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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.



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  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

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  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

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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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