Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature
Tanya G. K. Bentley, Gina D’Andrea-Penna, Marina Rakic, Nick Arce, Michelle LaFaille, Rachel Berman, Katie Cooley, Preston Sprimont
Brain Sciences December 22, 2023 DOI: 10.3390/brainsci13121612 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Topics | Breathwork Anxiety |
| Keywords | Breathing Respiration Diaphragmatic Stress |
| Key findings | Effective breath practices avoided fast-only breath paces and sessions shorter than five minutes, while including human-guided training, multiple sessions, and long-term practice. |
Abstract
Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies’ 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.
Comparable studies
Other systematic reviews and meta-analyses on anxiety, most cited first.
Citations in the library
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- Simply breathing anxiety away? A pilot, just-in-time ecological momentary intervention study of one-minute cyclic sighing versus box breathing as tools for acute anxiety reduction and attention promotion in real life Anxiety, Stress, and Coping April 19, 2026
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Cites 9
- Brief structured respiration practices enhance mood and reduce physiological arousal Cell Reports Medicine 2023
- Effects of yogic breath regulation: A narrative review of scientific evidence Journal of Ayurveda and Integrative Medicine February 2, 2018
- Breathwork in body psychotherapy: Clinical applications Body Movement and Dance in Psychotherapy November 1, 2013
- Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sciences February 2, 2023
- Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports January 9, 2023
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