Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature

May combine two claims.

Stress reduction may have been hindered by fast-only breathing in Watson et al. and by discomfort of deep diaphragmatic breathing after abdominal surgery in Aktas et al.

“Regarding the latter, stress reduction may have also been hindered by fast-only breathing in Watson and colleague’s intervention and by the discomfort of doing deep diaphragmatic breathing after abdominal surgery in Aktas and colleagues’ intervention [39,105].”

• cites [39] 2023, The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life, Obes. Surg. sourceNot checked — no full text of the source
• cites [105] Watson, G.M., Sutherland, J., Lacey, C., and Bridgman, P.G. (2022). A Randomised Cross-over Trial of QT Response to Hyperventilation-Induced Anxiety and Diaphragmatic Breathing in Patients with Stress Cardiomyopathy and in Control Patients. PLoS ONE, 17. sourceDisputed

  The Methods (page unavailable) describe two breathing conditions, not a fast-only intervention: hyperventilation was used to induce anxiety, while diaphragmatic breathing was used as the control because it may relieve anxiety. The Results (page unavailable) report that hyperventilation significantly increased anxiety. Watson et al. therefore do not support the proposed explanation that fast-only breathing hindered stress reduction; the separate claim about Aktas et al. is not assessed here. (LLM, conf=0.87)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Of 45 interventions incorporating both human-guided training and multiple sessions, only four were ineffective [44,47,50], likely due to taxing clinical situations, inadequate training/experience, and practice discontinuation.

“Of the 45 interventions in any population that incorporated both of these components, only four were ineffective [44,47,50], but this was likely due to taxing clinical situations [47], inadequate training or experience for a more technical practice [44], and practice discontinuation [50].”

• cites [44] Kamath, A., Urval, R.P., and Shenoy, A.K. (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., 2017. sourcePartly supported

  The Conclusion reports no significant decrease in anxiety, and the Discussion suggests that participants’ limited training may have affected their performance. However, the Methods describe a single 15-minute intervention, not multiple sessions. The paper does not establish inadequate training as the cause of the nonsignificant result. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [47] Ratcliff, 2019, A Randomized Controlled Trial of Brief Mindfulness Meditation for Women Undergoing Stereotactic Breast Biopsy, J. Am. Coll. Radiol. JACR sourceDisputed

  The Results (page unavailable) report that guided mindfulness produced a steeper reduction in anxiety during biopsy than either control condition. The Discussion (page unavailable) calls it effective for reducing anxiety; it found no significant pain difference, but suggests local anesthesia and low pain ratings as possible explanations—not a taxing clinical situation. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [50] Thomas, 2017, A Randomised Controlled Study of the Effectiveness of Breathing Retraining Exercises Taught by a Physiotherapist Either by Instructional DVD or in Face-to-Face Sessions in the Management of Asthma in Adults, Health Technol. Assess. Winch. Engl. sourcePartly supported

  The Process Evaluation (page unavailable) reports that 97 participants stopped regular practice, supporting the practice-discontinuation part associated with this citation. It does not say that discontinuation caused an intervention to be ineffective; Chapter 8, Conclusions (page unavailable), instead reports improved asthma-related quality of life with both breathing-retraining programmes. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Voluntary regulated breathing practices may offer an effective, accessible, and risk-free solution for stress and anxiety.

“Voluntary regulated breathing practices may offer such a solution.”

• cites [18] Sengupta, 2012, Health Impacts of Yoga and Pranayama: A State-of-the-Art Review, Int. J. Prev. Med. sourcePartly supported

  The “Stress and anxiety” section says yoga practices may reduce stress responses and help with anxiety, and describes slow, rhythmic pranayama as producing deep relaxation. It does not establish that regulated breathing alone is accessible or risk-free; the “Risks of yoga practice” section explicitly says yoga is not entirely risk-free. Page numbers are unavailable in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [19] Cramer, 2018, Yoga for Anxiety: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Depress. Anxiety sourceNot checked — no full text of the source
• cites [20] Sellakumar, 2015, Effect of Slow-Deep Breathing Exercise to Reduce Anxiety among Adolescent School Students in a Selected Higher Secondary School in Coimbatore, India, J. Psychol. Educ. Res. (JPER)Not checked yet

  Not checked in the free run.

• cites [21] Hunt, 2018, Positive Effects of Diaphragmatic Breathing on Physiological Stress Reactivity in Varsity Athletes, J. Clin. Sport Psychol. sourceNot checked — no full text of the source
• cites [22] Han, 1996, Influence of Breathing Therapy on Complaints, Anxiety and Breathing Pattern in Patients with Hyperventilation Syndrome and Anxiety Disorders, J. Psychosom. Res. sourceNot checked — no full text of the source

May combine two claims.

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].”

• cites [23] Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., and Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sci., 13. sourcePartly supported

  The Introduction (no page given) calls for cost-effective, self-administered therapies usable by large populations, and the Conclusions (no page given) describe breathwork options as feasible and accessible to patients with anxiety. The paper does not establish that breathing practices are universally accessible or cost-free, require no healthcare access, or have no side effects; it identifies side effects as a limitation of some existing treatments, not as an absence demonstrated for breathwork. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [24] Leyro, 2021, Respiratory Therapy for the Treatment of Anxiety: Meta-Analytic Review and Regression, Clin. Psychol. Rev. sourceNot checked — no full text of the source
• cites [25] Malviya, 2022, Identifying Alternative Mental Health Interventions: A Systematic Review of Randomized Controlled Trials of Chanting and Breathwork, J. Spiritual. Ment. Health sourceNot checked — no full text of the source

May combine two claims.

Breathing engages in a reciprocal relationship with stress and anxiety, whereby stress and anxiety can both affect and be affected by altered respiratory patterns.

“Breathing also uniquely engages in a reciprocal relationship with stress and anxiety, whereby stress and anxiety can both affect [28,29,30,31,32,33] and be affected by [20,21,22,34] altered respiratory patterns.”

• cites [28] Masaoka, 1997, Anxiety and Respiratory Patterns: Their Relationship during Mental Stress and Physical Load, Int. J. Psychophysiol. Off. J. Int. Organ. Psychophysiol. sourceNot checked — no full text of the source
• cites [29] Wilhelm, 2001, Respiratory Dysregulation in Anxiety, Functional Cardiac, and Pain Disorders. Assessment, Phenomenology, and Treatment, Behav. Modif. sourceNot checked — no full text of the source
• cites [30] Martinez, 2001, Respiratory Variability in Panic Disorder, Depress. Anxiety sourcePartly supported

  The Discussion (article pp. 232–237) suggests that anticipatory anxiety might drive respiratory variability and that greater baseline variability may increase vulnerability to CO₂-induced panic. It says the direction of the relationship remains unclear, however, and does not establish a reciprocal relationship between breathing and stress or anxiety generally. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [31] Nardi, 2009, Panic Disorder and Control of Breathing, Respir. Physiol. Neurobiol. sourceNot checked — no full text of the source
• cites [32] Bechbache, 1979, The Effects of Hypercapnia, Hypoxia, Exercise and Anxiety on the Pattern of Breathing in Man, J. Physiol. sourceNot checked — no full text of the source
• cites [33] Grossman, 1983, Respiration, Stress, and Cardiovascular Function, Psychophysiology sourceNot checked — no full text of the source
• cites [20] Sellakumar, 2015, Effect of Slow-Deep Breathing Exercise to Reduce Anxiety among Adolescent School Students in a Selected Higher Secondary School in Coimbatore, India, J. Psychol. Educ. Res. (JPER)Not checked yet

  Not checked in the free run.

• cites [21] Hunt, 2018, Positive Effects of Diaphragmatic Breathing on Physiological Stress Reactivity in Varsity Athletes, J. Clin. Sport Psychol. sourceNot checked — no full text of the source
• cites [22] Han, 1996, Influence of Breathing Therapy on Complaints, Anxiety and Breathing Pattern in Patients with Hyperventilation Syndrome and Anxiety Disorders, J. Psychosom. Res. sourceNot checked — no full text of the source
• cites [34] Bhimani, 2011, Effect of Pranayama on Stress and Cardiovascular Autonomic Function, Indian J. Physiol. Pharmacol.Not checked — no full text of the source

May combine two claims.

Common stress and anxiety treatments rely on external factors, such as a therapist or medication, and come with modest effect sizes or unfavorable side effects.

“Common stress and anxiety treatments rely on external factors, such as a therapist or medication, and come with modest effect sizes [16] or unfavorable side effects [17].”

• cites [16] Carpenter, 2018, Cognitive Behavioral Therapy for Anxiety and Related Disorders: A Meta-Analysis of Randomized Placebo-Controlled Trials, Depress. Anxiety sourceSupported
• cites [17] Bandelow, 2017, Treatment of Anxiety Disorders, Dialogues Clin. Neurosci. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

RCTs were assessed using a modified CLEAR-NPT checklist, and non-RCTs were assessed using the NHLBI-NIH quality assessment tool.

“RCTs were assessed using a modified form of the Boutron checklist to evaluate a report of a nonpharmacological trial (CLEAR-NPT; Appendix A.3) [51,62]. Non-RCTs were assessed using the National Heart, Lung, and Blood Institute of the National Institutes of Health (NHLBI-NIH) quality assessment tool for single-arm, pre-post, or non-randomized studies (Appendix A.4) [63].”

• cites [51] Chen, 2012, Meditative Therapies for Reducing Anxiety: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Depress. Anxiety sourceSupported
• cites [62] Boutron, 2005, A Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR NPT) Was Developed Using Consensus, J. Clin. Epidemiol. sourceNot checked — no full text of the source
• cites [63] (2023, August 17). Study Quality Assessment Tools|NHLBI, NIH, Available online: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools.Not checked yet

  Not checked in the free run.

May combine two claims.

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].”

• cites [23] Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., and Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sci., 13. sourceSupported
• cites [24] Leyro, 2021, Respiratory Therapy for the Treatment of Anxiety: Meta-Analytic Review and Regression, Clin. Psychol. Rev. sourceNot checked — no full text of the source
• cites [25] Malviya, 2022, Identifying Alternative Mental Health Interventions: A Systematic Review of Randomized Controlled Trials of Chanting and Breathwork, J. Spiritual. Ment. Health sourceNot checked — no full text of the source
• cites [35] Fincham, 2023, Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomised-Controlled Trials, Sci. Rep. sourcePartly supported

  The Results (Subgroup analyses for stress) report significant stress benefits for slow-paced breathwork, and the Discussion (Breathwork, anxiety and depression) reports reduced anxiety across breathwork interventions. The Discussion (Clinical implications) also reports nonsignificant effects in mental and physical health populations and urges caution. Thus the paper supports benefits and some null findings, but not unqualified, widespread benefits or negative results specifically for slow breathing. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [36] Hopper, 2019, Effectiveness of Diaphragmatic Breathing for Reducing Physiological and Psychological Stress in Adults: A Quantitative Systematic Review, JBI Database Syst. Rev. Implement. Rep. sourceNot checked — no full text of the source
• cites [37] Miri, 2023, Effects of Breathing Exercise Techniques on the Pain and Anxiety of Burn Patients: A Systematic Review and Meta-Analysis, Int. Wound J. sourcePartly supported

  The Results section reports that breathing exercises, including deep, slow breathing, reduced anxiety in burn patients; the Discussion likewise concludes that breathing techniques reduced anxiety during burn care (page unavailable). This supports the benefit cited in the first part of the sentence, but not a widespread stress-reduction benefit across populations. The null-or-negative-results clause has a separate set of citations and is not attributed to this source. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [38] Rung, 2021, Alternate Nostril Breathing to Reduce Stress: An Option for Pregnant Women Survivors of Intimate Partner Violence?, J. Holist. Nurs. Off. J. Am. Holist. Nurses Assoc. sourceNot checked — no full text of the source
• cites [39] 2023, The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life, Obes. Surg. sourceNot checked — no full text of the source
• cites [40] Biggs, 2003, The Effects of Deep Diaphragmatic Breathing and Focused Attention on Dental Anxiety in a Private Practice Setting, J. Dent. Hyg. JDHNot checked — no full text of the source
• cites [41] Boaviagem, 2017, The Effectiveness of Breathing Patterns to Control Maternal Anxiety during the First Period of Labor: A Randomized Controlled Clinical Trial, Complement. Ther. Clin. Pract. sourceNot checked — no full text of the source

May combine two claims.

The presence of core components in the three effective <5 min interventions suggests that short sessions may be particularly sensitive to practice implementation, requiring human guidance, multiple sessions, or long-term practice for effective stress reduction.

“The presence of core components in the three effective interventions [39,105,106] suggests that such short sessions may be particularly sensitive to practice implementation, such that human guidance, multiple sessions, or long-term practice are required for effective stress reduction.”

• cites [39] 2023, The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life, Obes. Surg. sourceNot checked — no full text of the source
• cites [105] Watson, G.M., Sutherland, J., Lacey, C., and Bridgman, P.G. (2022). A Randomised Cross-over Trial of QT Response to Hyperventilation-Induced Anxiety and Diaphragmatic Breathing in Patients with Stress Cardiomyopathy and in Control Patients. PLoS ONE, 17. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [106] McCaul, 1979, Effects of Paced Respiration and Expectations on Physiological and Psychological Responses to Threat, J. Pers. Soc. Psychol. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Shifting breathing patterns may shift neural circuit dynamics and thus mood and mental state.

“Yet another interpretation resides in the connection between breathing patterns and the brain’s neural circuitry, whereby shifting breathing patterns may correspondingly shift neural circuit dynamics and thus mood and mental state [26].”

• cites [26] Ashhad, 2022, Breathing Rhythm and Pattern and Their Influence on Emotion, Annu. Rev. Neurosci. sourceSupported

May combine two claims.

Most reviews include breathing interventions incorporating biofeedback, which is not readily applicable to at-home practice.

“In addition, most reviews include breathing interventions incorporating biofeedback [23,25,35,52], which is not readily applicable to at-home practice.”

• cites [23] Banushi, B., Brendle, M., Ragnhildstveit, A., Murphy, T., Moore, C., Egberts, J., and Robison, R. (2023). Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review. Brain Sci., 13. sourcePartly supported

  The Results (§3.4; page unavailable) show that this review includes biofeedback-assisted breathing interventions, supporting its use as an example of such a review. The paper does not establish that most reviews include them, and the Discussion (§4; page unavailable) describes biofeedback as implementable in real-world settings rather than saying it is unsuitable for at-home practice. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [25] Malviya, 2022, Identifying Alternative Mental Health Interventions: A Systematic Review of Randomized Controlled Trials of Chanting and Breathwork, J. Spiritual. Ment. Health sourceNot checked — no full text of the source
• cites [35] Fincham, 2023, Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomised-Controlled Trials, Sci. Rep. sourcePartly supported

  The Discussion section, “Comparison to stress-reduction interventions” (page unavailable), discusses meta-analyses of HRV biofeedback and says that HRV biofeedback may be less accessible because it is routinely taught by a qualified professional. It does not establish that most breathing-intervention reviews include biofeedback or that biofeedback is not readily applicable to at-home practice; it also describes a portable biofeedback device used in two studies. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

The other regular-paced intervention was effective, possibly due to human-guided training and its 12 bpm pace.

“The other was effective, possibly due to human-guided training and its 12 bpm pace, which may have been slow enough to engender benefits [78].”

• cites [78] Conlon, 2022, Pulling the Trigger: The Effect of a 5-Minute Slow Diaphragmatic Breathing Intervention on Psychophysiological Stress Responses and Pressurized Pistol Shooting Performance, J. Sport Exerc. Psychol. sourcePartly supported

  The Paced breathing intervention section says an investigator trained participants at 12 breaths per minute, and the Discussion says paced breathing benefited psychological stress responses. The paper does not identify human-guided training or the 12-breath pace as the reason for those benefits; that explanation remains the citing authors’ speculation. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

More human guidance may be needed in situations of clinical stress, for learning more technical practices, or for high-anxiety populations.

“More human guidance may be needed in situations of clinical stress, such as undergoing a breast biopsy [47], for learning more technical practices, such as ANB and UNB, or for high-anxiety populations.”

• cites [47] Ratcliff, 2019, A Randomized Controlled Trial of Brief Mindfulness Meditation for Women Undergoing Stereotactic Breast Biopsy, J. Am. Coll. Radiol. JACR sourceSupported

May combine two claims.

The two ineffective ANB interventions had either human-guided training in a yoga-naive population [44] or no such training in a yoga-breathing-experienced population [49].

“The two ineffective ones had either human-guided training in a yoga-naive population [44] or no such training in a yoga-breathing-experienced population [49].”

• cites [44] Kamath, A., Urval, R.P., and Shenoy, A.K. (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., 2017. sourceSupported
• cites [49] Telles, 2019, Changes in Shape and Size Discrimination and State Anxiety After Alternate-Nostril Yoga Breathing and Breath Awareness in One Session Each, Med. Sci. Monit. Basic Res. sourcePartly supported

  The Participants section (page unavailable) says volunteers had at least three months’ experience with the breathing practices, and the Discussion says alternate-nostril breathing did not reduce state anxiety. The Interventions section describes instructions but does not establish that there was no human-guided training. Calling the intervention simply “ineffective” is also broader than the paper’s finding: it improved haptic discrimination. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

The two fast-only interventions either lacked framework adherence [48] or incorporated poor study design [105].

“The two fast-only interventions either lacked framework adherence [48] or incorporated poor study design [105].”

• cites [48] Sakakibara, 1996, Effect of Slowed Respiration on Cardiac Parasympathetic Response to Threat, Psychosom. Med. sourceNot checked — no full text of the source
• cites [105] Watson, G.M., Sutherland, J., Lacey, C., and Bridgman, P.G. (2022). A Randomised Cross-over Trial of QT Response to Hyperventilation-Induced Anxiety and Diaphragmatic Breathing in Patients with Stress Cardiomyopathy and in Control Patients. PLoS ONE, 17. sourcePartly supported

  The Methods describe three-minute breathing interventions and state that allocation was not hidden from participants or investigators. The Discussion identifies a study weakness: hyperventilation induced only moderate anxiety. These passages support the presence of design limitations, but the paper does not characterize its overall design as poor. (LLM, conf=0.74)

  Experimental — accuracy not yet measured

May combine two claims.

Youth may easily catch on to these practices with human guidance, and their developing nervous systems may be highly receptive to interventions.

“Accustomed to being in learning environments, youth may easily catch on to these practices with human guidance, and their developing nervous systems may be highly receptive to interventions [119].”

• cites [119] Griffin, A. (2017). Adolescent Neurological Development and Implications for Health and Well-Being. Healthcare, 5. sourcePartly supported

  Section 3.2 says adolescence may be a useful time to intervene because the brain is still plastic and amenable to change. Section 3.1 recommends working with young people on solutions, but does not say that being accustomed to learning environments makes them quick to learn the cited practices with human guidance. The latter part of the claim is therefore not supported by this paper. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

May combine two claims.

Breathing acts directly on the autonomic nervous system as a bottom-up approach to stress reduction, so its benefits likely persist across diverse populations.

“Because breathing acts directly on the autonomic nervous system as a “bottom-up” approach to stress reduction [113,114,115,116,117,118], its benefits likely persist across diverse populations.”

• cites [113] Driscoll, 2000, The Effects of Metronome Breathing on the Variability of Autonomic Activity Measurements, J. Manip. Physiol. Ther. sourceNot checked — no full text of the source
• cites [114] Li, 2018, Effects of Slow Breathing Rate on Heart Rate Variability and Arterial Baroreflex Sensitivity in Essential Hypertension, Medicine sourcePartly supported

  The Discussion (page unavailable) reports that slow breathing shifted heart-rate-variability measures toward greater vagal activity in patients with essential hypertension, supporting an effect on autonomic regulation. The paper does not test stress reduction or characterize breathing as a “bottom-up” stress-reduction approach. The statement about benefits across diverse populations follows the citations as the citing authors’ inference, rather than a finding attributed specifically to this source. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [115] Kromenacker, 2018, Vagal Mediation of Low-Frequency Heart Rate Variability During Slow Yogic Breathing, Psychosom. Med. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Fincham et al. reported a significant benefit of breathwork on stress in non-clinical populations only.

“This finding contrasts with those from Fincham and colleagues, whose review reported a significant benefit of breathwork on stress in non-clinical populations only [35].”

• cites [35] Fincham, 2023, Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomised-Controlled Trials, Sci. Rep. sourceSupported

May combine two claims.

Schlatter et al.'s effective intervention [79] lacked human guidance but used a 6 bpm practice among 5th-year medical residents guided via screen cursor with an investigator present to ensure adherence.

“While Schlatter and colleagues’ effective intervention [79] lacked human guidance, their 6 bpm practice among 5th-year medical residents was guided via a screen cursor with an investigator present to ensure practice adherence.”

• cites [79] Schlatter, S.T., Thérond, C.C., Guillot, A., Louisy, S.P., Duclos, A., Lehot, J.-J., Rimmelé, T., Debarnot, U.S., and Lilot, M.E. (2022). Effects of Relaxing Breathing Paired with Cardiac Biofeedback on Performance and Relaxation during Critical Simulated Situations: A Prospective Randomized Controlled Trial. BMC Med. Educ., 22. sourceSupported

May combine two claims.

The 30 min of standing during Meier et al.'s intervention may have caused discomfort and interfered with benefits.

“The 30 min of standing during Meier and colleagues’ human-guided intervention may have caused discomfort and interfered with potential benefits [46]; though perhaps shorter standing practice durations would be effective.”

• cites [46] Meier, 2021, Laughter Yoga Reduces the Cortisol Response to Acute Stress in Healthy Individuals, Stress sourcePartly supported

  The Study procedure describes a 30-minute intervention, and Experimental groups says participants in the guided relaxation-breathing group stood during their exercises. The paper does not suggest that standing caused discomfort or interfered with benefits. If the claim refers to the laughter-yoga group, Experimental groups instead says participants lay down for the final ten minutes. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Multiple sessions took various forms, ranging from two guided individual sessions in one day [67] to five group sessions over 9 months alongside twice-daily at-home practice [71].

“Multiple sessions took various forms, ranging from two guided individual sessions in one day [67] to five group sessions over 9 months alongside twice-daily at-home practice [71].”

• cites [67] Bargale, 2021, Comparative Evaluation of Effect of Two Relaxation Breathing Exercises on Anxiety during Buccal Infiltration Anesthesia in Children Aged 6–12 Years: A Randomized Clinical Study, J. Indian Soc. Pedod. Prev. Dent. sourceSupported
• cites [71] Sundram, 2014, “Taking My Breath Away by Keeping Stress at Bay”–An Employee Assistance Program in the Automotive Assembly Plant, Iran. J. Public HealthNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

HRV is a well-established stress measure.

“For example, HRV is a well-established stress measure [120].”

• cites [120] Kim, 2018, Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature, Psychiatry Investig. sourcePartly supported

  The Introduction (page not specified) says many researchers use HRV to measure stress, and the Conclusion supports its use for objective assessment. But the Introduction also says few studies had confirmed whether HRV is a good stress indicator, so “well-established” overstates the paper’s position. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Another review found that breathwork benefits may persist for a brief period after practice ends, although practice adherence was not assessed.

“Another review found that breathwork benefits may persist for a brief period after practice ends, although practice adherence was not assessed in that study [35].”

• cites [35] Fincham, 2023, Effect of Breathwork on Stress and Mental Health: A Meta-Analysis of Randomised-Controlled Trials, Sci. Rep. sourcePartly supported

  The Discussion (‘Breathwork and stress’; page unavailable) says home-practice compliance was not reported for many studies, so adherence could not be adequately assessed. But the Results (‘Summary of findings for stress’; page unavailable) say there were too few studies to analyse follow-up stress scores, and the Discussion notes limited scope to report follow-up effects. The review therefore does not establish that benefits persisted after practice ended. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Zaccaro et al. propose a checklist of data points to include in breath studies.

“Zaccaro and colleagues propose a checklist of data points to include in breath studies [52], including factors such as breath pace, inspiration/expiration ratio, pauses/holds duration, and others.”

• cites [52] Zaccaro, 2018, How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing, Front. Hum. Neurosci. sourceSupported

May combine two claims.

Participants in Thomas et al.'s 2017 ineffective interventions engaged in regular practice for 6 to 8 weeks but were not practicing most days by the 12-month stress measurement [50].

“Participants in Thomas and colleagues’ 2017 ineffective interventions engaged in regular practice for 6 to 8 weeks but were not practicing most days by the time of the 12-month stress measurement [50].”

• cites [50] Thomas, 2017, A Randomised Controlled Study of the Effectiveness of Breathing Retraining Exercises Taught by a Physiotherapist Either by Instructional DVD or in Face-to-Face Sessions in the Management of Asthma in Adults, Health Technol. Assess. Winch. Engl. sourcePartly supported

  The “Impact of breathing retraining” section reports that many participants initially practised regularly, and the Process Evaluation reports that 97 stopped regular practice. But the cited passages do not establish that participants generally practised for 6–8 weeks or were not practising most days at 12 months; the 6–8-week figure appears as a response category. They also do not support describing the asthma interventions as ineffective or the 12-month follow-up as a stress measurement. Page numbers were not supplied for these passages. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims. The quote only partly states this claim.

Five main parameters were identified as components associated with stress reduction effectiveness, subdivided into exclusionary components (breath pace and session duration) and core components (human-guided training, multiple sessions, and long-term practice).

“Thus, five main parameters were identified as components associated with stress reduction effectiveness, which were subdivided into exclusionary and core components.”

May combine two claims.

In youth and high-anxiety adults, all eight interventions incorporated at least one of the three core components, and none used fast-only or <5 min practices.

“All eight of these interventions incorporated at least one of the three core components of human-guided training, multiple sessions, and long-term practice; and none used fast-only or <5 min practices.”

Classified as probably not a substantial claim. May combine two claims.

The search identified 2904 unique articles, 731 abstracts, and 181 full texts screened, and 58 met the inclusion criteria.

“Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria.”

May combine two claims.

Adherence and compliance with at-home practice were measured and reported poorly or not at all, and reports on human-guided training lacked detail in duration, timeline, and extent of guidance.

“Adherence and compliance with at-home practice were measured and reported poorly or not at all, and reports on human-guided training lacked detail in duration, timeline, and extent of guidance.”

May combine two claims.

Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness.

“Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness.”

May combine two claims.

Of the 58 included studies, 7 RCTs and 0 non-RCTs received 'good' quality ratings, 20 RCTs and 9 non-RCTs received 'fair' ratings, and 14 RCTs and 8 non-RCTs received 'poor' ratings.

“Of the 58 included studies, 7 RCTs and 0 non-RCTs received “good” quality ratings, 20 RCTs and 9 non-RCTs received “fair” ratings, and 14 RCTs and 8 non-RCTs received “poor” ratings (Table A2).”

May combine two claims.

Among the fourteen ineffective interventions within clinical and simulated-stress populations, seven used one or more core components; of these seven, one used <5 min sessions, and another used both fast-only and <5 min practices.

“Among the fourteen ineffective interventions within those populations, seven used one or more core components; of these seven, one used <5 min sessions, and another used both fast-only and <5 min practices.”

May combine two claims.

RCTs made up 72% of effective and 67% of ineffective interventions, with no significant difference (p = 0.78).

“RCTs made up 72% of effective (39 of 54) and 67% of ineffective (12 of 18) interventions, with these proportions not differing significantly (p = 0.78).”

May combine two claims.

Intervention effectiveness was not significantly associated with population category (p = 0.14), session duration beyond 5 min (p = 0.81), group versus individual versus group + individual practice (p = 0.79), and use of at-home practice (p = 0.24).

“Intervention effectiveness was not significantly associated with population category (p = 0.14), session duration beyond 5 min (p = 0.81), group versus individual versus group + individual practice (p = 0.79), and use of at-home practice (p = 0.24; Table 3).”

May combine two claims.

Stress/anxiety was a primary outcome in 67% of effective and 61% of ineffective interventions, with no significant difference (p = 0.67).

“Stress/anxiety was a primary outcome in 67% of effective and 61% of ineffective interventions (p = 0.67).”

May combine two claims.

Many pre-post studies did not include a control group, and those that did lacked an active control.

“Many pre-post studies did not include a control group, and those that did lacked an active control.”

May combine two claims.

Among healthy adults, 17 of 21 (81%) interventions were effective; among acute clinical populations, 17 of 21 (81%); among chronic clinical populations, 7 of 11 (64%); among simulated stress populations, 5 of 11 (45%).

“Among healthy adults, 17 of 21 (81%) interventions were effective; these numbers were 17 of 21 (81%) among acute clinical populations, 7 of 11 (64%) among chronic clinical populations, and 5 of 11 (45%) among simulated stress populations.”

May combine two claims.

Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice.

“Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice.”

May combine two claims.

Within the 58 included studies, 72 breathing interventions met inclusion criteria, and 54 of these significantly reduced participants' stress/anxiety.

“Within the 58 studies, 72 breathing interventions that met our inclusion criteria were identified, and 54 such interventions significantly reduced participants’ stress/anxiety.”

• Also stated in: § Abstract · plain

  “Fifty-four of the studies’ 72 interventions were effective.”

May combine two claims.

Effectiveness was no longer associated with breath pace when considering any pace besides fast-only (p = 0.10) or when comparing fast-only to any other pace (p = 0.06).

“Effectiveness was no longer associated with breath pace when considering any pace besides fast-only (p = 0.10) or when comparing fast-only to any other pace (p = 0.06).”

May combine two claims.

Effective interventions in clinical and simulated-stress populations always used at least one core component; three used <5 min sessions.

“The effective interventions in clinical and simulated-stress populations always used at least one core component; three used <5 min sessions.”

May combine two claims.

In healthy adults, all seventeen effective interventions incorporated at least one core component, and all four ineffective ones used zero core components and <5 min sessions.

“In healthy adults, all seventeen effective interventions incorporated at least one core component, and all four ineffective ones used zero core components and <5 min sessions.”

May combine two claims.

Fifty of 54 effective and 1 of 18 ineffective interventions incorporated multiple breath practice sessions throughout the intervention.

“Fifty of the 54 effective and 1 of the 18 ineffective interventions incorporated multiple breath practice sessions throughout the intervention (Figure 5C), with up to 100+ sessions incorporated.”

May combine two claims.

Any session duration beyond 5 min can be effective, as there was no significant association between effectiveness and session durations ≥5 min.

“The lack of significant association between effectiveness and session durations ≥5 min indicates that any session duration beyond 5 min can be effective.”

May combine two claims.

Population, breath paces other than fast-only, session duration beyond 5 min, group vs individual practice, and setting were not associated with effectiveness.

“Neither the population doing the practice, other breath paces besides fast-only, session duration beyond 5 min, group versus individual practice, nor setting were associated with effectiveness.”

May combine two claims.

Human-guided training does not guarantee stress reduction benefits, and its lack does not prevent effectiveness.

“While important, human-guided training does not guarantee stress reduction benefits, and the lack thereof does not prevent effectiveness.”

May combine two claims.

We identified 58 clinical studies, comprising 41 RCTs and 17 single-arm, pre-post, non-randomized trials; 5407 total participants were included, with a mean age of 35.9 years and 43.92% female.

“We identified 58 clinical studies, comprising 41 RCTs and 17 single-arm, pre-post, non-randomized trials; 5407 total participants were included, with a mean age of 35.9 years and 43.92% female.”

May combine two claims.

Of the four effective interventions lacking human-guided training, three included multiple sessions [39,80,106], and the other [79] may have incorporated unreported and unintentional human guidance due to investigator presence.

“Of the four effective interventions that lacked such training, three included multiple sessions [39,80,106], and the other [79] may have incorporated some unreported and unintentional human guidance due to the investigator’s presence during the practice.”

• cites [39] 2023, The Effect of Deep Breathing Exercise and 4-7-8 Breathing Techniques Applied to Patients After Bariatric Surgery on Anxiety and Quality of Life, Obes. Surg. sourceNot checked — no full text of the source
• cites [80] Clark, 1990, Effects of Paced Respiration on Anxiety Reduction in a Clinical Population, Biofeedback Self-Regul. sourceNot checked — no full text of the source
• cites [106] McCaul, 1979, Effects of Paced Respiration and Expectations on Physiological and Psychological Responses to Threat, J. Pers. Soc. Psychol. sourceNot checked — no full text of the source

May combine two claims.

All other ANB studies were effective in reducing stress and incorporated ≥2 of the three core components.

“All other ANB studies were effective in reducing stress and incorporated ≥2 of the three core components.”

May combine two claims.

Among the <5 min ineffective interventions, four incorporated no core component, and the remaining two included other factors that may have influenced effectiveness.

“Among these, however, four incorporated no core component, and the remaining two included other factors that may have influenced effectiveness.”

May combine two claims.

Simply engaging in a breathing practice provides benefits, with sessions as short as 5 min yielding comparable benefits to longer sessions.

“Our findings indicate that simply engaging in a breathing practice provides benefits, with sessions as short as 5 min yielding comparable benefits to longer sessions.”

May combine two claims.

Of the two regular-paced interventions, one was ineffective, possibly due to lack of framework adherence [42].

“Of the two regular-paced interventions, one was ineffective, which may relate to its lack of framework adherence [42].”

• cites [42] Holmes, 1978, Control of Respiration as a Means of Controlling Responses to Threat, J. Pers. Soc. Psychol. sourceNot checked — no full text of the source

May combine two claims.

Provided fast-only practices are avoided, specific breath pace may not matter, as effectiveness was not associated with pace when fast-only practices were excluded.

“Our analysis further suggests that, provided fast-only practices are avoided, specific breath pace may not matter, as effectiveness was not associated with pace when fast-only practices were excluded.”

May combine two claims.

Fast breathing can successfully reduce stress when paired with slower paces or holds, as seen in the 12 fast + slow interventions, all of which were effective.

“Interestingly, fast breathing can successfully reduce stress when paired with slower paces or holds, as seen in the 12 fast + slow interventions, all of which were effective.”

May combine two claims.

Seven of eight single-session interventions with simple, device-guided practices were ineffective, highlighting the importance of multiple sessions when human guidance is lacking.

“Interestingly, seven of eight single-session interventions with such simple, device-guided practices were ineffective, highlighting the importance of multiple sessions when human guidance is lacking.”

May combine two claims.

Some single-session interventions were effective, with 10 of 23 providing stress reduction benefits.

“Nevertheless, some single-session interventions were, in fact, effective, with 10 of 23 providing stress reduction benefits.”

May combine two claims.

Nine of the 10 effective single-session interventions were human-guided, suggesting that adequate training may make up for multiple sessions.

“Nine of these 10 were human-guided, suggesting that adequate training may, in some cases, make up for multiple sessions in breath practice efficacy.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Both initial training sessions and ongoing practice sessions can be as short as 5 min.

“Both initial training sessions and ongoing practice sessions can be as short as 5 min.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A protocol was not developed or registered for this systematic review.

“A protocol was not developed or registered.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two independent reviewers conducted all levels of screening and data extraction, with discrepancies resolved through discussion or review by a third reviewer.

“Two reviewers conducted all levels of screening and data extraction. Discrepancies were resolved through discussion or review by a third reviewer.”

• Also stated in: § Abstract · plain

  “Two independent reviewers conducted all screening and data extraction.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Studies were assessed by two independent reviewers for methodological and reporting quality, with disagreements resolved through discussion or by a third reviewer.

“Studies were assessed by two independent reviewers for methodological and reporting quality. Disagreements between reviewers were resolved through discussion or by a third reviewer.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review was conducted in strict accordance with PRISMA guidelines.

“The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were strictly followed throughout.”

May combine two claims.

Incorporating human-guided training, multiple sessions, and long-term practice actively contributes to stress reduction benefits.

“while incorporating the core components of human-guided training, multiple sessions, and long-term practice actively contributes to stress reduction benefits.”

May combine two claims.

Avoiding fast-only practices and sessions <5 min appears conducive to but not sufficient for intervention effectiveness.

“Breath pace and session duration comprised exclusionary components, in which avoiding fast-only practices and sessions <5 min appears conducive to but not sufficient for intervention effectiveness”

Classified as probably not a substantial claim.

All selected studies were included in data extraction and synthesis regardless of their methodological quality.

“All selected studies were included in data extraction and synthesis, regardless of their methodological quality, as assessed with these tools.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Ratcliff (2019), effectiveness may have been diluted by difficulty of doing diaphragmatic breathing while lying still and face-down on a procedure table during a breast biopsy.

“In Ratcliff (2019), effectiveness may have been diluted by the difficulty of doing diaphragmatic breathing while lying still and face-down on a procedure table during a breast biopsy.”

May combine two claims.

The framework identifies caveats that may reduce intervention effectiveness: extensive standing, repeated interruptions, involuntarily restricted diaphragmatic expansion, and inadequate training for highly technical practices.

“The framework also identifies caveats reflecting factors that may potentially reduce intervention effectiveness, such as extensive standing, repeated interruptions, involuntarily restricted diaphragmatic expansion, and inadequate training for highly technical practices.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Human-guided training could be live or pre-recorded and as minimal as one 5 min session, implying accessibility to broad populations.

“The fact that this training could be live or pre-recorded and as minimal as one 5 min session implies accessibility to broad populations, although it is notable that all effective interventions among high-anxiety populations included two or more human-guided sessions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fast + slow practices may train the autonomic nervous system to engage the parasympathetic branch more readily following high sympathetic activation.

“They may, alternatively, train the autonomic nervous system to engage the parasympathetic branch more readily following high sympathetic activation [111].”

• cites [111] Brown, 2005, Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I-Neurophysiologic Model, J. Altern. Complement. Med. sourceNot checked — no full text of the source

May combine two claims.

The conceptual framework of components associated with effective stress reduction breathing interventions comprises avoiding fast-only breathing and session durations <5 min, and including human-guided training, multiple sessions, and/or long-term practice.

“Synthesis results were used to develop a conceptual framework of components associated with effective stress reduction breathing interventions (Figure 6): avoiding fast-only breathing and session durations <5 min; and including human-guided training, multiple sessions, and/or long-term practice.”

• Also stated in: § 4.1. Overview · plain

  “Findings were used to develop a conceptual framework of breath practice effectiveness, specifying that stress-reducing interventions incorporated five components: avoidance of fast-only breathing and sessions <5 min; and inclusion of human-guided training, multiple sessions, and/or long-term practice.”

May combine two claims.

Only two interventions met the 12-20 bpm regular-paced breathing definition, so the stress-reducing effects of regulated breathing at one's normal pace cannot be definitively assessed.

“Because only two interventions met our 12–20 bpm regular-paced breathing definition, we cannot definitively assess the stress-reducing effects of regulated breathing at one’s normal pace.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Hearing real-time instructions allows participants to receive performance cues and, with live guidance, to ask questions and/or get feedback.

“Hearing real-time instructions allows participants to receive performance cues and, in the case of live guidance, to ask questions and/or get feedback.”

May combine two claims.

In Meier (2020), standing still for 30 min and repeated interruptions likely explain the lack of effectiveness.

“In Meier (2020), the fact that participants were standing still for a 30 min practice and were repeatedly interrupted for stress surveys likely explains the lack of effectiveness.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

If breathwork's benefits relate to respiration-induced neural entrainment, any breathing pace different from one's usual pattern may offer stress relief, even fast-only practices.

“Should breathwork’s benefits relate to respiration-induced neural entrainment, any breathing pace different from one’s usual pattern may offer stress relief—even fast-only practices.”

May combine two claims.

Human guidance may enhance adherence and stress reduction outcomes.

“Such guidance may enhance adherence and stress reduction outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Strohmaier et al. reported that larger doses of mindfulness practices were no more effective than smaller ones.

“Interestingly, a recent review by Strohmaier and colleagues reported similar findings about mindfulness-based programs, with larger doses of mindfulness practices no more effective than smaller ones [112].”

• cites [112] Strohmaier, 2020, The Relationship Between Doses of Mindfulness-Based Programs and Depression, Anxiety, Stress, and Mindfulness: A Dose-Response Meta-Regression of Randomized Controlled Trials, Mindfulness sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Fast breathing could hypothetically reduce stress by acting as an acute stressor that builds resilience or by providing a sense of control.

“Fast breathing could hypothetically reduce stress by acting as an acute stressor that builds resilience over time or by providing a sense of control from learning to regulate one’s own breathing and internal state.”

May combine two claims.

Fast + slow practices may provide benefits by teaching practitioners to slow breathing and self-soothe, or by building CO2 tolerance.

“Such practices may provide benefits by teaching practitioners to slow their breathing patterns and self-soothe during stressful situations; or by building CO2 tolerance, which is inversely related to symptoms of stress and anxiety [110].”

• cites [110] Battaglia, 2014, Early-Life Risk Factors for Panic and Separation Anxiety Disorder: Insights and Outstanding Questions Arising from Human and Animal Studies of CO2 Sensitivity, Neurosci. Biobehav. Rev. sourceNot checked — no full text of the source

May combine two claims.

In a highly technical practice such as ANB, multiple sessions or prior experience plus human-guided training may be required for stress-reducing effects.

“It may be that in a highly technical practice such as ANB, multiple sessions or prior experience plus human-guided training are required for stress-reducing effects.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

The observed importance of multiple sessions likely relates to greater practice familiarity and consistency.

“The observed importance of multiple sessions likely relates to greater practice familiarity and consistency.”

May combine two claims.

Human-guided training does not appear necessary beyond the first session; after that, breathing practices can be carried out individually at home.

“Thus, human-guided training does not appear necessary beyond the first session, after which breathing practices can be carried out individually at home.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The effects of breathwork may be more potent in high-anxiety populations and youth.

“Alternatively, the effects of breathwork may be more potent in high-anxiety populations and youth.”

May combine two claims.

Long-term practice more likely enhances intervention effectiveness when coupled with at least one human-guided session, which may help teach novice practitioners proper technique.

“It is more likely that long-term practice enhances intervention effectiveness when coupled with at least one human-guided session, which may help teach novice practitioners proper technique.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Repeated data collection interruptions in Meier's study may have reduced focus and induced sufficient stress to negate benefits.

“While practicing breathing in a standing position may have influenced Meier’s findings, so could its repeated data collection interruptions, which may have reduced focus and induced sufficient stress to negate benefits.”

May combine two claims.

Prolonged standing or involuntary diaphragmatic immobilization may reduce effectiveness.

“On the physical side, breath practices should be performed in a comfortable position without prolonged standing or involuntary diaphragmatic immobilization.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The effectiveness in youth and high-anxiety populations may be a coincidence due to small sample sizes or prevalence of human-guided training and multiple sessions.

“Perhaps this is a coincidence due to the small sample sizes of four interventions each or due to the prevalence of human-guided training and multiple sessions in these interventions.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Breath practices may be less likely to reduce stress when they include interruptions.

“Breath practices may also be less likely to reduce stress when they include interruptions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Populations with particularly dysregulated breathing may fare better with one-on-one attention, given small number of group interventions in high-anxiety and acute chronic populations.

“However, given the small number of group interventions in high-anxiety and acute chronic populations, it is possible that populations with particularly dysregulated breathing [28,29,33] may fare better with one-on-one attention.”

• cites [28] Masaoka, 1997, Anxiety and Respiratory Patterns: Their Relationship during Mental Stress and Physical Load, Int. J. Psychophysiol. Off. J. Int. Organ. Psychophysiol. sourceNot checked — no full text of the source
• cites [29] Wilhelm, 2001, Respiratory Dysregulation in Anxiety, Functional Cardiac, and Pain Disorders. Assessment, Phenomenology, and Treatment, Behav. Modif. sourceNot checked — no full text of the source
• cites [33] Grossman, 1983, Respiration, Stress, and Cardiovascular Function, Psychophysiology sourceNot checked — no full text of the source

May combine two claims.

The framework is based on associations and does not necessarily represent causal relationships.

“The framework presented here is based on associations between breath practice components and effectiveness; it does not necessarily represent causal relationships.”

Classified as probably not a substantial claim. May combine two claims.

Prior knowledge that breathing practices support stress reduction existed, but how effects vary across populations, practice types, and implementation approaches remained unclear.

“Despite prior knowledge that breathing practices support stress reduction, how these effects vary across populations, breath practice types, and implementation approaches remained unclear.”

• AssumptionRests on an assumption: How breathing practice effects vary across populations, breath practice types, and implementation approaches remained unclear before this review.

May combine two claims.

Human-guided training and long-term practice may not be necessary for exceedingly simple breathing practices, such as slightly slower-than-normal pace, which may be more accessible to breathwork-naive individuals.

“Conversely, human-guided training and long-term practice may not be necessary for exceedingly simple breathing practices, such as those at a slightly slower-than-normal pace (e.g., 10 or 8 bpm) that may be more accessible to breathwork-naive individuals [80,106].”

• cites [80] Clark, 1990, Effects of Paced Respiration on Anxiety Reduction in a Clinical Population, Biofeedback Self-Regul. sourceNot checked — no full text of the source
• cites [106] McCaul, 1979, Effects of Paced Respiration and Expectations on Physiological and Psychological Responses to Threat, J. Pers. Soc. Psychol. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

There may be finer distinctions among populations and outcomes in which different practices help specific populations in different ways.

“Although our results suggest that any breath pace besides fast-only can be effective when the framework criteria are applied, there may be finer distinctions among populations and specific outcomes of interest in which different practices help specific populations in different ways.”

Classified as probably not a substantial claim.

Physiological outcomes were not considered in our analysis.

“Physiological outcomes were also not considered in our analysis.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Results may have differed if we had included practices combined with yoga, meditation, or biofeedback.

“Although we aimed to address breathing practices performed in isolation and accessible to broad populations, results may have differed if we had included those combined with other practices such as yoga, meditation, or biofeedback.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The potential caveats are hypotheses based on data from outlier interventions; other factors could have driven effectiveness.

“The potential caveats identified in this framework are hypotheses based on data available in outlier interventions; it could be that other factors drove effectiveness in these interventions.”

May combine two claims.

Only two databases were searched, but the large number of included studies lends credence to the conclusions.

“Only two databases were searched for this systematic review; however, the large number of identified and included studies lends credence to the conclusions presented.”

May combine two claims.

The methodological quality of included studies was mediocre at best, so some effectiveness findings may not be as reliable or valid as assumed.

“Due to the mediocre-at-best methodological quality of included studies, some effectiveness findings may not be as reliable or valid as assumed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Caution is warranted in applying these results to individuals with certain clinical conditions, such as epilepsy, heart conditions, or pregnancy.

“Lastly, caution is warranted in applying these results to individuals with certain clinical conditions, such as epilepsy, heart conditions, or pregnancy, whose reactions to intense practices may vary.”

Classified as probably not a substantial claim. The quote only partly states this claim.

Following the framework criteria will increase the likelihood of beneficial stress outcomes.

“Following the below framework criteria will increase the likelihood of beneficial stress outcomes associated with breath practices (Table 4).”

May combine two claims.

Extensive standing, interruptions, involuntarily restricted diaphragmatic movement, and inadequate training for highly technical practices may render otherwise promising interventions ineffective.

“Extensive standing, interruptions, involuntarily restricted diaphragmatic movement, and inadequate training for highly technical practices may render otherwise promising interventions ineffective.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Changes in self-reported stress may differ when participants see HRV responses and modify breath pace to achieve certain HRV outcomes.

“Changes in self-reported stress may differ when participants see HRV responses and modify their breath pace to achieve certain HRV outcomes.”

Probably not a substantial claim: may not pass S2 (checkable).

We have identified simple yet important criteria for learning and implementing breath practices for effective stress reduction.

“We have identified simple yet important criteria for learning and implementing breath practices for effective stress reduction.”