Effectiveness of pranayama for mental disorders: a systematic review and meta-analysis of randomized controlled trials.
Christian Mütze, Dietmar Mitzinger, Heidemarie Haller
Frontiers in Psychiatry 2025 DOI: 10.3389/fpsyt.2025.1616996 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review with meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 517 |
| Population | Patients with posttraumatic stress disorder, depression, and mixed non-psychotic mental disorders |
| Topics | Breathwork |
| Keywords | Complementary medicine Integrative medicine Mental disorders Yoga Yogic breathing |
| Key findings | Prāṇāyāma significantly reduced post-intervention symptom severity compared to passive controls and showed comparable results to standard care, but with high risk of bias and small sample sizes. |
Abstract
This review systematically assessed the evidence on the effectiveness and safety of prāṇāyāma, traditional yogic breathing techniques, for patients diagnosed with mental disorders. We searched PubMed, PsycINFO, and Central until April 2024. We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) from both intention-to-treat (ITT) and per-protocol (PP) data for symptom severity (primary outcome) and health-related quality of life and depression (secondary outcomes) using Hedges' correction for small samples. For risk of bias (RoB) assessment, we used the Cochrane RoB 2 tool. We included seven publications on six randomized controlled trials that examined 517 patients with posttraumatic stress disorder (PTSD), depression, and mixed non-psychotic mental disorders and compared prāṇāyāma to passive controls (wait list and attention control) or standard care (psychotherapy, electroconvulsive therapy, and antidepressants). Overall RoB was assessed with some concerns in two studies and as high in four studies. The meta-analyses of the ITT samples (SMD = -0.27, 95% CI = [-0.52, -0.03], I2 = 10%) as well as the PP samples (SMD = -0.35, 95% CI = [-0.57, -0.12], I2 = 0%) showed that prāṇāyāma significantly reduced post-intervention symptom severity in comparison to passive controls. When compared to standard care, both ITT and PP meta-analyses showed comparable results in reducing symptom severity. For secondary outcomes, only PP analyses on quality of life showed significantly higher post-intervention effects for prāṇāyāma in comparison to passive controls (SMD = 0.59, 95% CI = [0.31, 0.87], I2 = 20). No significant effects were found for depression. Sensitivity analyses excluding all studies with a high risk of overall bias revealed significant effects of prāṇāyāma on symptom severity and quality of life, but only in PP samples and in comparison to passive controls. Adverse events were more frequently associated with fast than with slow breathing techniques. This meta-analysis suggests short-term effects of prāṇāyāma when integrated in outpatient and inpatient care of mental disorders. In consideration of the overall high risk of bias and low number of analyzed patients, prāṇāyāma should not be used instead of standard therapies. Further research is needed to explore long-term effects and adequately assess adverse events. CRD42024550239.
Comparable studies
Other systematic reviews and meta-analyses on breathwork, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Pranayamas and their neurophysiological effects | 2020 | Systematic review | |
| Implication of asana, pranayama and meditation on telomere stability | 2018 | Systematic review | |
| Effect of a single session of yoga and meditation on stress reactivity: A systematic review. Healthy adults | 2024 | Systematic review | n = 2,574 |
| The role of non-ordinary states of consciousness occasioned by mind-body practices in mental health illness. | 2023 | Systematic review | |
| Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis. Patients with cardiovascular disease | 2024 | Systematic review and meta-analysis | n = 927 |
Citations in the library
Cited by 2
- Prana-Centered AI Integrating Subtle Yogic Energetics Into Intelligent Wellness Systems Advances in Computational Intelligence and Robotics June 18, 2026
- Posttraumatic growth following culturally grounded intervention among tribal young women with dissociative disorders in Sikkim: an interpretative phenomenological analysis Frontiers in Psychology September 1, 2026
Cites 7
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- Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports January 9, 2023
- Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans. BMJ Open August 25, 2022
and 2 more in the library