Paced Breathing
Participants are instructed to breathe at a specified pace, typically on the slower side like 0.1 Hz (i.e. 6 breaths per minute), often following an audio or video-guided media that provides an explicit stimulus to synchronize their with breathing for a designated period of time (e.g. 3 to 10 minutes) at a specific frequency and for a specific duration (e.g. daily for 30 days).
Reasoning
Attending to one’s own pattern of inhalation and exhalation and purposefully adopting a pace of breathing that is typically associated with calmer states (e.g. slower, longer breaths) can induce a state of calm in the moment. Directing attention in this interoceptive and embodied way may steer attentional resources away from involuntary rumination or habitual thoughts and feelings related to information and knowledge that evoke stress, and boost metacognition - or awareness and agency over inner mental experiences. Directing awareness to the physical process of slower breathing in real time may privilege parasympathetic activation in the autonomic branch of the peripheral nervous system, which can help people feel more calm, emotionally stable, and content. With practice and repetition, paced breathing exercises may improve a person’s long term capacity to both self-induce calm and more rapidly recover from unpleasant states in response to both acute and chronic stressors.
Procedure
Participants are asked to sit or lie comfortably with eyes open or closed and breathe for a designated period of time at a given frequency, often in the range of 0.1 Hz, or ten seconds per cycle of inhalation (I) and exhalation (E). Some studies use a 1:1 IE ratio (a.k.a. box breathing), others use a shorter I and longer E (e.g. 4 sec inhale, 6 sec exhale; a.k.a. cyclic sighing), and some use a longer I and shorter E (a.k.a. cyclic hyperventilation). Participants may be instructed to internally count the duration of I and E while breathing, or to follow a timed signal with different characteristics for inhalation and exhalation. For example, the signal could be an acoustic tone that changes in pitch or volume, a visual display of the words “inhale” and “exhale”, or a shape that changes in appearance (size or color) for intended periods of inhaling and exhaling. Depending on the outcome measurement aims (e.g. immediate impact, long term effects, self-reported anxiety or calm, or physiological indices like blood pressure or heart rate variability), participants may be instructed to repeat the paced breathing multiple times in sequence, or over multiple days, weeks, or longer.
Primary Citation & Study Summary:
Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023 Jan 17;4(1):100895. doi: 10.1016/j.xcrm.2022.100895. Epub 2023 Jan 10. PMID: 36630953; PMCID: PMC9873947.
A randomized controlled study compared the subjective and psychophysiological effects of 5-min daily practice of three different paced breathing exercises (i.e. cyclic sighing: I<E, box breathing: I=E, cyclic hyperventilation with retention: I>E) and mindfulness meditation over 1 month. All study procedures were conducted online; participants performed the practices remotely and used a commercially available physiological measurement device. Paced breathing exercises were associated with reduced negative affect and anxiety on par with mindfulness, but uniquely predicted increases in positive affect. Paced breathing and mindfulness practices were both associated with decreases in respiratory rate, and showed no significant impact on heart rate variability, resting heart rate, or sleep.
Evidence
A meta-analysis of studies comparing the impact of paced breathing tasks (a.k.a. breathwork) to control conditions suggest that it can decrease stress and improve mental wellbeing with a medium effect size (Fincham, 2023). Meta Analysis of studies investigating the link between paced breathing tasks (voluntary slow breathing) and heart rate variability, an acute and tonic measure of physiological resilience, also suggest a reliable relationship whereby paced breathing can increase HRV in the moment, shortly thereafter, and in a more enduring way after repeated practice (Laborde, 2022). Assigning people to engage in daily paced breathing practices virtually for 30 days led to decreases in self-reported stress and negative affect, increases in positive affect, and lower respiration rate (Balban, 2023). Effects of paced breathing tasks are comparable to those observed for other approaches to stress reduction (e.g. mindfulness, CBT).
Additional cited References
Fincham, G. W., Strauss, C., & Cavanagh, K. (2023). Effect of coherent breathing on mental health and wellbeing: A randomised placebo-controlled trial. Scientific Reports (Nature Publisher Group), 13(1), 22141. doi:https://doi.org/10.1038/s41598-023-49279-8
Participants were randomly assigned to do either coherent breathing (5.5 breaths per minute) or paced breathing (12 breaths per minute) with equal I:E ratios via audio guided remote instruction for 10 minutes per day for 28 days. Both interventions were associated with reduced self-reported stress, and 1-month later, reductions in stress, as well as symptoms of anxiety, and depression alongside increased wellbeing.