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

We reviewed the peer-reviewed published literature to evaluate practice components associated with stress reduction effectiveness. We identified 58 clinical studies, comprising 41 RCTs and 17 single-arm, pre-post, non-randomized trials; 5407 total participants were included, with a mean age of 35.9 years and 43.92% female. Among the 72 included interventions, breathing practices significantly reduced stress/anxiety in 54 interventions. Findings were used to develop a conceptual framework of breath practice effectiveness.

While commonly emphasized factors such as specific breath pace, population, and group versus individual practice were not found to be associated with effectiveness, five core components were: avoiding fast-only and <5 min practices; and incorporating human-guided training during initial sessions, multiple sessions, and long-term practice. Following this simple, evidence-based framework can help maximize the stress reduction benefits of breathing practices among broad populations.