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Breathing and mental health -- the vagus nerve connection

Respiratory discipline, if contemplative activities like prayer and meditation are any evidence, is beneficial to mental health (as is well documented) because it elicits changes in autonomic balance. It is in this spirit that we, who are in the clinical business of maximizing airway health, speak to you, the mental health professionals. The operative mechanism behind this connection? Part of it, very likely, is vagal tone.1 Breathing, with all its measurable inputs and outputs is surprisingly complex, and in these somewhere it truly does appear related to psychological wellbeing. There are coupled oscillatory microcircuits in the brain that manage breathing’s rhythmic core, for example, like the preBötzinger Complex, which, remarkably, interacts with orofacial behaviors (our strong suit) and emotion and cognition (yours).2

The psychological effects of managed breathing are improvements in stress response and negative affect.3-9 There are documentable changes downstream in symptoms of depression, anxiety disorders and post-traumatic stress disorder.10-17 In cognitive performance as well, some studies show enhanced executive functioning and working memory.18-24 Breathing correctly bears on attentional control, too.25-30 A breathing effect exists even in global cognition and creativity.31

There is a concrete link between vagal tone, via heart rate variation, and cognition, first sketched in the neurovisceral integration model of Thayer and Lane.32 That’s why cognitive researchers and clinicians have spent time developing interventional techniques for vagal nerve stimulation, and doing so in concert with breathing exercises. Notable trial endpoints have focussed on memory consolidation and recognition33-35 and depression.36

There is a respiratory vagal stimulation model of breathing in stress response and cognition, in other words. Breathing correctly influences physiology, and physiology mediates mental activity; the same is true in reverse. In the mental health domain, strikingly, there may be an autonomic balance in play even in some of the pathways throughout dysfunctional emotional regulation and executive function in schizophrenia.37

Chronic stress response is probably the significant negative mediator in all of the domains that benefit from disciplined breathing. It’s reasonable to propose, as it has been, that this is a matter of vagal dominance, itself mediatable at least in part by breathing exercises.38-40 The same calculus obtains in the positive relationship between vagal tone and the executive functioning network,41 especially in emotional control,42-43 in such foci as risk aversion in anxiety,44 attentional lapses,45 cognitive inhibition,46-47 and emotional modulation of conditioned fear.48 Meta-analysis continues to support particular effect on executive functioning, pooled across population subdivisions,49 even in cognitively demanding settings.50

So it is that healthy breathing, an unremarkable thing by itself, far less interesting intellectually than matters of ‘consciousness’ among mental health practitioners, functions profoundly in the overall domain of mental health. BreatheWorks, as our sister clinic name implies, specializes in this. We optimize airway function, craniofacial development, and biomechanical well-being in the head and neck. It’s a tricky job sometimes, the mechanics of breathing being what they are. But we are experts. To you, in the mental health space, we wish to say that breathing intervention, as pedestrian as that sounds, but on the basis of very good data, is something that very much matters.

  1. Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018 Oct 9;12:397. doi: 10.3389/fnhum.2018.00397

  2. Del Negro CA, Funk GD, Feldman JL. Breathing matters. Nat Rev Neurosci. 2018 Jun;19(6):351-367. doi: 10.1038/s41583-018-0003-6

  3. Grossman P., Niemann L., Schmidt S., Walach H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. J. Psychosom. Res. 57, 35–43. 10.1016/S0022-3999(03)00573-7

  4. Kirkwood G., Rampes H., Tuffrey V., Richardson J., Pilkington K. (2005). Yoga for anxiety: a systematic review of the research evidence. Br. J. Sports Med. 39, 884–891. 10.1136/bjsm.2005.018069

  5. Jahnke R., Larkey L., Rogers C., Etnier J., Lin F. (2010). A comprehensive review of health benefits of Qigong and Tai Chi. Am. J. Health Promot. 24, e1–e25. 10.4278/ajhp.081013-lit-248

  6. Wang C., Bannuru R., Ramel J., Kupelnick B., Scott T., Schmid C. H. (2010a). Tai Chi on psychological well-being: systematic review and meta-analysis. BMC Complement. Altern. Med. 10:23. 10.1186/1472-6882-10-23

  7. Keng S. L., Smoski M. J., Robins C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clin. Psychol. Rev. 31, 1041–1056. 10.1016/j.cpr.2011.04.006

  8. Eberth J., Sedlmeier P. (2012). The effects of mindfulness meditation: a meta-analysis. Mindfulness 3, 174–189. 10.1007/s12671-012-0101-x

  9. Pascoe M. C., Thompson D. R., Jenkins Z. M., Ski C. F. (2017). Mindfulness mediates the physiological markers of stress: systematic review and meta-analysis. J. Psychiatr. Res. 95, 156–178. 10.1016/j.jpsychires.2017.08.004

  10. Chiesa A., Serretti A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res. 187, 441–453. 10.1016/j.psychres.2010.08.011

  11. Kuyken W., Hayes R., Barrett B., Byng R., Dalgleish T., Kessler D., et al.. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet 386, 63–73. 10.1016/S0140-6736(14)62222-4

  12. Klainin-Yobas P., Cho M. A. A., Creedy D. (2012). Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis. Int. J. Nurs. Stud. 49, 109–121. 10.1016/j.ijnurstu.2011.08.014

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  16. Kim S. H., Schneider S. M., Kravitz L., Mermier C., Burge M. R. (2013). Mind-body practices for posttraumatic stress disorder. J. Investig. Med. 61, 827–834. 10.2310/JIM.0b013e3182906862

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  18. 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

  19. Gard T., Hölzel B. K., Lazar S. W. (2013). The potential effects of meditation on age-related cognitive decline: a systematic review. Ann. N Y Acad. Sci. 1307, 89–103. 10.1111/nyas.12348

  20. Gothe N. P., Mcauley E. (2015). Yoga and cognition: a meta-analysis of chronic and acute effects. Psychosom. Med. 77, 784–797. 10.1097/psy.0000000000000218

  21. Luu K., Hall P. A. (2016). Hatha Yoga and executive function: a systematic review. J. Altern. Complement. Med.22, 125–133. 10.1089/acm.2014.0091

  22. Wu Y., Wang Y., Burgess E. O., Wu J. (2013). The effects of Tai Chi exercise on cognitive function in older adults: a meta-analysis. J. Sport Health Sci. 2, 193–203. 10.1016/j.jshs.2013.09.001

  23. Wayne P. M., Walsh J. N., Taylor-Piliae R. E., Wells R. E., Papp K. V., Donovan N. J., et al.. (2014). Effect of Tai Chi on cognitive performance in older adults: systematic review and meta-analysis. J. Am. Geriatr. Soc. 62, 25–39. 10.1111/jgs.12611

  24. Zheng G., Liu F., Li S., Huang M., Tao J., Chen L. (2015). Tai Chi and the protection of cognitive ability: a systematic review of prospective studies in healthy adults. Am. J. Prev. Med. 49, 89–97. 10.1016/j.amepre.2015.01.002

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  26. van Vugt M. K., Slagter H. A. (2014). Control over experience? Magnitude of the attentional blink depends on meditative state. Conscious. Cogn. 23, 32–39. 10.1016/j.concog.2013.11.001

  27. Colzato L. S., Sellaro R., Samara I., Baas M., Hommel B. (2015a). Meditation-induced states predict attentional control over time. Conscious. Cogn. 37, 57–62. 10.1016/j.concog.2015.08.006

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News from Eugene Speech Therapy/BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.

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