Several psychophysiological mechanisms of action are proposed to underpin such techniques: from polyvagal theory and interoception literature 3 along with enteroception, central nervous system effects, and increasing heart-rate variability (HRV) via modulation of the autonomic nervous system (ANS) and increased parasympathetic activity 4. Slow-paced breathing practices have gained most research attention thus far. Recently, breathwork has been garnering public attention and popularity in the West due to supposed beneficial effects on health and well-being 2 in addition to the breathing-related pathology of covid-19, however it has only been partly investigated by clinical research and psychiatric medical communities. These techniques have emerged worldwide with complex historical roots from various traditions such as yoga (i.e., alternate nostril breathing) and Tibetan Buddhism (i.e., vase breathing) along with psychedelic communities (i.e., conscious connected breathing) and scientific/medical researchers and practitioners (i.e., coherent/resonant frequency breathing). 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.īreathwork comprises various practices which encompass regulating the way that one breathes, particularly in order to promote mental, emotional and physical health (Oxford English Dictionary) 1. Overall, results showed that breathwork may be effective for improving stress and mental health. Heterogeneity was moderate and significant for both. 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 intermediate and approaching significance, χ 2 11 = 19, p = 0.06, I 2 = 42%. The random-effects analysis yielded a significant small-to-medium mean effect size, g = − 0.35, z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Most studies were deemed as being at moderate risk of bias. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials ( k = 12) with a total of 785 adult participants. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, and ISRCTN up to February 2022, initially identifying 1325 results. 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. 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.
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