Wellness Goals · Stress and relaxation guide
Breathing Exercises for Stress and Anxiety
Slow diaphragmatic breathing for stress and anxiety · also called Breathing exercises for stress, slow breathing, belly breathing, diaphragmatic breathing, deep breathing for anxiety, ejercicios de respiracion para el estres
Breathing exercises for stress and anxiety are simple slow-breathing practices. The NHS gives a five-minute version: breathe gently into the belly, counting 1 to 5 in and 1 to 5 out. A 2023 meta-analysis of 12 trials found a small-to-medium fall in self-reported stress, with caution about bias. No source read shows one named pattern beats plain slow breathing, and breathing alone is not shown to treat an anxiety disorder. Occasionally people feel more anxious; see a clinician if stress or panic will not settle.
General information, not medical advice. Last substantive update · Not medically reviewed. A named clinician has not signed off on this page. How this page is made
About Breathing Exercises for Stress and Anxiety
Breathing exercises for stress and anxiety are slow-breathing practices, such as the NHS five-minute belly breathing exercise. Reviews find small-to-medium falls in self-reported stress and anxiety, but the studies are mixed in quality, no pattern is shown to beat plain slow breathing, and breathing alone is not shown to treat an anxiety disorder. Safety is generally good for healthy people, with occasional rises in anxiety. See a clinician if stress or panic will not settle.
What breathing exercises for stress are: a simple five-minute exercise
The NHS describes a breathing exercise for stress, anxiety and panic that takes a few minutes and can be done anywhere. Get comfortable sitting, standing or lying down and loosen tight clothes. Place both feet flat, about hip-width apart, or rest your arms away from your sides with palms up if lying. Breathe in gently and regularly, letting the breath flow deep into the belly without forcing it, counting steadily from 1 to 5, ideally in through the nose and out through the mouth. You may not reach 5 at first. Let it flow out gently, counting 1 to 5 again if it helps. Repeat for at least 5 minutes. The NHS says you get most benefit by doing it regularly as part of a daily routine.
NCCIH calls slow, deep breathing of this kind diaphragmatic breathing. This page describes what the NHS says and what studies found. It does not tell you what to do.
Stress and anxiety: what you may notice
The NHS says stress is usually a reaction to mental or emotional pressure. It can bring headaches, muscle tension, stomach problems, a faster heartbeat, trouble concentrating, feeling overwhelmed, irritability and changes in sleep or appetite. NCCIH says long-term stress may contribute to digestive disorders, headaches and sleep disorders. Common triggers listed by the NHS include work, family, money and health problems.
How breathing might help
NCCIH describes a built-in relaxation response, a "stress reset button" that works against the stress response, and lists slow diaphragmatic breathing as one way to trigger it. A 2018 systematic review of slow breathing under 10 breaths a minute found higher heart rate variability, changes in brain waves and more relaxation in healthy people. These are body measures and proposed mechanisms; they do not prove a lasting effect on stress.
Established care for stress and anxiety disorders
The NHS lists seeing a GP, self-referring to NHS talking therapies, and self-help such as breathing exercises, planning and peer support. For panic disorder NIMH says treatment typically involves psychotherapy, medication or both, with cognitive behavioral therapy the well-studied choice. A clinician decides what suits you. Breathing exercises are an extra, not a replacement.
Does a particular pattern work better?
Box breathing, 4-7-8 breathing and alternate nostril breathing are popular. Proper evidence not found in the sources read that any one beats plain slow breathing for stress. A 2025 lab study of 84 students found 6 breaths a minute raised heart rate variability more than box or 4-7-8 breathing, with no change in mood, and the authors say the named patterns have little empirical support.
Fitting it into the day
Linking the exercise to something you already do, such as after waking or before a meeting, is a practical tip and not a study finding. For breathwork as a wider practice, see the Breathwork page. For sleep, see the relaxation and sleep page.
At a glance
Traditional uses history, not proof
Studied for research
- Slow belly breathing for stress, low certainty
- Anxiety and low mood, low certainty
- Exhale-focused cyclic sighing, low certainty
- Exam stress in students, very low certainty
- Breathing training in panic disorder care, low certainty
- Added to care for generalized anxiety disorder, very low certainty
- HRV biofeedback, low certainty
- Blood pressure, mixed
- Box breathing and 4-7-8, insufficient
- Alternate nostril breathing, very low certainty
- Wim Hof style fast breathing, insufficient
Main compounds
- Slow diaphragmatic breathing
- Cyclic sighing
- HRV biofeedback
- Box breathing
- 4-7-8 breathing
- Alternate nostril breathing
Common forms
- Counted belly breathing for 5 minutes
- Guided audio or app sessions
- Biofeedback devices
- Clinician-led breathing training
Research links: NHS: Breathing exercises for stress · 2023 meta-analysis: breathwork and stress (12 trials) · NCCIH: Relaxation Techniques: What You Need To Know · 2017 meta-analysis: HRV biofeedback for stress and anxiety · 2023 trial: cyclic sighing and mood · NIMH: Panic Disorder: When Fear Overwhelms · Research Library · Genes & Biomarkers Library
What it is and its history
- Accepted scientific name
- Breathing exercises for stress and anxiety
- Common names
- Breathing exercises for stress (English); Slow breathing (English); Diaphragmatic (belly) breathing (English); Ejercicios de respiracion para el estres (Spanish)
- Family or group
- Self-help relaxation technique (breath control). It overlaps with breathwork, yoga breathing (pranayama), meditation and biofeedback.
- Look-alikes and adulterants
- Name: Breathwork; Note: A wider set of breathing practices; has its own therapy page.; Name: Meditation and mindfulness; Note: Often uses the breath as a focus but trains attention rather than breathing pattern.; Name: Hyperventilation syndrome; Note: Over-breathing that causes dizziness and tingling; needs its own assessment.
Traditional use and history history, not clinical proof
| Tradition or era | Documented use | Source |
|---|---|---|
| Yoga and related traditions | Controlled breathing (pranayama) is a traditional practice in yoga. The sources read here do not give a detailed history. | s-nccih-relax |
| Modern guidance | The NHS and NCCIH describe slow deep breathing as a simple, low-cost way to help with stress. | s-nhs-breathing |
Traditional use shows how it was used. It does not show that it works or is safe today.
What is inside, and how it may work
What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.
Main compounds
| Compound | Family | Where it is concentrated | Activity studied | Level of evidence |
|---|---|---|---|---|
| Slow diaphragmatic breathing | breathing technique | Slow breaths into the belly, often counted, about 5 to 6 breaths a minute in lab studies. | Raises heart rate variability and promotes a calmer body state in studies. 4 19 | Human data |
| Exhale-focused breathing (cyclic sighing) | breathing technique | Deep breath in, a short top-up breath, long exhale. | Improved mood and slowed breathing in one trial. 1 | Human data |
| HRV biofeedback | device-guided breathing | Device shows heart rhythm and paces breathing. | Fewer stress and anxiety symptoms in meta-analyses. 6 10 | Human data |
Mechanisms, receptors and pathways
| Target or pathway | Gene or receptor | What was found | Level |
|---|---|---|---|
| Heart rate variability and the autonomic nervous system | Slow breathing was linked to higher heart rate variability and EEG changes in healthy people; how this causes calm is a hypothesis. 19 | Human, mechanism not established |
Isolated compounds versus whole extracts
Trials mix many breathing patterns, rates and session lengths, so results for "breathing exercises" describe a family of practices rather than one standard technique.
1 mixed findings5 low certainty3 very low certainty3 not enough evidence
What was looked at
The 12 benefits and uses checked for Breathing Exercises for Stress and Anxiety, each with how strong the evidence is. Tap one to open it.
- Slow, diaphragmatic (belly) breathing for everyday stressLow certainty
- Breathwork for anxiety symptoms and low moodLow certainty
- Exhale-focused breathing and "cyclic sighing"Low certainty
- Breathing for exam and performance stress in studentsVery low certainty
- Breathing training inside panic disorder treatmentLow certainty
- Breathing exercises added to care for generalized anxiety disorderVery low certainty
- Paced breathing with heart rate variability (HRV) biofeedbackLow certainty
- Slow breathing and blood pressureMixed findings
- Box breathing, 4-7-8 and other named patternsNot enough evidence
- Alternate nostril breathingVery low certainty
- Fast-breathing styles such as the Wim Hof MethodNot enough evidence
- Breathing exercises for over-breathing (hyperventilation syndrome)Not enough evidence
Lab markers tracked in the studies
Heart rate variability (HRV)
What is Breathing Exercises for Stress and Anxiety good for?
These are the breathing approaches studied for stress and anxiety and how strong the human evidence is for each. They describe what trials found, not advice to try anything. Established medical care is described in the About tab.
Benefits, one by one
Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.
Slow, diaphragmatic (belly) breathing for everyday stress
Low certaintySlow belly breathing is the exercise the NHS describes for stress, anxiety and panic. Reviews find small to medium drops in self-reported stress, but the studies are mixed in quality.
5 studiesNHS exercise: sit, stand or lie down; breathe in through the nose int…
Studies, doses and limits
What the trials found
A 2023 meta-analysis pooled 12 randomised trials (785 adults) and found a small-to-medium fall in self-reported stress with breathwork versus controls. A 2019 review of 3 studies of diaphragmatic breathing alone found lower stress on cortisol, blood pressure or a stress questionnaire, but could not pool them. A 2018 review of 15 studies of slow breathing in healthy people found higher heart rate variability and less arousal and anxiety. The NHS page (reviewed June 2026) gives a simple 5-minute exercise.
Results
Stress g = -0.35 (95% CI -0.55 to -0.14); heterogeneity 42 percent. No pooled estimate for diaphragmatic breathing alone.
Effect sizes as reported
2023: g = -0.35 for stress (95% CI -0.55 to -0.14).
Why this rating
Several reviews point the same way, but most trials had moderate risk of bias, many techniques were pooled, outcomes were self-reported and the authors themselves warn against hype.
Form and dose studied
NHS exercise: sit, stand or lie down; breathe in through the nose into the belly, count 1 to 5, breathe out through the mouth counting 1 to 5, for at least 5 minutes. In trials, practice ranged from one 20-minute session to nine months. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults in good health and adults with stress, in studies from several countries.
Limits
Unclear which technique or dose matters; short follow-up; control groups often did nothing, so attention and expectation are not separated out.
Why researchers looked
Stress is common and breathing is free, quick and easy to teach, so researchers have tested whether slowing the breath lowers stress.
Proposed mechanism Hypothesis
Proposed: slow breathing raises heart rate variability and shifts the body toward a calmer state. This was measured in some studies but a causal chain was not shown.
A proposed mechanism does not show that the effect happens in people.
The NHS page lists no warnings. NCCIH says relaxation techniques are generally safe for healthy people but some report more anxiety, intrusive thoughts or fear of losing control. See the Safety tab.
Breathwork for anxiety symptoms and low mood
Low certaintyThe same 2023 analysis found small-to-medium falls in self-reported anxiety and depressive symptoms. This is about everyday symptoms, not treatment for an anxiety disorder.
2 studies2026 trial: 5-second inhale, 5-second exhale, 2-second hold, twice da…
Studies, doses and limits
What the trials found
The 2023 meta-analysis found anxiety g = -0.32 (20 effect sizes) and depressive symptoms g = -0.40 (18 effect sizes), with moderate and significant heterogeneity. A 2026 randomised trial of 98 student paramedics practising slow breathing twice daily for 12 weeks found lower stress, anxiety and depression and higher resilience than controls (medium to large effects), but no change in insomnia or wellbeing, and more dropout in some arms.
Results
Anxiety g = -0.32; depressive symptoms g = -0.40; 2026 trial effects medium to large (values not in the abstract).
Effect sizes as reported
2023: anxiety g = -0.32; depression g = -0.40.
Why this rating
Consistent direction across a meta-analysis and a recent trial, but heterogeneity was moderate, outcomes were self-rated and the 2026 trial had uneven dropout.
Form and dose studied
2026 trial: 5-second inhale, 5-second exhale, 2-second hold, twice daily for 12 weeks, with video and audio guides. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Mostly adults without a diagnosed disorder; student paramedics in the 2026 trial.
Limits
Not a test of anxiety disorders; self-reported scores; the 2026 trial is a single study with attrition differences.
Why researchers looked
Stress, anxiety and low mood often travel together, so trials measured all three after breathwork.
Proposed mechanism Hypothesis
Proposed: calmer body signals feed back to the brain and ease worry. Not shown in these trials.
A proposed mechanism does not show that the effect happens in people.
Same cautions as above.
Exhale-focused breathing and "cyclic sighing"
Low certaintyA 2023 trial found five minutes a day of exhale-focused cyclic sighing improved mood and slowed breathing more than mindfulness meditation over one month. It is one trial.
2 studiesCyclic sighing in the 2023 trial: a deep breath in, a second short to…
Studies, doses and limits
What the trials found
In a remote randomised study (NCT05304000), daily 5-minute cyclic sighing, box breathing or cyclic hyperventilation with retention were compared with mindfulness over 1 month. Breathwork, especially cyclic sighing, gave greater improvement in mood and lower respiratory rate (both p < 0.05). A 2025 trial of 139 undergraduates found one session of slow breathing with a longer exhale lowered stress and raised mood right afterwards, but stress rose again after a hard task.
Results
Mood and respiratory rate improved more with cyclic sighing than mindfulness (p < 0.05).
Effect sizes as reported
Effect sizes not given in the abstract.
Why this rating
One main trial plus one short single-session trial; benefits were small and temporary and effect sizes were not in the abstracts.
Form and dose studied
Cyclic sighing in the 2023 trial: a deep breath in, a second short top-up breath, then a long slow exhale, for 5 minutes a day. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults in a remote study; university students in the 2025 trial.
Limits
Comparison was mindfulness, not no treatment; remote and self-reported; one trial for each claim.
Why researchers looked
Longer exhales are thought to be calming, so researchers compared structured patterns with mindfulness.
Proposed mechanism Hypothesis
Proposed: a long exhale slows the heart through the vagus nerve. Not tested directly in these studies.
A proposed mechanism does not show that the effect happens in people.
Same cautions. Over-breathing and light-headedness can follow forced deep breathing; see Safety.
Breathing for exam and performance stress in students
Very low certaintySmall trials in students suggest short breathing sessions can ease stress for a short time. A device-guided practice helped test anxiety in one small trial, while a self-directed breathing exercise did not.
3 studiesDevice group in 2021: a biofeedback respiratory practice device durin…
Studies, doses and limits
What the trials found
A 2025 trial of 139 undergraduates found one slow-paced breathing session with a longer exhale lowered stress and improved working memory, but only for a while. A 2021 trial of 34 students found only the group using a biofeedback respiratory device had a significant fall in test anxiety; the self-directed breathing exercise group did not. A 2017 pilot of 30 medical students found a 15-minute alternate nostril breathing session gave a non-significant trend toward lower anxiety before a simulated public speaking test.
Results
Test anxiety fell significantly only in the device group (p < 0.05); public speaking pilot not significant.
Effect sizes as reported
Effect sizes not given in the abstracts.
Why this rating
Three small trials, one session or a few weeks, mixed results, student samples.
Form and dose studied
Device group in 2021: a biofeedback respiratory practice device during the exam period. Pilot: 15 minutes of alternate nostril breathing once. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
University and medical students.
Limits
Tiny samples; temporary effects; one study needed a device; results do not apply to older adults or clinical groups.
Why researchers looked
Exams are a clear, repeatable stressor, so students are a common study group.
Proposed mechanism Hypothesis
Proposed: a calmer body state helps attention. Working memory improved in one trial.
A proposed mechanism does not show that the effect happens in people.
Same cautions.
Breathing training inside panic disorder treatment
Low certaintyBreathing training guided by a carbon dioxide monitor, given by a clinician, reduced panic symptoms about as much as thought-focused training in one small trial. This is clinic-based care, not a self-help exercise.
3 studiesFour weeks of sessions with a clinician using a carbon dioxide monito…
Studies, doses and limits
What the trials found
A 2010 randomised trial of 41 people with panic disorder and agoraphobia compared 4 weeks of capnometry-assisted respiratory training with cognitive training: both lowered panic severity by similar amounts, and only the breathing training corrected low carbon dioxide levels. A 2009 study of 35 patients found carbon dioxide change, not breathing rate, partly explained lower fear of body sensations. NIMH calls cognitive behavioral therapy the well-studied "gold standard" psychotherapy for panic disorder; no source read here tested a plain breathing exercise on its own as treatment for panic disorder.
Results
Panic symptom severity fell about equally with breathing and cognitive training.
Effect sizes as reported
Effect sizes not given in the abstracts.
Why this rating
Two small studies by the same group with no no-treatment group; breathing training matched thought training but was not shown to be better.
Form and dose studied
Four weeks of sessions with a clinician using a carbon dioxide monitor. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults with panic disorder (with agoraphobia in the 2010 trial).
Limits
Same research group; small; needs a monitor and a trained clinician; not a home exercise.
Why researchers looked
Panic attacks include fast breathing and dizziness, so clinicians tested training that corrects over-breathing.
Proposed mechanism Hypothesis
Proposed: raising low carbon dioxide levels to normal lowers fear of body sensations. In the studies, carbon dioxide change came before symptom change.
A proposed mechanism does not show that the effect happens in people.
Panic disorder needs assessment by a clinician; see Safety.
Breathing exercises added to care for generalized anxiety disorder
Very low certaintyOne small trial added breathing exercises to medication and counselling in generalized anxiety disorder. Lung measures improved but anxiety scores did not differ significantly.
1 studiesBreathing exercises in addition to usual care for 8 weeks. Amounts an…
Studies, doses and limits
What the trials found
A 2022 randomised double-blind trial of 41 patients with generalized anxiety disorder compared medication plus counselling plus breathing exercises with medication and counselling alone over 8 weeks. The FEV1/FVC lung ratio rose more in the breathing group at about two months; anxiety and several other measures leaned the desired way but not significantly.
Results
No significant difference in anxiety.
Effect sizes as reported
Not given in the abstract.
Why this rating
One small trial with no significant anxiety result.
Form and dose studied
Breathing exercises in addition to usual care for 8 weeks. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
41 patients with generalized anxiety disorder.
Limits
Small; breathing was an add-on; the authors suggest longer follow-up and more practice.
Why researchers looked
People with an anxiety disorder often look for something extra they can do themselves.
Proposed mechanism Hypothesis
Not proposed in the abstract.
A proposed mechanism does not show that the effect happens in people.
Do not stop prescribed care for breathing exercises.
Paced breathing with heart rate variability (HRV) biofeedback
Low certaintyHRV biofeedback uses a device that guides slow breathing at about the rate that maximises heart rate swings. Meta-analyses find fewer stress and anxiety symptoms, though one recent trial found no anxiety difference.
4 studiesTrials used a device that displays heart rate and guides breathing; t…
Studies, doses and limits
What the trials found
A 2017 meta-analysis of 24 studies (484 participants) found a large fall in self-reported stress and anxiety (between-groups g = 0.83). A 2020 meta-analysis of 58 randomised studies found a small to moderate effect favouring HRV biofeedback, largest for anxiety and depression, smaller against active controls. A 2024 trial of 40 analysed students found HRV rose more with biofeedback but anxiety scores did not differ from an active control. NCCIH notes HRV biofeedback helps reduce self-reported stress and anxiety.
Results
2017: g = 0.83 between groups; 2020: small to moderate effect.
Effect sizes as reported
2017: between-groups g = 0.83; pre-post g = 0.81.
Why this rating
Pooled effect is large but built on small studies with risk of bias, effects are smaller against active controls, and a recent active-controlled trial found no anxiety difference.
Form and dose studied
Trials used a device that displays heart rate and guides breathing; the 2024 trial used 10 sessions of 20 minutes over 3 weeks. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults and students with stress or anxiety, healthy and clinical.
Limits
Needs a device; small studies; active-control results weaker; many outcomes pooled.
Why researchers looked
Slow breathing raises heart rate variability, so biofeedback was built to train that effect.
Proposed mechanism Hypothesis
Proposed: training the rhythm of heart and breath tunes the body-calming pathways. HRV rises in trials, but a link to anxiety change was not consistent.
A proposed mechanism does not show that the effect happens in people.
Same cautions; some people feel light-headed.
Slow breathing and blood pressure
Mixed findingsReviews disagree. A 2024 analysis of 15 trials found modest falls in blood pressure; a 2022 analysis found device-guided slow breathing did not lower it in people with high blood pressure.
3 studiesTrials used pranayama, alternate nostril, deep and slow breathing, or…
Studies, doses and limits
What the trials found
A 2024 meta-analysis of 15 randomised trials found breathing exercises lowered systolic blood pressure by 7.06 mmHg and diastolic by 3.43 mmHg, and heart rate by 2.41 beats a minute, but the studies were not free of bias. A 2022 meta-analysis of 22 studies in people with high blood pressure found device-guided slow breathing did not significantly lower blood pressure versus usual care (systolic MD -2.13 mmHg, 95% CI -12.71 to 8.44; very high heterogeneity). NCCIH says slow deep breathing may modestly lower blood pressure.
Results
2024: systolic -7.06, diastolic -3.43 mmHg. 2022: device-guided not significant.
Effect sizes as reported
2024 systolic 95% CI -10.20 to -3.92; 2022 systolic -12.71 to 8.44.
Why this rating
Two meta-analyses reach different answers, with high heterogeneity and risk of bias.
Form and dose studied
Trials used pranayama, alternate nostril, deep and slow breathing, or device-guided slow breathing. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults, including people with high blood pressure.
Limits
Heterogeneity up to 93 percent; short follow-up; blood pressure is a physical outcome, not stress itself.
Why researchers looked
Stress and blood pressure are linked, and slow breathing changes heart and vessel signals.
Proposed mechanism Hypothesis
Proposed: slower breathing changes heart and vessel reflexes. Not shown to explain the results.
A proposed mechanism does not show that the effect happens in people.
If you have high blood pressure, keep to the plan your clinician gave you; breathing practice is an addition, not a replacement.
Box breathing, 4-7-8 and other named patterns
Not enough evidencePopular patterns are widely shared online, but little research shows any one is better than plain slow breathing. A 2025 lab study found 6 breaths a minute raised heart rate variability more than box or 4-7-8 breathing.
2 studiesSquare breathing: equal in, hold, out. 4-7-8: in 4, hold 7, out 8. As…
Studies, doses and limits
What the trials found
A 2025 study of 84 college students compared square (box), 4-7-8 and 6-per-minute breathing. Six per minute raised heart rate variability more (small to medium effects); no condition meaningfully changed blood pressure or mood. The authors write that square and 4-7-8 breathing have little empirical support. In the 2023 randomised study, box breathing was one of three practices compared with mindfulness; the cyclic sighing arm, not box breathing, was singled out for mood.
Results
Small to medium HRV difference favouring 6 per minute; no mood change.
Effect sizes as reported
Not given in the abstracts.
Why this rating
Few comparisons, single sessions in students, and no stress outcome over time.
Form and dose studied
Square breathing: equal in, hold, out. 4-7-8: in 4, hold 7, out 8. As used in one lab study; counts are not recommendations. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
College students (84) and remote adult participants.
Limits
Single-session lab measures; no long-term practice; no clinical group.
Why researchers looked
These patterns are promoted by therapists and apps, so researchers started comparing them.
Proposed mechanism Hypothesis
Proposed: the count controls carbon dioxide and heart rhythm. Measured in one study: 6 per minute led to mild over-breathing.
A proposed mechanism does not show that the effect happens in people.
Breath holds can feel uncomfortable; stop if you feel faint.
Alternate nostril breathing
Very low certaintyA single 30-person pilot found only a non-significant trend toward lower anxiety before a mock public speaking test. Blood pressure reviews pool it with other breathing exercises.
2 studies15 minutes, once. Amounts and durations are given only as what each s…
Studies, doses and limits
What the trials found
A 2017 randomised pilot of 30 medical students found a 15-minute session did not significantly change anxiety scores before a simulated public speaking test, although the breathing group trended lower. The 2024 blood pressure meta-analysis searched for alternate nostril breathing among other terms, but its abstract does not give a result for this technique alone.
Results
Not significant.
Effect sizes as reported
Not given.
Why this rating
One small pilot, no significant result.
Form and dose studied
15 minutes, once. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Healthy young medical students.
Limits
Pilot; one session; healthy students.
Why researchers looked
Alternate nostril breathing is a traditional yoga practice (pranayama) widely used for relaxation.
Proposed mechanism Hypothesis
Not tested in the abstracts read.
A proposed mechanism does not show that the effect happens in people.
Same cautions.
Fast-breathing styles such as the Wim Hof Method
Not enough evidenceOne 84-woman trial found the Wim Hof breathing method and slow breathing improved stress, anxiety and depression about equally. All six dropouts were in the Wim Hof group.
2 studiesWim Hof group: daily 15-minute audio-guided breathing technique and c…
Studies, doses and limits
What the trials found
A 2024 randomised trial of 84 midlife women with high stress and high depressive symptoms compared a Wim Hof Method breathing technique plus cold showers with slow-paced breathing plus warm showers for 3 weeks. Both groups improved by about the same (depressive symptoms down 24 percent, anxiety 27 percent, perceived stress 20 percent), kept at 3 months. The Wim Hof group had a greater fall in rumination after daily stress. In the 2023 cyclic sighing trial, cyclic hyperventilation with retention was one of the three practices tested against mindfulness.
Results
Equivalent improvement in both groups.
Effect sizes as reported
Not given in the abstract.
Why this rating
One trial where slow breathing worked equally well, with uneven dropout.
Form and dose studied
Wim Hof group: daily 15-minute audio-guided breathing technique and cold showers for 3 weeks. As used in the study, not advice. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Healthy midlife women with high stress and depressive symptoms.
Limits
Small; pandemic period; the fast-breathing arm had all the dropouts; cold showers were part of the package.
Why researchers looked
Fast, forceful breathing with breath holds is promoted online for stress and mood.
Proposed mechanism Hypothesis
Proposed: short bouts of low oxygen act as a mild stressor that trains stress response. Not shown to explain the result.
A proposed mechanism does not show that the effect happens in people.
Fast, forceful breathing with breath holds can cause light-headedness or fainting; never practise it in water or while driving. This caution is general knowledge and was not taken from a study read for this page.
Breathing exercises for over-breathing (hyperventilation syndrome)
Not enough evidenceA Cochrane review found no credible evidence on breathing exercises for hyperventilation syndrome because only one small, poorly reported trial existed.
1 studiesNot given. Amounts and durations are given only as what each study us…
Studies, doses and limits
What the trials found
The 2013 Cochrane review of adults found a single small trial of 45 people across three groups, with no usable numbers. The authors say it cannot inform clinical practice and that it is unknown whether breathing exercises add value.
Results
No usable effect size.
Effect sizes as reported
Not available.
Why this rating
Only one poorly reported trial.
Form and dose studied
Not given. Amounts and durations are given only as what each study used. They are not advice.
Who was studied
Adults with dysfunctional breathing or hyperventilation syndrome.
Limits
One trial, no numbers.
Why researchers looked
Fast shallow breathing causes dizziness, tingling and chest tightness that are mistaken for anxiety, so breathing retraining is often used.
Proposed mechanism Hypothesis
Not tested in the sources read.
A proposed mechanism does not show that the effect happens in people.
Dizziness, chest tightness or breathlessness need a clinician to rule out other causes.
Connections to the rest of health
How Breathing Exercises for Stress and Anxiety connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.
Explore every connection: goals, body systems, organs, symptoms, genes
A. Wellness goals
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Stress Anxiety | Low certainty | Slow, diaphragmatic (belly) breathing for everyday stress: Slow belly breathing is the exercise the NHS describes for stress, anxiety and panic. Reviews find small to medium drops in self-reported stress, but the studies are mixed in quality. Breathwork for anxiety symptoms and low mood: The same 2023 analysis found small-to-medium falls in self-reported anxiety and depressive symptoms. This is about everyday symptoms, not treatment for an anxiety disorder. | 4 7 19 23 21 11 6 10 18 5 20 22 | |
| Stress Anxiety | Low certainty | Exhale-focused breathing and "cyclic sighing": A 2023 trial found five minutes a day of exhale-focused cyclic sighing improved mood and slowed breathing more than mindfulness meditation over one month. It is one trial. Breathing for exam and performance stress in students: Small trials in students suggest short breathing sessions can ease stress for a short time. A device-guided practice helped test anxiety in one small trial, while a self-directed breathing exercise did not. | 1 16 17 9 15 14 25 12 13 5 2 | |
| Stress Anxiety | Not enough evidence | Breathing exercises for over-breathing (hyperventilation syndrome): A Cochrane review found no credible evidence on breathing exercises for hyperventilation syndrome because only one small, poorly reported trial existed. | 8 |
B. Body systems
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Nervous System | Biological association | Low certainty | Studied for: Slow, diaphragmatic (belly) breathing for everyday stress Studied for: Breathwork for anxiety symptoms and low mood | 4 7 19 23 21 11 1 16 17 9 15 14 25 12 6 10 18 5 20 22 13 2 8 |
| Stress Mood | Biological association | Low certainty | Studied for: Slow, diaphragmatic (belly) breathing for everyday stress Studied for: Breathwork for anxiety symptoms and low mood | 4 7 19 23 21 11 1 16 17 9 15 14 25 12 6 10 18 13 5 2 8 |
| Cardiovascular | Biological association | Low certainty | Studied for: Paced breathing with heart rate variability (HRV) biofeedback Studied for: Slow breathing and blood pressure | 6 10 18 21 5 20 22 |
I. Biomarkers
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Heart rate variability (HRV) | Biological association | Low certainty | Measured in trials: Higher in slow-breathing studies. A lab change is not the same as a health benefit. | 18 13 19 |
L. Active compounds
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Slow diaphragmatic breathing | Biological association | Human | Raises heart rate variability and promotes a calmer body state in studies. | 4 19 |
| Exhale-focused breathing (cyclic sighing) | Biological association | Human | Improved mood and slowed breathing in one trial. | 1 |
| HRV biofeedback | Biological association | Human | Fewer stress and anxiety symptoms in meta-analyses. | 6 10 |
Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).
Evidence at a glance: what the research found for 12 outcomes
Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.
The evidence
The research centre for Breathing Exercises for Stress and Anxiety. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.
Evidence by outcome
Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).
How we rate evidence
High certainty
Several well-run trials or reviews agree; further research is unlikely to change the picture much.
Moderate certainty
Good trials point the same way, but some doubt remains.
Low certainty
Small, short or inconsistent trials. The finding could change with better research.
Very low certainty
Very little or very weak human data. Treat as a possibility only.
Mixed findings
Trials or reviews disagree with each other.
Not enough evidence
Not enough human research to say either way.
Evidence against
Good research found no benefit, or found harm.
We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, re-read the abstract of every review and trial cited, and read the NHS, NCCIH and NIMH pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading. Funding is not stated in most abstracts.
Study library: every study we checked 25
| Study | Design | People | Product, dose, length | Result |
|---|---|---|---|---|
| Balban 2023 Brief structured respiration practices enhance mood and reduce physiological arousal Cell Rep Med · PMID 36630953 · DOI |
Randomised controlled trial |
Adults in a remote randomised study (the abstract gives no sample size, age or condition) | Daily 5-minute cyclic sighing, box breathing or cyclic hyperventilation with retention 1 month · vs 5 minutes of mindfulness meditation daily |
All three breathing practices were compared with mindfulness. Breathwork, especially exhale-focused cyclic sighing, improved mood and lowered respiratory rate more than mindfulness (both p < 0.05). p < 0.05 for mood and respiratory rate (cyclic sighing versus mindfulness) (Not given in the abstract) Methods, limits and fundingOutcomes: Mood and anxiety; respiratory rate, heart rate and heart rate variability Limitations: Remote and self-reported; the comparison was mindfulness, not no treatment; effect sizes not in the abstract; Funding and conflicts: Not stated in the abstract. Registration: NCT05304000 Read: abstract |
| Blades 2024 A randomized controlled clinical trial of a Wim Hof Method intervention in women with high depressive symptoms Compr Psychoneuroendocrinol · PMID 39606690 · DOI |
Randomised controlled trial |
84 84 midlife women with high stress and high depressive symptoms |
Wim Hof Method (a breathing technique meant to induce brief low oxygen, plus cold showers) compared with slow-paced breathing and warm showers 15-minute daily audio instructions for 3 weeks, follow-up at 3 months · vs Slow-paced breathing and warm showers |
Both groups improved by about the same (24 percent less depression, 27 percent less anxiety, 20 percent less perceived stress), kept at 3 months. The Wim Hof group had a greater fall in rumination after daily stress. All 6 dropouts were in that group. Equivalent improvements in both groups (Not given in the abstract) Methods, limits and fundingOutcomes: Depressive symptoms, anxiety, perceived stress, rumination, cortisol reactivity Limitations: Small; during the pandemic; only women; the Wim Hof group had all the dropouts. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Farias 2020 Adverse events in meditation practices and meditation-based therapies: a systematic review Acta Psychiatr Scand · PMID 32820538 · DOI |
Systematic review |
6703 83 studies of meditation practices (breath-focused practices are among them; the abstract does not separate breathwork) with 6,703 adult participants |
Meditation practices and meditation-based therapies Varied · vs Varied |
65 percent of studies reported at least one adverse event type. Overall prevalence was 8.3 percent (3.7 percent in experimental studies; 33.2 percent in observational studies). Anxiety, depression and unusual thinking were the most common. It can happen to people with no mental health history. Overall prevalence 8.3 percent (95% CI 0.05 to 0.12) Methods, limits and fundingOutcomes: Adverse events Limitations: This covers meditation in general, not breathing exercises alone; observational studies had much higher rates than trials. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Fincham 2023 Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials Sci Rep · PMID 36624160 · DOI |
Systematic review meta analysis |
785 12 randomised trials of breathwork in adults (stress outcome); 20 effect sizes for anxiety and 18 for depressive symptoms; most studies at moderate risk of bias |
Breathwork techniques of many kinds, grouped together Not given in the abstract · vs Non-breathwork control conditions |
Breathwork was linked to lower self-reported stress than control conditions. Similar-sized reductions were found for anxiety and depressive symptoms. The authors urge caution and better-designed trials to avoid a gap between hype and evidence. Stress g = -0.35; anxiety g = -0.32; depressive symptoms g = -0.40 (Stress 95% CI -0.55 to -0.14 (I2 = 42%); heterogeneity moderate and significant for anxiety and depression) Methods, limits and fundingOutcomes: Self-reported stress (primary); anxiety and depressive symptoms (secondary) Limitations: Most studies at moderate risk of bias; many breathing techniques pooled; self-reported outcomes; heterogeneity for anxiety and depression. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Garg 2024 Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis Int J Cardiol Cardiovasc Risk Prev · PMID 38179185 · DOI |
Systematic review meta analysis |
15 randomised trials of breathing exercises (pranayama, alternate nostril, deep and slow breathing) and blood pressure | Breathing exercises of several kinds Varied · vs Control conditions |
Modest but significant falls in blood pressure and heart rate. The authors note the studies are not free of bias. Systolic -7.06 mmHg; diastolic -3.43 mmHg; heart rate -2.41 beats per minute (Systolic -10.20 to -3.92; diastolic -4.89 to -1.97; heart rate -4.53 to -0.30) Methods, limits and fundingOutcomes: Systolic and diastolic blood pressure; heart rate Limitations: Risk of bias in the included trials; many techniques pooled. Funding and conflicts: Not stated in the abstract. Registration: PROSPERO CRD42022316413 Read: abstract |
| Goessl 2017 The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis Psychol Med · PMID 28478782 · DOI |
Systematic review meta analysis |
484 24 studies of HRV biofeedback for stress and anxiety (484 participants) |
Heart rate variability biofeedback (paced breathing guided by a heart-rate display) Not given · vs Control conditions |
Large reduction in self-reported stress and anxiety. Effect was not changed by number of sessions, risk of bias or having an anxiety disorder. Between groups g = 0.83; before-after g = 0.81 (Not given in the abstract) Methods, limits and fundingOutcomes: Self-reported stress and anxiety Limitations: Small studies; risk of bias; needs better-controlled trials (the authors say so); biofeedback needs a device. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Hopper 2019 Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review JBI Database System Rev Implement Rep · PMID 31436595 · DOI |
Systematic review |
3 studies (1 randomised trial, 2 quasi-experimental) of adults using diaphragmatic breathing alone; the page earlier cited 880 people, but the abstract read here gives no total | Diaphragmatic (belly) breathing as an isolated intervention From one 20-minute session to nine months · vs No treatment or usual treatment |
All three studies reported reduced stress. One showed better respiratory rate and salivary cortisol, one better blood pressure, one a better DASS-21 stress score. Pooling was not possible. No pooled effect size (No pooled estimate) Methods, limits and fundingOutcomes: Physiological stress markers (respiratory rate, salivary cortisol, blood pressure) and DASS-21 stress score Limitations: Only three small studies, two not randomised; very different designs and durations; no pooling. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Jones 2013 Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults Cochrane Database Syst Rev · PMID 23728685 · DOI |
Systematic review |
45 1 small randomised trial (45 adults across three groups) in adults with dysfunctional breathing or hyperventilation syndrome |
Relaxation plus breathing exercises Not given · vs Relaxation only or no therapy |
The review found no credible evidence on breathing exercises for this condition because it found only one small, poorly reported trial. It could not tell whether they add value. No usable effect size (Not available) Methods, limits and fundingOutcomes: Quality of life; attack frequency and severity Limitations: Single poorly reported trial; no numerical data. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Kamath 2017 Effect of Alternate Nostril Breathing Exercise on Experimentally Induced Anxiety in Healthy Volunteers Using the Simulated Public Speaking Model: A Randomized Controlled Pilot Study Biomed Res Int · PMID 29159176 · DOI |
Randomised controlled trial |
30 30 yoga-naive medical students, healthy |
Alternate nostril breathing 15 minutes, once, before a simulated public speaking test · vs Sitting quietly in a room |
Anxiety scores did not differ significantly between groups; the breathing group showed a trend toward lower anxiety. Group effect not significant (Not given in the abstract) Methods, limits and fundingOutcomes: Mood and self-statements at phases of a public speaking test Limitations: Pilot; 30 people; young healthy medical students; one session; result not statistically significant. Funding and conflicts: Not stated in the abstract. Registration: CTRI/2014/03/004460 Read: abstract |
| Lehrer 2020 Heart Rate Variability Biofeedback Improves Emotional and Physical Health and Performance: A Systematic Review and Meta Analysis Appl Psychophysiol Biofeedback · PMID 32385728 · DOI |
Systematic review meta analysis |
58 randomised studies of HRV biofeedback for many problems and performance goals | Heart rate variability biofeedback Not given · vs Active and inactive controls |
Small to moderate effect favouring HRV biofeedback, not different from other effective treatments. Largest effects were for anxiety, depression, anger and performance; smallest for PTSD, sleep and quality of life. Effects were larger against inactive than active controls. Small to moderate effect (value not in the abstract) (Not given in the abstract) Methods, limits and fundingOutcomes: Symptoms and functioning across many areas Limitations: Few studies per problem; the authors call for more research for each use. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Little 2026 Examining the Effectiveness of Breathwork to Improve Resilience and Psychological Wellbeing While Reducing Anxiety, Depression, Stress, and Insomnia in Paramedicine Students: A Single-Blind Randomised Controlled Trial Stress Health · PMID 41787752 · DOI |
Randomised controlled trial |
98 98 student paramedics at two Australian universities |
A structured slow diaphragmatic breathing protocol with video and audio guides (5-second inhale, 5-second exhale, 2-second hold), practised twice daily 12 weeks · vs Control group (details not in the abstract) |
Stress, anxiety and depression were lower and resilience higher than controls (medium to large effects). Insomnia and wellbeing did not change significantly. Results are read in light of uneven dropout. Medium to large effects (values not in the abstract) (Not given in the abstract) Methods, limits and fundingOutcomes: Stress, anxiety, depression (DASS-21), insomnia, resilience, wellbeing Limitations: Uneven dropout; self-reported outcomes; students; engagement was a challenge. Funding and conflicts: Not stated in the abstract. Registration: ACTRN12625000101482 Read: abstract |
| Maleki 2022 Effect of breathing exercises on respiratory indices and anxiety level in individuals with generalized anxiety disorder: a randomized double-blind clinical trial J Phys Ther Sci · PMID 35400836 · DOI |
Randomised controlled trial |
41 41 patients with generalized anxiety disorder |
Breathing exercises added to medication and routine counselling 8 weeks with check-in calls · vs Medication and routine counselling only |
Lung function ratio (FEV1/FVC) rose more in the breathing group at about two months. Anxiety and other measures leaned the desired way but without significant differences. No significant anxiety difference (Not given in the abstract) Methods, limits and fundingOutcomes: Respiratory indices, end-tidal CO2, pulse, anxiety level Limitations: Small; breathing was an add-on to other care; anxiety result not significant. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Marchant 2025 Comparing the Effects of Square, 4-7-8, and 6 Breaths-per-Minute Breathing Conditions on Heart Rate Variability, CO2 Levels, and Mood Appl Psychophysiol Biofeedback · PMID 39864026 · DOI |
Randomised crossover or within subject trial |
84 84 college students (60 percent female) |
Square breathing, 4-7-8 breathing, 6 breaths per minute with a 4:6 ratio, 6 per minute with a 5:5 ratio Short laboratory sessions · vs Each other and baseline |
Six breaths per minute raised HRV more than square or 4-7-8 breathing (small to medium effects). None of the conditions meaningfully changed blood pressure or mood. Six per minute led to mild over-breathing. The authors note square and 4-7-8 breathing have little empirical support. Small to medium HRV effects favouring 6 per minute (Not given in the abstract) Methods, limits and fundingOutcomes: Heart rate variability, blood pressure, mood, end-tidal CO2 Limitations: Single-session effects; students; no stress test or long-term practice. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Meuret 2009 Changes in respiration mediate changes in fear of bodily sensations in panic disorder J Psychiatr Res · PMID 18835608 · DOI |
Clinical trial |
35 35 patients with panic disorder |
Capnometry-assisted breathing training targeting carbon dioxide 4 weeks |
Changes in carbon dioxide, not breathing rate, partly mediated lower fear of bodily sensations. Not given (Not given) Methods, limits and fundingOutcomes: Fear of bodily sensations (anxiety sensitivity), carbon dioxide level, respiration rate Limitations: Single group; mediation analysis; needs a monitor and a trained clinician. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Meuret 2010 Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity J Consult Clin Psychol · PMID 20873904 · DOI |
Randomised controlled trial |
41 41 patients with panic disorder and agoraphobia |
Capnometry-assisted respiratory training (breathing training guided by a carbon dioxide monitor) 4 weeks · vs Cognitive training aimed at panic-related thoughts |
Panic symptom severity fell significantly and about equally in both groups. Only the breathing training corrected low carbon dioxide to normal levels. Comparable reductions in both groups (Not given in the abstract) Methods, limits and fundingOutcomes: Panic symptom severity, panic-related thoughts, perceived control, carbon dioxide level and respiration rate Limitations: Small; no no-treatment group; a mediation study; needs a monitor and a trained clinician. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Pilcher 2025 Brief slow-paced breathing improves working memory, mood, and stress in college students Anxiety Stress Coping · PMID 40392328 · DOI |
Randomised controlled trial |
139 139 undergraduates (69 percent female) |
One session of slow-paced breathing with a longer exhale One session · vs Mind-wandering active control |
Stress dropped and mood rose after breathing compared with control, but stress rose again after the demanding task. Working memory improved in the breathing group. Stress lower than control right after the session (Not given in the abstract) Methods, limits and fundingOutcomes: Working memory task, mood, stress and arousal Limitations: One session; effects temporary; students. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Rosenberg 2021 Reducing Test Anxiety and Related Symptoms Using a Biofeedback Respiratory Practice Device: A Randomized Control Trial Appl Psychophysiol Biofeedback · PMID 33389280 · DOI |
Randomised controlled trial |
34 34 university students during exams |
Biofeedback respiratory device, or a self-directed breathing exercise During the exam period · vs Psychoeducation group |
Only the biofeedback device group reported a significant fall in test anxiety. The self-directed breathing exercise group did not. Significant only for the device group (p < 0.05) (Not given in the abstract) Methods, limits and fundingOutcomes: Test anxiety, depression, anxiety, quality of life Limitations: Very small groups; self-reported; a device was used. Funding and conflicts: Not stated in the abstract. Read: abstract |
| Saito 2024 Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG Appl Psychophysiol Biofeedback · PMID 38888656 · DOI |
Randomised controlled trial |
55 55 healthy students with anxiety were randomised; 40 analysed (21 biofeedback, 19 control) |
HRV biofeedback training through slow-paced breathing 10 sessions of 20 minutes within 3 weeks · vs Active control group |
Resting HRV rose more with biofeedback than control, but there were no differences in EEG, attentional bias or anxiety scores. People with higher starting HRV did better. No anxiety difference (Not given in the abstract) Methods, limits and fundingOutcomes: Resting vagally mediated HRV, EEG, attentional bias, State-Trait Anxiety Inventory Limitations: Small; healthy students; anxiety score did not differ between groups. Funding and conflicts: Not stated in the abstract. Registration: UMIN000047096 Read: abstract |
| Zaccaro 2018 How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing Front Hum Neurosci · PMID 30245619 · DOI |
Systematic review |
15 studies in healthy people of slow breathing techniques (fewer than 10 breaths per minute), out of 2,461 abstracts screened | Slow breathing techniques below 10 breaths per minute Varied · vs Varied |
Slow breathing was linked to higher heart rate variability, more alpha and less theta EEG power, and to more comfort, relaxation and alertness and fewer symptoms of arousal, anxiety, depression, anger and confusion. The authors offer two proposed mechanisms. No pooled effect size (No pooled estimate) Methods, limits and fundingOutcomes: Heart rate variability, brain activity (EEG) and psychological state Limitations: Only 15 small studies of healthy people; mechanisms are hypotheses; no meta-analysis. Funding and conflicts: Not stated in the abstract. Read: abstract |
| de Freitas Goncalves 2022 Device and nondevice-guided slow breathing to reduce blood pressure in hypertensive patients: A systematic review and meta-analysis Health Sci Rep · PMID 35601033 · DOI |
Systematic review meta analysis |
17214 22 studies in adults with high blood pressure (17,214 participants in total across the review) |
Device-guided and non-device-guided slow breathing Varied · vs Usual care or control |
Device-guided slow breathing did not significantly lower blood pressure compared with usual care in the 288 people pooled. Heterogeneity was very high. The authors suggest non-device slow breathing is a path for future study. Device-guided systolic MD -2.13 mmHg; diastolic MD -0.90 mmHg (not significant) (Systolic -12.71 to 8.44; diastolic -3.97 to 2.11) Methods, limits and fundingOutcomes: Systolic and diastolic blood pressure Limitations: Very high heterogeneity (I2 up to 93 percent); non-device-guided breathing was not pooled in the abstract result. Funding and conflicts: Not stated in the abstract. Read: abstract |
| s-nccih-relax NCCIH: Relaxation Techniques: What You Need To Know (last updated June 2021) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nccih-stress NCCIH: Stress (last updated April 2022) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nhs-breathing NHS: Breathing exercises for stress (page last reviewed 12 June 2026) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nhs-stress NHS: Stress (page last reviewed 6 March 2026) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nimh-panic NIMH: Panic Disorder: When Fear Overwhelms (revised 2025) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text |
What we do not know yet
- No long trial (over a few months) comparing a plain slow-breathing exercise with an active control was read.
- No head-to-head trial of box, 4-7-8 or alternate nostril breathing against plain slow breathing for stress was found in a clinical group.
- Nothing read tests a breathing exercise alone as treatment for an anxiety disorder.
- Which breathing rate, ratio or session length works best is not established.
- Pregnancy and child safety data for breathing exercises were not read.
How new research is added
New studies are found by a saved PubMed search and placed in a review queue before the page changes.
Lab markers
What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".
Other 1
Heart rate variability (HRV)
Higher in slow-breathing studies in trials
The small beat-to-beat changes in heart rate; higher resting values are generally taken as a sign of a flexible, calm-leaning body state.
Low certaintyResults and what it means
Why it was measured
Slow breathing raises HRV, so studies use it as a body signal of relaxation.
Statistical vs. clinical meaning
A body measure; a higher number does not by itself mean less anxiety.
Safety
What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.
Main points to know 4
- Breathing exercises are generally safe for healthy people, but not for everyone. NCCIH says relaxation techniques are generally considered safe for healthy people. Occasionally, people report increased anxiety, intrusive thoughts or fear of losing control. There are rare reports that some relaxation techniques may cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, and in people with a history of abuse or trauma. The NHS exercise page lists no warnings. Health agency guidance 21 23
- Do not force the breath. The NHS says to let the breath flow as is comfortable and not to force it. A 2025 study found breathing at 6 breaths a minute led to mild over-breathing (breathing out too much carbon dioxide), which can cause light-headedness. If you feel dizzy, tingling or faint, stop and breathe normally. Health agency guidance and trial 23 13
- See a clinician if stress or anxiety will not go away. The NHS says to see a GP if you find it hard to cope or self-help is not working. NCCIH says that if you are struggling to cope or the symptoms of your stress will not go away, it may be time to talk to a professional. NIMH advises seeking professional help when anxiety causes problems in everyday life. Breathing exercises are a self-help option and not a replacement for care. Health agency guidance 24 22 25
- Panic attacks and chest symptoms need proper assessment. NIMH says panic attacks are not life-threatening and describes cognitive behavioral therapy as the well-studied psychotherapy for panic disorder, with medicines sometimes discussed with a clinician. Chest pain, severe breathlessness or fainting should never be put down to anxiety without a medical check. Health agency guidance 25
Side effects 3
| Effect | How often | Severity and recovery | Evidence |
|---|---|---|---|
| Increased anxiety, intrusive thoughts or fear of losing control NCCIH lists these as occasional negative experiences with relaxation techniques. | Occasional | Mild to moderate Not stated | Health agency guidance 21 |
| Anxiety, depression and unusual thinking during or after meditation practices This 2020 review covers meditation in general, which includes breath-focused practices, and was not specific to breathing exercises. It found events can occur in people with no mental health history. | 8.3 percent overall (3.7 percent in experimental studies, 33.2 percent in observational studies) | Varied Not stated in the abstract | Systematic review 3 |
| Light-headedness from over-breathing A 2025 study found breathing at 6 per minute led to mild over-breathing in college students. | Not given | Mild Not stated | Clinical trial 13 |
Medicines and supplements 2
| With | Why it matters | Importance | Evidence | What to do |
|---|---|---|---|---|
| Blood pressure treatment prescription | Slow breathing may lower blood pressure a little | Reviews disagree on the size of the effect; no interaction study was read. | Systematic review Not enough evidence 5 20 | If you have high blood pressure, follow the plan your clinician prescribed; breathing practice is an addition, not a replacement. |
| Sedating products or alcohol general | No pooled estimate | No interaction study was read. | Absence of evidence Not enough evidence 21 | Practising when very drowsy is not studied; avoid breathing practice while driving or in water. |
Who should check first 4
| Situation | Advice | Evidence |
|---|---|---|
| Epilepsy, some psychiatric conditions, or a history of abuse or trauma | NCCIH reports rare cases where relaxation techniques worsened symptoms. If breathing practice brings on distress, panic or unwanted memories, stop and talk with a health professional. | Health agency guidance 21 |
| High blood pressure or heart conditions | Keep to the treatment plan prescribed by your provider. Forceful breath-holding or fast breathing styles were not studied for safety in these groups in the sources read. | Health agency guidance and absence of evidence 22 20 |
| Pregnancy | No source read gave pregnancy-specific safety data for breathing exercises. NCCIH says relaxation techniques might help women manage labour pain, with low to very low quality research. Ask your midwife or doctor before changing your care, and avoid forceful breath-holding. | Health agency guidance 21 |
| Children | Child-specific safety was not read for this page. A 2013 Cochrane review on breathing exercises for children with dysfunctional breathing exists but was not read. Ask a paediatric clinician. | Absence of evidence 21 |
Overdose, product quality and regulators
| Body | Action | Date |
|---|---|---|
| National Center for Complementary and Integrative Health (NCCIH, US NIH) (United States) | Says relaxation techniques are generally considered safe for healthy people, with occasional negative experiences and rare reports of worsening in epilepsy, some psychiatric conditions and trauma history. source | 2021-06 |
| National Health Service (NHS, England) (United Kingdom) | Publishes a simple breathing exercise for stress, anxiety and panic and advises seeing a GP if you cannot cope. source | 2026-06 |
When to get medical help
- Thoughts of harming yourself or feeling unable to keep yourself safe: contact your local emergency number now or go to the nearest emergency department. In the United States you can call or text 988, the Suicide & Crisis Lifeline (named by NCCIH and NIMH). Outside the United States, use the crisis service in your country.
- Chest pain, severe breathlessness, fainting or a racing heart that does not settle: get medical help; do not assume it is anxiety.
- Panic attacks that keep returning or stop you doing daily things, or stress that will not ease: talk to a doctor or a mental health professional.
- Breathing practice that makes you panic, brings back traumatic memories or causes tingling, dizziness or faintness: stop, return to normal breathing and speak to a health professional.
Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.
General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.
Frequently asked questions
How do I do the NHS breathing exercise for stress?
The NHS says get comfortable, then breathe in gently and regularly into the belly, in through the nose and out through the mouth, counting 1 to 5 each way if it helps. Repeat for at least 5 minutes, ideally as part of a daily routine.
How long should I practise breathing exercises?
Do breathing exercises reduce stress and anxiety?
A 2023 meta-analysis of 12 randomised trials found a small-to-medium fall in self-reported stress, and similar falls in anxiety and low mood, but the studies were at moderate risk of bias and the authors urge caution.
Does box breathing work better than normal slow breathing?
Proper evidence not found in the sources read. A 2025 study of 84 students found 6 breaths a minute raised heart rate variability more than box or 4-7-8 breathing, and no condition changed mood.
What is cyclic sighing?
A breathing pattern with a deep breath in, a short top-up breath and a long exhale. In a 2023 trial, five minutes a day improved mood more than mindfulness over a month.
Can breathing exercises treat an anxiety disorder or panic disorder?
Can breathing exercises make anxiety worse?
Occasionally. NCCIH says some people report increased anxiety, intrusive thoughts or fear of losing control with relaxation techniques. If it happens, stop and talk to a health professional.
Can breathing exercises lower blood pressure?
Is alternate nostril breathing better for anxiety?
Proper evidence not found. One 30-student pilot found only a non-significant trend toward lower anxiety before a mock speech.
Are fast-breathing methods like Wim Hof safe or better?
One 84-woman trial found the Wim Hof Method and slow breathing improved stress, anxiety and depression about equally, and all dropouts were in the Wim Hof group. Safety of fast breathing was not read; it can cause light-headedness.
When should I see a doctor instead of relying on breathing?
Can I use breathing exercises in pregnancy or with children?
No source read gave pregnancy or child-specific safety data for breathing exercises. Ask your midwife, doctor or paediatric clinician first, and avoid forceful breath-holding.
Explore by health goal
Editorial transparency
- Written by
- AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
- Medical review
- None. This page has not been reviewed by a physician or pharmacist.
- First published
- 2026-10-31
- Last substantive update
- 2026-10-31
- How we research
- We searched PubMed, re-read the abstract of every review and trial cited, and read the NHS, NCCIH and NIMH pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading. Funding is not stated in most abstracts.
- How we rate evidence
- See "How we rate evidence" in the Evidence tab.
- Independence
- No product is promoted on this page. No affiliate links are shown.
Sources 25
Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.
- Balban MY, Neri E, Kogon MM et al.. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023. PMID 36630953. DOI 10.1016/j.xcrm.2022.100895. (abstract)
- Blades R, Mendes WB, Don BP et al.. A randomized controlled clinical trial of a Wim Hof Method intervention in women with high depressive symptoms. Compr Psychoneuroendocrinol. 2024. PMID 39606690. DOI 10.1016/j.cpnec.2024.100272. (abstract)
- Farias M, Maraldi E, Wallenkampf KC et al.. Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatr Scand. 2020. PMID 32820538. DOI 10.1111/acps.13225. (abstract)
- Fincham GW, Strauss C, Montero-Marin J et al.. Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Sci Rep. 2023. PMID 36624160. DOI 10.1038/s41598-022-27247-y. (abstract)
- Garg P, Mendiratta A, Banga A et al.. Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis. Int J Cardiol Cardiovasc Risk Prev. 2024. PMID 38179185. DOI 10.1016/j.ijcrp.2023.200232. (abstract)
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- . NCCIH: Stress (last updated April 2022). . . (full-text)
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- . NHS: Stress (page last reviewed 6 March 2026). . . (full-text)
- . NIMH: Panic Disorder: When Fear Overwhelms (revised 2025). . . (full-text)
