The mental health benefits of breathwork

In a randomized controlled study of 108 adults, the researchers compared three different breathwork exercises, in which participants deliberately guided their breathing in various ways, and mindfulness meditation, in which people observed their breathing but didn’t try to control it. The participants did the breathwork at home, following video instructions.

One group of participants was told to practice cyclic sighing. Participants were instructed to slowly inhale through the nose to expand the lungs, and inhale again to maximally fill the lungs. Then they were asked to slowly and fully exhale the breath through the mouth.

A second group focused on box breathing, which is spending the same amount of time slowly inhaling, holding the breath, exhaling and holding, before repeating the sequence.

A third group practiced cyclic hyperventilation, which “emphasizes inhalation rather than exhalation. It’s kind of the mirror image of the cyclic sighing exercise,” said Spiegel, a professor of psychiatry and behavioral sciences, and director of the Center on Stress and Health at Stanford University.

They took one deep inhalation through the nose, exhaled passively and then let the air “fall out from the mouth,” he said. Every 30 cycles, they would hold the breath after passive exhalation for 15 seconds.

The fourth group performed mindfulness meditation, which emphasized being aware of breathing and their body — as opposed to actively controlling their breathing.

After 28 days, participants in both the mindfulness meditation and breathwork groups reported having more positive feelings and fewer negative ones compared with before they began their respective practices. Participants in both groups also reported reduced feelings of anxiety.

“That’s not bad for five minutes a day,” Spiegel said. “It seems that practicing some control over your respiration is a kind of entry into one way of controlling your autonomic activity.”

The positive effects of breathwork took time to kick in: The more days the participants spent doing their breathing exercises, the better they felt each successive day.

Cyclic sighing appeared to be particularly effective among the different breathing exercises. Participants in this group reported even greater positive mood improvements compared with participants who practiced mindfulness meditation.

The key to mindfulness meditation, however, is to practice it as a daily life routine for an extended period of time, said Gemignani, who was not involved in the study and who provides longer breathwork and meditation interventions to his patients. “I think five minutes are too short for inducing benefits for subjects.”