Side Effects, Benefits and Associated Mechanisms in High Ventilation Breathwork: A Naturalistic Online Survey

Abstract

High ventilation breathwork (HVB) has received growing interest as a potential therapeutic tool in the context of the psychedelic renaissance and the expanding scientific research on mind–body practices. It involves intentionally increasing the speed and/or depth of breathing and is often conducted in groups, guided by facilitators and accompanied by evocative music. HVB has been reported to reliably induce altered states of consciousness (ASCs) that resemble, in some respects, those described under psychedelic substances, and may therefore represent a legal, low-threshold, body-based alternative to psychedelic-assisted approaches. In psychedelic research, ASCs are increasingly examined for their potential therapeutic relevance in internalizing disorders. Similarly, HVB has been associated with beneficial mental health outcomes, including improvements in mental well-being and reductions in perceived stress and symptoms of anxiety and depression. However, the evidence base on HVB remains limited with respect to its side-effect profile and the psychological mechanisms that may underlie both beneficial and adverse responses. To address these gaps, we will conduct a naturalistic longitudinal online survey in which participants retrospectively report on a recent HVB session, including their subjective experiences during the session (e.g., ASCs intensity and quality, mental and physical side effects, and mental health related mechanisms such as acceptance, and experiential avoidance), relevant contextual factors (e.g., setting, music, facilitator guidance), and risk factors (e.g., prior or current psychological or physical diagnoses and symptoms). Outcomes will include acute, subacute and delayed side effects as well as perceived changes in mental well-being and symptoms of depression and anxiety, assessed immediately after the session and again two to three weeks later to evaluate whether any perceived effects persist beyond the immediate aftermath. In addition, the follow-up will exploratively assess whether breathwork-related experiences are associated with subsequent perceived changes in levels of psychological flexibility, sense of coherence, and gratitude. The study is divided into two main projects: (1) a systematic assessment of side effects and the safety profile of HVB and (2) an investigation of the therapeutic potential and underlying psychological mechanisms of HVB. By systematically characterizing the range of reactions to breathwork and identifying who might be more vulnerable to adverse outcomes, this research aims to contribute to a more comprehensive understanding of breathwork safety and to support the development of evidence-based guidelines for its responsible and effective use. Moreover, by identifying mental health–relevant mechanisms in HVB this project may inform facilitator guidance and participant preparation, helping to foster constructive coping with mentally challenging experiences and, in turn, optimize breathwork’s potential to enhance mental well-being.