Journal of Contemporary Psychotherapy

, Volume 47, Issue 4, pp 251–258 | Cite as

An Uncontrolled Clinical Trial of Guided Respiration Mindfulness Therapy (GRMT) in the Treatment of Depression and Anxiety

  • Lloyd Lalande
  • Robert King
  • Matthew Bambling
  • Robert D. Schweitzer
Original Paper


Guided respiration mindfulness therapy (GRMT) is a manualized intervention that synthesizes a sustained focus on self-regulation of respiration, mindfulness, and relaxation. In our previous publication (in Lalande et al. J Contemp Psychother 46(2):107–116, 2016) we reported an evaluation of a manual-based GRMT therapist training program for the treatment of depression and anxiety. Here we report the outcomes of the manualized treatment program for depression and anxiety with clients. Forty-two participants with a primary diagnosis of depression or anxiety disorder participated in an uncontrolled clinical trial evaluating treatment response using standardised outcome measures with data collected on a session-by-session basis. For the majority of participants, treatment led to statistically and clinically significant reduction in symptoms of depression, anxiety and stress, along with reduced anxiety sensitivity and increases in overall wellbeing. Results suggested GRMT shows promise as an effective brief treatment option that does not rely on cognitive or behavioural techniques.


Anxiety Depression GRMT Guided respiration mindfulness therapy Mindfulness Psychotherapy Respiration 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Anderson, D. E. (2001). Respiratory psychophysiology in hypertension research. Behavior Modification, 25, 606–620.CrossRefPubMedGoogle Scholar
  2. Anderson, D. E., & Chesney, M. A. (2002). Gender-specific association of perceived stress and inhibited breathing pattern. International Journal of Behavioral Medicine, 9, 216–227.CrossRefPubMedGoogle Scholar
  3. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  4. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143.Google Scholar
  5. Bolton, C. F., Chen, R., Wijdicks, E., & Zifko, U. A. (2004). Neurology of breathing. Philadelphia: Butterworth Heinemann.Google Scholar
  6. Bradley, D. (2002). Patterns of breathing dysfunction in hyperventilation syndrome and breathing pattern disorders. In L. Chaitow, D. Bradley & C. Gilbert (Eds.), Multidisciplinary approaches to breathing pattern disorders. London: Churchill Livingstone.Google Scholar
  7. Brown, K., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.CrossRefGoogle Scholar
  8. Burg, J. M., & Michalak, J. (2011). The healthy quality of mindful breathing: Associations with rumination and depression. Cognitive Therapy and Research, 35(2), 179–185. doi: 10.1007/s10608-010-9343-x.CrossRefGoogle Scholar
  9. Campbell, A., & Hemsley, S. (2010). Outcome rating scale and session rating scale in psychological practice: Clinical utility of ultra-brief measures. Clinical Psychology, 13(1), 1–9.CrossRefGoogle Scholar
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2 edn.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  11. Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J., & Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47, 990–999. doi: 10.1177/0004867414525841.CrossRefPubMedGoogle Scholar
  12. Crawford, J., Garthwaite, P., Lawrie, C., Henry, J., MacDonald, M., Sutherland, J., & Sinha, P. (2009). A convenient method of obtaining percentile norms and accompanying interval estimates for self-report mood scales (DASS, DASS-21, HADS, PANAS, and sAD). British Journal of Clinical Psychology, 48, 163–180.CrossRefPubMedGoogle Scholar
  13. Feldner, M. T., Zvolensky, M. J., & Schmidt, N. B. (2004). Prevention of anxiety psychopathology: A critical review of the empirical literature. Clinical Psychology: Science and Practice, 11(4), 405–424.Google Scholar
  14. Fokkema, D. S. (1999). The psychobiology of strained breathing and its cardiovascular implications: A functional system review. Psychophysiology, 36, 164–175.CrossRefPubMedGoogle Scholar
  15. Gelman, A., Hill, J., & Yajima, M. (2012). Why we (usually) don’t have to worry about multiple comparisons. Journal of Research on Educational Effectiveness, 5(2), 189–211.CrossRefGoogle Scholar
  16. Heck, R. H., Thomas, S. L., & Tabata, L. N. (2014). Multilevel and longitudinal modeling with IBM SPSS (2nd edn.). New York: Routledge.Google Scholar
  17. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169–183. doi: 10.1037/a0018555.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Jerath, R., Crawford, M. W., Barnes, V. A., & Harden, K. (2015). Self-regulation of breathing as a primary treatment for anxiety. Applied Psychophysiology and Biofeedback, 40, 107–115. doi: 10.1007/s10484-015-9279-8.CrossRefPubMedGoogle Scholar
  19. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., ... Hofmann, S (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33, 763–771.CrossRefPubMedGoogle Scholar
  20. Lalande, L. (2007). Guided respiration mindfulness therapy for depression and anxiety: Treatment manual for individual therapy. Unpublished therapy treatment manual.Google Scholar
  21. Lalande, L., King, R., Bambling, M., & Schweitzer, R. (2016). Guided respiration mindfulness therapy: Development and evaluation of a brief therapist training program. Journal of Contemporary Psychotherapy, 46(2), 107–116. doi: 10.1007/s10879-015-9320-5.CrossRefGoogle Scholar
  22. Lau, M., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, D. E., Carlson, L., ... Carmody, J. (2006). The Toronto mindfulness scale: Development and validation. Journal of Clinical Psychology, 62, 1445–1467.CrossRefPubMedGoogle Scholar
  23. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33, 335–343.CrossRefPubMedGoogle Scholar
  24. Lovibond, S. H., & Lovibond, P. F. (2005). Manual for the depression anxiety stress scales (2 edn.). Sydney: Psychology Foundation.Google Scholar
  25. Miller, S. D., Duncan, B. L., Brown, J., Sparks, J. A., & Claud, D. A. (2003). The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 91–100.Google Scholar
  26. Moran, P., Leese, M., Lee, T., Walters, P., Thornicroft, G., & Mann, A. (2003). Standardised assessment of personality - abbreviated scale (SAPAS): preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry, 183, 228–232.CrossRefPubMedGoogle Scholar
  27. Ñāṇamoli, B. (1964). Mindfulness of breathing (ānāpānasati); Buddhist texts from the Pali canon and extracts from the Pali commentaries (B. Ñāṇamoli, Trans. 2nd ed.). Kandy, Ceylon: Buddhist Publication Society.Google Scholar
  28. Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128–150.CrossRefPubMedGoogle Scholar
  29. Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424.CrossRefPubMedGoogle Scholar
  30. Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135(6), 974–999.CrossRefPubMedGoogle Scholar
  31. Panayiotou, G., Karekla, M., & Panayiotou, M. (2014). Direct and indirect predictors of social anxiety: The role of anxiety sensitivity, behavioral inhibition, experiential avoidance and self-consciousness. Comprehensive Psychiatry, 55, 1875–1882.CrossRefPubMedGoogle Scholar
  32. Rector, N. A., Szacun-Shimizu, K., & Leybman, M. (2006). Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behaviour Research and Therapy, 9, 17–26.Google Scholar
  33. Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.CrossRefPubMedGoogle Scholar
  34. Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: The Guilford Press.Google Scholar
  35. Seppala, E., Nitschke, J. B., Tudorascu, D., Hayes, A., Goldstein, M., Nguyen, D., ... Davidson, R. (2014). Breathing-based meditation decreases posttraumatic stress disorder symptoms in US military veterans: A randomized controlled longitudinal study. Journal of Traumatic Stress, 27(4), 397–405. doi: 10.1002/jts.21936.CrossRefPubMedGoogle Scholar
  36. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386.CrossRefPubMedGoogle Scholar
  37. Sheehan, D., & Lecruier, Y. (1998). MINI international neuropsychiatric interview: English version 5.0. Journal of Clinical Psychology, 59(20), 34–57.Google Scholar
  38. Smallwood, J., & Schooler, J. W. (2013). The restless mind. Psychology of Consciousness: Theory, Research, and Practice, 1(5), 130–149.Google Scholar
  39. Streeter, C., Gerbarg, P. L., Whitfield, T., Owen, L., Johnston, J., Silveri, M., ... Jensen, J. (2017). Treatment of major depressive disorder with Iyengar yoga and coherent breathing: A randomized controlled dosing study. Journal of Alternative and Complementary Medicine, 23(3), 201–207.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Taylor, S. (Ed.). (1999). Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. Mahwah, NJ: Erlbaum.Google Scholar
  41. Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1(3), 207–210.CrossRefGoogle Scholar
  42. Wang, D. J., Rao, H., Korczykowski, M., Wintering, N., Pluta, J., Khalsa, D. S., & Newberg, A. B. (2011). Cerebral blood flow changes associated with different meditation practices and perceived depth of meditation. Psychiatry Research: Neuroimaging, 191, 61–67. doi: 10.1016/j.pscychresns.2010.09.011.Google Scholar
  43. Wilhelm, F. H., Trabert, W., & Roth, W. T. (2001). Physiologic instability in panic disorder and generalized anxiety disorder. Biological Psychiarty, 49, 596–605.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Buddhist Tzu Chi University of Science and TechnologyHualienTaiwan
  2. 2.School of Psychology and CounsellingQueensland University of TechnologyBrisbaneAustralia
  3. 3.Department of Psychiatry, School of MedicineUniversity of QueenslandBrisbaneAustralia

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