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

Heart Rate Variability Modulation Through Slow-Paced Breathing in Health Care Workers with Long COVID: A Case-Control Study

BACKGROUND

Long COVID is a syndrome persisting 12+ weeks after COVID-19 infection, impacting life and work ability. Autonomic nervous system imbalance has been hypothesized as the cause. This study aims to investigate cardiovascular autonomic function in health care workers (HCWs) with Long COVID and the effectiveness of slow-paced breathing (SPB) on autonomic modulation.

METHODS

From December 1, 2022 to March 31, 2023, 6655 HCWs of the University Hospitals of Trieste (Northeast Italy) were asked to participate in the study by company-email. Inclusion/exclusion criteria were assessed. Global health status and psychosomatic disorders were evaluated through validated questionnaires. Heart rate variability was assessed by finger-photoplethysmography during spontaneous breathing and SPB, which stimulate vagal response. Long COVID HCWs (G1) were contrasted with Never infected (G2) and Fully recovered COVID-19 workers (G3).

RESULTS

There were 126 HCWs evaluated. The 58 Long COVID were assessed at a median time because COVID-19 of 419.5 days (interquartile range 269-730) and had significantly more psychosomatic symptoms and lower detectability of spontaneous systolic pressure oscillation at 0.1 Hz (Mayer wave - baroreflex arc) during spontaneous breathing compared with 53 never-infected and 14 fully-recovered HCWs (19%, 42%, and 40%, respectively, P = .027). During SPB, the increase in this parameter was close to controls (91.2%, 100%, and 100%, respectively, P = .09). No other differences in heart rate variability parameters were found among groups.

CONCLUSIONS

Resting vascular modulation was reduced in Long COVID, while during SPB, baroreflex sensitivity effectively improved. Long-term studies are needed to evaluate whether multiple sessions of breathing exercises can restore basal vascular reactivity and reduce cardiovascular risk in these patients.

Siddha medicine and modern neuroscience: a synergistic approach to neurological care

Neurological disorders burden modern healthcare causing cognitive and emotional issues. The Siddha system offers a promising herbal and non-invasive-based therapy. This present review explores the neuromodulatory and neuroprotective effects of the Siddha system integrating herbal and non-invasive interventions with modern neuroscience for a comprehensive treatment strategy against neurological disorders. A detailed literature review was conducted using sources, such as Google search engine, Web of Science, and published databases, focusing on keywords related to 'Siddha herbal, non-invasive, traditional approach for neurological disorders'. The findings indicate that Siddha-based herbal medicines exhibit significant pharmacological activities, which help slow the progression of neurological diseases. Additionally, Siddha-based non-invasive therapies, such as yoga, meditation, Varma (traditional pressure point therapy), massage, and other external manipulations, have been reported to significantly increase brain activity, improve cognitive function, and enhance the patient's quality of life. The findings suggest that complementing Siddha-based therapy with modern neuroscience could enhance personalized neurological care in patients. Although Siddha has a rich history in traditional medicine, a significant research gap remains in large-scale clinical trials, treatment standardization, pharmacological validation, and mechanistic understanding. Addressing these gaps could enhance clinical utility in contemporary healthcare, ultimately benefitting brain health and overall well-being. Integrating Siddha medicine with modern neuroscience holds promise for advancing neurological care.

Nurturing Resilience and Healing from Within: The Impact of an 8-Week Yoga Program on Nursing Students

Background/Objectives: Nursing students encounter significant stress due to the demanding nature of their academic and clinical training, negatively impacting their mental health and overall wellbeing. Self-care strategies, such as yoga, have been suggested to effectively manage stress and promote resilience. Despite the growing recognition of the importance of self-care in nursing education, there is limited research on the specific benefits of yoga. This study aimed to explore the experiences and perceived benefits associated with undergraduate nursing students' participation in an 8-week yoga study. Methods: A qualitative study using a hermeneutic phenomenological approach was conducted. Participants were Baccalaureate nursing students from an Australian university. Data were collected through semi-structured interviews and analysed using reflexive thematic analysis. Reporting methods followed the consolidated criteria for reporting qualitative research guidelines. Results: Among the 14 students who participated, three main themes emerged: "Me Time", highlighting the importance of prioritising self-care; "Slowing Down," emphasising the psychological benefits of yoga; and "Self-Acceptance," reflecting personal growth and improved self-awareness. Participants reported reduced stress, improved mood, and enhanced physical and mental wellbeing. Conclusion: Students who participated in yoga were positively impacted through greater stress management and wellbeing. As nursing students transition into the workplace, the ability to manage stress and maintain mental wellbeing becomes even more critical. The high-pressure environment of healthcare settings can exacerbate stress, leading to burnout and decreased job satisfaction. By incorporating self-care practices such as yoga into their routine, nursing students can develop resilience and coping mechanisms that will benefit them as students and throughout their careers.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

Impact of combined high-intensity bodyweight interval training and breathing exercise on cardiometabolic health in normal-weight middle-aged adults with hypertension

BACKGROUND

High-intensity interval training and breathing exercises alone have well-documented health benefits in people with hypertension. This study aimed to investigated the effects of combining the two methods on physical health among adults with hypertension.

METHODS

Ninety-six adults (59.4 ± 9.1 years; 84% female; BMI 22.7 ± 1.6 kg/m2) with hypertension were randomized into one of four groups: Breathing Exercise (BE), High-Intensity Bodyweight Interval Training (HIBIT), Combined Exercise (CE), or a Non-Exercise Control (CON) group. The intervention lasted 10 weeks, with all exercise groups having the same total training time of 3 days per week (BE: 30 min/day; HIBIT: 60 min/day; CE: BE 30 min/day plus HIBIT 60 min/day). Resting heart rate, resting blood pressure, hand grip strength, cardiorespiratory fitness assessed using 6-Minute Walking Test (6MWT) and blood lipids were measured pre- and post-intervention.

RESULTS

The BE group showed the greatest reduction in systolic blood pressure (SBP) compared to CON, although differences among the exercise groups were not statistically significant. The increase in 6MWT values in the combined exercise group differed significantly compared to the other three groups (p = 0.000 and effect size = 0.296). The combined exercise group showed significant reductions in total cholesterol, LDL and triglyceride levels compared to the control group. The average reduction in total cholesterol levels was 20.8 mg/dL (95% C: -41.9 - 0.4) with an effect size of 0.103. Meanwhile, the decrease in LDL and triglyceride levels was 20.1 mg/dL (95% CI: -37.6--2.5; p = 0.014) and -40.4 mg/dL (95% CI: -82.1-1.3; p = 0.04) with effect sizes of 0.118 and 0.101.

CONCLUSIONS

In conclusion combined exercise for 10 weeks could lower systolic and diastolic blood pressure, increase CRF, and improved lipid profile. As a clinical implication, the results of this study can be an alternative or complementary approach to treatment for hypertension, potentially reducing the need for medications and their associated side effects.

TRIAL REGISTRATION

TCTR20230707003 ( http://www.

CLINICALTRIALS

in.th/ ) registered on 28 January 2023.

Heart Rate Variability Biofeedback Training Can Improve Menopausal Symptoms and Psychological Well-Being in Women with a Diagnosis of Primary Breast Cancer: A Longitudinal Randomized Controlled Trial

Breast cancer survivors experience numerous chronic symptoms linked to autonomic dysfunction including anxiety, stress, insomnia, menopausal symptoms, and cognitive impairment. Effective non-pharmacological solutions to address these are currently lacking.

METHODS

Our three-armed longitudinal randomized controlled trial assessed the effectiveness of a 4-week remote smartphone-based heart rate variability biofeedback intervention which involved daily paced breathing at 6 breaths p/min; active (12 breaths p/min) and waitlist controls were included. Heart rate variability and self-reported cancer-related symptoms were assessed at baseline, post-, and 6 months-post intervention. Participants were 60 UK-based women with primary breast cancer history (6 to 60 months post-active treatment).

RESULTS

The intervention group showed significant increases in low-frequency heart rate variability over time (F (4, 103.89) = 2.862, p = 0.027, d = 0.33), long-lasting improvement in sleep quality (F (4, 88.04) = 4.87, p = 0.001, d = 0.43) and cessations in night sweats (X2 (2, N = 59) = 6.44, p = 0.04, Cramer's V = 0.33), and reduced anxiety post-intervention compared to the active and waitlist controls (F (4, 82.51) = 2.99, p = 0.023, d = 0.44). Other findings indicated that the intervention and active control participants reported lasting improvements in cognitive function, fatigue, and stress-related symptoms (all ps < 0.05). The waitlist group reported no symptom changes across time.

CONCLUSION

Heart rate variability biofeedback is a feasible intervention for addressing diverse chronic symptoms commonly reported by breast cancer survivors.

Mind the Breath: Feasibility of Capnography-Assisted Learned Monitored (CALM) Breathing for Dyspnea Treatment

PURPOSE

To evaluate the feasibility and acceptability of Capnography-Assisted Learned Monitored (CALM) Breathing, a carbon dioxide (CO 2 ) biofeedback, and motivational interviewing intervention, to treat dyspnea and anxiety together.

METHODS

We randomized adults (n = 42) with chronic obstructive pulmonary disease (COPD) to a 4-week, 8-session intervention (CALM Breathing, n = 20) or usual care (n = 22). The CALM Breathing intervention consisted of tailored, slow nasal breathing exercises, capnography biofeedback, motivational interviewing, and a home breathing exercise program. The intervention targeted unlearning dysfunctional breathing behaviors. All participants were offered outpatient pulmonary rehabilitation (PR) in the second phase of the study. The primary outcomes were feasibility and acceptability of CALM Breathing. Exploratory secondary outcomes included respiratory and mood symptoms, physiological and exercise tolerance measures, quality of life, and PR uptake.

RESULTS

Attendance at CALM Breathing sessions was 84%, dropout was 5%, and home exercise completion was 90% and 73% based on paper and device logs, respectively. Satisfaction with CALM Breathing therapy was rated as "good" to "excellent" by 92% of participants. Significantly greater between-group improvements in secondary outcomes-respiratory symptoms, activity avoidance, oxygen saturation (SpO 2 ), end-tidal CO 2 , and breathing self-regulation (interoception)-were found post-intervention at 6 weeks in support of CALM Breathing compared with usual care. At 3 months (after PR initiation), statistically significant between-group differences in Borg dyspnea and SpO 2 post-6-minute walk test were identified also supporting CALM Breathing.

CONCLUSIONS

Patient-centered CALM Breathing was feasible and acceptable in adults with COPD and dyspnea anxiety. A CALM Breathing intervention may optimize dyspnea treatment and complement PR.

Breathing Pattern Disorder: Translating Breathing at Rest to Exercise

Breathing pattern disorder (BPD) is an abnormal pattern of ventilation and movements of the upper and lower ribcage and abdomen that results in a constellation of symptoms. This paper discusses the management of BPD from a technical standpoint. Since there is not a one-size-fits-all model for practice, we offer a toolbox approach to care with quick reference tables and diagrams that allow the practitioner to easily find treatement approaches that may suite their athlete. While this article uses the athlete as a reference for treatment, there is also a consideration for how to approach the co-morbid patient as well.

Exhaled Breath Analysis: From Laboratory Test to Wearable Sensing

Breath analysis and monitoring have emerged as pivotal components in both clinical research and daily health management, particularly in addressing the global health challenges posed by respiratory and metabolic disorders. The advancement of breath analysis strategies necessitates a multidisciplinary approach, seamlessly integrating expertise from medicine, biology, engineering, and materials science. Recent innovations in laboratory methodologies and wearable sensing technologies have ushered in an era of precise, real-time, and in situ breath analysis and monitoring. This comprehensive review elucidates the physical and chemical aspects of breath analysis, encompassing respiratory parameters and both volatile and non-volatile constituents. It emphasizes their physiological and clinical significance, while also exploring cutting-edge laboratory testing techniques and state-of-the-art wearable devices. Furthermore, the review delves into the application of sophisticated data processing technologies in the burgeoning field of breathomics and examines the potential of breath control in human-machine interaction paradigms. Additionally, it provides insights into the challenges of translating innovative laboratory and wearable concepts into mainstream clinical and daily practice. Continued innovation and interdisciplinary collaboration will drive progress in breath analysis, potentially revolutionizing personalized medicine through entirely non-invasive breath methodology.

Adverse Effects of Meditation: Autonomic Nervous System Activation and Individual Nauseous Responses During Samadhi Meditation in the Czech Republic

Buddhist meditation practices, including Samadhi meditation, which forms the basis for mindfulness practice, are broadly promoted as pathways to wellbeing, but evidence of their adverse effects is emerging. In a single-group observational study with assessments of autonomic system before, during, and after Samadhi meditation, we explore the relationship between post-meditation nausea symptoms and the degree of change in autonomic system activity during meditation as compared to before and after in 57 university students (42 women; mean age = 22.6) without any previous experience in meditation or yoga practices. We hypothesize that nauseous feelings in meditation are connected to a rapid increase of activity in the sympathetic nervous system, as indicated by decreased heart-rate variability (HRV). We additionally explore links between meditation-induced nausea and two markers of parasympathetic activity: increased HRV and vasovagal syncope. Engaging in meditation and increased nausea during meditation were both associated with increased markers of HRV parasympathetic activity, but 12 individuals with markedly higher nausea demonstrated increased HRV markers of sympathetic activity during meditation. Vasovagal syncope was observed but found to be unrelated to nausea levels. Drivers of adverse effects of meditation in some individuals require further investigation.

Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults

BACKGROUND

This study investigated the immediate effects of structured deep breathing (SDB) and natural deep breathing (NDB) on heart rate variability (HRV) and blood pressure (BP) in community-dwelling older adults.

METHODS

Twenty-six participants were randomly assigned to SDB (n = 14) or NDB (n = 12) groups. HRV parameters (time domain: standard deviation of normal-to-normal intervals [SDNN], root mean square of successive differences [RMSSD]; frequency domain: low frequency [LF], high frequency [HF], LF/HF ratio, total power [TP], normalized low frequency [LFnu], normalized high frequency [HFnu]) and BP were assessed during spontaneous breathing, DB, and post DB.

RESULTS

Both groups showed significant increases during DB in SDNN (p < 0.001), RMSSD (p = 0.021), LF power (p < 0.001), LFnu (p < 0.001), TP (p < 0.001), and LF/HF ratio (p < 0.001). HFnu decreased significantly during DB (p < 0.001) with no group differences. HF power showed no significant effect in group and time. BP remained stable throughout the protocol, with no significant changes in either systolic or diastolic BP across time points or between groups.

CONCLUSIONS

This first direct comparison of structured versus natural DB in healthy older adults demonstrates that both approaches effectively enhance parasympathetic activity. These findings support DB as a cost-effective, accessible intervention for promoting autonomic balance in healthy aging, without requiring specialized equipment or instruction.

Effects of Heart Rate Variability Biofeedback Training on Anxiety Reduction and Brain Activity: a Randomized Active-Controlled Study Using EEG

Heart rate variability biofeedback (HRVBF) is a promising anxiety-reducing intervention that increases vagally-mediated heart rate variability (vmHRV) through slow-paced breathing and feedback of heart rhythm. Several studies have reported the anxiety-reducing effects of HRVBF; however, some studies have reported such training as ineffective. Furthermore, the effects of training and underlying brain activity changes remain unclear. This study examined the anxiety-reducing effects of HRVBF training and related brain activity changes by randomly assigning participants, employing an active control group, and measuring anxiety-related attentional bias using the emotional Stroop task and electroencephalography (EEG). Fifty-five healthy students with anxiety were randomly assigned to the HRVBF or control groups, and 21 in the HRVBF group and 19 in the control group were included in the analysis. Both groups performed 10 training sessions of 20 min each within 3 weeks. They were assessed using resting vmHRV, event-related potential (ERP), time-frequency EEG, attentional bias, and the State-Trait Anxiety Inventory-JYZ (STAI-JYZ) before and after training. The results demonstrated increased resting vmHRV in the HRVBF group compared to the control group after training. However, no differences were observed in ERP, time-frequency EEG, attentional bias, and STAI-JYZ. Participants with higher pre-training resting vmHRV achieved higher heart rhythm coherence in HRVBF training and had reduced attentional bias. This study suggests that individuals with higher resting vmHRV are more likely to be proficient in HRVBF training and benefit from its anxiety-reducing effects. The findings contribute to participant selection to benefit from HRVBF training and modification of the training protocols for non-responders.Clinical trial registrationOrganization: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), JapanRegistration number: UMIN000047096Registration date: March 6, 2022.

Neurobiological and Anti-Inflammatory Effects of a Deep Diaphragmatic Breathing Technique Based on Neofunctional Psychotherapy: A Pilot RCT

We examined the feasibility of using the neofunctional deep breathing (NDB) technique to reduce the allostatic load following the Trier Social Stress Test (TSST). Forty-four healthy subjects were randomised into experimental and control groups. Following the TSST procedure, participants underwent either a single session of NDB or an attention control intervention. The Procomp Infinity Biofeedback system measured breath per minute (BPM), respiratory amplitude, HRV linear domains, skin conductance, and trapezius muscle electromyographic activity. Cortisol and cytokine salivary concentrations, perceived stress, and anxiety levels were also assessed. These parameters were combined into an allostatic load index (ALI) to measure the intervention's effect. This pilot RCT demonstrated the feasibility of the study design and practicality of the intervention. The NDB group showed reduced ALI, increased respiratory abdominal amplitude, decreased BPM, increased HRV indicating parasympathetic activation, and decreased cortisol and inflammatory cytokines. This study highlighted the feasibility of testing the NDB technique in reducing allostatic load through a neurobiological and anti-inflammatory response after exposure to psychosocial stress. This protocol can represent a non-invasive therapeutic adjutant in disorders related to a dysregulation of the HPA axis or to an inflammatory state. Trial Registration: NCT04102813.

What can the psychoneuroimmunology of yoga teach us about depression's psychopathology?

Depression, the most prevailing mental health condition, remains untreated in over 30% of patients. This cluster presents with sub-clinical inflammation. Investigations trialling anti-inflammatory medications had mixed results. The lack of results may result from inflammation's complexity and targeting only a few of depression's abnormal pathways. Mind-body therapies' biological and neuro-imaging studies offer valuable insights into depression psychopathology. Interestingly, mind-body therapies, like yoga, reverse the aberrant pathways in depression. These aberrant pathways include decreased cognitive function, interoception, neuroplasticity, salience and default mode networks connectivity, parasympathetic tone, increased hypothalamic-pituitary-adrenal (HPA) axis activity, and metabolic hyper/hypofunction. Abundant evidence found yogic techniques improving self-reported depressive symptoms across various populations. Yoga may be more effective in treating depression in conjunction with pharmacological and cognitive therapies. Yoga's psychoneuroimmunology teaches us that reducing allostatic load is crucial in improving depressive symptoms. Mind-body therapies promote parasympathetic tone, downregulate the HPA axis, reduce inflammation and boost immunity. The reduced inflammation promotes neuroplasticity and, subsequently, neurogenesis. Improving interoception resolves the metabolic needs prediction error and restores homeostasis. Additionally, by improving functional connectivity within the salience network, they restore the dynamic switching between the default mode and central executive networks, reducing rumination and mind-wandering. Future investigations should engineer therapies targeting the mechanisms mentioned above. The creation of multi-disciplinary health teams offering a combination of pharmacological, gene, neurofeedback, behavioural, mind-body and psychological therapies may treat treatment-resistant depression.

Yoga-Based Group Intervention for Inpatients with Schizophrenia Spectrum Disorders-Feasibility, Acceptability, and Preliminary Outcomes of a Rater-Blinded Randomized Controlled Trial

BACKGROUND AND HYPOTHESIS

The efficacy of yoga as an adjunctive treatment for schizophrenia spectrum disorders (SSD) has garnered interest. While yoga may positively influence various symptom domains, further investigation is needed due to the limited number, quality, and generalizability of studies. This study assessed the feasibility and acceptability (primary outcome) of a yoga-based group intervention (YoGI) developed in a participatory approach and explored its preliminary effectiveness.

STUDY DESIGN

In addition to the primary outcomes, this preregistered randomized controlled trial examined rater-blinded general psychopathology, positive- and negative symptoms, and self-rated depression, anxiety, stress, body mindfulness, mindfulness, psychological flexibility, cognition, social functioning, quality of life, and medication regime at baseline and postintervention as secondary outcomes.

STUDY RESULTS

Fifty inpatients with SSD received either TAU (n = 25) or YoGI + TAU (n = 25) for four weeks. Outcomes showed 95% protocol adherence of YoGI, feasibility, and retention rates of 91% and 94%, respectively, and a dropout rate of 6%. ANCOVA revealed significant between-group postintervention improvements for YoGI + TAU in positive symptoms, depression, cognitive fusion, and a mindfulness subscale. Medium-to-large pre- to postintervention effects were found for body mindfulness, positive, negative, and general psychopathology, cognitive fusion, depression, anxiety, stress, quality of life, and attention in YoGI + TAU, while within-group changes were consistently smaller in TAU. No severe adverse events were reported.

CONCLUSIONS

This trial supports the feasibility and acceptability of YoGI for inpatients with SSD and provides preliminary evidence of YoGI's benefits beyond TAU. Further robust, multicentric RCTs are warranted to deepen our understanding of YoGI's therapeutic potential and inform clinical interventions for SSD.

Clinical effectiveness of guided breathing exercises in reducing anxiety, stress, and depression in COVID-19 patients

The COVID-19 pandemic has led to an increase in the prevalence of anxiety, stress and depression among affected people. This study was conducted with the aim of investigating the clinical effectiveness of guided breathing exercises in reducing anxiety, stress and depression in patients with COVID-19. A quasi-experimental study design was used, involving a sample of COVID-19 patients who underwent guided breathing exercises as a complementary therapy. After simple sampling, eligible subjects were randomly divided into two groups: intervention (30 patients) and control (30 patients) using random block method. The Depression Anxiety Stress Scale-21 (DASS-21) questionnaire was administered before and after the intervention to evaluate changes in anxiety, stress, and depression levels. The results of this study demonstrated that clinically guided breathing exercises had a significant effect on reducing anxiety and stress in COVID-19 patients. The intervention significantly reduced anxiety and stress scores (p < 0.001). However, there was no significant reduction in depression scores among patients who participated in guided breathing exercises (p = 0.946). Guided breathing exercises are an effective complementary technique in reducing the level of anxiety and stress in COVID-19 patients. Moreover, the exercises may provide a worthy non-pharmacological approach to managing psychological distress in COVID-19 patients.

A randomized controlled clinical trial of a Wim Hof Method intervention in women with high depressive symptoms

Objective

Stress is a driver of depression, and people with depression often struggle to cope with stress and anxiety. This study directly compares the mental health effects of a Wim Hof Method intervention to an active control condition (slow breathing) in women with high stress and high depressive symptoms.

Methods

We randomized 84 healthy midlife women with high stress and high depressive symptoms to either: 1) the hormetic stress condition based on the Wim Hof Method (WHM) involving a breathing technique designed to induce intermittent hypoxia and cold showers (n = 41) or 2) an active comparison condition involving slow-paced breathing and warm showers (n = 43). We provided participants with daily audio instructions (15 min) for three weeks during the COVID-19 pandemic (2020-2021). Our primary outcomes were depressive symptoms, anxiety symptoms, and perceived stress collected at pre-intervention, post-intervention, and 3 months later. We also assessed daily stress rumination and affect with daily diary during the intervention, and participants completed a laboratory stressor, the Trier Social Stress Test, before and after the intervention, and provided samples for salivary cortisol reactivity.

Results

Participants in the active control condition perceived the intervention to be more credible and expected greater mental wellbeing benefits compared to those in the Wim Hof Method condition. Differential attrition was observed with six participants (7 %) dropping out -- all from WHM condition. Among the participants who completed the intervention, both groups improved on mental health outcomes immediately after the intervention with a 24 % reduction in depressive symptoms, a 27 % reduction in anxiety symptoms, and 20 % reduction in perceived stress. Improvements were maintained at the 3-month follow-up with 46 % of the sample reporting mild or no depressive symptoms. Participants in the WHM condition had significant reductions in rumination after daily stressful events compared to those in the active control group. Both conditions had reduced daily negative affect across the intervention and lower peak cortisol reactivity to the lab stressor post-intervention.

Conclusions

Counter to the preregistered predictions, and despite participants' differing expectations, the interventions led to equivalent reductions in depressive symptoms, anxiety symptoms, and perceived stress, which were sustained at three months. They also produced comparable reductions in cortisol reactivity and daily negative affect. However, the WHM condition was associated with greater reduction in reported rumination after daily stressful events than the active control, a finding that needs replication with larger and more diverse samples.

Exploring neural markers of dereification in meditation based on EEG and personalized models of electrophysiological brain states

With mounting evidence for the benefits of meditation, there has been a growing interest in measuring and quantifying meditative states. This study introduces the Inner Dereification Index (IDI), a class of personalized models designed to quantify the distance from non-meditative states such as mind wandering based on a single individual's neural activity. In addition to demonstrating high classification accuracy (median AUC: 0.996) at distinguishing meditation from thinking states moment by moment, IDI can accurately stratify meditator cohorts by experience, and correctly identify the practices most effective at training the dereification aspect of meditation (decentering from immersion with thoughts and perceptions and recognizing them as mental constructs). These results suggest that IDI models may be a useful real-time proxy for dereification and meditation progress, requiring only 1 min of mind wandering data (and no meditation data) during model training. Thus, they show promise for applications such as real-time meditation feedback, progress tracking, personalization of practices, and potential therapeutic applications of neurofeedback-assisted generation of positive states of consciousness.

Indicators of emotional distress and mindfulness in undergraduate students: a cross-sectional study

OBJECTIVES

to assess the association between indicators of emotional distress and dispositional mindfulness in health students at a Brazilian federal public university.

METHODS

a cross-sectional study, developed with university students in the health area of a public institution from May to June 2022. In the analysis, multiple linear regression was used using SPSS software.

RESULTS

the sample was mostly female, ≤ 22 years old, non-white, studying the first semesters, with a higher prevalence for the medicine course. Students presented moderate dispositional mindfulness scores. It was observed that the variables of stress, depression and current suicide risk were associated with the capacity for mindfulness.

CONCLUSIONS

knowing the indicators of emotional distress that are related to the potential of mindfulness can contribute as a situational diagnosis to better design strategies that promote the improvement of emotional indicators of health students.

Slow-Paced Breathing Intervention in Healthcare Workers Affected by Long COVID: Effects on Systemic and Dysfunctional Breathing Symptoms, Manual Dexterity and HRV

BACKGROUND

Many COVID-19 survivors still experience long-term effects of an acute infection, most often characterised by neurological, cognitive and psychiatric sequelae. The treatment of this condition is challenging, and many hypotheses have been proposed. Non-invasive vagus nerve stimulation using slow-paced breathing (SPB) could stimulate both central nervous system areas and parasympathetic autonomic pathways, leading to neuromodulation and a reduction in inflammation. The aim of the present study was to evaluate physical, cognitive, emotional symptoms, executive functions and autonomic cardiac modulation after one month of at-home slow breathing intervention.

METHODS

6655 healthcare workers (HCWs) were contacted via a company email in November 2022, of which N = 58 HCWs were enrolled as long COVID (cases) and N = 53 HCWs as controls. A baseline comparison of the two groups was performed. Subsequently each case was instructed on how to perform a resonant SPB using visual heart rate variability (HRV) biofeedback. They were then given a mobile video tutorial breathing protocol and asked to perform it three times a day (morning, early afternoon and before sleep). N = 33 cases completed the FU. At T0 and T1, each subject underwent COVID-related, psychosomatic and dysfunctional breathing questionnaires coupled with heart rate variability and manual dexterity assessments.

RESULTS

After one month of home intervention, an overall improvement in long-COVID symptoms was observed: confusion/cognitive impairment, chest pain, asthenia, headache and dizziness decreased significantly, while only a small increase in manual dexterity was found, and no relevant changes in cardiac parasympathetic modulation were observed.

Autonomic nervous system activity correlates with peak experiences induced by DMT and predicts increases in well-being

BACKGROUND

Non-ordinary states of consciousness induced by psychedelics can be accompanied by so-called "peak experiences," characterized at the emotional level by their intensity and positive valence. These experiences are strong predictors of positive outcomes following psychedelic-assisted therapy, and it is therefore important to better understand their biology. Despite growing evidence that the autonomic nervous system (ANS) plays an important role in mediating emotional experiences, its involvement in the psychedelic experience is poorly understood. The aim of this study was to investigate to what extent changes in the relative influence of the sympathetic (SNS) and parasympathetic nervous systems (PNS) over cardiac activity may reflect the subjective experience induced by the short-acting psychedelic N,N-Dimethyltryptamine (DMT).

METHODS

We derived measures of SNS and PNS activity from the electrocardiograms of 17 participants (11 males, mean age = 33.8 years, SD = 8.3) while they received either DMT or placebo.

RESULTS

Results show that the joint influence of SNS and PNS ("sympathovagal coactivation") over cardiac activity was positively related to participants' ratings of "Spiritual Experience" and "Insightfulness" during the DMT experience, while also being related to improved well-being scores 2 weeks after the session. In addition, we found that the state of balance between the two ANS branches ("sympathovagal balance") before DMT injection predicted scores of "Insightfulness" during the DMT experience, as well as subsequent sympathovagal coactivation.

CONCLUSION

These findings demonstrate the involvement of the ANS in psychedelic-induced peak experiences and may pave the way to the development of biofeedback-based tools to enhance psychedelic therapy.

Effects of Vibroacoustic Stimulation on Psychological, Physiological, and Cognitive Stress

Global stress is widespread in today's post-pandemic world of political and economic uncertainty. Vibroacoustic technology is a vibrotactile intervention with multiple uses, but its impact on stress lacks interpretation. This research assessed if the vibroacoustic technology of a Vibroacoustic Sound Massage (VSM) can reduce psychological, physiological, and cognitive stress. The Perceived Stress Scale (PSS-10) and electrocardiogram (ECG) and electroencephalogram (EEG) biosignals were used to quantify results. Participants were divided into Low-Stress and High-Stress groups. The ECG results show VSM increased parasympathetic activity for all participants, with the Low-Stress group being more affected. The EEG results indicate increased concentration, reduced arousal, and increased relaxation, with participant well-being non-significantly affected, though variability in this metric was homogenised after VSM. Together, these results validate VSM as an effective support tool for stress management; however, further research is required.

The Effects of Heart Rhythm Meditation on Vagal Tone and Well-being: A Mixed Methods Research Study

Many studies have examined the effects of meditation practice focused on the normal breath on vagal tone with mixed results. Heart Rhythm Meditation (HRM) is a unique meditation form that engages in the deep slow full breath, and puts the focus of attention on the heart. This form of breathing likely stimulates the vagus nerve with greater intensity. The purpose of this study was (a) to examine how the practice of HRM affects vagal activity as measured by heart rate variability (HRV); and (b) to examine how it affects participants' well-being. 74 participants signed consent agreeing to: (a) take a six-week course to learn the practice of HRM; (b) engage in a daily practice for 10 weeks; (c) have their heart rate variability read through ECG technology and to take two validated well-being instruments at the beginning and end of the 10 weeks; and (d) participate in a focus group interview examining their perceptions of how the practice affected their well-being. 48 participants completed the study. Quantitative findings show the effect of the practice of HRM approached significance for multiple measures of HRV and vagal tone. An increase in well-being scores for those who did the meditation more than 10-minutes per day did meet statistical significance. Qualitative data indicate: (a) the positive effects of HRM on stress and well-being; (b) the development of a more expanded sense of self; and (c) an increased awareness of the interconnection of the body-heart-emotions and HRM's role in emotion regulation.

A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations

Aim: Nurses are well-qualified to deliver integrative complementary therapy interventions, a holistic approach to assist individuals experiencing anxiety and stress. Self-regulated, controlled breathing exercises (a clinical approach) are reported to decrease anxiety and increase stress tolerance. The aim of this systematic review was to evaluate the effectiveness of breathing exercise interventions on the psychological and physiologic outcomes of anxiety and stress among adults and assess the state of the science in the post-COVID-19 population. Methods: A systematic review was conducted, and four scientific databases were searched: PubMed, CINAHL, EMBASE, and Web of Science. Inclusion criteria included: (1) peer-reviewed studies, (2) adults over 18, (3) breathing exercise interventions, and (4) anxiety or stress as outcomes. Results: Out of 309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population.

Progressive Muscular Relaxation Versus Breathing Excercise Techniques to Control Blood Pressure among Mild Preeclamptic Pregnant Women

Background

Hypertensive disturbances during pregnancy are the leading cause of maternal and fetal death; unfortunately, no effective treatment exists. Therefore, interventions that reduce the likelihood of developing preeclampsia during pregnancy are required. This study aimed to see how Progressive Muscle Relaxation (PMR) compared to breathing exercise techniques affected Blood Pressure (BP) levels among mildly preeclamptic pregnant women.

Materials and Methods

A convenience sample was used in a quasi-experimental study of 75 mild preeclamptic pregnant women in the Obstetrical Outpatient Clinics at the Suez Canal University Hospital in Ismailia, Egypt. They were divided into three groups: study group [I]: the deep breathing exercise group; study group [II]: the PMR group; and study group [III]: the control group. Data were collected using two methods: an interviewing information collection tool and a physiological measurement tool.

Results

There was a statistical significant difference in systolic and diastolic blood pressure after six weeks of training among intervention groups (PMR and breathing excercise technique with p value 0.001 for both groups) compered to contol group. However, there was no statistical difference in BP (systolic or diastolic) after two weeks of intervention among the three groups.

Conclusions

PMR and breathing techniques could effectively control BP in pregnancy complicated by mild preeclampsia. Both techniques could be introduced in routine antenatal care for women diagnosed with mild preeclampsia. Health and fitness professionals should focus more on preparing and delivering various sports programs incorporating various muscle relaxations and breathing techniques.

Acute cardiac autonomic and hemodynamic responses to resistive breathing: Effect of loading type and intensity

OBJECTIVES

This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults.

METHODS

A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial.

RESULTS

The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal-to-normal RR intervals, the square root of the mean squared difference of successive normal-to-normal RR intervals and high-frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end-diastolic volume and end-diastolic volume index, compared to other loaded protocols (all p < 0.001).

CONCLUSION

These findings highlight the acute effect of type-specific and load-dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations.

Silence between words: Is solitude important for relatedness?

Chronic loneliness is a risk factor for physical and health problems, in part due to dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system. In contrast, temporary moments of positive solitude (passing good times alone and not feeling lonely) appear to have positive effects on mental health, social life, and creativity, and seems to be a buffer against loneliness. Herein, three ways of how solitude may have positive effects on health and relatedness are discussed, namely effects on enhancement of mind-wandering, interoceptive awareness, and spirituality. Solitude may facilitate (1) activation of the default mode network (DMN) underlying mind-wandering including daydreaming about other people; (2) activation of brain areas supporting interoceptive awareness; (3) deactivation of prefrontal cortex, or deactivation and decreased connectivity of the DMN, giving raise to susceptibility to spiritual experiences. The capacity to handle and enjoy solitude is a developmental process that may be difficult for many persons. Craving for social connections and external stimulation with digital technologies (e.g., internet, smartphones, social media) might be interfering with the development of the capacity for solitude and thereby increasing loneliness; this might be partly due to impaired interoceptive awareness and impaired functional mind-wandering (common in solitude). Congruently, overuse of digital technologies was associated with reduced activity, and reduced gray matter volume and density, in brain areas supporting interoceptive awareness, as well as with decreased connectivity of the DMN supporting creative insights. Solitude has been a relatively dismissed topic in neuroscience and health sciences, but a growing number of studies is highlighting its importance for well-being.

Towards virtual reality exposure therapy for cocaine use disorder: A feasibility study of inducing cocaine craving through virtual reality

Background

Craving is a core symptom of cocaine use disorders (CUD). Inducing craving in exposure to substance cues is of relevant interest for numerous clinical applications. Virtual reality exposure (VRE) might be a promising candidate for improving cue-exposure paradigms but remains almost not studied for cocaine. This feasibility study's main aim is to assess whether VRE to cocaine cues is capable to induce cocaine craving compared with VRE to neutral cues.

Methods

We conducted a within-subjects controlled trial in which cocaine users performed 3 consecutive 10 mins-tasks: VRE to neutral and cocaine cues, and a relaxation-based resting procedure. The primary outcome was the change in Cocaine Craving Questionnaire-Brief (CCQ-Brief) scores between VRE to neutral and cocaine cues. Secondary outcomes included between-tasks changes in scores of cocaine craving, pleasant/unpleasant emotions as well as self-efficacy to cope with craving.

Results

We recruited 11 chronic cocaine users including mostly crack smokers (45 %), cocaine snorters (36 %) and injectors (18 %), with 73 % of participants meeting DSM-IV criteria for cocaine dependence and/or abuse. Non-parametrical sign tests indicated significant large increases of CCQ-Brief scores from neutral to cocaine cue-VRE (S(11) = 11, p < 0.01, Cliff's Δ = 0.65, 95 % CI: 0.17-0.88). Exploratory comparative analyses indicated significant changes after our post-cues VRE relaxation procedure, with cocaine craving and emotions restored to baseline.

Conclusions

VRE to cocaine cues was feasible and capable to induce cocaine craving in cocaine users. This second VRE-based cue-reactivity study in cocaine paves the way for unexplored research on VRE clinical applications for CUD.

Vagus nerve stimulation for the treatment of epilepsy: things to note on the protocols, the effects and the mechanisms of action

Epilepsy is a chronic brain disorder that is characterized by repetitive un-triggered seizures that occur severally within 24 h or more. Non-pharmacological methods for the management of epilepsy were discussed. The non-pharmacological methods include the vagus nerve stimulation (VNS) which is subdivided into invasive and non-invasive techniques. For the non-invasive techniques, the auricular VNS, stimulation of the cervical branch of vagus nerve in the neck, manual massage of the neck, and respiratory vagal nerve stimulation were discussed. Similarly, the stimulation parameters used and the mechanisms of actions through which VNS improves seizures were also discussed. Use of VNS to reduce seizure frequency has come a long way. However, considering the cost and side effects of the invasive method, non-invasive techniques should be given a renewed attention. In particular, respiratory vagal nerve stimulation should be considered. In doing this, the patients should for instance carry out slow-deep breathing exercise 6 to 8 times every 3 h during the waking hours. Slow-deep breathing can be carried out by the patients on their own; therefore this can serve as a form of self-management.HIGHLIGHTSEpilepsy can interfere with the patients' ability to carry out their daily activities and ultimately affect their quality of life.Medications are used to manage epilepsy; but they often have their serious side effects.Vagus nerve stimulation (VNS) is gaining ground especially in the management of refractory epilepsy.The VNS is administered through either the invasive or the non-invasive methodsThe invasive method of VNS like the medication has potential side effects, and can be costly.The non-invasive method includes auricular VNS, stimulation of the neck muscles and skin and respiratory vagal nerve stimulation via slow-deep breathing exercises.The respiratory vagal nerve stimulation via slow-deep breathing exercises seems easy to administer even by the patients themselves.Consequently, it is our opinion that patients with epilepsy be made to carry out slow-deep breathing exercise 6-8 times every 3 h during the waking hours.

Short-Term Effects of Heart Rate Variability Biofeedback on Working Memory

Drawing upon the well-documented impact of long-term heart rate variability biofeedback (HRVB) on psychophysiological responses, this study seeks to explore the short-term effects arising from a single HRVB session during and after paced breathing exercise. The research aligns with the neurovisceral integration model, emphasizing the link between heart rate variability (HRV) levels and cognitive performance. Therefore, a randomized controlled trial employing a between-subjects design was conducted with 38 participants. Each participant was assigned to either the paced breathing intervention group or the spontaneous breathing control group. The study assessed various parameters such as cardiac vagal tone, evaluated through vagally mediated HRV measures, and working memory, measured using the N-back task. Additionally, participants' affective states were assessed through self-reported questionnaires, specifically targeting attentiveness, fatigue, and serenity. The results notably reveal enhancements in the working memory task and an elevated state of relaxation and attention following the HRVB session, as evidenced by higher averages of correct responses, serenity and attentiveness scores. However, the findings suggest that this observed improvement is not influenced by changes in cardiac vagal tone, as assessed using a simple mediation analysis. In conclusion, this study presents promising insights into the impact of a single HRVB session, laying the foundation for future research advancements in this domain.

The effectiveness of an osteopathic manual technique compared with a breathing exercise on vagal tone as indicated by heart rate variability, a crossover study

INTRODUCTION

Parasympathetic nervous system (PSNS) function can be inferred by heart rate variability (HRV) providing indications about an individual's health. Manual therapy may influence PSNS function, however the research outcomes in this regard are equivocal. This study explored the PSNS effect of a measured breathing technique with suboccipital balanced ligamentous tension, an osteopathic manipulative therapy technique.

METHODS

Healthy adult participants in this crossover study (n = 18) were randomly allocated into two groups with differing order of interventions. A 1:1 breathing rate of 6 breaths per minute maintained for 5 min was compared to the osteopathic intervention. HRV was measured for 5 min before and after each intervention and analysed using the root mean square of successive differences (RMSSD) between normal heartbeats and high frequency normalised units (HFnu).

RESULTS

The RMSSD data demonstrated no significant difference between groups or within groups (p > 0.05) over time. HFnu results showed a significant between-group difference over the four time points (p = 0.004) with a medium effect size (ηp2 = 0.240), and no significant within-group difference (p > 0.05).

DISCUSSION

The osteopathic intervention raised HRV to a small extent, however measured breathing lowered HRV. In the group that received the osteopathic technique first, HFnu values continued to rise post-osteopathic treatment possibly indicating an increasing parasympathetic effect over time. Recommendations for future studies include changing the breathing ratio to ensure parasympathetic response, take into account potential delayed effects of interventions, consider outcome measures less variable than HRV, and longer follow up times.

CONCLUSION

This study suggests parasympathetic stimulation may occur with the application of suboccipital balanced ligamentous tension and sympathetic stimulation from measured breathing.

Stress reduction experiments in daily life: Scaling from the lab to the world

Paced breathing-longer exhalation than inhalation-can show short-term improvement of physiologic responses and affective well-being, though most studies have relied on narrow sample demographics, small samples, and control conditions that fail to address expectancy effects. We addressed these limitations through an app-based experiment where participants were randomly assigned to paced breathing or sham control (hand closure) conditions. We first validated the conditions in an online sample (N = 201; Study 1) and in a lab environment (N = 72; Study 2). In the primary app-based experiment, participants (N = 3,277; Study 3) completed 3 days of baseline assessments that included three check-ins each day in which we obtained heart rate and blood pressure responses using an optic sensor and assessed current stress and emotions. Participants were then randomly assigned to either the paced breathing or hand closure condition for the next 6 days. Relative to baseline days, both conditions were associated with increased positive emotions and perceived coping, and reduced blood pressure. Moreover, the increase in positive emotions and perceived coping was not evident among a comparison sample (N = 2,600) who completed check-ins but did not participate in either of the paced breathing or sham-control conditions. However, their blood pressure declined over time, suggesting that the continual monitoring of one's blood pressure may result in detectable decreases. Our results highlight the importance of designing experiments with appropriately matched control conditions and suggest that changes associated with techniques like paced breathing, in part, may stem from positive incidental features of the technique. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Virtual Reality Breathing Interventions for Mental Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Breathing exercises have been shown to reduce mental health problems among clinical and non-clinical populations. Although virtual reality (VR) breathing interventions are assumed to have potential benefits, it remains unclear whether VR breathing interventions are more effective at improving mental health than non-VR breathing interventions. We conducted a systematic literature search in six electronic databases (Web of Science, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Scopus, and PubMed) from inception to 30th September, 2022. We included randomized controlled trials in adults evaluating effects of VR compared to non-VR breathing interventions on primary outcomes of mental health (stress, anxiety and mood), and secondary outcomes of physiological stress measures (e.g., heart rate (HR), heart rate variability (HRV)). Within these selected studies, we explored differences in likeability and future use between VR and non-VR breathing interventions. 2.848 records were identified of which 65 full-text articles were assessed. Six RCTs were included, of which five were suitable for meta-analyses. Comparing VR to non-VR breathing interventions, there were no significant differences in overall mental health, stress, anxiety or mood, nor in HR or HRV. There was no evidence that participants liked VR breathing interventions more than non-VR, nor would use them more in the future. These results suggest that there is no evidence that VR breathing interventions are more effective than non-VR in improving mental health outcomes, HR, HRV. Further research is required to determine whether there may be advantages to longer-term VR-implementation and practice, and explore possible mechanisms.

Influence of Respiratory Frequency of Slow-Paced Breathing on Vagally-Mediated Heart Rate Variability

Breathing techniques, particularly slow-paced breathing (SPB), have gained popularity among athletes due to their potential to enhance performance by increasing cardiac vagal activity (CVA), which in turn can help manage stress and regulate emotions. However, it is still unclear whether the frequency of SPB affects its effectiveness in increasing CVA. Therefore, this study aimed to investigate the effects of a brief SPB intervention (i.e., 5 min) on CVA using heart rate variability (HRV) measurement as an index. A total of 75 athletes (22 female; Mage = 22.32; age range = 19-31) participated in the study, attending one lab session where they performed six breathing exercises, including SPB at different frequencies (5 cycles per minute (cpm), 5.5 cpm, 6 cpm, 6.5 cpm, 7 cpm), and a control condition of spontaneous breathing. The study found that CVA was significantly higher in all SPB conditions compared to the control condition, as indexed by both root mean square of the successive differences (RMSSD) and low-frequency HRV (LF-HRVms2). Interestingly, LF-HRVms2 was more sensitive in differentiating the respiratory frequencies than RMSSD. These results suggest that SPB at a range of 5 cpm to 7 cpm can be an effective method to increase CVA and potentially improve stress management and emotion regulation in athletes. This short SPB exercise can be a simple yet useful tool for athletes to use during competitive scenarios and short breaks in competitions. Overall, these findings highlight the potential benefits of incorporating SPB into athletes' training and competition routines.

Acute effects of the 4-4-8 breathing technique on arterial stiffness in healthy young men

BACKGROUND

Increased arterial stiffness is a risk factor for cardiovascular disease. Slow, deep breathing decreases blood pressure related to arterial stiffness. The objective of the present study was to determine the acute effects of a single session of slow breathing on arterial stiffness, blood pressure, and cardiac autonomic function.

METHODS

Fifteen healthy men (20 ± 0 years) were administered (a) a slow breathing condition (12 consecutive breaths of 4 s of inhalation, 4 s of pause, and 8 s of exhalation through the nose, approximately 5 min per breath) and (b) a control, two-condition crossover design. Carotid-femoral artery pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), brachial blood pressure, high frequency (HF) and low frequency (LF) were measured at baseline, 30 min, 60 min and 24 h after respiratory control.

RESULTS

Brachial-ankle PWV and brachial systolic pressure on the 4-4-8 breathing trial decreased after 30 min of respiratory control compared to baseline (p < 0.05), but did not change on the CON trial. Carotid-femoral PWV on both trials was unchanged; HF on the 4-4-8 breathing trial increased (p < 0.05) and LF decreased (p < 0.05) after 30 min of respiratory control compared to baseline, but was unchanged on the CON trial.

CONCLUSIONS

These results suggest that slow breathing techniques may be effective in modulating autonomic function and improving arterial stiffness in healthy young adults.

The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions

Healthcare is presently experiencing a global workforce crisis, marked by the inability of hospitals to retain qualified healthcare workers. Indeed, poor working conditions and staff shortages have contributed to structural collapse and placed a heavy toll on healthcare workers' (HCWs) well-being, with many suffering from stress, exhaustion, demoralization, and burnout. An additional factor driving qualified HCWs away is the repeated experience of moral distress, or the inability to act according to internally held moral values and perceived ethical obligations due to internal and external constraints. Despite general awareness of this crisis, we currently lack an organized understanding of how stress leads to poor health, wellbeing, and performance in healthcare workers. To address this critical issue, we first review the literature on moral distress, stress, and health in HCWs. Second, we summarize the biobehavioral pathways linking occupational and interpersonal stressors to health in this population, focusing on neuroendocrine, immune, genetic, and epigenetic processes. Third, we propose a novel Psychoneuroimmunological Model of Moral Distress and Health in HCWs based on this literature. Finally, we discuss evidence-based individual- and system-level interventions for preventing stress and promoting resilience at work. Throughout this review, we underscore that stress levels in HCWs are a major public health concern, and that a combination of system-level and individual-level interventions are necessary to address preventable health care harm and foster resilience in this population, including new health policies, mental health initiatives, and additional translational research.

Breathing shifts visuo-spatial attention

Considering recent findings that breathing influences cognitive processes, two experiments explored the relationship between breathing and visuo-spatial attention. In Experiment 1, a lateralized probe detection task was inserted into the breathing cycles of 21 healthy adults to probe effects of breathing on the distribution of spatial attention. In Experiment 2 (N = 26), the Posner cueing task measured breathing-contingent detection speed for lateralized probes after endogenous or exogenous cueing. We consistently found faster responses for left probes after exhalation and for right probes after inhalation in both experiments. Breathing also affected the speed of re-alignment of spatial attention after invalid cueing in Experiment 2. This novel breathing bias shows that our ability to encode visuo-spatial information systematically fluctuates during breathing.

Effect of three modalities on emergence agitation among post-traumatic stress disorder patients undergoing laparoscopy: a randomized controlled study

BACKGROUND AND AIM

Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls.

METHODS

This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05.

RESULTS

Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation.

CONCLUSION

Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.

Respiratory patterns and physical fitness in healthy adults: a cross-sectional study

BACKGROUND

The altered respiratory patterns have a significant impact on our health. However, the links between respiration patterns during spontaneous breathing and physical fitness remain unknown. Therefore, we sought to examine how the respiratory pattern during spontaneous breathing interacts with physical fitness.

METHODS

A total of 610 participants (aged 20-59 years) were enrolled; 163 men (age = 41 ± 11) and 401 women (age = 42 ± 9) were included for analysis. The parameters of the respiration pattern were respiration rate (RR) and inhalation/exhalation (I/E) ratio. The physical fitness components were body size, visuomotor reaction time, balance, flexibility, hand grip strength, back extension strength, vertical jump height, number of push-ups, number of sit-ups, and the maximum rate of oxygen consumption. The data were analyzed separately for two gender groups. Participants within each gender group were further divided into two age categories (young: 20-39 years, middle-aged: 40-59 years) for the analysis, and both correlational and comparative tests were used to solidify the results.

RESULTS

Neither RRs nor the I/E ratios were substantially correlated with physical fitness in women. In addition, the I/E ratios showed no significant correlation with physical fitness in young men, while the results from correlational and comparative tests were inconsistent in middle-aged men. Consistently, men with lower RRs exhibited significantly shorter visuomotor reaction times in two age groups, and demonstrated significantly higher vertical jump heights in the middle-aged group.

CONCLUSIONS

In women, respiratory patterns were not correlated with physical fitness. The relationship between middle-aged men's I/E ratios and their physical fitness warrants further investigation. Men with lower RRs may have better visual-motor coordination and/or sustained attention, while middle-aged men with lower RRs may also have greater leg explosive power and neuromuscular coordination, which should be considered for physical assessment and health improvement.

Long Sudarshan Kriya Yoga enhances cardiovascular and respiratory synchronization: An observational study

BACKGROUND

Sudarshan Kriya Yoga (SKY - a rhythmic cyclic breathing) is known to produce several physiological changes in human body. Earlier it has been reported that SKY improves cardiovascular modulations, namely increase in heart rate variability.

OBJECTIVE

To observe the synchronization in oscillatory modulations in cardiac autonomic tone and ventilatory exchange during Long Sudarshan Kriya Yoga (LSKY). LSKY is a sequential combination of pranayama in ujjayi breath, bhastrika, and cyclic rhythmic breathing followed by yog-nidra.

METHODS

Regular LSKY practitioners from the Art of Living community with more than two years of experience participated in the study (n = 22; age 40.09 ± 12.68). The Electrocardiogram (ECG), respiration, oxygen saturation, and concentrations of oxygen and carbon-di-oxide from exhaled air were recorded before and during LSKY. The time domain parameters of heart rate variability (HRV) were calculated from ECG. All parameters were compared and correlated at each stage of LSKY.

RESULTS

Highly significant reciprocal correlation was found between HRV parameters and respiration rate during LSKY. Both O2 consumption and CO2 production increased significantly during three stages of pranayama and decreased towards the end of cyclic breathing. We also saw increased SPO2 simultaneously.

CONCLUSION

The autonomic parameters exhibited reciprocal response to respiratory rate and correlated well to the ventilatory parameters. Further during LSKY we observed enhanced synchronization. In conclusion the LSKY has a potential to influence cardiorespiratory parameters for improving the performance of both systems. LSKY - enhances oscillations in HRV that resets the autonomic system, indicative of better cardiac health and prepares body for better metabolic response. Such changes are capable of inducing resilience along with physiological, psychological relaxation and emotional well-being.

Effects of slow breathing training on hemodynamic changes, cardiac autonomic function and neuroendocrine response in people with high blood pressure: A randomized control trial

BACKGROUND

High blood pressure (BP) is a non-communicable disease that is a risk factor for cardiovascular disease and is the leading cause of mortality and morbidity worldwide. High BP can be managed by both pharmacological and non-pharmacological interventions. Non-pharmacological treatment, such as slow-breathing training (SBT), has been shown to reduce BP. However, there are few studies on the effect of SBT on both cardiac activation and oxidative stress in people with high BP.

OBJECTIVES

To explore the effect of SBT on cardiac autonomic function (i.e., heart rate variability: HRV) and neuroendocrine response (i.e., salivary cortisol).

METHODS

One hundred people (including 89 women) with high BP were randomly assigned to either a control (n = 50) or intervention group (n = 50). The intervention program was conducted for 30 min per day, for 5 days per week, for 4 weeks, with a total of 20 sessions of the SBT at the rate of 10 times per minute, whereas the control group was required to continue with their daily routine. HRV, BP, and salivary cortisol were measured before and after the intervention program. A two-way mixed ANOVA was performed for within-group and between-group comparisons over time.

RESULTS

Of the 100 participants, 71 individuals completed the study. The participants in the intervention group had a lower BP and salivary cortisol levels compared to those in the control group (p < .05). Further, those participants showed an increase in the standard deviation of normal R-R intervals after the 4-week intervention program (p < .05).

CONCLUSION

This study provided evidence demonstrating the effect of SBT on cardiac autonomic and stress reactivity, which has important implications for health promotion in people with high BP.

CLINICAL TRIAL REGISTRATION NUMBER

TCTR20180302008.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

The effect of a single-session heart rate variability biofeedback on attentional control: does stress matter?

Introduction

Vagally mediated heart rate variability is an index of autonomic nervous system activity that is associated with a large variety of outcome variables including psychopathology and self-regulation. While practicing heart rate variability biofeedback over several weeks has been reliably associated with a number of positive outcomes, its acute effects are not well known. As the strongest association with vagally mediated heart rate variability has been found particularly within the attention-related subdomain of self-regulation, we investigated the acute effect of heart rate variability biofeedback on attentional control using the revised Attention Network Test.

Methods

Fifty-six participants were tested in two sessions. In one session each participant received a heart rate variability biofeedback intervention, and in the other session a control intervention of paced breathing at a normal ventilation rate. After the biofeedback or control intervention, participants completed the Attention Network Test using the Orienting Score as a measure of attentional control.

Results

Mixed models revealed that higher resting baseline vagally mediated heart rate variability was associated with better performance in attentional control, which suggests more efficient direction of attention to target stimuli. There was no significant main effect of the intervention on attentional control. However, an interaction effect indicated better performance in attentional control after biofeedback in individuals who reported higher current stress levels.

Discussion

The results point to acute beneficial effects of heart rate variability biofeedback on cognitive performance in highly stressed individuals. Although promising, the results need to be replicated in larger or more targeted samples in order to reach stronger conclusions about the effects.

Effect of six-week short-duration deep breathing on young adults with chronic ankle instability-a pilot randomized control trial

BACKGROUND

Chronic ankle instability (CAI) is the most common injury in youth sports, which leads to psychological stress from doubting their performance. Cost effective and easy to access tool to reduce the stress among this target group are desired. Therefore, the purpose of this study was to investigate the effect of adding on intervention with short-duration deep breathing (SDDB) alongside with conventional physiotherapy (CP) among young adults with chronic ankle instability (CAI).

METHODS

Total of 30 CAI participants attended physiotherapy, who were randomly assigned into control and experimental groups. The participants in the experimental group received combined intervention (SDDB + CP), and the control group received CP for 6 weeks. The effectiveness of interventions was assessed at 3 intervals with a battery of questionnaires (Visual Analog Score, Cumberland Ankle Instability Tool, Mindful Attention Awareness Scale, and Oxford Happiness Questionnaire) at the end of week 3, week 6, and week 12 as follow-up. A two-way repeated measures of ANOVA was applied to report the statistical significance at p < 0.05.

RESULTS

The results showed a better improvement in pain, balance, happiness, and mindfulness attention among participants in the experimental group, with a significant improvement in mindful attention over the time point as compared to the control group.

CONCLUSION

The findings provide insight into incorporating SDDB additions to the existing CP for better CAI management. Breathing techniques that improve attention and happiness play a vital role in CAI, which recommends the biopsychosocial approach in chronic injury rehabilitation.

TRIAL REGISTRATION

Current Controlled Trials using Clinical Trials Registry under ID number NCT04812158 retrospectively registered on 23/03/2021.

The impact of a guided paced breathing audiovisual intervention on anxiety symptoms in Palestinian children: a pilot randomized controlled trial

BACKGROUND

Children in Palestine may be at high risk for anxiety symptoms. However, access to mental health services is limited. Therefore, the objective of this study was to conduct a pilot randomized controlled trial to examine whether a guided audiovisual paced breathing intervention was feasible, acceptable, and improved anxiety symptoms in Palestinian children.

METHODS

Students (6-10 years old) in an after-school program in Palestine were randomly assigned to the intervention or control condition. All participants completed a pre- and post-intervention measure of anxiety using the Revised Children's Manifest Anxiety Scale. Participants in the intervention completed 24 sessions over 8 weeks and rated breathing ease as well as pre- and post-session relaxation on a 5-point Likert scale. To examine condition differences in post-intervention anxiety, four analyses of covariance were conducted, adjusting for age, sex, and pre-intervention anxiety.

RESULTS

A total of 144 participants (65.3% girls; Mage  = 7.5 ± 1.2; 50% per condition) enrolled in the study. There were no differences in demographics or baseline anxiety between the two conditions (ps > .05). Participants reported that it was easy to breathe during the sessions (Ms = 4.1-4.7, SDs = 0.5-1.1). For all but the first session, participants reported being more relaxed after the breathing session than before (ps < .003). Post-intervention, participants in the intervention reported fewer anxiety symptoms compared to participants in the control condition (ps < .01).

CONCLUSION

A guided paced breathing audiovisual intervention was feasible and had a significant positive impact on anxiety symptoms in Palestinian children compared to a control condition. Future research should examine whether the audiovisual guided breathing intervention significantly improves long-term outcomes.

[Complementary methods in the treatment of complex regional pain syndrome]

BACKGROUND

Complex regional pain syndrome (CRPS) affects 10-15% of patients following injuries (fractures, surgery) to the outer extremities and people after a stroke. The affected area hurts, is inflamed and lacks strength, while mobility and sensitivity are restricted. Complementary medicine as part of integrative medicine offers additional effective treatment options.

RESEARCH QUESTION

Complementary therapies that extend the guideline recommendations, demonstrate clinical evidence and/or are plausible are presented.

RESULTS

Mind-body medicine procedures (mindfulness, relaxation, yoga, Qi Gong, etc.) support the patient's self-efficacy and stimulate the vagus nerve as well as promoting the reduction of pain, depression and anxiety and improving quality of life. Phytotherapeutics such as turmeric or stinging nettle have an anti-inflammatory effect. Water treatments reduce pain, and acupuncture and neural therapy can be tried.

CONCLUSIONS

Integrative, complementary medical therapy options support the CRPS patient in coping with their disease and the related pain. These options can play an important role in the multimodal, interdisciplinary treatment of this disease.

Short-term effects on heart rate variability of occipito-mastoid suture normalization in healthy subjects

Occipito-mastoid structure normalization (OMSN) is an osteopathic manipulative treatment aimed at reducing tension around the jugular foramen, where cranial nerves IX, X, and XI exit the skull. The purpose of this study was to observe how heart rate variability (HRV), a marker of autonomic cardiac regulation, was modulated after an OMSN vs. a sham technique (SHAM). Pre- and post-intervention HRV was analyzed in two randomly chosen groups of 15 participants (OMSN vs. SHAM group). HRV was collected in the supine position 5 min before and 5 min after a 10-min application of either OMSN or SHAM. The time and group effect was analyzed using a two-way ANOVA. Independently from group intervention, a significant time effect induced increased HRV. No group effect differences were observed. Multiple comparisons for time and group interaction showed that the root mean square of successive differences (RMSSD), a vagally mediated HRV variable, increased to a greater extent for the OMSN group (p = 0.03) than for the SHAM group. However, both OMSN and SHAM techniques had a significant effect on HRV. Compared to a SHAM technique, OMSN had a significant effect on HRV vagally related metric RMSSD in the short term. We conclude that 10 min of OMSN may be used to induce a short-term influence on parasympathetic autonomic nervous system modulations.

Yoga is effective for treating chronic pain in veterans with Gulf War Illness at long-term follow-up

BACKGROUND

Clinical Practice Guidelines for Gulf War Illness (GWI) recommend integrative health approaches such as yoga for relief from symptoms, yet little is known about the long-term efficacy of yoga in reducing symptoms of GWI. Here, we evaluated the long-term efficacy of yoga and cognitive-behavioral therapy (CBT) chronic pain treatment in a randomized controlled trial (RCT) of 75 Veterans (57 men, 42-71 ± 7.1 years of age) with Gulf War Illness (GWI).

METHODS

Participants received either 10 weeks of yoga or 10 weeks of CBT for chronic pain. The primary outcome measures were pain severity, and pain interference (Brief Pain Inventory-Short Form). The secondary outcome measures were fatigue, as indicated by a measure of functional exercise capacity (6-Minute Walk Test), depression, autonomic symptom severity, and quality of life. Piecewise linear mixed models were used to examine study hypotheses.

RESULTS

Compared to the CBT group, yoga was associated with greater reductions in pain severity during the 6-month follow-up period (group × time interaction: b = 0.036, se = 0.014, p = .011). Although we did not find between-group differences in the other primary or secondary outcome measures during follow-up (p's > 0.05), exploratory analyses revealed within-group improvements in pain interference, total pain (an experimental outcome variable which combines pain severity and interference), and fatigue in the yoga group (p's < 0.05) but not in the CBT group.

CONCLUSIONS

This is the first study to report long-term follow-up results of yoga as a treatment for GWI. Our results suggest that yoga may offer long-term efficacy in reducing pain, which is a core symptom of GWI.

TRIAL REGISTRATION

Secondary analyses of ClinicalTrials.gov NCT02378025.

Changes in the autonomic cardiorespiratory activity in parturient women with severe and moderate features of preeclampsia

Background

Cardiorespiratory coupling (CRC) is a physiological phenomenon that reflects the mutual interaction between the cardiac and respiratory control systems. It is mainly associated with efferent vagal activity from the central autonomic network. Few studies have explored the autonomic changes of CRC in preeclampsia, a critical obstetric complication related to possible autonomic dysfunctions and inflammatory disturbances. This study examined the autonomic mechanisms of CRC in women with severe and moderate preeclampsia and healthy controls by applying nonlinear methods based on information theory, such as mutual information (MI) and Renyi's mutual information (RMI) and the linear and nonlinear analysis of the Pulse-Respiration Quotient (PRQ).

Methods

We studied three groups of parturient women in the third trimester of pregnancy with a clinical diagnosis of preeclampsia without severe symptoms (P, 38.5 ± 1.4 weeks of pregnancy, n=19), preeclampsia with severe symptoms (SP, 37.5 ± 0.9 weeks of pregnancy, n=22), and normotensive control women (C, 39.1 ± 1.3 weeks of pregnancy, n=20). 10-minutes of abdominal electrocardiograms (ECG) and respiratory signals (RESP) were recorded in all the participants. Subsequently, we obtained the maternal beat-to-beat (RR) and breath-to-breath (BB) time series from ECG and RESP, respectively. The CRC between RR and BB was quantified by nonlinear methods based on information theory, such as MI and RMI, along with the analysis of the novel index of PRQ. Subsequently, we computed the mean PRQ (mPRQ) and the normalized permutation entropy (nPermEn_PRQ) from the PRQ time series generated from BB and RR. In addition, we examined the vagal activity in the three groups by the logarithm of the median of the distribution of the absolute values of successive RR differences (logRSA).

Results

The MI and RMI values were significantly lower (p<0.05) in the preeclamptic groups compared to the control group. However, no significant differences were found between the preeclamptic groups. The logRSA and nPermEn_PRQ indices were significantly lower (p<0.05) in SP compared to C and P.

Conclusion

Our data suggest that parturient women with severe and mild preeclampsia may manifest an altered cardiorespiratory coupling compared with normotensive control women. Disrupted CRC in severe preeclampsia could be associated with vagal withdrawal and less complex cardiorespiratory dynamics. The difference in vagal activity between the preeclamptic groups may suggest a further reduction in vagal activity associated with the severity of the disease.