mostly, I just focus on the long exhale, which also activates the parasympathetic nervous system. And I make sure that I’m breathing into the area below my navel, a result of my diaphragm being relaxed and fluid. (The diaphragm tightens up during sympathetic fight-flight activation.)

If I catch myself sharply mouth-breathing-in, I close my mouth and breath in the rest of the way into my lower belly, and then sigh or hum as I focus on a long exhale. Making audible sounds is not what an animal in danger does. It is what an animal in safety does. And so, this restores me back into the ventral vagal branch of the parasympathetic nervous system.

Some individuals cannot nose-breath or cannot tolerate wearing a face mask, for various reasons ranging from suffocation trauma to autism spectrum disorder to medical issues that inhibit nose-breathing. Some individuals have very tight diaphragms, which can make deep belly-breathing challenging. Some of these conditions can be treated more quickly than others; some folks have access to treatment, some do not.

Either way, intentional breathing is a gift, for it anchors each of us back into the grace of this moment where kindness is possible.


A Gathering of Warriors



Linda Thai, MSW, ERYT-200, CLYL is an adjunct faculty member in the Social Work Department at the University of Alaska Fairbanks and specializes in trauma-informed care and compassion fatigue resilience skills; Mental health clinician at ND Systems, specializing in somatic therapies and trauma therapy. She assists internationally renowned psychiatrist and trauma expert, Dr. Bessel van der Kolk, with his private small group psychotherapy workshops aimed at healing attachment trauma. In her work at Fairbanks Memorial Hospital, she is responsible for training clinicians in all departments, including psychology, nursing and medicine. She has a Master of Social Work with an emphasis on the neurobiology of attachment and trauma.

Linda has studied Sensorimotor Psychotherapy, Brainspotting, Havening, Internal Family Systems, and structural dissociation of the personality. Linda has worked in Fairbanks, AK with those recovering from addiction, trauma, and mental illness. She is passionate about yoga, meditation, and mindfulness and bringing those gifts to her community.

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