Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

Four phenotypes of obstructive sleep apnea hypopnea syndrome (OSAHS) have been identified. Only one of these is anatomical. As such, anatomically based treatments for OSAHS may not fully resolve the condition. Equally, compliance and uptake of gold-standard treatments is inadequate. This has led to interest in novel therapies that provide the basis for personalized treatment protocols. This review examines each of the four phenotypes of OSAHS and explores how these could be targeted using breathing re-education from three dimensions of functional breathing: biochemical, biomechanical and resonant frequency. Breathing re-education and myofunctional therapy may be helpful for patients across all four phenotypes of OSAHS. More research is urgently needed to investigate the therapeutic benefits of restoring nasal breathing and functional breathing patterns across all three dimensions in order to provide a treatment approach that is tailored to the individual patient.

Redefining electrosensitivity: A new literature-supported model

In critically examining literature on electrohypersensitivity and the reported somatic responses to anthropogenic modulated radiofrequency radiation (RFR) exposure, it becomes apparent that electrohypersensitivity is one part of a range of consequences. Current evidence on the necessity of considering patients' overall health status leads us to propose a new model in which electrohypersensitivity is but part of the electrosensitive status inherent in being human. We propose the likelihood and type of response to environmental RFR include i) a linear somatic awareness continuum, ii) a non-linear somatic response continuum, and iii) the extent of each individual's capacity to repair damage (linked to homeostatic response). We anticipate this last, dynamic, aspect is inextricably linked to the others through the autonomic nervous system. The whole is dependent upon the status of the interconnected immune and inflammatory systems. This holistic approach leads us to propose various outcomes. For most, their body maintains homeostasis by routine repair. However, some develop electrohypersensitivity either due to RFR exposure or as an ANS-mediated, unconscious response (aka nocebo effect), or both. We suggest RFR exposure may be one factor in the others developing an auto-immune disease or allergy. A few develop delayed catastrophic disease such as glioma. This model gives the blanket term ElectroMagnetic Illness (EMI) to all RFR-related conditions. Thus, EHS appears to be one part of a range of responses to a novel and rapidly changing evolutionary situation.

Yoga for Caregiving Dyads Experiencing Chronic Pain: Protocol Development for Merging Yoga and Self-Management to Develop Skills Intervention

CONTEXT

Caregivers often provide unpaid care for family members and friends with physical disabilities, often to the detriment of their health and well-being. Caregivers often experience pain, and individuals with physical disabilities also are likely to experience pain. Merging yoga and self-management to Develop Skills Study (MY-Skills) is an intervention that merges self-management education with yoga for dyads experiencing chronic pain.

AIM

This article presents the yoga protocol for the MY-Skills intervention.

METHODS

The yoga protocol was revised based on feedback from six caregiving dyads. The protocol focuses on reducing pain interference and supporting the caregiving dyad.

RESULTS

The final yoga protocol incorporated the following elements: Centering and mantra, prana vidya and pranayama, asanas, mudra, and guided savasana/dhyana.

CONCLUSION

The MY-Skills yoga protocol was modified by a yoga therapist with feedback from study participants. Revisions focused on the caregiving dyad, with specific attention to reducing pain interference.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

Introduction

Tinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity. It can manifest itself as sleep disturbances, anxiety and even depression. This condition can be reversed by bioelectrical vagal nerve stimulation (VNS). Conventional invasive VNS is an approved treatment for epilepsy and depression. Transcutaneous VNS (taVNS) stimulating the auricular branch of the vagus nerve has been shown to activate the vagal pathways similarly as an implanted VNS. Therefore, taVNS might also be a therapeutic alternative in health conditions such as tinnitus-related mental stress (TRMS). This retrospective study in 171 TRMS patients reports the clinical features, psychophysiological characteristics, and results of the heart rate variability (HRV) tests before and after test-taVNS. This study also reports the therapy outcomes of 113 TRMS patients treated with taVNS, in combination with standard tinnitus therapy.

Methods

Diagnostic tinnitus and hearing profiles were defined. To detect possible cardiac adverse effects, test-taVNS with heart rate monitoring as well as pre- and post-stimulation HRV tests were performed. Daily taVNS home therapy was prescribed thereafter. To assess therapeutic usefulness of taVNS, 1-year follow-up outcome was studied. Results of HRV tests were retrospectively analyzed and correlated to diagnostic data.

Results

The large majority of patients with TRMS suffer from associated symptoms such as sleep disturbances and anxiety. Baseline HRV data showed that more than three quarters of the 171 patients had increased sympathetic activity before test-taVNS. Test-taVNS shifted mean values of different HRV parameters toward increased parasympathetic activity in about 80% of patients. Test-taVNS did not cause any cardiac or other side effects. No significant adverse effects were reported in follow-up questionnaires.

Conclusion

TRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.

Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research

BACKGROUND

There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers' situatedness within participatory processes. As an implementation scientist, addressing one's own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process.

METHODS

We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative.

RESULTS

Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers' lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers' experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research.

CONCLUSION

Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one's values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.

Not All Competitions Come to Harm! Competitive Biofeedback to Increase Respiratory Sinus Arrhythmia in Managers

Despite the positive impact on achievement, competition has been associated with elevated psychophysiological activation, potentially leading to a greater risk of cardiovascular diseases. Competitive biofeedback (BF) can be used to highlight the effects of competition on the same physiological responses that are going to be controlled through BF. However, it is still unknown whether competition could enhance the effects of respiratory sinus arrhythmia (RSA)-BF training in improving cardiac vagal control. The present study explored whether competitive RSA-BF could be more effective than non-competitive RSA-BF in increasing RSA in executive managers, who are at higher cardiovascular risk of being commonly exposed to highly competitive conditions. Thirty managers leading outstanding private or public companies were randomly assigned to either a Competition (n = 14) or a Control (n = 16) RSA-BF training lasting five weekly sessions. Managers in the Competition group underwent the RSA-BF in couples and each participant was requested to produce a better performance (i.e., higher RSA) than the paired challenger. After the training, results showed that managers in the Competition group succeeded in increasing cardiac vagal control, as supported by the specific increase in RSA (p < 0.001), the standard deviation of R-R wave intervals (SDNN; p < 0.001), and root mean square of the successive differences between adjacent heartbeats (rMSSD; p < 0.001). A significant increase in the percentage of successive normal sinus beat to beat intervals more than 50 ms (pNN50; p = 0.023; η2 p = 0.17), low frequency (p = ≤ 0.001; η2 p = 0.44), and high frequency power (p = 0.005; η2 p = 0.25) emerged independently from the competitive condition. Intriguingly, managers who compete showed the same reduction in resting heart rate (HR; p = 0.003, η2 p = 0.28), systolic blood pressure (SBP; p = 0.013, η2 p = 0.20), respiration rate (p < 0.001; η2 p = 0.46), and skin conductance level (SCL; p = 0.001, η2 p = 0.32) as non-competitive participants. Also, the same reduction in social anxiety (p = 0.005; η2 p = 0.25), state (p = 0.038, η2 p = 0.14) and trait anxiety (p = 0.001, η2 p = 0.31), and depressive symptoms (p = 0.023, η2 p = 0.17) emerged in the two groups. The present results showed that managers competing for increasing RSA showed a greater improvement in their parasympathetic modulation than non-competing managers. Most importantly, competition did not lead to the classic pattern of increased psychophysiological activation under competitive RSA-BF. Therefore, competition could facilitate the use of self-regulation strategies, especially in highly competitive individuals, to promote adaptive responses to psychological stress.

No panacea? Tai Chi enhances motoric but not executive functioning in a normal aging population

Tai Chi Chuan (TCC) is a promising intervention against age-related decline. Though previous studies have shown benefits in motoric and cognitive domains, it is unclear how these effects are functionally related. Therefore, a randomized controlled trial was conducted in an aging population (53-85). Two measures of motor functioning - motor speed and functional balance - and three cognitive control measures - shifting, updating and inhibition - were included. The TCC condition consisted of an online 10 week 20 lessons video program of increasing level and control condition of educational videos of similar length and frequency. All analyses were done with Bayesian statistics. Counter to expectation no differences were found in cognition between TCC and control pre-to-posttest. However, there was extreme evidence for TCC benefits on functional balance and moderate evidence for increased motoric speed. After weighing the evidence and limitations of the intervention we conclude that TCC does not enhance cognitive control.

The Effect of Breath Pacing on Task Switching and Working Memory

The cortical and subcortical circuit regulating both cognition and cardiac autonomic interactions are already well established. This circuit has mainly been analyzed from cortex to heart. Thus, the heart rate variability (HRV) is usually considered a reflection of cortical activity. In this paper, we investigate whether HRV changes affect cortical activity. Short-term local autonomic changes were induced by three breathing strategies: spontaneous (Control), normal (NB) and slow paced breathing (SB). We measured the performance in two cognition domains: executive functions and processing speed. Breathing maneuvres produced three clearly differentiated autonomic states, which preconditioned the cognitive tasks. We found that the SB significantly increased the HRV low frequency (LF) power and lowered the power spectral density (PSD) peak to 0.1[Formula: see text]Hz. Meanwhile, executive function was assessed by the working memory test, whose accuracy significantly improved after SB, with no significant changes in the response times. Processing speed was assessed by a multitasking test. Consistently, the proportion of correct answers (success rate) was the only dependent variable affected by short-term and long-term breath pacing. These findings suggest that accuracy, and not timing of these two cognitive domains would benefit from short-term SB in this study population.

Dysregulation of inflammation, neurobiology, and cognitive function in PTSD: an integrative review

Compelling evidence from animal and human research suggest a strong link between inflammation and posttraumatic stress disorder (PTSD). Furthermore, recent findings support compromised neurocognitive function as a key feature of PTSD, particularly with deficits in attention and processing speed, executive function, and memory. These cognitive domains are supported by brain structures and neural pathways that are disrupted in PTSD and which are implicated in fear learning and extinction processes. The disruption of these supporting structures potentially results from their interaction with inflammation. Thus, the converging evidence supports a model of inflammatory dysregulation and cognitive dysfunction as combined mechanisms underpinning PTSD symptomatology. In this review, we summarize evidence of dysregulated inflammation in PTSD and further explore how the neurobiological underpinnings of PTSD, in the context of fear learning and extinction acquisition and recall, may interact with inflammation. We then present evidence for cognitive dysfunction in PTSD, highlighting findings from human work. Potential therapeutic approaches utilizing novel pharmacological and behavioral interventions that target inflammation and cognition also are discussed.

[Caring for the caregiver: The emotional impact of the coronavirus epidemic on nurses and other health professionals]

La crisis sanitaria provocada por la pandemia del virus COVID-19 ha vuelto a destacar el papel de los profesionales sanitarios como elemento clave para su contención, que sufren una alta tensión marcada por la presión asistencial y la falta de medios de protección. Ante esta tensión, resulta relevante analizar el impacto emocional en los profesionales sanitarios de la pandemia de coronavirus y los recursos de afrontamiento para disminuir o atenuar este impacto. Destacan el estrés, los trastornos del sueño y los síntomas depresivos. Se ofrecen algunas estrategias que han sido utilizados por profesionales que anteriormente han sufrido la presión del COVID-19 y les han sido de utilidad. Por último, se señalan algunas recomendaciones cuya eficacia es conocida para el manejo del impacto emocional.

Mindfulness with paced breathing reduces blood pressure

Elevated blood pressure (BP) is a major avoidable cause of premature morbidity and mortality in the United States (US) and worldwide, due primarily to increased risks of stroke as well as myocardial infarction. While there are therapeutic lifestyle changes and adjunctive pharmacologic medications of proven benefit, recent interest has increasingly focused on Complementary and Alternative Medicine, in particular, Mind-Body Interventions. With respect to BP, it is tempting to speculate that mindfulness with paced breathing will have beneficial effects in the short run that may translate into lowered risks of stroke in the long run. Paced breathing is deep diaphragmatic breathing with typical rates equal to or less than 5-7 breaths per minute compared with the usual rate of 12-14. One plausible mechanism of benefit is that paced breathing stimulates the parasympathetic nervous system which alters neuronal function in specific areas of the brain and reduces stress chemicals. The hypothesis that mindfulness with paced slow breathing reduces BP could be directly tested in randomized trials designed a priori to do so. Subsequently, a finding that mindfulness with paced breathing reduces BP would also lead to direct tests in randomized trials of reductions of carotid atherosclerosis and, if so, a larger scale trial to test whether there is a direct impact of mindfulness with paced breathing on reducing the risks of stroke and MI. If rigorous testing of this medical hypothesis led to positive results this would have large and important clinical and policy implications in the US and worldwide.

Understanding mind–body disciplines: A pilot study of paced breathing and dynamic muscle contraction on autonomic nervous system reactivity

Mind-body disciplines such as yoga, Tai Chi, and Qigong have been demonstrated to activate the parasympathetic nervous system, but it remains unclear how these practices achieve these results, whether by breathing, movement, or some combination. This pilot study establishes a model to examine the individual and combined effects of paced breathing and rhythmic skeletal muscle contraction on the activation of the parasympathetic system during a cognitive stressor. Male participants were randomly assigned to one of four preconditioning groups: (a) paced breathing alone, (b) alternating upper extremity muscle contractions, (c) paced breathing synchronized with alternating contractions, or (d) a neutral control task. Autonomic response was assessed by heart rate variability during a standardized cognitive stressor. The alternating contraction group had 71.7% higher activation of parasympathetic signal over respiration alone (p < .001). Alternating contractions synchronized with breathing demonstrated 150% higher parasympathetic activation than control (p < .0001). Comparing the contraction alone and synchronized groups, the synchronized group demonstrated 45.9% higher parasympathetic response during a cognitive stressor (p < .001). In conclusion, paced breathing synchronized with rhythmic muscle contraction leads to more resilient activation of the parasympathetic response than either alternating contractions or breathing alone, which may help explain the stress reducing benefits of mind-body disciplines.

Influence of a 30-Day Slow-Paced Breathing Intervention Compared to Social Media Use on Subjective Sleep Quality and Cardiac Vagal Activity

Breathing techniques are part of traditional relaxation methods; however, their influence on psychophysiological variables related to sleep is still unclear. Consequently, the aim of this paper was to investigate the influence of a 30-day slow-paced breathing intervention compared to social media use on subjective sleep quality and cardiac vagal activity (CVA, operationalized via high-frequency heart rate variability). Healthy participants (n = 64, 33 male, 31 female, M = 22.11, SD = 3.12) were randomly allocated to an experimental or control group. In the experimental group, they had to perform slow-paced breathing for 15 min each evening across a 30-day period. This was administered through a smartphone application. The control group used social media (e.g., Facebook, Instagram, Whatsapp) for the same duration. The night before and after the intervention, their CVA was assessed via a light portable Electrocardiogram (ECG) device, and they had to fill out the Pittsburgh Sleep Quality Index questionnaire. Results showed that in comparison to the use of social media, the slow-paced breathing technique improved subjective sleep quality and increased overnight CVA, while a tendency was observed for morning awakening CVA. Slow-paced breathing appears a promising cost-effective technique to improve subjective sleep quality and cardiovascular function during sleep in young healthy individuals.

The Relation of Parental Emotion Regulation to Child Autism Spectrum Disorder Core Symptoms: The Moderating Role of Child Cardiac Vagal Activity

This study investigated the role of parental emotion regulation (ER) on children's core symptoms in families of children with autism spectrum disorders (ASD) in middle childhood; the study also explored whether children's physiological ER functioning served as a risk or protective factor with respect to parental relationships. Thirty-one Chinese children with ASD (age 6-11) and their primary caregivers participated in this study. Parental ER and child ASD symptoms were collected via questionnaires from parents. Child cardiac vagal activity (derived from heart rate variability) was measured at rest and during a parent-child interaction task. Using moderation analyses, the results showed that parental ER was not directly associated with children's core ASD symptoms; rather, it interacted significantly with children's resting cardiac vagal activity, but not task-related changes of cardiac vagal activity, to exert an impact on children's core ASD symptoms. Specifically, our findings suggested that parents' difficulties with their own ER significantly impacted their children's core ASD symptoms only for the children who showed blunted resting cardiac vagal activity. Implications for the future measurement of ER in the family context and future directions for intervention are discussed.