Listen or Download Podcast Version:
Citation
Fincham, G.W., Strauss, C., Montero-Marin, J. et al. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci Rep 13, 432 (2023). https://doi.org/10.1038/s41598-022-27247-y
Additional Note
This was published in the prestigious Nature Scientific Reports. I never thought I’d see the word “breathwork” there. And although I dislike the word “breathwork” for some reason, it’s an amazing step forward for the scientific acceptance of breathing for better health. To date, this is probably the most significant study ever published on breathing.
4 FUNDAMENTALS
1. Essential Background Material
Although “breathwork” has been practiced for thousands of years, it has recently gained popularity due to COVID-19 and James Nestor’s book—yes, this Nature publication even referenced his book as part of the trend : )
Concurrently, chronic stress has also increased markedly over the past few years, negatively contributing to physical and mental health conditions like anxiety, hypertension, cardiovascular disease, and depression.
Breathwork can be defined as various practices that regulate the way we breathe to achieve better mental, emotional, and physical health. It can be easily taught in a variety of formats, making it an attractive option for mitigating the recent rise in stress and its associated adverse health effects.
In general, slow breathing techniques have the most evidence for reducing stress. They work by increasing parasympathetic activity in the nervous system, increasing HRV, influencing brain regions associated with emotion, and ultimately making the stress-response system more resilient.
Although slow breathing clearly works, more broadly, it’s unclear how much of breathwork’s popularity for stress reduction is “hype” and how much is grounded in science. That’s what this review aimed to investigate.
2. What Did this Research Do?
This is the first meta-analysis of randomized controlled trials (RCTs) examining the effect of breathing exercises on self-reported stress, anxiety, and depression. Nothing is perfect, but a meta-analysis of RCTs is essentially the most robust evidence you can get from published research, so this is perhaps the most rigorous review of breathing published to date.
Stress
The primary question they sought to answer scientifically was: Does breathwork help people feel less stressed?
They used robust search criteria to find published studies that measured how any type of breathwork (slow or fast) affected self-reported stress. Note that it had to be “breathwork,” not meditation, singing, chanting, or any other practice that indirectly changes breathing patterns.
They ended up with 12 studies having 785 total participants. Nine papers were scored as having “some concerns” for bias, while the other three scored as having a high risk of bias—not surprising given the low quality of most breathing studies. Two papers used fast breathing, and the other ten used slow.
Anxiety and Depression
The second (very related) question they sought to answer was: Does breathwork help people experience fewer symptoms of anxiety and depression?
Excess stress can cause or exacerbate symptoms of anxiety and depression, so there is considerable overlap between these conditions and stress.
For this secondary question, they analyzed 20 studies for anxiety and 18 for depression.
3. What Were the Major Findings?
Stress
Overall, breathwork significantly improved self-reported stress (statistically, it was a “small-medium effect”).
Statistically, the overall stress-reducing effects of breathwork are the same as those found for cognitive behavioral therapy (CBT), meditation, mindfulness, and acceptance of emotions therapy.
No one individual study accounted for these significant effects. If they removed one study at a time, the results did not change significantly, indicating they were robust.
This is really neat: The stress-reducing results found in the 12 studies were so powerful that there would have to be 69 additional studies published showing zero effects on stress to negate their statistical significance.
To restate that last point, there would need to be 69 papers published finding that “breathwork does not reduce stress” to overturn the results of this meta-analysis. So, if you see a headline claiming “new study finds breathwork doesn’t reduce stress,” it would take 68 more until it matters : )
The results remained significant regardless of if the breathwork was delivered remotely without an instructor (self-help), in-person, in a group setting, or in combinations of all the above.
A sub-analysis found that the results were only significant for the slow breathing studies. There were just two fast breathing papers, but if those two were analyzed alone, the stress-reducing effects were insignificant.
Nonclinical patients (i.e., those without a physical or mental health condition) saw the greatest improvements. If the studies with patients with physical or mental health conditions were analyzed separately, the stress-reducing effects were insignificant (like with fast breathing, the sample size may be too small).
Anxiety and Depression
Breathwork had a significant effect on reducing anxiety and depression (statistically, a “small-medium effect”).
Heterogeneity among the studies was significant, making the results less robust. This suggests that variables other than breathwork could explain the positive results.
Nonetheless, breathwork’s effects on anxiety and depression are statistically similar to those seen for physical activity. (They’re not saying breathwork can replace exercise—just that the impact on anxiety and depression is similar statistically).
Breathwork’s effects were also statistically the same as those found for CBT, mindfulness, meditation, and acceptance of emotions therapy.
4. Why Do These Results Matter?
Stress significantly contributes to many chronic diseases and complications, like cardiovascular disease, hypertension, and depression. Additionally, stress is pervasive—over 60% of adults report financial and occupational stress.
Here, for the first time, it is shown with the most rigorous scientific analysis (a meta-analysis of RCTs) that the stress-reducing effects of slow breathing exercises are legitimate and significant. Breathing yielded results comparable to the most widely used treatments like CBT, mindfulness, and meditation.
Slow breathing exercises also significantly reduced symptoms of anxiety and depression, similar to effects seen for commonly-used therapies.
Most importantly, this meta-analysis showed that the mode of delivery did not significantly impact the results. Most treatments for stress rely on therapists with extensive training and require ongoing supervision. Breathing exercises, on the other hand, can be self-learned remotely, in-person, or in group settings, and the benefits for stress remain significant.
1 BIG TAKEAWAY
The most rigorous scientific analysis to date shows that slow breathing significantly improves self-reported stress, anxiety, and depression to the same extent as many standard therapies, such as CBT and mindfulness. This holds true regardless of how the breathwork training is delivered (remote, in-person, or group settings).
1 PRACTICAL APPLICATION
For Yourself
Regularly practice essentially any slow breathing technique to reduce stress and symptoms of anxiety and depression.
If You Coach Others
This paper shows that you can teach your students slow breathing practices in-person, remotely, 1-on-1, or in a group setting and be confident that you will significantly reduce their stress levels.
For Your Business
Apply this knowledge by sharing it with others. Grab one of the results that resonates with you, re-write it in your own words, add your personal take on its importance, and share it so people learn the incredible power of the breath.