By Nidhi Saha, Scientific Reports

Practicing breathing exercises helps decrease stress and improve mental health. 

Background 

Breathwork practices date back to ancient times, as evidenced in yoga (India), vase breathing (Tibet), and Tai chi (China). Its bene!ts on spiritual, mental, and physical health and well-being have been conveyed through generations. 

Currently, breathwork is also advocated by medical practitioners and researchers and is steadily gaining popularity, especially in developed nations. The bene!cial therapeutic e#ects of breathwork practice have become more widely known since the coronavirus disease 2019 (COVID-19) outbreak and as the associated respiratory ill-e#ects emerged. Despite its well-known bene!ts, breathwork has been inadequately investigated by the scienti!c community. 

The World Health Organization (WHO) identi!es stress as a major factor contributing to non-communicable diseases leading to several mental health issues (like anxiety and depression) and physical ailments (like hypertension). 

Cognitive behavioral therapy (CBT) has been widely recommended and accepted as a treatment option for such mental disorders. However, it does not o#er a de!nitive cure and necessitates prolonged treatment and counseling under a trained therapist. 

Breathwork training can be easily and remotely imparted, online or o$ine, making it signi!cantly economical and accessible. 

Scientists have described multiple mechanisms instrumental in the bene!cial e#ects of practicing slow-paced breathing. These include central nervous system (CNS) paci!cation, polyvagal theory, interoception and enteroception, increased heart rate variability throug autonomic nervous system (ANS) modulation, and heightened parasympathetic action. 

Stress, depression, and anxiety impair ANS activity and lower HRV. Breath modi!cation alters the neurological signals sent by the respiratory system, in%uencing parts of the brain that regulate thoughts, emotions, and behavior. 

Additionally, slow-paced breathing synchronizes brain waves, improving communication between di#erent parts of the brain. Meanwhile, fast- paced breathing voluntarily induces transient stress, which aids in improving stress resilience. 

Current evidence proposes that one session of slow-paced deep breathing bene!ts the vagal tone (measured through HRV) and attenuates anxiety in adults. Hence, breathwork can be compared to mindfulness and meditation practices. Meditation and breathing 5-6 breaths/minute improves HRV. 

This is comparable to the electronic biofeedback device approved by the Food and Drug Administration (FDA). A ten-fold greater e#ect can be achieved by practicing meditation and breathwork. 

About the study 

This article reviewed various impacts of breath alteration on subjective stress levels and compared them to non-breathwork controls. The study also examined the dose-response e#ects of breath alteration on stress. 

This study solely focused on randomized control trials (RCTs). It entailed sub-analyses of the study population and controls based on their health status, breathwork technique, delivery, and the outcome measures employed. The dose-response e#ect on stress was evaluated. 

A systematic search was conducted through PubMed, PsycInfo, Scopus, Web of Science, and ProQuest databases and the clinical trial registers – ISRCTN and ClinicalTrials.gov. The meta-analysis included 12 RCTs (with 785 adults) until February 2022. 

Findings 

The result of the meta-analysis yielded a signi!cant association between breathwork intervention and lower stress levels compared to the controls. Despite the insu&cient data availability, the outcomes of the included studies seemed consistent. 

Further, the nonclinical samples also depicted similar results, excepting those with mental and physical health issues. The bene!ts on stress were noteworthy after slow-paced breathing intervention when taught alone rather than when imparted in groups. In addition, the bene!ts of the fast-paced breathing intervention were also mild in comparison. 

The technique seemed to be e&cacious whether taught in-person, remotely or both. The !ndings depicted a high safety pro!le of breathwork interventions––slow-paced breathing Hence, it can be prescribed to individuals experiencing high stress levels and populations with subclinical stress. 

Of note, the interventional technique and mode-of-delivery of breathing alterations did not impact outcomes. Thus, its various modalities can be e#ective. Another advantage was that breathwork showed attenuated stress in the inactive and active controls. Hence, the intervention can be deemed accessible and somewhat universal. 

Conclusions 

These results showed signi!cant improvements in self-reported anxiety, depression, and stress in individuals practicing breathwork compared to non-breathwork control populations. 

Although breathwork is a popular therapeutic approach to mitigate stress, more studies are warranted to di#erentiate between the “hype and evidence” and better understand breath alterations’ therapeutic potential. 

This study provides preliminary evidence for further research on breathwork before incorporating it into routine practice for improving public health. 

Keywords; breathwork, health