The Effect of Breathing Training in Choir Activities on Anxiety Levels in Adolescents: A Systematic Review
Article Sidebar
Main Article Content
Abstract
Background: Anxiety is a mental health problem that many adolescents experience and has an impact on academic, social, and long-term psychological well-being. Art-based nonpharmacological interventions, particularly choirs with breathing exercises, are reported to have the potential to reduce anxiety. However, systematic integration of scientific evidence remains limited.
Objective: This systematic review aims to synthesize scientific evidence on the effect of breathing training during choir activities on anxiety levels in adolescents.
Methods: The review was conducted following the PRISMA guidelines. Literature searches were conducted on Google Scholar, PubMed, and ScienceDirect for articles published in the last 10 years. Inclusion criteria include quantitative or mixed-methods studies of adolescents (ages 17–25) that examine breathing training in the context of choir or singing activities and measure anxiety as an outcome. Data is extracted and synthesized narratively.
Results: A total of 8 articles met the inclusion criteria. The majority of studies reported a significant reduction in anxiety levels after a breathing training intervention in a choir. The mechanisms identified include activation of physiological relaxation responses, emotion regulation, increased focus, and social support through group activities.
Conclusions: Breathing training in choir activities has the potential to be an effective and applicable nonpharmacological intervention to reduce anxiety in adolescents. However, the heterogeneity of the design and measurement instruments is a major limitation. Further research with a more robust experimental design is still needed.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Clift, S., Nicol, J., Raisbeck, M., Whitmore, C., & Morrison, I. (2010). Group singing, wellbeing and health: A systematic mapping of research evidence. UNESCO Observatory Multi-Disciplinary Journal in the Arts, 2(1), 1–25.
Coulton, S., Clift, S., Skingley, A., & Rodriguez, J. (2015). Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: Randomised controlled trial. The British Journal of Psychiatry, 207(3), 250–255. https://doi.org/10.1192/bjp.bp.113.129908
Fancourt, D., Ockelford, A., & Belai, A. (2014). The psychoneuroimmunological effects of music: A systematic review and a new model. Brain, Behavior, and Immunity, 36, 15–26. https://doi.org/10.1016/j.bbi.2013.10.014
Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2015). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 85(3), 486–496. https://doi.org/10.1016/j.mehy.2015.07.005
Kim, J., & Park, S. (2019). Effects of breathing-centered vocal training on anxiety and self-efficacy among adolescents. Journal of Music Therapy, 56(2), 123–145. https://doi.org/10.1093/jmt/thy020
Lee, J., & Lee, H. (2020). Effects of diaphragmatic breathing combined with choir activity on anxiety and emotional regulation in adolescents: A randomized controlled trial. Arts & Health, 12(3), 234–247. https://doi.org/10.1080/17533015.2019.1627894
Murray, M. (2002). Vocal breathing techniques and anxiety reduction in adolescent singers. Journal of Voice, 16(2), 226–234. https://doi.org/10.1016/S0892-1997(02)00089-4
Putri, A. R., Wahyuniar, L., & Santoso, B. (2024). Anxiety and academic stress among Indonesian adolescents: A cross-sectional study. National Journal of Public Health, 19(1), 45–53.
Skingley, A., & Bungay, H. (2010). The Silver Song Club Project: Singing to promote the health of older people. British Journal of Community Nursing, 15(3), 135–140. https://doi.org/10.12968/bjcn.2010.15.3.46902
Thoma, M. V., La Marca, R., Brönnimann, R., Finkel, L., Ehlert, U., & Nater, U. M. (2013). The effect of music on the human stress response. PLoS ONE, 8(8), e70156. https://doi.org/10.1371/journal.pone.0070156
Tsakona, P., Kitsatis, I., Apostolou, T., Papadopoulou, O., & Hristara-Papadopoulou, A. (2025). The Effect of Diaphragmatic Breathing as a Complementary Therapeutic Strategy in Stress of Children and Teenagers 6–18 Years Old. Children, 12(1), 59.
World Health Organization. (2021). Adolescent mental health. Geneva: WHO. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Zhao, L., Chen, S., & Wang, Y. (2018). Effects of structured diaphragmatic breathing on anxiety levels among adolescents: A randomized controlled study. Journal of Adolescent Health, 62(2), 234–240. https://doi.org/10.1016/j.jadohealth.2017.08.021