Controlled Breathwork Improves Mood and Reduces Anxiety

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Post by Leanna Kalinowski

The takeaway

Engaging in daily 5-minute breathwork exercises and mindfulness meditation improves mood and reduces anxiety. Cyclic sighing – a voluntary breathwork exercise that primarily focuses on exhales –  showed the greatest benefits compared to other voluntary breathwork techniques.

What's the science?

Controlled breathwork techniques have emerged as a promising avenue for improving mood and reducing stress. Methods that involve passive observation of the breath, such as meditation and yoga, are common practices that have well-demonstrated mental health benefits. These practices have different physiological effects from voluntary breathing techniques, where inhaling and exhaling patterns are directly controlled. However, little is known about how passive and voluntary breathing techniques uniquely affect mental health. This week in Cell Reports Medicine, Yilmaz Balban and colleagues evaluated the difference between passive and voluntary breathing exercises and their effectiveness in improving mood, anxiety, and physiological measures.

How did they do it?

108 participants were divided into four groups – a mindful meditation (control) group and three voluntary breathwork (treatment) groups – and instructed to complete their assigned daily breathing exercise at home for 28 days:

1)    Mindful Meditation (control group): Participants were instructed, for 5 minutes, to close their eyes and observe their breathing while focusing their mental attention on their forehead region. If their focus drifted from that region, they were told to first focus back on their breath, and then refocus back on their forehead.

2)    Cyclic Sighing (breathwork group 1): Participants were instructed to, repeatedly for 5 minutes, inhale slowly until their lungs are expanded, inhale once more to maximally fill their lungs, and then slowly and fully exhale their breath.

3)    Box Breathing (breathwork group 2): Participants were first instructed to take the “CO2 tolerance test”, which includes taking a full deep breath, exhaling as slowly as possible, and then timing how long it takes to empty their lungs. Then, repeatedly for 5 minutes, they inhaled for the same duration it took to empty their lungs in the CO2 tolerance test, held their breath for that same duration, then exhaled for that same duration, then held their breath again for the same duration.

4)    Cyclic Hyperventilation with Retention (breathwork group 3): Participants were instructed to inhale deeply and then exhale by passively “letting their air fall out from the mouth”. They repeated this pattern for 30 breaths, after which they exhaled via the mouth and calmly waited with empty lungs for 15 seconds.

Participants completed two surveys that measured affect and anxiety at baseline and again after the experiment. They also wore a wrist strap during their breathing exercises that collected several physiological measures, including their daily resting heart rate, respiratory rate, and hours of sleep. These measures were collected remotely via a smartphone app.

What did they find?

The researchers found that, following 28 days of breathing exercises, all four groups experienced an increase in daily positive affect, a decrease in negative affect, and a reduction in anxiety. While there were no differences between the meditation (control) and breathwork groups in anxiety and negative affect changes, the three breathwork groups had a higher increase in daily positive affect compared to the meditation group. Upon evaluating the physiological measurements, researchers found a similar pattern: the three breathwork groups had a higher reduction in baseline respiratory rate than the meditation group. For both the positive affect and respiratory rate results, group differences were largely influenced by the cyclic sighing group, suggesting particularly beneficial effects for breathing techniques that emphasize exhaling. No other physiological changes were observed in any of the groups.

What's the impact?

Results from this study suggest that engaging in intentional breath control exercises (e.g., the cyclic sighing technique) provides more benefits to mood than passive breath observation exercises (i.e., mindfulness meditation). While all four breathing techniques were effective in improving mood and decreasing anxiety, daily 5-minute cyclic sighing shows the most promise in being a low-commitment approach to managing stress. Future studies should evaluate whether the consistent practice of these techniques, beyond one month, remains effective in improving psychological outcomes.

How Habitual Checking of Social Media Changes the Adolescent Brain

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Post by Christopher Chen

The takeaway

Social media use has become nearly universal among American teenagers but its possible effects on adolescent brain development remain unclear. A new study indicates that habitual checking of social media may be disrupting the normal development of brain circuits linked to reward processing and cognitive control in the young adult brain.

What's the science?

The brain undergoes drastic changes during adolescence, particularly in regions associated with motivation, reward processing, and cognitive control. Furthermore, the maturation of these regions allows for developmentally normative neural and behavioral responses to social feedback. With its use of immediate feedback in the form of “likes” or notifications as well as its widespread use in adolescent populations, exploring how habitual social media use affects social feedback-based networks in the adolescent brain is more relevant than ever. In a recent article in JAMA Pediatrics, Maza et al. investigate differences in brain activity levels in regions associated with social feedback in adolescents who habitually check social media. 

How did they do it?

The experiment looked at approximately 200 students aged 12-13 from three middle schools in rural North Carolina. First, experimenters had the students self-report how often they checked three social media sites (Facebook, Instagram, and Snapchat). Based on this data, the participants were divided into three groups based on their rate of checking social media: habitual, moderate, and non habitual. Experimenters then used functional brain imaging (fMRI) to measure brain activity of participants during a Social Incentive Delay task, a cognitive task designed to measure anticipation of social feedback. Following initial measurements, the students took part in the same experiment each year for the next two years.

Following the completion of the study, experimenters compiled and combined data from both the Social Incentive Delay task and fMRI imaging to measure activation levels of specific brain regions from each participant during the cognitive task. They then used these individual datasets to make a general linear regression model measuring the change in brain activity levels in all three groups over time.  

What did they find?

From their generalized linear regression models, experimenters found that brain activation patterns were significantly different in habitual and non habitual checkers of social media. Interestingly, these patterns were most distinct in brain regions linked to social feedback: the insular and prefrontal cortex, ventral striatum, and amygdala. Habitual social media checkers showed a decreased sensitivity to social anticipation at 12 years of age.

In habitual checkers of social media, linear regression models revealed an increase in brain activity during social anticipation across all four brain regions over time. In non habitual and moderate checkers of social media, linear regression models revealed the opposite: brain activity decreased in all four regions. These divergent results in brain activity changes in habitual and non habitual checkers of social media suggest high social media usage impacts developmental trajectories of neural circuits linked to social feedback and cognitive control.

What's the impact?

The negative functional consequences – if any – of these increases in brain activity in habitual checkers of social media are unclear. Whether the rate of social media usage directly causes or is simply correlated to these neurological changes also remains to be seen. However, this study is the first to show distinct differences in brain development in adolescents who habitually check social media, suggesting that social media is indeed changing the young adult brain.     

Access the original scientific publication here.

How Mindfulness-Based Interventions Compare to Escitalopram as a Treatment for Anxiety

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Post by Baldomero B. Ramirez Cantu

The takeaway

Recently, mindfulness-based practices have become popular as potential treatments for psychiatric disorders. This study shows that a mindfulness-based intervention can be just as effective at reducing anxiety symptom severity as escitalopram, an anti-anxiety drug.

What's the science?

Anxiety disorders are remarkably debilitating and affect millions of individuals around the world. These disorders are complex and patients tend to respond differently to similar treatments. For example, some patients experience significant improvement from pharmacological interventions while others experience no improvement in their anxiety and suffer from debilitating side effects while taking the exact same drug and dosage. Today, it remains unclear what effective alternatives exist for those who are not responsive to drug-based treatments or psychotherapy for anxiety disorders. This week in JAMA Psychiatry, Hoge and colleagues assessed how mindfulness-based stress reduction (MBSR) compared to escitalopram in reducing anxiety symptom severity.

How did they do it?

The authors recruited adult patients diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia for a randomized clinical trial. Eligible patients were invited to attend an in-person evaluation with a physician where their baseline anxiety severity was measured using the CGI-S scale. This scale ranks anxiety severity from not anxious at all (CGI-S = 1) to severely anxious (CGI-S = 7) and was used to measure patient anxiety severity throughout the study. Next, the patients were randomly assigned to either the mindfulness-based (MBSR) or escitalopram intervention groups. 

1) MBSR Intervention: Patients in the MBSR group participated in an 8-week-long protocol consisting of weekly 2.5-hour sessions, a day-long weekend retreat, and daily 45-minute at-home exercises. All activities focused on meditation and mindfulness-based techniques or theory. 2) Escitalopram Intervention: Patients in this group started with 10 mg daily oral doses of escitalopram and in the absence of problematic side effects increased to 20mg daily doses at week two of the protocol. Patients received medication management visits at weeks 1, 2, 4, 6, and 8 of the 8-week protocol.

The authors performed a noninferiority analysis to compare the effects of MBSR versus escitalopram on patient anxiety severity by analyzing the changes in anxiety severity (CGI-S)  relative to baseline anxiety severity levels.

What did they find?

Analysis of patient outcomes after successful completion of the protocol showed that mindfulness-based stress reduction was in fact noninferior to escitalopram. Upon completion of the protocol, the difference between the average reduction in anxiety severity of the MBSR group (Mean CGI-S Reduction = 1.35) and the escitalopram group (Mean CGI-S Reduction = 1.43) was only -0.07 points. This indicates that the difference in the decrease in symptom severity between the two groups was not statistically significant. Individually, however, each treatment did produce a significant reduction in symptoms of anxiety. These results show that both treatments were successful in ameliorating the severity of anxiety symptoms and suggest that some degree of equivalence exists between these two treatments.

What's the impact?

This study is the first to show that mindfulness-based stress reduction can be just as effective as pharmacological interventions. This is important because it positions mindfulness-based stress reduction as a valid alternative to pharmacological treatment for anxiety disorders.