Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

Abstract

Deliberate control of the breath (breathwork) has recently received an unprecedented surge in public interest and breathing techniques have therapeutic potential to improve mental health. Our meta-analysis primarily aimed to evaluate the efficacy of breathwork through examining whether, and to what extent, breathwork interventions were associated with lower levels of self-reported/subjective stress compared to non-breathwork controls. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN up to February 2022, initially identifying 1325 results. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials (k = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g = − 0.35 [95% CI − 0.55, − 0.14], z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ211 = 19, p = 0.06, I2 = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes: g = − 0.32, p < 0.0001, and g = − 0.40, p < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk-of-bias study designs to avoid a miscalibration between hype and evidence.

Effects of brief remote high ventilation breathwork with retention on mental health and wellbeing: A randomised placebo-controlled trial

“…Comparator. One possibility is that we may have in fact created a comparator intervention with active, bene cial effects, an idea previously explored in our recent slow-breathwork trial 13 . In our best attempts to avoid this, we ensured mouth breathing (without explicit instructions to breathe nasally and 'diaphragmatically' since these two modalities may confer their own bene t 16,41 ) in the comparator group instructions.…”

“…The evidence-based picture surrounding HVBR is ambiguous, warranting a well-designed study as a tool to add credibility to an uncertain eld of ndings currently in its infancy. Building upon a robustly designed slow breathwork study 13 , we planned to complete a RCT comparing brief (~20 min/day) remotely delivered HVBR for three weeks to a 'placebo' HVBR comparator (paced breathing at 15 breaths/min with short breath holds). The metric of 15b/min is within the range of normal, healthy resting respiration of 12-16b/min 14 .…”

Evaluation of easy-to-implement anti-stress interventions in a series of N-of-1 trials: Study protocol of the Anti-Stress Intervention Among Physicians Study (ASIP)

“…Breathwork exercises have an impact on a range of symptoms and can lead to a reduction of anxiety, depression, and feelings of anger but also increase the feeling of comfort and relaxation [22, 23]. A recent meta-analysis showed a positive effect of paced breathing on stress perception [24]. Mindfulness interventions vary in type and duration and can positively affect depressive symptoms, anxiety, stress, well-being, and quality of life (meta-analysis in ref.…”

Decreased CO2 saturation during circular breathwork supports emergence of altered states of consciousness

“…While anecdotal evidence from practitioners of circular breathwork suggests that it can benefit mental health, the first scientific investigations of these claims are only just emerging (e.g. (Bahi et al, 2023;Banushi et al, 2023;Uthaug et al, 2021) for an overview, see (Fincham, Kartar, et al, 2023;Fincham, Strauss, et al, 2023;Lalande et al, 2012)). The studies conducted so far seem to generally demonstrate the benefits of circular breathwork for alleviating stress and anxiety (Balban et al, 2023;Fincham, Kartar, et al, 2023;Fincham, Strauss, et al, 2023;Lalande et al, 2012), reducing depression and PTSD (de Wit & Moraes Cruz, 2021), and enhancing self-awareness and life satisfaction Uthaug et al, 2021).…”

“…(Bahi et al, 2023;Banushi et al, 2023;Uthaug et al, 2021) for an overview, see (Fincham, Kartar, et al, 2023;Fincham, Strauss, et al, 2023;Lalande et al, 2012)). The studies conducted so far seem to generally demonstrate the benefits of circular breathwork for alleviating stress and anxiety (Balban et al, 2023;Fincham, Kartar, et al, 2023;Fincham, Strauss, et al, 2023;Lalande et al, 2012), reducing depression and PTSD (de Wit & Moraes Cruz, 2021), and enhancing self-awareness and life satisfaction Uthaug et al, 2021). What's more, these benefits have been hypothesized to be mediated by enhanced psychological openness (Lalande et al, 2012;Rhinewine & Williams, 2007).…”