Controlled breathing and heart rate variability biofeedback for substance use-related outcomes: A systematic review and meta-analysis.
Ariel Dart Roxburgh, Bosco Rowland, Dan I Lubman et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed controlled-breathing interventions, with or without heart rate variability biofeedback (HRVB), for substance use-related outcomes in people using alcohol, nicotine, and other drugs. Of 20 eligible quantitative repeated-measure studies, 15 contributed to meta-analyses. Compared with controls, breathing-based interventions were associated with a small reduction in craving (Hedges’ g = 0.30, 95% CI = 0.12-0.48; 12 studies, 696 participants). Evidence for withdrawal symptoms was uncertain, while a larger effect on substance dependence came from only two studies. Craving effects did not differ by inclusion of HRVB.
Key findings
- Craving was lower with breathing-based interventions than controls (Hedges’ g = 0.30, 95% CI = 0.12-0.48; 12 studies, 696 participants; I² = 23.5%).
- Withdrawal effects were uncertain (g = 0.46, 95% CI = -0.28 to 1.19; 4 studies, 289 participants; I² = 89.7%).
- Substance dependence showed a larger effect versus control (g = 0.85, 95% CI = 0.21-1.48), based on 2 studies and 144 participants.
- Craving outcomes did not differ between HRVB and other breathing interventions (Q between (1) = 0.17, P = 0.68).
Why it matters
Craving is a substance use-related outcome for which this review found a consistent, statistically significant benefit from breathing-based interventions. The findings suggest these approaches may warrant consideration as accessible adjuncts, while the uncertain withdrawal results and limited evidence for dependence outcomes mean benefits should not be assumed across all outcomes.
What to keep in mind
Only 15 of 20 eligible studies contributed to meta-analyses. Withdrawal and dependence estimates were based on few studies, and heterogeneity was high for both outcomes.