Does breathwork work? An empirical evaluation of the hype

Contemplative practices employing volitional manipulation of breathing (breathwork) have received a surge in interest and may have therapeutic potential to improve stress and health outcomes. Breathwork comprises both slow and fast breathing practices, wit h a history of use dating back millennia. However, despite emerging evidence and modern science gathering around these ancient practices, there remain considerable evidence gaps. This includes a lack of robustly designed randomised-controlled trials (RCTs) evaluating aspects pertaining to effectiveness and safety, along with the potential of remotely delivered breathwork which increases availability. It is imperative to answer such questions before rolling out any health intervention at scale – the remit of this thesis.

Following a brief introduction to stress, contemplative practices and breathwork, four published studies are presented. Chapter 2 provides a meta - analysis of RCTs with stress as the primary outcome, finding significant post-intervention between-group small-medium effects in favour of breathwork over controls. Building upon this, Chapter 3 evaluates a slow breathwork technique, coherent breathing, finding null effects from the largest RCT of this practice in a remotely delivered, fully-automated format, among a general population sample targeting stress, compared to a placebo comparator.

Focus then shifts towards faster, more intense techniques (high ventilation breathwork — HVB), with Chapter 4 reviewing their psychophysiological effects to inform potential mechanisms, safety profiles and clinical applications. Subsequently, Chapter 5 examines a HVB practice with breath holds/retention (HVBR), and presents the largest RCT of this technique, automated and delivered remotely in young, healthy adults, again targeting stress and finding null effects when compared to a placebo control. Whilst promise is found across the breathwork literature, this is not translated into findings from our studies of remote digital practice. Finally, an overall discussion is provided, including strengths, limitations, implications and directions for the breathwork field to evolve in a robust, scientific and evidence - based manner.