How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing

The importance of the olfactory system in human well-being, through nutrition and social behavior

The human sense of smell is still much underappreciated, despite its importance for vital functions such as warning and protection from environmental hazards, eating behavior and nutrition, and social communication. We here approach olfaction as a sense of well-being and review the available literature on how the sense of smell contributes to building and maintaining well-being through supporting nutrition and social relationships. Humans seem to be able to extract nutritional information from olfactory food cues, which can trigger specific appetite and direct food choice, but may not always impact actual intake behavior. Beyond food enjoyment, as part of quality of life, smell has the ability to transfer and regulate emotional conditions, and thus impacts social relationships, at various stages across life (e.g., prenatal and postnatal, during puberty, for partner selection and in sickness). A better understanding of how olfactory information is processed and employed for these functions so vital for well-being may be used to reduce potential negative consequences.

Guided relaxation-based virtual reality versus distraction-based virtual reality or passive control for postoperative pain management in children and adolescents undergoing Nuss repair of pectus excavatum: protocol for a prospective, randomised, controlled trial (FOREVR Peds trial)

INTRODUCTION

Virtual reality (VR) offers an innovative method to deliver non-pharmacological pain management. Distraction-based VR (VR-D) using immersive games to redirect attention has shown short-term pain reductions in various settings. To create lasting pain reduction, VR-based strategies must go beyond distraction. Guided relaxation-based VR (VR-GR) integrates pain-relieving mind-body based guided relaxation with VR, a novel therapy delivery mechanism. The primary aim of this study is to assess the impact of daily VR-GR, VR-D and 360 video (passive control) on pain intensity. We will also assess the impact of these interventions on pain unpleasantness, anxiety and opioid and benzodiazepine consumption. The secondary aim of this study will assess the impact of psychological factors (anxiety sensitivity and pain catastrophising) on pain following VR.

METHODS AND ANALYSIS

This is a single centre, prospective, randomised, clinical trial. Ninety children/adolescents, aged 8-18 years, presenting for Nuss repair of pectus excavatum will be randomised to 1 of 3 study arms (VR-GR, VR-D and 360 video). Patients will use the Starlight Xperience (Google Daydream) VR suite for 10 min. Patients randomised to VR-GR (n=30) will engage in guided relaxation/mindfulness with the Aurora application. Patients randomised to VR-D (n=30) will play 1 of 3 distraction-based games, and those randomised to the 360 video (n=30) will watch the Aurora application without audio instructions or sound. Primary outcome is pain intensity. Secondary outcomes include pain unpleasantness, anxiety and opioid and benzodiazepine consumption.

ETHICS AND DISSEMINATION

This study follows Standard Protocol Items: Recommendations for Interventional Trials guidelines. The protocol was approved by the Cincinnati Children's Hospital Medical Center's institutional review board. Patient recruitment began in July 2020. Written informed consent will be obtained for all participants. All information acquired will be disseminated via scientific meetings and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04351776.

Changes in the Electrical Activity of the Brain in the Alpha and Theta Bands during Prayer and Meditation

Focused attention meditation (FAM) is a category of meditation based on an EEG pattern, which helps the wandering mind to focus on a particular object. It seems that prayer may, in certain respects, be similar to FAM. It is believed that emotional experience correlates mainly with theta, but also with selective alpha, with internalized attention correlating mainly with the synchronous activity of theta and alpha. The vast majority of studies indicate a possible impact of transcendence in meditation on the alpha wave in EEG. No such reports are available for prayer. Seventeen women and nineteen men aged 27–64 years with at least five years of intensive meditation/prayer experience were recruited to participate in the study. We identified the two largest groups which remained in the meditation trend originating from the Buddhist system (14 people) (Buddhist meditators) and in the Christian-based faith (15 people) (Christian meditators). EEG signal was recorded with open eyes, closed eyes, during meditation/prayer, and relaxation. After the EEG recording, an examination was conducted using the Scale of Spiritual Transcendence. Buddhist meditators exhibited a statistically significantly higher theta amplitude at Cz during meditation compared to relaxation. Meanwhile, spiritual openness favored a higher theta amplitude at Pz during relaxation. Our study did not reveal statistically significant differences in frontal areas with regard to alpha and theta, which was often indicated in previous studies. It seems necessary to analyze more closely the midline activity in terms of dispersed neural activity integration.

The effectiveness of diaphragmatic breathing relaxation training for improving sleep quality among nursing staff during the COVID-19 outbreak: a before and after study

OBJECTIVES

Recent studies have demonstrated that first-line nurses involved in the coronavirus disease-2019 (COVID-19) crisis may experience sleep disturbances. As breathing relaxation techniques can improve sleep quality, anxiety, and depression, the current study aimed to evaluate the effectiveness of diaphragmatic breathing relaxation training (DBRT) for improving sleep quality among nurses in Wuhan, China during the COVID-19 outbreak.

METHODS

This study used a quasi-experimental (before and after) intervention strategy, with 151 first-line nurses from four wards in Leishenshan hospital. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) to evaluate the effectiveness of DBRT before and after the intervention. Data were examined using the Shapiro-Wilk test, Levene's test, and paired t-test.

RESULTS

A total of 140 nurses completed the DBRT sessions. First-line nurses achieved significant reductions in global sleep quality (p < 0.01), subjective sleep quality (p < 0.001), sleep latency (p < 0.01), sleep duration (p < 0.001), sleep disturbances (p < 0.001), habitual sleep efficiency (p = 0.015), daytime dysfunction (p = 0.001), and anxiety (p = 0.001). There were no significant reductions in the use of sleeping medication (p = 0.134) and depression (p = 0.359).

CONCLUSION

DBRT is a useful non-pharmacological treatment for improving sleep quality and reducing anxiety among first-line nurses involved in the COVID-19 outbreak. The study protocol was clinically registered by the Chinese Clinical Trial Registry.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000032743.

Comparing the Psychological Effects of Meditation- and Breathing-Focused Yoga Practice in Undergraduate Students

Objectives

The present study aimed to compare the psychological effects of meditation- and breathing-focused yoga practice in undergraduate students.

Methods

A 12-weeks yoga intervention was conducted among a group of undergraduate students enrolled in four yoga classes at an academically prestigious university in Beijing, China. Four classes were randomized to meditation-focused yoga or breathing-focused yoga. A total of 86 participants finished surveys before and after the 12-weeks intervention, measuring work intention, mindfulness, and perceived stress. The repeated-measure multivariate analysis of covariance (MANCOVA) followed by univariate analyses were conducted to examine the differences in work intention, mindfulness, and stress between the two yoga intervention groups over the semester, after controlling for age and gender.

Results

The repeated-measure MANCOVA revealed significant group differences with a median effect size [Wilks' lambda, Λ = 0.90, F(3, 80) = 3.10, p = 0.031, η² = 0.104]. Subsequent univariate analyses showed that students in the breathing-focused yoga group had significant higher work intentions [F _{(1, 82)} = 5.22; p = 0.025; η² _p = 0.060] and mindfulness [F _{(1, 82)} = 6.33; p = 0.014; η² _p = 0.072] but marginally lower stress [F _{(1, 82)} = 4.20; p = 0.044; η² _p = 0.049] than students in the meditation-focused yoga group.

Conclusion

Yoga practice with a focus on breathing is more effective than that with a focus on meditation for undergraduates to retain energy for work, keep attention and awareness, and reduce stress.

Effects of Yoga in Daily Life program in rheumatoid arthritis: A randomized controlled trial

OBJECTIVES

To explore the feasibility and effectiveness of a yoga program in improving health-related quality of life (HQOL), physical and psychological functioning in rheumatoid arthritis (RA) patients.

DESIGN

Single-centre parallel-arms randomized controlled trial comparing yoga (n = 30) and education control group (n = 27).

SETTING

Tertiary care University hospital.

INTERVENTION

A 12-week yoga program, based on the Yoga in Daily Life system, included 2x weekly/90-minute sessions. The control group had 1xweekly/60-minute educational lectures on arthritis-related topics.

MAIN OUTCOME MEASURES

Assessments were performed at baseline, 12 (post-intervention) and 24 weeks (follow-up). The primary outcome was change in The Short Form-36 (SF-36) HQOL at 12 weeks. Linear regression analysis was adjusted for baseline scores.

RESULTS

No significant between-group differences were found for SF-36 (all p > 0.05). At 12 weeks the adjusted mean difference between groups favoured yoga for Functional Assessment of Chronic Illness Therapy-fatigue (5.08 CI 1.29 to 8.86; p = 0.009) and Hospital Anxiety and Depression Scale (HADS)-depression (-1.37 CI -2.38 to -0.36); p = 0.008) and at 24 weeks for HADS-anxiety (-1.79 CI -3.34 to - 0.23; p = 0.025), while the impact on fatigue was sustained (5.43 CI 1.33 to 9.54, p = 0.01). The program had no impact on RA disease activity. Feasibility outcomes included recruitment rate 16 %, retention 80.7 %, and adherence to yoga 87.5 vs 82.7 % for control. No serious adverse events were recorded.

CONCLUSIONS

Yoga in Daily Life program was not associated with change in health-related quality of life of RA patients. Significant improvements in fatigue and mood were observed at postintervention and follow-up. This yoga program was found feasible and safe for patients and may complement standard RA treat-to-target strategy.

Neurophysiology of cognitive behavioural therapy, deep breathing and progressive muscle relaxation used in conjunction with ART treatments: a narrative review

BACKGROUND

Infertility is defined as the failure to achieve clinical pregnancy after 12 months of regular unprotected intercourse. It could be due to male or female factors, each requiring different treatment options. ART treatment exposes couples to numerous psychological stressors. Therefore, it has been recommended by the ESHRE Psychology and Counselling Guideline Development Group recently that psychosocial support should be offered as a complementary therapy during infertility treatments. In this context, the efficiency of different psychological interventions, such as cognitive behaviour therapy (CBT), deep breathing (DB), and progressive muscle relaxation (PMR), was evaluated in several clinical trials in terms of couples' mental health and pregnancy outcomes.

OBJECTIVE AND RATIONALE

The neurophysiology of CBT, DB and PMR, which are used in interventional studies, in both men and women undergoing ART, has not yet been fully elucidated. This review represents a comprehensive report, aiming to collate novel insights into the neurobiological processes and physiological mechanisms that occur during the practice of CBT, DB and PMR.

SEARCH METHODS

PubMed, Google Scholar and Cochrane Library were interrogated to conduct this comprehensive literature review. The search was carried out using combinations of MeSH terms and keywords: infertility, assisted reproductive techniques, IVF, ICSI, emotions, psychological stress, cognitive behavioural therapy, mind-body therapies and relaxation. Relevant information related to the mechanism of action of stress management techniques were obtained from original articles and reviews published in English without taking into consideration the time of publication. Moreover, as it was not the major focus of the review, only recent systematic reviews (2015-2019) pinpointing the effects of psychological interventions on infertility treatment outcomes were also retrieved from the above-mentioned databases.

OUTCOMES

CBT, DB and PMR may modify the activity of stress-related brain regions such as the prefrontal cortex, amygdala, hypothalamus and hippocampus, as demonstrated by functional MRI and electroencephalogram studies. Furthermore, applying these techniques was associated with mood improvements and a decline in stress biomarkers, and, hypothetically, reducing stress biomarkers attenuates the stress-induced effects on ART outcomes.

WIDER IMPLICATIONS

Increasing the knowledge of fertility staff, researchers and physicians regarding the mechanisms of action of these stress management techniques has several advantages. For instance, understanding the underlying neurophysiological pathways would assist practitioners to engage ART couples in the practice of these techniques. Also, it may enhance the quality of the support programmes and psychological research. Accordingly, this will ensure that these interventions reach their full potential and therefore improve clinical outcomes.

A Practical Guide to Resonance Frequency Assessment for Heart Rate Variability Biofeedback

Heart rate variability (HRV) represents fluctuations in the time intervals between successive heartbeats, which are termed interbeat intervals. HRV is an emergent property of complex cardiac-brain interactions and non-linear autonomic nervous system (ANS) processes. A healthy heart is not a metronome because it exhibits complex non-linear oscillations characterized by mathematical chaos. HRV biofeedback displays both heart rate and frequently, respiration, to individuals who can then adjust their physiology to improve affective, cognitive, and cardiovascular functioning. The central premise of the HRV biofeedback resonance frequency model is that the adult cardiorespiratory system has a fixed resonance frequency. Stimulation at rates near the resonance frequency produces large-amplitude blood pressure oscillations that can increase baroreflex sensitivity over time. The authors explain the rationale for the resonance frequency model and provide detailed instructions on how to monitor and assess the resonance frequency. They caution that patterns of physiological change must be compared across several breathing rates to evaluate candidate resonance frequencies. They describe how to fine-tune the resonance frequency following an initial assessment. Furthermore, the authors critically assess the minimum epochs required to measure key HRV indices, resonance frequency test-retest reliability, and whether rhythmic skeletal muscle tension can replace slow paced breathing in resonance frequency assessment.

Individual Stress Prevention through Qigong

Owing to work intensification and an accelerated pace of life in general, individuals in many Western countries are often overactivated and find it difficult to switch off. However, recovery from physiological and mental activation is critical to prevent stress symptoms and maintain one’s physiological and mental well-being. Extensive research evidence indicates that Qigong, a traditional Chinese movement practice for promoting health, provides an effective means to recover from work and off-work demands. The main objective of this paper is to offer a comprehensive, narrative review of the effects of Qigong and its core components. Attention is first paid to the outcomes of work and off-work demands and stress, and the role of recovery for individuals’ well-being. Then, Qigong and its components are explained, followed by the results of scientific research. Finally, limitations and implications for research and practiced are discussed.

[Improving parasympathetic functioning to contain the inflammatory response of COVID-19 infection]

COVID-19 infection results in an unrestrained inflammatory reaction in serious cases. The autonomic nervous system (ANS), in particular the parasympathetic branch, helps to regulate the inflammatory response. A dysfunction of this branch, frequent in people at risk of developing COVID-19, favours a pro-inflammatory effect. Reinforcing and stimulating the parasympathetic ANS is possible and accessible to paramedical and medical professionals.

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.

Respiratory Rhythm, Autonomic Modulation, and the Spectrum of Emotions: The Future of Emotion Recognition and Modulation

Pulmonary ventilation and respiration are considered to be primarily involved in oxygenation of blood for oxygen delivery to cells throughout the body for metabolic purposes. Other pulmonary physiological observations, such as respiratory sinus arrhythmia, Hering Brewer reflex, cardiorespiratory synchronization, and the heart rate variability (HRV) relationship with breathing rhythm, lack complete explanations of physiological/functional significance. The spectrum of waveforms of breathing activity correlate to anxiety, depression, anger, stress, and other positive and negative emotions. Respiratory pattern has been thought not only to be influenced by emotion but to itself influence emotion in a bi-directional relationship between the body and the mind. In order to show how filling in gaps in understanding could lead to certain future developments in mind-body medicine, biofeedback, and personal health monitoring, we review and discuss empirical work and tracings to express the vital role of bodily rhythms in influencing emotion, autonomic nervous system activity, and even general neural activity. Future developments in measurement and psychophysiological understanding of the pattern of breathing in combination with other parameters such as HRV, cardiorespiratory synchronization, and skin conductivity may allow for biometric monitoring systems to one day accurately predict affective state and even affective disorders such as anxiety. Better affective prediction based on recent research when incorporated into personal health monitoring devices could greatly improve public mental health by providing at-home biofeedback for greater understanding of one's mental state and for mind-body affective treatments such as breathing exercises.

Implementing Mobile HRV Biofeedback as Adjunctive Therapy During Inpatient Psychiatric Rehabilitation Facilitates Recovery of Depressive Symptoms and Enhances Autonomic Functioning Short-Term: A 1-Year Pre-Post-intervention Follow-Up Pilot Study

OBJECTIVE

New treatment options for depression are warranted, due to high recurrence rates. Recent research indicates benefits of heart rate variability biofeedback (HRVBF) on symptom recovery and autonomic functioning in depressed individuals. Slow-paced breathing-induced amplification of vagus nerve activity is the main element of HRVBF. Thus, the latter represents a safe and non-invasive complementary depression treatment. However, its efficacy in patients undergoing inpatient psychiatric rehabilitation receiving highly comprehensive treatments has not been evaluated.

METHODS

Ninety-two inpatients were randomly assigned to an intervention group (IG) or control group (CG). While the latter received the standard treatment only, adjunctive HRVBF was provided to the IG over 5 weeks. Depression severity and heart rate variability (HRV) were assessed before (pre) and after 5 weeks (post). Moreover, 1-year follow-up depression scores were available for 30 participants.

RESULTS

Although depression improved in both groups, the IG exhibited significantly larger improvements at post-assessment ( η p 2 = 0.065) and significant increases in resting LF-HRV (d = 0.45) and cardiorespiratory coherence (d = 0.61). No significant effects for RMSSD, SDNN, HF-HRV, or HR were found (ps > 0.05). Additionally, the IG showed a medium- to large-sized reduction in resting respiratory rate from 13.2 to 9.8 breaths per minute (p < 0.001, d = 0.86), with the CG exhibiting only a small decrease from 13.5 to 12.4 (p = 0.49; d = 0.35). While the IG exhibited significantly lower depression scores at post-assessment (p = 0.042, d = 0.79), this effect decreased during follow-up (p = 0.195, d = 0.48).

CONCLUSION

HRVBF as adjuvant therapy during inpatient psychiatric rehabilitation facilitated depression recovery. Additionally, amplified LF-HRV as well as cardiorespiratory coherence at rest and a decrease in resting breathing frequency was observed in the HRVBF group. These findings emphasize HRVBF's value as complementary therapy regardless of concurrent treatments. Moreover, these incremental benefits could serve as resource even after the actual training period. However, the additional antidepressant gains vanish during the long-term follow-up, indicating the need for more intense training or regular practice afterward, respectively. Thus, future studies are warranted to examine how the initial benefits of HRVBF during inpatient psychiatric rehabilitation can be preserved post discharge.

Promoting Mental Health and Psychological Thriving in University Students: A Randomized Controlled Trial of Three Well-Being Interventions

This study aimed to address the decline in mental health on U.S. university campuses by examining the effects of three interventions. University students suffer from high levels of anxiety, depression, and suicide. Counseling centers on university campuses are struggling to meet increased demand. The cost to students and universities could be buffered by offering preventative, psychoeducational, and skill-building training programs that promote mental health and psychological thriving. To date, the research literature has not yielded systematically evaluated and recommendable preventative mental health and well-being programs for university students. In a registered, randomized controlled trial, 131 university students were either placed in a non-intervention control group (N = 47) or received training in one of three 30-hour, eight-week semester-long well-being programs: SKY Campus Happiness ("SKY"; N = 29), Foundations of Emotional Intelligence ("EI"; N = 21) or Mindfulness-Based Stress Reduction ("MBSR"; N = 34). Compared to the control group and controlling for variance of baseline measurements and multiple comparisons, SKY Campus Happiness showed the greatest impact, benefiting six outcomes: depression, stress, mental health, mindfulness, positive affect and social connectedness. EI benefited one outcome: mindfulness. The MBSR group showed no change. Delivering SKY or EI to university students may be a cost-effective and efficient way to proactively and preventatively address mental health for university students and reduce the financial strain on universities.

Heart rate variability at bedtime predicts subsequent sleep features

Getting enough sleep during the night is important for preventing adverse short- and long-term health outcomes. The sympathetic-parasympathetic autonomic balance, characteristics of the pre-bed time resting period, correlates with sleep efficiency. We investigated in healthy subjects whether Low/High Frequencies (LF/HF) and other Heart Rate Variability (HRV) metrics, extracted in the period immediately before sleep onset, are able to predict quality/architecture sleep parameters in the sample group and in the Evening-Intermediate- chronotype subgroups. Linear correlations were found between HRV metrics and the investigated quality/architecture sleep parameters. The possibility to predict sleep parameters from the HRV metrics while falling asleep might pave the way to behavioral interventions during the bedtime period to increase the quality of sleep.

Effects of Yoga Respiratory Practice (Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial

Pranayama refers to a set of yoga breathing exercises. Recent evidence suggests that the practice of pranayama has positive effects on measures of clinical stress and anxiety. This study explored the impact of a Bhastrika pranayama training program on emotion processing, anxiety, and affect. We used a randomized controlled trial design with thirty healthy young adults assessed at baseline and after 4 weeks of pranayama practices. Two functional magnetic resonance imaging (MRI) protocols were used both at baseline and post-intervention: an emotion task as well as a resting-state acquisition. Our results suggest that pranayama significantly decreased states of anxiety and negative affect. The practice of pranayama also modulated the activity of brain regions involved in emotional processing, particularly the amygdala, anterior cingulate, anterior insula, and prefrontal cortex. Resting-state functional MRI (fMRI) showed significantly reduced functional connectivity involving the anterior insula and lateral portions of the prefrontal cortex. Correlation analysis revealed that changes in connectivity between the ventrolateral prefrontal cortex and the right anterior insula were associated with changes in anxiety. Although it should be noted that these analyses were preliminary and exploratory, it provides the first evidence that 4 weeks of B. pranayama significantly reduce the levels of anxiety and negative affect, and that these changes are associated with the modulation of activity and connectivity in brain areas involved in emotion processing, attention, and awareness. The study was registered at https://www.ensaiosclinicos.gov.br/rg/RBR-2gv5c2/(RBR-2gv5c2).

Deep slow nasal respiration with tight lip closure for immediate attenuation of severe tics

BACKGROUND

Severe intractable tics, which are associated with Tourette syndrome and chronic tic disorder (TS/CTD), severely affect the quality of life. Common less-invasive treatments are often unable to attenuate tics with deep brain stimulation currently being the only effective treatment. We aimed to assess the anti-tic effect of deep slow nasal respiration with tight lip closure using patients with TS/CTD.

METHODS

We retrospectively analyzed 10 consecutive patients (9 men, 1 woman; 23-41 years old). We instructed the patients to perform the procedure for 120 s and to obtain a video recording of before and during the procedure. The videos were used to count tics and determine lip competency or incompetency. The counted tics were rated using the modified Rush Video Rating Scale.

RESULTS

Compared with before the procedure, there were significantly lower frequencies of motor and phonic tics, as well as video scored, during the procedure. Eight patients presented with lip incompetency before the procedure and none after the procedure (P = 0.041). There were no side effects associated with the procedure.

CONCLUSION

Our findings indicate that deep slow nasal respiration with tight lip closure ameliorates tics in patients with TS/CTD. In accordance with our results, lip opening and oral breathing could be causes of tics, in addition to heritability. Therefore, this novel procedure could improve tics. Furthermore, our findings could contribute toward the development of tic treatments and elucidate their pathophysiology regarding the reward system, hypersensitivity, autonomic nerves, and nasal airway.

Use of viruses for interrogating viscera-specific projections in central nervous system

Each internal organ may perform many different functions under central regulation, yet how these processes are coordinated is poorly understood. The last three decades have witnessed a renaissance in tract tracing with genetically engineered strains of viruses that rapidly interrogate viscera-specific projections in the CNS. The application of novel methods to study cell type-specific projections through trans-synaptically transmitted virus 'label' highlights projections exclusively originating from neurons expressing a very specific molecular phenotype. This has opened the door to neuroanatomical studies interrogating organ-specific projections in the CNS at an unprecedented scale. In this contribution to the Special Issue we present an overview of the present state and of future opportunities in charting viscera-brain specific connectivity and in linking brain circuits to internal organ function.

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.

On the Hierarchical Organization of Oscillatory Assemblies: Layered Superimposition and a Global Bioelectric Framework

Bioelectric oscillations occur throughout the nervous system of nearly all animals, revealed to play an important role in various aspects of cognitive activity such as information processing and feature binding. Modern research into this dynamic and intrinsic bioelectric activity of neural cells continues to raise questions regarding their role in consciousness and cognition. In this theoretical article, we assert a novel interpretation of the hierarchical nature of "brain waves" by identifying that the superposition of multiple oscillations varying in frequency corresponds to the superimposing of the contents of consciousness and cognition. In order to describe this isomorphism, we present a layered model of the global functional oscillations of various frequencies which act as a part of a unified metastable continuum described by the Operational Architectonics theory and suggested to be responsible for the emergence of the phenomenal mind. We detail the purposes, functions, and origins of each layer while proposing our main theory that the superimposition of these oscillatory layers mirrors the superimposition of the components of the integrated phenomenal experience as well as of cognition. In contrast to the traditional view that localizations of high and low-frequency activity are spatially distinct, many authors have suggested a hierarchical nature to oscillations. Our theoretical interpretation is founded in four layers which correlate not only in frequency but in evolutionary development. As other authors have done, we explore how these layers correlate to the phenomenology of human experience. Special importance is placed on the most basal layer of slow oscillations in coordinating and grouping all of the other layers. By detailing the isomorphism between the phenomenal and physiologic aspects of how lower frequency layers provide a foundation for higher frequency layers to be organized upon, we provide a further means to elucidate physiological and cognitive mechanisms of mind and for the well-researched outcomes of certain voluntary breathing patterns and meditative practices which modulate the mind and have therapeutic effects for psychiatric and other disorders.

Effects of Heart Rate Variability Biofeedback in Patients With Acute Ischemic Stroke: A Randomized Controlled Trial

BACKGROUND

Autonomic dysfunction, cognitive impairment, and psychological distress are associated with poorer prognosis in patients with acute ischemic stroke (AIS). Heart rate variability (HRV) biofeedback (BF) improves autonomic dysfunction, cognitive impairment, and psychological distress in other patient populations, but its effect in patients with AIS is still unclear.

OBJECTIVE

This study investigated the effects of an HRVBF intervention on autonomic function, cognitive impairment, and psychological distress in patients with AIS.

METHOD

In this randomized, controlled, single-blind trial, patients with AIS were randomly assigned to the experimental or control group. The experimental group received four HRVBF training sessions. The control group received usual care. Repeated measures of HRV, mini-mental status examination (MMSE), and Hospital Anxiety and Depression Scales (HADS) were collected prior to and at 1 and 3 months postintervention.

RESULTS

A total of 35 patients completed the study (19 experimental, 16 control). HRV and HADS significantly improved in the experimental group (p < .001) but not in the control group. Likewise, only the experimental group showed significant improvements in HRV, MMSE, and HADS over time (p < .05).

CONCLUSION

HRVBF is a promising intervention for improving autonomic function, cognitive impairment, and psychological distress in patients with AIS. More studies of HRVBF interventions are needed to further optimize the effects of HRVBF on autonomic, cognitive, and psychological function in patients with AIS.

Shift-Based Emotional Stress Reactions in Emergency Nurses After Traumatizing Events

INTRODUCTION

Emergency nurses experience multiple traumatizing events during clinical work. Early identification of work-related tension could lead to a timely intervention supporting well-being. We sought to discover whether there is an immediately measurable effect on emotional stress, as determined by changes between pre- and postshift survey scores, associated with exposure to traumatizing events during a single emergency nursing shift.

METHODS

The Emotional Stress Reaction Questionnaire (ESRQ) is a real-time self-assessment tool based on positively, negatively, or neutrally loaded emotions. Participants voluntarily completed pre- and postshift ESRQs over a 6-month period at a quaternary academic emergency department and recorded the number of associated traumatizing events. Associations between number of traumatizing events and ESRQ scores were evaluated using Spearman rank correlation coefficients. Changes in positive-negative balance scores were compared between shifts using a 2-sample t-test.

RESULTS

There were 203 responses by 94 nurses. The mean preshift ESRQ score was 11.3 (SD = 5.2), mean postshift score 6.8 (SD = 7.4), and mean change -4.4 (SD = 8.2; t = -7.26; P < 0.001). The total number of traumatizing events was correlated with change in ESRQ scores (correlation coefficient of -0.31; P < 0.001). The mean change in positive-negative scores for shifts without traumatizing events was -1.4 (SD = 6.0) compared with -5.0 (SD = 8.5) for shifts with at least 1 event (t = 2.27; P = 0.03).

DISCUSSION

Our results suggest that repeated exposure to traumatizing events during a single clinical shift was associated with a measurable effect on negative emotional stress in emergency nurses as determined by ESRQ positive-negative balance scores.

Heart Rate Variability Biofeedback Based on Slow-Paced Breathing With Immersive Virtual Reality Nature Scenery

This study investigated the benefits of using a virtual nature environment to administer immersive heart rate variability biofeedback (HRV-BF) based on slow-paced breathing. We compared the virtual reality (VR)-based HRV-BF with a standard implementation in a randomized controlled experiment with 60 healthy employees. After a cognitive stress induction, the participants performed a single-session of HRV-BF before repeating the cognitive stressor task. VR-based versus standard HRV-BF was comparable in terms of biofeedback performance (cardiac coherence and cardiac vagal tone). However, the VR-based implementation buffered perceived stress in the subsequent stressor task, increased relaxation self-efficacy more, reduced mind wandering, helped participants focus on the present moment, and helped preserve attentional resources. Potential long-term effects and generalizability need to be assessed in future research.

Hypothesis: Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiological Relaxation

Control of respiration provides a powerful voluntary portal to entrain and modulate central autonomic networks. Slowing and deepening breathing as a relaxation technique has shown promise in a variety of cardiorespiratory and stress-related disorders, but few studies have investigated the physiological mechanisms conferring its benefits. Recent evidence suggests that breathing at a frequency near 0.1 Hz (6 breaths per minute) promotes behavioral relaxation and baroreflex resonance effects that maximize heart rate variability. Breathing around this frequency appears to elicit resonant and coherent features in neuro-mechanical interactions that optimize physiological function. Here we explore the neurophysiology of slow, deep breathing and propose that coincident features of respiratory and baroreceptor afferent activity cycling at 0.1 Hz entrain central autonomic networks. An important role is assigned to the preferential recruitment of slowly-adapting pulmonary afferents (SARs) during prolonged inhalations. These afferents project to discrete areas in the brainstem within the nucleus of the solitary tract (NTS) and initiate inhibitory actions on downstream targets. Conversely, deep exhalations terminate SAR activity and activate arterial baroreceptors via increases in blood pressure to stimulate, through NTS projections, parasympathetic outflow to the heart. Reciprocal SAR and baroreceptor afferent-evoked actions combine to enhance sympathetic activity during inhalation and parasympathetic activity during exhalation, respectively. This leads to pronounced heart rate variability in phase with the respiratory cycle (respiratory sinus arrhythmia) and improved ventilation-perfusion matching. NTS relay neurons project extensively to areas of the central autonomic network to encode important features of the breathing pattern that may modulate anxiety, arousal, and attention. In our model, pronounced respiratory rhythms during slow, deep breathing also support expression of slow cortical rhythms to induce a functional state of alert relaxation, and, via nasal respiration-based actions on olfactory signaling, recruit hippocampal pathways to boost memory consolidation. Collectively, we assert that the neurophysiological processes recruited during slow, deep breathing enhance the cognitive and behavioral therapeutic outcomes obtained through various mind-body practices. Future studies are required to better understand the physio-behavioral processes involved, including in animal models that control for confounding factors such as expectancy biases.

Warm Steam Inhalation before Bedtime Improved Sleep Quality in Adult Men

In humans, the inhalation of warm steam has been reported to decrease the respiratory rate. However, the effects of warm steam inhalation on sleep have not been studied closely. This study aimed to examine the effects of warm steam inhalation before bedtime on subsequent sleep quality. The participants included 17 adult men with mild sleep difficulties and anxiety. All experiments were conducted in the participants' homes. The participants were instructed to wear a warm steam-generating mask or sham mask over the nose and mouth for 15 minutes immediately before habitual bedtime and were then allowed to sleep until their habitual waking time. The functional mask provided approximately 600 mg of steam for 10 minutes and maintained an interior temperature of 38-40°C for 15 minutes. We evaluated the participants' electrocardiograms and subjective moods while wearing the mask. During sleep, electroencephalograms (EEGs) were recorded using a single-channel portable device. In the morning, each participant was instructed to report their sleep details subjectively using a visual analog scale. At bedtime, the subjects' subjective apprehension of the next day was reduced significantly under steam inhalation, compared with the sham condition. Compared to the sham condition, steam inhalation before bedtime was associated with a higher EEG delta power density during the first third of sleep episodes and better subjective sleep quality in the morning. These results suggest that safe and easy inhalation of warm steam via a steam-generating mask improves psychological relaxation and sleep.

"Switch-Off" of Respiratory Sinus Arrhythmia May Be Associated With the Activation of an Oscillatory Source (Pacemaker) in the Brain Stem

Recently, we reported on the unusual “switch-off” of respiratory sinus arrhythmia (RSA) by analyzing heart rate (HR) beat-to-beat interval (RRI) signals and respiration in five subjects during a potentially anxiety-provoking first-time functional magnetic resonance imaging (fMRI) scanning with slow spontaneous breathing waves (Rassler et al., 2018). This deviation from a fundamental physiological phenomenon is of interest and merits further research. Therefore, in this study, the interplay between blood-oxygen level-dependent (BOLD) activity in the cerebellum/brain stem, RRI, and respiration was probed. Both the cardiovascular and the respiratory centers are located in the medulla oblongata and pons, indicating that dominant slow rhythmic activity is present in the brain stem. The recording of BOLD signals provides a way to investigate associated neural activity fluctuation in the brain stem. We found slow spontaneous breathing waves associated with two types of slow BOLD oscillations with dominant frequencies at 0.10 and 0.15 Hz in the brain stem. Both BOLD oscillations were recorded simultaneously. One is hypothesized as vessel motion-based phenomenon (BOLDv) associated with the start of expiration; the other one as pattern associated with neural activity (BOLDn) acting as a driving force for spontaneous inspiration and RRI increase (unusual cessation of RSA) about 2–3 s after BOLDv. This time delay of 2–3 s corresponds to the neurovascular coupling time.

Training of paced breathing at 0.1 Hz improves CO2 homeostasis and relaxation during a paced breathing task

Volitional control of breathing often leads to excessive ventilation (hyperventilation) among untrained individuals, which disrupts CO2 homeostasis and may elicit a set of undesirable symptoms. The present study investigated whether seven days of training without any anti-hyperventilation instructions improves CO2 homeostasis during paced breathing at a frequency of 0.1 Hz (6 breaths/minute). Furthermore, the present study investigated the effects of training on breathing-related changes in affective state to examine the hypothesis that training improves the influence of slow paced breathing on affect. A total of 16 participants performed ten minutes of paced breathing every day for seven days. Partial pressure of end-tidal CO2 (PetCO2), symptoms of hyperventilation, affective state (before and after breathing), and pleasantness of the task were measured on the first, fourth, and seventh days of training. Results showed that the drop in PetCO2 significantly decreased with training and none of the participants experienced a drop in PetCO2 below 30 mmHg by day seven of training (except one participant who already had PetCO2 below 30 mmHg during baseline), in comparison to 37.5% of participants on the first day. Paced breathing produced hyperventilation symptoms of mild intensity which did not decrease with training. This suggests that some participants still experienced a drop of PetCO2 that was deep enough to produce noticeable symptoms. Affective state was shifted towards calmness and relaxation during the second and third laboratory measurements, but not during the first measurement. Additionally, the breathing task was perceived as more pleasant during subsequent laboratory measurements. The obtained results showed that training paced breathing at 0.1 Hz led to decrease in hyperventilation. Furthermore, the present study suggests that training paced breathing is necessary to make the task more pleasant and relaxing.

The neurophysiological basis of excessive daytime sleepiness: suggestions of an altered state of consciousness

Excessive daytime sleepiness (EDS) is characterized by difficulty staying awake during daytime, though additional features may be present. EDS is a significant problem for clinical and non-clinical populations, being associated with a range of negative outcomes that also represent a burden for society. Extreme EDS is associated with sleep disorders, most notably the central hypersomnias such as narcolepsy, Kleine-Levin syndrome, and idiopathic hypersomnia (IH). Although investigation of these conditions indicates that EDS results from diminished sleep quality, the underlying cause for this impairment remains uncertain. One possibility could be that previous research has been too narrow in scope with insufficient attention paid to non-sleep-related aspects. Here, we offer a broader perspective in which findings concerning the impact of EDS on cortical functioning are interpreted in relation to current understanding about the neural basis of consciousness. Alterations in the spatial distribution of cortical activity, in particular reduced connectivity of frontal cortex, suggest that EDS is associated with an altered state of consciousness.

Darwin's Other Dilemmas and the Theoretical Roots of Emotional Connection

Modern scientific theories of emotional behavior, almost without exception, trace their origin to Charles Darwin, and his publications On the Origin of Species (1859) and The Expression of the Emotions in Man and Animals (1872). The most famous dilemma Darwin acknowledged as a challenge to his theory of evolution through natural selection was the incomplete Sub-Cambrian fossil record. However, Darwin struggled with two other rarely referenced theoretical and scientific dilemmas that confounded his theories about emotional behavior. These included (1) the origin of social instincts (e.g., altruism, empathy, reciprocity and cooperation) and the reasons for their conservation in evolution and (2) the peripheral control of heart rate vis-à-vis emotional behavior outside of consciousness. Darwin acknowledged that social instincts are critical to the survival of some species, but had difficulty aligning them with his theory of natural selection in humans. Darwin eventually proposed that heart rate and emotions are controlled via one's intellect and cortical mechanisms, and that instinctive behavior is genetically programmed and inherited. Despite ongoing efforts, these two theoretical dilemmas are debated to this day. Simple testable hypotheses have yet to emerge for the biological mechanisms underlying instinctive behavior or the way heart rate is controlled in infants. In this paper, we review attempts to resolve these issues over the past 160 years. We posit that research and theories that supported Darwin's individualistic brain-centric and genetic model have become an "orthodox" Western view of emotional behavior, one that produced the prevailing behavioral construct of attachment as developed by John Bowlby. We trace research and theories that challenged this orthodoxy at various times, and show how these challenges were repeatedly overlooked, rejected, or misinterpreted. We review two new testable theories, emotional connection theory and calming cycle theory, which we argue resolve the two dilemmas We show emerging scientific evidence from physiology and a wide variety of other fields, as well from clinical trials among prematurely born infants, that supports the two theories. Clinical implications of the new theories and possible new ways to assess risk and intervene in emotional, behavioral and developmental disorders are discussed.

Default Mode Network, Meditation, and Age-Associated Brain Changes: What Can We Learn from the Impact of Mental Training on Well-Being as a Psychotherapeutic Approach?

Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.

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.