TOPLINE

Controlled breathing interventions, including heart rate variability biofeedback (HRVBF), were associated with reduced craving in patients with substance use disorders (SUDs) compared with control interventions, a new meta-analysis showed. However, their effects on withdrawal symptoms were uncertain, and evidence regarding their effects on dependence was limited.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis, with the former including 20 randomized and nonrandomized controlled trials and crossover studies identified through eight databases up to November 14, 2025. Five uncontrolled studies were excluded from the meta-analysis.
• Individuals with SUDs involving alcohol, nicotine, and/or other psychoactive substances were included.
• Resonant breathing, HRVBF, yogic breathing, and other interventions with controlled breathing as the primary therapeutic mechanism were examined. Comparators included active and passive control interventions.
• Outcome measures included craving (12 studies; n = 696), withdrawal symptoms (four studies; n = 289), and dependence (two studies; n = 144).

TAKEAWAY

• Breathing-based interventions were associated with lower craving than control interventions, with a small but statistically significant effect that was consistent across studies (P < .001).
• The effects of breathing-based interventions vs control interventions on withdrawal symptoms were uncertain, with substantial heterogeneity between studies.
• Although breathing-based interventions had a greater effect on substance dependence than control interventions (P = .009), the results were based on only two studies.
• In a subgroup analysis, no difference was observed between HRVBF and other breathing interventions, suggesting overlapping mechanisms of action.

IN PRACTICE

“Our review suggests that breathing interventions can be an effective and low-cost add-on to addiction treatment,” lead investigator Ariel Dart Roxburgh, PhD, Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia, said in a press release.

“What we need next is larger, preregistered trials with standardized measures and longer follow-up so we can improve our understanding of how these interventions work,” Roxburgh added.

SOURCE

The study was published online on July 29 in Addiction.

LIMITATIONS

Few studies assessed outcomes of withdrawal and dependence and changes in substance use. Variation in intervention type, duration, and setting may have led to unaccounted for confounding. Most studies weren’t preregistered trials, and blinding was often not feasible. Additional limitations included the reliance on subjective measures, limited long-term follow-up, and the requirement of repeated outcome measurements for inclusion of studies.

DISCLOSURES

No funding information was provided for the study. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.