Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature

Quick Summary

This comprehensive analysis examined 58 studies with 72 different breathing interventions to discover that an effective breathing practice for reducing stress and anxiety includes:

  • slow-only or a mix of slow and fast breathing;
  • a duration of at least 5 minutes;
  • at least one session of human guidance;
  • and at least six sessions spread out over one week.


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I hope the next 56’ish breaths are the most nourishing of your day.



4 Fundamentals

 

1. Essential Background Material

As you are likely aware, chronic stress and anxiety are a global problem.  They adversely affect physical health, for example, increasing our risk of heart disease, and negatively impact mental health, increasing our risk of mental illness.  Put simply, chronic stress and anxiety wear down our bodies and minds, reducing resilience, health, and hope.

Breathing practices are an attractive option for treating stress and anxiety because, as the authors of this paper state, they “have the advantage of being universally accessible, scalable, and cost-free.”  Moreover, millennia of practice and decades of scientific research have shown that breathing exercises are an effective antidote to stress and anxiety.

Surprisingly, no study has systematically examined what characteristics make a breath practice effective.  Why do some studies show considerable benefits while others find none?  Why do so many disparate techniques seem to work?  Do they share any commonalities?  That’s precisely what this paper answers: it provides a practical framework to help breath practitioners, coaches, and program developers create effective protocols.    



2. What Did this Research Do?

The authors found clinical trials that examined the impact of breathing exercises on stress and anxiety (which were assessed via questionnaires, inventories, observations, or self-reports).  It was especially unique because they included any type of controlled breathing (slow breathing, fast breathing, alternate nostril breathing, etc.) as long as they were used in isolation (for example, it couldn’t be slow breathing and meditation).

Moreover, this study included people with both clinically diagnosed and subclinical levels of stress or anxiety.  They included healthy adults, youth, and people with chronic health conditions, making the results applicable to the broader population.

Overall, they ended up 58 studies using 72 different breathing interventions with 5407 participants.  The studies included slow breathing, deep diaphragmatic breathing, fast breathing, alternate and uninostril breathing, breathing with holds/pauses, extended exhale, paced or pursed-lips breathing, and normal rate breathing.



3 & 4. What Were the Major Findings and Why Do They Matter?

This was an incredibly comprehensive study with TONS of neat results. However, they consolidated everything into a simple framework involving five items, which I’ll focus on below.  But definitely check out the paper for all the goodness.

Breathing improved stress and anxiety symptoms in 54 of the 72 interventions.

That’s 75% of the breathing interventions examined.  The rest of this section focuses on what characteristics separated effective (n=54) interventions from ineffective (n=18).

Item 1: Pace of Breathing – Slow or a combination of slow and fast is best.

Interventions using slow-only, or a mix of slow and fast breathing, were most effective.  Fast-only breathing interventions were not effective.  (Caveat: Only two fast-only breathing studies were included, so perhaps more studies with fast breathing need to be examined.) Crucially, among slow breathing interventions, the specific pace, pauses, and ratio were not significant.  What mattered was that the breath was slowed, not the precise pace

Item 2: Session Duration – At least five minutes or longer is the most critical.

Effective breathing interventions were generally five minutes or longer.  Surprisingly, there were no statistically significant improvements beyond five minutes, meaning a 20-minute session was no more effective than a 5-minute session for stress and anxiety.  This doesn’t mean longer is worse; it just means it isn’t vital for reducing stress and anxiety.

Item 3: Human Guidance – At least one session of human guidance is best.

Effective interventions generally included at least one session of human guidance, defined as prerecorded audio or video instruction for at least the first session.  Notably, it didn’t matter if the practices were done individually, within a group, or both; this finding provides lots of flexibility for coaches designing a program.

Item 4: Multiple Sessions – Do the breathing practice more than once.

There are no surprises here: Effective interventions required people to perform the breathing practice more than once. Consistency is crucial to teaching our bodies and minds to relax.

Item 5: Long-Term Practice – At least six sessions over at least one week.

Again, no surprises here.  Like with multiple sessions, continued practice over time leads to sustained benefits for reducing stress and anxiety.

The Five Factors Altogether

An effective breath practice for reducing stress and anxiety includes:

  • Slow-only or a mix of slow and fast breathing.
  • At least 5 minutes of practice.
  • At least one session of human guidance.
  • Multiple sessions; and
  • Long-term practice of at least six sessions over one week

Limitations: Low Study Quality

There were several limitations, but study quality is one of the biggest.  Of the 58 studies, 7 had “good” quality, 29 had “fair” quality, and 22 had “poor” quality.  This has always been a problem with breathing research. Hopefully, papers like this one will pave the way for more rigorous trials in the future.



1 Big Takeaway

This comprehensive analysis examined 58 studies and 72 different breathing interventions to discover that an effective breathing practice for reducing stress and anxiety includes: slow-only or a mix of slow and fast breathing, a duration of at least 5 minutes, at least one session of human guidance; and at least six sessions spread out over one week.



1 Practical Application

If you’re a coach:

This is an open-access paper, so go print out Figure 6 or Table 4 and pin it to your wall or place it next to your computer.  Use it as guidance anytime you’re helping a client, designing a class, or building a program.

If you’re a practitioner:

Use and adapt these results to your situation to ensure you’re balancing your unique needs with the latest science to obtain maximum effectiveness for reducing stress and anxiety.


Support HHPF

HHPF is a non-profit organization providing scientifically proven breathing solutions to elevate health and optimize human performance in today’s stress crisis. It takes a lot of work to perform studies like this. If you can consider supporting their mission:

Original Article Citation

Bentley TGK, D’Andrea-Penna G, Rakic M, Arce N, LaFaille M, Berman R, Cooley K, Sprimont P. Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature. Brain Sci. 2023 Nov 21;13(12):1612. doi: 10.3390/brainsci13121612. PMID: 38137060; PMCID: PMC10741869.