Breathwork in embodied psychotherapies: a systematic review and meta-analysis

Breathwork techniques such as diaphragmatic, paced, and box breathing are increasingly used in psychotherapy and embodied clinical practice yet their efficacy and mechanisms remain unevenly documented. This systematic review and meta-analysis synthesised controlled studies examining breathwork as a stand-alone or adjunctive intervention for psychological (anxiety, depression, stress) and neurobiological (heart-rate variability, brain activation) outcomes. Twenty-five eligible studies (N = 1278) were pooled using random-effects models. Breathwork produced moderate to large reductions in anxiety, depression and perceived stress, with moderate to large increases in heart-rate variability and activation of neural regions implicated in emotion regulation. Subgroup analyses suggested that slow diaphragmatic and paced breathing protocols, delivered regularly and embedded within psychotherapy, were associated with the most robust effects. These findings support breathwork as a low-cost, scalable component of embodied psychotherapies and highlight the need for further trials that integrate somatic, dance/movement, and body-oriented approaches with mechanistically informed psychophysiology.