Exp Physiol 93.

9 pp 1011–1021 1011

Experimental Physiology – Review Article

Breathing rhythms and emotions

Ikuo Homma and Yuri Masaoka
Department of Physiology, Showa University School of Medicine, Tokyo, Japan

Respiration is primarily regulated for metabolic and homeostatic purposes in the brainstem.
However, breathing can also change in response to changes in emotions, such as sadness,
happiness, anxiety or fear. Final respiratory output is influenced by a complex interaction
between the brainstem and higher centres, including the limbic system and cortical structures.
Respiration is important in maintaining physiological homeostasis and co-exists with emotions.
In this review, we focus on the relationship between respiration and emotions by discussing
previous animal and human studies, including studies of olfactory function in relation to
respiration and the piriform–amygdala in relation to respiration. In particular, we discuss
oscillations of piriform–amygdala complex activity and respiratory rhythm.
(Received 22 February 2008; accepted after revision 16 May 2008; first published online 16 May 2008)
Corresponding author I. Homma: Department of Physiology, Showa University School of Medicine, Hatanodai 1-5-8,
Shinagawa-ku, Tokyo 142-8555, Japan. Email: ihomma@med.showa-u.ac.jp

Behavioural breathing muscles. Transection of the dorsolateral columns of the

spinal cord abolishes responses to electrical stimulation.
Respiratory chest wall movement is performed by the
However, transection does not affect the spontaneous
intermittent contraction of inspiratory and expiratory
rhythmic activities of the intercostal muscles.
respiratory muscles. Motor commands for the contraction
The medulla oblongata and pons comprise the centre
of these muscles are generated in complex neuronal
for metabolic breathing; this pathway descends along the
networks in the brain. Various afferent inputs are
spinal ventrolateral column as the bulbospinal pathway.
integrated to produce respiratory rhythm and tidal
The descending tract for autonomic inspiration is located
activity, primarily in response to metabolic demands.
laterally in the ventrolateral column, whereas the tract
The most important inputs for the regulation of
for expiration is located ventrally. Transection of the
breathing involve chemoreceptors that form reflex
tract abolishes autonomic rhythmic breathing but has no
feedback mechanisms for respiratory motor activities.
effect on responses of the respiratory muscles to cortical
However, respiratory motor output is also influenced by
stimulation.
internal and external environmental changes. This is called
Beside these studies that show the different pathways
behavioural breathing and is generally considered to have
for metabolic and behavioural breathing, studies of Orem
a different mechanism from metabolic breathing.
and Trotter show the cortical projections to brainstem
Final motor outputs for breathing are generated by
respiratory neurons (Orem, 1989; Orem & Trotter, 1994),
motoneurons in the spinal cord. Descending autonomic
indicating that behavioural influences arising from higher
(metabolic) and voluntary breathing pathways to spinal
centres modify metabolic breathing patterns.
motoneurons from higher centres are essentially and
Autonomic breathing is not only controlled by
functionaly different. The origin of the voluntary control
metabolic demands but also constantly responds to
of breathing is in the cerebral cortex; stimulation of
changes in emotions, such as sadness, happiness, anxiety
the primary motor cortex induces contraction of the
and fear. Final respiratory output involves a complex
diaphragm and intercostal muscles in humans (Gandevia
interaction between the brainstem and higher centres,
& Rothwell, 1987; Gandevia & Plassman, 1988). This
including the limbic system and cortical structures. It
primary motor area has been shown by transcranial
is interesting that respiration, which is important in
magnetic stimulation to coincide with the middle cortex
maintaining physiological homeostasis, and emotions co-
1 cm posterior to the vertex (Maskill et al. 1991). Aminoff
exist. In this review, we focus on the relationship between
& Sears (1971) reported in cats that electrical stimulation
respiration and emotions by discussing previous studies
of the cerebral cortex at the vertex induces short-latency
of olfactory function and respiration.
activation of contralateral motoneurons of the intercostal


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1012 I. Homma and Y. Masaoka
Emotional breathing in humans
Emotional breathing and the amygdala. Emotions
involve physiological changes within the entire body.
Animal and human studies have shown the autonomic
and behavioural responses during fear and the anxiety
state (Davis, 1992). In humans, the relationship between
emotions, increases of heart rate and blood pressure
have been investigated (Hugdahl, 1995). Relationships
between emotions and respiration have shown more
rapid breathing during an arousal state (Nyklicek et al.
1997; Boiten, 1998). Relationships between emotions and
respiratory reactions to natural noises or unpleasant
sounds have been explored (Masaoka & Homma, 1997;
Gomez & Danuser, 2004). Respiration also changes when
subjects look at photographs, which induces emotional
changes. Respiration is one of the physiological processes
altered by emotions (Boiten et al. 1994). In respiratory
patterns, respiratory rate is changed dramatically by
emotional changes. It can also be emphasized that changes
of respiratory rate are related to individuality; Masaoka &
Homma (1997) have shown the personality differences in
the patterns of breathing during mental stress and physical
load. Levels of individual anxiety affect respiratory rate,
especially the expiratory time (Masaoka & Homma, 1999).
It is fathomable that identical twins breathe in similar ways
(Shea et al. 1989). Anxiety is regarded as a basic emotion
and is associated with defense mechanisms (Öhman,
Figure 1. Relationship between respiratory frequencies (f) and
individual trait anxiety scores during anticipatory anxiety
All subjects were tested for anxiety levels by using Spielberger’s
State-Trait anxiety Inventory. A positive correlation between trait scores
and increase in respiratory frequency (f) was observed. Reproduced
with permission from Masaoka & Homma (2001).
Exp Physiol 93.9 pp 1011–1021
2000), that is, matter of life or death. Anticipatory
anxiety, which has been defined as the time between
the warning presentation and stimulation, increases the
respiratory rate; this change is not related to changes in
O 2 consumption, that is, changes in metabolic demand
(Masaoka & Homma, 2001). Thus, respiratory changes in
response to anxiety are affected by higher centres related
to the emotion. Respiratory rate has also been positively
correlated with individual trait anxiety scores (Fig. 1;
Masaoka & Homma, 2001).
Functional neuroimaging studies have investigated the
neuroanatomical correlates of negative emotions of fear
and anxiety (Adolph et al. 1994; Morris et al. 1998). These
studies have revealed that the amygdala plays a crucial
role for processing these negative emotions. In humans,
there are limitations to investigating the link between
the amygdala, emotions and respiration. However, recent
technology has advanced the study of functional anatomy
of the human brain using non-invasive methods of
functional brain mapping. Electroencephalogram (EEG)
dipole tracing is one method of neuroimaging that can
determine neural activation triggered by physiological
activities (Homma et al. 1994, 2001). If the subjective
feeling of anxiety increases the respiratory rate, electrical
current sources synchronized with the onset of inspiration
during anxiety are present in the limbic areas. From 350
to 400 ms after the onset of inspiration, in the averaged
EEG activities triggered at the onset of inspiration, a
positive wave is observed in the averaged potentials.
This positive wave is referred to as respiration-related
anxiety potentials (RAP; Fig. 2). A dipole tracing method
that incorporates a scalp–skull–brain head model has
estimated the source location of the RAP to be in the
right temporal pole, whereas it is in the right temporal
pole in subjects with low anxiety and left amygdala
in the most anxious subjects (Masaoka & Homma,
2000).
Recently, respiratory-related activities have been
estimated in the human brain using functional magnetic
resonance imaging (fMRI). Many studies have shown
activities in the limbic system. During the sensation of
air hunger (an uncomfortable urge to breathe) induced by
mechanical ventilation at a low tidal volume, the limbic
and paralimbic loci are activated in normal subjects (Evans
et al. 2002). Respiratory unpleasant sensation, usually
described as dyspnoea or breathlessness, depends on the
affective state of the subject. Respiratory sensation and
changes in respiratory pattern are involved or elicited by
anxiety and distress (Wilhelm et al. 2001).
Functional anatomical studies of disability of the
limbic system have been performed in patients with
mediotemporal lobe epilepsy. Lesions of the amygdala
impair recognition of a fearful face (Adolph et al. 1994).
Masaoka et al. (2003) have shown that anxiety levels and
respiratory rate during anticipatory anxiety are reduced
after lesion of the left amygdala in patients who show

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Exp Physiol 93.9 pp 1011–1021 Breathing and emotion 1013

foci of epileptic spikes in the left amygdala. Electrical
stimulation applied to the amygdala produces emotional
responses of fear (Halgren et al. 1978). A stimulation
study has also been performed in mediotemporal lobe
epileptic patients. Direct electrical stimulation of the left
amygdala, in a patient with deep electrodes installed to
evaluate the location of epileptic spikes, shows a decrease
in total respiratory time (Fig. 3). After the test, the subject
reported that during stimulation she had experienced the
feeling of losing the distinction between herself and an
external object and had a fear of losing herself (Masaoka
& Homma, 2004).
Harper et al. (1984) reported in an animal study that
electrical stimulation of the amygdala increases respiratory
rate. Electrical stimulation of the amygdala elicits specific
signs of fear, which include various autonomic and
physiological responses.
Emotion of anxiety. The above studies lead to the
question of whether anxiety enhances respiratory rate
or vice versa. The centre for these two outputs may
be in the limbic system, paticularly in the amygdala.
The respiratory-related anxiety potential recorded in
EEG activities may be produced in the amygdala or the
temporal pole. The temporal pole is included in paralimbic
areas involved in evaluation of environmental uncertainty
or danger (Reiman et al. 1989). If anxiety increases
respiratory rate, these areas may be activated before the
onset of inspiration. It is assumed that an increase in
respiratory rate is caused by unconscious evaluation in
the amygdala and that these two activities occur in parallel.
Stimulation of the amygdala produces a rapid increase in
respiratory rate followed by a feeling of fear and anxiety
(Masaoka & Homma, 2004). A period of 350–400 ms of
RAR after the onset of inspiration may be required for the
conscious representation or labelling of the physiological
event. Unconscious activation of the amygdala and an
uncertain feeling before labelling may represent emotion,
and later an interpretation of the physiological event may
represent feeling.

Figure 2. Respiration-related anxiety

potentials (RAP) and their source
generators
Top panel, EEG; bottom panel, Dipole
locations of RAP estimated by a dipole
tracing method. The generators of RAP
were observed in the right temporal pole in
subjects with low anxiety and in the
temporal pole and amygdala in the most
anxious subjects. Data modified with
permission from Masaoka & Homma
(2000).


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1014 I. Homma and Y. Masaoka Exp Physiol 93.9 pp 1011–1021

Figure 3. The effect of electrical stimulation of the left amygdala on respiration

Top panel shows total respiratory time (Ttot) during baseline, 0.5 and 1 mA of stimulation. Bottom panel shows
chest movement measured with Respitrace transducer during stimulation (1 mA) on left amygdala. Data modified
with permission from Masaoka & Homma (2004).

Respiration and emotion: why are they related?. In
various perceptions of sensations that influence or
produce emotion, the perception of odours is dependent
on respiration; our sense of smell is enhanced by inhalation
or inspiration. Olfactory cells have cilia (dendrites) that
extend from the cell body into the nasal mucosa. The
axons carry impulses from activated olfactory receptors
to the olfactory bulb. The olfactory bulb sends signals
to the prepiriform and piriform cortex, which include
the primary olfactory cortex, anterior olfactory nucleus,

Figure 4. Tidal volume (V T ) and

respiratory frequency (fR) during the
resting state (RS), pleasant
odour-threshold (PO-T), pleasant
odour-recognition (PO-R), unpleasant
odour-threshold (UO-T) and unpleasant
odour-recognition (UO-R)
Statistical differences between the
stimuli were judged by Bonferroni tests.
∗ P < 0.05, ∗∗ P < 0.01 and ∗∗∗ P < 0.001.

Reproduced with permission from

Masaoka et al. (2005).


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Exp Physiol 93.9 pp 1011–1021 Breathing and emotion 1015

Figure 5. Inspiration phase-locked α-band oscillation (I-α) and source generators of I-α estimated by a
dipole tracing method during unpleasant odour recognition
Dipoles were estimated in accordance with time after inspiration onset and were superimposed on a subject’s
coronal MRI sections (lower panel). RMS; mean absolute potentials recorded from 19 electrodes. Reproduced with
permission from Masaoka et al. (2005).

amygdaloid nucleus, olfactory tubercle and entorhinal

cortex (Rolls, 2001). Olfactory information ascends
directly to limbic areas and is not relayed through
the thalamus, so that each breath activates these areas
directly. Direct stimulation of the olfactory limbic areas
unconsciously alters the respiratory pattern. Unpleasant
odours increase respiratory rate and induce rapid shallow
breathing, and pleasant odours induce deep breathing
(Fig. 4; Masaoka et al. 2005). It is interesting to note that
the respiratory rate increases even before subjects discern
whether a smell is unpleasant. It is likely that physiological
outputs respond more rapidly than cognition (LeDoux,
1998).
Positron emission tomography (PET) and fMRI
studies have revealed olfactory-related brain regions that
are related to higher-order olfactory processing, such as Figure 6. Ventral view of the limbic brainstem–spinal cord
discrimination (Rolls et al. 2003) and emotion (Royet et al. preparation
Preparations were transected rostrally at a level slightly caudal to
2000) in humans. Electroencelphalography studies with
bregma (dotted line ‘a’), and half of the brain rostral to the pons was
the advantage of temporal resolution have also shown removed (dotted line ‘b’). Reproduced with permission from Onimaru
that during inspiration three to four negative and positive & Homma (2007).


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1016 I. Homma and Y. Masaoka Exp Physiol 93.9 pp 1011–1021

waves can be observed, and the waves are phase-locked
to inspiration (Masaoka et al. 2005). These waveforms,
referred to as inspiration phase-locked α-band oscillation
(I-α), are not observed during the expiratory phase or
during breathing of normal air. The EEG dipole tracing
method has estimated the location of source generators of
I-α to the entorhinal cortex, amygdala, hippocampus and
orbitofrontal cortex (Fig. 5). At 300–400 ms, the dipole
converges most in the orbitofrontal cortex. At this time,
recognition and identification of the odour occurs after
the evaluation in the olfactory limbic areas (Masaoka et al.
2005).
Slow-wave oscillations and respiration
Slow-wave oscillations. Neurons and neuronal networks
produce various rhythms in the brain, and activities
are synchronized and desynchronized with each other.
Synchronized neuronal rhythms are associated with

Figure 7. Optical recordings of spontaneous activity in the rostral cut surface of the limbic brainstem–
spinal cord preparation
A, left, optical image of the cut surface of the piriform–amygdala region at the time of burst initiation in the
piriform cortex (dark vertical bar in right panel). Abbreviations: BM, basomedial amygdaloid nucleus; Ce, central
amygdaloid nucleus; ec, external capsule; La/BL, lateral and basolateral amygdaloid nucleus; Pir, piriform cortex;
PRh, perirhinal cortex; and RF, rhinal fissure. Right, fluorescence changes at the two locations indicated in the left
panel: blue, dorsal part of the lateral amygdala; red, piriform cortex. Upward deflection (calibration arrow) denotes
a decrease of fluorescence intensity (i.e. depolarization) and corresponds to red in the pseudocolour calibration.
The fluorescence change is expressed as the ratio (per cent, fractional change) of fluorescence intensity to that of
the reference image. The C4 trace represents inspiratory activity of the C4 ventral root. Although this recording
appears to show occasional coactivation of C4 and piriform–amygdala activity, statistical analysis was required
to show significance. B, spatiotemporal pattern of the spontaneous burst activity. Numeric values at the bottom
left of each image denote time (in seconds) after burst initiation in the piriform cortex (time 0 in A). Propagated
activity terminated in the dorsal part of the lateral amygdala. Reproduced with permission from Onimaru & Homma
(2007).


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Exp Physiol 93.9 pp 1011–1021 Breathing and emotion 1017

functions or behaviours, but a detailed characterization
of these associations except for breathing rhythm has
yet to be reported. In the human brain, rhythmic
neuronal activity can be observed by EEG. Oscillations
appear as alterations in amplitude or frequency and are
synchronized broadly or locally and temporally. The origin
of EEG potential wave oscillations is generally believed
to be in the thalamocortical networks, and oscillations
can be classified into fast waves with frequencies >1.5 Hz
and slow waves with frequencies <1.5 Hz. Fast oscillations
show low amplitude and are observed during awake or
rapid eye movement (REM) sleep. Slow oscillations show
high amplitude during non-REM slow-wave sleep and
while under general anaesthesia (Steriade, 2000). During
deep sleep, inhibition of synaptic transmission arises
in thalamocortical neurons, blocking communication
between the thalamus and the neocortex. Slow oscillation
remains after thalamectomy and therefore is produced in
the neocortex (Steriade et al. 1993). Slow depolarization
and hyperpolarization are alternately repeated in neuronal
networks of the neocortex in the absence of sensory
afferents (Timofeev & Steriade, 1996). During deep sleep,
the brain is isolated from environmental stimuli, and
sensory coding via the thalamus is absent (Averbeck &
Lee, 2004). Sanchez-Vives & McCormick (2000) showed
in neocortex slice experiments that a slow oscillation with a
frequency of 0.1–0.5 Hz arises in response to an excitatory
interaction of pyramidal neurons which propagates to the
neocortex. The functional significance of this oscillation
is unclear; it has generally been believed that this slow
oscillation is related to the process of attention or memory
(Engel et al. 2001; Ward, 2003). Slow oscillations during

Figure 8. Effects of electrical

stimulation of the VLM (A) and dorsal
amygdala (DA; B–D)
A, activity in the DA induced by stimulation
of the VLM. Left, optical image of the cut
surface of the piriform–amygdala region at
the time point of the dark vertical bar in the
right panel. There is a focal fluorescence
change in the DA. Red arrow (VLM stim.)
indicates timing of stimulation. The C4
trace represents inspiratory activity of the
C4 ventral root. B, position of the
stimulation electrode (arrow) in the dorsal
amygdala. C, histological section of the cut
surface. Arrow indicates the position of the
stimulation electrode. Abbreviations: BM,
basomedial amygdaloid nucleus; Ce, central
amygdaloid nucleus; ec, external capsule;
La/BL, lateral and basolateral amygdaloid
nucleus; Pir, piriform cortex; PRh, perirhinal
cortex; and RF, rhinal fissure. D, effects of
stimulation of the DA (in B) on C4
inspiratrory activity. D , faster sweep
representation for the time period indicated
by the dotted line in D. Arrows (DA stim.)
indicate stimulation artifact. Note that the
stimulation induced a premature C4
inspiratory burst within 1 s. Reproduced
with permission from Onimaru & Homma
(2007).


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1018 I. Homma and Y. Masaoka
slow-wave sleep are thought to consolidate synapses
(Sejnowski & Destexhe, 2000; Steriade & Timofeev, 2003).
The origins of slow oscillations in the neocortex
are of interest. Electroencephalography studies with
256 channels in humans have indicated that the
distribution of slow oscillation potentials on the scalp
is not uniform and is localized exclusively in the
orbitofrontal area of the prefrontal cortex and conducted
to the anteroposterior area (Massimini et al. 2004).
Cerebral blood flow also decreases in this area during non-
REM sleep (Braun et al. 1997).
Slow oscillation in the limbic system. Slow oscillations
have been recorded in pyramidal cells in the neocortex
in both in vitro and in vivo animal experiments; they
have also been recorded in the perirhinal cortex and
showed a good correlation with those recorded in the
lateral amygdala in ketamine–xylazine-anaesthetized cats
(Collins et al. 2001). Lesion experiments have indicated
that the perirhinal cortex and the amygdala cortex are
associated with memory encoding (Buckley & Gaffan,
1998). Slow oscillations with frequencies <1 Hz have been
recorded in other neocortices as well (Lledo et al. 2005;
Buonviso et al. 2006). Fontanini et al. (2003) examined
slow oscillations in the olfactory system, paticularly in the
Figure 9. Schematic representation of connections of
orbitofrontal cortex (OFC), amygdala (AMG), piriform cortex
(Pir), entohinal cortex (Ent) and hippocampus (HC) with
respiratory rhythm
Exp Physiol 93.9 pp 1011–1021
olfactory bulb and piriform cortex, in ketamine–xylazine-
anaesthetized rats and reported a strong relationship
between the occurrence and timing of slow oscillations
and on-going sensory input resulting from respiration;
they concluded that there is a strong relationship between
the timing of respiration and brain rhythm. The piriform
cortex is part of the paleocortex, which is the primitive,
common cortex among species. Olfactory information is
a major emotional input in animals. Primates engage in
rapid sensing of environmental danger, identification of
food and recognition of sex differences; this is performed
via the olfactory system and enhances the immediacy of
responses to impending events. Fontanini et al. (2003)
suggested that the fundamental neuronal architecture of
the cerebral cortex was first evolved in the context of the
olfactory system and was adapted for uses in other sensory
systems via evolutionary development of the neocortex.
Low-frequency oscillations have also been recorded in
the frontal cortex in slices of the neonatal immature rat
cortex (Peinado, 2000; Calderon et al. 2003). The evolution
in neonates of the piriform cortex to the frontal neocortex
is unclear, but an early close relationship between olfaction
and the forebrain has been demonstrated (Aboitiz
et al. 2003). Slow oscillations have been recorded in
the entorhinal and perirhinal cortices in newborn rats
(Garashuk et al. 2000). Oscillatory waves induced by
a calcium influx regulate long-distance wiring in the
immature cortex by promoting synchronized neuronal
development over large cortical areas (Garashuk et al.
2000). Recent in vivo experiments have shown slow
intervals of recurrent calcium transients in the temporal
and parietal cortices of newborn mice (Adelsberger et al.
2005).
Onimaru & Homma (2007) reported an origin of the
slow wave and its propagation in a limbic brainstem–
spinal cord preparation in newborn rats. This preparation
is an intermediate between an in vitro and in vivo
preparation. The brainstem–spinal cord preparation
was first developed by Suzue (1984) and is currently
used worldwide. The preparation allows simultaneous
recordings of spinal motor output and neural activities in
the brainstem. Unlike the slice preparation, the brainstem–
spinal cord preparation can identify neurons from the
motor output. Characteristics of various respiratory
neurons, in particular pre-inspiratory (pre-I) neurons in
the medulla, have been examined with this preparation
(Ballani et al. 1999). The primary area of respiratory
rhythm generation has also been shown optically with
the use of a voltage-dependent dye (Onimaru & Homma,
2003).
Activations of the limbic and paralimbic systems,
including the piriform cortex, amygdala and
hippocampus, can be detected at the rostral surface
of coronal sections of the limbic brainstem–spinal
cord preparation. This preparation is appropriate for

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Exp Physiol 93.9 pp 1011–1021
the examination of characteristics of limbic system
neurons (Fig. 6). Spontaneous rhythmic activity has been
reported in the piriform cortex and amygdala in the
limbic brainstem–spinal cord preparation. Optical signals
appear initially in the piriform cortex and propagate
mediolaterally to terminate in the lateral amygdala
(Onimaru & Homma, 2007). The piriform–limbic
system rhythmic activity is associated with inspiratory
activity of the C4 ventral root (Fig. 7). Rhythmic activity
remains after complete separation of higher brain regions
from the lower brainstem by sectioning at the level of
the pons, but rhythmic activity is independent of C4
inspiratory activity. Electrical stimulation applied to this
region induces a C4 inspiratory burst; and stimulation
applied to the ventrolateral medulla (VLM), where the
brainstem respiratory rhythm generator exists, induces
an excitatory response in the dorsal amygdala complex
(Fig. 8). Neurons in the amygdala complex are connected
reciprocally with respiratory regions in the medulla
and pons (Fulwiler & Saper, 1984; Yasui et al. 2004).
Data obtained by Onimaru & Homma (2007) suggest
that the spontaneous oscillatory activity initiated in the
piriform–amygdala complex is associated with respiratory
activity in the medulla. This connection is not always
close functionally, but the piriform–amygdala complex
may control respiratory rhythm when it is activated by an
odorant or during various emotions.
The piriform–amygdala complex. This system may
connect functionally with the olfactory system. The
amygdala and entorhinal cortex receive inputs directly
from the olfactory bulb and inputs indirectly from the
piriform cortex (Harberly & Price, 1978; McDonald,
1998). Two routes have been identified by stimulation of
the olfactory nerve. One is the route from the piriform
cortex to the amygdala cortex via the medial pathway, and
the other is from the entorhinal cortex to the amygdala
cortex via the lateral pathway (Kajiwara et al. 2007). The
olfactory–amygdala route is considered to be associated
with fear in animals (Phillips & Ledoux, 1992; LeDoux,
2000). Almost all sensory modalities, including auditory,
visual and somatosensory, are associated with fear. Sensory
information produces fear behaviours via activation of the
central nucleus of the amygdala, the hypothalamus and the
brainstem (LeDoux, 2000).
Results of animal studies of olfactory centres and
amygdala activation have similarities to studies in humans.
Odour perception and odour-induced emotions are
dependent on inspiration. Therefore, it is not surprising
that respiratory rhythms are closely associated with
emotions. The piriform cortex may produce rhythms,
and the piriform–amygdala complex may alter respiratory
rhythm in response to qualitative changes in emotions.
The entorhinal cortex may also be necessary in this
system, as shown in our human experiments. Reciprocal

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Breathing and emotion 1019
connections between the entorhinal cortex and the
amygdala have been identified in animal experiments. This
system may be involved not only in odour stimulation
but also in various emotional states (Fig. 9). Breathing
and emotion are linked with meditation, especially in East
Asia (Fontanini & Bower, 2006). Breathing and emotion
are also linked with culture. Homma et al. (2006) have
shown in actors of Japanese traditional ‘Noh’ drama that
the internal expression of the mind is generated in the
amygdala with breathing rhythm.
References
Aboitiz F, Morales D & Montiel J (2003). The evolutionary
origin of the mammalian isocortex: towards an integrated
developmental and functional approach. Behav Brain Sci 26,
535–552.
Adelsberger H, Garaschuk O & Konnerth A (2005). Cortical
calcium waves in resting newborn mice. Nat Neurosci 8,
988–990.
Adolph R, Tranel D, Damasio H & Damasio AR (1994).
Impaired recognition of emotion in facial expressions
following bilateral damage to the human amygdala. Nature
372, 669–672.
Aminoff MJ & Sears TA (1971). Spinal integration of
segmental, cortical and breathing inputs to thoracic
respiratory motoneurons. J Physiol 215, 557–575.
Averbeck BB & Lee D (2004). Coding and transmission of
information by neural ensembles. Trends Neurosci 27,
225–230.
Ballani K, Onimaru H & Homma I (1999). Respiratory
network function in the isolated brainstem-spinal cord of
newborn rats. Prog Neurobiol 59, 583–634.
Boiten FA (1998). The effects of emotional behavior on
components of the respiratory cycle. Biol Psychol 49, 29–51.
Boiten FA, Frijda NH & Wientjes CJE (1994). Emotions and
respiratory pattern: review and critical analysis. Int J
Psychophysiol 17, 103–128.
Braun AR, Balkin TJ, Wesenten NJ, Carson RE, Varga M,
Baldwin P, Selbie S, Belenky G & Herscovitch P (1997).
Regional cerebral blood flow throughout the sleep-wake
cycle. An H 2 15 O PET study. Brain 120, 1173–1197.
Buckley MJ & Gaffan D (1998). Learning and transfer of
object-reward associations and the role of the perirhinal
cortex. Behav Neurosci 112, 15–23.
Buonviso N, Amat C & Litaudon P (2006). Respiratory
modulation of olfactory neurons in the rodent brain. Chem
Senses 31, 145–154.
Calderon DP, Leverkova N & Peinado A (2003). Gq/11-induced
and spontaneous waves of coordinated network activation in
developing frontal cortex. J Neurosci 25, 1737–1749.
Collins DR, Pelletier JG & Pare D (2001). Slow and fast
(gamma) neuronal oscillations in the perirhinal cortex and
lateral amygdala. J Neurophysiol 85, 1661–1672.
Davis M (1992). The role of the amygdala in fear and anxiety.
Ann Rev Neurosci 15, 353–375.
Engel AK, Fries P & Singer W (2001). Dynamic predictions:
oscillations and synchrony in top-down processing. Nat Rev
Neurosci 2, 704–716.
1020 I. Homma and Y. Masaoka
Evans KC, Banzett RB, Adams L, McKay L, Frackowiak RSJ &
Corfield DR (2002). BOLD fMRI identifies limbic,
paralimbic, and cerebellar activation during air hunger. J
Neurophysiol 88, 1500–1511.
Fontanini A & Bower JM (2006). Slow-waves in the olfactory
system: an olfactory perspective on cortical rhythms. Trends
Neurosci 29, 429–437.
Fontanini A, Spano P & Bower JM (2003).
Ketamine-xylazine-induced slow (<1.5 Hz) oscillations in
the rat piriform (olfactory) cortex are functionally correlated
with respiration. J Neurosci 23, 7993–8001.
Fulwiler CE & Saper CB (1984). Subnuclear organization of the
efferent connections of the parabrachial nucleus in the rat.
Brain Res 319, 229–259.
Gandevia SC & Plassman BL (1988). Responses in human
intercostals and truncal muscles to motor cortical and spinal
stimulation. Respir Physiol 73, 325–337.
Gandevia SC & Rothwell JC (1987). Activation of the human
diaphragm from the motor cortex. J Physiol 384, 109–118.
Garashuk O, Linn J, Eilers J & Konnerth A (2000). Large-scale
oscillatory calcium waves in the immature cortex. Nat
Neurosci 3, 452–459.
Gomez P & Danuser B (2004). Affective and physiological
responses to environmental noise and music. Int J
Psychophysiol 53, 91–103.
Halgren E, Babb TL, Rausch R & Crandall PH (1978). Mental
phenomena evoked by electrical stimulation of the human
hippocampal formation and amygdala. Brain 101, 83–117.
Harberly LB & Price JL (1978). Association and commissural
fiber systems of the olfactory cortex of the rat. I. Systems
originating in the piriform cortex and adjacent areas. J Comp
Neurol 178, 711–740.
Harper RM, Frysinger RC, Trelease RB & Marks JD (1984).
State-dependant alternation of respiratory cycle timing by
stimulation of the central nucleus of the amygdala. Brain Res
306, 1–8.
Homma I, Masaoka Y, Hirasawa K, Yamane F, Hori T &
Okamoto Y (2001) Comparison of source localization of
interictal epileptic spike potentials in patients estimated by
the dipole tracing method with the focus directly recorded
by the depth electrodes. Neurosci Lett 304, 1–4.
Homma I, Masaoka Y & Umewaka N (2006). Breathing mind
in ‘Noh’. In Breathing, Feeding, and Neuroprotection, ed.
Homma I & Shioda S, pp. 125–134. Springer-Verlag, Tokyo.
Homma S, Musha T, Nakajima Y, Okamoto Y, Blom S, Flink R,
Hagbarth KE & Moström U (1994). Location of electric
current sources in the human brain estimated by the dipole
tracing method of the scalp-skull-brain (SSB) head model.
Electroencephalogr Neurophysiol 91, 374–382.
Hugdahl K (1995). Psychophysiology. Harvard University Press,
London.
Kajiwara R, Tominaga T & Takashima I (2007). Olfactory
information converges in the amygdaloid cortex via the
piriform and entorhinal cortices: observations in the guinea
pig isolated whole-brain preparation. Eur J Neurosci 25,
3648–3658.
LeDoux JE (1998). The Emotional Brain: The Mysterious
Underpinnings of Emotional Life. Simon & Schuster, New
York.
LeDoux JE (2000). Emotion circuits in the brain. Annu Rev
Neurosci 23, 155–184.
Exp Physiol 93.9 pp 1011–1021
Lledo PM, Gheusi G & Vincent JD (2005). Information
processing in the mammalian olfactory system. Physiol Rev
85, 281–317.
McDonald AJ (1998). Cortical pathways to the mammalian
amygdala. Prog Neurobiol 55, 257–332.
Masaoka Y, Hirasawa K, Yamane F, Hori T & Homma I (2003).
Effects of left amygdala lesions on respiration, skin
conductance, heart rate, anxiety, and activity of the right
amygdala during anticipation of negative stimulus. Behav
Modif 27, 607–619.
Masaoka Y & Homma I (1997). Anxiety and respiratory
pattern: their relationship during mental stress and physical
load. Int J Psychophysiol 27, 153–159.
Masaoka Y & Homma I (1999). Expiratory time determined by
individual anxiety levels in humans. J Appl Physiol 86,
1329–1336.
Masaoka Y & Homma I (2000). The source generator of
respiratory-related anxiety potential in the human brain.
Neurosci Lett 283, 21–24.
Masaoka Y & Homma I (2001). The effect of anticipatory
anxiety on breathing and metabolism in humans. Respir
Physiol 128, 171–177.
Masaoka Y & Homma I (2004). Amygdala and emotional
breathing. In Post-genomic Perspectives in Modeling and
Control of Breathing, ed. Champagnat J, pp. 9–14. Kluwer
Academic/Plenum Publishers, New York.
Masaoka Y, Koiwa N & Homma I (2005). Inspiratory
phase-locked alpha oscillation in human olfaction: source
generators estimated by a dipole tracing method. J Physiol
566, 979–997.
Maskill D, Murphy K, Mier A, Owen M & Guz A (1991). Motor
cortical representation of diaphragm in man. J Physiol 443,
105–121.
Massimini M, Huber R, Ferrarelli F, Hill S & Tononi G (2004).
The sleep slow oscillation as a traveling wave. J Neurosci 24,
6862–6870.
Morris J, Friston KJ, Buechel C, Frith CD, Young AW, Calder
AJ & Dolan RJ (1998). A neuromodulatory role for the
human amygdala in processing emotional facial expressions.
Brain 121, 47–57.
Nyklicek I, Thayer JF & Van Doorner LJP (1997).
Cardiorespiratory differentiation of musically-induced
emotions. J Psychophysiol 11, 304–321.
Öhman A (2000). Fear and anxiety: evolutionary, cognitive and
clinical perspectives. In Handbook of Emotion, ed. Lewis M &
Haviland-Jones JM, pp. 573–593. The Guilford Press, New
York.
Onimaru H & Homma I (2003). A novel functional neuron
group for respiratory rhythm generation in the ventral
medulla. J Neurosci 23, 1478–1486.
Onimaru H & Homma I (2007). Spontaneous oscillatory burst
activity in the piriform-amygdala region and its relation to in
vitro respiratory activity in newborn rats. Neurosci 144,
387–394.
Orem J (1989). Behavioral inspiratory inhibition: inactivated
and activated respiratory cells. J Neurophysiol 62, 1069–1078.
Orem J & Trotter RH (1994). Behavioral control of breathing.
News Physiol Sci 9, 228–252.
Peinado A (2000). Travelling slow waves of neural activity: a
novel form of network activity in developing neocortex. J
Neurosci 20, RC54.

C 2008 The Authors. Journal compilation 
C 2008 The Physiological Society
Exp Physiol 93.9 pp 1011–1021
Phillips RG & LeDoux JE (1992). Differential contribution of
amygdala and hippocampus to cued and contextual fear
conditioning. Behav Neurosci 106, 274–285.
Reiman EM, Fusselman MJ, Fox PT & Raichle ME (1989).
Neuroanatomical correlates of anticipatory anxiety. Science
243, 1071–1074.
Rolls ET (2001). The rules of formation of the olfactory
representations found in the orbitofrontal cortex olfactory
areas in primates. Chem Senses 26, 595–604.
Rolls ET, Kringelbach ML & de Araujo IE (2003). Different
representations of pleasant and unpleasant odours in the
human brain. Eur J Neurosci 18, 695–703.
Royet JP, Zald D, Versace R, Costes N, Lavenne F, Koenig O &
Gervais R (2000). Emotional responses to pleasant and
unpleasant olfactory, visual, and auditory stimuli: a positron
emission tomography study. J Neurosci 20, 7752–7759.
Sanchez-Vives MV & McCormick DA (2000). Cellular and
network mechanisms of rhythmic recurrent activity in
neocortex. Nat Neurosci 3, 1027–1034.
Sejnowski TJ & Destexhe A (2000). Why do we sleep? Brain Res
886, 208–223.
Shea SA, Benchtrit G, Pham Dinh T, Hamilton RD & Guz A
(1989). The breathing patterns of identical twins. Respir
Physiol 75, 211–224.

C 2008 The Authors. Journal compilation 
C 2008 The Physiological Society
Breathing and emotion 1021
Steriade M (2000). Corticothalamic resonance, states of
vigilance and mentation. Neuroscience 101, 243–276.
Steriade M, Contreras D, Curró Dossi R & Nuñez A (1993).
The slow (<1 Hz) oscillation in reticular thalamic and
thalamocortical neurons: scenario of sleep rhythm
generation in interacting thalamic and neocortical networks.
J Neurosci 13, 3284–3299.
Steriade M & Timofeev I (2003). Neuronal plasticity in
thalamocortical networks during sleep and waking
oscillations. Neuron 37, 563–576.
Suzue T (1984). Respiratory rhythm generation in the in vitro
brainstem–spinal cord preparation of the neonatal rat. J
Physiol 354, 173–183.
Timofeev I & Steriade M (1996). Low-frequency rhythms in the
thalamus of intact-cortex and decorticated cats. J
Neurophysiol 76, 4152–4168.
Ward LM (2003). Synchronous neural oscillations and
cognitive processes. Trends Cogn Sci 7, 553–559.
Wilhelm FH, Gevirtz R & Roth WT (2001). Respiratory
dysregulation in anxiety, functional cardiac, and pain
disorders. Assessment, phenomenology, and treatment.
Behav Modif 25, 513–545.
Yasui Y, Tsumori T, Oka T & Yokota S (2004). Amygdaloid
axon terminals are in contact with trigeminal premotor
neurons in the parvicellular reticular formation of the rat
medulla oblongata. Brain Res 1016, 129–134.
 MOJ Anatomy & Physiology

Mini Review Open Access

Functional correlation between breathing and

emotional states
Abstract Volume 3 Issue 5 - 2017

Breathing changes in response to emotional states, such as sadness, happiness, anxiety or

Anjali A Sarkar
fear. On the other hand, emotional states change the pattern, rate and depth of breathing. A Freelance, USA
complex coordination, not yet fully understood, involving widely dispersed brain centres
in the cerebral cortex, limbic system, medullary and pontine areas, together control the Correspondence: Anjali A Sarkar, Freelance, 2916 Weisman
correlation between breathing and emotion. This intricate correlation between breathing Road Silver Spring MD 20902, USA, Email sarkaraa@gmail.com
and emotion is essential to synchronize metabolism, energetic and other physiological
parameters of homeostasis with changes in the environment. Adept correlation of breathing Received: March 14, 2017 | Published: May 18, 2017
with emotional states not only maintains homeostasis but is also essential for survival.

Introduction B(Nmb) or gastrin releasing peptide (Grp) expressed in neurons of

a breath control center (RTN/pFRG) that project to the respiratory
Almost everyone is intuitively aware of a connection between rhythm generator (preBötzinger Complex).8
breathing and emotion. We know that when we are agitated and
anxious our breath is rapid and shallow and when we’re relaxed and Effect of breathing on emotion
content our breath is slow and deep. We might be somewhat less
Conscious regulation of the breath activates the motor cortex.9
aware, however that when we compel our breath to be rapid and
Observation of the breath has revealed that breath cycles through a
shallow we become agitated and anxious and when we compel our
predominance of the right and left nostril with brief intervening periods
breath to be slow and deep we promote relaxation and contentment.
where the breathing in both nostrils are equally balanced. Yogic
Breathing is the only essential physiological function that is both
practice of alternate nostril breathing (Nadi Shodhan Pranayama,
under voluntary and involuntary control. For example, the heart needs
translated as the cleansing of the nerve centres) has long espoused a
to beat for us to live but we cannot increase or decrease our heart rate
calming effect when breathing is restricted to the left nostril and an
at will. Breathing on the other hand is more amenable to conscious
activating or energizing effect when breathing is restricted to the right
regulation. e
nostril. In a single breathing cycle, extension of the inhalation phase
Three areas of the brain regulate breathing and respiration. has an energizing and activating effect whereas the extension of the
Here, breathing is defined as the physiological process of inhalation exhalation phase has a relaxing and calming effect.
and exhalation that carries oxygen laden air into the alveoli of the
Respiratory symptoms are the best predictor of panic attacks, as
lungs and expels carbon dioxide laden air into the atmosphere,
defined in the DSM IV. Studies have shown that particularly in a
whereas respiration is defined as the cellular metabolism process of
carbon dioxide enriched environment, respiration is highly correlated
oxygen transfer and the combustion of high energy bio molecules
to feelings of fear and discomfort.10
that maintain homeostasis. Widely dispersed centres located in
the brainstem, the limbic system and the cerebral cortex regulate Therapeutic applications of breath-emotion dynamics
breathing and respiration. The regulation of breath by the brain stem
is largely unconscious and serves to maintain homeostasis whereas Symptoms and treatment of cancer generate extreme anxiety.
the regulation of breath by the limbic system generates emotional A study conducted on 16 age-matched cancer patients receiving
repercussions, while the higher cognitive centers of the cerebral chemotherapy, shows the beneficial effect of four pranayama breathing
cortex exert voluntary and intentional control on breathing. techniques on cancer related emotional symptoms.11 Simple breathing
techniques feasible to be practiced in class and at home by cancer
Effect of emotion on breathing patients is used in this study. The first technique involves maintaining
a continuous awareness of the breath; the second technique (Ujjayi
Neuroscientists have been using braining imaging studies to
Pranayama, translated as the victorious breath) involves a partially
understand anatomical signatures for emotional states,1‒6 establishing
closed glottis, deep inhalations extending the lower and upper
the brain regions that are activated in synchrony in a given emotion
lungs and extended exhalation; the third technique (Kapalabhati
or mood. Emotions generate not only brain signatures but also body
Pranayama) involves gentle inhalation, brief retention and forceful
(somatic) signatures in the form of responses in the peripheral nervous
exhalation, tailored to the strength of the patient; the fourth technique
system and behavioral expression. Emotion changes heart rate, blood
(NadiShodhan Pranayama) involved using the fingers in a specific
pressure, skin conductance and breathing,7 largely unconsciously.
orientation (mudra) to close alternate nostrils so as to restrict breath
Animal model studies have revealed detailed mechanisms to either the right or left nostril. The practice of these four breathing
underlying the neural control of breathing and the coordination of techniques significantly reduced fatigue, sleep disturbance, anxiety,
emotion and breathing. For example, sighs, that are long deep breaths depression and stress in the limited sample of cancer patients.
and express sadness, relief or exhaustion are regulated by a peptidergic
A larger study on 74 young adults that involves training in Ujjayi
circuit regulated by bombesin-like neuropeptide genes neuromedin

Submit Manuscript | http://medcraveonline.com MOJ Anat Physiol. 2017;3(5):157‒158. 157

© 2017 Sarkar. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.

Functional correlation between breathing and emotional states
breathing, Bhastrika pranayama and Sudarshan Kriya for 20hours over
a five day period shows improvements in self-reported depression,
stress, satisfaction, social connectedness and gratitude.12 Breathing
based meditation techniques have also been shown to reduce post
traumatic stress disorder in US army veterans13 and effectively reduce
anxiety and depression in COPD patient.14
Conclusion
Before adopting any Yoga-based breathing technique, it is crucial
to ascertain the skill, experience and knowledge of the instructor.
This is because just as correct breath control technique can alleviate
undesirable emotional states, incorrect breathing techniques can be
harmful, generating neural injury in the brain that can affect a wide
range of physiological systems. This is supported by studies on
patients with abnormal breathing patterns during sleep that show
injury in the medulla, pons, cerebellum, neurotransmission through
serotonergic, adrenergic and peptidergic neurons, somatosensory and
limbic cortices and the hippocampus.15
Acknowledgements
None.
Conflict of interest
Author declares that there is no conflict of interest.
References
1. Contreras Rodriguez O, Pujol J, Batalla I, et al. Disrupted neural
processing of emotional faces in psychopathy. Soc Cogn Affect
Neurosci. 2014;9(4):505‒512.
2. Pujol J, Giménez M, Ortiz H, et al. Neural response to the observable
self in social anxiety disorder. Psychol Med. 2013;43(4):721‒731.
3. Tettamanti M, Rognoni E, Cafiero R, et al. Distinct pathways
of neural coupling for different basic emotions. Neuroimage.
2012;59(2):1804‒1817.
4. MacConnell G, Aston M, Randel P, et al. Nurses’ experiences
providing bereavement follow-up: an exploratory study using
feminist poststructuralism. J Clin Nurs. 2013;22(7‒8):1094‒1102.
Citation: Sarkar AA. Functional correlation between breathing and emotional states. MOJ Anat Physiol. 2017;3(5):157‒158. DOI: 10.15406/mojap.2017.03.00108
Copyright:
©2017 Sarkar 158
5. van der Zwaag MD, Dijksterhuis C, de Waard D, et al. The influence
of music on mood and performance while driving. Ergonomics.
2012;55(1):12‒22.
6. van der Zwaag W, Da Costa SE, Zurcher NR, et al. A 7 tesla
FMRI study of amygdala responses to fearful faces. Brain Topogr.
2012;25(2):125‒128.
7. Boiten FA, Frijda NH, Wientjes CJ. Emotions and respiratory
patterns: review and critical analysis. Int J Psychophysiol.
1994;17(2):103‒128.
8. Li P, Janczewski WA, Yackle K, et al. The peptidergic control circuit
for sighing. Nature. 2016;530(7590):293‒297.
9. Masaoka Y, Izumizaki M, Homma I. Where is the rhythm generator
for emotional breathing? Prog Brain Res. 2014;209:367‒377.
10. Colasanti A, Salamon E, Schruers K, et al. Carbon dioxide-
induced emotion and respiratory symptoms in healthy volunteers.
Neuropsychopharmacology. 2008;33(13):3103‒3110.
11. Dhruva A, Miaskowski C, Abrams D, et al. Yoga breathing for cancer
chemotherapy-associated symptoms and quality of life: results
of a pilot randomized controlled trial. J Altern Complement Med.
2012;18(5):473‒479.
12. Goldstein MR, Lewis GF, Newman R, et al. Improvements in well-
being and vagal tone following a yogic breathing-based life skills
workshop in young adults: Two open-trial pilot studies. Int J Yoga.
2016;9(1):20‒26.
13. Seppala EM, Nitschke JB, Tudorascu DL, et al. Breathing-based
meditation decreases posttraumatic stress disorder symptoms in
U.S. military veterans: a randomized controlled longitudinal study. J
Trauma Stress. 2014;27(4):397‒405.
14. Valenza MC, Valenza Peña G, Torres Sánchez I, et al. Effectiveness
of controlled breathing techniques on anxiety and depression in
hospitalized patients with COPD: a randomized clinical Trial. Respir
Care. 2014;59(2):209‒215.
15. Harper RM, Kumar R, Ogren JA, et al. Sleep-disordered breathing:
effects on brain structure and function. Respir Physiol Neurobiol.
2013;188(3):383‒391.
How We Breathe Affects Our Thoughts and Emotions,
Northwestern Researchers Find
bigthink.com/philip-perry/how-we-breathe-effects-our-thoughts-and-feelings-northwestern-
neuroscientists-find
4. siječnja 2017.

Man with a lot on his mind. Getty Images.

Focusing on one’s breathing has been a preoccupation of Eastern philosophy for

centuries and in some cases, millennia. It is considered a means to attain inner peace
and illumination. Yogis and Zen masters alike have traditionally begun their teachings
having students focus on their breathing. It seems that science has finally caught up. A
new study published in the journal Neuroscience outlines the interrelationship between
breathing and cogitation.

Researchers at Northwestern University’s Feinberg School of Medicine conducted the

study. General respiration in adults is between 12 and 18 breaths per minute. Those who
are in a stressful situation often take 20 breaths per minute. Assistant professor of
neurology Christina Zelano wondered if breathing faster made us think more rapidly.
She’s the lead author of this study. The idea is that faster breathing could mean quicker
brain function and a better response time when faced with a dangerous situation.

Zelano and colleagues discovered that the rhythm in which we breathe directly affects
activity in our brain. Yet, there are a lot of factors involved such as how deep or shallow
our breathing is and whether we do so through our nose or mouth. Inhaling through the
nose stimulates the brain, it was found. Doing so through the mouth however causes
little stimulation.

This interrelationship was initially discovered by studying seven severely epileptic

patients who were scheduled for brain surgery. Each was hooked up to an
electroencephalograph (EEG), which measures brain waves. Several of these participants
had electrodes surgically implanted inside their skulls in order to collect data on their
seizures and find out where they came from. Soon, researchers discovered that brain
activity was intimately linked with the act of breathing.

In fact, there is an exact synchronicity between these two processes. The Northwestern
team delved further and found that three major areas of the brain are affected by
breathing: the hippocampus which is responsible for memory, the amygdala—our
emotional center, and the piriform cortex, which controls our olfactory system or our
sense of smell. These are all part of the limbic system which is responsible for our basic
emotions such as anger and fear, along with our instinctual drives such as hunger, the
sex drive, and caring for offspring. The limbic system is also responsible for our higher
emotions.

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2/5
Top articles1/5READ MORE

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The limbic system. By BruceBlaus. Blausen.com staff. "Blausen gallery 2014". Wikiversity
Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. (Own work) [CC BY 3.0], via
Wikimedia Commons

These neuroscientists also discovered that there are major changes in brain activity
when you inhale. Inhalation effects the amygdala, hippocampus, and piriform cortex.
Now, researchers moved into a second phase. Here, 70 participants between the ages of
18 and 30 were recruited. Each was asked to look at images of faces on a computer
screen that only lasted about a second, while hooked up to a machine that monitors
breathing.

Recruits were to determine whether the face expressed surprise or fear. The scientists
wanted to know if inhalation or exhalation through the nose versus the mouth changed
the participant’s recognition capability in any way. They discovered that when breathing
in through the nose, participants could recognize a scared face a fraction of a second
earlier.

In a third portion of the study, 42 recruits were shown objects on a computer screen and
were told to remember them. They were hooked up to a breath recorder at this time.
Later, participants were asked what they remembered. This was meant to gauge
memory, specifically how breathing affected the hippocampus. Those who breathed in
when they saw the objects tended to remember better than those who breathed out.
Also, inhalation through the nose made recall five percent more accurate.

So how can you use this knowledge to your advantage? Cognition may work better when
we inhale through our nose, especially when worried or scared. This can help us react
better to situations. Deep breathing exercises can also improve our memory and help us
to make better decisions where our emotions are a central part of evaluation. So should

4/5
you stay with a partner whom you love, even though they don’t ever want to get married
and you do? Breathe in deeply through your nose while you think it over. It should help
you sort it out.

Jay Gottfried is a professor of neurology at Northwestern and the senior author of this
study. Gottfried said that these practices are already an essential part of focused
breathing and meditation. But now we come to understand why they work on a
biological level. “When you inhale, you are in a sense synchronizing brain oscillations
across the limbic network,” he said. Though these findings are exciting, this study utilized
a small participant pool. A much larger study must be conducted to find out the
intricacies of how breathing and brain activity are interrelated and how one effects the
other.

To learn more about this study, click here:

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How heart rate variability affects emotion regulation brain
networks
ncbi.nlm.nih.gov/pmc/articles/PMC5761738

PMCID: PMC5761738

NIHMSID: NIHMS931316

PMID: 29333483
and
The publisher's final edited version of this article is available at Curr Opin Behav Sci
See other articles in PMC that cite the published article.
Go to:
Individuals with high heart rate variability tend to have better emotional well-being than
those with low heart rate variability, but the mechanisms of this association are not yet
clear. In this paper, we propose the novel hypothesis that by inducing oscillatory activity
in the brain, high amplitude oscillations in heart rate enhance functional connectivity in
brain networks associated with emotion regulation. Recent studies using daily
biofeedback sessions to increase the amplitude of heart rate oscillations suggest that
high amplitude physiological oscillations have a causal impact on emotional well-being.
Because blood flow timing helps determine brain network structure and function, slow
oscillations in heart rate have the potential to strengthen brain network dynamics,
especially in medial prefrontal regulatory regions that are particularly sensitive to
physiological oscillations.

Having high heart rate variability (HRV) is associated with higher emotional well-being
[1–3], including being correlated with lower levels of worry and rumination [ 4], lower
anxiety [5], and generally more regulated emotional responding [ 6]. Thus, individuals
with higher HRV appear to be better at regulating their emotions. However, it is not clear
from these correlational studies if HRV is simply an output measure of regulatory brain
health, or whether it somehow increases prefrontal regulation effectiveness. In healthy
individuals, high HRV is not simply the result of random variability. Instead, much of the
variability is due to the heart responding to physiological oscillatory signals such as
breathing and blood pressure feedback, such that heart rate slows down and speeds up
in a rhythmic fashion at certain frequencies. In this paper, we review findings that
suggest that such oscillations in heart rate play a causal role in improving emotion
regulation processes. Furthermore, we propose that high amplitude oscillations in heart
rate modulate brain oscillatory activity, especially in brain regions associated with

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emotion regulation, and that daily episodes of synchronized activity within these
networks can lead to enhanced functional connectivity strength in these emotion
regulation networks even when HRV is not high.

Go to:
Emerging research indicates that emotion regulation and HRV are associated via the
common brain regions involved in both systems [7]. For instance, in a meta analysis, HRV
was significantly associated with regional cerebral blood flow in ventromedial prefrontal
cortex (including anterior cingulate regions) and the amygdala [7]. In both younger and
older adults scanned while at rest, higher HRV (measured used the root mean square
successive differences; RMSSD) was associated with higher medial prefrontal cortex and
amygdala functional connectivity [8; see also 9], a pattern associated with emotion
regulation [10]. In addition, among younger and older adults, greater structural thickness
in prefrontal regions was associated with greater HRV [11; see also 12; 13].

Go to:
High HRV could be associated with better emotion regulation simply because the same
brain regions are involved in regulation of both systems, allowing HRV to serve as an
indicator of the functioning of brain regulatory systems. However, recent findings [for
review see 14] suggest that HRV itself influences brain and emotional function. In these
studies, participants are taught to increase their HRV by breathing at around 10 s per
breath. This .1 Hz frequency is a “resonance” frequency at which paced breathing
induces oscillations in heart rate at an especially high amplitude [15]. shows an example
of heart rate at rest in a healthy individual (panel A) followed by heart rate during paced
breathing at their resonance pace (panel B). In resonance breathing HRV biofeedback
studies, participants get feedback on how successfully they are increasing heart rate
oscillations [15]. They typically engage in HRV biofeedback for at least 20 minutes a day
for several weeks. A recent meta-analysis of 24 studies revealed that HRV biofeedback
reduced self-reported stress and anxiety with a large effect size [16]. For instance, in one
study, basketball players scoring high on anxiety were randomly assigned to HRV-
biofeedback during resonance paced breathing, to an active control, or a no-contact
control condition [17]. Participants completed sessions 10 days in a row for 20 minutes
in each session and were tested before and after the 10-day intervention and again a
month later. The intervention reduced state anxiety, and increased performance on
standardized tests of basketball dribbling, passing and shooting. HRV biofeedback also
has other positive effects on emotions. Coronary artery disease patients randomly
assigned to HRV biofeedback during resonance breathing instead of a wait-list control
showed decreased expressive and suppressive hostility and these effects were
maintained a month after the 6-week intervention ended [18]. Likewise, veterans with
post-traumatic stress disorder randomly assigned to HRV-biofeedback during resonance
breathing showed reduced symptoms after 8 weeks of HRV-biofeedback whereas those
assigned to treatment as usual did not show significant reductions in symptoms [19]. In
addition, patients with post-stroke depression randomly assigned to treatment-as-usual
in addition to HRV biofeedback during resonance breathing showed greater reductions

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in some indices associated with depression than those not assigned to HRV biofeedback
[20]. Thus, in these studies, a series of HRV-biofeedback sessions using resonance paced
breathing enhanced emotional outcomes.

A. An example of heart rate variability during about a 2.5 minute time period during
quiet rest. B. The same person’s heart rate during resonance breathing during another
2.5 minute time period.

Go to:
The studies reviewed above using HRV biofeedback during paced breathing take
advantage of the fact that two physiological rhythms that have a strong influence over
the heart rate can be coordinated to induce high amplitude heart rate oscillations. The
first of these physiological rhythms is the baroreflex. The vascular branch of the
baroreflex has a lag time of approximately 10 seconds [21]. When vessels are stretching,
baroreceptors signal via the brainstem to the heart to slow down the pace of heartbeats.
There is a few-second delay in this feedback loop [between 4–6.5 s; 22] that creates
oscillations in heart rate that take twice as long as the delay (from 0.075–0.12 Hz,
depending on the individual) to complete a full oscillatory cycle [14; 22]. The second
major influence over HRV is breathing. As we breathe in, heart rate tends to increase and
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as we breathe out, heart rate tends to decrease [23], although with a phase delay [24].
We usually breathe at a faster frequency (between .15 and .4 Hz) than the baroreflex.
However, unlike the baroreflex, which has a fixed frequency, we can alter the pace of our
own breathing. When breathing is slowed down to the same frequency as the baroreflex
feedback loop, this creates resonance, a non-linear effect that is greater than an additive
effect of the two influences. Thus, at an individual’s resonance frequency, there is the
potential for high amplitude oscillations in heart rate.

A fascinating relevant phenomenon is that, in many meditative and religious chanting

practices, breathing slows to around a 10-s (.1 Hz) rate and heart rate oscillates at this
frequency [25–29]. For instance, reciting either the rosary Ave Maria prayer or a yoga
mantra leads to breathing at a 10-s/breath rate and increased blood pressure and heart
rate oscillations at that .1 Hz resonance frequency [25]. Hypotheses about the
mechanisms of the positive effects of meditative practices typically focus on the role of
attentional training and body awareness [30]. In contrast, there has been little focus on
the role of physiological rhythms induced by the meditative practice.

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We propose that episodes of high amplitude oscillations in heart rate (like those
observed during meditative practice or HRV biofeedback) promote functional
connectivity between certain brain regions, in particular among brain regions involved in
emotion regulation. Why might this be the case?

First of all, brain activity is fueled by oxygen transported by blood, and so should be
affected by oscillations in blood flow. Indeed, heart rate contributes to blood-oxygen
level dependent (BOLD) fluctuations during functional magnetic resonance imaging
(fMRI) [31–33]. Strong phase coupling of heart rate interval and BOLD oscillations have
been observed in the mid cingulate and posterior cingulate regions at around the .1 Hz
frequency [34]. These hemodynamics are likely to impact neural activity. In particular,
oscillations in blood flow may lead to oscillations in the sensitivity of local cortical circuits
to sensory stimuli [35].

Different brain regions vary in how long it takes for blood to reach them, with distant
brain regions sometimes having similar vascular delays. Estimating vascular delay times
for each voxel in an fMRI image and then running independent component analyses
reveals components that resemble commonly identified resting state networks [36].
Resting state networks reflect brain regions that activate in correlated fashion at slow
frequencies [<.1 Hz; 37]. It is intriguing that just knowing the vascular delays of different
brain regions provides enough information to partially reconstruct resting state
networks [36]. Indeed, part of what may lead some brain regions to develop coordinated
network activity with each other may be their similar timing of blood delivery. Increasing
the amplitude of blood flow oscillations via resonance breathing increases the impact of
these coordinated vascular activities and thereby further stimulates networks that were

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shaped in part by blood flow patterns. Repeated brief episodes of coordinated activity
within a network can strengthen its internal pathways, promoting greater functional
connectivity during rest [e.g., 38; 39].

In addition to timing, regional differences in blood flow volume are also associated with
functional connectivity [40]. Brain regions with high resting cerebral blood flow also show
high functional connectivity with other brain regions, and the correlation between
functional connectivity strength and blood flow is higher for measures of long-range
than for short-range functional connectivity [40]. Brain regions showing strong cross-
subject correlations between functional connectivity strength and blood flow include
medial prefrontal cortex, anterior and posterior cingulate, and insula [40]. Thus, brain
regions associated with emotion regulation are among those that experience high
regional blood flow and serve as hub regions for brain functional connectivity. Thus,
oscillations in blood flow are especially likely to impact these brain regions.

Breathing also influences brain rhythms. Breathing volume and pace help determine
arterial CO2, which is a cerebral vasodilator and is expelled during breath exhalation.
Brain regions differ in the timing and strength of their responses to these CO2
fluctuations, likely related to their proximity to large vessels, with strong correlations
seen in insula and midline cingulate regions [41; 42]. Breathing causes respiration-
synched oscillations across much of the neocortex and gamma power waxes and wans
depending on the respiratory oscillation phase [43]. Breathing through one’s nose
synchronizes oscillations in olfactory cortex as well as the amygdala and hippocampus
[44]. In these limbic regions, nostril breathing entrains higher frequency oscillations in
the delta, theta and beta ranges to the respiratory phase [44]. Thus, the breathing
component of resonance breathing biofeedback practice should also contribute to
neural oscillatory activity, especially in the limbic regions during nostril breathing.

Heartbeats also cause EEG responses known as heartbeat-evoked potentials that are
particularly prominent in brain regions associated with interoceptive sensation and
emotion, including medial prefrontal cortex, cingulate cortex, insula, and amygdala [45;
46]. Thus, heartbeats should be especially likely to influence brain rhythms in these brain
regions. Consistent with this, BOLD activity in the ventromedial prefrontal cortex
covaries with heart rate more than does activity other brain regions [47], and as already
reviewed, in general, medial prefrontal/anterior cingulate regions show activity
associated with HRV [7].

In summary, resonance breathing stimulates high amplitude oscillations that can

influence brain rhythms via several channels, including fluctuations in blood flow, CO2
levels, and sensory input from breathing and from heartbeats. These channels each are
especially likely to modulate activity in brain regions associated with emotion regulation
networks [48].

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In the previous section, we laid out the case that resonance breathing is likely to lead to
oscillations in brain activity. Here we argue that, in addition to provoking oscillations at
the same frequency, resonance breathing should also modulate faster oscillatory
activity. The power density of EEG is inversely proportional to frequency, such that more
powerful and widespread slow oscillations can modulate weaker but faster local
oscillations [49; 50]. Slow oscillations are also critical for brain networks, because the
limited number and speed of neuronal connections connecting distant regions mean
that large-scale brain networks can only oscillate in tandem during slow oscillations [50].

The ability of lower frequency oscillations to modulate the phase of higher frequency
oscillations leads to a hierarchical structure for EEG. For instance, in awake macaque
monkeys, delta phase (1–4 Hz) modulates theta phase (4–10 Hz) and theta modulates
gamma phase (20–50 Hz) amplitude, with these oscillations controlling baseline
excitability and leading to phasic oscillations in responsiveness to stimuli [51]. Activity at
one frequency is especially likely to modulate activity at other frequencies that are
multiples of that frequency, a phenomenon known as harmonic frequency. Indeed, one
speculative proposal is that the heart rate is the basic frequency and scaling factor for
EEG frequency domains [52]. EEG is categorized into a set of different frequency bands
(delta, theta, alpha, beta, gamma). The center frequency of each of these frequency
bands (estimated at 2.5, 5, 10, 20 and 40 Hz, respectively) is twice as high than the
previous lower frequency [52]. If the harmonic sequence of EEG frequency bands is
extended down from delta to slower oscillations, the next lower one is 1.25 Hz, which, at
75 beats per minute, is close to the average resting heart rate [e.g., 53], suggesting that
heart rate may be a basic frequency that serves as a scaling factor (depending on
individual differences in average heart rate) for the EEG frequency domains [52].
Furthermore, if one continues going down to the subharmonic frequencies, one of the
frequencies overlaps with high frequency HRV range influenced by breathing and
another overlaps with the low frequency HRV range influenced by baroreflex feedback
[52]. Consistent with these harmonic relationships, during sleep high frequency HRV
shows synchronization with each of the different EEG frequency bands [54].
Furthermore, during wakefulness, the EEG spectral peak frequency is correlated with
heart rate and this correlation decreases as sleep depth increases [55].

Thus, low frequency oscillations induced by resonance breathing should be able to

promote functional connectivity between non-adjacent brain regions while also
modulating oscillations at higher EEG frequency bands. Studies examining the oscillatory
properties of brain activity are consistent with this notion that oscillations in the
resonance frequency range help organize and modulate activity at higher frequencies.
For instance, oscillations in prefrontal oxyhemoglobin in the frequency band between .07
and .13 Hz were coupled with EEG alpha and/or beta power oscillations [56]. Intracranial
recordings from human posteromedial cortex revealed that the magnitude of cross
frequency theta-to-gamma modulation fluctuated at around a 0.1 Hz frequency [57].
Thus, oscillations in brain activity at around the resonance frequency can modulate
interactions among faster frequency signals [see also 58].

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Go to:
Stimulation of the baroreflex with resonance paced breathing is also likely to modulate
brainstem arousal pathways. As already touched upon, as part of their feedback loop,
baroreceptors project to the nucleus of the solitary tract and stimulate both
sympathoinhibitory and a vagal cardioinhibitory pathways that decrease heart rate [59].
In addition to its effects on the heart, the baroreflex pathway also interacts
bidirectionally with brainstem and forebrain regions that regulate arousal [59]. Breathing
also stimulates brainstem arousal centers and breathing and blood pressure signals
interact in affecting sympathetic activity [e.g., 60]. Thus, resonance breathing should
modulate arousal. Most likely, these effects will involve oscillatory influences. Consistent
with this possibility, during slow breathing, muscle sympathetic nerve activity decreases
in a phasic fashion, reaching the same peak level as in control conditions but showing
phasic segments of suppression [61–63]. If inducing high amplitude oscillations in heart
rate phasically suppresses sympathetic action while stimulating parasympathetic action,
this could help explain the stress- and anxiety-reducing effects of resonance breathing
[16].

Go to:
Past research has focused on heart rate variability as a downstream measure, rather
than something that itself affects emotion regulation. For instance, the Neurovisceral
Integration Model proposed that the medial PFC along with a core set of neural
structures integrates information from different system to regulate the heart, and that
HRV provides an index of the effectiveness of this “core integration” system [7].
Furthermore, previous research has not distinguished whether it is random noise or
increases in the amplitude of oscillatory activity that is the key component of HRV that is
associated with better emotional outcomes. The findings we outlined in this paper
suggest that heart rate oscillations can enhance emotion by entraining brain rhythms in
ways that enhance regulatory brain networks.

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How resonance breathing could lead to improved emotional well-being by stimulating
functional connectivity of emotion regulation networks within the brain.

Highlights

Breathing at a 10-s (.1 Hz) rate typically increases amplitude of heart rate
oscillations.

Daily practice increasing heart rate oscillations improves emotional well-being.

Physiological oscillations stimulate oscillatory activity in brain regions involved in

emotion regulation.

Slow (~.1 Hz) oscillations can also modulate interactions among faster neural
frequencies.

Heart rate oscillations thereby have potential to strengthen regulatory brain

networks.

Go to:
Work on this review was supported by NIH grant R01AG057184.

Go to:
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Mara Mather, University of Southern California.
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Julian Thayer, Ohio State University.

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1. Beauchaine TP, Thayer JF. Heart rate variability as a transdiagnostic biomarker of
psychopathology. International Journal of Psychophysiology. 2015;98(2):338–350.
[PubMed]
2. Kemp AH, Quintana DS. The relationship between mental and physical health: Insights
from the study of heart rate variability. International Journal of Psychophysiology.
2013;89(3):288–296. [PubMed]
3. Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative
review of the heart’s anatomy and heart rate variability. Frontiers in psychology. 2014:5.
[PMC free article] [PubMed]
4. Ottaviani C, Thayer JF, Verkuil B, Lonigro A, Medea B, Couyoumdjian A, Brosschot JF.
Physiological concomitants of perseverative cognition: A systematic review and meta-
analysis. 2016;142(3):231–259. [PubMed]
5. Chalmers JA, Quintana DS, Abbott MJ, Kemp AH. Anxiety disorders are associated with
reduced heart rate variability: a meta-analysis. Frontiers in psychiatry. 2014;5:80. [PMC
free article] [PubMed]
6. Appelhans BM, Luecken LJ. Heart rate variability as an index of regulated emotional
responding. Review of general psychology. 2006;10(3):229.

7. Thayer JF, Åhs F, Fredrikson M, Sollers JJ, Wager TD. A meta-analysis of heart rate
variability and neuroimaging studies: implications for heart rate variability as a marker of
stress and health. Neuroscience and Biobehavioral Reviews. 2012;36(2):747–756.
[PubMed]
8. Sakaki M, Yoo HJ, Nga L, Lee TH, Thayer JF, Mather M. Heart rate variability is
associated with amygdala functional connectivity with MPFC across younger and older
adults. Neuroimage. 2016;139:44–52. For both younger and older adults, those with
higher heart rate variability had stronger amygdala-medial prefrontal cortex functional
connectivity, indicating that functional connectivity within an emotion regulation circuit is
related to heart rate variability. [PMC free article] [PubMed]
9. Jennings JR, Sheu LK, Kuan DCH, Manuck SB, Gianaros PJ. Resting state connectivity of
the medial prefrontal cortex covaries with individual differences in high-frequency heart
rate variability. Psychophysiology. 2016;53(4):444–454. [PMC free article] [PubMed]
11. Yoo HJ, Thayer JF, Greening SG, Lee TH, Ponzio A, Min J, … Koenig J. Brain structural
concomitants of resting state heart rate variability in the young and old: Evidence from
two independent samples. Brain Structure & Function in press. [PMC free article]
[PubMed]
15. Lehrer P, Vaschillo B, Zucker T, Graves J, Katsamanis M, Aviles M, Wamboldt F.
Protocol for heart rate variability biofeedback training. Biofeedback. 2013;41(3):98–109.

16. Goessl V, Curtiss J, Hofmann S. The effect of heart rate variability biofeedback training
on stress and anxiety: a meta-analysis. Psychological Medicine. 2017:1–9. This meta-
analysis of 24 studies found that HRV biofeedback training reduced self-reported stress
and anxiety with a large effect size. Treatment efficacy was not moderated by the
9/11
presence of an anxiety disorder, suggesting it had benefits even for those without clinical
levels of anxiety. [PubMed]
18. Lin IM, Fan SY, Lu HC, Lin TH, Chu CS, Kuo HF, … Lu Y-H. Randomized controlled trial
of heart rate variability biofeedback in cardiac autonomic and hostility among patients
with coronary artery disease. Behaviour Research and Therapy. 2015;70:38–46.
[PubMed]
25. Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, Wdowczyc-Szulc J, Lagi A.
Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms:
comparative study. BMJ. 2001;323(7327):1446–1449. This study demonstrates that the
classic rosary prayer (the Ave Maria in Latin) and a typical yoga mantra (“om-mani-
padme-om”) both take about 10 seconds to chant out loud and result in .1 Hz (10-s cycle)
oscillations in heart rate and blood pressure in the person chanting. This suggests that
these classic chants may have endured as calming practices because they stabilize the
respiratory rate at the .1 Hz frequency that stimulates particularly high oscillations in
heart rate and blood pressure. [PMC free article] [PubMed]
32. de Munck JC, Gonçalves SI, Faes TJC, Kuijer JPA, Pouwels PJW, Heethaar RM, Lopes da
Silva FH. A study of the brain’s resting state based on alpha band power, heart rate and
fMRI. Neuroimage. 2008;42(1):112–121. [PubMed]
33. Shmueli K, van Gelderen P, de Zwart JA, Horovitz SG, Fukunaga M, Jansma JM, Duyn
JH. Low-frequency fluctuations in the cardiac rate as a source of variance in the resting-
state fMRI BOLD signal. Neuroimage. 2007;38(2):306–320. [PMC free article] [PubMed]
36. Tong Y, Hocke LM, Fan X, Janes A, Frederick B. Can apparent resting state connectivity
arise from systemic fluctuations? Frontiers in Human Neuroscience. 2015;9 These
authors found that a significant portion of BOLD fMRI slow oscillations (~.1 Hz) are
associated with the vascular low frequency oscillations that can be detected in peripheral
regions such as fingertips and toes. These systemic low frequency oscillations reach
different brain regions at different time delays depending on local cerebral vasculature.
The authors computed the delay time for these signals to reach each voxel in an
functional magnetic resonance scan. Simulation data using just these voxel delay times in
an independent components analysis revealed a number of the well-known resting-state
network patterns in brain activity, indicating that such networks are related to systemic
vascular fluctuations. [PMC free article] [PubMed]
46. Park H-D, Bernasconi F, Salomon R, Tallon-Baudry C, Spinelli L, Seeck M, … Blanke O.
Neural Sources and Underlying Mechanisms of Neural Responses to Heartbeats, and
their Role in Bodily Self-consciousness: An Intracranial EEG Study. Cerebral Cortex.
2017:1–14. [PubMed]
52. Klimesch W. An algorithm for the EEG frequency architecture of consciousness and
brain body coupling. Frontiers in Human Neuroscience. 2013;7 Brain activity measured
using an electroencephalogram (EEG) is categorized into frequency bands (δ, θ, α, β, γ).
Klimesch points out that the center frequency of each of these bands is twice as high
than its next lower neighbor, making them a series of harmonic frequencies. He suggests
that heart rate may be the basic frequency that serves as the scaling factor for all other
frequency and speculates about how this may make heart rate variability adaptive. [PMC
free article] [PubMed]

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61. Mozer M, Fadel P, Johnson C, Wallin B, Charkoudian N, Drobish J, … Wehrwein E.
Acute slow-paced breathing increases periods of sympathetic nervous system
quiescence (1170.12) The FASEB Journal. 2014;28(1 Supplement)

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The breathing conundrum – interoceptive sensitivity and
anxiety
ncbi.nlm.nih.gov/pmc/articles/PMC3805119

PMCID: PMC3805119

NIHMSID: NIHMS517481

PMID: 23468141
, MD1,2
Copyright notice
The publisher's final edited version of this article is available at Depress Anxiety
See other articles in PMC that cite the published article.
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Cognitive and affective processing has been the central focus of brain-related functions
in psychology and psychiatry for many years. Much less attention has been paid to, what
could be considered the primary function of the brain, to regulate the function of the
body. Recent developments, which include the conceptualization of interoception as a
process consisting of integrating the information coming from the inside of the body in
the central nervous system (CNS) and the appreciation that complex emotional
processes are fundamentally affected by the processing and regulation of somatic
states, have profoundly changed the view of the function and dysfunction of the brain.
This review focuses on the relationship between breathing and anxiety. Several anxiety
disorders have been associated with altered breathing, perception of breathing and
response to manipulations of breathing. Both clinical and experimental research studies
are reviewed that relate breathing dysfunctions to anxiety. Altered breathing may be
useful as a physiological marker of anxiety as well as a treatment target using
interoceptive interventions.

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Anxiety is an emotional state associated with a (a) cognitive component of increased
attentional focus on threat to the integrity of the individual [1], (b) a complex
sympathetic arousal response [2], and (c) behaviors aimed to avoid stimuli or contexts
predictive of threat to the individual [3]. Breathing is one of the most fundamental
physiological functions of the human body. Moreover, it is an integral component of
interoceptive processing, i.e. the sensing of the physiological condition of the body [4],
the representation of this internal state [5] within the context of ongoing activities, and
the initiation of motivated action to homeostatically regulate the internal state [6].
Changes in breathing can be both the consequence of an increased level of anxiety (e.g.

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[7]) as well as the source of threat experienced by the individual, which, in turn, leads to
increased anxiety [8]. Thus, assessing breathing might be a useful physiological marker
of the level of anxiety but can also serve as an experimental tool to influence anxiety
levels. The elucidation of the physiological mechanisms and neural pathways regulating
breathing can help to better delineate how an emotional state emerges from the
interaction between the body and the brain.

We have recently refined [9] a previously proposed insular model of anxiety [10]. The aim
of this model is to integrate emerging neuroanatomy of interoception with a process
focused formulation of anxiety to provide a novel heuristic for the development of
assessments and interventions. In this model, we considered that anxiety is a result of an
increased anticipatory response to the potential of aversive consequences, which
manifests itself in enhanced anterior insular cortex processing. Specifically, when anxious
individuals receive body signals they cannot easily differentiate between those, which are
associated with potential aversive (or pleasant) consequences versus those, which are
part of constantly ongoing and fluctuating interceptive afferents. As a consequence,
these individuals imbue afferent interoceptive stimuli with motivational significance, i.e.
an increased tendency to plan and act upon the reception of this input. Specifically, an
internal body signal, e.g. an inspiratory breathing sensation, is associated with negative
valence and linked to belief-based processes, e.g. “I am not getting enough air”, which
results in an increased “fight/flight” response and potential withdrawal or avoidance
behaviors. As a consequence of this noisy amplification, top-down modulatory brain
areas such as the anterior cingulate, dorsolateral prefrontal cortex, and orbitofrontal
cortex are engaged constantly to differentially amplify or attenuate signals that are
predictive or not predictive of future states, respectively. This relative “overactivity” of
cognitive control related brain areas is subjectively experienced as increased production
of thoughts and associated beliefs, which provide prediction-enhancing propositions.
Practically, these cognitive processes result in “worrying”, which is aimed at providing
increased prediction accuracy. This model relies on the notion of “accurate” processing of
interoceptive afferents in general and breathing in particular. However, it is unclear at
what level inaccurate processing of interoceptive afferents occurs in anxious individuals.
This review aims to delineate the current status of knowledge about the physiological
and neural pathways of breathing perception to provide a background and potential
targets of research as well as opportunities to modulate breathing in order to decrease
anxiety

Previous investigations have shown that individuals with anxiety disorders show altered
breathing characteristics [11; 12] or altered responses to manipulating breathing [13].
The focus of this review is to provide insights into the physiology of breathing, its
underlying neural circuitry, challenge paradigms, and its relation to emotional
processing. In particular, the focus is on changes in breathing load, i.e. the degree to
which individuals experience breathing resistance during inspiration. Other studies,
which will not be reviewed here, have focused primarily on the regulation of carbon
dioxide and its contribution to anxiety (e.g. see [14; 15]). The goal is to provide clinicians
and researchers with information that can be useful to better understand why breathing
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is so closely linked to anxiety or to consider modulation of breathing as a mode of
treatment and to develop a program of research aimed at better understanding the
pathophysiology that relates breathing changes to anxiety.

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The sensation of breathing and its impairment is a complex process that is modulated by
both peripheral and central nervous factors. From a peripheral perspective there are at
least seven sensory airway receptors, which have been characterized electrophysiological
[16] that contribute to the sensation and regulation of breathing. Among these are
slowly and rapidly adapting receptors, bronchial and pulmonary C-fiber receptors, high
threshold Aδ-receptors, cough receptors and neuroepithelial bodies. This diversity of
afferents gives rise to a complex representation of breathing in the brain. Thus, emotions
such as anxiety can profoundly influence the subjective experience by amplifying
particular afferent sensory components of breathing. On a subjective level, individuals
are able to separately assess work of breathing, the degree of breathing coordination,
the sense of suffocation, and the sense of struggling for air. Evidence from statistical
analyses support the idea that these subjective experiences can be subsumed into two
super-ordinated clusters, which have been termed perceived breathing effort and air
hunger, both of which contribute to the overall sensation of dyspnea [17]. Thus, even on
a basic neurophysiological level breathing is a complex sensation that emerges from the
interplay of multiple sensory afferents. The relationship between levels of anxiety and
experienced breathing effort or air hunger may be bi-directional. First, genetic or
molecular heterogeneity in the afferent breathing pathway may give rise to differential
amplification of perceived breathing effort or air hunger, which become associated with
increased levels of anxiety. Second, anxiety levels may act to amplify breathing afferents
thereby generating a subjective experience of increased breathing effort or air hunger.

In an important review of the neural systems underlying breathing, Davenport [ 18] has
argued that there are two primary cortical pathways, which he has termed the
discriminative pathway, which is related to respiratory proprioception, and the affective
pathway related to the qualitative assessment of breathing. Whereas the former
processes the awareness of the spatial, temporal, and intensity of the breathing
sensation, the latter is concerned about the evaluative or emotive aspects of breathing.
Not surprising, the discriminative pathway includes the somatosensory cortex,
associated thalamic nuclei, and higher order association areas. In comparison, the
affective pathway involves the limbic circuitry including the amygdala and the insular
cortex as well as thalamic relay nuclei. This circuit contributes to the perception of effort
of breathing, interoceptive perception of ventilatory status [18], and is thought to be
altered in individuals with high trait anxiety [19; 20] or panic disorder [21]. Finally, this
affective dimension of the perception of breathing is particularly vulnerable to emotional
influences, irrespective of objective lung function [22]. However, it is unclear whether
anxiety in general and pathological anxiety states in particular selectively affects the
discriminative or evaluative pathway or whether modulation of these breathing-specific
pathways can alter levels of anxiety.

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Until recently, investigations of the neural basis of breathing have relied mostly on
electroencephalogram (EEG) methodology. The ability of humans to program and control
breathing related movements in the EEG is accompanied by a low-amplitude negativity
starting approximately 2.5 s before inspiration that is best known as a
Bereitschaftspotential (BP). The presence of this BP is considered to be a regulatory
marker that is modulated by different inspiratory breathing resistance and is thought to
be generated as part of the cortical involvement during ventilatory behavior [23].
Another approach to examine the contributions of the different brain areas on breathing
and disruption of breathing is to examine the electrophysiological signature associated
with breathing efforts. Respiratory-related evoked potentials (RREP) can be elicited by
inspiratory occlusions and have a number of component waves, which can be modulated
by voluntary attention, changes in resistance to inspiration and pulmonary disease state
[24]. In particular, respiratory sensory gating has been demonstrated with the RREP
using different levels of intensities and frequencies of respiratory stimuli [24]. Finally,
modulation of these peaks using various experimental approaches can be mapped to
differences in respiratory perceptions [25]. Taken together, the electrophysiological
studies show that the sensation and regulation of breathing occurs on different levels
and can be mapped onto specific ERP signatures.

Consistent with the notion that anxiety plays an important role in the perception of
breathing, von Leupoldt and colleagues [8] found that whereas low anxious individuals
showed the expected pattern of reduced magnitudes of later RREP components P2 and
P3 during the unpleasant compared to the neutral affective context higher anxious
individuals showed greater magnitudes of P2 and P3 during the unpleasant compared to
the neutral affective context. In comparison, earlier components of the RREP (Nf, P1, N1)
were not affected by anxiety. During an anticipatory anxiety situation, high trait anxiety
relative to low trait anxiety individuals showed an increase in flow of breathing and a
decreased expiration time [26] but greater tidal volume increases [27]. Similarly,
anticipatory threat cues can elicited significant startle potentiation, enhanced skin
conductance, heightened corrugator EMG changes, and pronounced “fear bradycardia”
consistent with defensive activation in the context of threatened respiratory dysfunction,
which are enhanced in high trait anxious individuals [28]. Others have reported an
altered temporal pattern of breathing consisting of an increased variability and
unpredictability in panic disorder patients [21], which was significantly attenuated after
treatment with a serotonin-specific reuptake inhibitor [29]. This underlying respiratory
vulnerability in PD seems to constitute a subtle, unstable trait, which may be subject to
significant environmental modulation [30]. There also appears to be a relationship
between breathing patterns as indexed by breath holding duration and level of
avoidance symptoms in patients with Post-Traumatic Stress Disorder. Specifically, lower
breath-holding duration was associated with greater PTSD Avoidance symptom severity
[31]. Finally, subjects a specific phobia of fear of flying were more accurate in detecting
the loads, thereby indicating higher interoceptive awareness [32]. Together, these
findings support the idea that EEG-derived measures of breathing and breathing

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manipulations may be useful to characterize individuals with anxiety disorders. However,
little is known whether these can serve as a physiological marker of fluctuations of
severity of predictors of outcomes to interventions.

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Manipulating breathing opens the possibility for both assessing the significance of
specific physiological pathways in anxiety and as a technique to intervene in order to
lower anxiety levels. Resistive load, i.e. restricted inspiration, was first introduced by
Lopata [33] and Gottfried [34], is an airflow-dependent load [35] and a simple but
powerful experimental approach to induce an altered interoceptive state. In contrast to
expiratory breathing load which affects C0 2 [33], inspiratory breathing load results in
stable, unchanged carbon dioxide levels [36]. Inspiratory breathing loads can be used to
examine experienced breathing effort and generate respiratory-related evoked
potentials with several peaks that indicate the transition from an early sensory
component to a later cognitive aspect [37-40]. Moreover, resistive loads generate pre-
motor potentials that reflect the involvement of higher cortical motor areas [41], they
decrease systolic blood pressure [42], they differ for males and females [ 43], they are
perceived less intense in older individuals [44], they generate load-dependent increases
of unpleasantness [45], and the subjective effects can be modified by attentional
distractions [46]. Thus, inspiratory breathing load provides a powerful experimental
approach to examine the relationship between breathing as a form of interoceptive
processing and anxiety.

Not surprisingly, there are significant inter-individual differences in breathing load

perception and load-related processing. Interestingly, individuals who report relatively
more breathing-related symptoms were less accurate when reporting different loads
than low symptom reporters [47]. Consistent with the idea that reduced accuracy may
accompany pulmonary pathology is the finding that children with life-threatening
asthma are at risk of life-threatening asthma attacks, in part because it requires a
greater change in resistance above their baseline resistance before they sense an
increased mechanical load [48]. Tiller and colleagues [13] found that contrary their initial
hypothesis that there may be a heightened sensitivity to respiratory stimuli in patients
with anxiety disorder, sensitivity may actually be blunted. These authors concluded that
anxious patients do not perceive changes in respiratory proprioceptive stimuli in a
normal fashion but only after substantial deviations from homeostasis. The abrupt
change in their perceptions following substantial deviations may then be perceived as
increased anxiety “out of the blue” and responded to as such, as there is no basis to
appropriately ascribe the altered perceptions. This contrasts with the situation for
normal subjects, who readily perceive proprioceptive changes and adapt and respond to
them gradually as they occur. Others have reported that levels of individual anxiety
affect respiratory rate, especially the expiratory time [49] and that the amount of
perspiration response, i.e. breathing habituation and sweating, and state anxiety scores
may reflect altered homeostatic adjustment mechanisms [49]. The notion of attenuated
sensitivity to different loads is consistent with our extended insular model of anxiety [9].
Specifically, an increased “noisy” input of interoceptive afferents due to indiscriminate
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amplifications of these signals would make it difficult for the individual to differentiate
between different loads. As a consequence, attenuated discriminability of interoceptive
afferents results in increased uncertainty about the actual interoceptive state, which is
proposed to result in greater compensatory cognitive activity to reduce this uncertainty.

The relationship between manipulated breathing and various forms of conditioning is an

important but yet under-developed line of research [50]. Similar to the affective
assessment of visual and auditory stimuli, interoceptive responses to breathing load are
organized to a certain degree along the dimensions of valence and arousal and
represent a homeostatic balance between metabolic activity and affective arousal [51].
Thus, inspiratory breathing loads themselves can be viewed as an aversive interoceptive
stimulus, which evoke affective reactions comparable or stronger than those evoked by
the emotional pictures [52]. More recently, this cue-related activation has been extended
to startle potentiation [53]. Taken together, similar to exteroceptive stimuli, interoceptive
stimuli such as increased breathing load can be subject to conditioning. For example
[54], cues signaling breathing may be difficult resulted in significant startle potentiation,
enhanced skin conductance, heightened corrugator EMG changes, and pronounced “fear
bradycardia” consistent with defensive activation in the context of threatened
respiratory dysfunction. These data indicate that anticipating respiratory resistance
activates defensive responding, which may mediate symptomatology in patients with
panic and other anxiety disorders. Increased breathing rate can also affect the affective
evaluation of visual stimuli sensations yielding increased autonomic arousal [55]. Finally,
interoceptive fear conditioning (IFC) to an interoceptive and exteroceptive conditional
stimulus (CS) with a severe respiratory load applied for 30s as the unconditional stimulus
(US) resulted in a CS-load associated larger startle blinks and a smaller decrease in
respiratory rate and tidal volume. In comparison, a CS-picture evoked an increase in tidal
volume and self-reported fear [50]. Therefore, breathing modulation via inspiratory
loads is associated with the similar neural and behavioral plasticity that occurs with
other exteroceptive stimuli. However, there are no studies examining differential
conditioning of breathing loads in anxiety versus comparison populations.

Although modulating breathing has long been considered an important therapeutic

intervention for anxiety, surprisingly little is known about (a) the effect of interoceptively-
based interventions on breathing or (b) how modulating breathing affect levels of
anxiety. In a recent study, Vlemincs and colleagues showed that worry is characterized by
decreased respiratory stability and flexibility whereas mindfulness seem to have
countering effects these parameters [56]. For example, a mindfulness-based stress-
reduction program [57] had a significant effect on breathing patterns during exercise
[57]. It has been well-established that mindfulness approaches have profoundly
beneficial effects for anxiety [58], yet we are only beginning to examine how these
approaches work on a neurophysiological [59] and molecular level. Future studies will
need to examine whether the response to loaded breathing can be used as a biomarker
for the degree of anxiety severity or could be a treatment target to reduce the
interoceptive sensitivity of anxious individuals.

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Go to:
The physiology and neurobiology of breathing is a rapidly progressing field that provides
an experimental scaffold to study the biological basis of how the body and the brain
interact. More importantly, the experimental tools available enable one to begin to
delineate how specific emotions emerge as a consequence of the body brain interaction.
There are some intriguing initial findings of altered breathing perception, different
breathing patterns, and changes in the neural signature related to breathing in
individuals with high anxiety or anxiety disorders. However, much work needs to be done
to better delineate the direction of the relationship between breathing and anxiety as
well as to evaluate how brain systems respond to the modulation of breathing as a
powerful intervention to attenuate levels of anxiety. A deeper understanding of anxiety
and associated disorder can emerge from investigating the molecular characteristics of
peripheral lung receptors to the influence of controlled breathing during mindfulness.

Go to:
1. Mogg K, Bradley BP. A cognitive-motivational analysis of anxiety. Behav.Res.Ther.
1998;36(9):809–848. [PubMed]
2. Hoehn-Saric R, McLeod DR. Anxiety and arousal: physiological changes and their
perception. J Affect Disord. 2000;61(3):217–24. [PubMed]
3. Aupperle RL, Paulus MP. Neural systems underlying approach and avoidance in
anxiety disorders. Dialogues Clin Neurosci. 2010;12(4):517–31. [PMC free article]
[PubMed]
4. Craig AD. How do you feel? Interoception: the sense of the physiological condition of
the body. Nat.Rev.Neurosci. 2002;3(8):655–666. [PubMed]
5. Craig AD. How do you feel - now? The anterior insula and human awareness.
Nat.Rev.Neurosci. 2009;10(1):59–70. [PubMed]
6. Craig AD. Interoception and Emotion: a Neuroanatomical Perspective. In: Lewis M,
Haviland-Jones JM, Feldman Barrett L, editors. Handbook of Emotions. Guilford Press;
New York: 2007. pp. 272–290.

7. Leivseth L, Nilsen TI, Mai XM, et al. Lung function and anxiety in association with
dyspnoea: the HUNT study. Respir Med. 2012;106(8):1148–57. [PubMed]
8. von Leupoldt A, Chan PY, Bradley MM, et al. The impact of anxiety on the neural
processing of respiratory sensations. Neuroimage. 2011;55(1):247–52. [PMC free article]
[PubMed]
9. Paulus MP, Stein MB. Interoception in anxiety and depression. Brain Struct.Funct.
2010;214(5-6):451–463. [PMC free article] [PubMed]
10. Paulus MP, Stein MB. An Insular View of Anxiety. Biol.Psychiatry. 2006;60(4):383–387.
[PubMed]
11. Stein MB, Millar TW, Larsen DK, Kryger MH. Irregular breathing during sleep in
patients with panic disorder. Am.J Psychiatry. 1995;152(8):1168–1173. [PubMed]
12. Yeragani VK, Pohl R, Jampala VC, et al. Increased QT variability in patients with panic
disorder and depression. Psychiatry Res. 2000;93(3):225–235. [PubMed]
13. Tiller J, Pain M, Biddle N. Anxiety disorder and perception of inspiratory resistive
loads. Chest. 1987;91(4):547–51. [PubMed]
7/8
14. Griez E. Experimental models of anxiety. Problems and perspectives. Acta Psychiatr
Belg. 1984;84:511–532. [PubMed]
15. Pappens M, De Peuter S, Vansteenwegen D, et al. Psychophysiological responses to
CO(2) inhalation. Int J Psychophysiol. 2012;84(1):45–50. [PubMed]
44. Allen SC, Vassallo M, Khattab A. The threshold for sensing airflow resistance during
tidal breathing rises in old age: implications for elderly patients with obstructive airways
diseases. Age Ageing. 2009;38(5):548–52. [PubMed]
57. Robert McComb JJ, Tacon A, Randolph P, Caldera Y. A pilot study to examine the
effects of a mindfulness-based stress-reduction and relaxation program on levels of
stress hormones, physical functioning, and submaximal exercise responses. J Altern
Complement Med. 2004;10(5):819–27. [PubMed]

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The Effect of Diaphragmatic Breathing on Attention,
Negative Affect and Stress in Healthy Adults
ncbi.nlm.nih.gov/pmc/articles/PMC5455070

,1,2 ,3 ,4,5 ,3 ,3 ,3 ,5,6,* and 2,*

This article has been cited by other articles in PMC.
Go to:
A growing number of empirical studies have revealed that diaphragmatic breathing may
trigger body relaxation responses and benefit both physical and mental health.
However, the specific benefits of diaphragmatic breathing on mental health remain
largely unknown. The present study aimed to investigate the effect of diaphragmatic
breathing on cognition, affect, and cortisol responses to stress. Forty participants were
randomly assigned to either a breathing intervention group (BIG) or a control group (CG).
The BIG received intensive training for 20 sessions, implemented over 8 weeks,
employing a real-time feedback device, and an average respiratory rate of 4 breaths/min,
while the CG did not receive this treatment. All participants completed pre- and post-
tests of sustained attention and affect. Additionally, pre-test and post-test salivary
cortisol concentrations were determined in both groups. The findings suggested that the
BIG showed a significant decrease in negative affect after intervention, compared to
baseline. In the diaphragmatic breathing condition, there was a significant interaction
effect of group by time on sustained attention, whereby the BIG showed significantly
increased sustained attention after training, compared to baseline. There was a
significant interaction effect of group and time in the diaphragmatic breathing condition
on cortisol levels, whereby the BIG had a significantly lower cortisol level after training,
while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic
breathing could improve sustained attention, affect, and cortisol levels. This study
provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body
practice, on mental function, from a health psychology approach, which has important
implications for health promotion in healthy individuals.

Keywords: breathing technique, mental health, real-time feedback, relaxation, sustained

attention

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Breathing practice, also known as “diaphragmatic breathing” or “deep breathing,” is
defined as an efficient integrative body–mind training for dealing with stress and
psychosomatic conditions. Diaphragmatic breathing involves contraction of the
diaphragm, expansion of the belly, and deepening of inhalation and exhalation, which
consequently decreases the respiration frequency and maximizes the amount of blood
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gases. Benefits of diaphragmatic breathing have been investigated in association with
meditation and ancient eastern religions (such as Buddhism) and martial arts (Lehrer et
al., 2010). It is considered to be a core component of yoga and Tai Chi Chuan (TCC) and
contributes to emotional balance and social adaptation (Sargunaraj et al., 1996;
Beauchaine, 2001; Porges, 2001), as well as special rhythmic movements and positions.

Psychological studies have revealed breathing practice to be an effective non-

pharmacological intervention for emotion enhancement (Stromberg et al., 2015),
including a reduction in anxiety, depression, and stress (Brown and Gerbarg, 2005a,b;
Anju et al., 2015). A 1-day breathing exercise was found to relieve the emotional
exhaustion and depersonalization induced by job burnout (Salyers et al., 2011). A 30-
session intervention with a daily duration of 5 min can significantly decrease the anxiety
of pregnant women experiencing preterm labor (Chang et al., 2009). In addition, similar
effects on anxiety was observed in a 3-days intervention study, where breathing
practices were performed 3 times per day (Yu and Song, 2010). Further evidence from a
randomized controlled trial (RCT) suggested that a 7-days intensive residential yoga
program that included pranayama (breathing exercises) reduced anxiety and depression
in patients with chronic low back pain (Tekur et al., 2012). Supportive evidence has also
come from a line of RCTs of TCC and yoga (Benson, 1996; Telles et al., 2000; Oakley and
Evans, 2014). Currently, breathing practice is widely applied in clinical treatments for
mental conditions, such as post-traumatic stress disorder (PTSD) (Sahar et al., 2001;
Descilo et al., 2010; Goldin and Gross, 2010), motion disorders (Russell et al., 2014),
phobias (Friedman and Thayer, 1998), and other stress-related emotional disorders.

Earlier studies have observed an attention/vigilance impairment related to breathing

dysfunction in dementia and sleep-disordered breathing in individuals across all ages
(Chervin et al., 2006). More recent studies have suggested that there is a bidirectional
association between breathing and attention. A growing number of clinical studies have
demonstrated that breathing-including meditation may represent a new non-
pharmacological approach for improving specific aspects of attention. Mindfulness, for
instance, contributes to alerting and orienting, but conflicts with monitoring. In addition,
an 8-weeks mindfulness-based stress reduction yielded a larger effect than a 1-month
intensive mindfulness retreat, on the attention altering component (Jha et al., 2007).
Focused attention meditation is a Buddhist practice, whereby selective attention and the
sensation of respiration must be sustained (Gunaratana, 1993/2002; Gyatso and Jinpa,
1995). Three months of intensive focused attention meditation have been found to
reduce variability in attentional processing of target tones and to enhance attentional
task performance (Lutz et al., 2009). Some studies have investigated cognitive and
emotional improvement simultaneously, and have indicated that a brief mental training
could enhance sustained attention as well as reduce fatigue and anxiety (Zeidan et al.,
2010). Some researchers believe that the relaxation generated by peaceful breathing
helped to manage inattention symptoms among children with attention deficit-
hyperactivity disorder (ADHD) (Amon and Campbell, 2008). These results led to the
development of a breath-controlled biofeedback game called ChillFish, which improved
children’s sustained attention and relaxation levels (Sonne and Jensen, 2016).
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Studies orientated toward the physiological mechanism of breathing intervention effects
have indicated a shared physiological basis underlying breathing, emotion, and cognition,
involving the autonomic nervous system. Physiological evidence has indicated that even
a single breathing practice significantly reduces blood pressure, increases heart rate
variability (HRV) (Wang et al., 2010; Lehrer and Gevirtz, 2014; Wei et al., 2016) and
oxygenation (Bernardi et al., 1998), enhances pulmonary function (Shaw et al., 2010), and
improves cardiorespiratory fitness and respiratory muscle strength (Shaw et al., 2010). A
daily 15-min breathing training for 2 weeks significantly promoted mean forced
expiratory volume in 1 s and peak expiratory flow rate (Bernardi et al., 1998). Breathing
with a certain frequency and amplitude was found to relieve clinical symptoms in
patients of all ages with sleep-disordered breathing (Chervin et al., 2006). Evidence from
yoga practice also confirms a reduction of sympathetic and an increase of
parasympathetic nervous system activity (Vempati and Telles, 2002; Raghuraj and Telles,
2003). Cardiac vagal tone is assumed to form part of the shared physiological basis of
breathing and emotion. It is influenced by breathing and is also integral to vagal nerve
stimulation that is closely associated with the physiological basis of emotion, including
emotional regulation, psychological adaptation (Sargunaraj et al., 1996; Beauchaine,
2001), emotional reactivity and expression, empathic responses, and attachment
(Porges, 2001). Moreover, dysfunction of the autonomic nervous system is observed in
adults with anxiety (Kawachi et al., 1995; Thayer et al., 1996; Friedman and Thayer, 1998),
depression (Carney et al., 1995; Lehofer et al., 1997), PTSD (Sahar et al., 2001), panic
disorder (Friedman and Thayer, 1998), and other stress-related mental and physical
disorders (Benson, 1996; Becker, 2000; Bazhenova et al., 2001; Jacobs, 2001).

The shared physiological basis of attention and breathing can be detected in part in the
autonomic nervous system of patients with ADHD (Beauchaine, 2001), but more
evidence is provided by electroencephalographic (EEG) studies and functional magnetic
resonance imaging (fMRI) studies (Lutz et al., 2004). For instance, EEG studies have
suggested that regular breathing practice during yoga and meditation can increase β-
activity in the left frontal, midline, and occipital brain regions (Bhatia et al., 2003; Snayder
et al., 2006), which has been associated with enhanced cognitive performance, such as
during attention, memory, and executive functions (Freeman et al., 1999). In addition,
fMRI studies have also detected a significant increase in activation in the bilateral inferior
frontal and temporal regions under meditation, as compared to a relaxation condition.
Such studies implicated the right inferior frontal cortex/right insula and right
middle/superior temporal cortex as the regions involved in meditation (Hernández et al.,
2015).

Cortisol, a steroid hormone of the glucocorticoid class, is released in response to stress.

Cortisol release is associated with depression, anxiety, and other negative emotions. The
underlying mechanism may be grounded in its sensitivity for the activity of the
hypothalamic–pituitary–adrenal (HPA) axis (Clow et al., 2010), which regulates
metabolism, immunity, and some mental processing, including memories and emotional
appraisal (Pariante and Lightman, 2008). Plasma cortisol levels reflect changes in the
activation of the HPA axis with changes in CO2 inhalation (Argyropoulos et al., 2002),
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while salivary cortisol levels have been associated with fast withdrawal of attention in
response to angry faces (van Honk et al., 1998). However, the associations between
breathing, emotion, attention, and cortisol have not been tested together.

Although breathing practice offers an integrated benefit for mental and physical health,
the results of studies on this topic are inconsistent, because of methodological
limitations in the experimental design, a lack of measurable breathing feedback, and
limited sample sizes. Most cross-sectional and longitudinal studies have focused on how
breathing treatment benefits individuals with particular conditions, such as women
during pregnancy (Schmidt et al., 2000; Booth et al., 2014) and clerks experiencing job
burnout (Salyers et al., 2011), rather than on its health promotion function in a healthy
population. Most importantly, most studies have investigated physiological effects,
emotional benefits, and cognitive benefits separately, which prevents an understanding
of the possible mental and physiological mechanisms of breathing in terms of its
potential benefit for both mental and physical health.

The present study was a pilot RCT with visible feedback breathing recordings used to
monitor the breathing performance overall and to evaluate the outcomes of breathing
practice. The aims of this study were to investigate the mental benefits and the hormone
levels in healthy volunteers who completed an 8-weeks breathing training scheme. An
emotional self-reporting scale and cognitive tests were used to measure mental benefits.
Additionally, cortisol a major HPA-axis-related stress hormone in humans (Matousek et
al., 2010), was also measured to examine whether the breathing practice could be a
buffer for modulating stress levels in the working population. We hypothesized that an 8-
weeks breathing training course would significantly improve cognitive performance, and
reduce negative affect (NA) and physiological stress.

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Participants
Participants were recruited from a local IT company in Beijing, China. The Institute
Review Board of Beijing Normal University approved this study. This study was
performed in accordance with the ethical standards laid down in the 1964 Declaration of
Helsinki and its later amendments. The procedure of the study was fully explained to the
participants, and informed written consent was obtained from each participant before
the study.

All participants completed the following screening forms: (1) a health approval from a
recent physical check-up at a medical center and (2) a demographic questionnaire that
included basic demographic information and mind–body training experience.
Participants who had a history of physical health problems, such as cardiovascular or
cerebrovascular diseases, respiratory diseases, autoimmune diseases, diabetes,
neuropathy, and drug or alcohol abuse, were excluded from the study. In addition,
participants who had yoga, TCC, or Qigong experience, as well as other mind–body
training, were excluded.
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Experimental Protocol
All interventions and tests were performed in a sunny, soundproof, open-air conference
room at the IT company rather than in our laboratory. We reasoned that this would
avoid any potential anxiety that could be brought on by rushing from the workplace to
the laboratory. Participants sat comfortably in leather armchairs throughout the study.

A final total of 40 participants were included in this study. They were assigned to a
breathing intervention group (BIG, 10 females and 10 males) or a control group (CG, 10
females and 10 males) by alternating the order of their registration. Gender balance was
also taken into consideration during this sampling procedure.

The BIG learnt basic knowledge and essential skills about diaphragmatic breathing, and
became familiar with experiencing breathing in as deeply as possible and then exhaling
almost all the air from the lungs, slowly, in a self-controlled, slow rhythm, under the
guide of a coach. All participants were instructed to focus on their breathing and the
sensations produced in the body, while sitting comfortably in chairs with their eyes
closed. Participants were considered as performing diaphragmatic breathing if their
respiratory rate decreased while their respiratory amplitude increased in waveform.

After this learning phase, both groups completed the baseline tests. These included the
Positive and Negative Affect Schedule (PANAS), the Number Cancellation Test (NCT), and
a cortisol test. Thereafter, the BIG received 20-sessions of breath-controlling
intervention. Each intervention involved a 15-min resting breathing session and a 15-min
diaphragmatic breathing session consequently. The diaphragmatic breathing session
began with general verbal guidance from the breathing coach, who spoke at a slow
speed to help participants to become more easily involved. A final test, similar to the
baseline test, was implemented at the end of the 20th intervention. In contrast, the CG
received only an introduction of breathing and rest, a baseline test, and a final test,
without any other intervention.

The experimental training procedure consisted of 20 sessions over a period of 8 weeks.

Each session was conducted every other day on weekdays. Both groups were informed
of the purpose and the procedures of this study after training. In the BIG, 20 participants
were required to conduct resting breathing for 15 min and diaphragmatic breathing for
15 min in each session (Figure ). During resting breathing, participants were instructed to
breathe in a normal state. With closed eyes while sitting comfortably. During
diaphragmatic breathing, they were instructed to inhale as deeply as they could while
their abdomen expanded, and to exhale as slowly as they could while their abdomen
contracted, in a self-paced rhythm, under the instruction of a breathing training coach
and with feedback via a recording device. The two breathing conditions were recorded
during the entire 30-min training. Therefore, each participant’s breathing waves were
visible and monitored by the experimenter to ensure that participants were following the
instructions completely. For the CG, data of resting breathing and diaphragmatic

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breathing from 20 participants were collected on the first day of training and on the last
day of training. Before and after the entire training, the two groups completed the
PANAS, NCT, and cortisol level test (Figure ).

Experimental procedure of intervention.

Breath Recording
Synchronous breathing signals were recorded using breathing monitors (Dongtuo
Science and Technology Ltd., Beijing, China) that recorded participants’ respiration with a
high temporal resolution. All data were collected by inductive sensors (JD/PW-5; Boda
Electron Co., Beijing, China), which were kept against the chest of each participant during
the rest condition, or alternatively against the abdomen during diaphragmatic breathing.
Data were transferred to the host computer (Lenovo, M4600 P3.0HT 25640VN) via
Bluetooth and expressed on-screen as continuous visual waveforms. The height of the
wave crest represented the amplitude of a single breath, while the wavelength indicated
the duration. Each computer was connected to two inductive sensors; 10 recordings
were made simultaneously.

All five research assistants were postgraduate students in psychology. They attended a
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meeting in which training was given and breath recording was practiced for
approximately 1 week prior to the formal experiment, in order to standardize the data
collection procedure. Each of them monitored breathing processes for two participants
concurrently and ensured that data input and output proceeded smoothly.

Throughout the breathing process, all participants kept their eyes closed and breathed
through the nose. The assistants supervised their recordings and obtained the help of
the coach if the recording vibrated or if the breathing frequency remained higher than 6
breaths/min by 2 min after the intervention began. The coach offered special guidance to
help these participants attain diaphragmatic breathing.

Psychological Measurements
All participants were asked to complete behavioral measurements before training and
after training. The behavioral measurements included the PANAS and the NCT. The
PANAS (Watson et al., 1988) is a 5-point Likert scale that measures participants’ feelings
during the past week. It includes 20 self-reported items that are equally divided into a
positive affect (PA) subscale and a NA subscale. Items are scored on a scale of 1–5,
indicating very slightly or not at all, a little, moderately, quite a bit, and very much,
respectively. The PANAS scale is highly internally consistent, largely uncorrelated, stable,
and reliable across cultures, and can distinctively estimate PA and NA at the same time
(Thompson, 2007).

The NCT includes one short practice sheet and four test sheets for evaluate attention
sustainability, which is reflected by the scores generated according to the accuracy in the
test. Each sheet contains 200 single digits with special symbols below or above them. The
targets are “9” digits with two symbols below, above, or on either side. Participants were
asked to cross out targets with a slash and ignore targets placed subsequent to a “5” as
quickly as possible, within 1 min for each sheet. Participants had a 10- to 20-s interval
break between two sheets. The final scores were yielded by the sum of the correct
number of target digits for each sheet.

Neuroendocrine Test
Salivary cortisol was collected four times with the Salivette ® Cortisol (Art. No. 51.1534)
(Sarstedt AG and Co., Nümbrecht, Germany) at two time points: before and after
diaphragmatic breathing at baseline, and before and after the diaphragmatic breathing
at the final test. All salivary cortisol samples were processed according to the
manufacturer’s instructions. Before collection, all participants were required to take a 5-
min break. Each participant was asked to refrain from eating or drinking (except water)
within 20 min before saliva collection. In both the BIG and CG, the saliva sample was
collected between 11:00 and 12:00 to control for the variation in cortisol levels over the
circadian rhythm.

Salivary cortisol was analyzed using a competitive enzyme immunoassay (ELISA,

DiaMetra®, Perugia, Italy), which had a 3–10 g/mL limit of cortisol, for collections before
® 7/23
lunch, according to specifications provided by the manufacturer DiaMetra®. An intra-
assay coefficient variation (9.8%) and an inter-assay coefficient variation (15%) were
calculated according to Jaedicke et al. (2012) (Validation and quality control of ELISAs for
the use with human saliva samples) (Kirschbaum and Hellhammer, 1994; Ogbureke and
Ogbureke, 2015).

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Demographic Characteristics
Demographic characteristics of all the participants in each group are summarized in
Table . The paired t-tests showed that there were no between-group differences in
terms of age [t(38) = 1.31; p = 0.56, Cohen’s d = 0.420], years of education [ t(38) = 1.47; p
= 0.56, Cohen’s d = 0.465], or work experience [ t(38) = 1.05; p = 0.22, Cohen’s d = 0.331].
These results indicate that the BIG and CG were well balanced in age, years of education,
and work experience.

Table 1
Demographic characteristics in the breathing intervention group (BIG) and control group
(CG).

Characteristics BIG (n = 19) CG (n = 20) t p

Age (years) 30.16 ± 5.11 28.25 ± 3.91 1.31 0.56

Education (years) 16.21 ± 1.03 15.85 ± 0.37 1.47 0.10

Work experience (years) 7.24 ± 5.34 5.75 ± 3.31 1.05 0.22

Respiratory Rate
Descriptive statistics showed the average respiratory rate to be 4 times/min in the
diaphragmatic breathing condition (M ± SD = 3.45 ± 1.86) and 17 times/min in the resting
breathing condition (M ± SD = 17.51 ± 5.02) (Table ).

Table 2
Respiratory rate in resting breathing and diaphragmatic breathing.

Resting breathing ( n = 19) Diaphragmatic breathing ( n = 19)

Session

Mean Standard deviation Mean Standard deviation

1 14.82 2.95 9.95 3.09

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 Resting breathing ( n = 19) Diaphragmatic breathing ( n = 19)

Session

Mean Standard deviation Mean Standard deviation

2 16.92 4.00 8.30 2.04

3 17.46 3.59 6.51 4.73

4 16.60 2.44 4.91 1.60

5 16.04 2.71 4.07 1.08

6 16.01 4.04 3.95 1.06

7 17.80 4.40 3.48 1.41

8 16.22 4.68 3.81 1.13

9 17.06 4.62 3.32 1.00

10 16.86 3.91 3.19 1.30

11 19.73 9.95 2.80 1.13

12 18.12 5.83 2.72 0.60

13 15.81 4.44 4.32 1.49

14 18.00 3.28 4.01 1.63

15 16.84 5.35 2.88 0.96

16 16.89 3.58 3.46 1.08

17 17.34 4.32 4.30 1.46

18 17.59 4.88 3.89 1.24

19 17.43 3.77 3.46 0.97

20 17.51 5.02 3.45 1.67

A 2 × 20 within-subject repeated measures analysis was conducted to analyze the change

in respiratory rate between the resting and diaphragmatic breathing conditions across
all time-points, after each of the 20 sessions, in the BIG. The within-group factors were
breathing conditions (diaphragmatic vs. resting) and intervention times (20
assessments). This analysis revealed a significant effect of time, F(19,133) = 2.09, p =
0.008, η2p = 0.23, and a significant effect of breathing condition, F(1,7) = 99.60, p < 0.000,
η2p = 0.93. There was also a significant interaction between time and condition, F(19,133)
= 5.28, p < 0.000, η2p = 0.43. The simple effect revealed that there were significant
9/23
frequency drops (compared to time point 1) at time point 8, MD = 2.36, p = 0.027, time
point 11, MD = 1.77, p = 0.018, time point 13, MD = 2.38, p = 0.019, time point 15, MD =
2.53, p = 0.006, time point 16, MD = 2.28, p = 0.014, time point 18, MD = 1.61, p = 0.033,
and time point 20, MD = 2.23, p = 0.023. The simple effects on breathing shows that the
respiratory frequencies in diaphragmatic breathing were significantly below that in
resting breathing at every intervention time point, with the MDs ranging from 5.63 to
15.93, all ps < 0.002. These results indicated that the breathing intervention successfully
reduced the breathing frequency in the diaphragmatic breathing condition in the BIG.

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in the
respiratory rate between the resting and diaphragmatic breathing conditions across time
points and groups (see Figure ). The within-group factor was the intervention session
(baseline test and final line test), while the between factor was group (BIG vs. CG). The
reduction of breathing frequency between diaphragmatic and resting conditions was
employed as the measure. This analysis revealed a significant main effect of condition,
F(1,36) = 23.36, p = 0.000, η2p = 0.39, and an interaction between condition and groups,
F(1,36) = 7.66, p = 0.009, η2p = 0.175. A simple effect measurement was conducted and
revealed that there was no significant between-group difference during resting
breathing, MD = 0.43, p = 0.861, but diaphragmatic breathing frequency was significant
lower than that during resting breathing, MD = 7.12, p = 0.000. The respiration frequency
in diaphragmatic breathing was significantly less than that in resting breathing in the
BIG, MD = 9.19, p = 0.000, but no similar result was detected in the CG, MD = 2.50, p =
0.153. These results indicated that the diaphragmatic breathing intervention was
effective in both the BIG and the CG, but a significant breathing frequency decrease was
only observed in the BIG.

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Respiratory frequency changes in breathing intervention group (BIG) under different
breathing conditions. Diaphragmatic breathing frequency was significantly lower than
that in the resting breathing condition in BIG.

Positive and Negative Affect

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in NA
across the intervention (see Figure ). The between-group factor was group (BIG vs. CG),
while the within-group factor was test time (baseline test vs. final test). Time and group
revealed a marginally significant interaction, F(1,37) = 3.43, p = 0.07, η2p = 0.09. A simple
effect measurement was conducted and revealed that the BIG demonstrated a
significant reduction in NA score after the intervention, MD = 2.55, p = 0.02, while no
similar results were detected in the CG, MD = -0.15, p = 0.88. There was no significant
main effect of time, F(1,37) = 2.72, p = 0.11, η2p = 0.07, or of group, F(1,37) = 0.9, p = 0.34,
η2p = 0.02.

Negative affect (NA) score changes after intervention. Negative affect scores are
significantly decreased in the breathing intervention group (BIG) compared to the control
group (CG).

A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in PA

across the intervention. We measured the between-group differences (BIG vs. CG) in PA
at the baseline test and final test and detected an insignificant interaction between
group and test times, F(1,37) = 0.17, p = 0.68, η2p = 0.005, a non-significant main effect of
time, F(1,37) = 0.96, p = 0.33, η2p = 0.03, and a non-significant main effect of group,
F(1,37) = 0.29, p = 0.60, η2p = 0.008.

Sustained Attention
A 2 × 2 mixed repeated measures analysis was conducted to analyze the change in the
NCT score across the intervention (see Figure ). We measured between-group
differences (BIG vs. CG) in the NCT score change at the baseline and final tests. The NCT
11/23
result revealed a significant interaction between time and group, F(1,37) = 9.68, p = 0.004,
η2p = 0.21. A simple effect measurement was conducted and revealed that the BIG
showed a significant increase in the NCT score after the intervention, MD = 6.728, p =
0.000), and similar results were detected in the CG, MD = 4.19, p = 0.000. The main effect
of time was significant, F(1,37) = 191.48, p = 0.00, η2p = 0.84, so was the main effect of
group, F(1,37) = 0.01, p = 0.93, η2p = 0.00.

Number cancellation test (NCT) score changes after intervention. The BIG showed higher
scores in sustained attention than did the CG after training, while there was no
significant difference between these two groups after training.

Salivary Cortisol
A 2 × 4 mixed repeated measures analysis was conducted to analyze the change in
salivary cortisol concentration across the intervention (see Figure ). The between-group
factor was group (BIG vs. CG), while the within-group factor was test time (test 1, test 2,
test 3, and test 4). The salivary cortisol samples were collected before and after
diaphragmatic breathing for both baseline and final tests. The concentration result
revealed a significant interaction of time and group, F(3,111) = 9.06, p = 0.000, η2p = 0.20.
A simple effect measurement revealed that the BIG showed a significant decrease in
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salivary cortisol concentration after the intervention, whereby the concentration was
significantly lower in test 3 and test 4 as compared to test 1 and test 2, MD 1-3 = 1.32, p =
0.003, MD 1-4 = 1.39, p = 0.002, MD 2,3 = 1.59, p = 0.00, MD 1-3 = 1.66, p = 0.00. However, no
similar result was found in the CG, p > 0.05. The main effect of time was significant,
F(1,37) = 4.17, p = 0.008, η2p = 0.10, but there was no significant main effect of group,
F(1,37) = 0.01, p = 0.92, η2p = 0.00.

Cortisol concentration changes after intervention. Cortisol levels were significantly

decreased after training in BIG, but no significant changes were detected in the CG.

Go to:
Using a randomized controlled design, the present study examined whether 8 weeks of
intensive diaphragmatic breathing training, a core component of mind–body practices,
could influence cognition, emotion, and physiological responses. As expected, the
lowered frequency of respiration after the intervention suggested that the diaphragmatic
breathing intervention had been inculcated. The NA score decreased after the
intervention, but the PA did not change. Sustained attention scores increased after the
intervention. Moreover, a significant time effect of diaphragmatic breathing on cortisol
levels was observed (before training vs. after training tests), although no group
differentially influence cortisol. We interpret the findings as illustrating the potential
benefits of diaphragmatic breathing practice for improving cognitive function and
reducing negative affect and physiological responses to stress in healthy adults.

The Effectiveness of Breathing Practice

Numerous studies in health psychology and clinical treatment have demonstrated that
diaphragmatic breathing is an effective relaxation technique in complementary and
alternative medicine, with beneficial effects on physical and mental health (Cahalin et al.,

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2002; Tsang et al., 2015; Chen et al., 2016). However, in most studies of mind–body
intervention, diaphragmatic breathing worked as a latent component or an essential
preparation for the core intervention regime, such as meditation, TCC, or yoga (Telles et
al., 2000; Oakley and Evans, 2014). In the present study, we monitored the breathing as
an independent mind–body intervention form to discuss the health contribution to
cognition, emotion, and stress response when respiration slowed. In order to achieve
this aim, we adopted a unique breathing control method, which combined a monitoring
device and coach supervision simultaneously.

In previous studies, practice duration and times were key characters for depicting an
intervention protocol, but these seldom reported the final breathing rate and the
manner in which respiration frequency decreased. In a study of slow-breathing training
on chronic heart failure (Drozdz et al., 2016) reported its protocol as a 10–12 weeks’ (15
min per day) slow-breathing training with a breathing rate at 6 breaths/min, which meets
the key requirements of diaphragmatic breathing. A clear respiration frequency provides
a reliable and reproducible operation standard for estimating whether the intervention
successfully decreased the respiration frequency. In the present study, the significant
difference in respiration rate between the diaphragmatic breathing and resting
breathing conditions confirmed that participants correctly followed the protocol for
diaphragmatic breathing. The non-significant between-group difference in the
respiration frequency in the resting breathing condition confirmed the distinction
between the two breathing conditions. In addition, the continuous decrease in
respiration rate observed in the BIG represented the process of learning and practice. All
these results indicate that the change in respiratory rate could be attributed to the
effectiveness of the diaphragmatic breathing practice over the 8 weeks. They also
indirectly implied that the positive effects in this study were induced by intensive
diaphragmatic breathing practice, rather than any confounding variables.

The present study employed a breathing monitor with results visualized on a screen and
with a senior yoga coach providing professional guidance and instruction. Previous
studies have demonstrated that most participants could follow self-paced breathing
instructions via audio or video cues. Clinical studies usually adopt a breathing device with
quantitative feedback parameters, such as respiratory rate or HRV (Sherlin et al., 2010).
Respiratory sinus arrhythmia biofeedback has also been used to examine the effect of
breathing practice on HRV and symptoms of PTSD, which revealed a significantly greater
reduction in depressive symptoms and increases in HRV indices for individuals with
respiratory sinus arrhythmia (Zucker et al., 2009). These breathing devices with feedback
parameters have an advantage over visual or auditory instructions, without feedback
(Brown et al., 2013), and have been widely applied in treatment for physical and mental
disorders. Inviting a senior breathing coach is an alternative solution for breathing
practice and control (Drozdz et al., 2016). In the present study, the coach strictly guided
and monitored the entire process of diaphragmatic breathing during 20 sessions in a
previous study. These two methods guaranteed that the participants breathed properly
under two conditions under specific supervision during training. Having an appropriate
monitor was another problem that was encountered in breathing practice studies.
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Breathing Practice to Decrease Negative Affect
Emotional improvements have been reported to be the most obvious benefit of mind–
body interventions (Stromberg et al., 2015). It has been suggested that the detrimental
effects of stress and negative emotions could be counteracted by different forms of
breathing techniques, meditation, and relaxation (Jerath et al., 2015), as well as by yoga
and TCC (Benson, 1996; Telles et al., 2000; Oakley and Evans, 2014). A non-randomized
study suggested that a 1-week breathing practice decreased the mean of Post-traumatic
Checklist-17 (PCL-17), Beck Depression Inventory (BDI-21), General Health Questionnaire
(GHQ-12) in survivors of the 2004 South-East Asia tsunami. Their results indicated an
equivalent effect of breathing practice with a traumatic incident reduction exposure
therapy. Moreover, the effects persisted for at least 24 weeks after the intervention had
finished (Descilo et al., 2010). As a non-pharmaceutical treatment, breathing control
therapy is now wildly used in dealing with depression (Tsang et al., 2006), PTSD (Descilo
et al., 2010), insomnia (Manjunath and Telles, 2005), and other relevant mental disorders
(Brown and Gerbarg, 2005a). It is also applied as an adjuvant treatment for patients with
physical disorders, including stroke (Marshall et al., 2014) and cancer (Hayama and
Inoue, 2012). All these lines of evidence confirmed the efficacy of diaphragmatic
breathing in clinical conditions, but we have shown its benefit for healthy individuals. A
previous study has also reported that a better breathing technique was associated with
greater reductions in anxiety (Sherlin et al., 2010). A 6-weeks’ breathing training course
was long enough to cause a significant decrease in anxiety levels in healthy adults
(Chandla et al., 2013). Evidence from diaphragmatic breathing studies suggested a
significant reduction in the state anxiety after an 8-weeks’ intervention measured using
the Beck Anxiety Inventory Assessment in adults (Chen et al., 2016), and a decrease in
self-reported feelings of state anxiety and test performance in primary school students,
by a pre-test/post-test, training-versus-control experiment (Khng, 2016). In the present
study, our 20 sessions of diaphragmatic breathing practice significantly decreased the
NA scores in the BIG. This is consistent with previous results and suggested a relief of
basic NA in individuals’ daily lives. Although we did not detect the time point at which the
emotional benefit occurred, previous studies suggested that even a one-time
intervention could reduce stress, disengaged coping (Arsenio and Loria, 2014), and could
provide certain curative alleviation of job burnout, as well as other emotional disorders.
In that case, it remains unknown whether the reduction of NA occurs after the first
intervention or after a significant reduction in respiration frequency. This could indicate
that diaphragmatic breathing can provide an emotional improvement as a potential
health care effect in healthy volunteers.

Breathing Practice to Enhance Sustained Attention

Sustained attention is critical for maintaining performance over a period of time. Deficits
in sustained attention are major symptoms for several mental disorders (Winterer et al.,
2000). In normal healthy participants, fatigue, work burnout, and task difficulty usually
lead to poor performance in sustained attention (Aston-Jones et al., 1999). In the present
study, we investigated the diaphragmatic breathing as a single intervention method for
15/23
sustained attention improvement. The results suggested that 20 session’s intervention
provided an improvement in the NCT score. Indirect evidence supported these results,
obtained from studies about breathing involving meditation (Lutz et al., 2009) and yoga
training (Velikonja et al., 2010). In previous studies, both long-term intervention
(MacLean et al., 2010), lasting for weeks, and short-term (Tang et al., 2007) intervention,
for a few days, were effective. Consistent with previous studies, we have detected both
long-term benefits after completing the intervention as a whole in the BIG and an
immediate improvement in the CG. Notably, attention improvement was gained after 15
min of diaphragmatic breathing, which was markedly shorter than the 5 days’ training
reported in a previous study (Tang et al., 2007).

Previous studies have hypothesized that perceptual improvements (MacLean et al., 2010)
and stress reduction (Jensen et al., 2012) are the mechanisms by which attentional
improvement is gained. Combining the increase in the NCT score and the decrease in
the NA observed in the present study, we propose that relaxation gained from
diaphragmatic breathing improved the attention test performance (Amon and Campbell,
2008; Sonne and Jensen, 2016). From the point of view of neuroscience, adjusting the
imbalances in the autonomic nervous system is the unique contribution provided by
breathing intervention, and was directly supported by TCC research. It indicated that the
HRV increased when diaphragmatic breathing was performed, which indicated an activity
balance between the sympathetic and parasympathetic systems (Wei et al., 2016).
Therefore, it is reasonable to infer that diaphragmatic breathing might modulate
cognitive performance by predominantly exerting its influence on the autonomic
nervous system. Although the neuro-mechanism remains to be clarified, it is likely that
deep breathing could link mind and body together to regulate the information
processing related to attention.

Breathing Practice and Physiological Responses

Cortisol is a reliable indicator of stress (Feder et al., 2009), because its concentration
increases when having to cope with stressful events. We employed salivary cortisol as a
measure of physiological response in the present study to estimate the
neurophysiological benefit of diaphragmatic breathing. Its concentration decreased
significantly after the 20 sessions’ intervention, which was consistent with previous
results from parents of children and adolescents with diabetes type 1 (Tsiouli et al.,
2014). This result was consistent with previous studies and indicated that breathing
practice reduced the stress-related physiological response level in healthy volunteers.

Cortisol is also closely associated with the HPA axis ( Clow et al., 2010), which can
involuntarily control metabolism, immunity, and some mental processing, including
memory and emotional appraisal (Pariante and Lightman, 2008), and can easily be
affected by breathing (Argyropoulos et al., 2002). Its association with attention (van Honk
et al., 1998), as well as breathing practice, cognitive processing, and emotional arousal is

16/23
strong. It has been suggested that the sympatho-vagal stress response returns to an
optimal balance at 4.5–5.5 bpm breathing in most adults (Lehrer et al., 2010), but no
direct evidence has illuminated the potential mechanism of this physiological effect.

A hypothesis provided by Jerath et al. (2015) suggested that breathing stimulates vagal
activation of GABA pathways from the prefrontal cortex and insula, to inhibit amygdala
over-activity (Brown et al., 2013). A tuning function of the brain toward a
parasympathetically driven mode and positive states was observed in the left insula and
left orbitofrontal cortex with increasing yoga experience (Villemure et al., 2015). Evidence
from brain imaging studies has supported this hypothesis. These results suggested that
long and regular breathing-involving meditation practice significantly deactivated the
limbic system (Kalyani et al., 2011) and rostral prefrontal cortex (Tomasino and Fabbro,
2016), and increased the activation of the right dorsolateral prefrontal cortex (DLPFC)
while performing an attention-focused task. Moreover, specific changes, such as an
increased cortical thickness (Wei et al., 2013), prefrontal-hippocampus functional
connectivity (Tao et al., 2016), and a decreased regional homogeneity in the DLPFC (Wei
et al., 2014), were also detected during the resting state among TCC senior practitioners.
A structural change was proposed according to the autonomic nervous evidence, and
was supported by an absence of age-related gray matter decline in senior yoga
practitioners, as seen on structural MRI (Villemure et al., 2015). All these results
suggested that the prefrontal cortex served as the predominant commander,
supervising the activity from the limbic system, and modulating the activity of the
autonomic nervous system.

Limitations
In the present study, we employed healthy volunteers as our target population. In that
case, we estimated the improvement in mood and cognition and the physiological
response of stress, rather than clinical symptoms, such as anxiety, depression,
attentional impairment, or other stress-related pathological symptoms. In comparison to
a previous study, our results investigated the application of diaphragmatic breathing as a
daily health care for health population. Some of the limitations of the present study
should be acknowledged. First, we discussed the diaphragmatic breathing benefits from
the points of view of emotion, cognition, and physiology, respectively, rather than by
combining these three aspects together to obtain further mechanism-related results.
Therefore, we have deduced a limited contribution to elucidating the underlying
associations between cognitive progressing, affective improvement, and physiological
change. Moreover, in terms of the neuroendocrine response, the cortisol levels were
reduced after a 20 interventions, but no reference criteria were provided to demonstrate
whether this decrease resulted in a real physiological benefit or was only statistically
significant.

In future studies, it would be interesting to investigate the time-course between NA

reduction and a sustained attention score increase. We expect that a time-course would
elucidate the association between emotional and cognitive benefit, and allow testing of
17/23
the hypothesis that the relaxation induced by diaphragmatic breathing relieves stress
and thereby benefits cognitive possessing.

Go to:
The present study illustrates the potential for diaphragmatic breathing practice to
improve cognitive performance and reduce negative subjective and physiological
consequences of stress in healthy adults. Despite the promise of diaphragmatic
breathing practice in supporting function and health, further investigation is needed to
delineate mechanisms that underlie these benefits.

Go to:
The effect of diaphragmatic breathing exercise on attention, negative affect and stress
level: a preliminary randomly controlled study on occupational population was approved
by the ethical broad of school of psychology, Beijing Normal University. The method,
experiment design, and safety of participants were strictly approved by the ethical broad
of school of psychology, Beijing Normal University.

Go to:
G-XW and Y-FL designed the work, drafted and finalized the manuscript. XM, Z-QY, HZ, N-
YD, Y-TS, and Z-QG collected and analyzed the data, and revised the manuscript.

Go to:
The authors declare that the research was conducted in the absence of any commercial
or financial relationships that could be construed as a potential conflict of interest.

Go to:
We thank Mr. Ying Lu for his technical help in providing support on the devices used and
for recruiting participants, and Miss Xiangshu Cui for data collection.

Go to:
Funding. This work was supported by grants from the MOE (Ministry of Education in China) Project of
Humanities and Social Sciences (No.16YJC890012) and the National Natural Science Foundation of China
(31671163).

Go to:
Amon K., Campbell A. (2008). Biofeedback video games to teach ADHD children
relaxation skills to help manage symptoms. Patoss Bull. 34–38. Available at:
http://www2.fhs.usyd.edu.au/arow/biofeedback4adhd/Amon_Campbell_2008.pdf
(accessed January 21, 2011).
Argyropoulos S. V., Bailey J. E., Hood S. D., Kendrick A. H., Rich A. S., Laszlo G., et al.
(2002). Inhalation of 35% CO 2 results in activation of the HPA axis in healthy
volunteers. Psychoneuroendocrinology 27 715–729. 10.1016/S0306-4530(01)00075-0
[PubMed] [CrossRef]
Aston-Jones G., Rajkowski J., Cohen J. (1999). Role of locus coeruleus in attention
and behavioral flexibility. Biol. Psychiatry 46 1309–1320. 10.1016/S0006-
3223(99)00140-7 [PubMed] [CrossRef]
Beauchaine T. (2001). Vagal tone, development, and Gray’s motivational theory:
18/23
Toward an integrated model of autonomic nervous system functioning in
psychopathology. Dev. Psychopathol. 13 183–214. 10.1017/S0954579401002012
[PubMed] [CrossRef]
Becker I. (2000). Uses of yoga in psychiatry and medicine. Complement. Altern. Med.
Psychiatry 19 107–145.
Benson T. (1996). Timeless Healing: The Power and Biology of Belief . New York, NY:
Scribner.
Bernardi L., Spadacini G., Bellwon J., Hajric R., Roskamm H., Frey A. W. (1998). Effect
of breathing rate on oxygen saturation and exercise performance in chronic heart
failure. Lancet 351 1308–1311. 10.1016/S0140-6736(97)10341-5 [PubMed]
[CrossRef]
Booth S., Burkin J., Moffat C., Spathis A. (2014). Breathing Techniques for
Breathlessness Managing Breathlessness in Clinical Practice. Berlin: Springer; 67–112.
10.1007/978-1-4471-4754-1_5 [CrossRef]
Brown R. P., Gerbarg P. L. (2005a). Sudarshan kriya yogic breathing in the
treatment of stress, anxiety, and depression: Part II—Clinical applications and
guidelines. J. Altern. Complement. Med. 11 711–717. 10.1089/acm.2005.11.711
[PubMed] [CrossRef]
Brown R. P., Gerbarg P. L. (2005b). Sudarshan Kriya yogic breathing in the
treatment of stress, anxiety, and depression: part I-neurophysiologic model. J.
Altern. Complement. Med. 11 189–201. 10.1089/acm.2005.11.189 [PubMed]
[CrossRef]
Brown R. P., Gerbarg P. L., Muench F. (2013). Breathing practices for treatment of
psychiatric and stress- related medical conditions. Psychiatr. Clin. North. Am. 36
121–140. 10.1016/j.psc.2013.01.001 [PubMed] [CrossRef]
Carney R. M., Saunders R. D., Freedland K. E., Stein P., Rich M. W., Jaffe A. S. (1995).
Association of depression with reduced heart rate variability in coronary artery
disease. Am. J. Cardiol. 76 562–564. 10.1016/S0002-9149(99)80155-6 [PubMed]
[CrossRef]
Chang S.-B., Kim H.-S., Ko Y.-H., Bae C.-H., An S.-E. (2009). Effects of abdominal
breathing on anxiety, blood pressure, peripheral skin temperature and saturation
oxygen of pregnant women in preterm labor. Korean J Women Health Nurs 15 32–42.
10.4069/kjwhn.2009.15.1.32 [CrossRef]
Chen Y. F., Huang X. Y., Chien C. H., Cheng J. F. (2016). The effectiveness of
diaphragmatic breathing relaxation training for reducing anxiety. Perspect.
Psychiatr. Care 10.1111/ppc.12184 [Epub ahead of print]. [PubMed] [CrossRef]
Clow A., Hucklebridge F., Stalder T., Evans P., Thorn L. (2010). The cortisol
awakening response: more than a measure of HPA axis function. Neurosci.
Biobehavior. Rev. 35 97–103. 10.1016/j.neubiorev.2009.12.011 [PubMed] [CrossRef]
Descilo T., Vedamurtachar A., Gerbarg P. L., Nagaraja D., Gangadhar B. N.,
Damodaran B., et al. (2010). Effects of a yoga breath intervention alone and in
combination with an exposure therapy for post- traumatic stress disorder and
depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatr. Scand.
121 289–300. 10.1111/j.1600-0447.2009.01466.x [PubMed] [CrossRef]

19/23
Freeman F. G., Mikulka P. J., Prinzel L. J., Scerbo M. W. (1999). Evaluation of an
adaptive automation system using three EEG indices with a visual tracking task.
Biol. Psychol. 50 61–76. 10.1016/S0301-0511(99)00002-2 [PubMed] [CrossRef]
Friedman B. H., Thayer J. F. (1998). Autonomic balance revisited: Panic anxiety and
heart rate variability. J. Psychosomat. Res. 44 133–151. 10.1016/S0022-
3999(97)00202-X [PubMed] [CrossRef]
Gunaratana H. (1993/2002). Mindfulness in Plain English. Boston, MA: Wisdom.
Gyatso T., Jinpa G. T. (1995). The World of Tibetan Buddhism: An Overview of Its
Philosophy and Practice. Somerville, MA: Wisdom Publications.
Hayama Y., Inoue T. (2012). The effects of deep breathing on ’tension-anxiety’ and
fatigue in cancer patients undergoing adjuvant chemotherapy. Complement. Ther.
Clin. Pract. 18 94–98. 10.1016/j.ctcp.2011.10.001 [PubMed] [CrossRef]
Hernández S. E., Suero J., Rubia K., González-Mora J. L. (2015). Monitoring the
neural activity of the state of mental silence while practicing Sahaja yoga
meditation. J. Altern. Complement. Med. 21 175–179. 10.1089/acm.2013.0450
[PubMed] [CrossRef]
Jaedicke K. M., Taylor J. J., Preshaw P. M. (2012). Validation and quality control of
ELISAs for the use with human saliva samples. J. Immunol. Methods 377 62–65.
10.1016/j.jim.2012.01.010 [PubMed] [CrossRef]
Jensen C. G., Vangkilde S., Frokjaer V., Hasselbalch S. G. (2012). Mindfulness training
affects attention– or is it attentional effort? J. Exp. Psychol. Gen. 141 106–123.
10.1037/a0024931 [PubMed] [CrossRef]
Jerath R., Crawford M. W., Barnes V. A., Harden K. (2015). Self-regulation of
breathing as a primary treatment for anxiety. Appl. Psychophysiol. Biofeedback 40
107–115. 10.1007/s10484-015-9279-8 [PubMed] [CrossRef]
Jha A. P., Krompinger J., Baime M. J. (2007). Mindfulness training modifies
subsystems of attention. Cogn. Affect. Behav. Neurosci. 7 109–119.
10.3758/CABN.7.2.109 [PubMed] [CrossRef]
Kawachi I., Sparrow D., Vokonas P. S., Weiss S. T. (1995). Decreased heart rate
variability in men with phobic anxiety (data from the normative aging study). Am. J.
Cardiol. 75 882–885. 10.1016/S0002-9149(99)80680-8 [PubMed] [CrossRef]
Khng K. H. (2016). A better state-of-mind: deep breathing reduces state anxiety and
enhances test performance through regulating test cognitions in children. Cogn.
Emot. 10.1080/02699931.2016.1233095 [Epub ahead of print]. [PubMed] [CrossRef]
Lehofer M., Moser M., Hoehn-Saric R., McLeod D., Liebmann P., Drnovsek B., et al.
(1997). Major depression and cardiac autonomic control. Biol. Psychiatry 42 914–
919. 10.1016/S0006-3223(96)00494-5 [PubMed] [CrossRef]
Lehrer P., Karavidas M. K., Lu S. E., Coyle S. M., Oikawa L. O., Macor M., et al. (2010).
Voluntarily produced increases in heart rate variability modulate autonomic effects
of endotoxin induced systemic inflammation: an exploratory study. Appl.
Psychophysiol. Biofeedback 35 303–315. 10.1007/s10484-010-9139-5 [ PubMed]
[CrossRef]
Marshall R. S., Basilakos A., Williams T., Love-Myers K. (2014). Exploring the benefits
of unilateral nostril breathing practice post-stroke: attention, language, spatial

20/23
abilities, depression, and anxiety. J. Altern. Complement. Med. 20 185–194.
10.1089/acm.2013.0019 [PubMed] [CrossRef]
Matousek R. H., Dobkin P. L., Pruessner J. (2010). Cortisol as a marker for
improvement in mindfulness- based stress reduction. Complement. Ther. Clin. Pract.
16 13–19. 10.1016/j.ctcp.2009.06.004 [PubMed] [CrossRef]
Ogbureke K. U., Ogbureke E. I. (2015). “The history of salivary diagnostics,” in
Advances in Salivary Diagnostics ed. Streckfus C. F., editor. (Berlin: Springer; ) 17–31.
Pariante C. M., Lightman S. L. (2008). The HPA axis in major depression: classical
theories and new developments. Trends Neurosci. 31 464–468.
10.1016/j.tins.2008.06.006 [PubMed] [CrossRef]
Porges S. W. (2001). The polyvagal theory: phylogenetic substrates of a social
nervous system. Int. J. Psychophysiol. 42 123–146. 10.1016/S0167-8760(01)00162-3
[PubMed] [CrossRef]
Raghuraj P., Telles S. (2003). Effect of yoga-based and forced uninostril breathing
on the autonomic nervous system. Percept. Motor Skills 96 79–80.
10.2466/pms.2003.96.1.79 [PubMed] [CrossRef]
Russell M. E. B., Hoffman B., Stromberg S., Carlson C. R. (2014). Use of controlled
diaphragmatic breathing for the management of motion sickness in a virtual reality
environment. Appl. Psychophysiol. Biofeedback 39 269–277. 10.1007/s10484-014-
9265-6 [PubMed] [CrossRef]
Sahar T., Shalev A. Y., Porges S. W. (2001). Vagal modulation of responses to mental
challenge in posttraumatic stress disorder. Biol. Psychiatry 49 637–643.
10.1016/S0006-3223(00)01045-3 [PubMed] [CrossRef]
Sargunaraj D., Lehrer P. M., Hochron S. M., Rausch L., Edelberg R., Porges S. W.
(1996). Cardiac rhythm effects of .125-Hz paced breathing through a resistive load:
implications for paced breathing therapy and the polyvagal theory. Biofeedback Self
Regul. 21 131–147. 10.1007/bf02284692 [PubMed] [CrossRef]
Shaw I., Shaw B. S., Brown G. A. (2010). Role of diaphragmatic breathing and
aerobic exercise in improving pulmonary function and maximal oxygen
consumption in asthmatics. Sci. Sports 25 139–145. 10.1016/j.scispo.2009.10.003
[CrossRef]
Sherlin L., Muench F., Wyckoff S. (2010). Respiratory sinus arrhythmia feedback in a
stressed population exposed to a brief stressor demonstrated by quantitative EEG
and sLORETA. Appl. Psychophysiol. Biofeedback 35 219–228. 10.1007/s10484-010-
9132-z [PubMed] [CrossRef]
Snayder N. A., Agarkova N. O., Lyulyakina E. G. (2006). “The bioelectrical brain
activity in humans who practiced Sudarshan Kriya,” in Proceedings of the World
Conference Expanding Paradigms: Science, Consciousness and Spirituality New Delhi.
Sonne T., Jensen M. M. (2016). “ChillFish: a respiration game for children with
ADHD,” in Proceedings of the TEI’16: Tenth International Conference on Tangible,
Embedded, and Embodied Interaction Eindhoven: 10.1145/2839462.2839480
[CrossRef]
Stromberg S. E., Russell M. E., Carlson C. R. (2015). Diaphragmatic breathing and its
effectiveness for the management of motion sickness. Aerosp. Med. Hum. Perform.

21/23
86 452–457. 10.3357/AMHP.4152.2015 [PubMed] [CrossRef]
Tekur P., Nagarathna R., Chametcha S., Hankey A., Nagendra H. R. (2012). A
comprehensive yoga programs improves pain, anxiety and depression in chronic
low back pain patients more than exercise: an RCT. Complement. Ther. Med. 20 107–
118. 10.1016/j.ctim.2011.12.009 [PubMed] [CrossRef]
Telles S., Reddy S. K., Nagendra H. (2000). Oxygen consumption and respiration
following two yoga relaxation techniques. Appl. Psychophysiol. Biofeedback 25 221–
227. 10.1023/A:1026454804927 [PubMed] [CrossRef]
Tomasino B., Fabbro F. (2016). Increases in the right dorsolateral prefrontal cortex
and decreases the rostral prefrontal cortex activation after-8 weeks of focused
attention based mindfulness meditation. Brain Cogn. 102 46–54.
10.1016/j.bandc.2015.12.004 [PubMed] [CrossRef]
Tsang H. W., Cheung W. M., Chan A. H., Fung K. M., Leung A. Y., Au D. W. (2015). A
pilot evaluation on a stress management programme using a combined approach
of cognitive behavioural therapy (CBT) and complementary and alternative
medicine (CAM) for elementary school teachers. Stress Health 31 35–43.
10.1002/smi.2522 [PubMed] [CrossRef]
Tsang H. W., Fung K. M., Chan A. S., Lee G., Chan F. (2006). Effect of a qigong
exercise programme on elderly with depression. Int. J. Geriatr. Psychiatry 21 890–
897. 10.1002/gps.1582 [PubMed] [CrossRef]
Tsiouli E., Pavlopoulos V., Alexopoulos E. C., Chrousos G., Darviri C. (2014). Short-
term impact of a stress management and health promotion program on perceived
stress, parental stress, health locus of control, and cortisol levels in parents of
children and adolescents with diabetes type 1: a pilot randomized controlled trial.
Explore 10 88–98. 10.1016/j.explore.2013.12.004 [PubMed] [CrossRef]
van Honk J., Tuiten A., van den Hout M., Koppeschaar H., Thijssen J., de Haan E., et
al. (1998). Baseline salivary cortisol levels and preconscious selective attention for
threat: a pilot study. Psychoneuroendocrinology 23 741–747. 10.1016/S0306-
4530(98)00047-X [PubMed] [CrossRef]
Velikonja O., Curic K., Ozura A., Jazbec S. S. (2010). Influence of sports climbing and
yoga on spasticity, cognitive function, mood and fatigue in patients with multiple
sclerosis. Clin. Neurol. Neurosurg. 112 597–601. 10.1016/j.clineuro.2010.03.006
[PubMed] [CrossRef]
Vempati R. P., Telles S. (2002). Yoga-based guided relaxation reduces sympathetic
activity judged from baseline levels. Psychol. Rep. 90 487–494.
10.2466/pr0.2002.90.2.487 [PubMed] [CrossRef]
Wang S.-Z., Li S., Xu X.-Y., Lin G.-P., Shao L., Zhao Y., et al. (2010). Effect of slow
abdominal breathing combined with biofeedback on blood pressure and heart rate
variability in prehypertension. J. Altern. Complement. Med. 16 1039–1045.
10.1089/acm.2009.0577 [PubMed] [CrossRef]
Wei G. X., Li Y., Yue X., Ma X., Chang Y., Yi L., et al. (2016). Tai Chi Chuan modulates
heart rate variability during abdominal breathing in elderly adults. Psych. J. 5 69–77.
10.1002/pchj.105 [PubMed] [CrossRef]
Winterer G., Ziller M., Dorn H., Frick K., Mulert C., Wuebben Y., et al. (2000).

22/23
 Schizophrenia: reduced signal-to-noise ratio and impaired phase-locking during
information processing. Clin. Neurophysiol. 111 837–849. 10.1016/S1388-
2457(99)00322-3 [PubMed] [CrossRef]
Yu W.-J., Song J.-E. (2010). Effects of abdominal breathing on state anxiety, stress,
and tocolytic dosage for pregnant women in preterm labor. J. Korean Acad. Nurs. 40
442–452. 10.4040/jkan.2010.40.3.442 [PubMed] [CrossRef]
Zeidan F., Johnson S. K., Diamond B. J., David Z., Goolkasian P. (2010). Mindfulness
meditation improves cognition: evidence of brief mental training. Conscious. Cogn.
19 597–605. 10.1016/j.concog.2010.03.014 [PubMed] [CrossRef]
Zucker T. L., Samuelson K. W., Muench F., Greenberg M. A., Gevirtz R. N. (2009). The
effects of respiratory sinus arrhythmia biofeedback on heart rate variability and
posttraumatic stress disorder symptoms: a pilot study. Appl. Psychophysiol.
Biofeedback 34 135–143. 10.1007/s10484-009-9085-2 [ PubMed] [CrossRef]

Articles from Frontiers in Psychology are provided here courtesy of Frontiers Media SA

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Change How You Feel: Change How You Breathe
psychcentral.com/lib/change-how-you-feel-change-how-you-breathe

Catherine Dowling 17. svibnja 2016.

Emotions add flavor to life. Joy, love and contentment

Meditation
make living a pleasure. Anger and fear act as warning
signals telling us when to protect ourselves. Most of all,
emotions are the glue that binds us to family and friends.

But those same emotions can be so intense it feels as if they’re both tearing us apart
and, at the same time, controlling our lives. Emotions can be powerful drivers of our
behavior. In the grip of an emotion such as anger we tend to repeat old behavior
patterns, patterns we know won’t serve us well. Yet we feel powerless to change what
we’re doing.

Managing emotion is, therefore, a vital life skill. If we want to perfect that skill, it’s helpful
and often essential to get to the source of our feelings.

From psychologist William James in the 1880s to today, scientists have tried to work out
what causes us to experience emotion. Because emotions are felt in the body and have
obvious physiological components — shaking, crying, a racing heartbeat — James
believed the physiological phenomenon gave rise to the emotions. We don’t cry because
we feel sad; we feel sad because we cry.

Over the centuries since James, scientists have put forward a range of theories: emotions
are caused by the way we interpret physical responses to events … or by interpreting the
events themselves through the prism of our past experience … or by hormones … or by
all of the above.

Cognitive-behavioral therapy links our emotions to our thought processes. If, for
example, I think people are out to get me, I may feel anxious and fearful. If I think
everyone loves me, I am likely to feel joyful or happy. From this perspective, emotions
are almost like symptoms generated by our thoughts. But according to a joint study
carried out by staff from the University of Quebec and the University of Louvain, William
James might have been onto something. The findings show a clear and direct link
between emotions and breathing patterns.

The study, entitled “Respiratory Feedback in the Generation of Emotion,” involved two
groups of volunteers. Group 1 was asked to produce four emotions (joy, anger, fear and
sadness) through the use of memory, fantasy and by modifying their breathing pattern.
For each of the emotions under examination, scientists monitored and analyzed the
various breathing components — speed, location in the lungs, amplitude — and used
their findings to draw up a list of breathing instructions.

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These instructions were then given to a second group of volunteers who had been told
only that they were participating in a study of the cardiovascular impact of breathing
styles. Members of Group 2 were asked to breathe according to the instructions drawn
up from the earlier experiment. At the end of the 45-minute breathing session,
participants completed a questionnaire designed to elicit a range of information,
including details of their emotional responses. The results were unmistakable. To varying
but significant degrees, the four breathing patterns induced the anticipated emotional
responses.

This is important information for anyone struggling to manage his or her emotional life.
When caught up in the intensity of an emotion, particularly the so-called “negative”
emotions — anger, sadness, fear and its low-lying cousin, anxiety — it is difficult to
observe one’s own breathing pattern. But to a detached observer the patterns are
obvious. When we’re sad we sigh frequently. When angry, we breathe rapidly. In the grip
of fear our breathing is shallow and from the top of the lungs. And sometimes we hold
our breath without realizing that’s what we’re doing.

My experience as a therapist tells me the source of our emotions can be complex. They
can be linked to thought patterns, old memories and unconscious belief systems, as well
as physiological changes in the body. Plumbing these depths alone can be daunting and
we often need the support of a therapist. But the element of our emotions that we can
manage by ourselves is breathing. We can do this in two ways:

1. Short term: Manage the moment.The researchers gave simple instructions

during this study. To elicit joy, “breathe and exhale slowly and deeply through the
nose; your breathing is very regular and your ribcage relaxed.” Deep, slow
breathing into the belly is strong medicine for anxiety, fear and anger. When we
cry, for example, we usually gulp air into our upper chest. It is almost impossible to
cry and breathe into our belly at the same time. Belly breathing loosens the grip of
feeling. Return to upper chest breathing and the emotion and the tears will return.
In the midst of strong emotion, the breathing of joy can be utilized to ease
emotional pain and stress.
2. Long term: Emotional balance.Does the breathing pattern cause the emotion or
does the emotion cause the breathing pattern? This study indicates that emotions
may be caused, at least in part, by the way we breathe. We all have our own way of
breathing. If you observe breathing patterns in others you will see great variation
in speed, depth, location in the lungs, and in the length and type of pause between
breaths.
The significance of a particular breathing pattern varies from person to person but
they all say something about the way that person interacts with life. Shallow
breathing often accompanies fear, however subtly that fear might be felt. Deep, full
breathing often accompanies confidence, however quietly confidence might be
expressed. When a full breather takes shallow breaths over a prolonged period,
they begin to feel the hint of panic that lack of oxygen can induce. The shallow
breather can feel that all the time, without being aware of it.
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The real key to managing our emotional states through breathwork is to become aware
of how we breathe as we go through our day and practice more calming, joyful
breathing. We need to practice breathing techniques like the breathing of joy, not just
when we’re in the grip of strong feeling, but daily, as a routine, much like brushing our
teeth.

Reference

Philippot, P. & Blairy, S. (2010). Respiratory Feedback in the Generation of Emotion,

Cognition and Emotion, Vl. 16, No 5 (August 2002), pp. 605-627. Or free at:
http://www.ecsa.ucl.ac.be/personnel/philippot/RespiFBO10613.pdf.

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Breathing: The Little Known Secret to Peace of Mind
psychologytoday.com/us/blog/feeling-it/201304/breathing-the-little-known-secret-peace-mind

We take our breath for granted, but learning to breathe can

change our life.
Posted Apr 15, 2013

“A few weeks ago shooting, cars exploding, screaming, death, that was your world. Now
back home, no one knows what it is like over there so no one knows how to help you get
back your normalcy. They label you a victim of the war. I am not a victim... but how do I
get back my normalcy? For most of us it is booze and Ambien. It works for a brief period
then it takes over your life. Until this study, I could not find [the] right help for me,
BREATHING like a champ!” Those were the words of a 25 year old marine, a veteran of
the war in Afghanistan who partook in the research study I ran with Dr. Richard
Davidson at the University of Wisconsin-Madison. Whereas therapeutic and drug
treatments had not helped many of the participants who volunteered for my study, a
breathing practice - the intervention we used - did. One of the veterans in our study has
since gone on to become an instructor so he can share the practices he learned with
other veterans. "Thank you for giving me my life back," he told us.

The Breath Is a Powerful Tool to Calm the Mind

We have an intuitive understanding that the breath can regulate our mind and emotions.
Most of us have either told others or been told ourselves to "take a deep breath” when
things got challenging. Most clinical psychologists use some kind of breathing practice
with patients. However, because breathing happens automatically, many of us don’t give
the breath as much attention as it deserves nor have we learned to harness its full
potential to calm our minds.

One of the reasons why breathing can change how we feel is that emotions and
breathing are closely connected. A revealing research study by Pierre Phillipot showed
that different emotional states are associated with distinct respiration patterns. In
Phillipot's study, participants came in and were instructed to generate emotions like
sadness, fear, anger and happiness to the best of their ability. While they were
experiencing the emotions, Phillipot's team requested participants to closely observe
and report on their own respiration patterns. The research team found that each
emotion was associated with a distinct pattern of breath. For example, when the
participants felt anxious or afraid, they breathed more quickly and shallowly and when
they felt happy, they breathed slowly and fully. Even more interesting was the follow-up
study in which the researchers invited in a different group of participants into their lab
and instructed them to breathe in the patterns they had observed corresponded to

1/3
emotions. The researchers literally told the participants how to breathe and then asked
them how they felt. Lo and behold, the participants started to feel the emotions that
corresponded to the breathing patterns!

This finding is revolutionary: We can change how we feel using our breath! Given the fact
that it is so difficult to change one’s emotions using thoughts alone - try "talking yourself
out of" intense anger or anxiety - , learning to use the breath becomes a very powerful
tool. Since it is so difficult "talk" our way out of our feelings, we can learn to "breathe" our
way through them. After participating in a 6-day workshop, veterans who said they had
felt “dead” since returning from Iraq said they felt alive again. 2 years later, they are
spokespeople for the program, volunteering to encourage other veterans to learn to
breathe again.

More Benefits of Learning Breathing Practices

Several studies suggest that controlled yogic breathing has immediate and positive
effects on psychological well-being, as well as on physiological markers of well-being,
such as blood pressure and heart rate. Within minutes you will feel better and place
your body in a significantly healthier state. The long-term effects of a daily breathing
practice are even more pronounced. By activating the part of our nervous system
associated with “resting and digesting” (the parasympathetic nervous system), breathing
practices may “train” the body to be calmer. For example, preliminary studies have found
that regularly practicing breathing exercises lowers one’s level of cortisol — the “stress
hormone.” Having lower levels of this hormone may be indicative of an overall calmer
state of being, which may translate into less reactivity in the face of inevitable life
stressors and less risk of heart disease. Although substantial studies of yogic breathing
and the brain have yet to emerge, preliminary brain studies of meditation and the breath
suggest that they activate brain areas involved in the control of the autonomic system,
such as the insula. Control of the breath appears to activate brain regions that guide the
parasympathetic, or “rest and digest,” processes of the body, perhaps thereby inducing
its calming effects. Deep breathing has even been found to reduce pain.

A Breathing Practice to Try at Home: Alternate Nostril Breathing

article continues after advertisement

This gentle pranayama is said to cool the mind and emotions. You may notice that, at
any given time, one nostril is dominant (that is, air flows more smoothly through one
nostril and only partially through the other). The dominant nostril alternates throughout
the day. Preliminary research suggests that breathing through the right nostril
oxygenates the left side of the brain, while breathing through the left nostril oxygenates
the right side of the brain. One of the reasons alternate nostril breathing may induce its
calming and balancing effects on the mind is that it gently allows for airflow through
both nostrils.

2/3
To practice, place the index and middle finger of the right hand on the center of the
eyebrow, and place the thumb on the right nostril, and the ring finger and pinky on the
left nostril. The left hand rests on the lap, palm facing up. Take a deep breath in and,
closing the right nostril with your thumb, breathe out through the left nostril. Then take a
deep breath in through the left nostril, close the left nostril with your ring finger and
pinky at the end of the inhale, and exhale through the right nostril. Take a deep breath in
through the right nostril and, closing the right nostril with the thumb, exhale on the left
side, and start over. Do this with your eyes closed for about five minutes. Notice the
effects on your body and mind.

Want to Learn to Breathe Again?

The veterans I worked with learned the practices taught in the Project Welcome Home
Troops workshop which teaches Sudarshan Kriya Yoga. The International Association for
Human Values offers this program programs for veterans (www.pwht.org), in schools
(http://www.youthempowermentseminar.org), and in prisons (
http://www.prisonsmart.org/). This practice is also taught for the general population by
the Art of Living Foundation, see artofliving.org. Elementary yogic breathing practices can
also be learned in general yoga classes. Kundalini yoga classes, for example, place a
particular emphasis on breathing practices.

article continues after advertisementTo stay updated on the science of happiness, health
and social connection, see emmaseppala.com.
Emma is the founder of Fulfillment Daily, science-based news for a happier life.

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Also see the Center for Compassion and Altruism Research and Education at Stanford
University, ccare.stanford.edu

3/3
Relaxation techniques: Breath control helps quell errant
stress response
health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-
response

Updated: April 13, 2018

Published: January, 2015

The term "fight or flight" is also known as the stress response. It's what the body does as
it prepares to confront or avoid danger. When appropriately invoked, the stress
response helps us rise to many challenges. But trouble starts when this response is
constantly provoked by less momentous, day-to-day events, such as money woes, traffic
jams, job worries, or relationship problems.

Health problems are one result. A prime example is high blood pressure, a major risk
factor for heart disease. The stress response also suppresses the immune system,
increasing susceptibility to colds and other illnesses. Moreover, the buildup of stress can
contribute to anxiety and depression. We can't avoid all sources of stress in our lives, nor
would we want to. But we can develop healthier ways of responding to them. One way is
to invoke the relaxation response, through a technique first developed in the 1970s at
Harvard Medical School by cardiologist Dr. Herbert Benson. The relaxation response is a
state of profound rest that can be elicited in many ways, including meditation, yoga, and
progressive muscle relaxation.

1/3
Breath focus is a common feature of several techniques that evoke the relaxation
response. The first step is learning to breathe deeply.

Deep breathing benefits

Deep breathing also goes by the names of diaphragmatic breathing, abdominal
breathing, belly breathing, and paced respiration. When you breathe deeply, the air
coming in through your nose fully fills your lungs, and the lower belly rises.

For many of us, deep breathing seems unnatural. There are several reasons for this. For
one, body image has a negative impact on respiration in our culture. A flat stomach is
considered attractive, so women (and men) tend to hold in their stomach muscles. This
interferes with deep breathing and gradually makes shallow "chest breathing" seem
normal, which increases tension and anxiety.

Shallow breathing limits the diaphragm's range of motion. The lowest part of the lungs
doesn't get a full share of oxygenated air. That can make you feel short of breath and
anxious.

Deep abdominal breathing encourages full oxygen exchange — that is, the beneficial
trade of incoming oxygen for outgoing carbon dioxide. Not surprisingly, it can slow the
heartbeat and lower or stabilize blood pressure.

Practicing breath focus

Breath focus helps you concentrate on slow, deep breathing and aids you in disengaging
from distracting thoughts and sensations. It's especially helpful if you tend to hold in
your stomach.

First steps. Find a quiet, comfortable place to sit or lie down. First, take a normal breath.
Then try a deep breath: Breathe in slowly through your nose, allowing your chest and
lower belly to rise as you fill your lungs. Let your abdomen expand fully. Now breathe out
slowly through your mouth (or your nose, if that feels more natural).

Breath focus in practice. Once you've taken the steps above, you can move on to regular
practice of controlled breathing. As you sit comfortably with your eyes closed, blend
deep breathing with helpful imagery and perhaps a focus word or phrase that helps you
relax.

2/3
 Ways to elicit the relaxation response
Several techniques can help you turn down your response to stress. Breath focus helps with
nearly all of them:

Progressive muscle relaxation

Mindfulness meditation
Yoga, tai chi, and Qi Gong
Repetitive prayer
Guided imagery

Creating a routine
You may want to try several different relaxation techniques to see which one works best
for you. And if your favorite approach fails to engage you, or you want some variety,
you'll have alternatives. You may also find the following tips helpful:

Choose a special place where you can sit (or lie down) comfortably and quietly.
Don't try too hard. That may just cause you to tense up.
Don't be too passive, either. The key to eliciting the relaxation response lies in
shifting your focus from stressors to deeper, calmer rhythms — and having a focal
point is essential.
Try to practice once or twice a day, always at the same time, in order to enhance
the sense of ritual and establish a habit.
Try to practice at least 10–20 minutes each day.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of
archived content. Please note the date of last review on all articles. No content on this site,
regardless of date, should ever be used as a substitute for direct medical advice from your
doctor or other qualified clinician.

3/3
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/232965660

Respiratory feedback in the generation of emotion

Article  in  Cognition and Emotion · September 2010

DOI: 10.1080/02699930143000392

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 Respiratory Feedback 1

Running Head: RESPIRATORY FEEDBACK IN EMOTION

Respiratory Feedback in the Generation of Emotion

Pierre Philippot, Gaëtane Chapelle

Université de Louvain, Louvain-la-Neuve, Belgique

Sylvie Blairy

Université du Québec à Montréal, Canada

Authors' notes
The studies presented in this paper have been made possible by a grant from the "Fonds
National de la Recherche Scientifique de Belgique" 1,5,041,94F.

The authors appreciate helpful comments of Robert S. Feldman, Ursula Hess, Arvid
Kappas and two anonymous reviewers on earlier drafts of this paper.
Correspondence regarding this paper should be addressed to Pierre Philippot who is at
Faculté de Psychologie, Université de Louvain, place du Cardinal Mercier, 10, B- 1348
Louvain-la-Neuve, Belgique. Electronic mail may be sent via Internet to

"Philippot@clis.ucl.ac.be".
 Respiratory Feedback 2

Abstract

This article reports two studies investigating the relationship between emotional

feelings and respiration. In the first study, participants were asked to produce an
emotion of either joy, anger, fear or sadness and to describe the breathing pattern that fit

best with the generated emotion. Results revealed that breathing patterns reported
during voluntary production of emotion were (a) comparable to those objectively

recorded in psychophysiological experiments on emotion arousal, (b) consistently

similar across individuals and (c) clearly differentiated among joy, anger, fear and
sadness. A second study used breathing instructions based on Study 1’s results to

investigate the impact of the manipulation of respiration on emotional feeling state. A

cover story was used so that participants could not guess the actual purpose of the study.

This manipulation produced significant emotional feeling states that were differentiated
according to the type of breathing pattern. The implications of these findings for
emotion theories based on peripheral feedback and for emotion regulation are discussed.
 Respiratory Feedback 3

Respiratory feedback in the generation of emotion

It is commonly agreed that emotion is best conceived of as a multi-component

process whose most central components include appraisal, facial expressions,

physiological responses, and subjective feeling states (i.e., Buck, 1985; Ekman, 1984;

Russell, 1991; Scherer, 1984). One of the oldest debates in emotion psychology
addresses the specification of the relations existing among these different components.

Historically, this debate can be traced back to William James' (1884) peripheral theory

of emotion, which stated that subjective feeling states were merely the
phenomenological result of body state. This position was vigorously counter-attacked

by Cannon (1927) who attempted to prove that body changes followed subjective
feeling states. As reviewed at the occasion of the centennial anniversary of William

James’s (1890) Principles of Psychology (Personality and Social Psychology Bulletin,

1990), this theoretical debate is far from being closed.
Presently, three main conceptions of the relationship between emotional feelings
and body states can be found in the literature. One conception--that we will label the

“undifferentiated arousal model”--states that autonomic responses increase as a function

of emotional intensity but that their pattern is undifferentiated across emotions
(Reisenzein, 1983; Schachter, 1964). At the functional level, the undifferentiated
arousal model predicts that the perception of emotional intensity can be influenced by
arousal intensity (i.e., that individuals’ perception of the intensity of their emotional

states is not only a function of their evaluation of the situation but also of the intensity

of their state of arousal). Research in this area has focused on the effect of the
manipulation of undifferentiated arousal on the intensity--but not on the quality--of

subjective feeling state. As reviewed by Reisenzein (1983) or Kirouac (1995), the

strong and consistent finding from this line of research is the intensification of the
emotional feeling state following exposure to an arousing stimulus, an effect known as

"activation transfer" (Zillmann, 1979, 1983). From this perspective, to influence

subjective feeling intensity, arousal must be (a) consciously perceived and (b)

subjectively attributed to the impact of the emotional situation.

 Respiratory Feedback 4

Another conception, which we will label the “cognitive appraisal model,”

proposes that body changes in emotion are a function of cognitive appraisal (e.g.

Scherer, 1984; Pecchinanda & Smtih, 1996; Smith & Kirby, 2000) or of the direct
output from appraisal, action readiness (Frijda, 1986). More precisely, this model

suggests that the activation of a specific appraisal dimension would induce specific
body changes. For instance, novelty appraisal would induce a pause in breathing and a

deceleration followed by an acceleration of heart rate. The pattern of body changes with

a specific emotional state would be the sum of the changes induced by each appraisal
component. As different feeling states result from different appraisal patterns, they are

also characterized by different patterns of body changes. In the cognitive appraisal

model, the role played by body changes in the elicitation of feeling state is less

explicitly stated and definitely marginal, the central role being played by cognitive
appraisal.
A third conception, which we will label the “central network model” states that
emotions are centrally organized by neural or cognitive networks that connect the

different emotion components together. For some, these networks are innate neural
structures (e.g., Ekman, 1999; Izard, 1979; Tomkins, 1980); for others, they are
cognitive networks or schemata that develop as a function of individuals’ experiences
(e.g., Lang, 1979, 1984; Philippot & Schaefer, 2001; Teasdale, 1996). Though the
theories we gather under the central network model differ in many ways, they all share

similar features with respect to the patterning and function of body changes in emotion.

First, they all postulate that patterns of body changes are differentiated according to the
type of emotion experienced, even if cognitive network theories predict more

idiosyncratic patterns than theories postulating innate neural structures. Second, they

posit that the activation of the body state typical of an emotion elicits that emotion, a
process known as peripheral feedback. Third, they suggest that peripheral feedback

occurs automatically, at an implicit level (i.e., without awareness of the process;

Cacioppo, Berntson & Klein, 1992; Damasio, 1994; Teasdale, 1996). The implication
 Respiratory Feedback 5

of these three postulates is that a specific emotion could be induced by manipulating

one’s body state, outside of this person’s awareness of the process.

At the empirical level, the central network model is supported by research

addressing the relation between facial expression and subjective feeling states, the

research area investigating the "facial feedback hypothesis." A wealth of evidence has
documented that manipulating facial expression affects feeling state (Laird, 1984;

Manstead, 1988; Matsumoto, 1987; McIntosh, 1996). The effect size of the so-called

facial feedback is generally small (around 13% of explained variance) but reliably
significant. The impact of facial muscle manipulation has been extended to

physiological changes, such as heart rate or skin temperature (Hess, Kappas, McHugo,
Lanzetta & Kleck, 1992; Kappas, 1989; Levenson, 1992; Levenson, Carstensen,

Friesen, and Ekman, 1991; Levenson, Ekman & Friesen, 1990). Further, Stepper and
Strack (1993) have documented that manipulating posture also has an impact on
subjective feeling states and affects later judgment of valenced material, extending
previous findings from Duclos, Laird, Shneider, Sexter, Stern, and VanLighten (1989)

showing that posture affects mood. Overall, there exists empirical evidence that
manipulating facial or postural muscles affects subjective feeling states, and possibly
physiological states, outside of individuals’ awareness of the process. Still, the
underlying mechanism of facial feedback is the object of a controversy (e.g., Izard,
1990; Laird, 1984; McIntosh, 1996) and the interpretation of the effect of facial

manipulation on physiological changes in terms of facial feedback has been questioned

(e.g. Boiten, 1996; Zajonc & McIntosh, 1992).

We propose that three questions must be addressed to further our understanding

of the relationship between body state and subjective feelings: First, are subjectively

differentiated feeling states characterized by different body states? Second, does body
state influence the intensity and/or the quality of subjective feelings? Third, does this

influence operate implicitly (i.e., outside of individuals’ awareness of the process), or

explicitly? This latter question is particularly important as explicit knowledge about

body changes may not relate to actual body changes (Rimé, Philippot & Cisamolo,
 Respiratory Feedback 6

1990; Philippot & Rimé, 1997) and as several recent theories issued from the central

network model are based on a distinction between implicit and explicit processing (e.g.

Damasio, 1994; Teasdale, 1996; for a review see Philippot & Schaefer, 2001). The
undifferentiated arousal model postulates that emotional body states are undifferentiated

and have an explicit impact on feelings intensity but not quality. The central network
model posits that emotional body states are differentiated and influence the quality of

feeling states and that these effects can occur at an implicit level. The cognitive

appraisal model is vague and unspecific about whether and how changes in
physiological patterns might influence emotional feeling states.

At the empirical level, the first question--the peripheral differentiation of

emotion--is still the object of a controversy, with different reviews reaching different

conclusions (Levenson, 1992; Stemmler, 1992; Zajonc & McIntosh, 1992). With
respect to the second and third questions, the activation transfer research mentioned
above has shown that arousal can explicitly affect the intensity of feeling state,
providing that it is attributed to an emotional cause; the facial and postural feedback

research has demonstrated that muscular feedback can influence subjective feeling state
outside of individuals’ awareness of the process. Yet, despite its theoretical importance,
the possibility of a visceral--and not solely muscular--feedback on the quality of
emotional feelings has not been pursued at an experimental level. From this
perspective, physiological state should be manipulated, not in intensity but in quality, in

order to observe the impact of such manipulations on the nature rather than the intensity

of feeling states. Further, it should be established whether this effect occurs without
individuals explicitly using body state as a source of information to determine their

emotional feeling state. The present studies aim at exploring these neglected questions.

Specifically, they will examine the effects of respiration manipulation on

emotional feeling state. We choose to manipulate body state through respiration for

four reasons. First, like facial musculature, breathing is under both voluntary and
automatic control, allowing for the same types of manipulation as the ones commonly

used in facial feedback research. Second, clinical evidence has repeatedly confirmed
 Respiratory Feedback 7

relations between breathing and at least one feeling state, anxiety (e.g. Beck & Scott,

1988). Moreover, these studies have also demonstrated the clinical efficacy of

respiration manipulation in reducing anxiety through breathing retraining. Third, a

recent literature review suggests that reliable respiratory differences might be found

between positive or negative feeling states, as well as tense or relaxed feeling states
(Boiten, Frijda & Wientjes, 1994). Fourth, while they can easily be achieved non

invasively, respiration changes affect many physiological responses, such as cardio-

vascular changes or skin conductance. They thereby constitute an easy but potent
avenue to manipulate the whole physiological state of the organism.

In order to induce specific emotions through respiratory manipulations, one has

to determine which are the respiratory patterns that correspond to these emotions. One

source of such information is constituted by the results of psychophysiological research

that observed respiratory changes during emotion induction. Boiten et al. (1994) have
reviewed the psychophysiological literature pertaining to respiratory changes occurring
during emotion. They note that there is very little empirical work on the topic and that

the available studies are fraught with methodological shortcomings. As a result, they
conclude that “it is difficult to draw specific and detailed conclusions concerning the
influence of emotion upon respiration” (Boiten et al., 1994, p. 119). Yet, they were able
to identify some consistency across studies that can be summarized as four types of
breathing related to emotional state. Fast and deep breathing was associated with

excitement, such as in anger, fear, or sometimes even joy. Rapid shallow breathing was

typical of tense anticipation, including concentration, fear, and panic. Slow and deep
breathing was most often observed in relaxed resting state. Finally, slow and shallow

breathing was associated with states of withdrawal and passiveness, such as depression

or calm happiness.
As can be seen from these descriptions, few of the four types of breathing

identified can be unequivocally associated with a specific emotional state. Two remarks
concerning these observations are of importance. First, that psychophysiological

research has not identified specific breathing patterns differentiating basic emotions
 Respiratory Feedback 8

does not necessarily means that such patterns do not exist. This lack of definitive

evidence maybe due to under-sophisticated recording of breathing that most often

measures only frequency (see the discussion by Boiten et al. [1994] in this respect) or to
problems in inducing emotion in psychophysiological experiments (see the discussion

of this point by Stemmler [1989]). Second, although no unequivocal correspondence

between breathing patterns and emotions can be drawn, these descriptions suggest that

(a) fast and deep breathing might characterize anger, (b) rapid shallow breathing might

characterize fear, (c) slow breathing whether deep or shallow might characterize a state
of relaxed happiness, and (d) slow and shallow breathing might characterize sadness.

These propositions have to be considered cautiously, as, for instance, pattern (a) might
also characterize joyful or fearful excitement and pattern (d) might also characterize

calm happiness. In sum, although suggestive, the results of Boiten et al.’s review do not
provide an empirical basis precise enough to construct breathing instructions specific to
basic emotions.
Another source of information regarding emotional breathing patterns pertains to

previous studies investigating whether breathing manipulations induce differentiated

emotional feeling states. The only existing work as been conducted by Bloch,
Lemeignan, & Aguilera-T (1991) who propose that each of six emotions they qualify as
basic (joy, sadness, anger, fear, erotic love, and tenderness) is characterized by a
specific facial, postural and respiratory pattern they labeled “emotional effector

pattern.” The respiratory components of the patterns were derived from visual

inspection of polygraphic records of either actors expressing specific emotions or

participants relieving these emotions under deep hypnosis (Bloch [1994, personal

communication], the original report [Bloch & Santibanez, 1972] cannot be obtained).

The patterns obtained with this procedure differ in several respects from the
observations of Boiten et al (1994). Bloch’s et al. (1991) joy pattern, referring to

laughter, (quick and deep nasal inspiration, followed by oral expiration with small jolts)
is quite different from the pattern associated with calm happiness by Boiten, although it

presents some similarities with Boiten’s pattern of excitement, but for inspiration only.
 Respiratory Feedback 9

Bloch’s et al. anger pattern (regular, quick, and deep nasal breathing) corresponds to our

prediction derived from Boiten et al. With respect to fear, Bloch et al. propose a quick

and shallow inspiration through the mouth, followed by a pause and a long expiration.
In contrast, our prediction based on Boiten et al. is that fear is characterized by shallow

and fast breathing. Finally, Bloch’s proposition for sadness (quick nasal inspiration
with jolts followed by a quick expiration through the mouth) does not correspond to our

prediction derived from Boiten et al. (i.e., slow and shallow breathing).

In their work, Bloch et al. (1991) have demonstrated that extensively training
actors to reproduce these emotional effector patterns results in the induction of the

corresponding emotion feeling state. Unfortunately, in these studies, participants were

explicitly (a) told that the aim of the training was to produce emotion through

respiratory, facial, and postural changes, and (b) informed of which emotional effector
pattern was intended to induce which emotion. Hence the effect of these manipulations
on feeling states may simply be the result of experimenter's demand. Further, breathing
was not manipulated independently from posture or facial expression, hence preventing

estimation of the specific impact of each source of peripheral feedback.

In order to confront the divergence between Bloch’s patterns and those
suggested by Boiten, and given the fact that Bloch et al. (1991) report positive results,
we examined in a preliminary study whether the respiratory component of their
emotional effector patterns is in itself sufficient to induce a specific emotional feeling

state. We replicated the study of Bloch et al. (1991) for four emotions (joy, anger, fear,

and sadness) with two major changes. First, in order to avoid experimental demands,
we used a procedure in which participants were oblivious to the fact that the actual topic

of the study was emotion or emotion induction. Second, in order to disentangle the

effect of facial and postural feedback from those of a possible respiratory feedback, we
only manipulated breathing, keeping facial expression and posture constant. The results

revealed that participants tended to report the target emotion in the joy and anger
breathing condition1, F(9,153) = 1.97, p<.10.
 Respiratory Feedback 10

In sum, the findings of Bloch et al. (1991) are only partially replicated in the

breathing conditions of joy and anger. There are three possibilities accounting for these

weak results. First, respiratory feedback may have no effects on emotional feeling
states. Second, it is possible that respiratory feedback alone is not a sufficient condition

to induce emotional feeling state; It may additionally require the corresponding facial
and postural pattern. Along this line, Bloch (personal communication, July 16th, 1994)

argues that not only the whole respiratory, facial and postural pattern needs to be

activated, but also that no emotion can be induced if the “correct “ pattern is not exactly
reproduced. (This notion of correctness has also been debated in the context of the

facial feedback hypothesis, see for instance, McIntosh [1996].) Finally, a third
possibility is that the respiratory instructions used by Bloch et al. (1991) are not the

most appropriate to induce discrete emotions. Indeed, it is unclear how Bloch et al.’s
respiratory patterns were originally established (i.a., no statistical analysis are reported
and the original report [Bloch & Santibanez, 1972] cannot be obtained). Further, the
breathing patterns for joy attempts to mimic laughter, while the one for sadness attempts

to mimic crying. While expressive emotional components such as laughter or tears tend
to be associated with joy and sadness respectively, this does not necessitate that they
determine the breathing patterns associated with these emotions.
Study 1
Study 1 was designed to investigate whether different, more precise and accurate

breathing instructions than those used by Bloch et al. (1991) could be established. It

consisted in explicitly asking participants to generate emotional states and to identify

and report the corresponding breathing patterns. These subjective reports were to be
compared with the results of Boiten’s et al. (1994) review of the studies that
investigated objective respiratory parameters. Our expectations were that (a) the

information obtained from subjective reports would offer more details and a greater

differentiation among emotions than the information issued from Boiten’s et al. review,
and (b) the subjective reports would be concordant with the breathing patterns derived

from Boiten et al., the latter thus validating to some extent the former. The rationale
 Respiratory Feedback 11

was that if, and only if, predictions (a) and (b) were met, Study 1’s results could provide

breathing patterns potentially able to induce specific emotions. However, this

possibility would be void if either of the two predictions were not met.
Participants were invited to produce four emotional feeling states (of joy, anger,

fear, and sadness), following a procedure adapted from the one described by Hess et al.
(1992). When participants felt that they had reached the desired state, they were invited

to describe their breathing in a questionnaire investigating several respiratory

parameters.
Method

Participants and procedure

Eleven female and 12 male students volunteered to take part in the study. They

were aged between 18 and 29 years (mean age = 23.8) and they participated individually
in the experiment. The experimenter told them that the purpose of the study was to
investigate how emotions could be expressed via respiratory patterns. They were
simply instructed to produce an emotion--either joy, anger, fear, or sadness, in a random

order--by modifying their respiration. They were also encouraged to maximize the
intensity of their emotions and they were told that they could help themselves with
personal memories or fantasies. Participants performed the experimental trials standing
up alone in a laboratory room. The experimenter was in an adjacent room and contact
was maintained with an interphone system. When participants judged themselves to

have reached their best production of the target feeling state, participants reported in a

questionnaire the characteristics of the specific respiratory pattern they had performed to
express the emotion and, on a 7-point scale, the degree to which they felt they were

successful in producing a breathing pattern corresponding to that emotion.

As a manipulation check, participants were also asked to report on the French

version of the Differential Emotion Scale (Philippot, 1993) the intensity of the emotion

feeling states they had experienced during the trial (from 0: no emotion at all to 6: the
most intense emotion possible). This scale included the following items: concentrated,

joyful, sad, angry, afraid, anxious, disgusted, scornful, surprised, ashamed, guilty and
 Respiratory Feedback 12

happy. Only the six relevant items were retained for the data analysis (joyful, sad,

angry, afraid, anxious, and happy).

Respiration questionnaire
Based on a pre-test study, a questionnaire investigating several respiratory

parameters was constructed. Participants were asked to describe their inspiration and
their expiration separately on five items: Was their respiration diaphragmatic, thoracic

or both? Did they breath through their nose, their mouth or both? Did the frequency

change (from “-3” = much slower to “3” = much faster), did the amplitude change (from
“-3” = much more shallow to “3” = much deeper), and did they pause (from “0” = not at

all to “4” = a lot)? Additional questions were asked for the whole respiratory pattern:
Were there sighs, tremors, or tensions in the thorax (from “0” = not at all to “4” = a lot),

and did the regularity of the respiration change (from “-3” = much more irregular to “3”
= much more regular)?
Results
Manipulation check

On average, participants reported that they felt successful in producing

emotional breathing patterns (mean success = 3.74 with “0” = unsuccessful trial, “3” =
rather successful trial, and “6” = perfect trial). Yet, a MANOVA with emotion
condition as a within-subject factor revealed that reported success varied according to
emotion, F(3,20) = 4.99, p < .01. Post-hoc analyses indicated that the joy respiratory

pattern (mean = 4.48) was easier to produce than patterns of sadness, fear, and anger

(respective means = 3.61, 3.56, 3.30).

Not only did participants indicate that they were successful in producing

breathing patterns subjectively related to the target emotion, but they also reported
feeling the corresponding subjective state. Indeed, a 4 X 6 MANOVA with emotion

condition and emotion item of the DES as within-subject factors and sex as a between-

subjects factor revealed main effects of emotion and emotion item, respectively, F(3,63)
= 3.99, p < .02, F(5,105) = 6.93, p < .0001, that were qualified by an emotion X

emotion item interaction , F(15,315) = 34.01, p < .0001. The pattern of the results and
 Respiratory Feedback 13

the post-hoc analyses represented in Table 1 clearly demonstrate that the manipulation

induced specific emotional feeling states of a significant intensity.

-------------------------------------------------------------
Insert about here Table 1

-------------------------------------------------------------
Respiratory patterns

The central question of the present study was whether people can report

respiratory patterns that differentiate among each basic emotional feeling state. Thus, to
investigate the effect of emotion condition on the different parameters of inspiration and

expiration, 2 X 4 MANOVAs were computed with inspiration-expiration and emotion

as within-subjects factors. For the frequency and amplitude parameters, only the effect

of emotion was significant, F(3,20) = 29.22, p < .0001, and F(3,20) = 16.54, p < .0001,
respectively. For the pause parameters, only the interaction between inspiration-
expiration and emotion reached significance, F(3,20) = 3.70, p < .03. Post-hoc analyses

detailed these effects. As shown in Table 2, respiratory frequency increased for anger
and fear, decreased for joy and did not change from baseline level for sadness.
Respiratory amplitude increased dramatically in joy and, although to a lesser extent, in

anger. For fear and sadness, amplitude remained at baseline levels. For pauses, post-

hoc analyses revealed that the interaction was accounted for by the fact that while
people reported more pauses after expiration in joy, F(1,22) = 4.80, p <.04, they
reported less pauses after inspiration in fear, F(1,22) = 3.61, p <.07.

-------------------------------------------------------------
Insert about here Table 2

-------------------------------------------------------------
The effects of emotion on regularity, sighs, tremors, and thoracic tension were

examined with a single factor (emotion) MANOVA. It appeared that all these

parameters were significantly modulated by the type of emotion produced, F(3,20) =

4.09, p < .02, for sighs; F(3,20) = 25.30, p < .0001, for tremors; F(3,20) = 13.06, p <

.0001, for regularity; and F(3,20) = 45.89, p < .0001, for thoracic tension. Post-hoc
 Respiratory Feedback 14

analyses specified these effects. As indicated in Table 2, sighing is specifically

associated with sadness. In joy, respiration is more regular and presents much less

thoracic tension than in anger and fear. Sadness falls in between this pattern and is
characterized by tremors, which are totally absent in joy and moderately present in

anger and fear.

Finally the impact of emotion on whether the respiration was oral or nasal, and

whether it was diaphragmatic or thoracic was examined using separate χ2 for

inspiration and expiration in each breathing condition. As displayed in Table 2, a

majority of participants judged the respiration to be nasal for joy and sadness,

respectively, χ 2 = 40.29, p < .001, χ 2 = 29.82, p < .001, for inspiration and expiration

in joy, and χ 2 = 34.77, p < .001, χ 2 = 25.39, p < .001, for inspiration and expiration in
sadness. Respiration also tended to be nasal in anger, although to a lesser extent, χ 2 =
5.82, p < .10, for inspiration and χ 2 = 10.76, p < .01, for expiration. No significant

trend appeared for fear. As regards the diaphragmatic or thoracic quality of the
respiration, participants reported that expiration was predominantly diaphragmatic in

anger and thoracic in fear, χ 2 = 6.61, p < .05.

Discussion
Study 1 yielded three important findings: First, respiratory patterns that are
differentiated among basic emotions were established on the basis of subjective reports;

Second, these subjective patterns are congruent with the objective patterns reviewed by
Boiten et al. (1994); Third, the explicit manipulation of respiration combined with

imagery induced significant and specific emotional feeling states.

Regarding the first finding, the consistency of naive participants in their

association between type of breathing pattern and specific emotion is remarkable.

Previous research has already shown that people report experiencing different body
sensation profiles for different emotions (Lyman & Waters, 1986; Rimé et al., 1990;

Philippot & Rimé, 1997). Yet these studies had all considered a rather global

perception of body changes (e.g. respiratory changes were measured on a single

“respiratory change” item) and no precise body changes had been explored as
 Respiratory Feedback 15

specifically as in the present study. Thus, previous findings can be extended to note that

people experience a very fine differentiation of body state during emotion, not only for

the body as a whole but also for very specific changes, at least including breathing
changes. In addition, these body sensations are quite homogenous across individuals

and differentiated across emotions. These observations are contradictory to the

undifferentiated arousal model notion of diffused perception of undifferentiated arousal

inherited from Schachter’s (1964) theory. They are congruent with cognitive appraisal

models and central network models such as the Somatovisceral Afference Model of
Emotion (SAME) proposed by Cacioppo et al. (1992).

With respect to the second finding, Study 1 participants’ reports do not

contradict the findings of Boiten et al. (1994). In the present study, joy is associated

with regular, moderately deep and slow breathing through the nose and with minimal
thoracic tension, tremors, and sighs. The breathing tends to be diaphragmatic or both
thoracic and diaphragmatic. This pattern is parallel to the slow and deep breathing
Boiten et al. (1994) observed in a relaxed resting state. Yet, these authors report that

calm happiness (as well as depression) is associated with slow but shallow breathing,
whereas excited joy (as well as anger or fear) is associated with fast and deep breathing.
Bloch’s et al. (1994) joy pattern (quick and deep nasal inspiration, followed by oral
expiration with small jolts) is different from the pattern associated with joy by the
participants of the present study as well as from the three patterns associated with

positive states by Boiten et al. As mentioned above, Bloch’s et al. joy breathing pattern

attempts to imitate laughter and might not be typical of joy.

For anger, participants in the present study reported a rather fast, irregular and

deep nasal breathing with marked thoracic tension, minimal sighs, and some tremors.

The expiration was diaphragmatic. This pattern corresponds to the fast and deep
breathing Boiten et al (1994) associated with excitement, including angry excitation. It

also parallels to some degree Bloch’s et al. anger pattern (regular, quick, and deep nasal
breathing), except that our participants reported irregular rather than regular breathing.
 Respiratory Feedback 16

With respect to fear, our participants reported fast, irregular, rather shallow

breathing, with much thoracic tension, some tremors, and minimal sighs. More thoracic

breathing was reported for fear than for any other emotions. This pattern corresponds
very well to the rapid, shallow breathing associated with tense anticipation by Boiten et

al. It has also basic features in common with Bloch’s et al. fear pattern. Yet, the latter
has additional specifications not reported by our participants : for Bloch et al. the

respiration has to be oral and there must sometimes be a long expiration.

Finally, for sadness, our participants reported nasal breathing with average
amplitude and frequency, marked with sighs and tremors as well as some thoracic

tension and irregularity. Of the four types of breathing proposed by Boiten et al., the
present pattern is closest to the slow and shallow breathing associated with state of

withdrawal and passiveness. It shares some similarities with Bloch’s et al. sadness
pattern (inspiration with brief jolts through the nose and expiration at one time through
the mouth), specifically, normal frequency and amplitude, but also marked
dissimilarities, including oral expiration, jolts in the inspiration and expiration in one

time through the mouth for Bloch et al. As mentioned above, Bloch’s et al. sadness
pattern attempts to imitate crying and might not be specific to sadness.
In summary, as predicted, the emotional breathing patterns reported by the
participants of the present study are characterized by a clear and detailed differentiation
among emotions. Moreover, they are congruent with the results of Boiten’s et al.

(1994) meta-analysis. This suggests that, in their attempts to produce emotional states

by manipulating their respiration, our participants have relied on breathing patterns that
are similar to observations of psychophysiological studies investigating respiratory

changes during emotion induction. As the conditions of clear differentiation among the

four emotions investigated and congruence with Boiten’s et al meta-analysis are met,
the data of the present study can provide a valid basis for the construction of different

sets of breathing instructions that would be specific to the discrete emotions of joy,
anger, fear, and sadness.
 Respiratory Feedback 17

The third finding of the present study is precisely related to emotion induction.

Indeed, the analysis of the emotional feeling state questionnaire revealed that specific

and rather intense emotions have resulted from the explicit instruction to produce
emotion by manipulating respiration. This observation is in line with the report of Hess

et al. (1992) that people have the ability to produce rather intense and specific emotions
“on demand.” Future research should examine whether the instruction to alter one’s

breathing adds a specific contribution to voluntary production of emotion. Of course,

effects of experimenter demand can certainly not be completely discounted, although,

during debriefing, participants reported that they had experienced genuine emotions.

Similarly, the relative influence of other strategies, such as relying on personal

memories, cannot be assessed in the present experiment.

Still, the present findings suggest that an explicit manipulation of respiration

might be sufficient to induce a specific emotional feeling state. However, to test this
assertion, the effects on feeling states resulting from the manipulation of respiration
needs to be observed in a context free of experimental demand and in which other facets

of emotion responses are kept constant.

Study 2
Study 2 examined whether specific emotional states could be induced by
manipulating participants’ breathing patterns with instructions based on Study 1's

results. In addition, Study 2 investigated whether this effect could occur implicitly, this
is, without participants explicitly using breathing changes to infer their emotional

feeling state. Participants were told that they were participating in a health psychology

experiment aimed at examining the impact of breathing style on cardio-vascular

characteristics. After a training session, they performed the four breathing patterns that,

unknown to them, were characteristic of joy, anger, fear, and sadness. Their feeling
state was recorded by disguised items hidden in a questionnaire supposedly addressing

the body symptoms induced by the breathing patterns.

Method
Participants and procedure
 Respiratory Feedback 18

Twenty one female and 5 male students aged between 17 and 23 years (mean

age: 19.2) volunteered for the study. They participated individually in the experiment

which consisted of two sessions of 45 minutes separated by a minimum of one night

and a maximum of 48 hours. Participants were trained to perform the procedure during

the first session and the actual data collection took place during the second session.
During the first session, the experimenter explained the cover story. Participants

were told that the study had been designed to investigate the effects of breathing on

cardio-vascular changes and on physical feelings. Participants were told how

respiration could influence the cardio-vascular system at a functional and at a

mechanical level. They were told that the hypothesis was that these effects could also
influence subjective physical sensations. Then, the experimenter explained the

procedure. The experiment consisted of four trials. Each trial was preceded by a short
relaxation period during which participants had to close their eyes, breathe smoothly,
relax every muscle, and visualize an imaginary circle inflating and deflating at the
rhythm of their respiration. After relaxation, participants were to perform a respiratory

pattern for two minutes and, immediately after, to complete a questionnaire on physical
sensations. The experimenter explained that various respiratory and cardio-vascular
measurements would be taken during the breathing exercises. He showed the
transducers (a respiratory belt and the FinaPress sensor of the Ohmeda 2300 blood
pressure monitor2) and explained how this equipment operated.

Once the procedure was explained, the experimenter gave the breathing

instructions, showed how to perform them and gave feedback to the participant about
his or her performance. After having ascertained that the participant understood the

breathing instructions, the experimenter affixed the transducers and went to the adjacent
technical room. Communication with the participant was maintained throughout the

experiment via an intercom system. After calibration of the physiological

measurements, the rehearsal of the procedure began. The experimenter gave the
relaxation instructions, then reminded the participant of the breathing instructions, had

the participant perform them for two minutes, and asked to the participant to fill in the
 Respiratory Feedback 19

questionnaire. During the breathing trial, the experimenter could monitor on a

computer screen the respiratory movements of the participant and check whether the

instructions were correctly followed.

When they arrived for the second session, participants were reminded of the

procedure. Then the experimenter affixed the respiratory belt and the FinaPress sensor
and went to the technical room. The four trials were performed in a random order.

Respiration was recorded during relaxation and trial periods. Finally, participants were

debriefed and the actual purpose of the experiment was explained. They were
specifically asked whether they suspected that the experimenter attempted to modify

their emotional state by manipulating their respiration. No participants reported any

suspicion about the real purpose of the experiment, about the fact that it concerned

emotion induction, or about the fact that the questionnaire measured their emotional
feeling state. Thus, if an effect on feeling state is observed, it can be considered as
occurring outside of the participants’ awareness of the process, i.e. the awareness of a
relationship between breathing and feeling state.

Questionnaire
The questionnaire consisted in 22 items comprising different sensations. Items
were "vertigo," "nausea," "paresthesia," "lump in the throat," "headache," "impression
of unreality," "stomach sensations," "feeling cold, shivering," "feeling hot," "racing
heart," "muscular tension," "perspiration," "goose flesh," "blushing," "weak knees," and

"general activation." Mixed among these items, four scales indexed emotional feeling

states: "feelings of fear, anxiety,” for fear; "feelings of sadness, depression," for
sadness; "positive feelings, good spirit," for happiness; and "feelings of aggressivity,

aggravation," for anger. Each item had to be rated by marking a check on a 10

centimeter line, anchored 0% to 100%. Participants were instructed that 0% reflected

no such sensation at all, while 100% was the strongest sensation they could imagine

feeling for this item. The dependent measures consisted of millimeters from the zero-
point on each scale.

Physiological measures
 Respiratory Feedback 20

Respiration was recorded by an elastic tube strapped around the participant's

chest. A sound of 575 Hz emitted at one end of the tube is received at the other end.

The phase of the sound received varies according to the length of the tube which is itself
determined by the respiratory movements of the ribcage. A coupler monitors these

phase changes and outputs a signal varying in tension as a function of tube length (1.2
cm/V). Technical aspects of this system are described in van Rossum (1988). The

signal of the coupler was sampled at a frequency of 10Hz by a Computer-based

Oscillograph and Data Acquisition System (CODAS) of Dataq Instruments. Codas,

which consists of a combination of hardware and software, allows continuous data

through-put to hard disk while maintaining a real time display directly on the host
computer's monitor. In addition, after the acquisition, data can be displayed on the

monitor for artifacts inspection.

Respiration indices were derived from the raw signal of the strain-gauge (Boiten,
1993). The computer program used to that effect (Philippot & Philippot, 1991) outputs
for each respiratory cycle: its length, amplitude, ratio of inspiration and expiration

times, number of pauses and their length, and number of hampers.

Breathing instructions
The breathing instructions were derived from the results of Study 1:
Joy: "Breathe and exhale slowly and deeply through the nose; your breathing is
very regular and your ribcage relaxed."

Anger: "Breathe and exhale quickly through the nose; slightly deeper than

regular breathing amplitude. Your breathing is slightly irregular with some tremors and
your ribcage is very tense."

Fear: “Breathe and exhale quickly from the top of your ribcage; with a normal
amplitude. Your breathing is slightly irregular with some tremors and your ribcage very

tense.”

Sadness: “Breathe and exhale through the nose with a normal amplitude and
pace. Your ribcage is slightly tense, and there are some sighs in your expiration.”

Results and discussion

 Respiratory Feedback 21

First, analyses were conducted to ascertain that participants' actual breathing

patterns differed across conditions. MANOVAs with breathing condition as a within

subject factor were computed on the differences scores (mean during the trial minus
mean during relaxation) for the indices of frequency, amplitude and ratio of inspiration

and expiration times. As can be seen in Table 3, the effect of breathing condition was
clearly significant for each index. Post-hoc analyses using the Bonferroni procedure

revealed that participants followed the instructions (see subscripts in Table 3).

Respiration time was longest during the joy condition, slightly shorter for the sadness
condition and much shorter in the anger and fear conditions, with fear respiration being

slightly faster than anger respiration. The amplitude increased in the joy condition,
remained at baseline levels for the anger and sadness conditions, and was shorter during

fear. Finally, the ratio of inspiration and expiration times increased for anger, fear, and
sadness but stayed at baseline level in joy.
-------------------------------------
Insert Table 3 about here

-------------------------------------
Second, the impact of breathing condition on emotional feeling state was
examined. A MANOVA with breathing condition and feeling scale as within-subject
factors was computed on the measures of the four feelings. A significant effect of
breathing condition indicated that, overall, some breathing patterns induced more

intense feeling state than others, F(3,23) = 9.02, p<.0004. Similarly, some feeling states

tended to be reported as more intense than others, as indicated by a significant effect of

feeling scale, F(3,23) = 5.89, p<.004. Of direct interest for our hypothesis, a significant

interaction indicated that feeling state varied according to breathing conditions, F(9,17)
= 8.73, p<.0001; This effect accounts for 40% of the variance.

Post-hoc analyses specified the impact of breathing condition on feeling state

(see Table 4). MANOVAs with feeling scale as within-subject factor were computed
for each breathing condition. The effect of feeling scale was significant for each

condition, indicating that each breathing condition induced a differentiated feeling state,
 Respiratory Feedback 22

F(3,22) = 13.32, p<.0001, for joy; F(3,22) = 7.20, p<.001, for anger; F(3,22) = 5.71,

p<.004, for fear; and F(3,22) = 4.10, p<.02, for sadness, respectively. These effects
were specified with paired t-test using the Bonferroni procedure. As can be seen in

Table 4, the joy breathing condition induced significantly more positive feeling than any
other condition and more than any other feeling within this condition. The same is true

for the feeling of anger in the anger breathing condition. It should be noted that this
breathing pattern also induced feelings of fear and anxiety, although to a lesser degree

than anger feelings. The fear breathing condition induced feelings of anger and of

fear/anxiety at a similar intensity level. Yet, the feelings of fear/anxiety induced in this
condition are not more intense than those induced by any other conditions. Finally, the

sadness breathing condition induced to a comparable extent positive feelings and

feeling of sadness. It should be noted that it is in this condition that feelings of sadness

were the most intensely reported, as the three other breathing conditions induced no
feeling of sadness at all.
--------------------------------------------------------
Insert Table 4 about here

--------------------------------------------------------
In sum, it appears that the joy and anger breathing conditions successfully

induced the target feeling state. The fear and sadness breathing conditions induced a
mixed pattern of fear/anxiety and anger for the former and of positive state and sadness
for the latter. These blends in pattern could be explained in two different ways. One

possibility is that these breathing conditions indeed induced a blended emotional feeling

state. Another possibility is that some individuals responded to these manipulations

with a given feeling state, while others responded with another feeling state. For
instance, some participants may have felt joy while performing the sadness breathing

task, while other participants may have felt sad.

To decide between these alternatives, correlations were computed between

feeling scales. In the fear condition, anger and fear were positively correlated (r(27) =
.58, p < .002), indicating that the fear breathing pattern did indeed induce a blended
 Respiratory Feedback 23

emotional feeling state. In contrast, in the sadness condition, positive state and sadness

were negatively correlated (r(27) = -0.32, p < .10). Thus, it seems that different

individuals reacted with different feeling states to the sadness breathing pattern. A
possibility is that, given the similarity in breathing instructions between the sadness and

joy breathing conditions, some participants performed a breathing pattern closer to the
joy breathing patterns, while other performed a “purer” sadness pattern. If this were

true, based on data presented in Table 3, "happy responders" in the sadness breathing

condition should evidence longer respiration time and amplitude, and smaller ratio of
inspiration/expiration time than "sad responders". Pauses parameters, however, should

not discriminate between these two groups. To test these hypotheses, respiratory
parameters were compared with t-tests between "sad and happy responders".

Participants who reported more happiness than sadness in the sadness breathing
condition were classified as "happy responders". If the opposite was true, they were

classified as "sad responders". Six participants who reported as much happiness as

sadness were eliminated (generally, these participants reported no sadness together with
no happiness at all). There were no differences between groups for the respiration time,
amplitude, or pauses parameters. However, as predicted, "sad responders" were
characterized by longer inspiration / expiration time ratio (M = .23, SD = .09) than
happy responders (M = .10, SD = .16), t(18) = 2.20, p < .03. Thus, it seems that one
objective respiratory parameter distinguishes between happy and sad responders. This

finding suggests that the quality of the feeling state observed results directly from the

breathing pattern performed rather than from any other factors. Future research might

attempt to better control the breathing patterns performed by using a bio-feedback

procedure.
General discussion

Study 1 has indicated that people experience respiratory changes that are

subjectively differentiated across different types of emotions. Study 2 has documented

that differentiated emotional feeling states were induced by respiration manipulations

without participants’ awareness of the process. The intensity of the feeling states
 Respiratory Feedback 24

induced in Study 2 was not trivial: Mean ratings of joy, anger and fear were of 54, 55,

and 47 on a scale in which 100 indicated the strongest intensity that participants could

imagine feeling. The amount of variance accounted for by this effect (40%) is larger
than the one accounted for by facial feedback (13%, in Matsumoto [1987]). To our

knowledge, this is the first demonstration that the alteration of respiration is sufficient
to induce emotion. It extends to visceral feedback the effects of body feedback on

emotional states established for facial expression (e.g. Matsumoto, 1987) and posture

(e.g. Stepper & Strack, 1993). These observations support the notion that body
feedback plays a role in the determination of the quality of emotional feeling state and

that this effect can occur without awareness of the process.

Taken together, the present results are totally congruent with the central network

perspective described in the introduction. They are not congruent with the
undifferentiated arousal model that postulates that emotion is characterized by a state of
undifferentiated arousal that uniquely influences the intensity of feelings, provided that
the individual is aware of the arousal and consciously attributes it to an emotional

cause. Indeed, in Study 2, although individuals were aware of their body changes, they
did not consciously relate them to an emotional state, as confirmed by a thorough
debriefing on the matter. Thus, the present results indicate that body changes might
influence feeling states independently of one’s awareness of the process. Still, it is
uncertain whether the awareness of the body state is necessary or not for peripheral

feedback to occur. A convincing demonstration against this specific question would be

to demonstrate the influence of respiratory changes on feeling states with participants

who were aware of neither the process nor the respiratory changes. However, for

practical reasons, such a demonstration, might be very difficult to realize.

Considering more specifically our results, it appears that joy, anger, and sadness-
-provided the execution of the proper breathing pattern--were successfully induced with

instructions derived from the observations of Study 1. However, mixed results were
observed for fear, which was not differentiated from anger. This observation raises the

question of whether breathing manipulation affects feeling state by activating discrete

 Respiratory Feedback 25

emotions (e.g. Ekman, 1984; Levenson et al., 1990) or by moving it along dimensions

of pleasantness and activation (e.g. Feldman Barrett & Russell, 1998). Indeed, of the

four states induced, only fear and anger were in the same quadrant of unpleasant, high
arousal state. Anger was successfully induced, though accompanied by some fear,

whereas fear was not distinguished from anger.

There are at least four different interpretations that could account for this

observation. The first interpretation is that respiratory feedback is capable of inducing

discrete emotions and the fear breathing instructions derived from Study 1 were
incomplete or inadequate. This possibility can only be examined by further

psychophysiological research on respiration during emotion. A second interpretation is

that, while body feedback as a whole is capable of inducing discrete emotions, breathing

alone would not be sufficient to induce differentiated states of anger and fear because
additional feedback from other body functions is necessary. According to the SAME
model proposed by Cacioppo et al. (1992), one source of peripheral feedback might not
be enough to produce a discrete somatovisceral pattern that specifically refers to a

specific emotion. A third possibility is that peripheral feedback is not capable of such
fine distinctions, the latter requiring more cognitive appraisal processes. Finally, as
suggested above, it may be that feeling states are organized dimensionally (Feldman &
Russell, 1998) and that Study 2 results simply reflect this reality. Future research is
needed to decide among these possibilities. To test the second possibility, we are

presently planning studies in which facial, postural, and respiratory feedback will be

manipulated independently. By providing ambiguous and unambiguous somatovisceral

patterns (emotionally incongruent or congruent feedback from face, posture or

respiration), such manipulations allow for testing the Somatovisceral Afference Model

of Emotion (SAME) proposed by Cacioppo et al. (1992).

From a clinical perspective, our results suggest relations between anger-hostility

and fear-anxiety, as induced by rapid breathing. Indeed, it is remarkable that the fast
and deep breathing normally expected to induce more hyperventilation (Beck & Scott,

1988; Huey & West, 1983)--and consequently, more anxiety--than the fast and shallow
 Respiratory Feedback 26

breathing actually induced more anger than anxiety. The fast and shallow breathing

induced as much anger as anxiety. These observations suggest that hyperventilation

might be as strongly related to anger and hostility as to fear and anxiety. This is
congruent with the observation that people who panic, for whom hyperventilation is

functional, score higher on hostility (Dadds, Gaffney, Kenardy, Oei, et al., 1993). The
anxiety produced by hyperventilation might thus originate in a hostile coping attitude in

challenging situations.

A final comment concerns the regulation of emotion. Previous research has

shown that attempts to regulate emotion by the suppression of its expression resulted in

an increase in physiological responding (Gross, 1998; Manstead, 1991). Other

researchers have observed juste the opposite (Kappas, McHugo, & Lanzetta, 1989).

Thus, attempts to regulate emotion in one physiological system (facial muscles) resulted
in increased manifestation in other body channels (visceral arousal) in some studies and
in decreased manifestation in other studies. Also relevant to this question, a wealth of
clinical evidence has shown that feelings of anxiety can be alleviated by specific

breathing exercises (Lum, 1981). It is therefore unclear whether the control of one body
channel necessarily results in increased manifestations in other channels. It might be
that the direction of the effect depends upon the body channel and the type of control
considered. The findings of the present studies encourage future research to examine
the regulatory effects of specific breathing instructions in people exposed to emotional

situations by independently manipulating breathing instructions and emotional

situations.
In sum, the present studies have shown an implicit influence of respiratory

feedback on the induction of emotional feeling state. They thus offer further support to

those theories of emotion stating that the quality of emotional feelings are, at least in
part, modulated by body feedback, without necessity of individual’s awareness of the

relationship between body changes and feeling state. It remains to be established

whether respiratory feedback induces discrete emotions or whether it moves the feeling

state along pleasantness and arousal dimensions. Finally, we propose that the
 Respiratory Feedback 27

respiratory feedback effect constitutes a rich avenue for future research in emotion

regulation.
 Respiratory Feedback 28

References
Beck, J.G. & Scott, S.K. (1988). Physiological and symptom responses to

hyperventilation: A comparison of frequent and infrequent panickers. Journal of

Psychopathology and Behavioral Assessment, 10, 117-127.

Bloch (1994, July 16th). personal communication.

Bloch, S., Lemeignan, M., & Aguilera-T, N. (1991). Specific respiratory patterns

distinguish among human basic emotion. International Journal of Psychophysiology,11,

141-154.
Bloch, S., & Santibanez-H, G. (1972). Simposio Latino-Americano de

psicobiologia del aprentizaje (pp. 170-184). In S. Bloch & R. Anerios (Eds.)

Psicobiologia del aprentizaje. Santiago, Chile: Universidad de Chile.

Boiten, F.A. (1994). Component analysis of task-related respiratory patterns.

International Journal of Psychophysiology, 15, 91-104.
Boiten, F.A. (1996). Autonomic response patterns during voluntary facial action.
Psychophysiology, 33, 123-131.
Boiten, F.A., Frijda, N.H., Wientjes, C.J.E. (1994). Emotions and respiratory
patterns: review and critical analysis. International Journal of Psychophysiology, 17,
103-128.
Buck, R. (1985). Prime theory: An integrated view of motivation and emotion.

Psychological Review, 92, 389-413.

Cacioppo, J.T., Berntson, G.G. & Klein, D.J. (1992). What is an emotion? The

role of somatovisceral afference, with special emphasis on somatovisceral « illusions ».

In M.S. Clark (Ed.), Review of Personality and Social Psychology, 14, 68-98.

Cannon, W.B. (1927). The James-Lange theory of emotions: A critical

examination and an alternative theory. American Journal of Psychology, 39, 106-124.

Dadds, M.R., Rosenthal-Gaffney, L., Kenardy, J., Oei, T.P.S., et Evans, L.

(1992). An exploration of the relationship between expression of hostility and the

anxiety disorders. Journal of Psychiatric Research.
 Respiratory Feedback 29

Damasio, A.R. (1994) Descartes' error: emotion, reason and the human brain.

New York: Grosset/Putnam Books.

Duclos, S.D., Laird, J.D., Schneider, E., Sexter, M., Stern, L. & VanLighten, O.

(1989). Emotion-specific effects of facial expressions and postures on emotional

experience. Journal of Personality and Social Psychology, 57, 100-108.

Ekman, P. (1984). Expression and the nature of emotion. In K. Scherer and P.

Ekman (Eds.), Approaches to emotion (pp. 319-343). Hillsdale, N.J.: Erlbaum.

Ekman, P. (1999). Basic emotions. In T. Dalgleish & M.J. Power, (Eds).

Handbook of cognition and emotion. (pp. 45-60). Chichester, England: John Wiley &

Sons.
Feldman Barrett, L., Russell, J.A. (1998) Independance and Bipolarity in the

Structure of Affect. Journal of Personality and Social Psychology, 74, 967-984.

Frijda, N.H. (1986). The emotions. Cambridge, UK: Cambridge University

Press.
Gross J.J. (1998) Antecedent- and response-focused emotion regulation:

divergent consequences for experience, expression, and physiology. Journal of

Personality and Social Psychology, 74, 224-237.
Hess, U., Kappas, A., McHugo, G.J., Lanzetta, J.T. & Kleck, R.E. (1992). The
facilitative effect of facial expression on the self-generation of emotion. International

Journal of Psychophysiology, 12, 251-265.

Huey, S.R., & West, S.G. (1983). Hyperventilation: its relation to symptom

experience and to anxiety. Journal of Abnormal Psychology, 92, 422-432.

Izard, C.E. (1979). Emotion in personality and psychopathology. New York:

Plenum Press.
Izard, C.E. (1990). Facial expressions and the regulation of emotions. Journal of

Personality and Social Psychology, 58, 487-498.

James, W. (1884). What is an emotion? Mind, 9, 188-205.

James, W. (1890). Principles of psychology (2 Vols.). New York: Holt.
 Respiratory Feedback 30

Kappas, A. (1989). Control of emotion. Unpublished Ph.D. dissertation,

Darmouth College, USA.

Kappas, A., McHugo, & G.J., Lanzetta, J.T. (1989, October). Componential
control and the modulation of emotional experience. Paper presented at the Twenty-

Ninth Annual Meeting of the Society for Psychophysiological Research, New Orleans.
Kirouac, G. (1995). Les émotions. Québec: Presses de l'Université du Québec.

Laird, J. (1984). The real role of facial response in the experience of emotion: a
reply to Tourangeau and Ellsworth, and others. Journal of Personality and Social
Psychology, 47, 909-917.

Lang, P.J. (1979). A bio-informational theory of emotional imagery.

Psychophysiology, 16, 495-512.

Lang, P.J. (1984). Cognition in emotion: Concept and action. In C. Izard, J.

Kagan, & R. Zajonc (Eds.), Emotion, Cognition, and Behavior. New York: Cambridge
University Press.
Lazarus, R.S. (1991). Progress on a cognitive-motivational-relational theory of

emotion. American Psychologist, 46, 819-834.

Levenson, R.W. (1992). Autonomic nervous system differences among
emotions. Psychological Science, 3, 23-27.
Levenson, R.W., Carstensen, L.L., Friesen, W.V., & Ekman, P. (1991).
Emotion, physiology, and expression in old age. Psychology and Aging, 6, 28-35.

Levenson, R.W., Ekman, P. & Friesen, W.V. (1990). Voluntary facial action

generates emotion-specific autonomic nervous system activity. Psychophysiology, 27,

363-384.
Lum, L.C. (1981). Hyperventilation and anxiety state. Journal of the Royal
Society of Medicine, 74, 1-4.

Lyman, B. & Waters, J.C.E. (1986). The experiential loci and sensory qualities

of various emotions. Motivation and Emotion, 10, 25-37.

 Respiratory Feedback 31

Manstead, A.S.R. (1988). The role of facial movement in emotion. In H.L.

Wagner (Ed.), Social psychophysiology and emotion: Theory and clinical application.

Wiley.
Manstead, A.S.R. (1991). Expressiveness as an individual difference. In R.S.

Feldman and B. Rimé (Eds.), Fundamentals of Nonverbal Behavior (pp. 285-328).

Cambridge: Cambridge University Press.

Matsumoto, D. (1987). The role of facial responses in the experience of

emotion: More methodological problems and a meta-analysis. Journal of Personality

and Social Psychology, 52, 769-774.

McIntosh, D.N. (1996). Facial feedback hypotheses: evidence, implications, and

directions. Motivation and Emotion, 20, 121-147.

Pecchinenda, A. & Smith, C.A. (1996). The affective significance of skin

conductance activity during a difficult problem-solving Cognition-and-Emotion, 10,
481-503.
Personality and Social Psychology Bulletin (1990). Special issue: Centennial

celebration of the Principles of Psychology of William James. Personality and Social

Psychology Bulletin, 16, 597-783.
Philippot, P. (1993). Inducing and assessing differentiated emotion-feeling states
in the laboratory. Cognition & Emotion, 7, 171-193.
Philippot, M. & Philippot, P. (1991). Thorax: A program of respiratory signal

analysis [computer program]. Louvain-la-Neuve, Belgium: University of Louvain,

Experimental & Social Psychology Unit.

Philippot, P. & Rimé, B. (1997). The perception of bodily sensation during

emotion: A cross-cultural perspective. Polish Bulletin of Psychology, 28, 175-188.

Philippot, P. & Schaefer, A. (2001). Emotion and memory. In T.J. Mayne and

G.A. Bonano (Eds.), Emotion: current issues and future directions. New York: Guilford

Press.
Reisenzein, R. (1983). The Schachter theory of emotion: Two decades later.

Psychological Bulletin, 94, 239-264.

 Respiratory Feedback 32

Rimé, B., Philippot, P., & Cisamolo, D. (1990). Social schemata of peripheral

changes in emotion. Journal of Personality and Social Psychology, 59, 38-49.

Russell, J. (1991). In defence of a prototype approach to emotion concepts.

Journal of Personality and Social Psychology, 60, 37-47.

Schachter, S. (1964). The interaction of cognitive and physiological

determinants of emotional state. In L. Berkowitz (Ed.), Advances in Experimental

Social Psychology: Vol. 1. (pp. 49-79). New York: Academic Press.

Scherer, K.R. (1984). On the nature and function of emotion: A component

process approach. In K. Scherer and P. Ekman (Eds.), Approaches to emotion (pp. 293-

317). Hillsdale, N.J.: Erlbaum.

Smith, C.A. & Kirby, L.D. (2000). Consequences require antecedents: Toward a

process model of emotion elicitation. In J.P. Forgas (Ed). Feeling and thinking: The role

of affect in social cognition. New York: Cambridge University Press.

Stemmler, G. (1989). Autonomic differentiation of emotion revisited:
Convergent and discriminant validation. Psychophysiology, 26, 617-632.
Stemmler, G. (1992). The vagueness of specificity: Models of peripheral
physiological emotion specificity in emotion theories and their experimental

discriminability. Journal of Psychophysiology, 6, 17-28.

Stepper, S. & Strack, F. (1993). Proprioceptive determinants of affective and
nonaffective feelings. Journal of Personality and Social Psychology, 64, 211-220.

Teasdale, J.D. (1996). Clinical relevant theory: Integrating clinical insight with

cognitive science. In P. Salkovskis (Ed.), Frontiers of cognitive therapy. New York:

Guilford.
Tomkins, S.S. (1980). Affect as amplification: some modification in theory. In

R. Plutchik & H. Kellerman (Eds.), Theories of emotion (pp. 141-164). New york:
Academic Press.

van Rossum, E. (1988). Ademhalingsmeetsystee (ReportNo. 5). Amsterdam,

Holland: Vrij Universiteit, Subfakulteit Psychologie, Electronische Werkplaats.
 Respiratory Feedback 33

Zajonc, R.B. & McIntosh, D.N. (1992). Emotions research - Some promising

questions and some questionable promises. Psychological Science, 3, 70-74.

Zillmann, D. (1979). Excitation transfer in hostility and aggression. In D.

Zillman (Ed.), Hostility and aggression. Hillsdale, N.J.: Erlbaum.

Zillmann, D. (1983). Transfer of excitation in emotion behavior. In J.T.

Cacioppo & R.E. Petty (Eds.), Social psychophysiology (pp. 215-240). New York:

Guilford.
 Respiratory Feedback 34

Notes
1
It should be noted that only 20 participants took part in this study and that, although it

used a within-subject design its statistical power is consequently weak.

2
This apparatus only served to convince participants of the cover story. Cardiovascular

data were thus not recorded. Given the strong impact of breathing on cardiovascular
parameters, such data would have been useless in the present context.
 Respiratory Feedback 35

Table 1.

Emotional Feeling State as a Function of Emotion Condition.

Feeling Emotion Condition

State Joy Anger Fear Sadness

Joyful Mean 3.09b 1.48c 1.34d 1.17c

SD 1.62 0.89 0.71 0.49

Sad Mean 1.09c 1.61c 1.69cd 4.13a

SD 0.28 1.15 1.18 2.09

Angry Mean 1.04c 4.39a 1.91cd 2.13b

SD 0.20 1.97 1.44 1.68

Afraid Mean 1.00c 1.52c 4.08b 1.43c
SD 0.00 0.89 2.25 0.78

Anxious Mean 1.13c 3.04b 3.91b 2.43b

SD 0.34 1.96 1.95 1.99

Happy Mean 4.30a 1.17c 1.34d 1.13c

SD 1.79 0.49 0.77 0.45
Note. Means with different subscripts differ at least at the 0.05 level of significance

according to t-test using Bonferroni’s correction.

Only emotional feeling states items relevant to the emotion conditions are presented in

this Table.
 Respiratory Feedback 36

Table 2.

Respiration Parameters Means Values and Standard Deviation as a Function of

Emotion.

Respiration Emotion
Parameter Joy Anger Fear Sadness

Frequency Mean -1.85 c 1.04 a 1.45 a -0.35 b

SD 1.25 1.22 1.36 1.61

Amplitude Mean 2.07 a 0.91 b -0.22 c 0.22 bc

SD 0.82 1.27 1.91 1.95

Regularity Mean 1.69 a -0.83 c -0.91 c -0.61 b

SD 1.26 1.59 1.93 1.56

Sighs Mean 1.26 b 0.96 b 0.87 b 2.39 a
SD 1.35 1.43 1.46 1.53

Tremors Mean 0.04 c 1.39 b 1.48 b 2.65 a

SD 0.21 1.23 1.40 1.59

Thoraxic Tension Mean 0.13 c 2.43 a 2.65 a 1.52 b

SD 0.34 1.44 1.03 1.53

Note. Means with different subscripts differ at least at the 0.01 level of significance

according to t-test using Bonferroni’s correction.

 Respiratory Feedback 37

Table 3

Respiratory Parameters as a Function of Breathing Condition.

Respiratory Breathing Condition

Parameter Joy Anger Fear Sadness F(3,23) p

Time Mean4.13a -6.41c -7.26d -1.26b 84.14 .0001

SD 4.85 2.48 2.50 2.70

Amplitude Mean0.50a 0.04b -0.20c 0.15b 20.98 .0001

SD 0.45 0.34 0.26 0.29

Ti/Te Mean0.05b 0.14a 0.32a 0.17a 6.90 .002

SD 0.17 0.24 0.38 0.14

Pause Length Mean-0.44a -1.20b -1.39b 0.25a 6.22 .002

SD 1.55 1.75 1.69 2.35

Pause Number Mean-0.15 0.52 0.22 0.67 1.12 .35

SD 0.99 2.15 1.67 1.84
Note. Means with different subscripts differ at least at the 0.01 level of significance
according to t-test using Bonferroni’s correction.
 Respiratory Feedback 38

Table 4.

Emotion Feeling States as a Function of Breathing Condition.

Emotion Breathing Condition

Feeling State Joy Anger Fear Sadness

Positive state Mean 54a I 5c III 6c II 23b I

SD 33 8 12 25
Anger Mean 1c II 55a I 47b I 7c II

SD 2 37 32 12
Anxiety, Fear Mean 1b II 40a II 39a I 8b II

SD 2 35 34 13
Sadness Means 5b II 12b III 13b II 21a I
SD 13 16 26 27

Note. Means with different subscripts differ at least at the 0.01 lsmithevel of
significance according to t-test using Bonferroni’s correction. Alphabetic subscripts
indicate a comparison between breathing conditions for a given feeling state; Roman
figures subscripts indicate a comparison between feeling state for a given breathing
condition.

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The Way You Breathe Could Be Affecting Your Emotions
sciencealert.com/the-way-you-breath-could-change-your-emotions

HEALTH

ERIN BRODWIN, BUSINESS INSIDER

27 JUL 2016

It’s literally the most boring thing you do every day. And thank goodness - if breathing
weren’t completely rote, we’d all be dead.

But if you’re like me, your inhales and exhales seem to be inexplicably linked with your
state of mind. When I’m stressed, I steal antsy, shallow sips of air and puff them out
quickly. When I’m relaxed, on the other hand, I breathe in gently and deeply, before
letting go of the air slowly.

Studies suggest that I’m not the only one who’s noticed a link between their emotional
state and their breathing.

While rapid breathing can often be a symptom of stress or anxiety, research shows that
taking control of our breathing can also influence how we feel.

Consciously taking deep, slow breaths, for example, may calm us down by convincing our
minds that we’re already in a state of relaxation, Dr. Martin Paulus, a professor of
psychiatry at the University of California San Diego professor, writes in a 2013
manuscript in the journal Depression and Anxiety.

Unfortunately, many of us are used to breathing in a way that tends to be bad for us.

1/2
"For many of us, deep breathing seems unnatural. There are several reasons for this. For
one, body image has a negative impact on respiration in our culture. A flat stomach is
considered attractive, so women (and men) tend to hold in their stomach muscles," write
the folks at the Harvard Medical School in a recent blog post.

"This interferes with deep breathing and gradually makes shallow ‘chest breathing’ seem
normal."

These quick inhalations and exhalations can actually make us feel more tense. But there
are plenty of ways to change this pattern - and plenty of research that supports doing so
too.

A 2012 randomised controlled study of 46 male and female musicians who were briefly
trained in deep breathing and biofeedback suggested that a single 30-minute session of
slow breathing (with or without the biofeedback component) helped reduce symptoms
of anxiety before a performance, particularly in musicians who said they tended to get
very anxious.

The benefits may extend to people with more severe anxiety as well. The authors of
a small 2014 study of male veterans with PTSD found that those who did three hours
each day of a breathing-based meditation program for a week experienced a decrease in
PTSD symptoms and anxiety.

If you’ve never tried deep breathing before, Harvard has some tips for giving it a shot.
First, find a quiet, comfortable place to sit or lie down. Then, inhale slowly through your
nose, letting your chest and lower stomach expand.

Finally, exhale slowly through your mouth or nose. It also can be helpful to count while
you’re breathing as a way of helping to even out your inhales and exhales.

This article was originally published by Business Insider.

More from Business Insider:

2/2
Short communicationMechanisms of mindfulness:
Emotion regulation following a focused breathing
induction
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Outline
1. Abstract
2. Keywords
3. Introduction
4. Method
5. Results
6. Discussion
7. References

Figures (2)
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2.

Tables (2)
1. Table 1
2. Table 2
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Joanna J.Archa Michelle G.Craskeab
https://doi.org/10.1016/j.brat.2005.12.007Get rights and content

Abstract
The current study investigated whether a 15 min recorded focused breathing induction
in a normal, primarily undergraduate population would decrease the intensity and
negativity of emotional responses to affectively valenced picture slides and increase
willingness to remain in contact with aversive picture slides. The effects of the focused
breathing induction were compared with the effects of 15 min recorded inductions of
unfocused attention and worrying. The focused breathing group maintained consistent,
moderately positive responses to the neutral slides before and after the induction,
whereas the unfocused attention and worry groups responded significantly more
negatively to the neutral slides after the induction than before it. The focusing breathing
group also reported lower negative affect and overall emotional volatility in response to
the post-induction slides than the worry group, and greater willingness to view highly
negative slides than the unfocused attention group. The lower-reported negative and
overall affect in response to the final slide blocks, and greater willingness to view
optional negative slides by the focused breathing group may be viewed as more adaptive
responding to negative stimuli. The results are discussed as being consistent with
emotional regulatory properties of mindfulness.

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Keywords
Emotion regulation

Behavioral willingness

Mindfulness

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Proper Breathing Brings Better Health
scientificamerican.com/article/proper-breathing-brings-better-health

By Christophe André on January 15,

2019

As newborns, we enter the world by inhaling. In leaving, we exhale. (In fact, in many
languages the word “exhale” is synonymous with “dying.”) Breathing is so central to life
that it is no wonder humankind long ago noted its value not only to survival but to the
functioning of the body and mind and began controlling it to improve well-being.

As early as the first millennium B.C., both the Tao religion of China and Hinduism placed
importance on a “vital principle” that flows through the body, a kind of energy or internal
breath, and viewed respiration as one of its manifestations. The Chinese call this energy
qi, and Hindus call it prana (one of the key concepts of yoga).

A little later, in the West, the Greek term pneuma and the Hebrew term rûah referred
both to the breath and to the divine presence. In Latin languages, spiritus is at the root of
both “spirit” and “respiration.”

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Recommendations for how to modulate breathing and influence health and mind
appeared centuries ago as well. Pranayama (“breath retention”) yoga was the first
doctrine to build a theory around respiratory control, holding that controlled breathing
was a way to increase longevity.

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In more modern times, German psychiatrist Johannes Heinrich Schultz developed
“autogenic training” in the 1920s as a method of relaxation. The approach is based partly
on slow and deep breathing and is probably still the best-known breathing technique for
relaxation in the West today. The contemporary forms of mindfulness meditation also
emphasize breathing-based exercises.

In fact, every relaxation, calming or meditation technique relies on breathing, which may
be the lowest common denominator in all the approaches to calming the body and
mind. Research into basic physiology and into the effects of applying breath-control
methods lends credence to the value of monitoring and regulating our inhalations and
exhalations.

Yoga and meditation have inspired many of the breathing exercises used today. The
benefits of controlled respiration were first theoretically posited centuries ago by the
practitioners of pranayama yoga. Credit: Getty Images

Mind under the Influence

Even a rudimentary understanding of physiology helps to explain why controlled
breathing can induce relaxation. Everyone knows that emotions affect the body. When
you are happy, for instance, the corners of your mouth turn up automatically, and the
edges of your eyes crinkle in a characteristic expression. Similarly, when you are feeling
calm and safe, at rest, or engaged in a pleasant social exchange, your breathing slows
and deepens. You are under the influence of the parasympathetic nervous system,
which produces a relaxing effect. Conversely, when you are feeling frightened, in pain, or
tense and uncomfortable, your breathing speeds up and becomes shallower. The
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sympathetic nervous system, which is responsible for the body’s various reactions to
stress, is now activated. Less well known is that the effects also occur in the opposite
direction: the state of the body affects emotions. Studies show that when your face
smiles, your brain reacts in kind—you experience more pleasant emotions. Breathing, in
particular, has a special power over the mind.

This power is evident in patients who have breathing difficulties. When these difficulties
are sporadic and acute, they can trigger panic attacks; when they are chronic, they often
induce a more muted anxiety. It is estimated that more than 60 percent of people with
chronic obstructive pulmonary disease (COPD) have anxiety or depressive disorders.
These disorders probably stem in part from concerns about the consequences of the
disease (what could be more distressing than struggling to breathe?), but purely
mechanical factors may contribute as well: the difficulty these patients experience often
leads to faster breathing, which does not necessarily improve the quality of their oxygen
supply but can aggravate their physical discomfort and anxiety.

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Rapid breathing can contribute to and exacerbates panic attacks through a vicious circle:
fear triggers faster breathing, which increases fear. In 2005 Georg Alpers, now at the
University of Mannheim in Germany, and his colleagues observed significant and
unconscious hyperventilation when people who had a driving phobia took their vehicles
on the highway (where they might not be able to pull over if they become agitated).

Whether anxiety derives from breathing problems or other causes, it can be eased by a
number of breathing techniques derived from traditional Eastern approaches (see “Six
Techniques for Relieving Stress”). For example, “follow your breath,” an exercise that
focuses attention on breathing, is one of the first steps in mindfulness meditation,
whereas alternate nostril breathing comes from yoga. Combining reassuring thoughts
with breathing is an approach incorporated into sophrology, a technique that
emphasizes harmony of body and mind and that borrows exercises from many
approaches, including yoga and mindfulness.

Overall, research shows that these techniques reduce anxiety, although the anxiety does
not disappear completely. Breathing better is a tool, not a panacea. Some methods have
been validated by clinical studies; others have not. But all of those I describe in this
article apply principles that have been proved effective. They aim to slow, deepen or
facilitate breathing, and they use breathing as a focal point or a metronome to distract
attention from negative thoughts.

Spotlight on Cardiac Coherence

A close look at one popular technique—cardiac coherence—offers more detail about the
ways that breathing exercises promote relaxation. With the help of biofeedback, the
approach attempts to coordinate breathing with heart rate, slowing and steadying
breathing to slow and stabilize the heartbeat.
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The method was developed based on the understanding that slow, deep breathing
increases the activity of the vagus nerve, a part of parasympathetic nervous system; the
vagus nerve controls and also measures the activity of many internal organs. When the
vagus nerve is stimulated, calmness pervades the body: the heart rate slows and
becomes regular; blood pressure decreases; muscles relax. When the vagus nerve
informs the brain of these changes, it, too, relaxes, increasing feelings of peacefulness.
Thus, the technique works through both neurobiological and psychological mechanisms.

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Cardiac coherence’s stabilization of the heartbeat can dampen anxiety powerfully.

Conversely, patients with overactive heartbeats are sometimes misdiagnosed as victims
of panic attacks because their racing heartbeat affects their mind.

A typical cardiac coherence exercise involves inhaling for five seconds, then exhaling for
the same amount of time (for a 10-second respiratory cycle). Biofeedback devices make it
possible to observe on a screen how this deep, regular breathing slows and stabilizes the
beats. (The space between two heartbeats on the display is never exactly the same, but it
becomes increasingly more consistent with this technique.) Several studies have
confirmed the anxiety-diminishing effect of these devices, although the equipment
probably has more influence on the motivation to do the exercises (“It makes it seem
serious, real”) than on the physiological mechanisms themselves. Simply applying slow
breathing with the same conviction and rigor could well give the same result.

Some versions of cardiac coherence recommend spending more time on exhaling than
on inhaling (for example, six and four seconds). Indeed, your heart rate increases slightly
when you inhale and decreases when you exhale: drawing out the second phase
probably exerts a quieting effect on the heart and, by extension, on the brain. This
possibility remains to be confirmed by clinical studies, however.

Other work suggests that the emotional impact of the breathing done in cardiac
coherence and various other kinds of exercises stems not only from effects on the
periphery—on the parasympathetic nervous system—but also from effects on the
central nervous system. Breathing may well act directly on the brain itself.

In 2017, for instance, Mark Krasnow of Stanford University and his colleagues showed in
mice that a group of neurons that regulates respiratory rhythms (the pre-Bötzinger
complex in the brain stem) controls some of the activity of the locus coeruleus, a region
involved in attention, wakefulness and anxiety. Breathing techniques may influence this
seat of emotions by modulating the activity of the pre-Bötzinger complex.

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Beyond any direct effects produced by slowed breathing, the attention given to inhaling
and exhaling may play a role in the brain’s response. In 2016 Anselm Doll and his
colleagues, all then at the Technical University of Munich, showed that this attentional
focus eases stress and negative emotions, in particular by activating the dorsomedial
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prefrontal cortex, a regulatory area of the brain, and by reducing activity in the
amygdala, which is involved in these emotions.

In addition, paying attention to breathing causes most people to slow it down and to
deepen it, which as I have mentioned, is soothing. Cognitive resources are limited, and
so when individuals concentrate on breathing, they are not thinking about their worries.
Those who practice mindfulness learn to notice when their attention drifts away from
breathing and goes back to their concerns, and they train themselves to return
periodically to their breathing. This refocusing has a relaxing effect on anyone and helps
to combat ruminative thinking in people who have anxiety or depression, especially
those who are particularly prone to negative thoughts that run in a loop.

When to Use Breathing Techniques

What is the best time to apply slow-breathing techniques? One is during occasional
episodes of stress—for example, before taking an exam, competing in a sporting event
or even attending a routine meeting at work. In 2017 Ashwin Kamath of Manipal
University in India and his colleagues studied stage fright before a public speaking
engagement. The participants, all medical students, spent 15 minutes doing alternate
nostril breathing—that is, slowly inhaling through one nostril and exhaling through the
other by applying finger pressure to the side of the nose not being used. Compared with
members of the control group, participants experienced somewhat less stress when
speaking publicly.

These exercises may also help when insomnia strikes. In 2012 Suzanne M. Bertisch of
Harvard Medical School and her colleagues reported, based on survey data, that more
than 20 percent of American insomniacs do these breathing exercises to sleep better.
They may be on to something. In 2015 Cheryl Yang and her team at National Yang-Ming
University in Taiwan showed that 20 minutes of slow breathing exercises (six respiration
cycles per minute) before going to bed significantly improves sleep. Insomniac
participants went to sleep faster, woke up less frequently in the night and went back to
sleep faster when they did wake up. On average, it took them only 10 minutes to fall
asleep, almost three times faster than normal. The investigators attributed the results
both to the calming mediated by the parasympathetic system and to the relaxing effect
of focused breathing.

But respiratory techniques do not work only for acute stresses or sleep problems; they
can also relieve chronic anxiety. They are particularly effective in people with psychiatric
disorders such as phobias, depression and post-traumatic stress disorder. In 2015
Stefania Doria and her colleagues at Fatebenefratelli e Oftalmico Hospital in Milan, Italy,
offered 10 training sessions of two hours each, spread out over two weeks, to 69
patients with anxiety or depressive disorders. The training included a varied set of
breathing techniques (such as abdominal breathing, acceleration and deceleration of
rhythm, and alternate nostril breathing.), combined with some yoga stretches. The

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researchers observed a significant decrease in symptoms at the end of the protocol.
Even better, improvement was maintained two and six months later, with follow-up
sessions just once a week and some home practice during this period.

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Breathing exercises also help to counter the accumulation of minor physical tension
associated with stress. Therapists recommend doing them regularly during the day,
during breaks or at moments of transition between two activities: you simply stop to
adjust your posture and allow yourself a few minutes of quiet breathing. Therapists
often suggest the “365 method”: at least three times a day, breathe at a rhythm of six
cycles per minute (five seconds inhaling, five seconds exhaling) for five minutes. And do
it every day, 365 days a year. Some studies even suggest that, in addition to providing
immediate relief, regular breathing exercises can make people less vulnerable to stress,
by permanently modifying brain circuits. In a practice that may seem counterintuitive,
however, counselors may encourage some anxious patients to breathe rapidly instead of
slowly, as part of an effort to train them to cope with their anxieties (see box “Inhale for
Panic!”).

But why confine breathing techniques to negative emotions? It is also worth applying
them during pleasurable moments, to take the time to appreciate and remember them.
In short, one can pause and breathe for enjoyment as well as to calm down.

Open Questions
Tradition and experience encourage the use of respiratory-control techniques, and
scientific studies increasingly suggest that it is a good idea. Nevertheless, further
research is still needed, particularly given that some studies lack control groups. One
exception stands out: focusing on breathing often is not a good idea for people having a
panic attack that stems from anxiety over their physical state (also known as
interoceptive anxiety). In this case, focusing on physiology, such as muscle tension or
breathing, may actually amplify panic (“Now that I’m paying attention to it, my breathing
doesn’t seem regular. Am I choking? What will happen if I suddenly stop breathing?”) For
these people, breathing techniques should be tested and practiced under the
supervision of a therapist.

Otherwise, considering how often everyone experiences emotional discomfort in their

everyday life and its negative consequences on health, we would all do well to regularly
pay attention to the way we breathe. Start with brief periods of conscious, quiet
breathing several times a day. Breathing is like solar energy for powering relaxation: it’s a
way to regulate emotions that is free, always accessible, inexhaustible and easy to use.

In fact, I am mystified that controlled breathing is not recommended and practiced more
widely. Perhaps it is perceived as too simple, commonplace and obvious to be a remedy.
Faced with the complexity of negotiating the ups and downs of human life, many people
may assume that simple solutions cannot be effective.
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Or maybe we are intimidated by the sacred aspect of breathing, by its connection to life
and, especially, to death. In the 1869 novel The Man Who Laughs, Victor Hugo wrote:
“Generations are puffs of breath, that pass away. Man respires, aspires, and expires.”
Ultimately, we don’t like to think that we are nothing more than “puffs of breath.”

Six Techniques for Relieving Stress

Here are some commonly used breathing techniques. Five to 10 minutes of exercise can
relieve sporadic stress and even fend off panic attacks. More regular practice can lower
the daily levels of anxiety.

Stand Up Straight

Posture is important for breathing: hold yourself straight, without stiffness, shoulders
back, sitting or standing. This body posture facilitates the free play of the respiratory
muscles (of the diaphragm and between the ribs). Good posture enables your body to
breathe properly on its own.

Follow Your Breath*

Simply observe your respiratory movements: be aware of each inhalation and

exhalation. Focus on the sensations you feel as air passes through your nose and throat
or on the movements of your chest and belly. When you feel your thoughts drift (which
is natural), redirect your attention to your breath.

Abdominal Breathing

Breathe “through your stomach” as much as possible: start by inflating your belly by
inhaling, as if to fill it with air, then swell your chest; as you exhale, first “empty” your
stomach, then your chest. This type of breathing is easier to observe and test while lying
down, with one hand on your stomach.

Rhythmic Breathing

Near the end of each inhalation, pause briefly while mentally counting “1, 2, 3” and
holding the air before exhaling. This counting while not breathing can also be done after
exhaling or between each inhalation or exhalation. It is often recommended for anxious
patients to calm anxiety attacks because it induces a beneficial slowing of the breathing
rate.

Alternate Nostrils*

Breathe in and out slowly through one nostril, holding the other one closed using your
finger; then reverse and continue by alternating regularly. There are many variations of
this exercise—for example, inhaling through one nostril and exhaling through the other.
Research suggests that what is most important, aside from slowing the breathing
rhythm, is breathing through the nose, which is somewhat more soothing than breathing
through your mouth.
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Think Reassuring Thoughts While Breathing

With each breath, think soothing thoughts (“I am inhaling calm”). With each exhalation,
imagine that you are expelling your fears and worries (“I am exhaling stress”).

*Technique validated by clinical studies.

Inhale for Panic!

Whereas slow breathing soothes, overly rapid breathing can induce feelings of stress
and anxiety. This phenomenon is used in behavioral therapy sessions to train anxious
patients to confront their emotions directly. By deliberately hyperventilating, patients
artificially trigger an unpleasant anxiety, which they get accustomed to feeling and learn
to put in perspective. This technique also enables them to see that poor breathing habits
amplify their fear.

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Take a deep breath — no really, it will calm your brain
theverge.com/2017/3/30/15109762/deep-breath-study-breathing-affects-brain-neurons-emotional-state

Sophie Kozub 30. ožujka 2017.

When you’re stressed, people often advise you to take a deep breath — and for good
reason, a new study shows. Slowing your breathing calms you, and now scientists may
have figured out how you can relax your brain through your breath. It has to do with
your brain’s pacemaker for breath.

For anyone looking for ways to deal with stress and negative emotions, that’s big news.
Although it’s been generally known that breathing exercises can have a calming affect on
emotions, the researchers’ findings could provide a scientific explanation for why
hyperventilation makes us anxious, or why breathing slowly can calm us down.

"“It has considerable potential for therapeutic use.”"

The findings stem from ongoing research on the respiratory or breathing pacemaker, a
cluster of neurons in the brainstem. Called the pre-Bötzinger complex (or preBötC), it
was initially discovered in mice in 1991 by study co-author Jack Feldman, a professor of
neurology at UCLA. Since then, the structure has been identified and studied in humans.
Feldman and study co-authors Mark Krasnow and Kevin Yackle have also identified and
studied the preBötC neurons in mice that affect sighing in 2016. Their latest findings
continue this research, focusing more on how these neurons affect breathing, emotional
states, and alertness, which scientists call arousal.

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“It’s a tie between breathing itself and changes in emotional state and arousal that we
had never looked at before,” says Feldman. “It has considerable potential for therapeutic
use.”

In their research, the scientists identified and studied 175 of these preBötC neurons. By
eliminating these neurons in the mice, the mice’s major breathing patterns were
unchanged, but they became significantly calmer. That finding led to the discovery of a
link between the preBötC and another brainstem structure which affects arousal, called
the locus coeruleus. In other words, they found the neural circuit that causes us to be
anxious when we breathe rapidly, and calm when we breathe slowly.

"The discovery was not what the scientists had initially set out to find"
That discovery, however, was accidental. When the scientists started their work, they
wanted to identify key neurons involved in generating the breathing rhythm, according
to Yackle, the lead author of the study and a faculty fellow at the University of California-
San Francisco. When they targeted these specific neurons, they expected them to be
important for breathing.

“So initially I was very disappointed to find that they were not involved in generating the
breathing rhythm, but then very surprised when we found that they are instead
important for controlling the arousal state of the animal,” says Yackle in an email
statement to The Verge. “Although in retrospect we might now appreciate that this neural
circuit would exist, I would have never predicted it going into these studies.”

The ties between these neurons and brainstem structures have different practical
applications. Many people already use pranayama, the meditative breathing exercises
found in several varieties of yoga, in order to enter a calm emotional state. Some of us
might be deliberately utilizing these pathways on a regular basis by intentionally slowing
our breathing to relax ourselves.

"“By changing patterns of breathing, we can change our emotional states and how we
think and how we interact with the world.”"
Slowing one’s breath through breathing exercises is already in use for some kinds of
anxiety disorders, and has been systemized by some organizations such as Breath-Body-
Mind. Led by Patricia Gerbarg, an assistant clinical professor in psychiatry at New York
Medical School and author of a 2009 study on pranayama, the group has teamed up with
therapists in locations such as Berlin to relieve stress, anxiety, depression, and trauma in
refugees by using movement, breathing and meditative practices.

“By changing patterns of breathing, we can change our emotional states and how we
think and how we interact with the world,” says Gerbarg. “That’s a very powerful tool for
psychological practices.”

The newly discovered neural pathways, however, might be targets for drugs, especially
for panic and anxiety disorders which can be triggered by hyperventilation, according to
Yackle. By designing drugs that specifically target the place in the brain where anxiety
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and hyperventilation are linked, scientists may be able to help people with these
disorders to lower the likelihood of panic attacks — which are typically characterized by
difficulty maintaining normal breath.

"Yackle plans to continue studying the breathing pacemaker region, and hopes to
identify the neural types that generate breathing rhythm"
Gerbarg, however, warns that much more work need to be done before the study’s
findings are fully applicable to humans. In part, this is because you can’t ethically knock
out nerves in humans. “It takes a few more steps to get it to a clinical matter,” says
Gerbarg.

Some of these next steps might include silencing this neural circuit, and seeing if that
prevents anxiety caused by hyperventilation, says Yackle. He plans to continue studying
the breathing pacemaker region, and hopes to identify the neural types that generate
breathing rhythm.

For many of us, the practicality of these findings boils down to having scientific evidence
that confirms what we already know: our breathing is related to our emotional state, and
slowing breath really can calm you down. So if you’re worried about Congress clearing
the way for internet providers to sell your web browsing history, it might be time to take
a few deep breaths — that way you won’t panic.

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You've been breathing all wrong
businessinsider.com.au/how-to-relax-by-breathing-2016-7

Erin Brodwin Jul 27, 2016, 4:20 27. srpnja 2016.

AM

Photo: Jamie Squire/ Getty Images.

It’s literally the most boring thing you do every day. And thank goodness — if breathing
weren’t completely rote, we’d all be dead.

But if you’re like me, your inhales and exhales seem to be inexplicably linked with your
state of mind. When I’m stressed, I steal antsy, shallow sips of air and puff them out
quickly. When I’m relaxed, on the other hand, I breathe in gently and deeply, before
letting go of the air slowly.

Studies suggest that I’m not the only one who’s noticed a link between their emotional
state and their breathing.

While rapid breathing can often be a symptom of stress or anxiety, research shows that
taking control of our breathing can also influence how we feel. Consciously taking deep,
slow breaths, for example, may calm us down by convincing our minds that we’re already
in a state of relaxation, Dr. Martin Paulus, a professor of psychiatry at the University of
California San Diego professor, writes in a 2013 manuscript in the journal Depression
and Anxiety.

Unfortunately, many of us are used to breathing in a way that tends to be bad for us.
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“For many of us, deep breathing seems unnatural. There are several reasons for this. For
one, body image has a negative impact on respiration in our culture. A flat stomach is
considered attractive, so women (and men) tend to hold in their stomach muscles. This
interferes with deep breathing and gradually makes shallow ‘chest breathing’ seem
normal,” write the folks at the Harvard Medical School in a recent blog post. These quick
inhalations and exhalations can actually make us feel more tense.

Photo: Olivier Morin/ AFP/ Getty Images.

But there are plenty of ways to change this pattern — and plenty of research that
supports doing so too.

A 2012 randomised controlled study of 46 male and female musicians who were briefly
trained in deep breathing and biofeedback suggested that a single 30-minute session of
slow breathing (with or without the biofeedback component) helped reduce symptoms
of anxiety before a performance, particularly in musicians who said they tended to get
very anxious.

The benefits may extend to people with more severe anxiety as well. The authors of a
small 2014 study of male veterans with PTSD found that those who did three hours each
day of a breathing-based meditation program for a week experienced a decrease in PTSD
symptoms and anxiety.

If you’ve never tried deep breathing before, Harvard has some tips for giving it a shot.
First, find a quiet, comfortable place to sit or lie down. Then, inhale slowly through your
nose, letting your chest and lower stomach expand. Finally, exhale slowly through your

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mouth or nose. It also can be helpful to count while you’re breathing as a way of helping
to even out your inhales and exhales.

NOW WATCH: This sober rave starts at 6:30 a.m. — and it

comes with dancing, yoga and coffee
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