The Science Behind Breathwork and Mental Health

The Science Behind Breathwork and Mental Health

Research shows breathwork rooted in physiology may reduce panic and anxiety symptoms.

Alicia E. Meuret, PhD, is a professor of clinical psychology and director of the Anxiety and Depression Research Center at Southern Methodist University. Her research has revealed opportunities to address anxiety and mood disorders with controlled breathing—or “breathwork”—while contending with shifting perceptions of breathwork in science and society. 

How is breathwork different from breathing?
Breathwork refers to practices that encompass regulating the way one breathes in order to promote a positive mental and physical outcome. Breathing, on the other hand, is spontaneous; we do it without having to think about it. 

What is unique about breathing is that it is the only autonomic system that can be brought under complete voluntary control. Say for example, my heart is racing, or I feel my body temperature rising—I can directly go to my breath, influence my breath, and because all these autonomic systems are interconnected, by influencing one system, you influence all the other ones. So eventually, if I alter my breathing in a certain way that promotes relaxation or a parasympathetic function, the other organs will have to follow. 

Why is breathwork relevant to mental health issues such as panic disorder?
Patients with panic disorder have this sensation as if they’re being chased by a lion, and yet there is no apparent threat in the environment. When this happens, patients develop respiratory symptoms—shortness of breath, feeling dizzy, chest pain, the sensation of choking. 

What I noticed when I looked at the basic research was, it wasn’t that those patients were necessarily breathing extremely fast. Their CO2 was in an abnormally low range (known as hypocapnia), and that was because they were taking in too much volume. With every inhalation, they had triple or quadruple the amount of air as would be needed. 

What’s fascinating is that hypocapnia and hypercapnia create the same sensation. So, this person has, in essence, too much air, and that person has too little air, and yet the perception of suffocation is the same. They would get this feeling of ‘I cannot breathe’ but their oxygen is in a normal range. One can think of this as a biological error, but a very costly one, as sufferers often end up in the emergency room, where they are told it’s all in their head.

Tell me about the intervention you developed.
Exhaled CO2 is a sensitive indicator of hyperventilation, which O2 is not. CO2 can be assessed directly from the nose when a person exhales using a capnometer. Using this device, my colleagues and I devised a training, termed Capnometry-Assisted Respiratory Training (CART), where patients practice breathing very shallowly and more slowly. They would take this device home with them, and it would show them an instant reading of CO2, respiration rate, heart rate and oxygen. 

This would show them that whatever distressing respiratory symptom they experienced wasn’t due to them being hypoxic; it was because of their CO2 being too low, and [it would] basically give them feedback to increase their CO2 levels. Over a four-week training with a one-year follow-up, we found very substantial decreases in panic disorder severity, which were comparable to gold-standard cognitive behavioral therapy.

We were able to normalize those CO2 levels, and those levels remained stable after we took away the device, even 12 months later. Therapeutic gains and mechanisms of CART have been independently replicated and also tested in patients with other anxiety disorders and in people with asthma.

Importantly, changing respiration—breathing slower—was not responsible for the improvements. They had to breathe very shallowly in order to get the CO2 up. It was breathing less air, counter to what people would think. 

What are the next steps for this work? 
This intervention is still mostly used in academic or medical settings. That is because the key to this treatment is very specific to CO2, and in order to measure CO2, you spend $1,000-plus on a reliable device. As I can tell, there hasn’t been an alternative in terms of measuring CO2 reliably that is low in cost. So, I continue to work on finding an index or estimate of CO2 to come up with a device that would be more cost-friendly. If successful, therapeutic applications could be extended to treating patients with other conditions such as long COVID.

How have scientific and societal perceptions of breathwork affected your approach?
Breathwork has complex historic roots that go all the way back to yoga breathing and Tibetan Buddhism. 

For a while, breathing in the context of mental health became kind of a black sheep. It was viewed as a placebo and inhibiting people from getting better. Things have changed now due to the increased focus on mechanistic research and personalized medicine. In clinical psychotherapy, there’s a lot of focus toward meditation and mindfulness, and that also includes breathwork.

However, the one thing where I still feel the field is lagging behind is to do precision work, taking a careful look at the underlying mechanisms. Without that, we don’t know if a change was because of the intervention or a placebo effect.

I came in at a time when we had to prove that this works by doing careful mechanistic work. It’s an advantage when you have that pushback because then you work even harder to make your research as objective and mechanistically sound as possible. 

Interview conducted by science writer Anne Frances Johnson.

This article was originally published in the November 2025 issue of The Physiologist Magazine. Copyright © 2025 by the American Physiological Society. Send questions or comments to tphysmag@physiology.org.