Breathing exercises are techniques that involve intentionally changing the way you breathe to promote relaxation and reduce stress.
For individuals with anxiety disorders like generalized anxiety, these exercises can be a powerful tool for both immediate relief and long-term management.
By focusing on slowing down and deepening the breath, breathing exercises activate the body’s natural relaxation response, helping to calm the mind and reduce physical symptoms of anxiety in the moment.
When practiced regularly, these techniques can also help to improve overall emotional regulation and resilience to stress over time.
As part of a comprehensive treatment plan, they can be a valuable strategy for anyone looking to better manage their anxiety and improve their quality of life.
Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegal, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1). https://doi.org/10.1016/j.xcrm.2022.100895
Key Points
- The study found that both breathwork and mindfulness meditation significantly improve daily positive affect and reduce state anxiety and negative affect. However, breathwork, especially the cyclic sighing technique, was more effective than mindfulness meditation at increasing positive affect over the 28-day study period.
- Cyclic sighing breathwork produced a significantly greater reduction in respiratory rate compared to mindfulness meditation. The reduction in respiratory rate correlated with the increase in positive affect.
- The study was conducted remotely using wearable devices to monitor physiological data. While this allowed a diverse participant pool, the remote nature limited control over some variables like exact adherence to the breathing exercises.
- The findings suggest voluntary controlled breathing exercises can effectively regulate mood and physiology, with implications for stress management. More research is needed on the brain mechanisms and long-term effects.
Rationale
Breathwork has emerged as a potential mind-body intervention for well-being, but there is limited comparative data on the effects of different breathing techniques and how they compare to mindfulness meditation (Lavretsky & Feldman, 2021).
Previous research shows breathing impacts emotional and cognitive states (Boiten et al., 1994; Yilmaz Balban et al., 2021), so directly comparing structured breathing exercises to mindfulness meditation, which does not control breath, can elucidate their differential effects on mood and physiology.
This study aimed to address this research gap by comparing three daily 5-minute breathwork exercises to an equivalent period of mindfulness meditation over one month.
Method
The study employed a repeated-measures, randomized controlled design conducted entirely remotely during the COVID-19 pandemic.
Procedure
Participants completed baseline trait anxiety and sleep questionnaires.
Participants were randomized into a mindfulness meditation control group or one of three breathwork interventions (cyclic sighing, box breathing, or cyclic hyperventilation with retention). They were then mailed a wearable device to monitor physiological data.
Over the 28-day intervention period, participants completed their assigned 5-minute exercise once daily. Self-report mood and anxiety measures were collected daily before and after the exercises. Text message reminders were sent daily.
Physiological data (heart rate, heart rate variability, respiratory rate) was continuously monitored using a wearable device. After the intervention period, participants again completed the trait anxiety and sleep questionnaires.
Sample
The 108 participants included healthy English-speaking males and females ages 18 and up. Most were recruited from an undergraduate psychology class at Stanford University. Those with moderate to severe psychiatric, medical, or substance use disorders were excluded.
Measures
- State-Trait Anxiety Inventory (STAI): 20-item questionnaires measuring current (state) and general (trait) anxiety
- Positive and Negative Affect Schedule (PANAS): Measures current positive and negative mood
- WHOOP strap: Wearable device that monitors heart rate, heart rate variability, and respiratory rate
- PROMIS Sleep-Related Impairment Short Form: Measures sleep-related daytime impairment over the past week
Statistical Analysis
Daily changes in self-report measures were calculated by subtracting pre-exercise scores from post-exercise scores.
Average daily change scores were compared between groups using linear mixed effects models.
Changes in physiological measures were calculated as the slope of daily values over the 28 days and compared between groups using Mann-Whitney U tests.
Pre-post changes in trait anxiety and sleep impairment were compared using Wilcoxon tests.
Results
- Both mindfulness meditation and breathwork significantly improved daily positive affect and reduced state anxiety and negative affect.
- Breathwork, especially cyclic sighing, produced a significantly greater increase in daily positive affect compared to mindfulness meditation. This effect increased with more days of practice.
- Cyclic sighing breathwork resulted in a significantly greater reduction in respiratory rate over the study period compared to mindfulness meditation. The reduction in respiratory rate correlated with the daily increase in positive affect.
- No significant changes were observed in heart rate variability, resting heart rate, sleep measures, or trait anxiety in any of the groups.
Insight
This study demonstrates that even brief daily breathwork practice can have a meaningful impact on mood and physiology compared to mindfulness meditation.
The findings suggest the importance of the specific mechanics of breathing, with an emphasis on extended exhalation in the cyclic sighing technique producing the greatest improvements in positive affect and respiratory rate.
This aligns with previous research on the psychological and physiological impacts of sighing.
The results also show these effects can occur with minimal daily practice of 5 minutes, increase with more practice over time, and can be captured using remote study designs and wearable monitoring devices.
Further research should explore the brain mechanisms underlying these different breathing practices and their long-term effects.
Strengths
This study had several methodological strengths, including:
- Randomized controlled design with an active control condition (mindfulness meditation)
- Remote study procedures allowed for recruitment of a broader participant sample
- Repeated daily assessments captured change in measures over time
- Use of wearable devices enabled continuous, objective physiological measurement
- Compared three distinct breathing techniques to each other and to meditation
Limitations
Despite its strengths, this study also had several limitations, including:
- Remote nature of study limited control over participants’ exact adherence to the breathing exercise instructions
- Participant sample was mostly young adults recruited from a university setting, limiting generalizability
- Study duration of one month could not assess longer-term effects of the practices
- Did not include measures that might help explain mechanisms, like direct measures of vagal tone
Implications
This study provides evidence that voluntary controlled breathing exercises, especially those emphasizing prolonged exhalation, can have meaningful effects on mood and physiology even with very brief daily practice.
This offers a highly accessible tool for stress management and emotional regulation that could be easily incorporated into daily life or clinical practice.
The fact that these effects were found in a non-clinical sample also suggests potential for prevention and wellness promotion.
Remote study designs using wearable devices to monitor outcomes are a feasible way to study these practices that can enable more diverse participant recruitment.
Future studies should prioritize more mechanistic measures to understand how these practices impact the nervous system, as well as longer-term follow-up to assess the durability of effects. Research in clinical populations is also needed.
References
Boiten, F. A., Frijda, N. H., & Wientjes, C. J. (1994). Emotions and respiratory patterns: review and critical analysis. International Journal of Psychophysiology, 17(2), 103-128. https://doi.org/10.1016/0167-8760(94)90027-2
Lavretsky, H., & Feldman, J. L. (2021). Precision medicine for breath-focused mind-body therapies for stress and anxiety: are we ready yet?. Global Advances in Health and Medicine, 10, 2164956120986129. https://doi.org/10.1177/2164956120986129
Yilmaz Balban, M., Cafaro, E., Saue-Fletcher, L., Washington, M. J., Bijanzadeh, M., Lee, A. M., Chang, E. F., & Huberman, A. D. (2021). Human responses to visually evoked threat. Current Biology, 31(3), 601-612. https://doi.org/10.1016/j.cub.2020.11.035
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
- What are some of the proposed mechanisms by which controlled breathing may impact the autonomic nervous system and mood? What additional measures would help test these mechanisms?
- How might these findings be applied in clinical psychology practice? What populations or conditions might especially benefit from breathwork interventions?
- The study found effects with just 5 minutes of daily practice. What are the implications of this for habit formation and adherence? How would you design a study to determine optimal “dose” and duration of breathwork for different outcomes?
- Considering the measures used in this study, what are some of the limitations in our ability to interpret the results? What additional measures would be most important to include in future studies to build on these findings?
