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

Summary & key facts

This meta-analysis looked at randomized trials to see if deliberate breathing practices (breathwork) reduce self-reported stress. Across 12 trials with 785 adults, breathwork was linked with a small-to-medium drop in stress compared with non-breathwork controls (g = -0.35). Similar small-to-medium effects were seen for anxiety and depression. Most included studies had some risk of bias and the authors say the results are promising but should be treated with caution until better-quality trials are done.

Key facts:

• The primary analysis on stress pooled 12 randomized controlled trials with a total of 785 adult participants.
• Breathwork was associated with a mean effect size of g = -0.35 for self-reported stress (95% CI -0.55 to -0.14), z = 3.32, p = 0.0009 (interpreted as a small-to-medium effect).
• Heterogeneity for the stress outcome was I2 = 42% (χ2 11 = 19, p = 0.06), which the authors describe as intermediate and approaching significance.
• For self-reported anxiety, 20 trials were pooled and yielded an effect of g = -0.32 (p < 0.0001).
• For self-reported depressive symptoms, 18 trials were pooled and yielded an effect of g = -0.40 (p < 0.0001).
• Most of the included studies were judged to be at moderate risk of bias by the review authors.
• The review searched several databases (PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN) up to February 2022 and initially identified 1,325 records.
• The authors note that breathwork covers many different techniques (for example slow-paced breathing) and that underlying mechanisms proposed in the literature include changes in heart-rate variability and autonomic nervous system activity.
• The authors explicitly urge caution and call for more rigorous, low risk-of-bias trials so that evidence does not get overstated relative to the actual findings.

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.

Topics

Health and Wellbeing Research Health, psychology, and well-being Heart Rate Variability and Autonomic Control

Categories

Cardiology and Cardiovascular Medicine Health Sciences Medicine

Tags

Internal medicine Linguistics Medicine Mental health Meta-analysis Philosophy Psychiatry Randomized controlled trial Stress (linguistics)