Mütze Christian, Mitzinger Dietmar, Haller Heidemarie
Center for Integrative Medicine and Planetary Health, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Front Psychiatry. 2025 Aug 14;16:1616996. doi: 10.3389/fpsyt.2025.1616996. eCollection 2025.
This review systematically assessed the evidence on the effectiveness and safety of pranayama, traditional yogic breathing techniques, for patients diagnosed with mental disorders.
We searched PubMed, PsycINFO, and Central until April 2024. We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) from both intention-to-treat (ITT) and per-protocol (PP) data for symptom severity (primary outcome) and health-related quality of life and depression (secondary outcomes) using Hedges' correction for small samples. For risk of bias (RoB) assessment, we used the Cochrane RoB 2 tool.
We included seven publications on six randomized controlled trials that examined 517 patients with posttraumatic stress disorder (PTSD), depression, and mixed non-psychotic mental disorders and compared pranayama to passive controls (wait list and attention control) or standard care (psychotherapy, electroconvulsive therapy, and antidepressants). Overall RoB was assessed with some concerns in two studies and as high in four studies. The meta-analyses of the ITT samples (SMD = -0.27, 95% CI = [-0.52, -0.03], I = 10%) as well as the PP samples (SMD = -0.35, 95% CI = [-0.57, -0.12], I = 0%) showed that pranayama significantly reduced post-intervention symptom severity in comparison to passive controls. When compared to standard care, both ITT and PP meta-analyses showed comparable results in reducing symptom severity. For secondary outcomes, only PP analyses on quality of life showed significantly higher post-intervention effects for pranayama in comparison to passive controls (SMD = 0.59, 95% CI = [0.31, 0.87], I = 20). No significant effects were found for depression. Sensitivity analyses excluding all studies with a high risk of overall bias revealed significant effects of pranayama on symptom severity and quality of life, but only in PP samples and in comparison to passive controls. Adverse events were more frequently associated with fast than with slow breathing techniques.
This meta-analysis suggests short-term effects of pranayama when integrated in outpatient and inpatient care of mental disorders. In consideration of the overall high risk of bias and low number of analyzed patients, pranayama should not be used instead of standard therapies. Further research is needed to explore long-term effects and adequately assess adverse events.
CRD42024550239.
本综述系统评估了呼吸控制法（一种传统的瑜伽呼吸技巧）对被诊断患有精神障碍患者的有效性和安全性的证据。
我们检索了截至2024年4月的PubMed、PsycINFO和CENTRAL数据库。我们使用针对小样本的Hedges校正方法，从意向性分析（ITT）和符合方案（PP）数据中计算了症状严重程度（主要结局）以及与健康相关的生活质量和抑郁（次要结局）的标准化均数差（SMD）及其95%置信区间（CI）。对于偏倚风险（RoB）评估，我们使用了Cochrane RoB 2工具。
我们纳入了7篇关于6项随机对照试验的文献，这些试验研究了517例创伤后应激障碍（PTSD）、抑郁症和混合性非精神病性精神障碍患者，并将呼吸控制法与被动对照（等待列表和注意力控制）或标准治疗（心理治疗、电休克治疗和抗抑郁药）进行了比较。总体RoB在2项研究中被评估为存在一些担忧，在4项研究中被评估为高。ITT样本的荟萃分析（SMD = -0.27，95%CI = [-0.52, -0.03]，I² = 10%）以及PP样本的荟萃分析（SMD = -0.35，95%CI = [-0.57, -0.12]，I² = 0%）表明，与被动对照相比，呼吸控制法显著降低了干预后的症状严重程度。与标准治疗相比，ITT和PP荟萃分析在降低症状严重程度方面显示出相似的结果。对于次要结局，只有关于生活质量的PP分析显示，与被动对照相比，呼吸控制法在干预后的效果显著更高（SMD = 0.59，95%CI = [0.31, 0.87]，I² = 20）。未发现对抑郁有显著影响。排除所有总体偏倚风险高的研究的敏感性分析表明，呼吸控制法对症状严重程度和生活质量有显著影响，但仅在PP样本中且与被动对照相比。不良事件与快速呼吸技巧的关联比与慢速呼吸技巧的关联更频繁。
这项荟萃分析表明，呼吸控制法在纳入精神障碍门诊和住院治疗时具有短期效果。考虑到总体偏倚风险高且分析的患者数量少，呼吸控制法不应替代标准疗法。需要进一步研究以探索长期效果并充分评估不良事件。
在PROSPERO上的方案注册编号：CRD42024550239。
