Mental Health Intervention: Mindful Breathing and Anxiety Reduction Among College Students

Throughout college, a common stressor among students is anxiety, affecting their overall wellbeing and academic performance. While many interventions and treatments (e.g. therapy, medication) are available for students to treat anxiety, not all students are chronically anxious or require pharmaceutical medication. In fact, different kinds of anxiety require different treatments. One school of thought centers on using psychotherapy and pharmacotherapy to treat chronic anxiety such as  Generalized Anxiety Disorder (Gorman, 2003). This treatment is useful when patients meet the DSM symptoms. Another school of thought makes a distinction between chronic anxiety and “academic anxiety” among students. Scholars operationalize academic anxiety as a mental feeling of uneasiness or distress in reaction to a negatively perceived school situation (Shakir 2014; Tan et al., 2023). This distinction between types of anxiety matters when examining (i) the kind of anxiety within a specific context and population; and (ii) the best interventions and treatments to treat the latter. 

Some scholars suggest that academic anxiety is not a chronic disorder, but rather a subjective emotional state (Shakir 2014; Tan et al., 2023; Sandbothe et al., 2023). In this case, scholars have empirically tested the effect of non-psychotherapeutic and non-pharmacotherapeutic treatments to reduce academic anxiety among college students. As a result, scholars have examined the effect of mindfulness practices on academic anxiety. The objective of this literature review, therefore, is to synthesize the scholarship and evidence-based results on a specific mindfulness practice: mindful breathing among college students, mostly undergraduates, who experience academic anxiety in a school setting. It should be noted that the studies in this literature review define academic anxiety as a non-chronic type of anxiety; none of the studies herein examined mindful breathing on patients or participants in a psychiatric setting. 

Mindful breathing involves intentionally focusing on one’s breath, while bringing awareness to thoughts, emotions, and sensations without judgment. Unlike other breathing exercises, which may aim to control or regulate physical processes, mindful breathing emphasizes observing the breath rather than altering it (Call et al., 2014; McLeod et al., 2021). While mindful breathing doesn’t directly control the immune system, it can promote relaxation and reduce stress, which may have a positive, indirect effect on immune function (Konrad et al., 2023; Fagioli et al., 2023; de Sousa et al., 2021). In an experiment by Cho et al. (2016), researchers examined the daily effect of mindful breathing on 36 highly test-anxious students. They found a statistical significant reduction in test anxiety, compared to the control group that did not get the mindful breathing practice. The authors also suggest that mindful breathing increases positive automatic thought. Similar to Cho et al. (2016)’s results, Call et al. (2013) and Seppälä et al. (2020) found that mindful breathing practices decreased anxious thoughts on a student's academic performance among their college students samples. These findings suggest that mindful breathing is useful in promoting a more positive outlook and reducing negative thought patterns associated with academic anxiety. Additionally, the authors advocate for mindful breathing as an accessible tool for students to manage test anxiety throughout their academic life, especially given the practicality of this practice. 

Unlike pharmacotherapy and other treatments, some scholars argue that mindful breathing is an accessible and easy-to-use practice for college students with academic anxiety.  The latter is also because on-campus mental health centers are typically at full capacity and waitlists to access such resources are an impediment for students. Academic anxiety, however, can be treated with mindful breathing (Seppälä et al., 2020). In another experiment by Komariah et al. (2023), students who engaged in daily mindful breathing for 4 weeks showed significant reductions in their anxiety levels; the study was a randomized controlled trial that included 122 students. These findings are consistent with Cho et al. (2016)’s, finding a significant reduction in stress levels in the intervention group (mindful breathing practice) compared to the control group. The intervention consisted of 15 minutes of mindful breathing meditation each day for four weeks. This suggests that mindfulness breathing could be a valuable tool for students experiencing this non-chronic kind of anxiety. The simplicity and accessibility of mindfulness breathing techniques make them particularly appealing for students who may face challenges in accessing, or who may not need pharmaceutical treatments. Moreover, both Komariah et al. (2023) and Cho et al. (2016) emphasize the proactive nature of mindfulness breathing as a self-help strategy students can incorporate into their daily life to manage anxiety independently.

Thus far, the studies emphasize mindful breathing as an effective tool in treating academic anxiety. But what makes this practice unique? Academic anxiety is often intensified when individuals are unable to recognize the source of their apprehension. This lack of awareness can make it difficult to address or manage academic anxiety effectively, further exacerbating the emotional and mental strain (Shakir, 2014; Natarajan et al., 2024). Because of this inability to recognize the source of apprehension, mindful breathing’s focus on the breath allows students to focus their attention on the present moment. By bringing awareness to their breath and gently guiding their focus away from racing thoughts and judgements, students may become better equipped to reduce the intensity of anxiety even when the specific source of apprehension remains unclear (Arch & Craske, 2006). In other words, anxiety is a full-body experience, and breathing directly influences both the body and mind. Research shows that mindful attention to breath regulates emotions by increasing connectivity between the amygdala and prefrontal cortex, which helps manage emotional responses (Doll et al., 2016). This connection is central to the practice's effectiveness.

Konrad et al. (2023) investigated the effects of mindful breathing on university students' anxiety levels within the context of their regular courses. The researchers found that incorporating this practice did not only leave students feeling less anxious about their courses, but they also reported higher presence and motivation for their academics, as well as an increase in their overall mood. These benefits were observed immediately after the practice. The authors concluded these positive effects were consistent regardless of individual differences in students' personality traits, baseline stress levels, or attentional control abilities. This suggests that mindful breathing could be broadly beneficial for a wide range of students, irrespective of their academic pressures. A core idea of mindful breathing that manifests in this study is its adaptability as an intervention that can be easily integrated into the academic routine of students. This is consistent with other scholars who also assert that mindful breathing enhances mental health and academic performance (Komariah et al., 2023; Cho et al., 2016; Dawson et al., 2019; Johnson et al., 2023).

Other scholars have also found that mindful breathing not only reduces academic anxiety, but the practice also provides valuable skills. By practicing mindful breathing, students create a toolkit of skills such as time management, emotional awareness, and self-compassion that may help them throughout their college career.  Mahfouz and Levitan (2018) used a mixed-method approach to further examine the effects of mindful breathing on college students. First, they tested a mindful breathing intervention for students who were randomly assigned to either an 8-week mindful breathing group or a waitlist control group. Quantitative results showed that participants reported statistically significant lower levels of anxiety and significantly higher levels of life satisfaction. Furthermore, for qualitative results, interviews from students demonstrated that the mindful breathing practice provided them with “coping strategies” to combat common stressors and may have helped address underlying causes of stress. This suggests that while mindful breathing may be beneficial in reducing academic anxiety among students, the practice also brings other benefits beyond anxiety reduction. Thus, mindful breathing can be seen as a holistic tool for overall student well-being that promotes not only mental health but also practical life skills that potentially contribute to long-term success.

 Almost all studies on mindful breathing test this practice on a short-term basis (usually 1 to 8 weeks), limiting the understanding of its long-term efficacy and requiring further research. Moreover, since the mindful breathing studies in this literature review focus exclusively on college students it may limit the external validity of the findings. Some may suggest that the results may not apply to broader populations and contexts. However, college students are a population. They represent a diverse group that can provide insight into the practice's effectiveness within certain settings—and, as long as the research has a specific target, which in this case is to test mindful breathing on college students, the results contribute to the growing scholarship on this practice. 

While Cho et al. (2016) found significant reductions in test anxiety, the study was limited by a small sample size, which may affect the generalizability of the results. On the other hand, Komariah et al. (2023) conducted a randomized controlled trial with a larger sample, offering more robust evidence. However, neither study addressed potential confounding variables such as socioeconomic status or access to other forms of support, which could influence the outcomes. In higher education, where students come from various socioeconomic and cultural backgrounds, more scholarship is necessary to explore how different groups engage with mindful breathing. For instance, would a low-income academic-anxious student without access to a tutor experience the same benefits from mindful breathing as those with such resources? Controlling these external factors and variables is important for two reasons: 1) it helps determine the generalizability of the practice beyond anxiety and academic settings, and 2) it identifies potential confounding variables that could impact the internal validity of the study.

The literature on mindful breathing and anxiety reduction among college students offers practical and compelling implications. A consistent pattern across the studies reviewed is the effectiveness of mindful breathing in reducing symptoms of academic anxiety (Cho et al., 2016; Komariah et al., 2023). However, differences arise in the duration and intensity of the interventions. While Komariah et al. (2023) implemented a four-week daily intervention, Cho et al. (2016) used shorter, more frequent sessions. This suggests that the length of the intervention may not be as critical as the regularity and consistency of practice. Moreover, the scholarship herein highlights two key points: first, it's crucial to recognize the varying severities and types of anxiety present on college campuses. For some students, mindful breathing may not be as effective, given the different forms of anxiety they experience. Second, the control trials and strong findings from scholars indicate that mindful breathing is an evidence-based intervention. 

In conclusion, findings suggest that mindful breathing reduces academic anxiety among college students. Importantly, this practice also improved other areas of student's lives, such as nurturing skills like time-management, self-awareness and self compassion while practicing mindful breathing. Therefore, universities and stakeholders have practical implications to consider mindful breathing scholarship when developing strategies to promote a healthier, more supportive campus environment for students.

References 

Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858.

Call, D., Miron, L., & Orcutt, H. (2013). Effectiveness of brief mindfulness techniques in reducing symptoms of anxiety and stress. Mindfulness, 5(4), 658–668.

Cho, H., Ryu, S., Noh, J., & Lee, J. (2016). The effectiveness of daily mindful breathing practices on test anxiety of students. PLOS ONE, 11(10), e0164822.

Doll, A., Hölzel, B. K., Bratec, S. M., Boucard, C. C., Xie, X., Wohlschläger, A. M., & Sorg, C. (2016). Mindful attention to breath regulates emotions via increased amygdala–prefrontal cortex connectivity. NeuroImage, 134, 305–313.

Dawson, A. F., Brown, W. W., Anderson, J., Datta, B., Donald, J. N., Hong, K., ... &   Galante, J. (2019). Mindfulness-Based Interventions for University Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Applied Psychology: Health and Well‐Being, 12(2), 384–410. 

Fagioli, S., Pallini, S., Mastandrea, S., & Barcaccia, B. (2023). Effectiveness of a brief online mindfulness-based intervention for university students. Mindfulness, 14(4), 1234–1245.

Gorman, J. M. (2003). Treating generalized anxiety disorder. The Journal of Clinical Psychiatry, 64(Suppl. 2), 24–29.

Johnson, B. T., Acabchuk, R. L., George, E. A., Nardi, W., Sun, S., Salmoirago-Blotcher, E., Scharf, J., & Loucks, E. B. (2023). Mental and physical health impacts of mindfulness training for college undergraduates: A systematic review and meta-analysis of randomized controlled trials. Mindfulness, 14, 2077–2096.

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Mahfouz, J., Levitan, J., Schussler, D., Broderick, T., Dvorakova, K., Argusti, M., & Greenberg, M. (2018). Ensuring college student success through mindfulness-based classes: Just BREATHE. College Student Affairs Journal, 36(1), 1–16.

McLeod, C., & Boyes, M. (2021). The effectiveness of social-emotional learning strategies and mindful breathing with biofeedback on the reduction of adolescent test anxiety. Canadian Journal of Education / Revue canadienne de l'éducation, 44(3), 815–847.

Natarajan, A., Emir-Farinas, H., & Su, H.-W. (2024). Mindful breathing as an effective technique in the management of hypertension. Frontiers in Physiology, 14, 1339873.

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