A systematic review of brief respiratory, embodiment, cognitive, and mindfulness interventions to reduce state anxiety

Introduction: Anxiety is one of the most prevalent mental health conditions worldwide. Psychotherapeutic techniques often involve cognitive and/or embodiment strategies, with breathing-oriented approaches being particularly common. Given interoception’s role in emotion generation, embodiment and breathing techniques may address brain–body miscommunication implicated in anxiety. We conducted a systematic review and meta-analysis to assess the effects of acute administration of psychological interventions on state anxiety. Results: Following PRISMA and PROSPERO registration, randomized controlled trials were searched in PubMed, PsycINFO, and Scopus, including interventions focusing on cognitive, embodiment, breathing, or combinations thereof. Twelve studies met inclusion criteria. A single cognitive study showed a moderate reduction in state anxiety; embodiment practices showed moderate to large effects. Breathing-only interventions yielded inconsistent results, with both attention to and active control of breathing ranging from large to null effects depending on technique. Combined techniques involving passive attention (e.g., to cognitions, body and/or breathing) showed consistent moderate effects, whereas active combination techniques produced inconsistent results. Discussion: While brief interventions are under-studied, cognitive and embodiment techniques are consistently helpful for reducing state anxiety. Breathing-based exercises require careful selection of technique and may vary by individual. Combined practices such as mindfulness can be successful, but active changes to one or more elements should be introduced with care.