From the Guidelines
Breathwork practices such as diaphragmatic breathing, 4-7-8 breathing technique, alternate nostril breathing, coherent breathing, and box breathing have scientific evidence supporting their effectiveness in reducing stress, improving respiratory function, and enhancing overall well-being, as supported by recent studies 1.
Key Findings
- Diaphragmatic breathing has been proven to reduce stress, lower blood pressure, and improve respiratory function by engaging the diaphragm fully.
- The 4-7-8 breathing technique has demonstrated benefits for anxiety reduction and sleep improvement by activating the parasympathetic nervous system.
- Alternate nostril breathing has been shown to balance the autonomic nervous system and reduce stress.
- Coherent breathing has evidence for reducing anxiety and improving heart rate variability.
- Box breathing has proven benefits for stress management, particularly in high-pressure situations.
Recommendations
- To practice these techniques effectively, find a quiet space, maintain good posture, start with just 5 minutes daily, and gradually increase duration.
- These techniques work primarily by influencing the autonomic nervous system, reducing stress hormones like cortisol, improving oxygen exchange, and creating beneficial shifts in brain activity patterns.
Clinical Considerations
- Pulmonary rehabilitation, which includes breathwork practices, has been shown to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease, as stated in the American Thoracic Society clinical practice guideline 1.
- The American Thoracic Society and European Respiratory Society statement on pulmonary rehabilitation emphasizes the importance of a comprehensive and multidisciplinary approach to pulmonary rehabilitation, including patient education, exercise training, and psychosocial support 1.
From the Research
Evidence-Based Respiratory Therapy Practices
The following breathwork practices have been found to be effective in reducing stress and anxiety:
- Diaphragmatic breathing: studies have shown that diaphragmatic breathing can reduce physiological and psychological stress in adults 2, and may decrease stress as measured by physiologic biomarkers and psychological self-report tools.
- Cyclic sighing: a study found that daily 5-min cyclic sighing has promise as an effective stress management exercise, producing greater improvement in mood and reduction in respiratory rate compared to mindfulness meditation 3.
- Box breathing: a study compared the effects of box breathing, cyclic sighing, and cyclic hyperventilation with retention, and found that breathwork, especially exhale-focused cyclic sighing, produces greater improvement in mood and reduction in respiratory rate compared to mindfulness meditation 3.
- Slow diaphragmatic breathing: a feasibility pilot found that a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students was feasible and tolerable, although preliminary effectiveness analyses indicated no significant changes in anxiety symptoms 4.
Key Characteristics of Effective Breathwork Interventions
Effective breathwork interventions tend to have the following characteristics:
- Avoid fast-only breath paces and sessions <5 min 5
- Include human-guided training, multiple sessions, and long-term practice 5
- Do not include extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices 5
Applications of Breathwork Interventions
Breathwork interventions have been found to be effective in reducing anxiety symptoms in patients clinically diagnosed with anxiety disorders 6, and may be a useful tool for stress management and well-being in various populations, including high school students 4.