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Leyro TM, Versella MV, Yang MJ, et al. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev. 2021;84:101980doi: 10.1016/j.cpr.2021.101980.
Leyro, T. M., Versella, M. V., Yang, M. J., Brinkman, H. R., Hoyt, D. L., & Lehrer, P. (2021). Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clinical psychology review, 84101980. https://doi.org/10.1016/j.cpr.2021.101980
Leyro, Teresa M, et al. "Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression." Clinical psychology review vol. 84 (2021): 101980. doi: https://doi.org/10.1016/j.cpr.2021.101980
Leyro TM, Versella MV, Yang MJ, Brinkman HR, Hoyt DL, Lehrer P. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression. Clin Psychol Rev. 2021 Jan 24;84:101980. doi: 10.1016/j.cpr.2021.101980. Epub 2021 Jan 24. PMID: 33540222; PMCID: PMC8302658.
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Clin Psychol Rev. 2021 Jan 24;84:101980. doi: 10.1016/j.cpr.2021.101980. Epub 2021 Jan 24.

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

Clinical psychology review

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

Affiliations

  1. Department of Psychology, Rutgers, The State University of New Jersey, United States. Electronic address: [email protected].
  2. Department of Psychology, Rutgers, The State University of New Jersey, United States.
  3. Department of Psychology, Rutgers, The State University of New Jersey, United States; Department of Health Outcomes and Behavior, Moffitt Cancer Center, United States.
  4. Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, United States.

PMID: 33540222 PMCID: PMC8302658 DOI: 10.1016/j.cpr.2021.101980

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 implications of findings along with recommendations for ongoing investigations in this domain are discussed.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Keywords: Anxiety; Breathing; Intervention; Meta-analysis; Respiration; Treatment

References

  1. Arch Psychiatr Nurs. 2016 Apr;30(2):292-9 - PubMed
  2. J Altern Complement Med. 2012 May;18(5):473-9 - PubMed
  3. Epidemiol Psychiatr Sci. 2011 Jun;20(2):205-10 - PubMed
  4. Respir Physiol. 1966;1(2):121-37 - PubMed
  5. J Crohns Colitis. 2015 Jan;9(1):86-106 - PubMed
  6. Depress Anxiety. 2013 Apr;30(4):315-20 - PubMed
  7. J Consult Clin Psychol. 2007 Aug;75(4):513-22 - PubMed
  8. Arch Intern Med. 2006 May 22;166(10):1092-7 - PubMed
  9. ERJ Open Res. 2017 Dec 08;3(4): - PubMed
  10. Clin Auton Res. 2005 Dec;15(6):373-81 - PubMed
  11. Clin Psychol Rev. 2013 Aug;33(6):763-71 - PubMed
  12. Am J Geriatr Psychiatry. 2009 Feb;17(2):105-15 - PubMed
  13. Exp Ther Med. 2013 Apr;5(4):1194-1200 - PubMed
  14. J Pers Assess. 2000 Feb;74(1):106-25 - PubMed
  15. Child Adolesc Ment Health. 2015 Nov;20(4):182-194 - PubMed
  16. Int J Ment Health Nurs. 2019 Jun;28(3):635-656 - PubMed
  17. Schizophr Res. 2013 Oct;150(1):176-84 - PubMed
  18. Clin Psychol Rev. 2010 Aug;30(6):710-20 - PubMed
  19. Psychol Med. 2017 Nov;47(15):2578-2586 - PubMed
  20. Stress. 2015 Jan;18(1):57-66 - PubMed
  21. J Psychosom Res. 2015 Feb;78(2):116-22 - PubMed
  22. Psychol Bull. 2009 Nov;135(6):974-99 - PubMed
  23. Int J Psychophysiol. 2010 Oct;78(1):68-79 - PubMed
  24. J Clin Psychol. 2015 Oct;71(10):935-63 - PubMed
  25. Psychother Res. 2009 Jul;19(4-5):511-8 - PubMed
  26. PLoS One. 2013 Aug 26;8(8):e71834 - PubMed
  27. Appl Psychophysiol Biofeedback. 2000 Sep;25(3):177-91 - PubMed
  28. West J Nurs Res. 2009 Mar;31(2):245-79 - PubMed
  29. Appl Psychol Health Well Being. 2020 Jul;12(2):384-410 - PubMed
  30. Behav Ther. 2013 Sep;44(3):417-31 - PubMed
  31. Behav Res Ther. 2015 Sep;72:9-17 - PubMed
  32. J Investig Med. 2013 Jun;61(5):827-34 - PubMed
  33. Thorax. 2009 Jan;64(1):55-61 - PubMed
  34. J Psychiatr Pract. 2012 Jul;18(4):233-52 - PubMed
  35. Chest. 2004 Aug;126(2):405-11 - PubMed
  36. J Altern Complement Med. 2010 Jan;16(1):37-46 - PubMed
  37. Acta Neuropsychiatr. 2007 Apr;19(2):76-91 - PubMed
  38. Complement Ther Clin Pract. 2012 May;18(2):94-8 - PubMed
  39. Br J Psychiatry. 1989 Feb;154:232-6 - PubMed
  40. J Cardiopulm Rehabil Prev. 2010 Mar-Apr;30(2):77-84 - PubMed
  41. Am J Psychiatry. 1995 Aug;152(8):1168-73 - PubMed
  42. Mayo Clin Proc. 2019 Mar;94(3):432-446 - PubMed
  43. JBI Database System Rev Implement Rep. 2019 Sep;17(9):1855-1876 - PubMed
  44. Psychosom Med. 1978 Jun;40(4):321-8 - PubMed
  45. Behav Res Ther. 1995 Mar;33(3):335-43 - PubMed
  46. Appl Psychophysiol Biofeedback. 2004 Jun;29(2):121-33 - PubMed
  47. Behav Res Ther. 2010 Apr;48(4):312-20 - PubMed
  48. J Abnorm Psychol. 2017 May;126(4):454-477 - PubMed
  49. Biol Res Nurs. 2020 Jan;22(1):34-44 - PubMed
  50. J Anxiety Disord. 2014 Aug;28(6):612-24 - PubMed
  51. Behav Sci (Basel). 2017 Feb 13;7(1): - PubMed
  52. Am J Physiol Heart Circ Physiol. 2010 Nov;299(5):H1318-27 - PubMed
  53. Curr Psychiatry Rep. 2011 Aug;13(4):258-66 - PubMed
  54. Clin Psychol Rev. 2010 Feb;30(1):37-50 - PubMed
  55. Clin Respir J. 2008 Apr;2(2):86-91 - PubMed
  56. J Psychiatr Res. 2008 Jun;42(7):560-8 - PubMed
  57. Lancet. 1984 Sep 22;2(8404):665-9 - PubMed
  58. Psychol Med. 2014 Aug;44(11):2363-74 - PubMed
  59. J Consult Clin Psychol. 2000 Jun;68(3):417-24 - PubMed
  60. Mindfulness (N Y). 2016;7(5):1011-1023 - PubMed
  61. Neuropsychiatr Dis Treat. 2015 Oct 09;11:2619-27 - PubMed
  62. Psychol Health. 2016 Dec;31(12):1415-1434 - PubMed
  63. Complement Ther Med. 2016 Jun;26:1-10 - PubMed
  64. Curr Opin Obstet Gynecol. 2017 Dec;29(6):359-366 - PubMed
  65. Ir J Psychol Med. 2008 Mar;25(1):3-4 - PubMed
  66. Appl Psychophysiol Biofeedback. 2015 Dec;40(4):257-68 - PubMed
  67. Clin Psychol Rev. 2011 Jun;31(4):617-25 - PubMed
  68. Int Clin Psychopharmacol. 2015 Jul;30(4):183-92 - PubMed
  69. Int J Chron Obstruct Pulmon Dis. 2017 Sep 06;12:2655-2668 - PubMed
  70. Clin Psychol Rev. 2011 Aug;31(6):923-33 - PubMed
  71. JAMA Intern Med. 2014 Mar;174(3):357-68 - PubMed
  72. Semin Dial. 2018 Jan;31(1):59-64 - PubMed
  73. Int J Psychophysiol. 2018 Dec;134:168-177 - PubMed
  74. Isr J Psychiatry Relat Sci. 1995;32(1):38-43 - PubMed
  75. Cogn Behav Ther. 2008;37(2):90-100 - PubMed
  76. Acad Psychiatry. 2013 May 1;37(3):158-64 - PubMed
  77. Gastroenterol Clin North Am. 2017 Dec;46(4):859-874 - PubMed
  78. Patient Educ Couns. 2016 Mar;99(3):348-355 - PubMed
  79. Clin Psychol Rev. 2010 Mar;30(2):194-202 - PubMed
  80. Appl Psychophysiol Biofeedback. 2011 Mar;36(1):27-35 - PubMed
  81. Nicotine Tob Res. 2007 Apr;9(4):483-91 - PubMed
  82. Behav Res Ther. 2010 Oct;48(10):1032-40 - PubMed
  83. J Health Psychol. 2015 Apr;20(4):456-65 - PubMed
  84. J Consult Clin Psychol. 2010 Oct;78(5):691-704 - PubMed
  85. Psychol Med. 2015 Jun;45(8):1687-98 - PubMed
  86. J Indian Med Assoc. 2013 Oct;111(10):662-5 - PubMed
  87. Respir Med. 2014 Nov;108(11):1594-600 - PubMed
  88. Psychol Assess. 2016 Dec;28(12):1663-1673 - PubMed
  89. Eur J Appl Physiol. 2007 Mar;99(5):511-8 - PubMed
  90. J Psychosom Res. 2010 Jun;68(6):539-44 - PubMed
  91. PLoS One. 2018 Jan 24;13(1):e0191332 - PubMed
  92. Aust Occup Ther J. 2015 Apr;62(2):147-8 - PubMed
  93. Am J Clin Hypn. 2012 Apr;54(4):311-30 - PubMed
  94. J Anxiety Disord. 2016 May;40:29-36 - PubMed
  95. Respir Care. 2014 Feb;59(2):209-15 - PubMed
  96. Curr Opin Psychiatry. 2012 Nov;25(6):522-8 - PubMed
  97. J Consult Clin Psychol. 1988 Dec;56(6):893-7 - PubMed
  98. Eur Addict Res. 2018;24(3):137-162 - PubMed
  99. J Evid Based Complementary Altern Med. 2014 Oct;19(4):271-86 - PubMed
  100. Psychiatr Clin North Am. 2010 Sep;33(3):557-77 - PubMed
  101. Acta Psychiatr Scand. 1983 Jun;67(6):361-70 - PubMed
  102. Behav Modif. 2013 Mar;37(2):170-88 - PubMed
  103. Int J Geriatr Psychiatry. 2017 Dec;32(12):1352-1361 - PubMed
  104. Psychol Med. 2013 May;43(5):897-910 - PubMed
  105. J Appl Physiol. 1956 Nov;9(3):371-4 - PubMed
  106. Lancet. 1998 May 2;351(9112):1308-11 - PubMed
  107. Int J Environ Res Public Health. 2019 Mar 23;16(6): - PubMed
  108. J Anxiety Disord. 2006;20(2):158-74 - PubMed
  109. Psychooncology. 2013 Sep;22(9):2148-51 - PubMed
  110. Behav Res Ther. 2000 Feb;38(2):203-14 - PubMed
  111. Int J Psychophysiol. 2013 Jul;89(1):72-7 - PubMed
  112. J Clin Psychol. 2017 Jun;73(6):626-637 - PubMed
  113. J Cogn Psychother. 2013;27(2):111-125 - PubMed
  114. Behav Modif. 2003 Oct;27(5):731-54 - PubMed
  115. Clin Psychol Rev. 2011 Aug;31(6):1041-56 - PubMed
  116. Behav Res Ther. 2004 Mar;42(3):277-92 - PubMed
  117. J Consult Clin Psychol. 1979 Jun;47(3):551-6 - PubMed
  118. J Anat. 2015 Jun;226(6):542-8 - PubMed
  119. Expert Rev Neurother. 2014 Apr;14(4):411-23 - PubMed
  120. J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62 - PubMed
  121. Perspect Psychiatr Care. 2017 Oct;53(4):329-336 - PubMed
  122. Respir Med. 2006 Oct;100(10):1843-9 - PubMed
  123. J Clin Psychol. 2016 Apr;72(4):365-83 - PubMed
  124. Arch Gen Psychiatry. 2005 Jun;62(6):629-40 - PubMed
  125. J Psychosom Res. 2015 Jun;78(6):519-28 - PubMed
  126. Appl Psychophysiol Biofeedback. 2011 Jun;36(2):101-12 - PubMed
  127. Int J Community Based Nurs Midwifery. 2017 Jan;5(1):61-69 - PubMed
  128. Clin Ther. 2009;31 Suppl 2:S77-S103 - PubMed
  129. Exp Brain Res. 2005 Sep;165(3):328-42 - PubMed
  130. Games Health J. 2016 Feb;5(1):50-67 - PubMed
  131. Stroke. 1992 Dec;23(12):1728-32 - PubMed
  132. Biopsychosoc Med. 2014 Mar 21;8(1):10 - PubMed
  133. J Adv Nurs. 2017 May;73(5):1017-1034 - PubMed
  134. Explore (NY). 2017 Jan - Feb;13(1):26-45 - PubMed
  135. J Consult Clin Psychol. 1976 Jun;44(3):381-9 - PubMed
  136. Clin Psychol Rev. 2017 Nov;57:12-20 - PubMed
  137. J Clin Psychiatry. 2008 Apr;69(4):621-32 - PubMed
  138. J Consult Clin Psychol. 2010 Apr;78(2):169-83 - PubMed
  139. Appl Psychophysiol Biofeedback. 2012 Jun;37(2):131-44 - PubMed
  140. Eur J Psychol. 2017 Aug 31;13(3):573-598 - PubMed
  141. Psychiatry Res. 2003 Nov 1;121(1):93-7 - PubMed
  142. Br J Clin Psychol. 1997 Feb;36(1):85-99 - PubMed
  143. PLoS One. 2016 May 16;11(5):e0155720 - PubMed
  144. Behav Res Ther. 2006 Jan;44(1):1-25 - PubMed
  145. Cognit Ther Res. 2012 Oct 1;36(5):427-440 - PubMed
  146. J Child Adolesc Psychiatr Nurs. 2017 Feb;30(1):35-46 - PubMed
  147. Mindfulness (N Y). 2017;8(6):1421-1437 - PubMed
  148. J Psychosom Res. 2014 May;76(5):341-51 - PubMed
  149. J Ayurveda Integr Med. 2017 Apr - Jun;8(2):99-104 - PubMed
  150. Complement Ther Med. 2016 Feb;24:19-28 - PubMed
  151. Am J Psychiatry. 1997 Nov;154(11):1557-65 - PubMed
  152. Am J Med. 2017 Oct;130(10):1219.e1-1219.e17 - PubMed
  153. J Affect Disord. 2018 Nov;240:247-261 - PubMed
  154. J Behav Ther Exp Psychiatry. 2016 Dec;53:41-51 - PubMed
  155. Int J Psychophysiol. 2014 Jul;93(1):105-11 - PubMed
  156. Psychosom Med. 2013 Feb;75(2):187-95 - PubMed
  157. Trends Psychiatry Psychother. 2017 Jul-Sep;39(3):207-215 - PubMed
  158. J Clin Nurs. 2019 Nov;28(21-22):3747-3758 - PubMed
  159. Psychol Med. 2018 Sep;48(12):1945-1953 - PubMed
  160. J Affect Disord. 2013 Apr 5;146(2):158-73 - PubMed
  161. J Psychosom Res. 1990;34(3):327-37 - PubMed
  162. Psychosom Med. 2003 Sep-Oct;65(5):796-805 - PubMed
  163. Pain Manag Nurs. 2020 Jun;21(3):225-232 - PubMed
  164. J Nerv Ment Dis. 2014 May;202(5):353-9 - PubMed
  165. J Psychosom Res. 2004 Jul;57(1):35-43 - PubMed
  166. Phys Sportsmed. 2014 May;42(2):88-99 - PubMed
  167. J Nerv Ment Dis. 2006 Dec;194(12):951-7 - PubMed
  168. J Asthma. 2011 Apr;48(3):259-65 - PubMed
  169. Psychol Med. 2018 Jul;48(9):1427-1436 - PubMed
  170. Appl Psychophysiol Biofeedback. 2009 Jun;34(2):135-43 - PubMed
  171. Spec Care Dentist. 2009 Jan-Feb;29(1):51-7 - PubMed
  172. J Clin Psychol. 2018 Sep;74(9):1485-1508 - PubMed
  173. Eur Respir Rev. 2016 Sep;25(141):287-94 - PubMed
  174. Issues Compr Pediatr Nurs. 1989;12(5):339-44 - PubMed
  175. Psychiatr Clin North Am. 2013 Mar;36(1):141-52 - PubMed
  176. Biol Psychol. 2000 Jul;53(2-3):233-52 - PubMed
  177. J Child Psychol Psychiatry. 2019 Mar;60(3):244-258 - PubMed
  178. Gynecol Oncol. 2012 Mar;124(3):477-89 - PubMed
  179. Clin Psychopharmacol Neurosci. 2019 May 31;17(2):222-232 - PubMed
  180. J Affect Disord. 2011 Oct;133(3):371-80 - PubMed
  181. JMIR Ment Health. 2018 Sep 25;5(3):e10278 - PubMed
  182. Clin Psychol Rev. 2015 Feb;35:19-34 - PubMed
  183. J Affect Disord. 2013 May 15;148(1):1-11 - PubMed
  184. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S35-8 - PubMed
  185. Cochrane Database Syst Rev. 2011 Jul 06;(7):CD007559 - PubMed
  186. Aviat Space Environ Med. 1978 Aug;49(8):943-6 - PubMed
  187. Acta Psychiatr Scand. 2011 Aug;124(2):102-19 - PubMed
  188. J Bodyw Mov Ther. 2011 Jan;15(1):24-34 - PubMed
  189. Nat Clin Pract Gastroenterol Hepatol. 2008 Nov;5(11):624-36 - PubMed
  190. Depress Anxiety. 2018 Jun;35(6):502-514 - PubMed
  191. Int J Methods Psychiatr Res. 2012 Sep;21(3):169-84 - PubMed
  192. J Consult Clin Psychol. 2012 Dec;80(6):1007-20 - PubMed
  193. Appl Psychophysiol Biofeedback. 2019 Jun;44(2):71-82 - PubMed
  194. J Psychosom Res. 2019 Jul;122:43-51 - PubMed
  195. Mindfulness (N Y). 2016;7(2):372-383 - PubMed
  196. AIDS Behav. 2019 Jan;23(1):60-75 - PubMed
  197. Res Synth Methods. 2017 Mar;8(1):5-18 - PubMed
  198. J Anxiety Disord. 2016 Oct;43:79-89 - PubMed
  199. Exp Physiol. 2013 Sep;98(9):1327-36 - PubMed
  200. Arch Psychiatr Nurs. 2019 Feb;33(1):120-130 - PubMed
  201. Nurse Educ Today. 2018 Jun;65:201-211 - PubMed
  202. J Anxiety Disord. 2014 Mar;28(2):195-202 - PubMed
  203. Appl Psychophysiol Biofeedback. 2018 Sep;43(3):179-192 - PubMed
  204. Hanguk Simni Hakhoe Chi Kongang. 2015;20(2):391-408 - PubMed
  205. Acta Anaesthesiol Scand. 1985 Jul;29(5):547-51 - PubMed
  206. J Pediatr Gastroenterol Nutr. 2018 Jul;67(1):18-22 - PubMed
  207. Behav Res Ther. 1986;24(1):1-8 - PubMed
  208. Percept Mot Skills. 1992 Jun;74(3 Pt 1):895-904 - PubMed
  209. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Aug 1;45:34-9 - PubMed
  210. Complement Ther Clin Pract. 2018 Feb;30:68-78 - PubMed
  211. Psychol Health Med. 2019 Jan;24(1):51-58 - PubMed
  212. Clin Psychol Rev. 2015 Aug;40:91-110 - PubMed
  213. J Clin Psychol. 2015 Apr;71(4):283-301 - PubMed
  214. BMJ. 2003 Sep 6;327(7414):557-60 - PubMed
  215. J Psychiatr Res. 2001 Sep-Oct;35(5):293-6 - PubMed
  216. Br J Clin Psychol. 2005 Jun;44(Pt 2):227-39 - PubMed

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