What is breathwork and why is it trending?
How breathing affects the autonomic nervous system
Scientific studies on breathwork and cortisol levels
Clinical applications: PTSD, anxiety, burnout
Comparing modalities: Box breathing, wim hof, pranayama
Breathwork in corporate and therapeutic settings
Breathwork has rapidly gained popularity worldwide as a tool for enhancing mental and emotional health. Traditionally rooted in practices like yoga and Tibetan Buddhism, deliberate breath control techniques are now widely used for stress relief, resilience building, and emotional regulation.
A meta-analysis of randomized controlled trials showed that breathwork interventions significantly reduced self-reported stress, anxiety, and depressive symptoms. Slow-paced breathing was particularly effective in promoting parasympathetic activity and increasing heart rate variability (HRV).
Complementing these findings, recent research confirmed that even brief sessions of slow or mindful breathing can improve executive function under psychological stress, enhancing mental clarity and reducing emotional volatility.
Slow breathing at six breaths per minute was especially noted for boosting oxygen saturation and sustaining cognitive performance. With the rising mental health challenges post-pandemic, breathwork offers an accessible, scalable, and evidence-supported approach to improve stress management and mental well-being.1,2
This article explores the science behind breathwork and its rising use for stress reduction. It highlights how specific techniques influence the autonomic nervous system, lower cortisol levels, and support mental health in clinical and everyday settings.
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What is breathwork, and why is it trending?
Breathwork, the deliberate control of breathing patterns, is rapidly gaining popularity as a powerful relaxation technique. Traditionally linked to ancient practices like yoga and Tibetan meditation, breathwork is now embraced globally for its mental and physical health benefits.
It directly targets the body’s stress response- the “fight or flight” mechanism- helping individuals manage daily challenges like financial pressure, traffic, and work anxiety. When practiced regularly, breathwork promotes parasympathetic nervous system activation, enhancing vagal tone and HRV, markers of better emotional resilience and cardiovascular health.2,3
A recent meta-analysis of randomized controlled trials confirms that breathwork significantly reduces self-reported stress, anxiety, and depression levels compared to controls. Public interest surged further during the coronavirus disease 2019 (COVID-19) pandemic when breathing-related issues spotlighted the importance of lung and stress health. Unlike therapies requiring extensive resources, breathwork is simple, scalable, and accessible online or in person.
It appeals to clinical and non-clinical populations, offering a low-cost, low-risk method to support emotional well-being. As more evidence emerges, breathwork is transitioning from ancient wisdom to a scientifically backed wellness practice, bridging modern neuroscience with timeless breathing techniques.2,3
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How breathing affects the autonomic nervous system
Breathing is intricately controlled by both the central and peripheral nervous systems, involving a network of cortical and brainstem centers. Voluntary breathing engages widespread cortical areas like the motor and sensory cortices. In contrast, involuntary breathing is regulated by brainstem nuclei, notably the pontine respiratory group, dorsal respiratory group (DRG), and ventral respiratory group (VRG).
These centers integrate mechanical and chemical feedback from the lungs and blood to adjust breathing patterns automatically.4,5
Recent studies have also uncovered how breathing rhythms directly influence brain arousal states. A small cluster of neurons in the pre-Bötzinger complex not only regulates different types of breaths but also sends signals to the locus coeruleus, a brain region responsible for alertness and emotional responses. Slow, controlled breathing dampens arousal pathways, promoting calmness, while rapid breathing increases anxiety and stress.4,5
Peripheral receptors, such as those in the carotid and aortic bodies, detect oxygen and carbon dioxide levels and relay this information to the brainstem, ensuring homeostasis.
Together, these neural circuits illustrate how breathing is not merely a mechanical process but a powerful modulator of the autonomic nervous system, influencing heart rate, emotional state, and overall physiological balance.4,5
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Scientific studies on breathwork and cortisol levels
Scientific studies have increasingly validated the role of breathwork in reducing stress and anxiety by influencing cortisol levels. A systematic review of 58 clinical trials revealed that regulated breathing practices, such as slow diaphragmatic breathing and alternate-nostril breathing, often led to significant decreases in psychometric measures of stress and anxiety.
The studies indicated that effective interventions shared key features: human-guided training, multiple sessions, long-term practice, and a session duration of at least five minutes. Importantly, interventions that avoided fast-only breathing patterns were more successful in reducing stress markers.4,6
Slow and deep breathing enhanced parasympathetic tone and helped regulate the hypothalamic-pituitary-adrenal (HPA) axis, which controls cortisol secretion. Although some studies reported mixed results, the overall evidence suggests that consistent, structured breathwork can positively influence cortisol levels and emotional resilience.
The findings highlight that not all breathwork methods are equally effective; rigorously studied protocols with proper implementation strategies deliver the most benefits. Future research is needed to refine these approaches further and explore their broader clinical applications for stress-related disorders.4,6
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Clinical applications: PTSD, anxiety, burnout
Breath-based interventions have shown significant promise for clinical conditions like posttraumatic stress disorder (PTSD), anxiety, and burnout. Studies demonstrate that slow, paced breathing improves HRV, indicating enhanced parasympathetic activity and reduced stress.
In PTSD populations, yoga and breath-focused programs, such as Sudarshan Kriya Yoga (SKY) and Breath-Body-Mind (BBM), significantly reduced symptoms of anxiety, depression, and trauma among survivors of abuse, disasters, and military veterans.
For anxiety disorders, including generalized anxiety disorder (GAD), multiple randomized controlled trials and pilot studies reported marked reductions in anxiety, improved sleep, and better emotional regulation following structured breath interventions. Burnout among healthcare workers has also been alleviated through BBM training, leading to lower perceived stress and emotional exhaustion.7,10
Notably, interventions like coherent breathing and alternate nostril breathing are particularly effective and safe, even in populations with heightened physiological vulnerability. These practices are low-cost, scalable, culturally adaptable, and can complement traditional therapies, offering patients greater emotional resilience and physiological balance.
Importantly, patient safety is enhanced when breath practices are introduced carefully, avoiding rapid breathing techniques in vulnerable individuals. Breath-based methods represent an accessible and evidence-based adjunct to conventional treatments for stress-related psychiatric conditions.7,10
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Comparing modalities: Box breathing, wim hof, pranayama
Breathing techniques like Box Breathing, the Wim Hof Method (WHM), and Pranayama offer distinct approaches to managing stress. Box Breathing, often used by athletes and military personnel, involves slow, controlled inhalations, holds, and exhalations of equal duration, aiming to stabilize the autonomic nervous system and enhance vagal tone.
In contrast, the WHM combines deep cyclic breathing, cold exposure, and commitment-building exercises. Its breathing pattern alternates hyperventilation with breath-holds, stimulating both sympathetic nervous system activation and subsequent resilience to inflammatory responses.
Research links the WHM to reduced stress markers and improved immune regulation. Pranayama, rooted in yogic traditions, emphasizes controlled breathwork to harmonize energy flow, enhance parasympathetic activation, and promote emotional balance.8
Studies on Pranayama highlight improvements in inflammatory mediators and perceived stress reduction. Interestingly, the WHM breathing technique mirrors aspects of Pranayama but integrates physical stress via cold exposure to induce hormesis- a mild stress that strengthens overall adaptation.
While Box Breathing offers immediate regulation, and Pranayama fosters gradual resilience, the WHM’s integrated model appears especially potent for stress tolerance. Comparative findings suggest that while all modalities benefit stress management, combining breath control with hormetic stress, as seen in WHM, yields amplified mental health benefits.8
Breathwork in corporate and therapeutic settings
Breathwork is emerging as a powerful tool in corporate and therapeutic settings to manage stress, reduce blood pressure, and improve mental health. In workplaces, daily deep breathing exercises (DBE) offer a simple, low-cost intervention to counteract hypertension and chronic stress, major contributors to cardiovascular disease and reduced productivity.
Employers can foster DBE adoption by subsidizing breathwork apps, offering incentives, and integrating short, guided breathing breaks into the workday. New technologies like apps and wearables now help people track their breathing and heart rate, making breathwork easier and more accessible at work.2,9
In therapeutic settings, a meta-analysis of randomized controlled trials confirmed that breathwork significantly lowers self-reported stress, anxiety, and depressive symptoms. Techniques like slow-paced breathing strengthen the autonomic nervous system by boosting vagal tone and HRV, enhancing resilience to stress.
Breathwork interventions are highly scalable, delivered in-person, remotely, individually, or in groups. While breathwork should supplement, not replace, clinical therapies, its minimal risk, broad accessibility, and physiological benefits position it as a compelling strategy to enhance well-being in both professional and healthcare environments.2,9
References
- Liang, W. M., Xiao, J., Ren, F. F., Chen, Z. S., Li, C. R., Bai, Z. M., & Rukšenas, O. (2023). Acute effect of breathing exercises on muscle tension and executive function under psychological stress. Frontiers in Psychology, 14, 1155134.https://doi.org/10.3389/fpsyg.2023.1155134
- Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials. Scientific Reports, 13(1), 432. https://doi.org/10.1038/s41598-022-27247-y
- Komaroff, A. (2006). Relaxation techniques: breath control helps quell errant stress response. Harvard Medical School. Family health guide. Boston (EUA): Harvard. https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response
- Goldman, B. (2017). Study shows how slow breathing induces tranquility. Standford Medicine, March, 30. https://med.stanford.edu/news/all-news/2017/03/study-discovers-how-slow-breathing-induces-tranquility.html
- Urfy, M. Z., & Suarez, J. I. (2014). Breathing and the nervous system. Handbook of clinical neurology, 119, 241-250. https://doi.org/10.1016/B978-0-7020-4086-3.00017-5
- Bentley, T.G., D’Andrea-Penna, G., Rakic, M., Arce, N., LaFaille, M., Berman, R., Cooley, K. and Sprimont, P., (2023). Breathing practices for stress and anxiety reduction: Conceptual framework of implementation guidelines based on a systematic review of the published literature. Brain Sciences, 13(12), 1612. https://doi.org/10.3390/brainsci13121612.
- Brown, R. P., Gerbarg, P. L., & Muench, F. (2013). Breathing practices for treatment of psychiatric and stress-related medical conditions. Psychiatric Clinics, 36(1), 121-140. https://doi.org/10.1016/j.psc.2013.01.001
- Kopplin, C. S., & Rosenthal, L. (2023). The positive effects of combined breathing techniques and cold exposure on perceived stress: a randomised trial. Current Psychology, 42(31), 27058-27070. https://doi.org/10.1007/s12144-022-03739-y
- Tavoian, D., & Craighead, D. H. (2023). Deep breathing exercise at work: Potential applications and impact. Frontiers in Physiology, 14, 1040091. https://doi.org/10.3389/fphys.2023.1040091
- WHO, Mental health (2022) https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response#:~:text=All%20WHO%20Member%20States%20are,of%20the%20agreed%20action%20plan.
Further Reading