Breathwork has seen a massive spike in interest in the Western world over the past decade. But what does science have to say about its effectiveness in alleviating psychological maladies? New research published in Scientific Reports helps to summarize the current state of research and provides evidence that breathwork can have beneficial effects on stress and mental health.
Breathwork refers to various practices that involve deliberate control of breathing patterns in order to bring about physical and psychological benefits. There are several different breathing techniques that can be used for breathwork, including slow breathing, rhythmic breathing, and alternate nostril breathing. These techniques are often incorporated into meditative practices.
Preliminary research suggests that controlled breathing can help to reduce anxiety, depression, and stress, and that it can also help to improve overall well-being. This is thought to occur through several mechanisms, including the regulation of the autonomic nervous system, the activation of the parasympathetic nervous system, and the release of endorphins.
Motivated in part by personal experience, the authors behind the new research sought to investigate whether the hype around breathwork was grounded in evidence.
“I was introduced to meditation when I was studying at the University of California, Berkeley — I remember reading ‘The Art of Happiness’ by the Dalai Lama and Howard Cutler,” said lead author Guy William Fincham (@breath_Guy), a doctoral researcher at the University of Sussex School of Psychology, and Brighton and Sussex Medical School.
“I practiced here and there for several years. After moving to China where I met my long-term partner, she had to go back to Italy and I stayed; I was becoming increasingly stressed, anxious (without truly knowing and grasping this) and physically ill. From as early as I can remember, I always lived in the future (constantly planning, etc.) — and deemed this to be the root of my ‘problems’ — so I devoted myself to mindfulness meditation practice.”
Fincham participated in Buddhist meditation retreats in India and Sri Lanka, and was first introduced to the importance of nasal breathing and breathwork in the form of Yogic pranayama. He pursued a master’s degree in psychology with a focus on mindfulness and meditation. Fincham was practicing daily, but still experienced mental and physical health issues and was diagnosed with chronic fatigue syndrome and anxiety disorder.
The researcher discovered Wim Hof breathing technique and found it helpful, then learned about various other breathing techniques and decided to pursue research and teaching in breathwork and its potential impact on mental health. “Simply put, my purpose is to conduct research and teaching, contributing the best I can to bring scientific validity to various modalities involving breathwork, which may (or may not!) help people and improve their lives,” Fincham said.
To this end, Fincham and his colleagues conducted a meta-analysis of randomized-controlled trials (RCTs) on the potential efficacy or effectiveness of breathwork. The total sample included 785 adult participants.
A meta-analysis is a statistical technique that combines the results of multiple studies to determine a summary effect size or overall conclusion. It is used to examine the accumulated evidence from multiple studies on a particular topic or research question. Meta-analyses are useful because they provide a way to synthesize the results of many individual studies, increasing the power and accuracy of the conclusions that can be drawn.
“Breathwork has received an unprecedented surge in public interest and breathing practices may improve mental health,” Fincham told PsyPost. “More accessible approaches are needed to reduce or build resilience to stress worldwide, made even more evident by the COVID-19 pandemic. However, while breathwork has become increasingly popular in the West owing to its possible therapeutic potential, there also remains potential for a mismatch between hype and evidence.”
“Accordingly, we (myself and my supervisors at Sussex Profs Kate Cavanagh and Clara Strauss; research leads at Sussex Mindfulness Centre, and Dr Jesus Montero-Marin, an Oxford Mindfulness Centre senior researcher at the Department of Psychiatry, University of Oxford) examined whether breathwork interventions were associated with lower levels of self‐reported/subjective stress (classed as our primary outcome), anxiety and depression (classed as secondary outcomes) compared to non-breathwork control groups.”
“We searched seven databases (including two trial registers),” Fincham explained. “The primary outcome of subjective stress included 12 RCTs. Most studies were deemed as being at moderate risk of bias. The secondary outcomes of subjective anxiety and depressive symptoms comprised 20 and 18 RCTs, respectively.”
“Meta-analyses yielded significant small‐medium mean effect sizes, meaning breathwork was associated with lower levels of subjective stress, anxiety, and depression than non-breathwork control groups. Thus, our results showed that breathwork may have potential efficacy for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk‐of‐bias study designs to avoid a miscalibration between hype and evidence.”
“Nonetheless, breathwork could at least be, or form, part of the solution to meeting the need for more accessible therapeutic behavioral approaches regarding improving mental health but, again, more robust, well-designed studies are now needed to ensure such recommendations are grounded in research evidence.”
Fincham was surprised by the type of breathing techniques that were investigated in the studies.
“Examples include coherent/resonant frequency breathing, abdominal/diaphragmatic and pursed lip breathing, along with Sudarshan Kriya Yoga,” he told PsyPost. “Less than half of the studies used practices related to Yoga and pranayama, and there were only six studies with a primary focus on fast-paced breathwork (which requires much more research in order to determine its safety profile).”
“Breathing techniques have emerged worldwide with complex historical roots from various traditions including but certainly not limited to: Hinduism (Yoga and pranayama — where ‘prana’ means ‘vital energy’ or ‘life force’ and ‘ayama’ means ‘regulation’ or ‘control’), Buddhism, Sufism, Shamanism, psychedelic communities, along with scientific/medical researchers, and practitioners. Using the umbrella term ‘breathwork’ seemed most inclusive, without focusing on one tradition in particular, and this rubric appeared most accessible for the core audience of the journal Scientific Reports.”
The researcher was also surprised by the public interest in the meta-analysis. According to Altmetric, a platform that measures research outputs, the paper is in the 99th percentile of all research papers ever tracked. The author received congratulations from Stanford neurobiology professor and popular podcast host Andrew Huberman.
But there is still much to learn about the potential psychological benefits of breathwork and the underlying mechanisms involved. Further research is needed to fully understand the psychological effects of breathwork and to determine its effectiveness for various mental health conditions.
“A key limitation of our meta-analysis was that, given the small sample size (likely due to the relatively recent phenomena of breathwork in the West) paired with moderate risk of bias across included RCTs, the results should be interpreted very cautiously and not extrapolated,” Fincham said. “Breathwork may help some but not others.”
“Meditation received an unprecedented surge in public interest and research over recent decades. We may be at a similar cusp with breathwork and anticipate considerable growth in the field. Given the close ties of breathwork to psychedelic research, this could accelerate growth further. The scientific research community can build on the preliminary evidence provided here and thus, potentially pave the way for effective integration of breathwork into public health.”
“It’s still very early, but we are lucky in the sense that we can try and avoid mistakes previously made by meditation research, and ensure that we start off with robust, well-designed studies early on,” Fincham explained. “While there is a possibility that it could simply be the cognitive-attentional components of both meditation and breathing practices that explain their effects, observation of the breath (i.e., most practices within mindfulness curricula) versus control of the breath (i.e., breathwork) warrants nuanced investigation.”
The study, “Effect of breathwork on stress and mental health: A meta‑analysis of randomised‑controlled trials“, was authored by Guy William Fincham, Clara Strauss, Jesus Montero‑Marin, and Kate Cavanagh.
Read more background on Guy Fincham and his research interests below:
“My doctoral research at Sussex explores the effects of breathwork on health and wellbeing. At present, I’m about to launch a RCT funded by a Sylff Research Grant, collaborating with the organisation Othership who make very high production value breathwork practice sessions, and am in the process of designing another study (again working with Othership, and funded by an Alchemist Grant from PsyDAO, a very early-stage decentralised organisation with the goal of funding research at the intersection of psychedelics and mental health), which will involve collaboration with the Psychology and Medical Schools here at Sussex and Prof Elissa Epel at UCSF.
I’m also working with the Brighton and Sussex Medical School who’re exploring the phenomenological, psychedelic and physiological effects of therapeutic breathwork via MRI, ECG and NIRS. This research is being led by psychiatrist Dr Alessandro Colasanti, MD. You can see a sneak peak of this here. Under the guidance of Dr Colasanti, we’re currently writing a physiologically-oriented review on breathwork.
Additionally, I’m a co-investigator on The Breathwork Survey, launched by the Centre for Psychedelic Research at Imperial College London. The principal investigator is Prof Robin Carhart-Harris, and you can find out more about this study through this thread. In late 2022 I travelled to Amsterdam/Haarlem in the Netherlands for ICPR 2022 (Interdisciplinary Conference on Psychedelic Research), and primarily for a workshop the day before on breathwork as this is my research focus (Breathwork as Psychedelic Therapy). I had a profound experience that I could never have imagined nor expected from breathwork (and so much more). I have undergone a personal paradigm shift and have gained an increasingly newfound respect for the therapeutic potential of breathwork as/for psychedelic therapy. The experience was invaluable and has made me view psychedelic breathwork under a new lens, which will benefit my future research and work.
Ultimately, I hope my work can help build a larger evidence-based picture of the psychophysiological effects (and potential efficacy) of breathwork. I wish to pursue a postdoc here at Sussex with collaboration between the Psychology and Medical Schools (as it is emerging as a central hub for this kind of research, along with mindfulness meditation research) and establish a Sussex Breathwork group/lab (and ultimately a centre, like the Sussex Mindfulness Centre) dedicated to breathwork research and practice, focusing on mental and physical health paired with psychedelic outcomes. Funders and donors please reach out if interested!”
