How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases

Vagally Mediated Heart Rate Variability and Mood States in Patients with Chronic Pain Receiving Prolonged Expiration Regulated Breathing: A Randomized Controlled Trial

Reduced vagally mediated heart rate variability (VmHRV) has been reported in patients with chronic pain. In healthy persons, breathing with longer expiration relative to inspiration increases VmHRV at 12 breaths per minute. The present study aimed to determine the immediate effect of breathing with longer expiration relative to inspiration on VmHRV and mood states in patients with chronic pain. Fifty patients with chronic pain aged between 20 and 67 years were prospectively randomized as two groups with an allocation ratio of 1:1. The interventional group practiced breathing with metronome based visual cues, maintaining an inspiration to expiration ratio of 28:72 (i/e ratio, 0.38) at a breath rate of 12 breaths per minute. The average i/e ratio they attained based on strain gauge respiration recording was 0.685 (SD 0.48). The control group, which looked at the metronome without conscious breath modification had an average i/e ratio of 0.745 (SD 0.69). The VmHRV, respiration and self-reported mood states (using the Brief Mood Introspection Scale (BMIS)) were assessed. There was a significant increase in HF-HRV and RMSSD during low i/e breathing (repeated measures ANCOVA, Bonferroni adjusted post-hoc test, p < 0.05; in all cases). Self-reported mood states changed as follows: (i) following low i/e breathing positive-mood states increased while the aroused mood state decreased whereas (ii) following the control intervention the aroused mood state increased (repeated measure ANOVA, p < 0.05; in all cases). Hence breathing with prolonged expiration is possibly useful to increase VmHRV and improve self- reported mood states in patients with chronic pain.

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.

Benefits From Different Modes of Slow and Deep Breathing on Vagal Modulation

Slow and deep breathing (SDB) is a relaxation technique that can increase vagal activity. Respiratory sinus arrhythmia (RSA) serves as an index of vagal function usually quantified by the high-frequency power of heart rate variability (HRV). However, the low breathing rate during SDB results in deviations when estimating RSA by HRV. Besides, the impact of the inspiration-expiration (I: E) ratio and guidelines ways (fixed breathing rate or intelligent guidance) on SDB is not yet clear. In our study, 30 healthy people (mean age = 26.5 years, 17 females) participated in three SDB modes, including 6 breaths per minute (bpm) with an I:E ratio of 1:1/ 1:2, and intelligent guidance mode (I:E ratio of 1:2 with guiding to gradually lower breathing rate to 6 bpm). Parameters derived from HRV, multimodal coupling analysis (MMCA), Poincaré plot, and detrended fluctuation analysis were introduced to examine the effects of SDB exercises. Besides, multiple machine learning methods were applied to classify breathing patterns (spontaneous breathing vs. SDB) after feature selection by max-relevance and min-redundancy. All vagal-activity markers, especially MMCA-derived RSA, statistically increased during SDB. Among all SDB modes, breathing at 6 bpm with a 1:1 I:E ratio activated the vagal function the most statistically, while the intelligent guidance mode had more indicators that still significantly increased after training, including SDRR and MMCA-derived RSA, etc. About the classification of breathing patterns, the Naive Bayes classifier has the highest accuracy (92.2%) with input features including LFn, CPercent, pNN50, [Formula: see text], SDRatio, [Formula: see text], and LF. Our study proposed a system that can be applied to medical devices for automatic SDB identification and real-time feedback on the training effect. We demonstrated that breathing at 6 bpm with an I:E ratio of 1:1 performed best during the training phase, while intelligent guidance mode had a more long-lasting effect.

Robots as Mental Health Coaches: A Study of Emotional Responses to Technology-Assisted Stress Management Tasks Using Physiological Signals

The current study investigated the effectiveness of social robots in facilitating stress management interventions for university students by evaluating their physiological responses. We collected electroencephalogram (EEG) brain activity and Galvanic Skin Responses (GSRs) together with self-reported questionnaires from two groups of students who practiced a deep breathing exercise either with a social robot or a laptop. From GSR signals, we obtained the change in participants' arousal level throughout the intervention, and from the EEG signals, we extracted the change in their emotional valence using the neurometric of Frontal Alpha Asymmetry (FAA). While subjective perceptions of stress and user experience did not differ significantly between the two groups, the physiological signals revealed differences in their emotional responses as evaluated by the arousal-valence model. The Laptop group tended to show a decrease in arousal level which, in some cases, was accompanied by negative valence indicative of boredom or lack of interest. On the other hand, the Robot group displayed two patterns; some demonstrated a decrease in arousal with positive valence indicative of calmness and relaxation, and others showed an increase in arousal together with positive valence interpreted as excitement. These findings provide interesting insights into the impact of social robots as mental well-being coaches on students' emotions particularly in the presence of the novelty effect. Additionally, they provide evidence for the efficacy of physiological signals as an objective and reliable measure of user experience in HRI settings.

Fairness: from the guts to the brain - a critical examination by Atlantic fellows of the Global Brain Health Institute

In January 2023, the Global Brain Health Institute (GBHI) at UCSF hosted an online salon to discuss the relationship between fairness and brain health equity. We aimed to address two primary questions: first, how is fairness perceived by the public, and how does it manifest in societal constructs like equity and justice? Second, what are the neurobiological foundations of fairness, and how do they impact brain health? Drawing from interdisciplinary fields such as philosophy, psychology, and neuroscience, the salon served as a platform for participants to share diverse perspectives on fairness. Fairness is a multifaceted concept encompassing equity, justice, empathy, opportunity, non-discrimination, and the Golden Rule, but by delving into its evolutionary origins, we can verify its deep-rooted presence in both human and animal behaviors. Real-world experiments, such as Frans de Waal's capuchin monkey study, have proven enlightening, elucidating many mechanisms that have shaped our neurobiological responses to fairness. Contemporary cognitive neuroscience research further emphasizes the role of neuroanatomical areas and neurotransmitters in encoding fairness-related processes. We also discussed the critical interconnection between fairness and healthcare equity, particularly its implications for brain health. These values are instrumental in promoting social justice and improving health outcomes. In our polarized social landscape, there are rising concerns about a potential decrease in fairness and prosocial behaviors due to isolated social bubbles. We stress the urgency for interventions that enhance perspective-taking, reasoning, and empathy. Overall, fairness is vital to fostering an equitable society and its subsequent influence on brain health outcomes.

Brief structured respiration practices enhance mood and reduce physiological arousal

Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.

Neuromodulation Applied to Diseases: The Case of HRV Biofeedback

The vagus or “wandering” nerve is the main branch of the parasympathetic nervous system (PNS), innervating most internal organs crucial for health. Activity of the vagus nerve can be non-invasively indexed by heart-rate variability parameters (HRV). Specific HRV parameters predict less all-cause mortality, lower risk of and better prognosis after myocardial infarctions, and better survival in cancer. A non-invasive manner for self-activating the vagus is achieved by performing a slow-paced breathing technique while receiving visual feedback of one’s HRV, called HRV-biofeedback (HRV-B). This article narratively reviews the biological mechanisms underlying the role of vagal activity and vagally mediated HRV in hypertension, diabetes, coronary heart disease (CHD), cancer, pain, and dementia. After searching the literature for HRV-B intervention studies in each condition, we report the effects of HRV-B on clinical outcomes in these health conditions, while evaluating the methodological quality of these studies. Generally, the levels of evidence for the benefits of HRV-B is high in CHD, pain, and hypertension, moderate in cancer, and poor in diabetes and dementia. Limitations and future research directions are discussed.

Pulling the Trigger: The Effect of a 5-Minute Slow Diaphragmatic Breathing Intervention on Psychophysiological Stress Responses and Pressurized Pistol Shooting Performance

This study examined the effect of slow diaphragmatic breathing on psychophysiological stress responses and pressurized performance. Sixty-seven participants (40 female; Mage = 20.17 ± 2.77 years) were randomly assigned to either a diaphragmatic-breathing, paced-breathing, or control group. Participants completed a nonpressurized shooting task and then received instructions about a pressurized version. Next, the diaphragmatic group was told to breathe at 6 breaths/min, the paced group at 12 breaths/min, and the control group received no instructions. Following a 5-min intervention period, participants completed the pressurized task while performance was assessed. Psychophysiological stress responses (e.g., cognitive anxiety, heart rate) were recorded throughout. Results revealed that diaphragmatic breathing had mixed effects on stress responses, with some unaffected (e.g., heart rate) and others reduced (e.g., cognitive anxiety), and little effect on performance. Findings suggested that slow diaphragmatic breathing might not aid pressurized performance but could benefit psychological stress responses.

An Empirical Approach to Analyzing the Effects of Stress on Individual Creativity in Business Problem-Solving: Emphasis on the Electrocardiogram, Electroencephalogram Methodology

In this study, experiments were conducted on 30 subjects by means of electrocardiogram (ECG) and electroencephalogram (EEG) methodologies as well as a money game to examine the effects of stress on creativity in business problem-solving. The study explained the relationship between creativity and human physiological response using the biopsychosocial model of challenge and threat. The subjects were asked to perform a cognitive mapping task. Based on the brain wave theory, we identified the types of brain waves and locations of brain activities that occurred during the creative problem-solving process in a business environment and studied the effects of stress on creativity. The results of the experiments showed significant differences in creativity in business problem-solving depending on whether or not stress was triggered. Differences were found in the time domain (SDNN, RMSSD) and frequency domain (HF, LF/HF ratio) of heart rates, a physiological stress indicator, between the stress group and the no-stress group. A brain wave analysis confirmed that alpha waves increased in the frontal lobe of the brain during creative business problem-solving but decreased when the subjects were under stress, during which beta waves in the brain increased. This study seeks to examine creativity in business problem-solving by studying the effects of stress on human physiological response and cognitive functions in the hope of providing a new and objective interpretation of existing research results.

Breath Tools: A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running

Running is among the most popular sporting hobbies and often chosen specifically for intrinsic psychological benefits. However, up to 40% of runners may experience exercise-induced dyspnoea as a result of cascading physiological phenomena, possibly causing negative psychological states or barriers to participation. Breathing techniques such as slow, deep breathing have proven benefits at rest, but it is unclear if they can be used during exercise to address respiratory limitations or improve performance. While direct experimental evidence is limited, diverse findings from exercise physiology and sports science combined with anecdotal knowledge from Yoga, meditation, and breathwork suggest that many aspects of breathing could be improved via purposeful strategies. Hence, we sought to synthesize these disparate sources to create a new theoretical framework called “Breath Tools” proposing breathing strategies for use during running to improve tolerance, performance, and lower barriers to long-term enjoyment.

Taking a few deep breaths significantly reduces children's physiological arousal in everyday settings: Results of a preregistered video intervention

This preregistered, randomized field experiment tested the effectiveness of a brief deep breathing intervention on children's concurrent physiological arousal in naturalistic settings (N  = 342; M_age  = 7.48 years; 46% female; 53% Asian, 26% White; 21% other race/ethnicity). The treatment consisted of an animated video that introduced deep breathing as a self-regulation strategy and scaffolded the child in taking a few slow-paced breaths, while the control group watched an informational video featuring similar animated images. Respiratory sinus arrhythmia (RSA) and heart rate (HR) were measured while children were sitting still (baseline) and subsequently while watching 1-min videos. Relative to baseline arousal, RSA increased and HR decreased only in response to the deep-breathing treatment video. Effects were larger in the second 30-s epoch of the video, which included most of the deep breathing practice. RSA fully mediated the intervention's effects on HR. By analyzing all children exposed to intervention video regardless of their engagement in the deep breathing practice (intention-to-treat design) and by using easily scalable treatment videos, the study identifies an effective and pragmatic approach to reducing children's physiological arousal in everyday, group settings. Implications for advancing applied developmental psychophysiological research are discussed.

The experience of nursing leadership in a crisis: A hermeneutic phenomenological study

AIM

This study aimed to understand nursing leaders' experience during the pandemic.

BACKGROUND

COVID-19 is a public health crisis that affects every nation in the world.

METHODS

Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology.

RESULTS

The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future.

CONCLUSION

Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications.

IMPLICATIONS FOR NURSING MANAGEMENT

In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.

The Influence of Slow-Paced Breathing on Executive Function

Abstract. The aim of this experiment was to test the immediate effects of slow-paced breathing on executive function. Slow-paced breathing is suggested to increase cardiac vagal activity, and the neurovisceral integration model predicts that higher cardiac vagal activity leads to better executive functioning. In total, 78 participants (41 men, 37 women; Mage = 23.22 years) took part in two counterbalanced experimental conditions: a 3 × 5 min slow-paced breathing condition and a television viewing control condition. After each condition, heart rate variability was measured and participants performed three executive function tasks: the color-word match Stroop (inhibition), the automated operation span task (working memory), and the modified card sorting task (cognitive flexibility). Results showed that performance on executive function tasks was better after slow-paced breathing compared to control, with higher scores observed for Stroop interference accuracy, automated operation span score, and perseverative errors, but not Stroop interference reaction times. This difference in executive function between experimental conditions was not mediated by cardiac vagal activity. Therefore, findings only partially align with predictions of the neurovisceral integration model. Slow-paced breathing appears a promising technique to improve immediate executive function performance. Further studies are recommended that address possible alternative underlying mechanisms and long-term effects.

Autonomic Rehabilitation: Adapting to Change

Adaption to changes of external environment or internal health, the body-mind connection, or autonomic nervous system must be flexible and healthy. Population health studies with wearable technology and remote monitoring will lead to paradigm shifts in how to approach the physiology of emotion. Heart rate variability as a whole health biomarker could emerge as a foundation for a process beginning with objective habits and skills of real-time modulation with focused breathing for healthier decision making and autonomic health trajectory change. Physical medicine and rehabilitation is uniquely poised to refine an autonomic rehabilitation process in an integrative manner to help individuals adapt.