Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression

Leyro, Teresa M.; Versella, Mark V.; Yang, Min-Jeong; Brinkman, Hannah R.; Hoyt, Danielle L.; Lehrer, Paul

doi:10.1016/j.cpr.2021.101980

Cited by 58Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsDigital Mental Health Interventions

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Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression

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Leyro, Teresa M., Versella, Mark V., Yang, Min-Jeong, Brinkman, Hannah R., Hoyt, Danielle L., Lehrer, Paul·2021·Clinical Psychology Review

DOI 10.1016/j.cpr.2021.101980PMC PMC8302658

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Abstract

Objective Respiratory abnormalities are a hallmark of anxiety symptomatology and may serve as clinically useful modifiers for alleviating anxiety symptoms. However, gold-standard anxiety treatments (e.g., cognitive-behavioral interventions) often do not directly address respiratory components despite their theoretical utility and clinical accessibility. This review examined the clinical effectiveness of respiratory interventions, interventions that directly target respiration abnormalities and processes, in treating trait anxiety symptoms. Methods The final analysis included 40 randomized controlled trials including at least one measure of trait anxiety, a respiratory-focused intervention group, and a non-respiratory control-group (active or inactive treatment). Overall effects of respiratory focused interventions were examined, as well as the effect of hypothesized moderators. Results Respiratory component interventions yielded significantly greater improvements (moderate to large effect) in anxiety symptoms than controls, with the stronger effects observed in comparison to inactive, rather than active, control conditions. Significant heterogeneity in findings suggests that variability in intervention design, population, and control comparison may obfuscate interpretation of findings. Conclusions Evidence supports the clinical utility of respiratory interventions as either an independent anxiety treatment, or as an adjunct to other interventions. Clinical and research implic…

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Existing literature confirms widespread benefits of slow breathing practices for stress/anxiety reduction, but null or negative results are reported in some studies.
“Although existing literature confirms the widespread benefits of slow breathing practices for stress/anxiety reduction [23,24,25,35,36,37,38], null or negative results are reported in some studies [39,40,41,42,43,44,45,46,47,48,49,50].”
From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [24]
Breathing practices, when used in isolation, are universally accessible, scalable, and cost-free, and are not limited by access to healthcare services nor burdened by side effects.
“Breathing practices, when used in isolation, have the advantage of being universally accessible, scalable, and cost-free. They are not limited by access to healthcare services nor burdened by side effects and put potential treatment tools in the hands of the individual [23,24,25].”
From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [24]
Another recent meta-analysis found significant effects in both psychiatric and healthy populations [24].
“and another recent meta-analysis found significant effects in both psychiatric and healthy populations [24].”
From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [24]
Fincham et al.'s analysis may have been underpowered with only one intervention in mental health populations.
“However, their analysis may have been underpowered with only one intervention in mental health populations; and another recent meta-analysis found significant effects in both psychiatric and healthy populations [24].”
From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [24]
Reviews finding no treatment duration effect may have been limited by small samples, study heterogeneity, and exclusion of human-guided training.
“Although these results contrast with other findings of no treatment duration effect [24,35], those reviews may have been limited by small samples, study heterogeneity, and exclusion of human-guided training, which may interact with long-term practice.”
From Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature (2023) · cites this paper as [24]

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Authors: Leyro, T. M., Versella, M. V., Yang, M.-J., Brinkman, H. R., Hoyt, D. L., & Lehrer, P.
Affiliations: Rutgers, The State University of New Jersey (US)
Corresponding author: Leyro, Teresa M.
ORCID: Leyro, Teresa M.
Yang, Min-Jeong
Brinkman, Hannah R.
Hoyt, Danielle L.
Lehrer, Paul
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2021-03
Volume: 84
Pages: 101980
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2021.101980
PMC: PMC8302658
OpenAlex: W3126092337
Cited by: 53
References: 252
Citations by year: 2026: 11 · 2025: 12 · 2024: 15 · 2023: 11 · 2022: 4
FWCI: 1.23
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Drug Abuse
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: respiratory care, anxiety, trait anxiety, treatment moderators, adjunctive therapy, cognitive-behavioral intervention, treatment effectiveness

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Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression

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