The findings of a study published in Scientific Reports suggest that practicing breathing exercises helps reduce stress and improve mental health.

Study: Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomized Controlled Trials. Image credit: Nata Bene/Shutterstock


Breathwork practices date back to ancient times, as evidenced by yoga (India), vase breathing (Tibet), and Tai chi (China). Its benefits for spiritual, mental and physical health and well-being have been passed down from generation to generation.

Currently, breathwork is also recommended by doctors and researchers and is steadily gaining popularity, especially in developed countries. The beneficial therapeutic effects of breathwork have become more widely known since the 2019 coronavirus (COVID-19) outbreak and as associated respiratory illnesses came to light. Despite its known benefits, breathwork has not been under-researched by the scientific community.

The World Health Organization (WHO) identifies stress as a major contributing factor to non-communicable diseases leading to various mental health problems (such as anxiety and depression) and physical conditions (such as hypertension).

Cognitive behavioral therapy (CBT) is widely recommended and accepted as a treatment option for such mental disorders. However, it does not provide a definitive cure and requires long-term treatment and counseling under a trained therapist.

Breathwork training can be delivered easily and remotely, online or offline, making it significantly economical and accessible.

Scientists have described multiple mechanisms that play a role in the beneficial effects of practicing slow breathing. These include central nervous system (CNS) pacification, polyvagal theory, interoception and enteroception, increased heart rate variability through modulation of the autonomic nervous system (ANS), and increased parasympathetic action.

Stress, depression and anxiety decrease ANS activity and decrease HRV. Breath modification alters the neurological signals sent by the respiratory system and affects parts of the brain that regulate thoughts, emotions, and behavior.

In addition, slow breathing synchronizes brain waves, improving communication between different parts of the brain. Meanwhile, rapid breathing voluntarily induces transient stress, which helps improve stress resistance.

Current evidence suggests that one session of slow deep breathing benefits vagal tone (as measured by HRV) and reduces anxiety in adults. Hence, breathwork can be compared to mindfulness and meditation exercises. Meditation and breathing 5-6 breaths/minute improves HRV.

This is similar to the electronic biofeedback device approved by the Food and Drug Administration (FDA). A tenfold greater effect can be achieved by practicing meditation and breathwork.

About the study

This paper reviewed various effects of breathwork on subjective stress levels and compared them to non-breathwork controls. The study also examined the dose-response effects of breath change on stress.

This study focused exclusively on randomized control trials (RCTs). It included subanalyses of the study population and controls based on their health status, breathwork technique, delivery and the outcome measures used. The dose-response effect on stress was evaluated.

Systematic searches were made through PubMed, PsycInfo, Scopus, Web of Science, and ProQuest databases and clinical trial registries – ISRCTN and The meta-analysis included 12 RCTs (with 785 adults) up to February 2022.


The result of the meta-analysis showed a significant association between breathwork intervention and lower stress levels compared to the controls. Despite the insufficient availability of data, the outcomes of the included studies seemed consistent.

Furthermore, the non-clinical samples showed similar results, except those with mental and physical health problems. The stress benefits were notable after a slow breathing intervention when taught alone rather than when taught in groups. In addition, the benefits of the rapid breathing intervention were also mild in comparison.

The technique appeared to be effective whether given in person, at a distance, or both. The findings showed a high safety profile of breathwork interventions: slow breathing. Therefore, it can be prescribed for individuals with high stress levels and populations with subclinical stress.

Note that the interventional technique and mode of administration of breathing changes did not affect the results. So the different modalities can be effective. Another benefit was that breathwork showed reduced stress in the inactive and active controls. Therefore, the intervention can be considered accessible and somewhat universal.


These results showed significant improvements in self-reported anxiety, depression, and stress in individuals who practiced breathwork compared to control populations without breathwork.

While breathwork is a popular therapeutic approach to reduce stress, more studies are warranted to differentiate between the “hype and evidence” and better understand the therapeutic potential of breath changes.

This study provides preliminary evidence for further research on breathwork before incorporating it into everyday practice to improve public health.

Source link