Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review

Abstract

Anxiety disorders are the most common group of mental disorders, but they are often underrecognized and undertreated in primary care. Dysfunctional breathing is a hallmark of anxiety disorders; however, mainstays of treatments do not tackle breathing in patients suffering anxiety. This scoping review aims to identify the nature and extent of the available research literature on the efficacy of breathwork interventions for adults with clinically diagnosed anxiety disorders using the DSM-5 classification system. Using the PRISMA extension for scoping reviews, a search of PubMed, Embase, and Scopus was conducted using terms related to anxiety disorders and breathwork interventions. Only clinical studies using breathwork (without the combination of other interventions) and performed on adult patients diagnosed with an anxiety disorder using the DSM-5 classification system were included. From 1081 articles identified across three databases, sixteen were included for the review. A range of breathwork interventions yielded significant improvements in anxiety symptoms in patients clinically diagnosed with anxiety disorders. The results around the role of hyperventilation in treatment of anxiety were contradictory in few of the examined studies. This evidence-based review supports the clinical utility of breathwork interventions and discusses effective treatment options and protocols that are feasible and accessible to patients suffering anxiety. Current gaps in knowledge for future research directions have also been identified.

Keywords: agoraphobia; anxiety; anxiety disorders; breathwork; diaphragmatic breathing; heart rate variability biofeedback; hyperventilation; phobia; pranayama; stress.

Figure 1

Effects of slow-diaphragmatic breathwork practices on the nervous system. Slow diaphragmatic breathing has an impact on the cardiovascular and respiratory systems and can stimulate the parasympathetic activity of the nervous system (NS). Stress causes hyperactivation of the sympathetic nervous system and results in cardioacceleration and bronchial dilatation. Generated using Biorender, https://biorender.com/, accessed on 17 December 2022.

Figure 2

PRISMA flowchart of the study selection process.

Figure 3

Number of studies published per year.

Figure 4

Number of studies per type and setting.

Figure 5

Number of studies per style of breathwork with relative outcome on anxiety improvement (significant or not significant). Abbreviations: breathing retraining cognitive restructuring (BRCR), Surdashan Kriya Yoga (SKY), and heart rate variability-biofeedback (HRV-BF).