{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:42:17Z","timestamp":1792604537473,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Stress has reached epidemic proportions globally. Unidentified sequela of physiological and psychological stress can result in anxiety, depression, heart disease, cancer, immunologic conditions and death. There is a high cost associated with the treatment of stress related health conditions in the United States and worldwide. Many treatments are pharmacologic and cannot be self-initiated. Therefore, it is critical to identify evidence-based, low-cost, non-pharmacologic, self-administered interventions that can mitigate physiological and psychological stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Inclusion criteria:<\/jats:title>\n                    <jats:p>This review considered adults 18 years and over engaged in diaphragmatic breathing as an isolated intervention to reduce physiological and psychological stress. There were no exclusions based on physical or psychological conditions. The comparator was no treatment or usual treatment, which may constitute ordinary breathing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The comprehensive literature search included published and unpublished studies in English from the beginning of the databases through January 2018. The databases searched included: PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, ProQuest Nursing and Allied Health and Health Source: Nursing\/Academic Edition. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Three studies met the criteria for review: one randomized controlled trial and two quasi-experimental studies. Statistical pooling was not possible due to clinical and methodological heterogeneity of interventions and outcome measures of the included studies. All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. Given the benefits of diaphragmatic breathing on stress reduction, ongoing research is needed to continue to establish the evidence-base for this self-administered, low-cost, non-pharmacologic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.11124\/jbisrir-2017-003848","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T20:10:13Z","timestamp":1566418213000},"page":"1855-1876","source":"Crossref","is-referenced-by-count":176,"title":["Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review"],"prefix":"10.11124","volume":"17","author":[{"given":"Susan I.","family":"Hopper","sequence":"first","affiliation":[{"name":"College of Health Professions, Pace University, New York, USA"},{"name":"The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherrie L.","family":"Murray","sequence":"additional","affiliation":[{"name":"College of Health Professions, Pace University, New York, USA"},{"name":"The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucille R.","family":"Ferrara","sequence":"additional","affiliation":[{"name":"College of Health Professions, Pace University, New York, USA"},{"name":"The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne K.","family":"Singleton","sequence":"additional","affiliation":[{"name":"College of Health Professions, Pace University, New York, USA"},{"name":"The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R3-20230825","article-title":"Studies of measuring stress in psychiatric and physical disorders","author":"Cohen","year":"1997","journal-title":"Measuring stress: A guide for health and social scientists"},{"issue":"(4269)","key":"R4-20230825","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1126\/science.790570","article-title":"Life events, stress, and illness","volume":"194","author":"Rabkin","year":"1976","journal-title":"Science"},{"issue":"(12)","key":"R5-20230825","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/j.1751-9004.2012.00467.x","article-title":"A social neuroscience perspective on stress and health","volume":"6","author":"Muscatell","year":"2012","journal-title":"Soc Personal Psychol Compass"},{"issue":"(3)","key":"R7-20230825","doi-asserted-by":"crossref","first-page":"745","DOI":"10.3233\/WOR-162308","article-title":"Stress management through regulation of blood pressure among college students","volume":"54","author":"Joshi","year":"2016","journal-title":"Work"},{"issue":"(2)","key":"R8-20230825","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.teln.2007.10.003","article-title":"Effects of diaphragmatic breathing on stress levels of nursing students","volume":"3","author":"Consolo","year":"2008","journal-title":"Teaching and Learning in Nursing"},{"issue":"(6)","key":"R12-20230825","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1080\/07448481.2013.813853","article-title":"Examining the efficacy of a brief mindfulness-based stress reduction (Brief MBSR) program on psychological health","volume":"61","author":"Bergen-Cico","year":"2013","journal-title":"J Am Coll Health"},{"issue":"(3)","key":"R13-20230825","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s10072-016-2790-8","article-title":"The role of deep breathing on stress","volume":"38","author":"Perciavalle","year":"2017","journal-title":"Neurol Sci"},{"issue":"(10)","key":"R14-20230825","doi-asserted-by":"crossref","first-page":"e46597","DOI":"10.1371\/journal.pone.0046597","article-title":"Matter over mind: a randomised-controlled trial of single-session biofeedback training on performance anxiety and heart rate variability in musicians","volume":"7","author":"Wells","year":"2012","journal-title":"PLoS One"},{"issue":"(4)","key":"R16-20230825","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/YIC.0000000000000078","article-title":"Efficacy of treatments for anxiety disorders: a meta-analysis","volume":"30","author":"Bandelow","year":"2015","journal-title":"Int Clin Psychopharmacol"},{"issue":"(1)","key":"R18-20230825","first-page":"B256","article-title":"Effectiveness of deep breathing exercise on blood pressure among patients with hypertension","volume":"8","author":"Janet","year":"2017","journal-title":"Int J Pharma Bio Sci"},{"issue":"(3)","key":"R19-20230825","first-page":"263","article-title":"Taking my breath away by keeping stress at bay\u201d - an employee assistance program in the automotive assembly plant","volume":"43","author":"Sundram","year":"2014","journal-title":"Iran J Public Health"},{"key":"R20-20230825","article-title":"Relaxation Response","author":"Benson","year":"1993","journal-title":"Mind body medicine: how to use your mind for better health"},{"issue":"(2)","key":"R21-20230825","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/j.1526-4637.2011.01243.x","article-title":"The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing\u2014an experimental study","volume":"13","author":"Busch","year":"2012","journal-title":"Pain Med"},{"key":"R22-20230825","doi-asserted-by":"crossref","first-page":"874","DOI":"10.3389\/fpsyg.2017.00874","article-title":"The effect of diaphragmatic breathing on attention, negative affect, and stress in healthy adults","volume":"8","author":"Ma","year":"2017","journal-title":"Front Psychol"},{"issue":"(5)","key":"R23-20230825","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4174\/jkss.2012.82.5.312","article-title":"Measuring the stress of the surgeons in training and use of a novel interventional program to combat it","volume":"82","author":"Christakis","year":"2012","journal-title":"J Korean Surg Soc"},{"issue":"(6)","key":"R25-20230825","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.11124\/JBISRIR-2017-003477","article-title":"Effectiveness of diaphragmatic breathing on physiological and psychological stress in adults: a quantitative systematic review protocol","volume":"16","author":"Hopper","year":"2018","journal-title":"JBI Database System Rev Implement Rep"},{"issue":"(7)","key":"R26-20230825","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analysis: The PRISMA Statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"issue":"(3)","key":"R27-20230825","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/XEB.0000000000000065","article-title":"Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness","volume":"13","author":"Tufanaru","year":"2015","journal-title":"Int J Evid Based Healthc"},{"issue":"(1)","key":"R28-20230825","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2752\/175303710X12627079939341","article-title":"Exploratory study of stress-buffering response patterns from interaction with a therapy dog","volume":"23","author":"Barker","year":"2010","journal-title":"Anthrozo\u00f6s"},{"issue":"(1)","key":"R29-20230825","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00124509-200303000-00008","article-title":"Effects of Animal-assisted therapy on patients\u2019 anxiety, fear, and depression before ECT","volume":"19","author":"Barker","year":"2003","journal-title":"J ECT"},{"issue":"(2)","key":"R30-20230825","article-title":"Short-term effects of a randomized controlled worksite relaxation intervention in Greece","volume":"21","author":"Alexopoulos","year":"2014","journal-title":"Ann Agric Environ Med"},{"issue":"(3)","key":"R31-20230825","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ijpsycho.2004.09.009","article-title":"Human salivary alpha-amylase reactivity in a psychosocial stress paradigm","volume":"55","author":"Nater","year":"2005","journal-title":"Int J Psychophysiol"}],"container-title":["JBI Database of Systematic Reviews and Implementation Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.11124\/JBISRIR-2017-003848","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T13:01:02Z","timestamp":1786453262000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.11124\/JBISRIR-2017-003848"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.11124\/jbisrir-2017-003848","relation":{},"ISSN":["2202-4433"],"issn-type":[{"value":"2202-4433","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}